How to Stifle a Practice in 12 months or less By: Sally McKenzie, CMC

Bury yourself in your work. Adjust the blinders to shield your vision from anything that would indicate a potential p-r-o-b-l-e-m. Keep extremely busy so you simply cannot be bothered, and tell yourself every hour on the hour that everything will take care of itself – it always does. Congratulations, doctor! You too can stifle your practice – or worse – in 12 months or less.

Ah yes, I see it, the look of righteous indignation spreading across your face. After all, who am I to waltz in and tell you that things aren’t picture perfect? Things are ok you tell yourself. “We have just the same problems as every other practice.” Indeed, you have done an excellent job of convincing yourself of that. Were it not for those little issues that you keep stuffing back behind the growing pile of inactive patient records – those insignificant matters that “every other practice has” that just keep spilling out and getting in your way. If it were not for those minor things – personnel, scheduling, and hygiene – well, everything would be just…perfect.

First, let’s talk infrastructure –
not physical, human. Admittedly, staff issues are a major challenge. You rely on your employees to keep the practice running. You want to trust that they can and will operate in the best interests of the practice. All the more reason you need to look carefully at your team and ask yourself if you really do have confidence in them. Do they uphold the standard of excellence that you have committed yourself to?

Or has your practice become the final resting place for the ever-popular Matron of Mediocrity. She’s been there a long time. She’s comfortable. She knows the computers. She doesn’t go out of her way to strain her brain, and she hasn’t had a performance review since … well who can remember those things. The other problem – sorry, I know you don’t like that word – let’s say challenge. Ms. Mediocrity isn’t alone. She has a following. They are the Mediocre Minions. It’s not that they choose to do a poor or average job; it’s more likely that they have not been challenged to perform at their best.

If you peek over your tightly adjusted blinders, you might see conflict among Ms. Mediocrity and the Mediocre Minions, lack of motivation, poor attitudes, turf wars, and poor performance. You simply cannot afford to ignore staffing issues. They never just go away. They become deeper and more divisive. The results then begin to manifest themselves in poor patient relations and, ultimately, lower profits.

The good news, yes, there is good news. Most employees sincerely want to perform well. They want to be challenged. They want to feel like they are part of something bigger than themselves. Invest some time and resources to answer five basic questions for your team members. I promise your efforts will reap significant rewards, and you will learn very quickly if Ms. Mediocrity and the minions are committed to poor performance or just misdirected.

 

---

Do you have unclear job descriptions
with no accountability?

36% answered yes*

 

---

Employee Question (EQ) #1: How Do I Fit In?
Assess the personality of each team member. You work very closely with your team and personality is a factor to be considered for some, if not all, positions. Try personality testing to place current and prospective employees in positions for which they are best suited. The Keirsey Temperament Sorter Test found in the book Please Understand Me, by David Keirsey and at www.keirsey.com is an excellent tool to use for this process.

EQ #2: What Am I Supposed to Do?
I know you think they should have figured this one out by now, but have you ever actually told your employees what their job duties are? With input from your team, develop job descriptions for each team member. Define the job that each staff member is responsible for performing. Specify the skills the person in the position should have. Outline the specific duties and responsibilities of the job. Include the job title, a summary of the position and its responsibilities, and a list of job duties. This can be both a real eye opener and the ideal tool to spell out to employees exactly what is expected of them.

EQ #3: How Am I Supposed to Do THAT?
Train your team—all of them. It is unconscionable that you would allow tens of thousands of dollars to be handled by a member of your team who has not been trained. Read the following sentences carefully. Your practice lives or dies based on collections. The person responsible for this and scheduling must be given the tools and training to succeed and be expected to meet certain performance measurements.

 

---

Is your collection ratio less than 98%
of production?

64% answered yes*

 

---

EQ #4: So, Doctor, How Am I Doing?
Monitor and measure employee performance. Performance reviews are one of the most effective tools in creating a total climate of success in your practice. They provide an objective and neutral means of leveling the playing field for the entire staff. While resistance is common initially, employees rated against objective measures will place more trust and confidence in the process. They also see the direct relationship between their performance, the success of the practice, and ultimately their potential for individual achievement.

With input from the employee, establish individual performance goals that complement practice goals, such as increasing collection ratio, improving accounts receivables, expanding production, reducing time to prepare treatment rooms, and increasing clinical skills. Provide job expectations in writing, and rate the employees on those expectations. For example, if you expect collections to be at 98%, tell your front desk staff, help them to develop a strategy to achieve that rate, including collections training if necessary, and hold them accountable. Whoa, Nelly, now there’s a revolutionary concept. EQ#5: Can You Say “Thank You”?
Reward your team. Celebrate success and encourage each member of the team to not just perform a task but to excel. Inspire the team with a practice vision and goals and recognize the progress you make together in achieving those goals.

Now, let’s examine that stifling schedule. From the looks of it, you and your team could be training for the New York Marathon just in the hours you appear to be running from room to room. Why, you must be doing blockbuster business, right? WRONG. We see this frequently – the illusion of the overcrowded schedule. On paper, it looks like you are so busy you could pull that yellow page ad and give yourself a big fat bonus next year.

And those patients, well they better think twice about moving their appointments. Take this scenario with Mrs. Dennis, for example. “You have to cancel your appointment, and you want to schedule another one? Oh, Mrs. Dennis this is not a good thing. That’ll be a six-month wait.” Now there’s a targeted approach for patient elimination. What’s worse, although the schedule looks packed, not a soul is paying any real attention to the impact of cancellations or no shows. So round about 2 p.m. when there’s a big fat hole in the schedule, production comes to a standstill. Meanwhile, Mrs. Dennis has had her records sent to a more accommodating practice.

As they say, you get what you pay for. Many practices invest very little in one of the most vital systems necessary to not just sustain the practice but also to actually grow the business—recall. And guess what? The payoff is even smaller. Dump the six-month scheduling routine. Practices using this technique eke out only 76% patient retention and, if that weren’t bad enough, they have a nearly 50% higher loss of patients than similar-sized practices that do not pre-appoint. As the example of Mrs. Dennis illustrates, ours is no longer a culture in which patients can predict what they will be doing in six months.

 

---

Do you worry about when to give raises,
how to hire, fire and give performance
reviews?

52% answered yes*

 

---

Integrate a new system. At the next appointment, the hygienist should clearly explain the need for follow-up prophies and exams to the patient. Ask the patient to address the envelope in which their recall notice will be sent. Instruct them to schedule their next appointment when the notice arrives in the mail. The hygienist writes a personal message to the patient on the professionally written recall letter, noting something specific relating to that patient’s dental needs. Also included in the mailing is an educational brochure relating to the patient’s condition or a new practice service – such as whitening.

Delegate responsibility for the recall system to a patient coordinator. This person is accountable for its success and should be expected to:

• Make a specific number of patient phone calls each day within a certain time frame.

• Schedule a definite number of appointments.

• Ensure that a specific number of patients complete treatment.

• Schedule to ensure the hygienist achieves a daily or monthly financial goal.

• Manage a precise number of unscheduled time units in the hygiene schedule per day.

A good patient coordinator should be able to manage a patient base of 500 to 1000 on an average of 15 hours per week at an hourly rate of about $12-$15. Reactivate a few inactive patients and this position quickly pays for itself.

Establish clear goals for your patient retention plan, and monitor the system at least every 30 days. A “value added” benefit of this approach is the fact that you can better monitor hygiene production, which brings me to my next point…

 

---

Do recall patients, due this month,
have to wait past their due date
to get an appointment?

8% answered Yes*

 

---

Hygiene – cash cow or money pit? It’s 10 a.m. Monday morning, Jane, the hygienist, is having coffee and perusing a products catalog because nothing else was on her schedule at this hour, hmmm. On Wednesday, you find her color sorting the recent shipment of toothbrushes. While Jane’s killing time, profits are being sacrificed as well, and the hygiene department is well on its way to yet another below average month. If one of the Mediocre Minions has set up camp in your hygiene department it’s time for her to find new real estate.

Lackluster hygiene production translates into smaller raises, lower bonuses, fewer new technologies, and on, and on, and on. If you are tolerating average performance from your hygiene department, you’re tolerating an average practice. Get the most out of your hygiene production by measuring outcomes and insisting on accountability. Take these steps and build a hygiene department that is a full contributor to the success of the practice.

 

---

Are hygiene salaries more than
33% of production?

44% answered yes*

 

---

If the hygienists receive guaranteed salaries regardless of their production, the expectation must be that they produce three times their salaries.

Schedule the hygienists to produce at 3x their daily wages.

In addition to a base salary, consider paying hygienists a commission for achieving additional production.

Evaluate fees and determine if they are too low. Look at the procedures conducted in an hour to determine the production per hour costs. If the hygienist is paid $25 per hour and the cost for the prophy, not including the dentist’s exam, is $50, the hygienist is making 50 cents on the dollar.

The hygiene salary should be less than 33% of their production, not including the doctor’s exam fee.

Insist on periodontal assessment. One-third of hygiene production should be in interceptive periodontal therapy. Require the hygienist to measure the total number of dollars produced in the 4,000 code and divide it by their total production.

Review hygiene production each month during the team’s monthly meeting.

Customize the time per patient based on patient need not on a standard one-hour allocation for each patient.

Provide hygiene hours in the evening if patients are requesting late appointments.

Resist the temptation to dismiss or ignore issues like those outlined in this article. It’s not just an insignificant personality tiff, a little scheduling issue, a minor lull in the storm of patients. It’s your practice – watch it carefully.

---

Sally McKenzie, Certified Management Consultant is a nationally known lecturer, author, and consultant to the Council on Dental Practice of the ADA. She is President of McKenzie Management, which provides in-office analysis of the business, clinical, and hygiene department; conducts on-site staff training; and offers a full line of educational management books, audiotapes, and videos. McKenzie Management has developed the most expedient practice systems and most resourceful methodologies, which are critical to optimizing practice profitability. Additionally, Ms. McKenzie’s 34 years of experience and expertise are now available as on-tap resources for the dental profession at The Center for Dental Career Development, which provides advanced business education to the dental profession as well as team-building retreats in La Jolla, CA. For information on what any of these companies can do for your practice, call Sally toll-free at 877-777-6151, email sallymck@mckenziemgmt.com and visit her websites at: www.mckenziemgmt.com, www.dentalcareerdevelop.com.