Part I:
Set rigid hygiene goals and set yourself up for failure
Cindy Campbell, RDH
Is it your goal to achieve a dramatic increase in the hygiene department? If you play the numbers game in hygiene, you`re bound to come up short. You`re better off looking at your overall goal. If your goal is to see as many patients as possible, keep on measuring those hygiene numbers - you`re on the right track. But if your ultimate goal is to expand your practice, then you might want to think twice about gauging the success of your hygiene department by using only hard numbers.
Success that`s hard to measure
It`s only natural that you`d want a numeric goal for your practice. With numeric goals, you can evaluate your progress with handy percentage points and easily calculate a return on investment. But there are subtleties to dentistry that don`t translate into numbers, and success in the hygiene department is one of those subtleties.
In our practice, we don`t impose financial or production goals upon the hygiene department. In fact, hygiene`s objective is to help patients achieve good dental health through education and service. The question that many practices face when adopting this objective is, "How do we measure our success?" It can feel uncomfortable to commit to a plan and not have daily, weekly, or even monthly numerical results. But when you can shift your focus toward patient service, you can confidently measure the success of your hygiene department in the daily successes you experience with each patient, which will ultimately improve your bottom line. If you educate your patients, and help them make the right dental decisions, your patients succeed. With educated patients, it`s much easier to bring them to case acceptance, which helps your practice to succeed.
Imposing production goals
In my 18 years as a hygienist, I`ve worked for several different practices that employed different philosophies and enjoyed different success rates. One practice focused heavily on achieving a dramatic increase in the hygiene department. The doctor decided what he wanted his yearly income to be, and then calculated what we needed to do on a monthly, weekly, and, ultimately, a daily basis to meet that goal. He raised fees and created a daily production goal for the hygiene department. There was ongoing pressure to see a certain number of patients, to diagnose a certain number of cases, and then to successfully achieve patient acceptance - each and every day. This directed the hygiene department away from quality patient care and more toward the speedier "selling" of dental health services.
It was a weak model. Although an increase in the hygiene department occurred in the short term (with more patients being seen and charging higher fees), the model couldn`t sustain itself. Hygienists spent less time treating patients and were under more pressure to sell treatment. As a result, our patients received less individualized attention, which meant less education to help them understand why they needed treatment. It negatively affected case acceptance, patient retention, and staff satisfaction.
Doctors must delegate
For the hygiene department to have an impact on the growth of the practice, the doctor has to be comfortable delegating responsibilities to his staff. In short, you must hire good people and trust them to do their jobs. When a doctor feels compelled to get involved in each and every detail of how the practice is run - from the scheduling to the supply ordering - he disables the staff, distracts focus away from the patient, and weakens the dental team.
At my current practice, the hygienist performs the soft tissue exam and then calls the doctor in to see the patient. Instead of repeating the work we just did, or reviewing our report in detail, Dr. Snodgrass takes the opportunity to talk to the patient, allowing the hygienist to review the report by focusing on the highlights. I might say, "Doctor, Mr. Smith had some concerns about his gums," or "Doctor, would you like to take a look at Mr. Smith`s lower left molars?" when a section of the oral exam concerns me or the patient.
When the doctor can delegate, he spends more time building relationships with patients, making them feel comfortable, and educating them about treatment options.
Increase patients` dental IQ
Education is the cornerstone of a hygiene department`s success. You must educate your staff, and, most importantly, you must educate your patients. The staff needs to be educated so that they can all be on the same page as they send the same messages to patients. The patients need to be educated so that they can appreciate the importance of dental health and see the value of your expertise.
So how do you measure the success of your patient education program? If your patients value your time, your expertise, your therapeutic services, and the products (the crown, filling, denture, etc.), then they have a high dental IQ and they`ll make good decisions, including accepting the recommended treatment.
Our practice is successful because we are committed to raising the patients` dental IQ on a daily basis. We work in unison to educate patients, attending to it in small steps. We`re committed to it each and every day.
In my 18 years as a hygienist, I have used numerous educational tools to help raise my patients` dental IQ, ranging from charts to before-and-after photos; pamphlets to videos; and tooth models to multimedia patient education programs. Each has its strengths and weaknesses.
But for patient education in the hygiene department, our most valuable tools are the intraoral camera, CAESY on DVD, and a customized perio chart. We also have tactile tools and models to help patients visualize their treatment needs.
During a typical visit, I`ll examine the patient and we`ll discuss what our treatment proposal might be. Then I show a DVD presentation to give the patient a visual reinforcement of what we discussed. The presentation meanwhile gives me a chance to do some charting. I remain at the patient`s side in the event they have questions. Once we view the presentation and answer the questions, I`ll pull out the intraoral camera and ask the patient if he or she like to "see what we see" for a better understanding of the treatment proposal. Most patients are fascinated and jump at the opportunity.
Some patients, however, are terrified of the intra oral camera. In fact, several patients have declined my offer of a visual tour of their mouth because they`re afraid of what they`re going to see. "Please don`t show me the gory details," some say. The patient-friendly animation and images of the DVD program, however, spare the patient the "gory details," while demonstrating the problem and the treatment alternatives in a non-threatening manner.
Another patient education tool that I recommend is one that we created for our patients. We recently designed an easy-to-understand perio chart that has gotten a positive response from our patients. We basically simplified the standard perio chart, eliminating the more clinical information such as treatment codes. It`s still a diagnostic chart that can be sent to periodontists. But it also doubles as a patient education piece - something patients can take home and use to chart their perio progress.
Often, by the time the doctor gets into the exam room, the patient is already saying "yes" to the treatment recommendation (which is not to say that every patient accepts every treatment recommendation). We get our fair share of challenging cases, but we definitely see a direct correlation between the growth of patients` dental IQ, and their willingness to accept the recommended treatment plan. The time invested by hygienists into patient education today pays back dividends down the line. Maybe it`s the next cleaning appointment. Maybe it`s a year later. As we build on the patients` dental IQ, they become better patients - for the rest of their lives.
Barriers to treatment acceptance
Increasing your patients` dental IQ takes time. And it`s difficult to know what a patient does or doesn`t already understand. Interactive patient education is a savior to me because I know that I`m not going to forget to tell the patient something. It offers consistent messages, provokes questions from patients, and clearly demonstrates the value of the treatment. But that understanding doesn`t always happen overnight. The hygienist has to propose options to patients, make sure they fully understand each option (both short-term and long-term), and explain what the treatment entails, both clinically and financially.
Finances are often a barrier to treatment acceptance. Even as patients begin to understand the importance of treatment options, they may still make decisions based on finances. Although they may choose the lesser treatment first, I still count it as a success. If they understand the ultimate goal, they`re on the right track. At the next treatment we move closer to the recommended treatment. It`s a pattern I`ve seen again and again.
Sometimes, cultural differences are the barrier. I once had a Russian patient who needed dentures. She was an elderly lady who had a row of gold teeth, and she wanted gold on her new dentures as well. Gold teeth were a symbol of good government care in her culture, and it was difficult for us to not try to talk her out of it. But, beyond giving her the treatment options and our recommendation, it was, of course, her needs that we were there to meet. And this lady needed gold dentures to be happy.
I encourage hygienists to fight those inner frustrations such as, "Can`t this person see how important this treatment is?" Ultimately, those aren`t our judgments. If a patient tells me they`re not going to floss, I`m going to believe them. It`s not going to do me any good to berate them for not flossing. Instead, I look for other ways they can clean their teeth and stimulate their tissue to maintain a healthy oral situation. I`ve found when I give patients something that works for them, they appreciate their oral care success and may consider adding other tools such as flossing to their routine later on.
Remember, we are facilitators, helping people discover what they need. We`re there to provide them with education and dental health care. Patients will always make the decision that`s right for them. Our job is to help them understand their options.
From compliance to facilitation
In the past, the communication approach in dentistry was one of compliance. Your focus was to get the patient to agree to your recommendation. With the advent of the Internet, and the free and easy access to health information, patients now are much more involved in their health care decisions. To be successful, your communication approach should adapt to this cultural change. You and your staff need to take the role of facilitators to your patients, who are now active participants in their dental health. Empower your patients with the information they need to choose the treatment that is right for them. Your hygiene department will better serve your patients, ultimately benefitting and expanding your practice.
