Marina Cove Consulting
  • Home
  • Who We Are
  • Our Philosophy
  • How We Work
  • Our Process
  • Contact
  • Curriculum Vitae
  • Thoughts on Dental Practice
  • Practice Analysis Sample
  • Patient Contact Form

Where Are My New Years' Resolutions?

1/28/2017

0 Comments

 
Picture
Where Are My New Years’ Resolutions?
How is your resolution list looking?  Mine is on my desk where I can see it every day.  In fact it is right next to my smart phone and my computer screen.  Those two items are wonderful tools that allow procrastination to sneak in and try to screw up my life.  Psychologists see procrastination as a kind of avoidance behavior, a coping mechanism gone awry, in which we “give in to feel good”  According to Timothy Pschyl[1] often this behavior is due to fear or anxiety about the important task awaiting us.  Then procrastination kicks in and we engage in some activity that feels good, then we feel guilty about not getting our real task done and look for another activity to make us feel good. 
This negative feedback cycle is enhanced by the incredible technology that we have at our fingertips.  In his recent book “Thank You for Being Late” Thomas Friedman[2] outlines the societal changes he has seen around the world since the advent of the smart phone and internet have become ubiquitous.  Picture this.  You sit down to review your office P&L.  While your computer boots up you check on your Facebook account, stream some music and text your wife about dinner plans.  Suddenly an hour is gone and your P&L is still waiting.  We have allowed the age of instant gratification to subvert our attention from something of lasting importance.   Now we leave the office for dinner feeling guilty about what we did not get done. 
Procrastination does not make us a “bad” person but it does waste precious time that could be used for more viable long-term goals.   We cannot tell ourselves or others to just stop procrastinating as it is so tied into our deeper psychological issues about gratification, fear of failure and our sense of lack of control of our lives.  However, we can recognize procrastination for what it is and forgive ourselves when we realize we have been giving in to the behavior.  Next we can recognize that we can overcome procrastination by following the NIKE phrase “ Just  do it” – whether we feel like it or not.  Accept that we may not feel like it but if the task is there get started on it. Once we get engaged in the task we usually find it is not so bad after all and we feel good when we get it done.  Follow the old African proverb about how to eat an elephant – one small bite at a time.
When we see ourselves, or others, as having a time management problem, we might want to consider the idea that what we are dealing with is an emotion management problem.   This leads us back to Friedman’s book.  We now have a generation that has grown up in an instant gratification world.  It is imperative that we learn about critical thinking and emotional intelligence and teach these concepts to our children.  Everything we do does not bring instant gratification.  Sometimes we just have to get on with tasks even if we don’t feel like it.  Procrastinators are dreamers.  They will tell you about the wonderful dental practice they will build one day.  Yet they will not do, or train their team in, the basic steps of a true comprehensive exam.  Change is hard, but it is easier when we give ourselves permission to recognize our fears and take small steps to move to a better future.  This leads to the issue of accountability.  Until we learn to manage procrastination it is very hard to hold ourselves or others accountable. Check out Totally Acciountable.com.


 
Visualizing our decisions using the Eisenhower Matrix as described in Covey’s “Seven Habits of Highly Effective People[3] will help us keep moving in a good direction.  When we review our daily “To Do “ list and assess where the items fall in the matrix we are less likely to let our emotions prevent us from getting to work on what needs to be done.  Equally important we prevent, as much as possible, spending time in quadrants 3 and 4 and work on things in quadrants 1 and 2.

I am absolutely certain that the “procrastination bug” will bite me frequently.  However, I have rewritten my New Years’ resolutions onto a sheet with the Eisenhower Matrix – along with a few other “to do’s” .  Even on days when I would really rather do something else the matrix is keeping me on task and helping me feel better and more free of guilt when I walk out of the office at the end of the day.  Here’s hoping you make time to rewrite your resolutions and end up feeling better at the end of your day.
Blg012617
 


[1] Pychyl, T., Procrastination Research Group, Carlton Univ., Ottawa, CN

[2] Friedman, T., Thank You For Being Late, 11/2016, Farrar, Strauss & Giroux

[3] Covey , S., Seven Habits of Highly Effective People, Stephen Covey.com
0 Comments

What Do You Think?   -  Confirming Communication  and Accountability

12/18/2016

0 Comments

 
​What Do You Think?  - Confirming Communication and Accountability
A recent experience working with a boat yard in another state brought to light the difficulty of establishing two way communication, mutual understanding and accountability.  When we discover a disappointed client or unhappy staff person take a moment to reaffirm that you are truly in communication with the person involved.  Too often we falsely assume that we have open lines of communication.  We make statements or requests and assume that the other party involved grasps our understanding of an issue because they say “OK” or because they don’t question our ideas.  Only later when one or both parties are unhappy with the outcome do we discover that both parties idea of a good outcome have been left unmet.  Here are a few pointers we learned in our recent boating experience that can be immediately applied in your office and daily life.
 We purchased a boat in Maryland in July and had it stored at a nearby boatyard where we were referred.  We created a list of some work to be done on the boat in preparation for taking it to Florida via the Atlantic Intercostal Waterway in late October. Over the course of the summer we had numerous conversations with the yard as well as email conversations about the projects and the timing of our arrival to pick up the boat.  However, when we arrived we were disappointed to find all the projects were not complete.  We found the workmanship at the yard was excellent but there was apparently no master plan expressed to the staff about when our projects were to be completed.  And, there was not sense of accountability on the part of the yard manager.
Just because you are talking does not mean you are communicating.  Communication requires a speaker and a listener.  In order to understand the speaker the listener should be asking the speaker questions.  If you are discussing a project as the speaker and the listener responds “OK” with no questions, that should be a red warning flag.  If you don’t get any questions someone is not listening.  Stop and ask the listener “What do you think?”  If they don’t have any comments or questions they have not been listening.   Either they are not focused on your project or they think they know what you want.  Require that the listener describe to you what they believe you want as the final outcome of the project before agreeing to move ahead.  Especially with staff, do not assume “they know what I want”.   With clients ask them to describe what they think the final outcome will feel like or look like and listen closely for signs they might be expecting more than you can deliver.
 
 
If you are working on longer term projects with multiple steps demand a written estimate with a completion date.  Unwillingness to provide these items means either the provider does not have the experience to know timing or costs or is unwilling to be held accountable.  We should have put a hold on our projects when an estimate was not forthcoming.  However, we were lulled into a false sense of confidence because the yard has a reputation of doing very high quality work.   As a provider, don’t let a referred client lull you into promising more that you might be capable of delivering.  Follow the old saying, “Under promise and over deliver”.  And, “get it in writing”.  Provide clients with multi-step cases a written timeline and cost estimate even if they say they don’t need it.  These steps help both parties be accountable.
Be accountable and demand accountability.  Our experience with the yard started well and ended with disappointment.  When we felt things were going downhill we should have followed Mike Scott’s rule of accountability. ACCOUNTABILITY: Doing what you said you would do, as you said you would do it, when you said you would do it- PERIOD![1]  We did not demand accountability as we felt we had several months for projects to get done.  When the first completion date was missed we should have had a conference call with the yard manager and the yard owner to determine what was going on.  In your office if you have a case that will be late don’t delegate the phone call to your client.  Do it yourself.  Apologize for the delay and ask if there is anything you can do to help out until you can move to completion. Usually clients understand.  Your willingness to reach out and help can reduce frustration for your client.
Provide constructive feedback and be a good listener.  In our case we were frustrated that we had to wait to leave on our planned trip.  Rather than get angry we decided to get things done right and move on.  However, after getting past the emotional aspects of the matter we took time to write the owner a letter explaining our disappointment.  We did not just complain.  Rather we pointed out where we felt there was poor communication or accountability and the steps that could prevent that in the future.  In the office, rather than grumbling at a staff person when you don’t get the result you thought you asked for, ask a clarifying question.  “Can you tell me why we are doing _______?”  You might not want to hear the answer but it will clarify the level of communication going on in the office.  When you have an unhappy client, put your emotions on the back burner and thank the person for their willingness to express how they feel.  You may feel their concerns are not justifies but their feedback provides insight about how others see you and your operation.  Don’t be in a hurry to do anything but listen.  Often that is all the person is looking for.  Once you demonstrate that you are really listening emotions tend to calm and rational discussion can begin to take place.  You may not be able to solve the issues of all who complain but when you convince them that you honestly listened they are less likely to bad mouth you to their friends.
Blg121516
 


[1] Mike Scott and Associates, Quotes to live by, Totally Accountalbe.com
0 Comments

Perception is Reality

8/24/2016

0 Comments

 
Perception is Reality
Recently our young associate approached me with this question. “How come you are doing more crowns than I am?  We are seeing the same general patient mix.  In fact I see more urgent care than you do.  You and I have the same philosophy about when a crown is clinically indicated.  I feel that I am recommending treatment that is in the patient’s best interest.  Yet, people are refusing or deferring ideal care and choosing what I consider a compromise in treatment.”
 I asked him to make a list of ten clients who had chosen “less than ideal” treatment in his mind and promised to review it with him. Later in the day we looked over the records.  In every case presented the clinical indications were such that a crown would be the recommended treatment.  Why were people saying yes to me and no to him?  My comments to him were as follows:
Gray hair makes a difference – You have a great educational background and excellent clinical skills.  However, you only have a limited relationship with the patients you are seeing.  Even if I am seeing a person for the first time I still have the advantage of a long history in the community and the likelihood that someone referred the person to our office who knows and trusts me.  Trust transfers with time and relationships.  You are more likely to be perceived as an “up and comer” who just wants to do nice dentistry and make money.  With patients who have been coming here I have two other advantages.  In most cases I have probably been telling them for years that a crown is indicated, or if something happens with the tooth a crown is indicated.  They come in all ready with the mental attitude that a crown is the treatment of choice.  In other cases where we have done a crown and it has worked out well they understand that the time and expense of a crown now is worth not having to deal with future problems.
Philosophy matters – In all cases the patient owns the problem.  Treatment is optional.  It makes no difference that we know what is technically best for the patient.  Our role is to provide appropriate diagnosis, educate the patient on the options and outcomes available, establish prices involved and allow the patient to choose the course of action that is right for them at this moment in time.  I can relate hundreds of cases over the years where we provided treatment that was palliative, to get by for an unspecified time.  Over the years those people came back when the time was right for them and asked for us to do the crown that they knew they needed.  If we had forced them into doing “what we knew they needed” they would have left the practice.
Look and act professional – Long ago we practiced in a shirt and tie because that is how “doctors” were supposed to look.  Today we follow the mandates of OSHA and practice in modified scrubs for our clinical team and coordinated attire for our business staff.  We are a team and we want to look and act like a team.  But professionalism is more than clothes.  How we act, appear, dress and treat others has a major impact on how our clients believe we think and act.  Active listening with our clients and staff is imperative at all times.  Being accountable is critical in gaining the respect of others and even of yourself.  Finally, how you appear to others in your dress and bodily appearance impacts how others think of you and how they perceive you feel about yourself.  You will gain the respect of others when you demonstrate that you respect yourself.  No words will be necessary.  
Blg081816
0 Comments

Associates - Hire for Character

4/18/2016

0 Comments

 
Associates – Hire for Character
Those of us in practice for 40 or more years know that finding an associate doctor that is a good fit with the practice can be time consuming and difficult.  In my small town practice, when a candidate appears, all parties are motivated to “make it work”.  However, hiring the wrong person is worse than hiring no one.  Following is a list of points to consider before signing a contract.  Some of this comes from the school of hard knocks and some from Bob Salvin of Salvin Dental Specialties.  Bob is one of the smartest and most helpful men in the business and is a wonderful resource in the hiring process.
Winners attract winners - First and foremost, do you like the candidate and do they like you?  If married do you like the spouse?  If you do not feel you have the personal skills to asses this area, request that the candidate have a meeting with a clinical psychologist and let you pay for an assessment and share it with one another.   This can save you huge amounts of gut lining and dollars in the long run.  If the candidate balks at this request let them go to find another office.  Do candidate and spouse both want to live in your area?   Why?  Where does the rest of the family live? When the first grandchild arrives the in-laws will push hard to have the baby nearby.
 Watch, Listen, Learn - If your initial response is positive, require that the person spend at minimum, two days in your office watching how you work.  Set aside several hours to listen to what the person has to say about what they observed.  The ideal candidate will have many questions.
Does the candidate have a similar work ethic to yours?  Do they show up for meetings and observation on time and in appropriate dress?  Did they observe the personality styles of clients and staff?  Do they have the clinical expertise and/or experience to understand the variety of procedures demonstrated? Do they display the characteristics of a lifetime learner? Be honest with yourself and the new doctor about what you expect.  Explain the standard of care that you expect to be delivered.  Create a detailed job description of the associate’s role, share it and use it as a discussion tool.  Explain what will happen if the doctor does not meet your criteria.   Most students will have no idea that you expect them to make follow up phone calls to patients, that you expect them to go to chamber of commerce or Rotary club meetings, how many hours per week they are expected to be in the office and that you expect them to participate in things like study clubs and continuing education on their own time.  Put in writing your expectations regarding dress, internet use, texting and phone use as well as how staff is to be addressed.  Assume nothing, discuss everything.
Does the candidate have a work history or are you going to be providing their first real paycheck?  No work history is a big red flag. How do they feel about the workload and speed that will be necessary if they are hired?  Do they understand the difference between completing the needed work to a high standard of care and completing the work in a manner that creates a relationship and leads to a long term client? 
What about the money - Does the candidate have any financial knowledge?  Does the new doctor understand that it is likely you will lose money employing him/her during the first year?  Does the spouse understand this?  If not, take a pass.   Candidates just getting out of school know that corporate dental practices are paying between $120,000 and $130,000 as a starting wage in a metropolitan area.  If your practice is in a part of the country where living costs are lower, does the doctor understand finances enough to know that a slightly lower wage might still be fair?  Wage discussions should always include the spouse.  If both parties are not capable of, or not interested in, the discussion of wages, pass on the candidate.
Don’t hope for the best - If you get this far and everyone is still feeling good and is excited to put things into a contract, don’t.  Check references.  Pay to have a through background check.  Call every reference and listen carefully for what is not said as well as what is said.  You should request permission to perform both a credit and criminal background check.   Simply say, “Before we move on to creating a contract we are going to conduct both a credit and criminal background check.”  “What will we find?”  If there is a lack of truth at this point what can you expect in the future?
Be accountable - If you have gotten this far and things still look good, follow through.  Provide a fair, businesslike contract as you said you would, when you said you would.  Don’t expect miracles.  Most associate positions are a money loser in the first year.  Are your ready to give up patients to a new provider?  If not, you are not ready for an associate.  Do not expect the new doctor to generate enough clients to keep busy for quite some time.  If you promise to be a mentor follow through.  Create a meeting schedule where you will be available to review cases, discuss questions and quietly listen to your new associate every week for 90 days, then every two weeks for a year and then hopefully, monthly forever.  Nothing except a death in the family should be allowed to violate this time.  Hold your associate accountable in the same manner.  Create a log of your discussions so you can refer to it in the future and not lose track of your path, have a record for legal use if ever needed.
 
Trust and respect – These two items will develop over time if you commit to being accountable.  Just as with your client base, it takes time and commitment from both parties to develop trust and respect.  We build an emotional bank account based on listening, honesty, kindness and accountability.  Open ended questions about what your associate expresses as a preferred future are important listening points to assess how the process is going. Occasionally there will be withdrawals from the account.  However, it the account stays positive and keeps growing you have a potential partner or practice buyer in the making.  You can teach the clinical skills necessary to deliver excellent care.  However, your potential associate’s character has been molded early in life and no matter what they say it will not change much over time.
Blg041816
0 Comments

Is Your Accounts RECEIVABLE Really the Issue?

4/4/2016

0 Comments

 
​Last week I met a doctor from New York State who sold his practice in January.  He stated that finding a buyer had been very difficult.  He tried marketing the practice on his own with no success and finally ended up using a practice broker.  In the end he had to discount his sale price and carry a portion of the debt for three years.  Much as we do not like to admit it, this is the current trend in practice sales in much of the country as discussed in a white paper by Charles Blair[1].  Although he is no longer an owner he has concerns about the practice viability as he is at risk for a portion of the debt.  He has a good relationship with the new owner and is trying to maintain a mentor relationship with him. He has noticed that the accounts receivable has moved up significantly since the sale and asked for ideas about how to address the matter.
We believe that there are probably several issues that need to be addressed – 1. The new doctor fears rejection. 2. Staff not 100% committed to new provider’s success. 3. Accountability issues.
A new provider has two issues to address even when they have been introduced to the client base and have a reasonable level of experience.  The new provider subconsciously does not want to be rejected when treatment is proposed.  Even though this feeling is unspoken clients may feel it.  This may lead to a lack of clarity about treatment proposed or fees involved.  When this happens staff will sense the change and be less assertive in setting up treatment and fee arrangements.  The new provider and old provider will naturally have different styles and differing trust levels with clients.  In some cases it may take several years before clients trust grows to the prior level.  In some cases clients will depart. The key to managing this aspect goes back to the principles expressed by Sandy Roth of ProSynergy[2].  Before any treatment takes place:  All parties must be clear about the outcomes desired,  All parties must agree on the means to achieve the outcomes,  All parties must agree on the prices involved. The doctor and every team member must use this model exclusively in discussing treatment of any sort with clients.  This is not a script it is a philosophy.  Dentistry is optional and the patient is the final authority on whether to move forward with treatment or not.
The team must be 100% committed to the success of the practice.  The practice is their reason for existence.  No practice equals no job.   The team must be committed to helping deliver the highest standard of health care that they are capable of and supporting one another in that goal.  As the new team leader the doctor must address this issue openly.  In a practice transition there will be a period of chaos where some staff yearn for the “old ways”, fear new leadership and test the boundaries of accepted behavior. 
The new provider would be wise to set aside several hours for a mandatory team meeting to review and clarify the philosophy of the practice and set goals and objectives that the team can agree on.  If that is not part of the skill set of the provider, bringing in a consultant would be money well spent. Rest assured that a practice transition where there are staff mergers and/or a new provider moving into an office with long-term staff there will be emotional turmoil.  Staff turnover may be necessary to develop a loyal team.  The only way to address this is to meet the issue head on and allow open and honest discussion.  Triangulation, back room talk or negative attitudes cannot be tolerated.
The new provider must demonstrate that he/she is accountable and require accountability from every member of the team. Mike Scott[3] has some excellent material on this topic on his website and is an excellent lecturer and consultant in this area. The doctor must demonstrate absolute accountability as the team leader.  Only then is it possible to expect accountability from the team.  Team members who are not accountable must go.  Everyone in the office team knows who the “bad apples” are.  Eliminating these bad influencers improves moral and frees up significant time and energy that was being wasted on gossip and excuses that can now be used to address A/R issues.  Carefully developing trust through the Outcomes, Means, Prices model, clarifying philosophy, goals and objectives and creating an atmosphere of accountability should move the accounts receivable in the proper direction.
Blg032816
 


[1] Blair, Charles, Eight Game changers in Dentistry, White Paper, Charles Blair.com

[2] Roth, Sandy, Personal Communication, Prosynergy.com
 

[3] Scott, Mike, Lecture Material, Totally Accountable.com
0 Comments

who is in control?

1/5/2016

0 Comments

 
​Who is In Control?
In dealing with doctors and staff I often find that they have the premise of who is in control with clients backwards.  Doctors and staff may have education, intellect and personality on their side but if they do not understand that the client is the final determining factor regarding treatment they are missing a key factor in practice success.  Everything we do with our client should be focused on helping them identify the appropriate choices that they have available to achieve maximum comfort, function, health and aesthetics.  Clients know best what is right for them.  We are there to help good things happen.
All of us have suffered through multitudes of slides from folks on the lecture circuit showing great clinical skills and improved appearance.  Few lecturers stop and discuss what it was that made the client choose them and why the client agreed to pay for their care with gratitude. There are many skilled doctors who could be performing significant amounts of excellent service, but they are not doing so because they have not learned the essential personal skills to allow people to find value in their office.   They get along telling people what to do and fixing one tooth at a time.  They wonder why they don’t get more referrals.
There is an old saying: “Show me where you spend your money and I will know your value systems.”  If we do not learn enough about our client to know their value systems we can never expect them to spend their money with us on excellent dental care.  We begin the process of understanding value with our clients from their first contact with us.  That may be a phone call or a visit to our web page.  We emphasize that our most important mission is to understand what outcome they are looking for from their interaction with us.  We want a relationship based on honesty, mutual respect and trust.  Sometimes this happens quickly and sometimes this takes years. 
We may know from a clinical perspective what is ideal for a client but they may not be able to take ownership of their specific problems.  If we try to “fix” the problems but they do not “own” the problems we have a disaster in the making.  Without ownership the client does not value the care skill and judgement you have rendered.  When things go wrong, and they will, it will always be “your crown came off doc” rather than “my crown came off eating a caramel”.   Without ownership the fees will always be too high no matter what it is.
L. D. Pankey used to relate this issue to what he called “dental I Q” or being above or below “the line”.  Many who heard him speak on his philosophy of dentistry thought he was talking about money.  He was really talking about whether the client owned their dental problems, had the intellect to understand them and the willingness to pay for and maintain the dentistry needed to help them regain their dental health.  We can help people improve their dental I Q but only with significant time and effort at building relationships and trust.
 
Our role, doctors and staff, is to listen with the intent of understanding, not with the intent to reply[1].  When we truly understand the outcomes our client is expressing we can begin the process of education necessary to provide them with alternatives open to them.  We cannot do this without a through diagnosis, a comprehensive and thoughtful treatment plan and a consultation with all appropriate parties present.    Each of these steps allows all parties to develop a deeper understanding of one another and refine treatment options that have the potential for long-term success.   The consultation is not a “selling” visit, it is a time to re-clarify our understanding of our client’s goals and provide possible outcomes that they may choose.  As long as our client knows the risks and rewards of the option they are considering we are fulfilling our role as educator/professional.  They may make choices that we are unwilling or unable to provide, but the choice is theirs not ours.  We are able to provide care, skill and judgement based on the outcomes defined with the client, the means all parties agree are necessary to reach those outcomes and fees that all parties agree are justified.  Our control is whether we are comfortable providing these elements in this case as we have the privilege of saying no.  Beyond that the client is in control.
Blg 011016


[1] Stephen Covey, Stephencovey.com
0 Comments

Does Your Schedule look like swiss cheese?

12/4/2015

1 Comment

 

Is your office experiencing “holes” in the schedule?  Are you having “no shows” in hygiene and rejections to treatment recommendations even though you are able to provide services that meet your client’s described outcomes?  Welcome to the “new normal” according to a recent Health Policy Institute[1] article.  Between 2005 and 2013 the HPI statistics show a continuing decline in adult dental care utilization rates for all income levels.  Here are several things we are doing to counteract this trend in our office.
Many speakers are talking about “Five Star Service” and “Five Star Google Reviews” as the key to a full schedule.  Dr. Michael Abernathy[2], who has surveyed over 18,000 patients, points out those patients already expect five star services in our offices. In difficult times we go back to basics.
  1. Pre—book hygiene patients before they leave the hygiene room.  If someone says “I don’t know my schedule” the hygienist should say, “I do know mine and I would like to have you in it.  Let’s make sure you have an appointment now.  If you have to change it later I will be able to move folks around to meet your needs rather than trying to find a hole in my schedule.”   A busy hygiene schedule is the key to a busy restorative schedule.
  2. Make post-operative phone calls.  Ideally the doctor should make follow up calls after any treatment that might involve lingering discomfort. We make them in the evening or the following day, depending on what the client wants.  We also give the client a card with our cell phone number and instructions to call us anytime if they are unsure about their situation.  The calls take little time and are a huge factor in client satisfaction. 
  3. Use pre-block scheduling.  We hold blocks of time in the schedule for highly productive procedures.  We do not fill those times with anything else until the day before if they are not booked.  By pre-blocking times for high production procedures we are controlling the work flow for the doctor and staff for lower stress and better profitability. That way we also always have the ability to take care of the broken tooth that needs a crown or endontics quickly.
  4. Pre-block specific times of each day for urgent care. Do not appoint these times until that day!  Being seen quickly when needed is a major item in patient satisfaction.  Patients with true urgent care needs will make time in their day to meet our schedule.  That way when they do arrive there is no waiting and the office is not stressed by trying to “work someone in”. 
  5. Patients calling for a new patient exam will be seen within two weeks unless their schedule requires otherwise.  Patients coming in for a new patient exam will be offered a hygiene appointment the same day if the wish it and we can accommodate it and they have time available,  Our new patient exam is comprehensive and requires about 90 minutes of patient time.
  6. We make coming to our office a “user friendly” experience.  We try to have convenient office hours.  In our case we are open every day by 7am.  For extensive cases we may work around the patient’s schedule.  We practice excellent telephone skills, utilize current technology like text messages for appointment reminders for those who wish them, use photos and videos for patient education,  We openly discuss fees and provide a variety of ways to make dental care affordable.   We run on time!  We respect our client’s time and make sure that they know it.
  7. We communicate with our clients.  When we know we have pleased a client we openly ask them for referrals, and we personally thank them when they do refer.  We send out quarterly newsletters with information about the office that reinforces the idea that our patients are a part of our dental “family”.  We are a part of the community outside the office – giving back through charity and community service.
  8. Finally, if things are really slow.  Take a day off.  Look at the schedule and be honest.  Could you be more effective if you blocked off a day and worked hard for the balance of the week?  Have your staff reschedule you effectively.  Get out of the office and do something fun rather than sitting around waiting for the phone to ring.  Go take a course in a new service you would like to offer.  When you show up for work looking forward to a busy day everyone will be more positive – you, staff and clients.
For a myriad of reasons the new normal in spending on adult dental care may be a lower number than we would like.  In the world of private practice fee for service care we must present a very high perceived value to our clients to keep them coming for care on a regular basis.  There is no “magic app” or psychological trick to make it better.  Stick with care, skill, judgement and respect.
Blg111515
 
 
 


[1] Gap in Dental Care Utilization Between Medicaid and Privately Insured Children Narrows, Remains Large for Adults , HPI, October 2015

[2] Summit Dental Practice Solutions, Dr. M. Abarnathy, Dallas, Tx,2012
1 Comment

Words Do Matter

8/15/2015

0 Comments

 
Words Do Matter

Recently we stopped at a local upholstery shop to have a seat cushion repaired.  The owner, who is a patient, said “Doc, I have a bone to pick with you.”  She then described coming to our office for her semi-annual exam and prophylaxis that included a doctor exam and cavity detection films.  She was very upset about the fees.  She said,“ I have no issues with the quality of care.  But I can’t understand why I have to have a doctor exam.  You spend about five minutes looking around, never find anything and charge me fifty dollars!  No offense intended, but can’t I skip the exam and save the money?  Remember, Doc, I pay cash and don’t have insurance.”

How would you respond to this situation?  What is our patient really saying?  Is her complaint about the money or the fact she sees no value in the service we have delivered?  The first thing we did was thank her for being open about her frustration.  She could have just left the practice.  Next we asked whether she understood what we were doing when we were looking around inside her mouth.  She said, “I know you have told me, but isn’t the hygienist doing the same thing?”  So, we took a moment to explain the difference between the hygienist doing an examination and the doctor reviewing the exam findings, diagnosing, and potentially proposing treatment.  Finally, we asked whether it would be better for her if at each appointment the hygienist told her ahead of time what the fees would be for her next appointment.  Also, we promised that we would only do doctor exams as necessary or as mandated by the dental practice law in our state.  That seemed to be a good idea to her.

We clearly have missed the mark with this patient.  Although we have reviewed the reasons for a doctor exam and the value of a healthy mouth she sees our care as similar to a “Jiffy Lube” oil change.  In our office we do have verbal protocols for each phase of our procedures so the message should have been getting through about what we are doing and why.  We reviewed her record when back at the office and determined that she has some minor periodontal issues that she has chosen not to address.  Whatever we are doing we are not getting her to take ownership of her problems.  We wrote her a short note reviewing our findings and promised that her hygienist would show her the areas of concern at her next visit.  The words we have been using up to now have not been working it is time for all parties to get involved in facilitating behavioral change.  Maybe this patient is not listening.  Maybe she is a visual not verbal person.  Maybe it is just about the money.  We need to keep asking and listening and teaching.  Words do matter.

Blg063015

0 Comments

My Study Club Experience

8/15/2015

0 Comments

 

0 Comments

NEW CLIENT INTERVIEWS ARE WORTH THE TIME

5/4/2015

0 Comments

 

New Client Interview – A Waste of Time?

If you are interested in doing “one tooth dentistry” there is not much reason for you to spend time trying to get to know your clients.  Most likely you will only see them on an urgent care basis “Doc, your filling broke while I was chewing ice. Can you fix me up like you did five years ago?”  If you want to practice more comprehensive care the new client experience is one of the first important steps in relationship and value development. 

The new client experience begins long before any phone call to your office.  Today a majority if potential clients will have looked at your website at least once and probably talked to an existing client as well.  Millennials will probably have Googled you to look for reviews or complaints.  By the time your office phone rings the person on the other end expects your staff to be happy that they called and helpful.  They do not expect a long quiz about insurance and data gathering.  Rule #1 – Get the patient appointed before they hang up.  You can gather data via your website, a phone call or mail when it is more convenient for all involved.

On the appointed day all staff should be alerted that a new client is coming at the morning huddle.  We want to be sure we know how to pronounce the person’s name and have any final paperwork needed ready before they arrive.  The assigned dental assistant should be introduced to the new client by the receptionist.  Then the assistant should give the patient a short tour of the office introducing people as appropriate.  Only then should the client be escorted to the location where an initial interview can take place.  The interview location should be non-threatening and reasonably private.   In our office we choose to use a treatment room with the patient seated upright and slightly above the doctor and the assistant beside the client where she can take notes.

The staff person reviews the patient’s medical and dental history for obvious issues and concerns and follows up those areas with open ended questions that allow the use of Emotional Intelligence to gauge the level of involvement of the patient at this point in time.  Essentially we are beginning to gauge the persons dental IQ and developing a needs analysis.  We want to understand where the client sees value and where we can provide benefit with our services.  We then alert the doctor that it is time for his/her portion of the interview.  The staff person makes an introduction if the client is not already familiar with the doctor.  The doctor thanks the person for coming to our office and asks the client if there are any questions from their office tour or the discussion so far.  Then the doctor asks if there are questions about him/her, the office or office philosophy.  Finally the doctor reviews the “Outcomes, Means, Prices” approach we believe in.  Once again we are trying to use our Emotional Intelligence to more deeply understand the needs and desires of the client and to understand if this is a person we can work with to find “win – win” solutions.  During this time the client should be talking 70% of the time and staff/doctor talking 30% of the time.  Up to this point we should be determining big picture goals not talking in technical terms.  This would be the time to ask the client to tell about their dental experiences or family history.  Also, this would be where we might tell a story about the value of comprehensive care.

 The staff person then goes over the medical and dental history with the doctor after asking the client to “chime in” if anything is missed or not correct and an opportunity for follow up questions.  Finally, the doctor asks if the client is comfortable with him/her performing an examination of the head, neck and oral tissues.  And, asks permission to tell the truth about what he/she sees as seen at this moment in time. Only after getting a yes to both questions should the exam move ahead.  We allow about 10 minutes of staff time and 30 minutes of doctor time for the interview and intra-extra oral exam once the client is seated.  There are rare occasions this does not work but over 35 years it has proven to work well in our office.

So where is the “value” in all this effort?  Clients see that we are letting them be the guide to reach the outcomes they want - not our need to make a payment on the “new boat”.  We get a chance to use our Emotional Intelligence to determine whether this person will add joy to our, and our staffs’, lives – if not, no amount of money is worth the aggravation of a lousy client. Our clients know we want to develop a real relationship of trust and respect that engenders mutual long-term commitment to one another – this is a rare item in today’s commodity driven health care system. We have had a chance to begin the education of the client about true comprehensive care that is values based and recognizes the client and doctor as the final arbiters of care to be delivered.  We are establishing a “permission based” relationship – we don’t do things without getting an OK first.  We are establishing an “expectations based” relationship – we explain what is going to happen before we perform treatment.  We are establishing a “fee based” relationship – we discuss fees openly and expect the client, not insurance, to arrange mutually acceptable payment arrangements.  When these elements are in alignment there is no longer a need to “sell dentistry” – a comprehensive exam, through diagnosis, thoughtful treatment plan and respectful (non-technical) treatment conference will provide plenty of clients who choose the best you can offer.

050515blg

0 Comments

Handling Toxic People

4/15/2015

0 Comments

 
Handling Toxic People

Recently we talked about our restaurant experience where we had a lovely meal seriously diminished by a “toxic” server.  We thought there would be merit in discussing how we chose to handle this situation.  This is not to say our method was correct as every situation is different.  We feel that this issue of toxic people is worth bringing up in a staff meeting for discussion.  We should listen closely to how team members respond to various situations as that may provide a window into how they respond when under stress as well as provide a springboard for development of systems/scripts fort how to deal with a toxic client.

Our dinner experience began with a server who was so toxic that before he spoke his first words we know we were in “trouble”.  He technically did all the right things and said all the right words but we felt he would have been just as happy to pour water on the table and then throw the food on top.  This was doubly sad as the food was wonderful.  So, what did we do and what might we have done?

First, circumstance drives available actions.  We were guests of another couple so we could not get up and leave.  Had we been on our own we would have done so.  In the restaurant and service business there is no excuse for a lousy attitude. There are other places to eat.  That may be what some of your clients choose to do when confronted with a staff person with “attitude”.  Our hosts did not seem as sensitive to the situation when we arrived, but by the time we departed they too were aware of the toxic person serving our table.  This was sad as they were then embarrassed by having put all of us in this situation.

Would confronting our server have made a difference?  We doubt it.  Our emotional intelligence indicated that while he knew we were a table to be served, his mind was so angry over some other matter he was looking for an excuse to blow up.  He performed his functions mechanically – perhaps thinking he was being ”professional”- but seriously diminishing what should have been a lovely meal.

What did we do?  We did choose to leave a gratuity – he fulfilled all the necessary steps expected.  But we did not leave what we would have for great service with a smile.  We left a note with our bill with his name on it.  It said, “David – Your attitude turned a wonderful meal into a less than fun experience”.   It is unfair to allow this toxic behavior to continue, especially if the server is unaware that his attitude is showing much louder than words.  We asked the hostess for a private moment and explained our experience enough so that she could understand this person was a detriment to the business. Will our actions make a difference?   We hope that at least the staff in the kitchen will no longer be dealing with an unseen enemy.

If you have a toxic employee that you are not aware of pray that someone has guts enough to confront them constructively. Also, pray that they address you or another staff member about whatever the issues are.  There may be legitimate reasons for what happened or you may have an “unseen adversary”.  Either way, whether you do not know about it or choose to ignore a poor attitude you are doing everyone a disservice.  You will have clients leaving and just like on Trip Advisor they will be telling everyone all over town.

041515blg

0 Comments

Your Unseen Advarsary

4/8/2015

0 Comments

 
Your Unseen Adversary

We recently had the opportunity to have dinner in one of the best restaurants in our area.  The chef is well known for paring sea food and beef with unusual sauces and vegetables that enhance the flavors of all the elements involved.  When our meal arrived we were not disappointed.  The plates were a work of art and the food was wonderful.  We choose to eat our salad after the entrée.  When the salad arrived it too was a taste and visual delight.

The evening was most memorable however, for the unseen adversary that the chef and hostess were battling - Our Server.  Let’s call him David.  When we were seated our hostess advised us David would be our server.  When he arrived we knew we were in for an “experience” even before he spoke.  You could feel the negative aura before his first surly response.  Everything David did was correct and “by the book” for a professional service person.  However his attitude was so pervasive the wonderful food was diminished.

So what?  The question is do you have a David in your practice?  If you do what will you do about it?  Just because our staff can do procedures and say correct words does not mean our clients are getting a positive experience.  We do not know what David’s “problem” was but it was coming out without him speaking. 

We must take time with our staff to educate them about proper and expected behavior.  Our staff should be able to model what they see in us – a passion for helping others learn to help themselves, concern for the body, mind and spirit of those we serve, joy in providing the highest level of care we are capable of.  Much of this comes with developing a level of emotional intelligence.  This is the capacity to actively listen to others and to see and understand our emotional response to the situation at hand.  It is imperative that we are able to trust our staff to say and do the right thing at the right time without us present.  This is accountability.

How can we know that this is happening?  We must take time to role play.  You can call it “scripting” or any other term but there is no other way.  You must be an active participant not the dictator.  Decide on an issue to discuss.  Work out how it will be handled and what will be said in detail as a group.  People may not use the exact same words but the message must be the same.  Empower the staff to help one another when they see someone need help.  If someone on the staff is unwilling to engage and participate for the benefit of all that is a red flag.  That person needs a private time with you and perhaps a path to another career.

Too often, we look for appearance, mechanical skills or a resume and forget that our staff is the presence and voice of our business that impacts clients far more than our technical time in an operatory.  Our restaurant experience had three out of four elements right and was ruined by one person with a lousy attitude.  Don’t let something going on behind the scenes in your office cause people to look for another dentist down the street.

Next post we will discuss how we chose to handle David and what we might do differently in the future.

040815blg

0 Comments

You can't treat what you don't diagnose

3/24/2015

0 Comments

 

When we talk about delivering comprehensive dentistry there are many steps in arriving at a diagnosis.  A comprehensive diagnosis not automatically connected to the delivery of extensive or expensive dentistry.  We like to begin our initial examination by taking time to try to get to know our client as a person – what are their likes and dislikes?, what kind of life are they living at the moment?, what are their goals in our office?, does our emotional intelligence suggest that we can work well together?  Do we feel that there is a good possibility that we can build a relationship of trust and respect?  In many cases this will take quite some time but we can usually tell if the “chemistry” is good rather quickly.  There is no point in wasting your client’s time or your time if you cannot get along in the long run.

Before we begin our examination process we like to ask two questions.  “After our discussion so far, are you comfortable allowing us to thoroughly evaluate your oral health?”  If we do not get a yes to this there is no point in going further.  If you do get a yes, the manner of the response will tell you something about the person if your emotional intelligence is working.  The second question is; “Are you comfortable with me telling the truth as I see it about everything I see”?  You may be surprised by some of the answers you get to this question.  Many people fear the worst or do not really want to hear about or admit the level of neglect in their oral health.  If the client does not want to ‘take ownership of the problem” that is a strong negative red flag in our office.  If the client does not own the problem there is nothing we can ”fix” that the client cannot destroy.  How often have we heard, “Doc, your filling broke” when the patient arrives with a 10 year old restoration with a broken cusp from chewing ice.

As you can see our diagnosis begins long before we are worried about teeth and gums.  We want a 30,000 foot view of the person attached to the teeth, we want to know who referred them and why.  Once we have permission and we believe we are the proper office and now is the proper time, we proceed with our exam (See: Back to Basics – What Constitutes a Comprehensive Exam).  Once we have the data in hand it is time to diagnose.

You can use our system (See: Back to Basics – Diagnosis), Frank Spear’s system, the Pankey Institute  approach or others.  Be consistent.  Review all the complete stomatognathic system, evaluate all the data, and look at the big picture as well as one tooth at a time.  Forget about money, insurance, time or fear.  Think about what the data is telling you – from the moment you first met this person until now.  You data may be telling you that this case needs multiple disciplines to reach your patient’s goals.  However, the family has two kids in college.  It is appropriate to discuss the totality of the case with this person but also morally right to discuss how to put the person in a “holding pattern” until the time is right for them to move ahead with comprehensive treatment that they can afford.  We owe our clients the very best that we can deliver in our diagnosis.  It is up to them to determine the outcomes that are suitable for them at this moment in time.  Remember, if you always tell the truth you do not have to waste time trying to remember what you said.

032415blg

0 Comments

A Letter to Our Patients

3/7/2015

0 Comments

 
On Philosophy, Insurance and Fees

Only about one half of our patients are covered under some form of dental benefit plan.   The national average is about 60 per cent of folks have a dental benefit plan.  Over 95 per cent of those with a benefit plan get coverage through their employer sponsored health plan.  It is too soon to tell what the effects of the Affordable Care Act (“Obama Care”) will be on dental coverage.  No matter what happens in the world of dental benefits we want to restate our philosophy regarding patient care.  We believe that our examination, diagnosis and recommended treatment have nothing to do with whether you have insurance or not.  Our goal is to provide care for our clients based on the outcomes you desire at the highest standards we can provide.  For most of those folks with insurance the amount of coverage has not increased in many years even though we all know costs have continued to go up.  In the past year or two several companies actually decreased the benefits they will pay out.  In an effort to force our office into being a participant in an insurance company plan the companies will not pay us on the same schedule as participating dentists.  They also try to force patients to see participating offices by withholding benefits if you see dentists outside the “network”.  In essence the insurance companies want to set the fees paid to our office and to determine what services we can deliver based on whether they will cover the service or not.  We don’t work for the insurance companies.  We work for you – our clients.   Our goal is your maximum health and well-being through education and prevention.  If treatment is needed we will discuss the financial issues before we begin.  We will provide care with respect and in a pain free manner.  We believe our client is the final arbiter of care.  We will still file your insurance paperwork for you but we work for you not the insurance company.

What about our fees?  Our fees for services are the same whether you have a benefit plan or not.  We believe that it is patently unfair that we would discount fees to a segment of our patient population because they have a dental benefit package while our non-insured clients pay more.   This is the insurance industry/government getting in the middle of our business.  They are telling dentists “work with us and we will send you more business”.  However they will demand we charge a lower fee, they will determine what services we deliver.  Dentistry is not a business where you can turn up the speed on a machine and produce higher volume to cover lower fees.  We still treat people one at a time.  This is sold to the employer and employee on the basis that if you see “our doctors” you will have little or no out of pocket cost. 

All we have to offer to our clients is Care, Skill and Judgment.  If we are going to prosper in the dental care business we must cover the costs of running a business – payroll, overhead, facility, reinvestment – and - we must make a fair return on investment – profit.  The level of service by every member of our team must be so superior to our competition that our clients are willing to pay for the “value added experience”.  There is no specific formula to create this experience.  For some it will be superior technical skill, for others it will be special behavioral talent.  If we listen to our clients we will know when we are getting the right combination to develop true long-term relationships based on mutual trust and understanding.  Our system must work with the terrain we are in.  Every member of our team must believe in our philosophy and have a passion for the delivery of great care.  We must great communicators and be accountable to others and ourselves.  We must be committed to deliver the highest standard of care we are capable of.  Finally we must go back to the very basic belief that the patient determines the outcomes that will be delivered, we must mutually agree on the means to “get there” and we must agree that the “fee” is appropriate for all concerned.  We respect the fact your trust in our care, skill, judgment and commitment to life-long learning has allowed us to prosper.  We honor your willingness to invest in dental health and well-being.  

0 Comments

All You Have Is Time

3/6/2015

0 Comments

 
All you have is Time

I practice in a small group setting with two other doctors.  When we built a new office a few years ago we decided to have our “private” office space as one room.  We have enjoyed this choice as we can banter back and forth during the day discussing everything from sports scores to case management and the latest antibiotic management regimes.  This open style also exposes our personal management styles as we can see the area we use for our desks.  What you see in each doctor’s area speaks volumes about personal style and self-management skills.

Early in my career I had a long conversation with Dr. Loren Miller at the Pankey Institute about how he developed his outstanding practice and still made time to teach.  One comment he made still is in my mind today.  “Son”, he said, “you have to get control of your time.  Then you can do some straight line thinking.”  After forty years I am still struggling with “getting control of my time”, but I continue to make progress.

Time management does not make you a rigid person.  In fact, the better you are at managing your time the more flexibility you have.  Key elements in time management can be found in Steven Covey’s Seven Habits of Highly Effective People.  Understand the difference between what is important and what is urgent.  Begin with the end in mind. Take time to “sharpen the saw”.

Learn to determine what things in life are truly important and you will eliminate many urgent, stress producing situations.  Some things are very simple – like being at work at the proper time.  Other things are not simple – like how to manage an issue of poor staff performance.  The key element is to determine the level of importance of the issue.  If it is important then deal with it now or create the time to deal with it and stick to that promise.  If an issue is not important do not waste time on it.  Most “urgent” issues are not really that important.   Delegate someone to deal with the issue or communicate that you will not be involved. Understand that you are not in control of many elements of life, let them go and focus on what you can control and make better.  This sounds easy but is extraordinarily difficult.  This is where the “straight line thinking” comes in.  Not as in rigid, but as in focused, open and analytic all at the same time.

Take time to think about what you want to see as the result of your actions before you act.  You would never start restorative care on a complex case without a comprehensive exam, diagnosis and treatment plan.  Why would you treat your personal and family life with less care, skill and judgment than that of your patients – and vise- versa?   Before you pick up a piece of correspondence or a patient chart commit that you will not put it down until you have completed the work involved with it.  This is the biggest time waster I see with most dentists.

  I see desks with piles of opened correspondence, unfinished charts and journals with dog eared pages.  These items are then picked up, put down and pushed around on the desk for days at a time while staff waits for a decision that could have been made in five minutes of focused, active concentration.   Don’t tell me that you don’t have the time!  All you have is time.  Each of us has 1,440 minutes in every day.  How we allocate them makes all the difference.. 

Consider making some changes in your personal schedule so that you can have some time to yourself.  Give your mind some “time off”.  This is time when our mind “resets” and subconsciously comes up with answers to the problems we agonize over every day.  This is Covey’s time to “sharpen the saw”.  Whether it is an hour off or two weeks off we all need time for recreation – think of it as “re-creation”.  Build time into your life for something more than just work.  Find a hobby or avocation to get your mind off work and develop new skills.  The mental “exercise” helps strengthen our mind to manage the stress of everyday life.

Here are some bullet points to consider trying:

Look at your desk – What can you throw away, put away, delegate?

If you pick it up – don’t put it down until you have finished with it.

Put it back – papers, books, tools – it will be where it belongs when you need it again

Make a list – At the end of the day make a short list of what you want to get done tomorrow.  Then let go of those issues until tomorrow.

Make a schedule – for chart review, morning staff meetings, vacations, family time, exercise                                             

Pre-block – productive time at work, staff meetings, vacations, CE time, urgent care time

Make a file – Tear out and file the articles you want to read and carry them with you to read when you have to wait somewhere.

Work on being an active listener – The person perceived as having the greatest social skills is the best listener.

Commit to a tiny change for the better and stick with it – measure your progress – celebrate your success.

You have only 1440 minutes in tomorrow’s time bank account  -  spend them wisely, with love and joy.

0 Comments

the Value of One Patient and One Referral

3/2/2015

0 Comments

 
The Value of One Patient and One Referral

When we get a sense that ever member of the office team is not 100% engaged in developing a deep and lasting relationship with the people who trust us for their dental care we do this little exercise at a staff meeting.  A number of years ago we heard Imtiaz Mange speak at a Mercer Advisors meeting about the dollar value of one patient in our practice.  More important to us was the impact of referral.  This information as helps all of us remember that a successful practice is developed by earning the patient’s trust one at a time. Yes, we know it is not just about “the money” but this helps people realize the business is all about treating one person at a time.

What is the dollar value of one patient in our practice over 20 years?

Let’s make some simple and conservative assumptions:

Assume that the average recare visit has a value of $150.00 and we assume that the average patient comes in twice a year.

Assume that over 20 years the patient will need at least some limited restorative care ( let’s say a couple crowns, a filling or two and limited perio treatment). Let’s say $6,000

Assume it takes five years to build a true trust relationship and the patient refers just one person every five years after year five.

Here are the numbers:

Recare value = $300/year                                          $300 x 20 = $6,000

Restorative care over 20 years                                                        $6,000

One referral per five years                                                            $48,000

Lifelong value of one patient who refers just one patient every five years after we have earned their trust.                                                                                        $60,000

How many patients do we see on an average day?   Let’s call “average” a day with two hygienists and two doctors and assume everyone sees just eight people per day.  What is the value to the practice of all the people we see on any given day?  Why is important to get them appointed, re-appointed and have them leave knowing we love them and love it when they invite their friends to be part of our practice?          

                       

 

Average day lifelong patient value:

Hygiene 16 patients                            $960,000

Doctors 16 patients                             $960,000

Total daily value                                 $1,920,000 passing through the office every day!

This is the potential lifelong dollar value of patients passing through your office on an “average” day.  How important is it that we do everything in our power to help these people to be happy in our office?  Why should we not be happy at work when these people are coming in and supporting us with their trust and hard earned dollars?  What is holding us back from inviting the people we enjoy working with to invite their friends and family to be part of our practice?

I suggest that you sit down with your staff and a white board or paper and “do the numbers” for your office.  It will amaze everyone.  Hopefully, it will turn that phone that keeps ringing from an annoyance into an opportunity and that person who says “I just don’t know my “ into a positive challenge to educate about the value of a pre-set recare visit.  Lastly, if you are getting referrals and fully scheduling your practice you can spend less on ads and marketing and more on making your current clients feel very special.

030115blg

0 Comments

Don't Be Fooled by Numbers

2/27/2015

0 Comments

 
         Don’t Get Fooled by Numbers

We recently attended a dental meeting where a presenter made a “big deal” over their office generating 70 new patients per month for the past several years.  My back of the napkin calculations would indicate that this means they are generating 840 new clients per year.  On the surface this might seem like really good news.  We all know our attrition rate is about 10% per year so we need to have new clients just to stay even.  But how many do we really need to be productive.   Let’s step back and do some more in depth analysis to see how this would work out in an office that is practicing what we would term comprehensive care.  That term means: through initial exam including necessary radiographs, photographs and periodontal charting, comprehensive diagnosis and treatment plan, personal consultation and financial plan before treatment.  We will use information from out office as we do not have data from the presenter’s office. 

In our office we are working 4 ½ days a week.  That equates to 36 hours of available chair time per doctor.  For an initial examination we allocate 30 minutes of doctor time and 90 minutes of chair time. We allocate diagnosis and treatment planning doctor time at 30 minutes.    We try to use non-productive time during the day to treatment plan.  Many cases will be very simple but some will require extensive time outside normal hours to consult with other colleagues, so this is an average.  We allocate 30 minutes of doctor time for a consultation and case discussion during productive time.  Our staff handles financial arrangements outside of that time.   We allocate an average of 90 minutes of doctor time before we begin to be productive with a new client.  Our presenter’s office had three doctors.  So let’s run some numbers and see what all those new patients do to a schedule.

Our numbers say that the three doctor practice has 432 hours available per month to produce.  If they use as much time as we do with new clients that eats up 105 hours leaving only 327 hours per month of production time.  If we allocate 90 minutes per day for hygiene checks that is another 81 hours of production time gone leaving only 246 hours per month to produce.  This assumes multiple hygienists with about 15 – 18 hygiene checks per day of only five minutes or about 9 checks per day at 10 minutes.  By the way – your hygiene department is where clients are educated on self care, reminded of the next steps for their long-term restorative plan and where relationship development takes place.  If your clients feel that the doctor is ‘rushed” in hygiene do you not think this is likely the perception of how the doctor is when doing restorative care? 

So what are we trying to say?  First, too many new clients in a mature restorative practice is not ideal.  What is the proper number?  You will have to do much more comprehensive analysis to determine what is right for you.  The ideal mix is driven by your desire and ability to deliver comprehensive, behaviorally adept care and your personal understanding of work-life balance and desire for financial reward.  Here are some questions to ask.  What is your active patient base?  Are you growing?  What is your hygiene retention rate?  You should have 85% or more of your patients actively appointed in hygiene with about 25% of that population in some sort of periodontal program.  This is the pool of folks that will drive your restorative practice.  What are you trying to produce per hour and per year.  Doctor should produce 65% and hygiene should produce 35%.  There is no one magic number but more is not always better.  Do the numbers for yourself.

022715blg                                                                            

0 Comments

Accountability

2/22/2015

1 Comment

 
Accountability – You cannot ask for what you don’t deliver

We recently had the pleasure of attending a presentation facilitated by Mike Scott[1] where we discussed what is involved in being accountable, and how to improve accountability in our practice.  Mike emphasized a definition of accountability – “doing what you said you would do, as you said you would do it, when you said you would do it – with no surprises.”    This seems so simple until we step back and realize the level of tolerance we all exhibit for “non-accountable” people in our everyday lives.  In encounter after encounter we deal with people who do not feel that they need to be accountable or do not understand accountability.  This leads to a spiral of negativity and higher stress for everyone involved.  These are the folks who answer a question with “whatever”, don’t show up on time and leave jobs unfinished or poorly done. They leave us unsatisfied and wondering if they can be trusted.

Mike used an example of two boxes, one inside the other.  The outside box is the amount of time and effort we expend on tolerance of less than ideal behavior and the inner box is the level of accountability in your life or your practice.  The larger the inner box is the less time and stress is wasted in your life. 

How do we create an “accountable environment”?  It starts with assessing our own behavior.  What is our tolerance level?  How do we express ourselves when others exhibit less than ideal behavior?  Do we have the emotional intelligence to see the cause of the behavior and our response to it?   What is the tolerance we expect of others?  When our desk is piled high with journals and correspondence and staff is looking for an answer to a case question somewhere on the desk, are we exhibiting accountable behavior? 

Accountability starts with the leader of the practice.  It has nothing to do with being ”tough” or demanding.  It starts with modeling the behavior you expect from others.  Start in small ways to live the definition of being accountable.  If you cannot deliver on your commitment be the first to talk to those involved and offer solutions to get to the goal.  When others miss a deadline DO NOT ASK WHY. Asking why allows the person to have an excuse.  Instead ask what is their next step to get the job done?  When will that be?  And can I count on you?  Empower your staff to take creative action and let them know that you “have their back”.

Some steps to move toward higher levels of accountability are:

Model the behavior you expect from others.  When you discover you have been tolerating non-performers help them find another career.  There is far less stress in training a motivated performer than in dealing with the daily “surprises” and excuses of a non-performer.

Grow the level of accountability by making time to train yourself and your staff.  Celebrate success and communicate openly and clearly about being accountable.  Use agendas and checklists for meetings and create action items and accountability lists – these are all available on the web.

You set the “culture” of your practice.   Be accountable and raise the standard of care for all. 



[1] www.totallyaccountable.com


1 Comment
Forward>>
    ​

    Archives

    January 2023
    October 2022
    November 2021
    February 2021
    December 2019
    July 2019
    May 2019
    March 2019
    August 2018
    July 2018
    March 2018
    February 2018
    November 2017
    August 2017
    July 2017
    June 2017
    January 2017
    December 2016
    August 2016
    April 2016
    January 2016
    December 2015
    August 2015
    May 2015
    April 2015
    March 2015
    February 2015

    Categories

    All

    RSS Feed

Proudly powered by Weebly