Is the office on auto pilot?

Feb. 1, 2001
Is the dental practice coasting - or on a crash course? Effective leadership from hygienists can make a difference.
Dentists are open to any idea that will increase their net bottom line. Hygienists must therefore summon and provoke the latent leadership qualities their doctors possess but fail to fully utilize.
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What sort of image pops into your mind when you think "auto-pilot?" An aircraft kept on course all by itself while the crew does other things? Does it make you a little uneasy because no one is actually steering the airplane? Is being on auto-pilot a good thing or a bad thing? What does this have to do with your dental office?

At a recent dental hygiene society meeting, I interviewed 14 hygienists whose ages ranged from fairly recent graduates to veterans of 30 years or more. I believe they represent a good cross-section of practicing hygienists. You be the judge. I learned their opinions and attitudes on "growth" vs. "complacency" in their dental offices. Their answers were often paradoxical. Most said they considered their office staff a "team," but that they didn't always coordinate tasks very well. All participants said they thought there was room for improvement in their practices, but eight said they were happy with the status quo. Twelve said they would welcome "radical sweeping changes to increase productivity and case acceptance." Yet, there really wasn't much danger of that happening, because only four of them thought of their boss as a leader. When I asked hygienists if they saw themselves as leaders, 12 said yes! Who is leading whom?

The answer seems to be that no one is leading at all. Sharmyn Long, RDH, a hygienist and former practice-management consultant, calls the phenomenon "supervised neglect." Dental professionals use a typical, undefined fly-by-the-seat-of-your-pants philosophy when running their practices. Most offices have their way of doing things - usually by trial and error rather than any organized plan. For better or worse, often it's the strongest personalities on the office staff who have the biggest influence on the way things are done. These power dynamics occur largely by default and vary from office to office. Only two of the 14 hygienists interviewed said that everyone in their office has a written job description, a situation that usually results in a great deal of "task overlap." Other, important tasks are left undone because they're "nobody's job." Worse, staff members may be in dispute about who's supposed to be doing certain tasks. This can result in unnecessary tension and conflict among staff members, with the patient ultimately losing. Good and conscientious employees may leave from frustration, while marginal workers stay. This is simply a law of the marketplace: First-rate employees seek better opportunities and working conditions. The dentist, meanwhile, just wants the office to run itself. Does any of this sound familiar?

Production goals were another nebulous topic. Only six in 14 stated there were "minimum production goals" to be met in order to make payroll and pay the bills. The eight-smember majority said their offices either didn't have production goals, or they were unaware of them. Is this any way to run a business?

Long formerly worked as a consultant with Dallas, Texas based Pinnacle Practices, Inc., for eight years. She interviewed hundreds of dentists. Long reports that "75 percent of dentists are afraid to change their practices," whether it was planned that way or by default. Their reason? "Because that's the way I learned it in dental school."

Steve Sperry, the president of Pinnacle Practices, currently has more than 800 dental practice clients in Texas and Oklahoma. He warns, "The dental industry is full of traditional thinkers and negative thinkers. Traditional thinking will kill the dental industry as we know it today ..."

Why? Sperry says that dental schools do a poor job of preparing graduates to run the "business end" of their practices. Moreover, most dentists do not actually consider their practices as a business. "Changing the way dentists do business is heavy-duty stuff," says Sperry. He adds, "Success has very little to do with how smart you are. It has more to do with being open to change."

What does it take for an office staff to go from "The Perfect Storm" to "The Perfect Team?" Sperry states that the goal is an evolving one. The keys are being open to better ways of doing things, hiring and training the right staff, and a lot of challenging but rewarding work. He adds that the "perfect team" is the ideal goal - practically unattainable. However, just training a better team can make a substantial improvement.

Team training is lacking in most dental offices. There is no game plan, no track to run on, and nobody in charge. Staff members like to think they're quite efficient at what they do, regardless of how their work coordinates. If it does, it's usually by accident, or because others have adapted to the will of the stronger personalities.

Professional sports teams are successful only when they learn to work as a team. Every player knows exactly what to do, and knows exactly how each job integrates with that of every team member. It may seem as if these pro teams really are on auto-pilot. However, they still need their coach to plan the strategy and method of execution, and to make course corrections when necessary. Is a similar scenario possible for the dental office? Yes, but only if the "coach" does some thorough planning, the team members get trained, the game plan is memorized, and everyone comes to practice.

In most dental offices, it is usually the doctor who acts as coach for his team. Most dentists, however, are reluctant to assume this role. The question remains: How do you get your boss interested in even looking at these ideas? That was my main problem in writing this article. But when I heard how many of you considered yourselves leaders (and indeed you are), I knew it could be done.

Statistically, 70 percent of all office income results from the hygiene exam. Patients put more trust in the hygienist's treatment recommendations than in what the dentist proposes to them. The reason? Patients spend significantly more time with the hygienist - two to four times more than with the dentist. Long-term patients will often follow a caring hygienist to another practice because of the trust and solid rapport. Without question, it is the hygienist who helps establish patient priorities and raises the dental I.Q.

Most dentists would be shocked to realize how much they're under-utilizing their hygienists. Long says that if dentists will work with hygienists as the vitally important team members they are, and take full advantage of their brains, education, and abilities, case-acceptance rates (and the net bottom line) would greatly improve. If dentists could further involve their entire office staff to reinforce treatment planning, the case acceptance rate would skyrocket. This requires clearly defined job protocols, and a specific and integral game plan for the entire office, with each team member thoroughly trained and versed in what to say and do.

What about you? Where do you start? First, realize that you are much more than a "hygiene producer." According to Sperry, a dental practice is actually two businesses: operative and hygiene. It's hardly a new concept, yet most dentists are seriously missing the boat with their limited vision of how hygiene affects their businesses. Dentists' operative business is generating an income, but they should also use the trust, rapport, and solid relationships developed by hygienists to generate wealth.

Dentists are no doubt open to any idea that will increase their net bottom line. Hygienists must therefore summon and provoke the latent leadership qualities their doctors possess but fail to fully utilize. Point out the benefits of doing a few things differently. Demonstrate how increased enthusiasm within the team can positively impact case acceptance. Tactfully communicate different methods of ensuring smoother operations, including the idea of outside help.

If the boss still isn't sold on the benefits, sometimes it's necessary to sound an alarm: "Doctor, I've noticed that things aren't running very smoothly around here. There's tension and conflict, and I'm worried that our patients aren't getting the kind of care and service they deserve." If that doesn't get his attention, check his pulse! Be ready to have a serious and important talk, should the situation call for it.

Is "auto-pilot" attainable? You can have something similar, but only with teachable attitudes, well-defined (written) task organization, effective training and scripting for the entire staff, hiring and training the right people, and regular follow-through to stay on course. Did a few red flags pop up just now?

Sperry advises, "Some practices that do recognize the need to change deceive themselves into thinking that they can achieve a transformation without pain and some degree of chaos. It doesn't work that way ... overhauling dentistry is an agonizing process. However, if you carry out the necessary changes correctly, the payoff is worth the price. This is a lot less painful than having the marketplace slowly drive a stake into the heart of your practice."

Ted Anibal is a free-lance writer with clinical experience in all dental specialites, including hygiene, crown and bridge, and office administration. He also has extensive knowledge of dental materials, equipment, and office design. Married 25 years - to a hygienist - Anibal currently resides in Tulsa, Okla.