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The old way vs. the new way

May 1, 2003
As the map of Europe has changed, so has the economic relevance of dental hygiene. Don't base the economics of the hygiene operatory on an old map.

by Cynthia McKane-Wagester, RDH

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Slightly more than a decade ago, the world watched with fascination as the old Soviet Empire crumbled. We saw Poland's Solidarity movement grow from a dissident fringe to a major political force. Not too long after this, we heard the amazed voices of news anchors announce, "Today, the Hungarian Communist Party voted to dissolve itself."

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We saw the Berlin Wall come tumbling down. Happy, champagne-sipping crowds chipped away pieces of it to take home as souvenirs. Ukraine voted to sever its ties with Russia and become an independent country. The Yugoslavia that was created by Marshall Tito after World War II splintered into Serbia and Macedonia and some other countries whose names most of us can't even spell.

One thing that I remember from this decade of change is something I heard on a television talk show. It was a comment made by a former political dissident of some Eastern European country, a prediction of the region's future prospects. I can't recall his name or his country, but I can recall almost word-for-word his view of what would occur. His major point was that success or failure would depend on economics. Countries that scrapped the old infrastructure and designed a new one would make it; countries that tried to "fix" and "patch" old systems would not. If we look at what is happening in the region today, we can see that he was right on the mark.

So what does this have to do with dentistry? Plenty.

During the last decade or so, one of the greatest revolutions in dentistry has been the change in perception about the purpose and function of the hygiene department. The department was once viewed as a necessary but costly component of every dental practice. The dental establishment now sees hygiene as something much more significant.

Partner in prevention

Once seen as the person who cleaned teeth, the hygienist is now seen as the practitioner's partner in prevention. He or she is someone integral to patient oral health and overall health. By now, almost everyone in the dental profession recognizes that what the hygienist contributes is more than a cleaning, particularly in light of the Surgeon General's 2000 report on the status of oral health in this country and the vital role hygienists must play in improving that status. And almost everyone has recognized that what goes on in the hygiene operatory has an impact on what happens in the entire practice, especially in light of the correlation between good preventive dentistry and good restorative dentistry.

However, we find that, in too many practices, the old infrastructure remains firmly in place. Instead of creating and implementing a new design, most dentists continue to "fix" and "patch" the old design. This is especially true in terms of economics — the most important aspect of the hygiene department that should be totally overhauled and revolutionized.

In some cases, the problem is a philosophical conflict between economics of the practice as a whole and the economics of the hygiene department. Many dentists still view their practices from the traditional perspective that the economics of restorative dentistry are the primary economic factors (sometimes the only economic factors) that need to be considered. This often means that their hygiene departments, while given more respect and greater responsibilities, are still operating under the tenets of the old economic infrastructure. It is time for some radical changes.

Monitoring the vitals

The first change is the need to recognize that hygiene and the practice must be economically integrated. Everyone needs to be on the same page and everyone needs to have the same economic goals. No one disputes that dentistry is a business. By the same token, everyone should recognize that hygiene is also a business and that the hygiene department is subject to the same principles that make all businesses succeed or fail. A "revamped" hygiene department that is not economically viable is a hygiene department that needs to be redesigned from the ground up.

The major economic components in the business of dentistry are case acceptance, collection efficiency, scheduling, and marketing. Intertwined with all of these is excellent product quality and excellent customer service. These same components should be seen as the core of the business end of hygiene. Yet in most practices, monitoring the vital economic signs of the whole is standard operating procedure while monitoring the vital economic signs of the hygiene department is seldom, if ever, given the same consideration. This is the most critical symptom of allowing the old infrastructure to remain entrenched.

Ignoring the fundamentals of the business design of the hygiene department is unacceptable. Hygiene represents (or should represent) up to 45 percent of the annual gross production of the practice and up to 80 percent of restorative dentistry comes from what is discovered in the hygiene operatory. Consider the potential of a perio program in which 100 percent of all patients can and should be scheduled for continuing care, 75 percent of all patients can and should be referred to more frequent recare schedules, and 50 percent of all patients can and should be referred to more intensive levels of periodontal treatment. Paying attention to the economic design of the department becomes even more critical with this patient potential.

Bold new design

What hygiene contributes to the practice as a whole has made it an economic force that deserves and requires an economic design and infrastructure that is boldly and unabashedly new. Rather than making the business aspect of hygiene a footnote to the business aspect of the practice, practitioners need to recognize that the numbers related to hygiene productivity and profitability merit their own chapter.

For this to work, practitioners need to give the department a crash course in the economics of the practice. This includes a road map that provides directions to the desired destination and measuring tools that specify not only what is to be measured, but also the implications of what the measurement reveals (see chart below).

And just as no one in the practice would dream of waiting till year's end to see how the practice did, no one in the hygiene department should wait till year's end to see how the hygiene department did. These numbers need to be collected daily, weekly, monthly, and annually. They need to be scrupulously monitored on a regular basis for trends and patterns and warning signs. They need to be analyzed in light of potential as well as achievement, and they need to be used as the baseline for new production goals. Knowing what happened will enable the department to forecast what is likely to happen if things remain the same and what could happen if things change for better or worse.

Commission compensation

The department should also be apprised as to how these numbers relate to salary, benefits, bonuses, and expenditures related to continuing education. Those practitioners who are truly ready to implement a radical new design might also wish to incorporate a new component — commission compensation for hygienists.

It stands to reason that changing the business protocol of the practice and the department means adopting effective measuring instruments and enlisting hygiene department team members as active participants in measurement and implementation of the new protocol. If the protocol and design of the new system are explained well, questions of control and supervision are almost immaterial.

The new design gives the department a significant level of autonomy, yet should operate within the parameters of the practice economic design — without disparity, without conflict, and without confusion. Enlightening everyone on the business and economic goals that you want to achieve for the practice allows the department to tailor its business and economic goals to follow suit.

Cynthia McKane-Wagester, RDH, is the president/founder of McKane & Associates, a full-service management company servicing health-care practices. Her company's expertise is in developing excellence in staffing systems, working philosophy, and in ensuring that all team members adapt their skills to meet the ever-changing workplace. She is the author of Dental Hygiene: Pulse of the Practice, which can be obtained from PennWell Publishing at (800) 752-9764. She also is the author of Dental Hygiene: A Practice Within a Practice, available in either a videotape set or DVD. Cindy can be reached at or, or at her office in Maryland at (800) 341-1244.

The Pulse of the Practice ... Looking beyond the gums!

In our competitive market, dental practices try many approaches to improving their productivity, ranging from expensive marketing schemes to new technology.

An approach that is commonly overlooked and that can revitalize a practice with significantly lower expense is to revamp the hygiene department to meet the demands of today's business environment.

Mastering these objectives, you will learn how to bring your hygiene department into the cutting edge of patient service and how to maximize hygiene income and profitability:

• Restructure the hygiene department as it relates to the business of dentistry.

• Maximize the effectiveness and efficiency of scheduling for productivity — create an "ideal day."

• Implement systems to improve the recare program.

• Learn scripts, tips, and tools to keep the repeat, loyal customers returning.

• Develop an educational arena.

• Develop the practice's periodontal program as it relates to the philosophy of the practice.

• Discuss the newest payment options available that will ensure patient compliance, financially as well as philosophically.

• Review the newest materials and medicaments utilized in the clinical practice of dental hygiene.

• Discuss the application of current technology and how it benefits the practice of dental hygiene.

• Develop the goals and vision of the department.

• Establish and monitor practice statistics as they relate to national averages.

• Assess the hygienist's role in the education of comprehensive dentistry. (team co-assessment)

• See the world of dentistry based on a commitment to a philosophy of excellence.

Among the things that need to be measured are the department's (and individual hygienist's):

• Gross production/net production
• Production per hour
• New patient appointment value
• Case presentation/case acceptance percentage
• Recare effectiveness percentage
• Scheduling effectiveness percentage
• Periodontal protocol success percentage
— Frequency of return
— Reactivation percentage
— Periodontal case acceptance
• Marketing retention percentage