Be a part of the solution

Dec. 1, 2000
Hygienists have a vested interest in changes a consultant may make in practice protocols. Let your voice be heard!

Hygienists have a vested interest in changes a consultant may make in practice protocols. Let your voice be heard!

Cat Zermatt Schmidt, RDH

We`ve all heard the horror stories - or lived them ourselves - about the consultant who enters an office, picks through the daily schedules like a miner searching for gold, then alters tried and true routines ... and leaves. In three short weeks, the practice reverts back to its former ways, a little less trusting and with a lot more office discord.

The return of office protocols to their previous state seems to be a common theme regarding consultations that hygienists felt were negative and counter-productive. According to one hygienist who endured such a consult, "We were a little skeptical because it was our second consulting firm in as many years. We saw it as one of those things that the doctor will soon get over, and then everything will go back to normal." In a case like this, for office procedures to return to normal usually means returning to a situation of strife and stress that the consultant was hired to alleviate.

Dentists contact consulting firms because something in the office is amiss. Usually, but not always, the dentist will perceive the problem as related to the books or final numbers. However, the hygienist and other staff members in the office might see the breakdown of relationships and lack of communication to be the primary areas of difficulty. When a consultant fails to address the concerns of all parties - not just the dentist-client - then it`s impossible to set in place the new systems and structures to make the office work more efficiently and effortlessly.

Just as there are good and bad dentists and good and bad dental offices, there are good and bad consultants. "Anyone can call themselves a consultant, so the range of quality is rather considerable," cautions dental consultant Daniel Bobrow, founder of the American Dental Company and Dentists Climb For A Cause. He recommends performing intense research into the background and performance of various consulting firms before hiring one. It`s vital that the philosophy of the practice gels with that of the consultant. A firm specializing in general health-care practices may not be aware of the specific nature of dentistry and the idiosyncrasies that come with the profession, potentially leaving an office in worse shape.

It`s important for hygienists to involve themselves in the process of hiring a consulting firm, or at least try to steer their employers in the right direction. First, you`ll want to shop around. Not all consultants offer equal services of equal value. Hiring a consulting firm is expensive, yet the results can be extremely rewarding. You and your dentist must put ample time into the selection process. Review the various programs and services offered by at least five or six different firms, and make sure they all offer a complimentary or low-cost assessment.

When you`ve narrowed down the choices, call the available list of references and talk to the people personally. Ask probing, open-ended questions of the consulting firm and former clients. Finally, don`t hire any consultant who doesn`t listen to you. If the consultants don`t listen to you during the interviewing process (i.e., before you hire them), then they certainly won`t listen to you during the consult! In fact, that`s an excellent thought to keep in mind for all circumstances - tigers don`t change their stripes! If the consultants are evasive in their answers at the onset, then you can expect them to continue that trend throughout the consult.

A good question to ask when interviewing consultants is: Why did you choose to become a consultant? Consultant Linda Krol picked periodontal-focused management because that`s been her life. "I spent 35 years in the trenches," she says, "and I was fortunate enough to work for almost 30 years with the finest dentist I`ve ever met." Krol and the dentist she worked with enjoyed a wonderful professional relationship. When she left the practice for a dental sales position, she found out that not every hygienist was as lucky. She felt every hygienist and dentist should have a great relationship, and resolved to do something about it. "That`s why I got into coaching ... because I wanted to help as many offices and as many dentists and hygienists be the best colleagues they can be. It`s my passion."

Sis boom bah!

The preconceived notion is that greedy dentists hire cheerleading consultants - rah! rah!- to earn more profit at the expense of hygiene protocol and proper patient care. This can lead those in the office to war over upstanding health-care delivery with enough time for patient interaction vs. profitability and a solvent practice. But, does it have to be that way?

The general consensus is no, it doesn`t. The best consultants in the market understand the importance of excellent patient relations maintained through the hygiene department. Often, this results in longer prophy appointment times, not shorter. Surprised? Probably not, if you work in a forward-thinking office. For those of us who don`t, the new methodology of running a hygiene department is shocking, to say the least. This new philosophy promotes long-term, solid relationships between the office and patient. It also builds better communication and rapport among the team members of a dental practice.

With more time per patient, we can concentrate on relationship-bonding, while generating periodontal and operative business at the same time. We also can boost peripheral business, such as whitening programs and cosmetic dentistry. Generating more revenue for the practice helps us in our quest for better bonus plans and salary increases. It`s not evil for us to want a bigger piece of the pie ... or the same piece of a bigger pie! Money is not evil; money puts food on the table and a roof over our head.

"The best practices have figured out that profitability and genuine care for the patient are not mutually exclusive," remarks Bobrow. He notes that dentists need to provide adequate resources for the hygienist to do a superior job of maintaining a diagnosis-driven practice. In addition to updated technology - such as intraoral cameras and computerized charting and radiographs - time is one of the most important resources hygienists have.

Changing erroneous thinking

The erroneous thinking of most dentists - who`ve had little, if any, business training - is that to increase hygiene production, you need to decrease recall appointment times, thus sneaking in extra prophy premiums per day. This may work in the short term, but not in the long run. The philosophy in the dental-consulting field now is for offices to create and maintain long-term relationships with patients. Consultants encourage practices to spend more time with each patient - educating them, involving them in decisions regarding their own dental treatment, and then constructing treatment plans that span three to five years. The emphasis is on life-long dental care, which only can be attained with patients who possess a high dental IQ. Guess which team member brings the patient up to speed?

Hygienists are the teachers and promoters of patient dental health; we know this. Besides our clinical and technical skills, we possess the ability to instruct and educate our patients about periodontal disease, oral disorders, dental decay, nutrition, and other related areas. As hygienists, we talk with patients, educate them, form relationships with them, as well as actually perform clinical work, all without playing party to a prophy mill. Our worth as practitioners is not measured by how quickly we scale or by how many prophys we perform in one day. We know - and first-rate dental consultants know - our worth is governed by how effectively and thoroughly we`ve counseled and treated an individual patient. If this thinking doesn`t sound like your office, it might be worth your while to sit down with your employer and discuss the possibility of hiring a consultant. Remember the caveat: ensure that you`re part of the process.

As much as some of us don`t want to hear it, most dental consultants still promote the team aspect of dental delivery ... and they make a good argument for it. When hygienists feel isolated - or others in the practice isolate them - it fragments dental delivery. Patients cannot be fully integrated into the office, nor can they be fully integrated with their treatment plans when hygiene takes place inside a bubble. Good communication among hygienists, dentists, assistants, front office, and business/insurance personnel is vital for effective healthcare treatment to take place. Otherwise, the patient loses out and does not receive the level of care we all desire to give.

Part of the problem with the isolation of hygiene is the attitude of others in the office. Perhaps the dentist does not treat the hygienist like a professional colleague. Maybe the assistant thinks of the hygienist as an interruption to important and profitable operative work. Likewise, the dentist may feel that way, too.

Some may see the hygiene department as a detached unit, an entity not related to the rest of the office. A professional attitude and respect for one another is the key ingredient in promoting good relationships within a practice. Lack of that can be the weakest link in any office, certainly when there is animosity between the hygienist and dentist. Jealousy, backstabbing, and general malice among office personnel spell disaster. This is where top-notch consultants do their best work, but it takes the unified cooperation of the dentist, the consultant, and all office personnel to make a consultation work.

As one hygienist pointed out, "Frequently, practices approach consultants as a quick fix, cookbook-type approach, rather than as a long-term process, meaning three to five years. So, many dentists and hygienists are against consultants when, in fact, they were the reason that change did not occur." This hygienist went on to point out that the level of participation of the office staff - including hygienists - appears to be a defining factor in determining a consultant`s success.

Enter the consultant

Let`s say your employer calls in a consultant. What do you do? First, answer these questions:

1) Are you committed to the practice?

2) Are you committed to staying there and making money?

If you are, then dig in and commit yourself to the consultation process. If you`re not, then maybe this is a good indication that you`re not where you should be. Perhaps this job isn`t working for you and you need a different venue to practice effectively. Think through your nagging concerns carefully and determine your level of commitment to the practice and the people with whom you work.

A good consulting firm can retool a broken office by utilizing hygiene as the place to set the tone for the relationship between the patient and the practice. Consultants can teach dentists the real value of leaving an operative procedure to perform a hygiene exam. They can instruct assistants and other support staff on the value of a well-run hygiene department, and point out that hygienists do much more than polish and earn big bucks. Consultants can promote better understanding and empathy among all workers, easing tension and envy.

"Coaches are focusing a lot on people skills," says Marsha Freeman, dental consultant and author of Standard Operating Procedures for Dentists. "I have found in my work that hygienists frequently feel isolated because other people on the team isolate and don`t welcome them. So, I focus on bringing hygienists back into the team." Freeman maintains that hygienists should be inclusive members of the team: "We need to remind those in the office that more than 50 percent of the restorative work comes from hygiene."

Freeman notes that improving the professional relationship among team members truly enhances the respect and self-esteem of all parties. She believes that there is no reason why anyone can`t get along at a professional level. She finds that, many times, when staff members don`t get along on a professional level, it`s because they question each other and fail to understand that they`re all an integral part of a team. When she broaches the subject of job descriptions and task inventories, suddenly everyone becomes systematically clear regarding the rules and parameters of each position and department.

This can be specifically helpful to the professional relationship between the hygienist and dentist. When the policies are in place and the job descriptions detailed, it removes presumptions from work-related interactions. Once the hygienist and dentist agree on system implementation, it takes all the guesswork out of functioning together. Certainly, they can deviate from the protocol at any time. However, adhering to the systems makes patients feel important says Freeman, noting that patients benefit from a well-run office.

"If the hygienist and the dentist have collaborated on systems, then the number one most important person in the practice gets the best attention ... and that person is the patient," states Freeman.

A recent survey showed that 79 percent of people leave the dental office for one reason only: they did not feel important. According to Linda Krol, if there isn`t office team togetherness and a mission to take patients to a better level of health - and keep them there - then what remains? A lot of frustration, she says emphatically. A patient who is happy and who enters the practice notices the teamwork. Even if patients don`t see it, they feel it and sense it. When practices don`t function well, they let their patients down. Patients don`t return and maintained dental health is lost.

Offices must promote teamwork, says Krol, because if teamwork is absent, the dollars will never come. "The money comes when you have the belief in the systems and structure, and the relationship between colleagues securely in place."

When a practice makes money, the hygienist makes money. If hygienists feel as if they`re not being compensated for their work, then they`ll move on to another practice, and this creates the problem of high turnover and no continuity of care. The trust and bond between patient and hygienist is broken, and the practice suffers for it.

Dentists who want their practices to thrive will compensate their staff, especially their producers, the hygienists. Most consultants recommend realistic bonus programs and profit-sharing as part of the remuneration process for hygienists. As producers, hygienists are entitled to more of the pot, but they have to contribute to it. A good consultant will put in place a system that benefits the dentist with a well-run practice and excellent profits, the hygienist with a great work atmosphere and superb benefits, and the patient with increased dental knowledge and a plan for life-long dental care.

Author`s Note: The following is contact information for those interviewed for this article: Linda Krol, (888) 590-4413, [email protected]; Marsha Freeman, Dental Communication Unlimited, (800) 253-2544, [email protected],; Daniel Bobrow, American Dental Company, (800) 723-6523, [email protected]; www.

Cat Zermatt Schmidt, RDH, is a free-lance writer living in San Jose, Calif. With her sister, she sells dental-training videos to resident-care facilities. E-mail her at Sis [email protected].

Protect yourself!

So, you`ve found yourself in the middle of a consultation? Don`t panic! Follow these guidelines to protect yourself and your position.

1) Speak up and let your voice be heard. Only you can present your unique view.

2) If it doesn`t feel right, question the consultant`s judgment and understanding of your situation. Top-notch consultants welcome the opportunity to quell your concerns.

3) Schedule appointments to talk with your employer before and after the consultation to share your thoughts. Ask important questions about how your paycheck will be affected, who has the final say in protocol matters, and if there could be repercussions from speaking openly and honestly to the consultant.

4) View the consult as an opportunity to voice your concerns and correct problems in the office that make your job stressful.

5) Be a willing player. Unless you want to give up on your office and employer by quitting, stay and be open to the process.

6) Try it before you diss it! No one likes change - it`s difficult and scary. But, try it first to see if it works, before you disparage the new system.

Finding the right consultant

If office discord has left you at the end of your rope, take the initiative and ask your employer to hire a consulting firm. If you get the green light, follow these guidelines in your search:

1. Shop around. Don`t select the first firm you locate.

2. Make sure the consultant listens to you and answers your questions/concerns.

3. Determine the various types of services offered.

4. Obtain a list of references and, more importantly, call them directly.

5. Compare rates among a handful of consultants.

6. Find a firm that offers a complementary or low fee assessment.

7. Ask if the firm has a specialty - i.e., periodontal programs, dental-office marketing, etc.

8. Ask what results you, the dentist, and the rest of the office staff can expect.

9. Realize that the problem you -or your employer - believes is causing frustration may not be the problem at all. An objective eye can offer a clearer picture.

10. Check the Web. Use search engines to find consultant Web sites or go to: