Th 244933

Profitable Hygiene: Inside and Outside the Realm

April 1, 2007
Do you know what’s needed to have a really profitable hygiene department that allows you to deliver excellent care? The first thing is a modus operandi that is realistic in which to work.
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by Deborah Dopson-Hartley, RDH

Do you know what’s needed to have a really profitable hygiene department that allows you to deliver excellent care? The first thing is a modus operandi that is realistic in which to work. Next is a sound set of obtainable goals and help and support to obtain those goals.

I am living proof that a thriving hygiene department can have a major impact on the overall success of a dental practice. Not only are hygiene services important to the overall health of patients, they are essential for the practice. The hygiene department generates revenues, and creates referral opportunities, dental sales, patient retention, and practice growth.

Inside the realm...what we do every day
Figure 1: A day in the life of a hygienist with a full schedule
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I named my company The Business of Dental Hygiene because that is how the hygiene department should be viewed ... as a business within a business. That is not to say that patient care will suffer, or that the hygienist, by paying attention to the business side, will sacrifice quality in work. What I’m saying is that the entire dental profession - the patients and hygienists themselves - will suffer if we do not view ourselves as a business.

Inside the realm...what should we do?
Figure 2: The same day, but in MY life as a hygienist
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Time is money
Being both a service provider and profit producer makes the time hygienists spend with their patients very valuable. Being unable to provide to our fullest potential could be extraordinarily expensive to the business in ways we hadn’t thought of.

Outside the realm...what we could do
Figure 3: The same day in my life as a hygienist using my systems and protocols
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To get the most out of the time a hygienist spends with a patient, it is important to have a focused agenda, clearly defined goals, and a workable system. It is not about cramming more work into less time during an appointment, but about getting the best use of the hygienist’s time with the patient. Let’s examine specific strategies to create the foundation of a successful hygiene program.

Inside the realm: redefining hygiene

A realistic way to evaluate hygiene’s profitability is to look at the blend of procedures as well as the associated fees. Examples include all the traditional preventive services and appropriate periodontal procedures, radiographs, sealants, and health-care products as seen in Figure 1.

Also included in most hygienists’ days, but rarely shown as production for hygiene, is the preliminary exam with the use of an intraoral camera or digital photography, prediagnostic treatment plan, and discussion. Tracking these elusive numbers can be difficult. I found the best way to track these numbers is to make them part of my daily goals.

Know the daily goals

There are two goals hygiene is held accountable for - daily production and recare. The scheduled daily goal for production and the next hygiene visit should no longer be the only considerations in a hygiene day. Today’s progressive hygiene departments should have daily sales presentations and sales acceptance goals. What are these, and how do we track them?

Here’s an example. My daily hygiene production goal is $1,500 per day according to my office, but my personal goal is $1,800. I exceed that on most days because I am paid on a 33.3 percentage basis. My sales presentation goal (esthetics, implants, quadrant, or comprehensive dentistry presented from my hygiene chair) is $6,500 per day, and my sales acceptance goal (financials accepted, secured, and scheduled) is $5,000 per day, as seen in Figure 2.

Because there is no definitive way to account for accuracy of these numbers, I made up a way to both establish and track them. These goals are obtained by simply adding my hygiene daily production goals to my doctor’s daily production goals ($1,500 + $5,000 = $6,500).

Sales acceptance goals from the hygiene chair are more difficult to track because patients must consider and organize their priorities, which are their financial and time restraints. But sales presentations are not difficult to monitor if we chart audit prior to an appointment, ask patients leading questions and really listen to their answers, and then document what is discussed.

To track your sales presentation and the treatment plan that you discussed with your patient, simply write a brief description next to the patient’s name on the day sheet. For example, you discussed restoring the LR (lower right), which consists of No. 31 MOD (onlay, $1,100), No. 30 MOD (porcelain crown, $1,100) No. 29 MO (inlay, $1,100), and No. 28 DO (two-surface direct, $250), for an estimated total of $3,500.

You can make it less confusing for the patient by calling everything a restoration. You then say, “We will be restoring the lower right side on the next visit. Your old restorations have outlived their usefulness. I know we’ve been preparing you for this for a while now, and it’s time. Nothing lasts forever, but you did get a very long life out of your old dentistry. With the proper care, you should get the same life expectancy from your new dentistry. Now, if we could have a moment of your time, we’d like to help you with the fee for your treatment and the payment options we have available. Let’s see what’s most convenient for you.” Then you escort the patient into the private consultation room where the financial coordinator is waiting to complete the process.

Something else of great importance is the daily retention rate for both the doctor and hygienist. Did the patient schedule his or her next visit? I consider any patient not scheduled for an appointment inactive, so tracking these numbers is critical to the health of the business. Your goal should be to have all patients walk out with at least their two next appointments scheduled, either doctor and hygiene or two hygiene visits. Attainment of all goals is shown in Figure 3.

For the hygiene department to obtain the goals for each hygienist, our office needs a full-time hygiene treatment coordinator, two rooms dedicated to each hygienist, and a scheduler who is attentive to the hygiene schedule. Years ago, I helped both doctors in this office and the scheduler understand that if the hygiene schedule is not full today, the doctors’ schedule would not be full tomorrow.

Outside the realm ... what we could do

Other profit areas in the hygiene department should be taking impressions for whitening procedures and their associated products, bite-splints, sports guards, snore appliances, diagnostic study models, and diagnostic cosmetic wax-ups. Adding these procedures can increase production substantially, as seen in Figure 3.

Attainment of all goals

Taking alginate impressions has always been agonizing for me. First, what hygienist has the time to take impressions, especially if the patient needs impressions for two different procedures, such as take-home whitening trays and a diagnostic cosmetic wax-up?

There are so many things that can go wrong with alginate impressions. We wonder if we mixed the proper ratio of alginate to water and hope the water temperature is accurate before we set it. Then we have to pour the alginate immediately before the impression distorts, which causes dimensional changes. This was so unappealing to me that I haven’t taken an alginate impression since my graduation in 1976.

That is, until last year, when my dentist brought back from an advanced hands-on dental conference a new alginate alternative impression material called StatusBlue® from DMG and distributed by Zenith Dental. The assistants all raved about StatusBlue because it was so convenient, time efficient, and easy to use that even I, the RDH, could handle it.

StatusBlue is an innovative, A-silicone alginate substitute formula that captures great impression detail, sets quickly, and provides complete dimensional stability. It is a 100 percent dust-free impression material that is stable in any working environment, so we no longer get the annoying white powder everywhere.

Where alginate impressions can only be poured once, this alginate alternative can be poured again and again, and reused indefinitely for up to three months, all from the original impression. We can now use one impression - the same one for today’s diagnostic study models and tomorrow’s cosmetic wax-ups, bite splints, orthotics, snore appliances, sports guards, whitening trays, and temporaries. Its smooth surface allows exact models and minimizes trimming, such as while producing temporaries.

Because StatusBlue comes in automix cartridges for the MixStar system or convenient handheld guns, there is no more mixing mess or bowls and spatulas to clean up, and no more hand fatigue. In our office, the MixStar machine is located in a central area for the doctor to use, and the handheld guns and cartridges are stored in each room for those times when patients say yes.

Keeping the StatusBlue guns in the hygiene rooms has increased my worth and profits to the practice by allowing simplicity and the ease of taking impressions immediately, while storing them for pouring later.

For me, as a hygienist, the biggest obstacle that StatusBlue overcame was the working time ... it goes from mix to set to removal with little guesswork. We are given one minute, 15 seconds working time before it must be seated in the mouth. The manufacturer’s recommended time in the mouth is one minute, 45 seconds before removal. Impressions do not have to be kept wet; i.e., wrapped with a moist paper towel as alginate does, so distortion doesn’t occur. Unlike alginate, StatusBlue impressions can be cleaned with water or any standard disinfection solution with no swelling or distortion prior to sending them to the lab or storage. Upon completion, I have an accurate, no-hassle impression that can be kept for up to three months for all types of use.

The bottom line

One of the main objectives of monitoring and managing hygiene production and refocusing on the functions of the hygienist is to expand our business’s universe and make us more valuable. Remember ... when one thing changes, it leads to another. Few things will remain the same.

Disclaimer: Ms. Dopson-Hartley works for Zenith Dental as its hygiene professional manager.

Deboarah Dopson-Hartley, RDH, is widely known as one of the most profitable hygienists in the country, as well an international speaker and consultant. She has practiced full-time dental hygiene for more than 28 years. She has authored numerous articles for all of the leading dental publications. For more information, call (813) 541-6225 or visit her Web site at