Recently a good friend of mine decided upon a change in career.
It was a big decision.
Having previously carved out significant careers in hospitality and also in food technology and sports nutrition, my friend decided on the challenge of a new role in an area that she had previously not worked in.
She had applied for a job in “retail”.
And she was one of the successful applicants.
And so began the induction…
The thing that surprised me about the induction process that this organisation used for new employees was that acceptance to the role required some SIGNIFICANT pre-employment training.
Pre-employment training? That’s fairly normal, you would think?
Well, as I said, this role involved some SIGNIFICANT pre-employment training.
The pre-employment training involved a four-week educational process followed by a two-week on the job training “live” before applicants were then allocated a position within the retail organisation.
So I asked myself, what could be so difficult about training for retail?
After all, it’s not life or death.
Well that’s what I thought….
Really, how much harder could a retail induction be compared to an induction to work as a dental assistant or to work as a dental front office receptionist?
Well, let me tell you this:
The training manual that my friend received was a two-ring binder with three inches thickness of pages.
Within said binder were more than ten modules of education that my friend was required to learn and to master in order to complete her PRE-employment training.
As an example of the attention to detail of this organisation, here are just five of the many topics that my friend was required to learn and master in order to complete her pre-employment onboarding process:
Greet customers in a polite and friendly manner within designated response times and make them a priority over other workplace duties.
Show interest in customer’s needs and maintain a welcoming customer environment free of complacency.
Selling to the customer by establishing customer needs, providing advice on any product or service, and facilitating the sale.
Use questioning and active listening to facilitate effective two-way communication.
Take opportunities to up-sell and cross-sell products and services that enhance customer request and maximise profitability of sale.
I found the attention to detail within this strict onboarding process to be quite extraordinary.
For a retail position, where I thought the staff attitude would be simply “you’re in our store because you have a NEED”, my feeling is that we have certainly come a long way, in terms of the impressions given by this organisation.
My observation is this:
In dentistry, sadly, the onboarding process is often as hurried and as brief as:
“You’ve answered the phone, there’s the phone, go answer it….”
A heck of a lot of the time.
Can we do better when hiring?
We need to live by the edict:
“Hire slow and fire fast.”
If we do not, other industries are going to pass us by….
Two weeks ago I discussed the important role that a dental hygienist plays in the creation of an EXPERIENCE for their patient so that the hygiene visit for the regular loyal dental patient is not simply “just another cleaning” or “it’s only a clean”.
This regularly scheduled visit truly can be an ULTIMATE PATIENT EXPERIENCE each and every time.
In that article we discussed the important role that the dental hygienist plays at the beginning of every patient’s hygiene appointment. We looked at the important role of Emily the hygienist in creating a perfect platform at the start of Mrs Smith’s hygiene appointment, truly “setting the stage” for the remainder of the visit to be a World Class Experience.
Then last week I discussed the level of trust established between the hygienist and the patient already during the first forty minutes of the hygiene appointment, and how with that, the time taken by the dentist to do the examination and explain treatment inside the hygiene room was significantly less than when the hygienist took no part in any uncovering and discovery of areas of concern prior to the arrival of the dentist.
The other major thing we found by doing hygiene exams this way was that the amount of diagnosed restorative treatment coming from the hygiene rooms that was explained and proposed, and subsequently scheduled and completed, was significantly more in each of those four categories, than when the dentist played the role of SOLO DIAGNOSTICIAN arriving when and where he felt like it.
How Does The Hygienist Notify The Dentist?
The hygienist must go and notify the dentist IN PERSON that she is ready for him to come and do the examination on her hygiene patient.
“Can’t she just BUZZ him?”
The replacement of *maximum* human interaction by any form of automation or diminished human participation seriously detracts from the derived benefit the office gains in creating an inviting environment of caring coworkers behaving warmly and lovingly towards each other and towards their patients and towards their duties and roles within the office.
The entry of the hygienist to the dentist’s treatment room, when done correctly, acts as an advertisement for the hygiene department, and also acts as an advertisement for the wonderful personality of the hygienist.
It allows the dentist to excuse himself from the treated patient and “introduce” the hygienist’s service, as he leaves the treatment room for a few minutes….
And if the dentist’s patient is known to the hygienist it also allows opportunity for the hygienist to “acknowledge” the doctor’s patient…
In all cases the personable arrival of the hygienist is a positive interruption for the practice…with a positive result.
This is because it also allows us to expose and show off our air of kindness atmosphere and culture, in the way that we herald and announce this minor interruption to the doctor.
And yes, I’ve seen in some dental offices where the dental software is used to alert the doctor that the hygienist is ready.
I like the idea of this process being discrete, but I also like the idea of announcing that the doctor is needed in the hygiene room being used as a “positive” for the dental office image.
Similarly, using the software and then having the dentist’s dental assistant announce to the doctor that he is needed to do a “hygiene check” is of little value to the practice and will be seen by the patient being treated in the dentist’s chair as an unnecessary and unwanted interruption and delay in the valuable appointment time that that patient is paying for.
Likewise, having someone else in the office enter the doctor’s treatment room and say something along the lines that the dentist is “needed to do a hygiene check” is also inappropriate and somewhat less than professional, in my view.
As I’ve said previously, at my dental office we decided that the best time for the dentist to be summoned to the hygiene room was at the 40-minute mark of the one-hour hygiene appointment.
This time worked best for both the hygienist as well as for the dentist, and became the “foundation” or the “spine” of the dental appointment book schedule.
The Dentist’s appointment book was then structured accordingly so that he was able to leave a treated patient, if needed, at this time.
This meant that a little thought then had to go in to the Dentist’s appointment book template, so that the dentist was always able to be available for each hygiene examination. For example, it meant that the doc was never to be doing endo, or anything under rubber dam, during the second half of every hour.
So here’s what happens:
Firstly, the hygienist notifies her patient that it is now time for the dentist to come and review her findings and “do the examination”, and she will go and get him.
She excuses herself from her hygiene patient, and adds:
“I’ll be back in a moment.”
She leaves her hygiene room and then enters the dentist’s treatment room.
She knows where to stand, so that her presence is known, and then she starts speaking.
She stands just to the right side of the dentist.
She has paperwork, including paper notes, that she can show the dentist if need be, without him having to turn or crane.
Her script, when she speaks, is polite and friendly, but more importantly it is purposeful.
She has a specific message to inform the doctor, as well as a subliminal message for the patient being treated.
“Excuse me Dr Moffet”.
“Good morning/ good afternoon/ hello, Emily”
followed by a pause.
Emily then says,
“I have Mrs. Joan Smith in today [pause].”
“She’s a new patient to the practice”
“She’s in for her regular six-month/three-month hygiene visit”.
By saying this, the hygienist subliminally informs the dentist’s patient being treated that the practice welcomes new patients, or that the practice encourages regular hygiene visits.
[I was never too concerned with identifying patients as it gave patients a name, and identity, rather than not. The advantages of using a person’s name far outweighed the risk of any privacy breaches… just saying.]
Emily then says, depending, whether Mrs. Smith has anything to be really investigated or not….she will usually say,
“and her teeth and gums are looking very good”,
“there a few areas I need you to look at…”
Emily may even *advertise* some of our services….
“She’s interested in Invisalign/ some porcelain veneers…”
“There are a couple of teeth with large old restorations that I think may require replacement….”
Here Emily may be planting some seeds or confirming some treatment options that the patient with the dentist may also be having, or may be considering.
The dentist then usually replies indicating when and whether he will be down to the hygiene room, and when he does go, there is always a pleasant and friendly apology to the patient being treated.
If he is not able to excuse himself immediately, there is opportunity for the dentist to inform the patient being treated anything from:
“that’s Emily our hygienist, you’ll be seeing her soon, she is so gentle…”
“Oh Mrs. Brown, she has been coming here every six months for must be about twenty years now….”
I can’t emphasise enough that over all of this is laid an atmosphere of pleasantry, respect for all, and clear and concise communication, so that the interruption to the dentist’s patient being treated is felt as minimally as possible.
And of course, if the dentist’s patient is a regular patient of the dental practice, she will be understanding of this minor interruption because she knows, that this is what happens when she is having a hygiene visit.
Next week we’ll talk about the nuts and bolts and interactions during the “actual” examination process.
One of the things that is brushed over regularly and routinely in dental offices is the metrics.
And accountability for those metrics.
Metrics can be defined as “parameters or measures of quantitative assessment used for measurement, comparison, or to track performance and production”.
Metrics are your vital statistics.
Metrics are your numbers.
And yet so many dental offices have no idea what their numbers, or their metrics are.
They don’t know how many new patients they have accepted this week.
Or this month, so far.
Or this quarter.
Or last quarter.
And they certainly do not access to the numbers to compare the New patients seen this year to the number of new patients seen last year.
So they just PLUCK a number out of thin air.
And we know that number has been plucked because the number they give you is a number ending in zero [in this instance].
The number they provide has totally been made up.
It’s usually a contrived combination of BS, hope, and deception.
[BS stands for Brave Stab, correct?]
It’s the number they throw back at you for being so bold as to even ask what the number is….
But the defining zero on the end gives the false number away.
It’s the same when I ask the dentist for the average new patient value.
Those who PLUCK reply with a number that ends in either triple zero or in five hundred.
Again, an estimated HOPE at best.
[they HOPE I won’t ask any more penetrating metric questions].
It gets better.
When I ask dentists about their annual or monthly productions, this is the less than EDUCATED answer that I receive:
A number ending in four zeros [monthly productions], or
A number ending in five zeros [annual productions].
And again, they HOPE that I’m so impressed with the size of the number that I magically disregard the size of the perpetrated PLUCK.
Is there any hope?
There is no hope for these poor souls.
They need total redemption.
Because while ever they BS to me about their magically PLUCKed large rounded numbers, if they are not being internally accountable to themselves and being anally analytic about these vital metrics, then how on Earth can they stand before their employees and ask for accuracy regarding vital metrics that the employees need to be measuring?
And so it all falls into a screaming heap….
“The fish stinks from the head down”
If you don’t reflect an attention to detail, as the leader, what you will find is that even if you employ a details person, they are soon going to become very very frustrated collecting accurate data for you that you don’t analyse and act upon.
And so the tradition will continue….
What gets measured gets improved upon.
“What gets measured gets improved upon”.
You cannot improve upon that which you do not measure.
How can you lose weight if you never ever jump on the scales?
How can you run faster if you don’t ever use a stopwatch?
How can you ever improve on your dental practice metrics if you do not record the important data accurately?
Going through your life guessing and hoping is not the answer.
Going through your life guessing and hoping is a recipe for disaster.
This is how you end up getting to age 65 and not being able to afford to retire, because you haven’t earned enough and saved enough to be able to afford to retire.
Dr Omer Reed told me that 95% of dentists reach age sixty-five and have to keep on working.
I’ll bet those 95% never bothered to keep score along the way…
So David what’s not being measured?
I see dental offices that don’t know how many new patients they see on a monthly basis.
And they don’t record whether each of those new patients has been referred or whether they’ve come as a result of specific marketing campaigns and media.
They don’t have any idea how many of their new patients for the month are seeking treatment because something is broken or painful, or whether they are seeking an examination, that may or may not be overdue.
I see dental practices that don’t know how many crowns they seat on an annual basis.
They don’t know how many hygiene visits are being performed on a quarterly basis, and they don’t know how many hygiene patients are on quarterly visits or on six-monthly visits.
I see dentists who don’t know how many hygiene patients return regularly on a three month or six-month basis, or whether those hygiene patients are “stretching things” out a little…
These dentists have no idea how many patients are scheduling appointments when they phone their offices, and what that percentage is.
They do not know what percentage of new patient first appointments scheduled are kept, and they have no idea how many of those new patients that do come for their first appointment return for a second appointment or ALL subsequent appointments.
And when you ask these dentists about their practices, they simply say:
“I just need more new patients”.
The trouble is, if you’re not measuring and monitoring numbers that easily affect your retention of patients, then adding more new patients into a faulty system is definitely not the answer….
Not measuring, and then HOPING, is not the answer.
Last week I discussed the important role that a dental hygienist plays in the creation of an EXPERIENCE for their patient so that the hygiene visit for the regular loyal dental patient is not simply “just another cleaning” or “it’s only a clean”.
This regularly scheduled visit truly can be an ULTIMATE PATIENT EXPERIENCE each and every time.
Last week I talked about the important role that the dental hygienist plays at the beginning of every patient’s hygiene appointment.
Last week we looked at the important role of Emily the hygienist in creating a perfect platform at the start of Mrs Smith’s hygiene appointment, truly “setting the stage” for the remainder of the visit to be a World Class Experience.
Today I’m going to look at the dental examination process in Dr Brown’s office and the crucial role that Emily the hygienist has in that examination.
Firstly, it is imperative in creating an experience for the hygiene patient that the dentist performs the dental examination AFTER all of the hygiene has been completed.
And I mean ALL.
And I mean AFTER.
I know dentists who like to do hygiene examinations when it suits the dentist, irrespective of whether the hygiene patient has a clean mouth, a dirty mouth a half-cleaned mouth, a bloody mouth…. or whatever….
Just imagine, the regular patient has an examination this time [this visit] before the clean. Next visit, the examination is done after the clean. And the following visit, the dentist does the examination in the middle of the cleaning process.
Do you think that might create a little confusion in the eyes of the regular hygiene patient?
Do you think that the regular hygiene patient may feel a little less valued if their examination is done when “it suits” the dentist, rather than at a clearly ordained and “logical” time?
And how does it look to the patient when the dentist walks in and says to the hygienist:
“I have a moment now. [Get out of my way and] let me do that examination now….”
Does this scenario build any respect for the role of the hygienist?
I’ve been to dental practices where the dentist doesn’t have time to do the examination and the hygienist leaves the patient sitting alone like “a shag on a rock”, waiting alone for the dentist, and goes off into another treatment room to start treating their next hygiene patient.
When the dentist visits the hygiene room at a specific regular time to do the examination following the completion of all hygiene, the patient has been able to build a very strong bond with the hygienist.
A very strong bond.
A strong bond of trust.
And it is this bond of trust that the dentist and the hygienist can then build upon to perform the thorough dental examination and to present a complete and detailed treatment plan of all necessary treatment.
You see, when the dentist arrives into the hygiene room at this pre-determined designated moment, and the hygienist has all of the photographic records and all of the radiographic records that were taken now up and instantly available for viewing on the monitors within that treatment room, this allows the dentist to perform an examination that is primarily framed as a “review” of findings.
As opposed to the dental examination that is conducted at “any old time”.
The “any old time” examination, or the “get out of my way, I’m here now” examination, can only be conducted as a “full discovery” examination.
Although a “full discovery” examination will take longer to perform than a “review of findings” examination, we know it will uncover ALL pathology.
We know nothing is ever missed by a dentist doing a “full discovery” examination.
Whereas a dentist who relies on the eyes of the hygienist and does a “review” of findings examination, because of its brevity, may miss discovering some critical dental pathology?
[For an interesting perspective on this examination “timing” ask a hygienist whether they have ever seen obvious pathology during one of their cleanings that the dentist doing the full discovery examination has failed to see and failed to notify the patient about…. And subsequently the necessary treatment has not been presented to the patient and therefore the pathology remains?]
My belief was that four eyed examinations were always better than two eyed dental examinations.
I believed that a dental hygienist who thoroughly cleaned all teeth and all surfaces of her hygiene patient had the knowledge and the “authority” to make note of all restorations present in the patient’s mouth.
I believed that a good dental hygienist could identify areas of concern ahead of time for the dentist, and have these listed as areas for the dentist to take a look at when the dentist arrived for the examination. These areas of concern could include any failing margins on restorations, any loose fillings, any caries, and any significant fracture lines, amongst others.
Here is what I used to have my hygienist do.…I used to have her start at the 18 tooth [tooth number 1 for my American friends] and let me know exactly what she had seen, if anything, on each and every tooth as I conducted the examination.
Together then, the hygienist and I would examine the patient’s mouth, and in conjunction, review each tooth and each surface AND all of the hygienist’s findings and concerns.
The important perspective that occurred because of this process, conducted in this well thought out way, was that it allowed the dentist to become the respected second opinion on any areas of concern that the hygienist had already discovered and explained to the patient.
Because of the level of trust established between the hygienist and the patient already during the previous forty minutes of this well-structured hygiene appointment, what we found was that the time taken by the dentist to do this examination and explain treatment inside the hygiene room was significantly less than when the hygienist took no part in any uncovering and discovery of areas of concern prior to the arrival of the dentist.
The second thing we found was that the amount of diagnosed restorative treatment coming from the hygiene rooms that was explained and proposed, and subsequently scheduled and completed, was significantly more in each of those four categories, than when the dentist played the role of SOLO DIAGNOSTICIAN arriving when and where he felt like it.
And so, if patients are having more detailed examinations that result in more pathology being identified, is that better for the patient?
If patients are leaving the hygiene room with a greater understanding of the treatment they need to have done, and are scheduling those appointments and are KEEPING those appointments, is that better for the patient?
In the next article in this series, I will discuss the dental examination process in more detail and explain how that detailed examination involving the hygienist at the completion of all the patient’s hygiene resulted in more thorough examinations and treatment plans for the patient.
There are four stages of competence, or as you will, there are four phases for going from not knowing to knowing well. Here they are:
1. Unconsciously Incompetent.
The person does not understand or know how to do something and does not recognise the deficit. They may deny the usefulness of the skill. This person must recognise their own incompetence, and the value of the new skill, before moving on to the next stage.
2. Consciously Incompetent.
Though they do not understand or know how to do something, the person recognises their deficiency, as well as the value of the new skill in addressing this deficiency.
3. Consciously Competent.
The person understands or knows how to do something. However, demonstrating that skill or knowledge requires significant effort and concentration. There is usually a significant conscious involvement in executing this new skill.
4. Unconsciously Competent.
Now the person has had so much practice with the new skill that it has become second nature and can be performed quite easily and routinely.
What does this all mean?
Being in a state of unconscious incompetence is a rather dangerous place to be….
You are totally ignorant or caring of the fact that a better way may even exist, and be of use.
You are happy in your own little world.
It is not a denial of a better way. It is simply a reluctance to even consider that a better way exists.
It truly is sad, because you truly do not know what you do not know.
How can this change?
Enlightenment must occur.
Sometimes it just needs to be an “Ah-ha moment”.
Sometimes it can also be a B.F.O.. A blinding flash of the obvious.
Have you ever had one?
Are you up for it?
I’ve always been one to look outside of the box, to look outside of my industry and to see what other industries are doing and to see whether those skills and tools can be applied to my business to create improvements and increased efficiencies.
Sometimes the adaptations can be quite subtle.
Other times the ideas and changes can be totally outside of left field.
For the mind to grow you must feed it.
And feed it well.
Our minds can become sedentary if they are not stimulated.
We need to be fertilizing our minds with significant “brain food”.
What are you doing?
What sort of external stimuli are you feeding your brain.
This week I attended and also spoke at a dental conference where the topic was business.
The problem was, because the topic was business, and not clinical, the number of attendees was low.
Which was sad, because the information shared there was truly out of left field, and when applied to the average dental practice, would result in a significant increase in revenue.
Far more than any new way of doing something clinically.
I guess the great advantage for the attendees was that they were receiving that GIFT.
While those who missed this meeting were still plodding along in their rut, I guess.
Sadly, they don’t even know it.
One of the attendees who had been “dragged along by her forward-thinking business partner, said to me that this was her first ever “dental business” conference.
But sadly, she was implying that she was attending begrudgingly.
When I asked her politely why this was the situation, and whether she perceived it as an area of personal concern, her reply to me indicated that her attendance on this day was begrudgingly.
And I felt that this dentist couldn’t wait to get out of the meeting and crawl back into the comfort of her rut.