The art of helping our patients develop ownership of their present condition and their desires for their dental health is built on the foundation of listening. But much of the time, we do all the talking and provide all the information.

Several years ago, my friend and I were coaching a young hygienist when her patient asked how she could get her teenage son to spend more effort caring for his teeth. I was ready to dazzle them with all the tips I had learned over my 20+ years in Hygiene but my friend Linda cautioned us to “stay in the question.” She was curious to know what the mother in the chair was really asking. That was the first time I became aware of the concept of staying in the question.

The model I learned in my clinical training—the model of teach and tell, really isn’t enough to help patients make choices about their dental care. And over the years, I learned that when I assumed I knew what a patient meant by a question and gave information I thought they wanted… I was wrong. My assumptions got in the way of my ability to really help my patients.

Are our patients asking for help or for information?

When I learned to combine the ability to stay in the question with my knowledge about dental health and dental care, all my conversations became a bit easier. I have come to realize that that mother with a teenage son, like so many of our patients, was asking for HELP but not information.

Today I can think of several questions I might have asked that mom before I jumped in to giving her information. I might have asked, “Well, what have you tried so far?” Or I might have asked, “What motivates your son in other areas of his life?” I might have asked, “What is he doing to care for his teeth?” I might have asked all those questions but asking even one of those questions, might have enabled me to better help.

Sometimes asking just one question before offering information is enough to open the door to real learning.

Staying in the question is both a skill and an attitude.

We need to skillfully ask authentic questions that are not designed to manipulate people into doing what we want them to do. If the questions help us understand our patients better, they are authentic questions. If the questions help them talk through and move through any barriers they perceive, they are authentic questions. If the questions open their minds to possibilities, they are authentic questions.

But staying in the question is not just about asking questions. It’s about an attitude of curiosity, of coming to the conversation with a desire to know more. It’s about releasing the attitude that we know everything we need to know to help the patient move forward.

Staying the question requires a genuine belief that our patients have information that we need to help them better.

How about a fun pre-pandemic memory? I was on a vacation cruise and had sought out a lounge to do my yoga privately early in the mornings. One morning, I arrived to find easels displaying paintings along the walls of the lounge and a team of people from the Art Gallery. One woman held up a camera and said, “Okay, go!” Then, four others ran along the sides of the room, picking up the paintings and rushing them up to the front of the room. Then they ran back, folded the easels, and moved them as well. The woman with the camera said, “You did it,” and everyone cheered and clapped.

Later that day, I ran into the woman who had held the camera. I had to ask… you know I did, “What were you doing in the lounge this morning?” She told me that every few months they do a quality control exercise to demonstrate they can breakdown the gallery in less than five minutes, because sometimes they only have five minutes to clear the lounge between events.

I had to ask… You know I did. “So, how well did you do?” She told me they were excited to do it this time in just over a minute. She was beaming from ear to ear.

So, that got me thinking…. You know it did. Turning a task into something fun can be energizing. In dentistry, we have to breakdown operatories and setup operatories all the time. What if, while following infection control guidelines and all things OSHA, there was still an element of fun in periodically demonstrating we can do this task at high speed? What record can we beat?

While I was on this same cruise in the Caribbean, it was flu season. There were bottles of hand sanitizer everywhere, and going into the dining room, there were four stations where you could stick your hand under an automatic dispenser. The cruise line did not want to leave it up to the honor system for passengers to clean their hands, so they had come up with a fun way to make us do it. Two men with Caribbean accents and funny attire greeted everyone coming into the room. They had Bluetooth speakers and danced as they said to everyone, “Washy, washy, yay, thank you.” So, every time I went into the dining room, I had a little dance with these gentlemen and sanitized my hands. For the entire cruise, everyone sanitized their hands upon entering the dining room!

During the final night’s dinner celebration… you know the one, where they bring in the blazing dessert and dance in a Conga line to “Hot, Hot, Hot,” the “Washy, washy” guys got on the microphone and thanked us for sanitizing our hands–and allowing them to help keep us healthy. Of course, we all cheered. We loved these guys!

So, that got me thinking… you know it did! They had found a fun and engaging way to improve our health and make us feel good about following the rules. I hope you noted that in my two cruise ship stories, having fun with systems increased the group’s performance. Research consistently demonstrates that when team members are enjoying themselves, work is performed at a higher caliber and with less stress. When patients are enjoying themselves, their participation in their own health is greatly improved.

I know dental care teams well, and they love a creative challenge. Where do you have systems that are trending boring that your care team might add a little fun and spice to? Have some great examples to share? Add them in the blog comments.

Being efficient with your time increases profitability. 

Life is busy and everyone is trying to find a better balance between work and time off. If you could produce the same amount of dentistry in three days as you did in four, how would your team react?

Efficiency is a mindset and can become part of your practice culture. Producing more in less time does not mean running around like chickens or being hasty with patients. We can learn the art of using time better for our patients. Focusing on the conversation rather then multi-tasking is one example. Being prepared is the Boy Scout motto and fits perfectly here. Most patients would prefer fewer visits to your office.

Being prepared for any possibility allows your team to feel confident.

Having enough tray set-ups for any opportunity that presents itself is a start towards efficiency. Having a team completely cross-trained allows the team members to shine by being prepared and results in greater efficiency.

More time is created when the practice culture is to offer a complete exam on patients. When there is a comprehensive plan, this moves a practice beyond patching and emergency care. There is a reason why patients come to you, and most want to know you have a plan for them. Along with this, at the end of every appointment, team members need to ask the doctor, “Is there anything else we can do at the next appointment?” It is a signal to the doctor to maximize every appointment. 

Combining treatments can be a measure of efficiency.

Always combine crown prep and endo, or any other treatment. If there are fillings and a crown, do the fillings first as you will complete the crown prep in the allotted time. This works well with CAD/CAM as there is downtime available during milling and baking time.

In Hygiene, collect the fee at the time of service. “Yikes,” say the hygienists, “We’ve never done that before.” Patients love it, and once the hygienists do it, they like the connection, too. This eliminates the line at the front desk and allows more concentration on phone conversations.

Follow Nordstrom and Apple examples. Clinically, encourage hygienists to do full mouth debridement at one appointment.  It saves the patient time, and the result is a healthier mouth.

Become completely paperless.

Operating two systems is a waste of time.  New patient forms are on your websites, and all patient records are digital. To be paperless, just start one day at a time, and don’t waste time putting people in digital who have not been in yet.

Efficiency starts over the phone by asking questions to eliminate the 30-minute “look-see” emergency appointment. With the patient records on your computer, ask, “Is this broken tooth one the doctor had already recommended for a crown?” From the records, ask if there are any other previously diagnosed teeth in the same quadrant needing treatment. Ask, “Would you like to have all three of these taken care of at the same time? I can make arrangements for that.”

The team is accountable for an efficient schedule.

Phone training is a big part of making days efficient and profitable. You can save a lot of time for the doctor and patient, practicing phone scripts for different scenarios that occur in your office on a regular basis.

Timing your procedures is a great way to evaluate your efficiency. We can learn great lessons from efficient assistants. We call this “Ruth’s Rule” as a tribute to one of those fine assistants: Use one bur or instrument, do what you need to do, and then move on. That bur does not appear again for that patient.

Efficient scheduling in blocks has a profound effect on efficiency and profit. 

For example, booking alike procedures at the same time eliminates the team having to shift gears both mentally and physically. Blocks of two hours with a production goal forces the team to focus on better scheduling.

For example, if your goal for each two-hour block is $3k, don’t schedule “look-see” appointments during this time. When you produce $6k in the morning, you are on track to efficiency and more time away from the office to rejuvenate.

Drs. Blatchford are America’s leading dental business coaches. Their book, Bringing Your ‘A’ Game 2.0 is now available at Blatchford.com (888) 977-4600. Blatchford Coaching results in less patient contact days, greater net, more focus on what is important to you.  

Enabling Your Team to Bring Their Best to Collaborative Problem Solving

One day, several years ago, our dental practice was facing an imminent snowstorm. We could see that the storm would play havoc with our professional and personal schedules. Decisions had to be made about our response. Should our plan be the same as the last time the office had been closed by weather? People were beginning to get nervous about how this was going to play out. A clear decision and well thought out plan were called for, but there was no one right answer. We needed to quickly make a collaborative plan (an agreement) to distribute power and communicate with our patients.

Planning for Contingencies

As in the case of the imminent snowstorm, I believe there are frequently practice decisions to be made for which there is no one right answer – no one strict plan that we can establish ahead of time and not expect to modify. Many variables need to be considered each time as the circumstances of owners, team members and patients change.

Collaborative planning takes “high engagement,” insight and practice. If you have preplanned team agreement on how to handle special events, you are ahead of the curve, but you will find it helpful to visit these agreements periodically, and you can anticipate you may need to collaborate “on your feet” when contingencies arise.

Role-Playing

Last year, at “Inspired Team Facilitation” with Joan Unterschuetz, we did role-playing that helped the team develop a collaborative plan for which every member of the team had buy-in and agreement. Role-playing has helped our team huddle in an emergency to clarify what needs to be done, who can best take the lead on each task, and acknowledge the compelling reasons why we are doing this as a team. It also has been helpful to prepare each department leader to motivate team members who will help them make sure we effectively communicate with patients, assure patients, and shut down if we need to do this swiftly; then in reverse, open up the practice and zero in on what needs to be done to open the schedule and reschedule patients as priority dictates.

Agreeing to Agree

From the earliest time possible, work on building a culture of agreement around:

• Team meetings with high-engagement of all stakeholders
• Understanding problems to be solved and why they must be solved
• Respecting all team members who would be affected by giving them a voice in the planning
• Understanding that department team leaders will be accountable for execution
• Coming to joint agreement and celebrating that fact at the time the agreement is made

The goal of these “coming to agreement” exercises (even about the small stuff) is to set a standard of collaboration that is in alignment with your practice philosophy. When an emergency arises, the team knows from experience that they can quickly collaborate and come to agreement on a plan of action…even when there is no one right answer and you need to kick start action immediately. If your collaborative meeting goes off track, the dentist as practice leader needs to remind everyone of the compelling reasons why they need to come to agreement now.

Can’t Involve Everyone?

Sometimes involving everyone is not possible in a crisis, but the goal is still the same. The goal is to be on the same page and united in decisions. All team members need to be informed of decisions, so if you and your department leads need to quickly create an agreement, the leaders will report back to other team members for implementation and keep them in the loop. Keeping everyone in the loop honors them and combats the human response of making false assumptions and experiencing energy-consuming emotions. In a culture of agreement, there is less opportunity for negative energy to accumulate—less “drama.”

It was August of 1995 when I walked through the doors of the Pankey Institute for the very first time.

I was attending a course specifically designed for hygienists and was literally in awe of every aspect of my experience there. Not only was the clinical information fresh and new from what I had been taught in hygiene school, I was also introduced first-hand to the philosophy that has since become the corner stone of my own personal and professional life.

The Power Of Development

Looking back over my shoulder at the past 24 years I realize that none of my learning or growth could have occurred if my “boss” had not invested in me. What I didn’t realize early on was that his investment was not just so that I could be a better hygienist. What happened was that I grew to become an incredibly high performing, deeply engaged, missionary and change agent for our practice. I learned that my thoughts, ideas, feelings, and questions were not only welcomed, but invited and encouraged each and every day. I become a perpetual student and my hunger for personal and professional development was fed and nurtured by the culture that we had intentionally created in our practice.

Today I have the opportunity to work with dental teams across the country, and my mission has evolved from being able to serve individual patients to supporting entire teams as they navigate their own growth and challenges. You see, my own experience as a team member was so powerful that I find it imperative to create my own version of Quid Pro Quo.   Yes, it’s rewarding to help practices learn and practice skills that can enhance every aspect of the patient experience, and even more rewarding to know I’m supporting each Dr and team member to be become the very best version of themselves.

What Does It Mean To Create A Healthy Culture?

Experience tells me it’s where each person is seen, heard, valued, recognized, and appreciated. Of course, it’s important to develop and implement systems, define clinical protocols and establish business operations. I ensure you that when team members feel a part of something bigger than themselves and connected to you and each other, a sense of accountability and responsibility to these standards increase exponentially…as does the presence of positive attitudes. And just in case you’re interested, I’ve also found that every single practice will ALWAYS have challenges, conflicts, and competing values to work out. The highest performing teams will be the ones who consistently push themselves to work ON their issues and work THROUGH their differences.

It was one of the greatest honors of my coaching career to be invited to work with the in-house team at the Pankey Institute last week. I left the building after our meeting filled with more pride than ever in the Institute’s commitment to excellence, and to their team. Your Pankey leadership team is continually helping each person find their voice, serve each participant, “walk the walk and talk the talk” of what it means to be in service and an agent for positive change.

Let me leave you with this question: What is the kind of culture that you want to have in your practice, and who are you willing to invest in to get there? I’m here to tell you, it’s worth the effort!

This is a continuation of a series of blogs exploring what it takes to become the leader you want to be. It’s all about breaking down Dr. Rich Green’s brilliant definition of a leader:

“A leader is a person…

Willing and Able

To influence behavior;

Their OWN FIRST

Then others

To a preferred future.”

-Rich Green, DDS

Know Thyself

In the previous blog, we looked at willingness and ability to influence behavior. The next piece of Dr. Green’s definition is “Their Own First.” Our ability to influence others starts with our ability to influence ourselves.

Just like our patients, we often “know” what we should do and even how to do it, but then we don’t do what we know we should. So, how do we influence our own behavior intentionally?

This is sometimes the hardest part. I believe it starts with “know thyself.” Dr. Pankey placed “know thyself” at the top of his Cross of Dentistry for a reason. I have observed (and experienced) that in general, dentists focus most of our attention and efforts on knowing our work and applying our knowledge.

Here at Pankey, we also focus on knowing our patients. But very few dentists, or humans for that matter, focus on really knowing ourselves—what matters to us, why it matters to us, why we do what we do, and what’s truly creating our results.

If we put attention and effort into knowing and growing ourselves first, our ability to lead others is exponentially improved. Here are the areas I believe are imperative to this:

Essential Concepts

1. Our competency and skill level is of course important. We do need to know what we’re doing.

Depending on our business model, it’s important that we are competent in these areas: clinical skills, how to run a successful business, and communication and relationship-building. We should continue to grow in each of these areas.

2. A basic understanding of how we are wired is crucial because this is where much of our behavior comes from. Each of us is a blank canvas from age 0-7. We are programmed during those years. We learn survival skills and form beliefs that shape our model of the world.

It is very helpful to understand how this shapes our world and how it drives our behavior. We can become aware of and change our programming with work and practice.

3. The ability to be with our emotions (and those of others) is also of utmost importance. As humans we have the ability to let emotions move through us. Not only that, it is vital and healthy to do so. Emotions have useful information in them as well.

4. The fourth area I’ll call ‘knowing your truth.’ This is the connection to your heart and soul. If we grow our clarity and trust in this and our worthiness of having what we desire, this will take us further than anything else.

What do you believe in your core? What matters most to you? What’s your purpose? What do you desire?

I hope this blog has convinced you that it is a worthy, worthwhile, and noble cause to spend time getting to know yourself better. Only by knowing ourselves can we really know others at the highest level. Then it is our honor and privilege to be able to influence them, which is what we will talk about in my next post …

The ABCs of dental office organization tell us how to prioritize our time, energy, and resources so that we can provide the best care possible. In Part 1 of this series, I discussed the definition of the three main ABCs: administrative tasks, behavior tasks, and clinical treatment.

Read on for how to implement an understanding of these principles into your practice efficiency protocol:

Dental Office ABCs: Prioritizing

How can you get better at organization and adherence to the ABCs? Here are three steps – 

1. Ask each team member to list all possible administrative tasks. This includes tasks they do not need patients to be present for or where they need uninterrupted time for maximum efficiency. You should generate your list as well.
2. Next, have them create a list of behavioral tasks.
3. Finally, have your team members delineate their clinical processes. This should lead to discussions on tray/room set-up, treatment preparation, and efficiency.

These lists can be developed by each person in the office prior to a staff meeting. Then, in a team meeting you can discuss each person’s “top 3” and consider periods in the schedule throughout the week where each team member can carve out A – B – C times.

A Productive Daily Conversation

For example, our business associate at my dental practice sets aside Thursday morning for uninterrupted “A” time to catch up on delayed insurance claims, payment calls, etc. This means our relationship coordinator/primary chairside rotates to handle incoming calls and our assistant chairside rotates to chairside duties. Everyone loves the cross-training and variable challenges.

The coordinator answering the phone does not need to be under pressure. If a call comes in for the business associate, they simply state, “Sue is busy right now. May I have her return your call in an hour?” or some such reassurance.

When done well with open respect of each person’s priorities, this can evolve into a daily conversation. For example, the relationship coordinator may ask for uninterrupted time to call a certain patient about emotional support or a referral to a specialist. The business associate may request time to call an insurance company.

Have fun with it. Your approach will evolve and remember that mistakes are the fruit of great progress. Celebrate/laugh at them. Keep at it and the ABCs will change your practice.

Efficient office organization leads to effective office functioning. It frees team members up to take care of people. It can greatly increase effectiveness – defined as helping people make choices appropriate to their health and improving efficiency of care delivery.

Dental office organization starts with understanding tasks and roles:

ABCs in the Dental Practice

A = Administrative Tasks

These are tasks that can be done when patients are not present. For example, planning next week’s schedule for effectiveness or following up on and processing insurance claims.

More examples:

• Filling the hygiene schedule.
• Working the re-care system.
• Supply ordering.
• Treatment planning.
• Specific treatment pre-planning.
• Review of x-rays, charting, and chart notes. 

B = Behavioral Tasks

These are usually communication efforts with patients. Focused, uninterrupted time is available.

Examples:

• Talking to new patients on the phone.
• Care instructions following treatment.
• Treatment conversations.
• Financial arrangements.

C = Clinical Treatment

Here the patient is present. Ideally, treatment has been organized and so thoroughly thought-out beforehand that care proceeds rapidly and efficiently.

I have heard it said that treatment can be fast and good, fast and bad, or slow and bad. Slow and good is virtually never possible.

Speed and efficiency respects the patient’s time and emotions. This is why effective clinical organization must include pre-planning. 

Understanding Office Roles

If you understand these roles for yourself and each team member, your week can proceed much more effectively. Many dentists do not feel “productive” unless they are chairside spinning the high speed, but this is not always the case.

If you consider your role in the practice as similar to a CEO (vision and implementation) and/or COO (efficient operations) you must consider “A” time important.

If you consider yourself an advocate for your patients, your “B” time – especially quiet time to ponder treatment options as well as learn and grow in communication – is essential.

To increase your dollar per hour productivity, you must practice continual chairside improvement and time management in treatment procedures. This is the only way to accomplish more work in a single day.

To be continued …

It’s important to consider your hygienists as autonomous skilled professionals independent from your management. Of course, as the leader you must provide guidance, but you should still defer to their training in their specific field.

A Hygienist’s Expertise

This is one of the hardest parts about managing a team – letting go of the reigns a little. But you don’t have to entertain a free for all to provide some freedom. If a hygienist has made it clear to you that they have both clinical and behavioral skills, then it’s your job to open up a dialogue.

You should discuss with them what you will individually bring to an exam. Find out what they feel comfortable recognizing and diagnosing, that way you can both be on the same page. Don’t rely on the antiquated belief that hygienists only know how to recognize. They are also fully capable of diagnostic techniques.

In hygiene school, they will have thoroughly reviewed the signs and symptoms of multiple conditions. But for them, their education tends toward directing them to call the problem to the dentist’s attention.

The key to all of this is to only offer advice in your area of expertise. That goes for both hygienists and dentists. As with most things, individuals vary. Dentists and hygienists will have different qualifications, therefore providing different perspectives in the practice. No matter our level, we must offer our opinions as opinions and be willing to listen to the thoughts of others.

Diagnosing versus recognizing comes down to semantics, while both are very different from the actual treatment planning designed by the clinician. It’s a hygienist’s responsibility to serve the patient’s needs to the best of their ability based on their skill level and judgement.

What do you consider a hygienist’s purview in the dental practice? We’d like to know what you think! 

Hygienists make up a huge component of a dental practice’s atmosphere and productivity. You should be devoting plenty of time to understanding their motivations as well as your own. Even better, you should actively consider how best to support them.

Supporting New Hygienists

One obvious instance of support a dentist can provide occurs with the dental hygienist who is fresh out of school. Hiring someone new to the field confers pros and cons. The biggest upside is that you can mold them to your preferences. But in that upside lies a heavy burden: You must be willing to guide their learning and influence their patient care.

A hygienist who is very new to either your practice or dentistry itself needs plenty of time to become oriented. You can support them by seeing all of their patients for a while and completing an extremely thorough exam. This will ensure both the hygienist and patient get the most out of the experience.

Take steps like:

1. Ensure all deposits that can be removed are removed.
2. Observe the gingiva and determine if prophylaxis has caused as little trauma as possible.
3. Measure pocket depths to calibrate the hygienists readings to yours.
4. Look closely for decay and provide an opportunity for the hygienist to feel the signs of disease that you do.
5. Check for wear or breakdown and teach both patient and hygienist how to see it.
6. Carry out an oral cancer exam and clarify what is cause for concern.
7. Point out what draws your attention on an x-ray.
8. Finally, make any diagnostics you offer into a learning experience for both the patient and the hygienist.

Once you feel comfortable that your hygienist is appropriately skilled, you must open lines of communication surrounding who handles what responsibilities.

How do you bring new hygienists into your practice culture? Please let me know!