Managing difficult behaviours

PRACTICE MANAGEMENT   Aesthetics and the hygiene department An overview of the hygiene department for 2003 By Linda L. Miles   January/February 2003 The hygiene department of a dental practice has never been as exciting as it is in today's dentistry. With a focus on systemic diseases, periodontal therapy and cosmetic enhancements, the role of the hygienist has never been more important than it is today. Burn-out is something of the "olden days" for the modern hygienist. Burn out came from repetitive procedures and a feeling of hopelessness for the hygienist. Today the duties and enhanced importance of the role of education makes dental hygiene one of the most fascinating careers of the new millennium. For the hygienist who is willing to learn the new skills of a gifted communicator, educator and salesperson, the rewards are too numerous to detail. Many hygienists say, "I'm not cut out for selling dentistry", or, "the need for further care should come from the dentist, not the staff". In light of this resistance and reluctance, I feel that one third of today's value as a dental employee is based on the ability to do their job (skills wise), whether it be business or clinical, one third is based on communication and case presentation skills, and the last third is their team attitude. Of all the topics I personally teach in seminars and consulting, the one that receives the highest response in value to the team is communication from staff to patients. In years past, the ratio of staff to patient communication regarding dentistry was 75-25 (social to dental). In all successful practices, that ratio is now 75% dental education and 25% social interaction. It is very empowering to the team when they can effectively teach patients about new procedures, especially in cosmetic dentistry, and have the patients rave about their new smile when the procedures are completed. This gives the team an effective way to save the dentist's time chair side. We have also found that case acceptance doubles when the patient hears their dental needs from the staff in the form of a concerned question or enthusiasm for modern dentistry. The dental hygienist is often looked upon as the role model of patient education. Others on the team look to the hygienists to set the stage for patient education. One of the main reasons some hygienists shy away from their role as patient educator is a lack of training and effective role playing. People only enjoy doing those tasks they feel they do exceptionally well. Another reason for a low acceptance rate for this new role in some offices is that the hygienist hears the dentist being redundant in patient education. It is, " why should I tell the patients about new procedures when the doctor will reiterate everything I teach?" In these practices, I recommend that the education be delegated and rehearsed to avoid confusion and redundancy, which is annoying to patients. Determining patient interest Not all patients are good candidates for cosmetic dentistry. It is not on every person's priority list to have a healthy or attractive smile. Some people assume that the ageing process of the mouth is a necessary part of longevity or that they have earned the right to spend money on travel, jewellery and other material things but not on aesthetic dentistry. In order to "qualify the candidates" before the dental team assumes they owe it to every patient to push cosmetic enhancement dentistry, there are a few key questions and phrases to use in the qualifying process. Through sincere patient education, with results and benefits to the patient outlined by the hygienist and others on the team, it is amazing how many patients who never considered cosmetic dentistry will become good candidates. Remember, no one on the team can diagnose dentistry except the dentist. Everyone, however, should be involved in setting the stage for case acceptance through effective communication chairside and at the desk. Some of the questions include: Mrs Bailey, if you could change one thing about your smile or teeth, what would you change? If the patient responds with, "Nothing, I like my teeth and smile just the way they are", this is a good indication the patient is happy with the status quo. If by chance the patient says, "I've never liked the colour or shape of my teeth, or this tooth is crooked and has white spots which embarrass me", your educational process is in progress as they are ready to hear how this can be changed. Mrs Bailey, how do you feel about keeping your natural teeth for a lifetime? If the patient says, "my parents both lost their teeth at age 30. I'm 38 and can't wait to get mine extracted", your work is cut out for you in the persuasion department. If however, the patient says, "my parents both lost their teeth at an early age, I'll do anything to save my teeth," your chances of educating this patient just went up considerably. Having chairside "props" for the treatment areas makes it easy for the team to communicate aesthetic and total restorative as part of every patient's visit. One of my favourite phrases is, "Mrs Bailey, while I'm in the lab, I'd like to show you some before and after photos of patients who have experienced restorative and cosmetic dentistry". These before and after photos make it easy for patients to see their own aesthetic flaws as well as others in their family, neighbourhoods, or workplaces. Caesy, the chairside CD interactive patient educator is also a very effective tool that educates the patients by third party. Every treatment room should have intraoral cameras, Caesy, before and after photos, and great communication from the staff. Patients accept dentistry because the staff and doctors are excited. Enthusiasm is contagious, so is the lack of it. The more interested in modern dentistry the dentist and staff are, the better the case acceptance especially on elective procedures such as aesthetic dentistry. Acceptance of cosmetic whitening is a total team effort One of the most exciting cosmetic procedures is whitening by laser, the light cure system, or home whitening trays. Patients must know about these procedures in order for the practice to perform them on a regular basis. Patients from teens to seniors should be given information on this positive procedure. Before, however, the dentist and the entire team must experience the whitening process in order to sell it. Those practitioners and staff who display whiter, brighter smiles are those who do two to four cases per day. Again, before and after photos and brochures are very effective in presenting this as an aesthetic option. Photos in the patient's rest room where they go into alone and have nothing to do but look around, is a great place to have pictures. In the hygiene room at eye level when the patient is seated is another good place for pictures of before and after cases. The business staff should display bright smiles, which cause patients to notice their teeth. Pamphlets and brochures should be offered to patients upon arrival. "Mrs Bailey, we have a new brochure you may wish to look over while you wait. Feel free to take it with you to share with others". Chairside, assistants and hygienists should also be models of white teeth. Often patients compliment these smiles. It is very easy to say, "Gee Mrs Bailey, thanks for noticing. In today's dentistry, everyone can have the smile of their dreams, thanks to cosmetic whitening procedures". Some dentists reflect the Hollywood smile while others obviously think their own teeth are invisible. How can anyone in dentistry tell patients they will personally benefit from a procedure when the dentist themself is in dire need of a cosmetically enhanced smile? If I look at my most successful clients who added $100,000 of passive income to their practices last year, they are all those who sincerely believe they and their staff must have the whitest teeth in town if they are to have patients accept cosmetic whitening. There are many ways of promoting cosmetic whitening. The first step is to stop calling the procedure "bleaching". It makes patients think of White King in their mouths. The second step is to realise that most patients who have shown a keen interest in the procedure don't follow through because of the fee involved. By offering a TWO-FOR-ONE special, the practice that did seven cases per month or year will suddenly find themselves doing two or three per day at half the fee. You do the math. If the fee is $400 for home whitening and your practice does seven per month, this is $2800. If your patients flock to the practice to have their trays made and products dispensed at three per day times 16 days per month at $200, the income is $9600. The second assistant, (new patient co-ordinator/cosmetic co-ordinator) sees these patients in Chair Two of the doctor's schedule. These are "filler appointments" opposite the doctor's busy time in Chair One. If the patient is not a patient of record in your office (friend, relative, or co-worker), they must have seen a hygienist in the past six months or they come into your practice as a new patient. Step Three of this total team effort is to have an incentive program for the team who supports this new and sought after procedure. After all, unless the entire team is behind a new program, it is doomed to fail no matter how much the doctor wants to see it instigated. I recommend that 10% of the cosmetic whitening fees go into a Continuing Education Bonus Fund for a major meeting and one Fun Office Retreat each year. Offices that learn together stay together in most cases. Staff thrive on projects and trips planned well in advance. The second 10% of the cosmetic whitening fees will be divided among the team each month as a cash incentive for supporting the procedure and giving exceptional care to each patient in the process. Part-time staff are always included in the bonus plans on a pro rata basis. Marketing cosmetic whitening is easy and fun. Besides targeting the TWO-FOR-ONE special to different professional groups each quarter, such as "We Appreciate Realtors", or "We Respect Teachers", and "We Salute Military Families", don't forget the complimentary angle of cosmetic whitening. Offer to do the complimentary whitening for the beauty Salon owner or one of the stylists who would be a great before and after "model" in exchange for their before and after photos at every mirrored work station in the salon. As we know, when we have our hair cut, we always look at the photos on the mirrors. Having your business cards at each station is also a good idea. Putting cosmetic whitening brochures or before and after photos in statements mailed is a great way to add value to the statements. The more education, the better the acceptance rate. Having the dentist or a staff person who loves public speaking show a 20 minute slide show to community gatherings is another way to teach the public about aesthetic dentistry. Entitle the talk, "How Your Smile Improves Your Face Value". Target bankers, investment brokers, etc. Women's groups are also great audiences as female consumers make up 76% of the dental dollars spent annually. They choose their dentists, their children's dentists and often their mate's dentist. Convincing patients to stay away from over-the-counter whitening products should be part of the chairside education. Using the analogy of professional hair treatments versus the do-it-yourself method is a great conversation for female patients. Most of them have experienced the nightmare, "I'm too busy to go to a stylist, I'll get some chemist colour and do it myself." For some patients, those who believe most of what they hear on TV, it is important to stress the damage that can be done to the teeth and tissue if the material is not dispensed under direct dentist supervision. The analogy of the whitewashed fence versus quality paint, or the inexpensive paint job on a prized automobile. Using the phrase, "a short term saving that creates a long term liability," could be the end result. The appointment sequence If the cosmetic whitening procedure is done chairside by the hygienist (laser or light system), it is best to leave flex time in the pre-appointed hygiene schedule for these procedures. There is no need to get the patient excited about the procedure if in fact there are no openings in hygiene to do the procedure for weeks or months. If the hygienist works in one room with one patient after the other, it is best to schedule the cosmetic whitening patient for an hour for the in-office procedure. Leaving two openings per day that are filled 72-48 hours in advance is best. If the procedure is done by the dentist who does not have an hygienist on staff, these appointments are best in the doctors second chair if the doctor employs two well trained dental assistants. It is not effective to work from two treatment rooms with only one assistant. This is "stepping over dollars to pick up dimes!" With home trays, it is best to schedule 30 minutes for the fabrication of the models, and 10 minutes to dispense the product. In some practices, the hygienist may work from two treatment rooms with a designated assistant. This concept, called assisted hygiene, is very effective in all hygiene procedures, and even more so in the aesthetic practices. Think of how frustrated and non-productive dentists would be if they worked in one treatment room with no support staff. They would have burned out years ago! This change in the care of patients has revolutionised the practice of dental hygiene. Being resistant to change as dentistry changes is counter-productive to modern patient care. Getting excited about these new concepts, setting new goals and target marketing can bring the fun and excitement back into dentistry. Having the entire team on the same page in communication skills confirms, "it isn't what we say, but how we say it that truly counts". Make this new year one for putting the enthusiasm back into the practice of which you are a part. See the patients get excited about modern dentistry when the doctor and staff become so. Last, but not least, become a role model of improved patient education and watch what happens over the next six months. Linda Miles, CEO of Linda Miles and Associates, a premier speaking and consulting firm, has enjoyed levels of success that only 12% of all speakers in North America achieve. Having been an active member of the National Speakers Association for 20 years, she earned her Certified Speaking Professional designation in 1983. She's a certified management consultant of the Institute of Management Consultants, a member of the Academy of Dental Management Consultants, and the American Academy of Dental Practice Administration. Known as the speaker who instinctively understands the business side of dentistry, Linda is an expert in dental communication. She greatly respects the dentists, the dental team, and the patients they serve. Practices make it a ritual to hear Linda Miles speak when they can, and as many have said, "she's our shot of Vitamin B-12". LLM&A's clients rank in the top 5% of dental practices world wide. 70% of her clients have doubled their practices in 12 to 24 months after their consulting services. And above all else, Linda and her consultants believe that dentistry should be fun, exciting and rewarding. Each year Linda hosts her Annual Sun Fun Seminars in exciting and exotic places. Her Two Day Dental Business Conferences which were founded in 1985, are a must for the entire dental team that wishes to stay on the cutting edge of communication, organization, motivation, and the art of appreciation for patients, dentists and co-workers.