An acceptable measurable percentage for non-productive time in hygiene is 5-8%. If the hygiene program is appropriately designed, the hygiene coordinator or the person responsible for booking the hygiene schedule will no longer need to operate from a place of urgency. Instead they will have several places to go to in order to fill the empty time slot. Through the establishment of a hygiene program, you can keep the hygienist’s time filled with a minimum amount of stress to all those involved.
The first step, which is absolutely necessary, is to have an accurate patient count so that you can calculate the number of hygiene hours that your practice actually needs. Once this has been determined, you can compare the number of patients to the number of available hygiene hours. Decreasing hygiene downtime may be as simple as decreasing the number of hygiene hours and booking the remainder more effectively.
Classifying your patients based upon appointment history is another way of decreasing hygiene downtime. You can use letters or numbers, such as A, B, or C. What’s important is that those patients with a good appointment history are those patients who place a high value on hygiene services and honour advanced scheduling. If we reward productive behaviour it will be repeated. Those patients that do not place a high value on their appointments and are chronic no show or short notice cancellation need to be placed on a short notice list, rather than have valuable appointment time reserved for them only to have them cancel and place the office in a difficult position. That’s not to say that a patient won’t change, but until they do, an “A” patient should not be handled appointment-wise, the same way as a “C” patient would be. Classifying the patients gives the person filling the hygiene schedule pools of patients to draw from if a time should become open.
There are other ways of decreasing hygiene downtime but the concepts are a little more abstract. One of the major areas that require work is the perception of what is done at the hygiene appointment itself. In the past, the hygienist performed a series of tasks that the dentist checked upon entering the operatory. To the patient, their hygiene appointment was a service much like getting their hair done or their car tuned. In order for that perception to change, hygienists must take advantage of the opportunities that are presented to them while the patient is in their treatment room.
The first thing we need to do is to establish a relationship with our patient; get to know them by becoming an effective listener. People love to talk about themselves and since the appointment is about the patient, let them. By becoming a good listener, you can find out what a patient’s priorities are. Is money the most important thing to them or their looks? Does their work take them away for long periods at a time or do they work from home? Are they involved in sports activities? Do they snore?
By finding out lifestyle information, you may learn that a patient who works from home doesn’t mind being called in at the last minute to fill a spot. If the patient likes to have everything planned down to the last second, chances are this kind of appointment won’t do. If their looks are important they may be more inclined to take the necessary steps to improve or keep their level of oral health.
The second thing we must do is to educate our patients. A lot of our patients have a very limited scope of what periodontal problems are and their effect on the entire body. Most patients feel that hygienists just “pick and flick.” That they treat the “hole in the centre of the face” and what they do or prevent has little, if anything, to do with the rest of the body. We need to be able to show our patients the links between periodontal disease and heart disease. Let them know that we do an oral cancer screening and why. We can educate our patients and let them know that snoring problems may be symptoms of more serious problems, but that wearing a dental appliance may help. We can let moms know that by sealing areas that are susceptible to decay we may prevent a child from ever experiencing a cavity.
As the patient begins to realize the significance of their oral health on the rest of the body, their perception of the value of their hygiene appointment increases. When this happens there is no longer the equivocation of their hygiene appointment to that of a hair appointment, and the hygiene downtime decreases. By educating the patient you have also begun to transfer the responsibility of the patient’s oral health to them. By placing the ownership of oral health in the hands of the patient, it includes them in the decisions that are made and makes them feel as though they are a part of the dental team.
Technology can go along way in patient education. For example, the use of the intra-oral camera by the hygienist to show existing conditions of oral health, restorations, whiteness and brightness of teeth, areas of stain (permanent or removable) evidence of habits, and their effects on oral/facial development can have a dramatic effect on the patient. As adults, we retain much more information if the source is visual. A patient will be much more accepting of a treatment plan if it can be validated to them visually. The notion of “what’s in it for me?” has been satisfied and with this in mind, the patient is less likely to cancel their hygiene appointment.
When the dentist is called into the operatory, it is important that we take this time to inform the dentist of all the important data. Have displayed intra-oral pictures and radiographs and verbally update medical/dental/ social changes that have taken place since the patient’s last visit. The patient now sees your role in the dental team not as a service provider but as a problem-solver and gatherer of pertinent information that is necessary for the dentist to form a treatment plan customized for them alone. The treatment plan that is formulated should first consist of a periodontal management program based upon the oral health of the patient. The fees and time scheduled are done based on this individualized approach and not on insurance coverage. Whether the hygienist schedules the appointment or a team member in the administrative area does it, it is imperative to keep downtime low. Therefore no patient should leave the office without his or her next hygiene appointment booked. This is sometimes referred to as pre-booking or pre-blocking.
This leads to our last area that will help to reduce hygiene downtime, and that is consistency. It is absolutely critical that everyone is clear on all office policy, terminology, and patient classification information. If the
hygienist is doing everything possible to educate their patient on the role of the hygienist in a patient’s oral health care, and the patient comes out to the administrative area and is asked, “when do they want to come in for their next cleaning,” the whole education lesson is lost. The perception doesn’t change. The value of the hygiene appointment isn’t seen and the patient will feel free to cancel or change their hygiene appointment at the last moment. Team members making confirmation calls, must also use correct terminology. Everyone must understand the practice philosophy. If your office has decided not to be insurance driven for example, then it is imperative for the entire team to stress that the personalized treatment plan is formulated on what is necessary to return the patient to optimum oral health and not what is covered through their insurance.
When patients see consistency, value, and professionalism, they elevate their perception of the hygiene visit and hygiene downtime is decreased.
Lisa Philp is the President of Transitions Group North America, a full service coaching company for dentistry. Lisa is a certified effectiveness trainer, certified facilitator in Integrity Selling, a Certified Management Consultant as designated by the Academy of Dental Management Consu
ltants; has been recognized in the National Register’s Who’s Who in Canadian Dentistry; is a member of NSA (National Speaker’s Association) and CAPS (Canadian Association of Public Speakers). Lisa also teaches the dental students at the University of Toronto, Faculty of Dentistry.
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Hygienists must take advantage of the opportunities that are presented to them while the patient is in their treatment room
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The patient now sees your role in the dental team not as a service provider but as a problem-solver and gatherer of pertinent information that is necessary for the dentist to form a treatment plan customized for them alone
