The Business of Hygiene

by Larry Wintersteen

In 1974 I entered the world of dental practice management. At that time, protocol and standards acceptability were starting to change, such as marketing, team utilization, patient communication, scheduling, financial rules, hygiene productivity, etc. The profession as a whole was starting to look not only at improved services but also profitability. Running a dental practice like a business was starting to gain acceptance.

Similarly, the hygiene department was placed under a magnifying glass. Compensation has transitioned from straight commission, to hourly, to daily to units of time. Some have suggested that hygienists produce only 38 percent of their potential. (See Dr. Tom Orent’s newsletter — The industry is trying to treat hygiene as a separate business within the practice and at the same time establish the importance of progressive thinking, cooperation and planning between the restorative practice and the hygiene component. Together they must contribute to the whole of service and measurable profitability.

For many years, hygiene was worked on a left-over attitude. In other words, if there was time in the day, go work the hygiene. Consequently, patient services were neglected in hygiene unless the patient happened to already be in the schedule. Patients were being lost in the cracks, some moving on to other dental practices and some coming in only as an emergency. Unfortunately, this could be interpreted as patient neglect and misconduct on the part of the dental office team. Not only were patients being neglected, but they were not being motivated to care about oral health and consequently there was a loss of revenue and patient loyalty.

I suggest that every practice have a member of the team be designated and accountable as a dental hygiene services coordinator. Consider the following job description and directives for this position. My experience indicates that this person spends an average of 4-6 uninterrupted hours a day working the business of hygiene and scheduling hygiene. This outline could also serve as a springboard for discussion with your entire team.

Objective: Develop the hygiene department, into a measurable profit centre, patient education centre and a feeder for restorative services.

Premise: Hygiene services have traditionally been worked on a “left over” attitude. However, in your office, we want total control and accountability of this “separate business”.

Instruction: Review the following numbered items and develop/edit the items to meet your standards and criteria. (keep in mind that it must be a measurable profit center.) Always place value on team approval, possibility thinking and understanding.

* ALL patients will be in the recall/recare system (manual or computer).

* ALL recall/recare cancellations will be tracked and accounted for.

* We should be able to pull a patient chart or look them up on the computer and know where they are — in relationship to hygiene services and visits.

* Create a separate spread sheet for monitoring and tracking hygiene department statistics. You should have figure tip control over Hygiene information such as:

Total # hygiene patients seen per work day. (Breakdown of Male Adults, Female Adults and Pedo.)

Total adjusted production per day — per provider.

Total hygiene collections per day — per provider.

Hygiene cancellations with notice.

Hygiene cancellations without notice.

Hygiene production on new patients.

Hygiene production on existing recall/recare patients.

Establish — and honor dental hygiene daily production goals and schedule accordingly.

* Determine if the hygienist are going to have expanded duty days vs. straight prophy days.

* Classify or categorize hygiene patients in the computer for more effective scheduling, stress management and time management.

* Determine if/when the hygienist is going to utilize an assistant or do some two chair scheduling. If so — how often and with whom? This needs to be determined and scheduled at least 6 months in advance. Double booking is not wise for all days.

* Hygiene coordinator will meet with and direct the hygiene department at least once a month. (review, motivation, implementation, etc.)

* Consider setting up a separate budget for the hygiene department. (Income standards and overhead guidelines.)

* Determine how the hygienists can actively participate in internal marketing and external marketing — for the practice.

* Remember — the hygiene coordinator is the development director for the hygiene profit center.

* Hygienists are accountable to self, the hygiene coordinator and then the Dr. (in that order) Of course all activities and decisions are sensitive to Patient satisfaction.

There should be NO dental hygiene down time. Create a call list system. Consider booking all empty chairs with hygiene — whenever possible. For example: if the Dr. is away and chairs are available. (Assuming that you can schedule hygiene patients without a Dr. in the office — as long as there is a prescription on file.)

* Determine the role of the hygienist in the new patient experience.

* Develop a ‘new patient’ checklist — for improved communication and understanding.

* Determine and educate patients and staff on the perio program or services in the office. Include a Dr. in this team scenario.

– Determine what dental products, if any, are being sold in the practice and who gets credit for the sale of those products.

– Make phone calls to patients who are two or more years overdue on hygiene. Find out why they have not been in. Attempt to get them scheduled or inactivate if they have moved on.

It is essential that there be accountability in the business of hygiene. It has been suggested that a hygienist, at the end of the work day, should be able to say — “I know that I have produced and collected at least three times what I have been paid today.” Some hygienists need to sacrifice some “sacred cows” and stretch themselves in terms of better use of time, team and technology.

Hygienists — imagine that this is your hygiene department and you had to make it a profit center. Where would you start? How would you measure success? Would you have an accurate knowledge of income, losses and expenses? How would you utilize space and down time? Could you make a living?

Larry Wintersteen founded the consulting firm Wintersteen & Associates in 1974 and entered into professional healthcare management consulting and human resource development. He has built an international reputation throughout the U.S. and Canada as a leading consultant, lecturer, author and trainer of dental, legal and medical professionals. He is also a faculty member of the University of Colorado, Dental School, Denver, CO.