Practicing the DREAM PART 6 —The power of dental hygiene

Nov. 1, 2002
Before starting her two-year commitment to management development, Dr. Thompson produced $255,000 a year, and she was doing her own dental hygiene. As a result, her doctor production was only $138 per hour.

by James R. Pride, DDS; Amy Morgan; and Mary Lynn Wheaton

Before starting her two-year commitment to management development, Dr. Thompson produced $255,000 a year, and she was doing her own dental hygiene. As a result, her doctor production was only $138 per hour. Two years later, however, total office production had more than tripled to $812,099 per year, with doctor production tripling to $412 per hour. Her newly formed hygiene department had become a profit center, with a production of $217,420. How did Dr. Thompson accomplish this?

A critical factor in the development of her successful practice was the creation, training, and maturing of a hygiene department. Today, Dr. Thompson extols her hygienists: "About 90 percent of my restorative cases originate through my exceptionally dedicated hygienists. The hygiene department is the lifeblood of my practice."

The key to any self-perpetuating dental practice is the strength of its continuing-care department. The role of hygiene is that of a copilot in reaching each patient's long-term goal of oral health. A viable continuing-care department must have as its primary objective the promotion and support of restorative treatment from the hygiene chair. This is the way to generate the highest quality of care and maximum profit.

With her consultant's guidance, Dr. Thompson created an enthusiastic, competent, extremely productive hygiene team offering its own comprehensive service mix, as well as supporting and promoting restorative treatment. This was accomplished by the following steps:

1. Hiring. Dr. Thompson had to hire a hygienist who would be right for the practice, which meant someone with excellent clinical and relationship-building skills, as well as a vision and values that matched the doctor's.

2. Developing. Dr. Thompson had to train the newly hired person and a second hygienist, whom she acquired through the practice she purchased, so that their performance would reflect the practice's philosophy and goals.

3. Creating an environment for success. Dr. Thompson had to create an environment in which the hygienists could give comprehensive care and implement the high level of treatment they learned in school, which should be reinforced by the dentist.

4. Supporting and promoting restorative care. Dr. Thompson had to train the hygienists to become "copilots" in the patient's journey toward total oral health, not just periodontal health.

Let's examine each of these important steps in detail.


Dr. Thompson found a hygienist who has been a phenomenal asset to the practice. She resisted the temptation to hire hastily and shortsightedly. This took resolve, since hygienists were in somewhat short supply in the area. By networking with patients, Dr. Thompson discovered that one of them had a relative who was a hygienist just moving into the state. Dr. Thompson found great potential in this person: "Her number-one priority was to work in an office where everyone got along and there was true team effort. She was also very forthcoming in her communication, and she had a strong desire to practice her profession at the highest level." A "working interview" demonstrated that the hygienist also possessed the necessary clinical skills. Dr. Thompson had to wait for her new hygienist to become licensed by the state. She shares, "She was well worth the wait. The whole experience has taught me to take my time and be sure I hire the right people."


Dr. Thompson communicated her philosophy and goals to her new hygienist and to a second hygienist whom she acquired through the practice she had purchased. The acquired hygienist had to be retrained. Her former employer essentially let the patients run the practice. Consequently, she had little opportunity to do more than the standard treatment or to educate patients on proper home care and optimal oral health. Dr. Thompson explained her vision of comprehensive care, teamwork, and customer service as her highest priorities. She expanded the hygiene function to include scaling and root planing and gained the support of the periodontist to whom she referred cases. The schedule was preblocked for scaling and root planing to ensure that once the treatment was diagnosed, patients could be appointed easily. Both of Dr. Thompson's hygienists were enthusiastic about their new roles.

Creating an environment for success

Dr. Thompson's consultant explained the importance of creating an environment in which comprehensive hygiene care is practiced, not just given lip service. The dentist worked with her hygienists on the following areas for giving quality care:

• Prediagnostic questions to ask patients regarding present and future goals for their oral health
• A review of the patient's home-care routine and how to improve it
• The verbal skills for promoting value in the next appointment, whether it be restorative or periodontal
• Patient education on periodontal disease
• Passing the baton to the appointment coordinator to ensure that the next visit is scheduled before the patient leaves the office

Dr. Thompson not only gave a clear direction, but also allocated time for accomplishing these goals. She allowed her hygienists to practice their profession at the high level they learned in school, instilling in them a sense of pride in their work and loyalty to the practice.

Promoting restorative care

Dr. Thompson created a hygiene department that contributed to the highest quality of care and maximum office production by offering its own service mix and by supporting and promoting the long-term treatment needs of patients. She gave continual guidance and feedback to her hygienists on how they could initiate co-discovery of needed treatment, educate patients on potential treatment options, and share their observations with the dentist in a coordinated periodic exam. In this way, the hygienists influenced patients toward their own ideal decisions for both restorative and cosmetic care. Dr. Thompson held meetings with her hygienists to hone their skills in supporting restorative care.

"We sat down," she recalls, "and developed clinical guidelines. I shared with my hygienists the factors I look for in diagnosing specific conditions, so that they could make observations prior to my periodic exam that would prepare the patient for a possible diagnosis and treatment options."

With Dr. Thompson's direction, the hygienists identified and highlighted areas of concern with the patients and shared their thoughts on what the dentist typically recommended in such cases.

"My diagnosis almost always agrees with the hygienists' observations," explains the Dr. Thompson. "In rare cases when it doesn't, I support them in front of the patients by granting validity to their observations and explaining why, in this particular instance, I choose to do something different. I create a learning opportunity for the hygienists and patients. It's important to support the hygienists' observations, even when I may not select that particular treatment option."

Dr. Thompson also allotted "administration time" for hygienists to review their charts for the next day. During the morning huddle, the entire team devises strategies on case acceptance from those hygiene patients with diagnosed treatment that has not yet been performed.

As a result of these efforts, the practice has shifted from requiring a continuous influx of new patients receiving less-than-optimal care to regularly performing comprehensive restorative and cosmetic treatment on patients-of-record. "We only see about 14 new patients a month now," says Dr. Thompson, "because most treatment is performed on our patients-of-record." These are the hallmarks not only of a mature hygiene department, but of a sophisticated general practice focused on long-term oral health.

In Dr. Thompson's practice, we see the total transformation of a young dentist who was tentative, modestly profitable, and struggling with practice management. Now, she is a mature dentist who is practicing her dream of comprehensive care, maximizing her profits, fully funding her pension plan, staffing her office with enthusiastic people who share her vision, leading her team to continued growth, reducing office stress, and enjoying her profession to the fullest. Her phenomenal increase in office production is the financial reward for her efforts. Her newfound pride and well-earned confidence is her personal reward for being an effective leader.

In just two years, Dr. Thompson utilized proven practice-management techniques to make her practice grow exponentially. She will reap the benefits of her efforts for her entire career, earning and saving substantially more each year. Her commitment to management improvement already has greatly improved her quality of life and it will give her the option of early retirement and financial freedom. Every dentist can enjoy the same success. It takes a vision of excellence and a commitment to turn that vision into reality.

For assistance in implementing new systems in your practice, call Pride Institute at (800) 925-2600.

This series chronicles the true story of a young dentist whom we're calling Dr. Mary Thompson. In two years, she transformed her $255,000-a-year start-up practice into an $812,099-a-year, high-quality office.

Previous articles in Dental Economics described how Dr. Thompson, just three years out of school, began her program of management improvement with the dream of buying the practice next door and doubling her patient base. Pride Institute consultants helped her develop a strategy to purchase the second practice and craft an annual plan.

After consolidating the two practices, however, her goals for increasing production were not met immediately. Changes had to be made in scheduling, hygiene, and recruiting new patients to the practice. These efforts, plus the replacement of a poorly performing staff member, yielded a year-end production of $549,169 — 115 percent higher than the previous year.

Dr. Thompson began her second year of management improvement with the challenging goal of raising total office production by 27 percent. Having learned how to base salary increases on collections — instead of on guesswork — the doctor gave raises to her staff members both to reward their efforts and to motivate them further. Staff meetings helped to hone verbal skills with patients, improving team communications and implementing changes.

How to build a great hygiene department

• Hire hygienists who are not only competent, but who also share your practice philosophy and goals.

• Set clear expectations for your hygienists in delivering quality care and exceptional service.

• Create an environment in which your hygienists have the time and tools to deliver the level of care that you envision.

• Develop your hygienists' ability to support and promote long-term care.

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