10 steps to creating a profitable hygiene department

Oct. 1, 1998
When was the last time you really stopped and evaluated the profitability of your hygiene department? Do you even look at the hygiene area as a separate production center from your clinical dentistry?

Kathy Torpey Garganta, RDH, MDPH

When was the last time you really stopped and evaluated the profitability of your hygiene department? Do you even look at the hygiene area as a separate production center from your clinical dentistry?

Challenge yourself and your hygienists to critically evaluate your hygiene department and reassess its true value to your practice. Ten steps will guide you through this development and assessment process.

1. Establish a clear, well-defined vision and philosophy for your hygiene department.

What is your current mind-set regarding how you perceive your hygiene area, the roles and responsibilities of the hygienists, policies for care, treatment advocates, patient-compliance facilitators, production outcomes, marketing strategies, and recare monitors? The first step in establishing a profitable hygiene department involves the dentist undergoing a paradigm shift from traditional hygiene care to a team-oriented, dual-practitioner-centered practice.

To begin your assessment, define the purpose, mission, and vision of your department. Ask yourself, "Do I think of hygiene as a separate department that has specific, defined goals and models of operation?" Do I perceive my hygiene department as having procedures and policies in place that are measurable in assessing quality of patient care, direct production, and (especially) indirect dollars produced?

2. Integrate hygienists` visions and goals.

To initiate or develop further a separate hygiene department, even if you have only one hygienist, there must be a blending of their beliefs and visions with yours. It is not the number of personnel in the department that defines a department, but rather its organizational function. Establish criteria for the function and evaluation of the hygiene department. What are your expectations and those of the hygienists? Identify a key player who can lead the department and report directly to you while acting as a liaison to the other hygiene-team members. Break out of traditional hygiene roles and be creative, yet realistic, with your list of what can be accomplished through the hygiene department.

3. Define roles and responsibilities.

Approach this section like an octopus with far-reaching tentacles whose touch has an impact on many areas of the practice. Don`t limit your list to traditional hygiene procedures but comprehensively identify both direct and indirect care. Direct care is the tangible hygiene services performed each day. Indirect care is the intangible extra customer service that results in referrals, commitment to treatment, loyalty to practice, and increased productivity.

4. Define skill-competency levels.

After drawing up an extensive list of services performed by the hygiene department, add the skills necessary to accomplish these tasks and assess individual abilities. You also may find this exercise helpful in establishing performance evaluations for staff members.

Many dental offices expect their hygienists to function at the same skill level and to offer all patients the same modes of treatment. While consistency among clinicians is of primary importance, recognize that each hygienist comes to your practice with special gifts that may be overlooked or baggage that may be overemphasized. Through your assessment and the hygienists` self-evaluations, skill-competency levels can be identified and a structure for the department can be developed.

Schedule patients based on hygienists` strengths, not just by open appointment times. For example, schedule new patients with the hygienist who has the strongest communication skills and can inspire her patients to choose the healthiest treatment plan. Match children with the hygienist who not only relates superbly with most children, but who can involve the parents in making sound dental decisions for their child. Allow hygienists to comfortably refer perio cases to the hygienist who thrives on difficult cases. Not every clinician enjoys or has enough skills to perform every hygiene procedure. By recognizing the strengths within the department, an environment is created that provides a specialized customer service to each patient based on his/her needs. In order to schedule efficiently and profitably, the front-desk personnel play a major role in understanding the methodology and structure behind the hygiene department.

5. Re-evaluate protocols for all hygiene responsibilities.

To create order within a department and improve patient management, develop clearly written policies and procedures. This will eliminate inconsistencies, misunderstandings, and improper treatment. Do you have a program for patients to fully experience your practice, protocols for soft-tissue management cases, or radiology guidelines in place? Yes, changing practices passed down from one hygienist to another is definitely time-consuming and annoying, but you probably will find that your hygienists are not at all on the same "page." Clarification will yield growth.

You can expect this exercise to bring up conflicting beliefs, incorrect assumptions, differences in opinion, and some stress. However, the benefits of continuity of care, increased treatment-planning, a rise in productivity, improved standards of care, and a decrease in patient miscommunication will be worth the investment. Ask your department liaison to monitor the process.

6. Create new roles and responsibilities.

Now that you have established an organized and functional department, take the next step and become innovative. What could the hygiene department be doing? Look at your target population (who you want to serve), identify your best clinical skills (what you love to do), and clarify the type of care your practice delivers (besides exquisite, esthetic, general, or implant dentistry). Is your hygiene department cultivating patients into understanding this vision?

A hygiene department can set the tone for the practice. In a truly preventive practice, the dentist supports a large and growing base of recare patients with the hygienist as the primary caregiver. The patients understand the meaning of good dental health and comply with the doctor`s recommendation when they initially join the practice. As a result, they return most often for maintenance - not new treatment. Therefore, the assumption is: "Do it right the first time and maintain thereafter."

Dentistry is about relationships. Patients choose care based on trust in caregivers and emotions. Hygienists impact your patients` decision-making based on their intricate understanding of your dental procedures, belief in your skill and competence, and their ability to take this information and influence patients` behavior.

Providing total quality care rests on keeping abreast with change. Does your hygiene department offer bleaching, sports guards, halitosis treatments, oral cancer exams, routine blood-pressure screenings, smoking-cessation programs, nutritional counseling, placement of tetracycline fibers, implant care, extensive preventive-maintenance therapy, advanced soft-tissue management programs, a new patient experience, computer-based case presentations, Web site information, digital radiography, or emergency triage? Do the hygienists actively participate in providing customer service, patient satisfaction, marketing initiatives, or community services?

When assessing the outcomes from the hygiene department, you should notice an increase in identification of dental disease from radiographs, a decrease in delinquent payments due to clear treatment plans and financial arrangements, an increase in referrals for biopsy, an increase in patient treatment acceptance, and an increase in new patients.

7. Include a hygiene assistant.

Creating an environment for the hygienist to utilize an assistant is based on similar principles for those used in four-handed dentistry. It will increase the production of the hygiene department. Be current with your state`s rules and regulations, and maximize those tasks that legally may be performed by either the hygienist or assistant. The hygiene/assistant team working in tandem will afford the patient a unique experience of personalized care while managing staff-overhead costs.

8. Develop the hygiene department into a marketing center.

Do your hygienists serve as ambassadors for your practice? Do they realize their networking potential with each patient? Do they understand that each experience they create for a patient is a "marketing moment" - or that the kind of customer service they provide to each individual patient builds or destroys the practice?

What is your team providing to your patients that isn`t being done by other dentists in your community? What puts your hygiene department above the rest? Does it send follow-up care notes, remember special events, and stock a variety of preventive aids for every situation? Can the hygienists present effectively to the patient the need for treatment? Are they a recognized dental-community resource involved in promoting dental health, organizing school field trips to your office, creating educational promotions, and designing newsletters or writing articles? Develop your personalized list of direct and indirect marketing strategies that can be achieved by the hygiene department. List the strategy, how it can be accomplished, and how it will be measured for success.

9. Monitoring and accountability

The size of your hygiene department will determine how you structure monitoring methods. Those practices with multiple staff members, especially those reliant upon part-time employees, will find that identifying a team leader or department liaison is an effective way of keeping the dentist and team informed. Routine meetings within the hygiene department and weekly meetings between the doctor and liaison will maintain stability.

Team members need to develop daily plans that include maximizing productive patient-appointment time. Too often, patients leave the operatory only to have the hygienists realize he/she didn`t assess the need for radiographs or sealants, forgot to demonstrate a preventive aid, or failed to explain how a bridge is made. Reviewing records, assigning anticipated treatment to the best team member, determining that adequate time is reserved, troubleshooting broken appointments, and establishing a plan for effective use of unscheduled treatment time are essential.

When evaluating the success of a new policy, randomly select patients who have participated in the new procedure. Then, compare them to randomly selected patients who did not participate.

For example, patients who participate in a new-patient model program should be tracked by identifying treatment recommended, treatment completed, dollars invested, and recare scheduled vs. that of nonparticipants. There should be a measurable difference in the choices patients made regarding needed care and an increase in dollars spent based on patients` understanding of their needs. Similarly, after establishing protocol for a periodontal-management program, random sampling of patients needing periodontal treatment should track patient acceptance, patient compliance, improved periodontal condition, and dollars spent. Patients actively involved in treatment will refer other patients more than healthy recare patients will. Monitoring will provide measures of success and indicate where procedural changes are needed.

Within two months of re-evaluating the PAN policy, one office identified a patient with a mixed tumor of the Parotid and another with lesions of endodontic origin on a maxillary central and lateral. The intent is not to have patients choose unnecessary treatment or to provide care based on old habits, but to consistently reassess the needs of the individual. When your ethical decisions are intact and sound, the practice`s profits will rise.

10. Invest in your hygiene department.

Use the available computer technology to monitor your department`s financial growth and reward the team for its successes. Create a budget that can be expended on continuing education, advanced technologies, new instruments or equipment, preventive aids, or creative marketing. Research the people you employ and hire the best. When you create an atmosphere for the team members to participate actively in their patients` well-being, the practice will profit and both staff and patients will be retained.

These steps will take time and will shift how you approach your hygiene department. Your hygienists, patients, and practice will notice and appreciate the difference. Begin today and take those first steps.

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