Dianne Glasscoe Watterson, MBA
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Dear Dianne,
About three years ago, I hired a new hygienist and decided to pay her 30% of her production. (My practice is primarily fee-for-service.) The previous hygienist was paid a daily rate and typically saw around eight patients in an 8 a.m. to 5 p.m. day. My current hygienist is very productive and sees 12 to 13 patients daily. She’s very fast; however, recently it was brought to my attention by a fill-in hygienist that many patients do not have recent periodontal chartings. I was also informed of the presence of significant subgingival calculus deposits on regular recall patients. This information has caused me to question the quality of care my current hygienist is delivering. I appreciate the strong productivity and work ethic she exhibits, but I’m concerned that she could be missing things. How can I solve this delicate situation?
Dr. John
Dear Dr. John,
Unfortunately, this sounds like a situation where production has taken precedence over quality. A solo hygienist, working alone from one operatory in an 8 a.m. to 5 p.m. day cannot possibly do everything that needs to be done and still deliver high-quality care on that many people. Corners have to be cut to stay on time, and usually the first thing to be omitted is that all-important periodontal charting, simply because it is so time-consuming.
The average time it takes for a solo hygienist to do a six-point probing with all numbers recorded, plus recession, furcations, bleeding points, etc., is 10 to 12 minutes. Your liability risk rises sharply when your patients do not have up-to-date periodontal chartings and radiographs. It is a serious issue.
However, if your hygienist was working with a qualified assistant and using two operatories, she could see the same number of patients and also keep the quality high. Peripheral duties, such as operatory tear-down and set-up, seating and dismissing patients, taking radiographs, and sterilization duties could be delegated to a qualified assistant. The hygienist could rotate between the rooms, plus she would always have an assistant to help with periodontal charting and recording. With an assistant’s help, the full six-point probing and recording takes about three minutes.
The necessary prerequisites for assisted hygiene are:
1. Two completely equipped and stocked hygiene operatories
2. An assistant dedicated to hygiene
3. Good schedule control
The trade-off is that you will have to pay an assistant. The assisted model is one of efficiency and productivity, and uses the hygienist’s time more wisely than solo hygiene.
If you do not have the prerequisites for assisted hygiene, I recommend you have a discussion with your hygienist about the need to keep periodontal chartings current for all your patients. Every adult should have a six-point probing and recording (with all numbers recorded) a minimum of once a year.
Also, you have to make it part of someone’s job description to help the hygienist get the numbers down on paper or in the computer. When you walk in the room to do your exam, ask to see the periodontal charting and radiographs if those items are not in full view.
Check for calculus deposits subgingivally on random patients if there is calculus evident on X-rays. In other words, start holding the hygienist accountable for the quality of her work. Shift the emphasis to improving work quality. Also consider changing the compensation to a base pay plus commission model.
The speed with which any clinician works is not an automatic indication of quality. I have seen fast and good, fast and not good, slow and good, and slow and not good. Since you know the standards have been slipping in your hygiene department, it’s your responsibility to take action to improve and ensure high-quality care for your patients.
Dianne Glasscoe Watterson, MBA, helps good practices become better through practical on-site consulting. Her book, Manage Your Practice Well, is available for purchase at www.professionalden talmgmt.com. For consulting or speaking inquiries, contact Dianne at [email protected] or call her at (301) 874-5240.
