Hygiene coordinators - Can they help grow your practice?

April 1, 2000
If you do it right, you can ensure that the addition of a hygiene coordinator will provide a powerful return on your investment.

If you do it right, you can ensure that the addition of a hygiene coordinator will provide a powerful return on your investment.

Risa Pollack-Simon

In the year 2000, the dental hygiene department has taken on more responsibility and influence than ever before. Along with these extra responsibilities comes a demand for extra treatment time. In most dental offices, however, the ability to provide extra time is very challenging within the current administrative structure.

Efforts to optimize technological advancements seen in instrument designs and power scalers have helped the hygienist gain greater access and root adaptation, which could ultimately save time and enhance the quality of care.

Preventive techniques and antibiotic therapies also can support optimum oral health. These treatment modalities, however,cannot build relationships or ensure consistent comprehensive quality care. However, when modalities such as these are combined with a coordinated team approach, the practice gains a multitude of benefits.

Building the hygiene team

The foundation to any effective hygiene department stems from a strong alliance between the dentist and the hygienist. This relationship must contain mutual respect, coordination of skills, and realistic time schedules to support consistent, comprehensive quality care. If these critical elements are lacking, the team cannot meet professional standards of care, thus sabotaging the primary objectives of its continuing care program.

Ideally, the hygiene team should never be rushed or pushed just to "get through" the procedure to stay on time. The importance of taking a little extra time to explain smile enhancement options more thoroughly, illustrate restoration failures more precisely, or even demonstrate home care instructions more carefully become your key strong suit when building patient loyalty.

This is of particular importance for those practices that choose to build their restorative procedures from existing patients-of-record. Management experts believe that one-third of doctor production should be referred from hygiene. This goal cannot become a reality if we do not have the time to see beyond the subgingival view and realize that there is a human being beyond the proposed treatment site. This realization encourages consistent, comprehensive continuing care and puts less of a demand on the need for volume new patient activity.

While dental offices strive to refer from hygiene, they still are unwilling to schedule an extra unit of the doctor`s time to accomplish this goal. The fear of lost production and/or excessive interruptions in treatment (which exist anyway), preclude these options.

This is even more evident when a typical hygiene appointment is assessed on the amount of time it takes to "clean teeth," rather than accounting for the total experience which includes debriefing, educating, collecting data, and helping the doctor to co-diagnose and present treatment options.

Simply put, you cannot effectively gain restorative referrals from hygiene or build patient loyalty when you are driven by unrealistic time frames. When the hygiene department is supported by proper scheduling systems and a strong customer-service touch, desired results can be actualized. Furthermore, the doctor`s time can be maximized by having all necessary diagnostic aids (including images from the intraoral camera) ready for transfer.

When the patient is informed about what to expect during the doctor`s exam, the process will flow more efficiently. To ensure consistency and stay on time, the hygienist must transfer the data collected to the doctor immediately following the arrival greeting. This will expedite the fact-finding process and eliminate redundancy in the patient interview, as well as target areas of concern during the examination.

Enter the hygiene assistant

Would you like your hygiene department to become more effective, fulfilled, and profitable? Ever consider adding an additional team member to your hygiene department to help you provide extraordinary care? Now I know what you are thinking: more staff equals more overhead. While that fact cannot be disputed, the strategy detailed in this article includes an insurance policy to receive a powerful return on that investment.

We are referring to an assistant for the hygienist, known as the hygiene coordinator. While this concept of a hygiene assistant is not new to dentistry, it lacks clarity and historical trends - which consequently continue to feed the objection pool regarding economic concerns. A combination of poor selection, inadequate training, and under-utilized individuals accounted for several practice failures and a very undesirable track record.

Purpose

The purpose of employing a "hygiene coordinator" (or HC) is to provide more time for relationship- building, education, and presentations. This concept gives the hygiene team the ability to blend the human side of patient relations with the technical side of comprehensive continuing care - key elements that support case acceptance!

The HC concept is designed to encourage universal assisting duties (legally allowable in your state) to be delegated to bright, motivated, and lower-wage employees. This process allows the hygiene therapist to focus on high level tasks that they are fully educated and skilled to perform.

Ingredients for success

The success of the HC position relies on the acceptance of hiring an additional staff member. This concept is not intended to steal or borrow other workers away from their required duties. Even though it is quite tempting, this arrangement only takes others away from their primary responsibilities, thus leaving you with half-hearted helpers and frustrated team members. This negative routine never will completely meet your level of expectation and only will compromise the success of the program.

Since the HC responsibilities will include patient reactivation and scheduling, a mature individual with, ideally, some dental background, should be utilized. The individual also should demonstrate a creative work style and express a desire to be involved in the decision-making process. This trait will encourage consistent input on improvement strategies.

ASSESSMENT PHASE I

Determining your needs

Step 1: Evaluate abilities of existing employees

Before considering this position, be certain to honestly assess your current team`s abilities and needs. This will avoid potential sabotage from soon-to-become resentful staff. It will be extremely challenging for a practice to effectively or financially create a new position within an overstaffed employee pool. Even though you may not be getting your needs met, be sure to review contributing factors that may be affecting your existing staff, such as poor scheduling, underutilization, lack of teamwork or burnout. Perhaps an employee evaluation or replacement may be called for before embracing this concept.

Step 2: Time management

Next, evaluate time management issues associated with required responsibilities. For example, determine if your hygienists realistically can perform all of the duties you would like them to perform during each patient visit - without running over schedule! Refer to the "Sample listing of hygiene responsibilities" chart on this page. If you find that all duties can be performed without compromise, you can stop here. If not, continue on with step three.

Step 3: Identify desired results

Step three forces you to be clear about what you want to change and/or improve. Begin by identifying desired results that currently do not exist. List each desired result. For example: "I want patients to be more prepared for the periodic exam to save time and increase case acceptance."

Step 4: Identify required tasks

Step four paints a picture of the process that will enable you to better visualize the master plan and the action required to achieve it. Begin step four by connecting the action behind the result. Identify the task to be delegated to each desired result. For example: "The hygiene coordinator will help the hygienist collect and transfer data (charting, digital images, pictures) for both periodontal conditions and restorative considerations, prior to the doctor`s arrival."

Step 5: Attach a benefit statement to the action

The fifth step broadens your perception of benefits and ensures that your entire practice will improve from the action. Step five actually moves each task down the field for a touchdown. All three elements can be tied together by creating an accompanying benefit statement for each task and associated desired result. Begin by listing the patient benefit statement and attach it to the action required. Then finish it off with the result you desire. For example:

Benefit statement: "To best serve my patients in the area of esthetic dentistry, improve their self-esteem, and increase case acceptance."

Action: "The trained hygiene assistant will capture images of the areas of concern and denote issues discussed with the patient during the debriefing session."

Desired result: "To enhance patient awareness and create interest and desire in obtaining treatment - (prior to the doctor`s arrival), which will expedite case-presentation time, reinforce the learning process, and increase case acceptance."

ASSESSMENT PHASE II

The bottom line

If by this point in this article, you have warmed up to the idea of incorporating an HC into your practice, additional steps must be completed before plunging forward.

Step 1: Cost-benefit analysis

The first step requires a cost-benefit feasibility study from your consultant or accountant. For example, will the HC increase production? Increase case acceptance? Increase the number of hygiene patients seen per day/month? Will the HC help increase referrals by strengthening patient loyalty?

Step 2: Non-monetary benefits

You also should consider the humanistic benefits achieved from sharing the work load which can otherwise lead to burnout. The mere ability to delegate and work as a team can enhance professional fulfillment significantly and ultimately secure long-term commitments with your practice. When the producer is less rushed or hurried in his/her approach to patient care, the quality of time and scope of service can be notably enhanced. When you add up the potential return on investment - from less stress, more thorough and comprehensive patient care, and greater pride in service - a more fulfilling career is born! This process increases production by reinforcing patient loyalty and case acceptance.

However, as the old saying goes, "Buyer Beware." Do not get blinded by the production increase or you`ll lose sight of overhead increases! It is critically important that the total economic picture be assessed and that specific elements are put into place before adopting this concept.

Step 3: Identify staff objections

The most obvious concern for the business owner is increased overhead affected by increased staff salary. The least obvious concern is a staff focused on the fear of tightened purse strings, loss of raises, or diminishing bonus programs. To that end, each practice must assess the cost effectiveness by evaluating the projected return on investment. Remember, you must ensure that the benefits outweigh the risk!

Step 4: Monitor effectiveness

To ensure that the cost of investment is well worth the risk, you must develop a plan to increase production (expediting procedures, increased case acceptance) and secure patient loyalty through a sound continuing-care system. If these objectives cannot be actualized, the true need for the HC must be carefully re-evaluated.

Be certain not to cut yourself too short - or wait to long while evaluating the effectiveness of your program. Ideally, a three-month period of time will suffice as an adequate amount of time to review results. If goals are not realized within that time period, a practice should either consider replacing the individual or discontinuing the position.

The master plan

Each practice must have a well-executed master plan. The key function of the master plan is to outline the job description and the performance monitors. It must detail specific duties and responsibilities, as well as performance objectives. For example, if the job responsibility is to manage the recall system, the master plan must state how it is to be managed (running missed recall reports, phone follow-up, letters, etc.) and the target percentage of recall retention must be identified (85 percent).

In addition to the details of the written plan, a respect oath must be taken by all staff members. This involves a pledge to recognize and honor the HC job description (and not abuse the primary focus of the position by turning the HC into a gofer). By doing this, existing staffers will be given boundaries and a better understanding of how disrespectful behavior can lead to failure. With that understanding comes a stronger desire to keep their respect oath, which ideally will help the HC feel accepted. The timing of acceptance is very important. If you do not achieve a comfort zone from all staff members within the first few days, you may end up with a reluctant or insecure helper who will never have an opportunity to bloom to full potential.

A perfect, low-risk scenario would be to incorporate an HC into a practice that is unable to see another patient in hygiene for at least three weeks or at a time when there is a shortage of hygienists in the area.

Two rooms vs. linear

Practices that can provide a second treatment room, (in addition to the main hygiene room) can dramatically maximize the use of an HC. When a second treatment room is not available, the doctor can consider linear scheduling for long appointments on special days. Linear scheduling strategically schedules the doctor for sequential primary appointments that only require one room. This would allow the primary hygiene room to be "dovetailed" into the extra hygiene room, thus providing two rooms for one hygienist assisted by a HC.

When using this two-room concept, it is critically important to ensure the economics. Bottom line, the hygiene production must equal three times that of the total hygiene-department salaries (hygienists + HC).

This strategy will ensure that while overhead will increase, the percentage of overhead stays the same or decreases and net stays the same or increases. When an extra room is utilized, it is equally important to ensure that production potential is not taken away from the dentist.

This is of particular importance when the dentist is limited to one room on these occasions. Therefore, linear scheduling should only be offered on special days of the week or month and should be closely monitored to ensure that this concept does not "rob Peter to pay Paul!" With this in mind, the extra room should never be considered essential, but rather as one approach to optimizing the use of the HC.

Multiple hygienists

Another example of HC utilization would include assisting multiple hygienists, all of which are operating out of one treatment room each. If you still are unsure that this position would be worthy in your practice, remember that in down time (if that ever exists), the HC can be reactivating recall or securing daily production by "massaging" the schedule - an ongoing responsibility that no one ever seems to have the time to do!

Remember that your goals related to patient care, retention, and production must be written down in detail. To secure success, be certain to monitor each goal so that it can be tracked to justify that these goals are relevant, realistic, and achievable - and are on target!

Results must be monitored by production and production must be compared to salary overhead (with a goal of salaries not exceeding one-third of production). For long-term security, a practice also must monitor changes in patient care, along with environmental improvements.

The value of stress reduction, team cohesiveness, and patient- appointment availability (which may appear to be superfluous) can be essential to long-term practice growth. For that reason, it should not be overlooked or undervalued.

The big picture

Preparation, planning, and goal-setting always will support low risk and ensure a high return. Smart practices that remain committed to attracting, training, and retaining high-caliber staff with interdependent, overlapping talent and skills will find the most reward in partnering relationships.

To that end, the hygiene coordinator concept is not to be confused with promoting a lazy hygienist, but rather as a means to fulfilling the objectives of providing the highest quality of care in a "stressless" environment. The overriding goal is to help the patient achieve and maintain optimum oral health for a lifetime - ideally a lifetime in your practice!

*A special thanks to the following sources for their contributions to this article: JP Consultants, West Hills, Calif; Jameson Management Group, Davis, Okla.; O`Grady & Williams, Los Gatos, Calif.; McKenzie Management, La Jolla, Calif.; and Dr. Charles Blair, Blair/McGill & Hill Group, LLC, Charlotte, N.C.

For more information about this article, contact the author by phone at (800) 366-8326. A biography of the author appears on page 12.

Visit Risa Pollack-Simon online at

www.simonsaysseminars.com

Sample listing of hygiene responsibilities

1. Prepare hygiene rooms

2. Greet the patient

3. Seat the patient

4. Update the patient`s chart

5. Take, process, and mount necessary X-rays (or capture digital images)

6. Review OHI

7. Probe and document pocket depths and tissue health

8. Administer anesthetic (when legally allowable)

9. Scale and polish

10. Collect restorative data

11. Capture images on the intra-oral camera for ease of case presentation

12. Educate and motivate patient

13. Enter/chart all newly proposed treatment during the periodic exam

14. Irrigate with anti-microbials

15. Apply fluoride

16. Take impressions for bleaching trays or other occlusal considerations*

17. Apply sealants*

18. Decontaminate treatment rooms

19. Sterilize/sharpen instruments

20. Post charges

21. Reschedule continuing-care appointments

22. Manage recall reports and subsequent follow up

23. Help fill in last minute changes in the hygiene schedule

24. Manage inventory control

*When previously diagnosed

Position profiles and duties

The ideal applicant to target for this position should be a mature individual that has excellent communication skills and enjoys educating patients. They need to get along with the primary hygienist(s), and feel a sense of co-ownership in the hygiene department.

Responsibilities must be clearly identified along with a clear description of the practice`s desired attitudes and aptitudes for the person applying. The objective of the HC should ideally be to facilitate patient flow.

Hygiene Coordinator Duties

- Room preparation

- Greeting

- Seating

- Charting

- Taking, processing, and mounting X-rays (capturing digital image)

- Capturing photos on intra-oral camera

- Taking and pouring impressions (i.e.; bleaching trays)

- Fabricating bleaching trays

- Assisting during administration of anesthetic, sonics, polishing, sealants, and exams

- OHI, nutritional counseling, fluoride application, smoking cessation

- Scheduling continuing-care appointment

- Scheduling supportive periodontal treatment

- Entering proposed treatment

- Securing financial arrangements on all new treatment

- Entering charges on completed treatment

- Escorting patients to financial coordinator

- Decontaminating treatment rooms

- Instrument sterilization

- Making calls and sending out letters to people on the missed recall report

- Recovering last minute cancellations, otherwise overlooked by the administrative staff

Is your practice ready for a hygiene assistant?

* Is hygiene retention 80-85 percent of all active patients in your practice?

* Is the hygiene department producing approximately one third of overall production?

* Is the hygiene department increasing case acceptance (hygiene therapy, restorative, and esthetic cases)?

* Do your hygienists have enough time to discuss new advances in comprehensive periodontal, restorative, and esthetic care?

* Are hygiene patients offered timely appointments at ideal intervals?

* Are your hygienists monitoring your "missed recall report" monthly?

* Can new patients be seen within 7 to 10 days?

* Is someone overseeing the hygiene schedule to manage last minute "fall out?"

* Do your hygienists run behind often?

* Do your hygienists feel burned out or stretched too thin?

* Are you pleased with the quality of care your hygienists provide?