Interdependence within and beyond the practice

Oct. 1, 2004
The U.S. Surgeon General's report issued in 2000 emphasized that dental health care in the United States needs to focus seriously and immediately on prevention and on prophylactic measures that ensure healthy teeth and gums for children and adults.

Cindy McKane-Wagester, RDH, MBA

The U.S. Surgeon General's report issued in 2000 emphasized that dental health care in the United States needs to focus seriously and immediately on prevention and on prophylactic measures that ensure healthy teeth and gums for children and adults. The same report also focused on the incontrovertible connection between the mouth and body. This should be of primary concern not only to hygienists but also to each member of the dental team; and to medical practitioners in every medical specialty ranging from obstetrics to cardiology to pediatrics to geriatrics. Government officials who have the interests of their constituents' oral health in mind must also focus on hygiene. The same goes for manufacturers and insurance carriers whose bottom line is influenced by the value of their products and services to their clients, dental practices, and patients. Print and electronic media journalists who deal with health issues should not be left out of this equation. Their sound bites on the potential of prevention in dentistry can be an invaluable tool in improving the nation's oral — and overall — health.

Clearly, the 21st century hygienist does not practice in a vacuum. He or she is part of a team that goes beyond the walls of the dental practice. Hygienists also practice "within the walls." They work in dental practices that are peopled by other dental health care professionals in an environment where an even more powerful interdependence should exist. Within a dental practice, each department and individual contributes skills, talents, resources, and knowledge.

The dental practice is a microcosm of what occurs on a global or national level — a partnership of team members. As with global or national conglomerates, if a problem emerges in one sector, it is likely to have an impact on another. The ultimate goal of the dental practitioner should be to preclude these problems or to minimize their impact. There are several ways to do this. The first is to focus on business.

Over the last few decades, the nature of business in the dental profession, as in other spheres, has changed. Business in the 21st century is characterized by interdependence. Few businesses, even small businesses, can survive as totally self-standing entities. Most rely to some degree on what has evolved as a global economy of partnerships with other businesses or even other countries. Within these interdependent partnerships, someone provides the raw materials while someone else produces a finished product. Someone provides services, training, or packaging; someone else provides a market for goods or services. The interdependence within this array of partnerships relies on communication, technology, access, stability, and successful policies and politics. It succeeds when there is equitability and a give-and-take relationship through which all participants benefit. When one partner feels exploited, undervalued, disenfranchised, or left out of the profit cycle, the entire system is affected.

All of this applies to the business of dentistry, and particularly to an understanding of hygiene as the heart of practice success. One of the things that every member of the team must be made aware of is that hygiene promotes business. An effective practice productivity/profitability program, with the dental hygiene department at its core, can improve case acceptance percentages for the entire practice. A hygiene department operating at peak efficiency can improve the level of quality patient care, ensuring patient satisfaction and patient loyalty to the practice. It also can do much more. Hygiene is the "glue" that connects preventive with restorative dentistry. It is the glue that cements the clinical components of a practice to its economic components. And, it should be the glue that creates strong bonds among all team members.

Hygiene, however, cannot succeed without the cooperation and participation of the entire team. Just as the entire team must recognize the importance of hygiene, hygiene must be fully apprised of the importance of every other practice position. The emphasis must be on "team" and on "us." Scheduling, case acceptance, customer service, collections, marketing, quality, and integrity as they apply to hygiene are everyone's business. Obviously, hygiene depends on the functions of others team members to be successful — the way hygiene interfaces with dentists, administrative and financial staff, and dental assistants determines how successful hygiene will be. Ideally, the individual parts are integrated to create a viable whole.

This requires consummate cooperation from each member of the practice team. People being people, this focus on hygiene as the hub of a thriving practice sometimes creates bad feelings in other dental team members. Are their jobs less important? Are their skills less important? Are they less important? Hardly. As the role of hygiene within the dental profession grows, the importance of every other team member increases exponentially. Each team member, in assuring the strength and power of hygiene as the preventive pulse of the practice, should also become stronger and more powerful.

If hygiene is in the limelight, so is every other department and every other individual connected to the practice. Teamwork is essential. Partnership is essential. Cooperation and integration are essential. Interdependence is an absolute.

All team members play a critical role in nurturing patient confidence and trust in the preventive work of the hygiene department and the practice. This by no means places other team members in the position of "supporting cast" that serve only to make the "star" look good. They become stars in their own right and their work should be Oscar-quality work. Whether they schedule appointments for the hygienist, process bills and insurance claims for preventive dentistry, assist patients in filling out medical questionnaires that provide the hygienist with critical information, or order supplies that are needed for the hygiene operatory, they need to perform in a manner that exudes professional excellence.

The hygienist, in turn, needs to interact with other team members in a manner that ensures the facilitation of their functions and responsibilities. The productivity of other team members is enhanced only to the extent that the hygienist contributes vital information and support. For this reason, the hygienist must understand and recognize fully the dynamics between hygiene and collections, hygiene and housekeeping, hygiene and marketing, hygiene and restorative dentistry, hygiene and practice philosophy, and hygiene and practice economy.

Within these dynamic interchanges, there is no room for ego. Everyone is important. Everyone contributes something. When even one element goes missing or is undervalued, the result is a precarious imbalance that can have a deleterious effect on other elements. When this happens, the team suffers, patients suffer, and the practice suffers — as well as productivity and profitability.

To prevent this, a practice must ensure that hygiene and prevention are viewed as an integral part of an equation whose variables contribute to global success. This is an equation that characterizes the most successful businesses. For example, every successful business provides a service or a product on which its success is centered. Yet, every successful entrepreneur recognizes that success is impossible without the respective contributions of all team members or employees or staff. The high-powered sales representative cannot succeed unless the individual pulling the lever on the assembly line is performing his or her job correctly. The receptionist who answers the telephone or greets visitors cannot succeed if the telephone connections are unreliable or the front office is not presentable. The financial coordinator in a dental practice cannot succeed unless the hygienist has provided accurate and complete information about a treatment plan or a procedure. The hygienist cannot succeed unless another team member has seen to it that the hygiene operatory is stocked with educational materials or has called a technician to fix the glitch in the intraoral camera.

Interdependence also means a commitment to improving the intangibles of a business. Self-esteem and pride, for example, must be global and must be bolstered not only by the CEO but also by others on the team. Acknowledgment for a job well done and appreciation for assistance or support should come not only from the top but also from everyone. Team and individual confidence should be nurtured not only by the dentist but also by the dental assistant, the hygienist, and the financial coordinator. Certainly, a positive attitude should be directed at patients, but it should also be standard operating procedure during team meetings and at other times when no patients are around to witness it. Communication among team members should be as good as communication between team members and patients. Quality control should be a global concern; a matter of team pride and team ethics as well as a matter of professional or legal standards. Team motivation should be as important as individual motivation. Ideally, the focus is on "us" not "me."

In exceptional business, all of these concepts are mastered through training and education. Nevertheless, on this subject of training and education, some businesses, including many dental practices, "miss the boat." For training and education to work, it must be viewed as a tool that empowers and creates potential. It must be innovative and challenging. It must provide a rationale and it must be ongoing. What was learned years ago does not necessarily work today. What was learned a single year ago may not be keeping up with today's technology or science. What was learned even a month ago may be useless unless it can be applied or implemented in a way that produces results. Knowledge without purpose is not really knowledge. By the same token, heavy doses of coursework and seminars that simply reinforce or update what was previously learned are not good enough. If you teach people to make hamburgers the same way, you'll keep getting the same hamburger. If you teach them to look at hamburger as a raw material that can be combined with other raw materials in a different way, you'll get something better.

Institutions of higher learning that focus on training dental team members are a case in point. There is a tendency to segregate and focus on this job skill or that job skill without looking at the big picture of how these skills mesh. So, a hygiene student is taught all about prophys and a financial coordinator is taught all about processing insurance claims and a dental assistant is taught all about how to sterilize instruments. In the practice that wants to maintain a competitive edge, this is not enough. For one thing, it reinforces all too strongly the "me-ism" that prevents teams from working together effectively.

Alternative programs emphasize "teamwork," either as part of degree-focused curriculums or as seminars that can be used for continuing-education credit. With many of these courses, however, the thrust is too general and the approach suggests that the goal is keeping everyone working harmoniously as if that were the only goal. It isn't. The ultimate goal should be a team that works harmoniously to achieve two far more important goals: the physical health of patients and the financial health of the practice.

Ultimately, the objective is to embrace an educational process that recognizes the connection between clinical skills and business skills as well as the connection between hygiene and other practice departments. Such programs exist on academic campuses or as in-house training. They work by empowering team members to become better team members. They promote independence as well as interdependence.

Every lesson in "what" also is a lesson in "what for." Teams learn how significantly their work impacts hygiene and that work takes on new meaning. Hygiene learns how it fits into a global design and how others fit into it. It begins to promote better teamwork. When everyone is aware that success depends on everyone being successful, it is in everyone's interest to make success happen. The result is synergy that has dramatic results. It cannot fail because everyone is on the same page and everyone is committed to make it work.

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