Empowered Performance

As you start your dental career, you may be expecting thousands of dollars of restorative treatment on your schedule every day, having every patient say yes to treatment plans and immediately scheduling

exactly what you’ve r e c o m m e n d e d . Sounds good, right? The reality is that with high level communication skills you can get pretty

close to this. But there will always be patients that say, “No,” or, “Not now”. So in order to produce $80,000 per month in restorative, you must present two, even three times that much treatment each and every month. The good news is that you don’t have to do it alone. Empowering your team, specifically your hygiene team, to help you enroll treatment will be one of the biggest keys to your success. Here, I’ll share with you some of the inside secrets I learned from years as a clinical hygienist in high-performance practices and years as a hygiene consultant helping practices grow. This brings up the first of a series of steps in creating a powerful hygiene department that keeps your schedule full with comprehensive care, creating an empowering environment.

Step 1 - Empower your hygienist by clearly stating that you are confident in their dental knowledge and skill

Unfortunately, we hygienists are sometimes stifled by what we can’t do versus being inspired by what we can do. So, when you say to your hygienist that you would love to see more restorative treatment coming out of hygiene, your hygienist might look at you and say “What part of ‘hygienists can’t diagnose’ do you not understand?.” If she doesn’t say it, there is a good chance she’s thinking it. What I have discovered is that when hygienists say “I can’t diagnose,” what they are really saying is “Show me a way through this barrier.”

Then, set out your expectations regarding co-diagnosis. It may sound something like this:

“I respect you as a highly skilled dental professional. To effectively support our patients in staying healthy, I need your help. Patients trust you and your opinions. To work as a team, we must all have the same beliefs in what is best for our patients. I would like to spend time with you reviewing my personal treatment philosophy and why I make certain treatment recommendations. This will allow us to discuss areas in which we may have different opinions on treatment and resolve them. Although it is my job to make a final diagnosis and treatment plan for our patients, I do expect you to contribute to that diagnosis with thorough observation and education of our patients. I will give you all the tools you need to feel comfortable doing this including specific training

Empowering your hygienists to maximize what they can do is powerful. When this shift occurs, hygienists are in a position to begin a whole new phase of their career: one filled with satisfaction and challenge. That new energy might be just what you need to turn hygiene from a loss-leader into a thriving source of growth for your practice.

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on how I diagnose and treatment plan a variety of dental conditions.”

Step 2 - Give your hygienists permission to observe restorative needs and to begin educating patients on those conditions

This includes permission to participate in diagnosis, not only for perio disease but for restorative needs as well. Give permission to think in a broader sense when reviewing X-rays, intra-oral photos, etc.; to think beyond calculus and gingival health and begin to think about what might have caused that abfraction on No. 11; to think about what you might recommend to strengthen that broken second molar; to look at X-rays and analyze the root tips as well as the bone level.

powerful.

Step 4 - Case review

I want to be very clear here. The doctor makes the final diagnosis and creates the final treatment plan. That being said, it is well within the parameters of the hygiene position description to offer information to patients about what conditions he or she has observed in the patient’s mouth. This prepares your patients for your recommendations.

Every practice has a gold mine waiting in the charts in the form of treatment that has been planned but not scheduled. In the case that all treatment planning is completed at the new patient visit, there is a perfect opportunity for hygiene to view the next phase of treatment and bring this to the patient’s attention without the specifics of “diagnosis” being an issue. Taking photos of the quadrant reminds the patient of their problem and opens the lines of communication before the doctor even enters the room.

Step 3 - Clearly communicate your treatment philosophy

Often, dentists assume that since their team works with them each day, they are familiar with their treatment philosophy. This may be true, but there may be some specific aspects of treatment where staff may need more information. Confusion about your treatment philosophy creates inaction. When your hygienist is not totally confident with your treatment philosophy, he or she may be reluctant

to reinforce recommend care to patients. Being unsure about how you would plan a restorative case is another key challenge that must be overcome before there is consistent enrollment taking place in hygiene.

Case Review

These case review guidelines are designed to facilitate learning between the dentist and team. The objective of case review time is to expand on the technical knowledge of hygienists and improve consistency in treatment recommendations between the dentist and hygienist. Initially, this should consist of two one-hour sessions in which the doctors and hygienists review the recommended treatment of a few chosen cases.

Empowering your hygienists to maximize

what they can do is

Doctor’s Role: • Give hygienists permission to think more like a dentist when viewing diagnostic information • Instill confidence in the intelligence and technical knowledge of the hygienist • Utilize one or two cases with complete x-rays, perio chart. A complete treatment plan, intra-oral photos and clinical notes are very helpful. • Explain what you saw during examination and give specific reasons for the treatment planned • Give team guidelines for ideal examination according to doctor’s preference

This may be the most important tool in increasing co-diagnosis in hygiene. First and foremost, all the dentists in your practice must on the same page. If you go through the case review process together before including the staff, it will create a “united front” for the team. I’ve had the opportunity to coach some very large practices through this process. While each dentist has or her own preferences and beliefs, in a large practice consistency is critical.

Below is a guide to walk you through a case review session. During this time, you will review several patient charts, discussing the treatment plan and what brought you to create that plan. You may discuss what cues you to recommend a crown versus an onlay versus a composite filling. Are there certain criteria that you use to determine the best treatment? Share those with your team and be specific. Utilize intra-oral photos and take photos during your restorative procedures to show your team how decay invades the inner part of the tooth when it’s allowed to grow. Use these photos to create a sense of urgency for your team to share this with their patients.

Exam Guidelines from Doctor to Team

Top three Items to look for when viewing X-rays • Alveolar bone quality, interproximal tooth structure, ratio of tooth vs. amalgam, #mm b/t pulp and restoration, periapical lesions, etc. • Top three to look for during Intraoral exam • Tissue health, broken teeth, fractures, fistula, suspicious soft tissue lesions, darkness around restorations, quality of restorative margins, etc. • If X-rays look like ___________, pre-frame patient for treatment • If Intra-oral photos look like ________, pre-frame patient for treatment Hygienist’s Role: • Be open to learning and asking questions

The Case Review session is a time of open learning, a safe environment where there are no dumb questions or wrong answers, only opportunities to learn. When reviewing the patient charts, have on hand the x-rays, any intra-oral photos, periodontal charting and the current treatment plan. This will support your diagnosis and explanation of the plan.

• Receive the challenge to think more like a dentist as a huge opportunity for growth and to increase level of patient care and education • Ask yourself *If I were an endodontist/periodontist/prosthodontist what would I see? *If there are fractures/cavities/wear patterns, which teeth have them? *If I see a problem on the right side, is it also present on the left?
• Have team develop a treatment plan *Hygienists create a treatment plan with the available information *Doctor reviews their mock treatment plan and gives feedback Going through such an exercise can help you in developing strong team support of your treatment philosophy. Including assistants and administrative staff in this meeting can be valuable. With every team member giving patients the same message, success is a given.

Review each Case: • Review each treatment plan • Ask yourself *Are there any teeth that are questionable as to what type of restoration is best? *Is there more than one treatment route available to this patient? *What is the most conservative treatment possible? *Are there external factors (health, habits) that affect the success of the treatment plan?

Following and implementing the steps outlined in this article will result in noticeable increase in restorative treatment enrolled in hygiene. Creating an empowering environment is just the beginning; to find out how to create a system for hygiene co-diagnosis that is lasting and dynamic go to www.InspiredHygine.com to get your free audio CD of “The 3 Secrets to Increase Hygiene Diagnosis”. ■

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As owner of Inspired Hygiene, Rachel helps dentists tap into hygiene’s profit potential. In addition to coaching, Rachel draws from her 18 years of experience as a hygienist and practice administrator to deliver to-the-point articles and speaking programs. She has spoken across the country including the AACD annual session and the popular The Profitable Dentist seminar in Destin, FL. Rachel’s articles have been published in numerous industry journals including The Profitable Dentist, Dental Practice Report, Dentistry Today, RDH, and Modern Hygiene. Inspired Hygiene’s programs include in-office coaching, a free weekly e-zine, the High Performance Hygiene Mastermind group and the new High Performance Perio webinar series. Inspired Hygiene is the preferred hygiene coaching group for the Productive Dentist Academy. To contact Rachel, email her at Rachel@InspiredHygiene.com or call 877-237-7230.

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