Hygiene

The Hygiene Department in the Contemporary General Practice

Individual soft tissue management programs in today’s dental practices have become quite successful, both in terms of clinical excellence and financial benefit. However, there is a lot more to a successful dental hygiene department than the implementation of a soft tissue management program. The purpose of this article is to provide the dentist with a blueprint for managing a successful hygiene department in today’s dental practice.

The decision to pursue clinical excellence is always the most important first step in this process, however this is only the foundation. The success of any dental practice hinges on a secure clinical foundation and sound business strategies. There are four main areas that can help dentists maintain a high level of clinical excellence and financial stability in their hygiene departments.:

* Developing a soft tissue management philosophy;

* Defining and communicating the dentist’s vision;

* Providing leadership and empowering the staff; and

* Tracking the practice’s vital signs.

Developing a Soft Tissue Management Philosophy

It is first necessary to address the clinical periodontal foundation of a patient-centered practice. Because of the current understanding of periodontal disease, based on years of clinical research, dentists have the ability to help their patients achieve perfect soft tissue health. This is defined as 0 to 3 mm pockets, etiology present only within the sulcus, and no bleeding on provocation. To develop a soft tissue management philosophy in which this standard is the goal, the dentist must first define six key procedures that routinely occur in the hygiene department. They are periodontal screening, comprehensive periodontal examination and charting, continued care (prophylaxes), periodontal maintenance, gingivitis therapy, and periodontal disease therapy (root detoxification and debridement). To define these procedures, the dentist needs to translate personal philosophy into writing, using the following guidelines:

* At what interval are all of the services provided? Three months, four months, six months?

* What team members are responsible for providing the services?

* What are the appropriate fees for each procedure?

* What communication does the dentist expect the patient to receive during each of these services?

* What visual educational support does the dentist expect the patient to receive?

* What type of documentation does the dentist expect, and where within the charting system will it occur?

* What are the clinical criteria for successful completion of each of these services?

* For what procedures is microsonic therapy indicated?

* When are site-specific antimicrobial medicaments indicated?

* When is laser therapy indicated?

* What are the clinical guidelines for referral to the periodontist?

By applying these guidelines, the dental team can begin to create treatment plans that go beyond mere calculus removal.

Defining and Communicating the Vision

Once the dentist has established a sound soft tissue management philosophy, he or she must communicate this to the team so it can be effectively executed. Team continuity and aligning staff members’ philosophies with those of the dentist is the first step in this process. One can start by sharing and committing to a practice mission statement, which is a hallmark of the patient-centered practice.

There are four steps necessary to refine hygiene department management. They are:

* Communication;

* Time management;

* Leadership of the team through mentorship; and

* Restorative procedure distinctions.

For communication to occur, the hygienist must understand and promote the dentist’s restorative and esthetic diagnosis. Hygienists will need to effectively incorporate all of their periodontal responsibilities as well as the procedures desired by the dentist if they are to achieve effective time management. leadership from the dentist is essential if team discussions on clinical philosophy and guidelines are to occur and the priorities and goals of hygiene management for the practice are to be mutually accepted and carried forward by all members of the team.

The restorative procedure distinctions may be difficult for the hygienist to master. For the hygiene department to effectively support the dentist’s restorative treatment plan, the following areas need to be discussed. First, each hygienist must understand his or her role in the discovery, communication, and educational support of the patient’s restorative and esthetic concerns. Next, the dentist must communicate how the hygienist will deal with any incomplete restorative and aesthetic treatment plans. Third, guidelines for fillings, veneers, bonding, bleaching, and other restorative procedures must be clearly articulated and supported.

Providing Leadership and Empowering the Staff

Business consultant Ken Blanchard said about partnering for the future, "The quickest way to increase dignity, meaning, and community in a workplace is to involve people in redesigning their work. That is also the shortest route too -- in the long run -- to lower cost, higher quality, and more satisfied customers."¹

A successful practice is not solely measured on production and collection numbers. Committed, empowered employees are found in successful dental offices. The dentist has involved the team in future strategies and implementation plans. Practitioners who are interested in creating such an atmosphere should read about successful companies or corporations and redefine and emulate their strategies for dentistry. The principles of managing a service-oriented business like dentistry are the same as those of a successful company. The hygiene department within the practice should be managed like a business within the business.

Tracking Practice Vital Signs

To achieve and maintain success, one must track the practice’s vital signs: key statistics that tell how well the practice is doing financially. If it can’t be measured, it can’t be managed. Tracking and monitors may seem like wasted paperwork to some team members; and they can be, if they aren’t consistently reviewed and analyzed. Vital signs that must be tracked to ensure the level of success one sets out to achieve include:

* Periodontal treatment diagnosis and case acceptance.

* Restorative and esthetic treatment diagnosis and case acceptance.

* Percentage of treatment service provided per month (e.g., 1110 -- 22 percent, 4341 -- 33 percent, and 4910 -- 45 percent).

* Production totals: hourly, daily, monthly, and year-end.

* Collections: acceptable accounts receivable percentages, expectations of over-the-counter collections.

* Openings in the schedule: How many, percentage to the number of appointments, what kinds of appointments are canceling? Which team member did they last see?

* Continued care system: percentage of patients that stay active each month, percentage of time allocated per day to work the system. When are the cards sent? Are appointments confirmed and if so, when? What is the communication the dentist expects?

* Reactivation system: number of patients per month reactivating? Percentage of time allocated to call? What communication is being used? What and when is written communication appropriate? Percentage of results of reactivating patients back into the practice?

While some areas can be tracked using the practice’s computer software, others will require a manual tracking method. For example, are cancellations distributed evenly between the hygienists in the office or do they tend to occur primarily with one hygienist? What type of appointment is canceled most, for example, are supportive periodontal therapy appointments canceled at a much higher rate than any of the other services? If so, the practice needs to identify the missing communication and educational support during those appointments.

Conclusion

The hygiene department is the backbone of the general practice office. It is the vehicle through which the patients attain the highest level of soft tissue health. It also gives the dentist and the team the opportunity to treatment plan patients based on their restorative and esthetic wants and needs. Management of a successful hygiene department requires the development of a philosophy for treatment and communicating this to the staff. Committed, empowered employees are essential to practice success and must be developed. Finally, the key performance indicators must be monitored and the team must be kept on track and motivated through effective leadership.

Authors

Peggy Lee Sprague, RDH, and Jan Lazarus, RDH, are co-founders of JP Consultants Institute, Periodontal Team Management.

References

1. Blanchard K, Mission Possible : Becoming a World-Class Organization While There’s Still Time. McGraw-Hill, New York, 1999.

To request a printed copy of this article, please contact/Peggy Lee Sprague, RDH, JP Consultants Institute, 7200 Hyannis Drive, West Hills, CA 91307.