*The following blog includes key takeaways from recent webinar led by Cindy Mark
Most of the questions I have from dental offices center around hygiene open time. Hygiene open time can appear as either an isolated problem, or a symptom of many other systems that are not in line with the growth of the rest of the practice. Moreover, if you have not built a strong foundation, the cracks can become apparent in other systems.
The key areas that I will be looking at include:
- knowing the Hygiene KPI’s (Key Performance Indicators) in all areas of your hygiene department,
- balancing your supply of hygiene hours versus the number of hours needed for your patient base,
- are you using Tracker to your advantage,
- learning to communicate in a way that puts patients’ needs first,
- having a Standard of Care protocol on the hygiene department.
Key Performance Indicators, aka: KPI’s, should be tracked on a regular basis. Whenever I talk about industry norm, this is the goal you are usually aiming to achieve. Sometimes this isn’t always achievable, so you may need to choose some smaller goals on your way to achieving industry norm.
For most practices, 10% hygiene open time is an industry norm. Unless you are picking patients up at their houses, a goal of 0% is unreasonable. We can do our best to get patients to the office, but we are not miracle workers! If you regularly have less than 10% hygiene open time, then perhaps you are not offering enough hygiene time. If you have more than 10% hygiene open time, then you may be offering too much hygiene time OR you need to make adjustments in patient education, team communication and hygiene systems. Luckily, Tracker has the End of Day Summary, which measures open time. Some offices see the solution to a surplus of open time as closing off open times, and then asking a hygienist to come in later or leave earlier. This time needs to remain open to count open time properly. As well, by doing this, you are limiting access to likely prime time appointments.
The KPI, or industry norm for hygiene billing per hour, should be looked at regularly as well. A hygienist’s billing should be based on their scaling, polish, and fluoride codes ONLY. Additionally, for these codes, it should be $190- to $210- per hour. You can easily take these figures from your End of Day Summary.
Patient retention rates in the hygiene department should be 80% of your patients participating in the hygiene program and keeping within their diagnosed treatment intervals. To compute this, if you have 1000 patients who had recall exams in the last 12 months, then you would expect to have 200 patients left on your appointment manager with pended appointments OR approximately 17 patients per month that haven’t booked during the time that they were due. It doesn’t mean that they are forgotten, it just means that they may come after their due date. You need a steady stream of new patients as one of the ways to keep your hygiene program healthy.
For offices that have extra space, or if they are making the decision to increase hygiene hours, it always feels like a guess as to whether you need to add more hygiene hours and how much to add. The number of hygiene hours offered each month must balance with the patient need for hygiene care each month. To determine the number of hours that you supply each month, calculate the number of hours that you have the hygienists scheduled for time with patients for the month. Calculating the patient demand is simple if you have been doing a good job of setting the recall interval for each patient. You will multiply the number of patients in each hygiene interval by the number of visits each year. This will be the total number of hygiene visits needed each year. A 3 month interval patient would need 4 appointments, whereas a 4 month patient would need 3 appointments, etc. If your office has not been updating this in the patient profile, then today is a good day to start!
Your Appointment Manager is the ultimate source for filling your hygiene schedule. The first area that I see problems is that there can be 15 to 20 different reasons for hygiene appointments in the drop-down list. You should have approximately five different hygiene reasons in your list (recall adult, scale, recall child, first child visit, np hygiene) any extra information can go into the details line for example – q1, 4m, needs bw. If you use colour coding for each reason, it will make it even easier if you are looking for a particular type of appointment to fill an opening.
Once a patient has been contacted, you will want to forward their follow- up dates to help you moving forward to sort when the next date is best to contact a patient. I suggest moving forward the follow up dates for three weeks from the day that you contacted the patients. Two weeks may make patients feel like they are being stalked, yet three weeks is usually more comfortable for the patients. Using the follow up dates accurately will cut down on some of the confusion when you open the appointment manager. Also, decide on a time range to appropriately keep a patient on the pended list. My suggestion is that any appointments that have been pended for longer than two years should be removed from your pending list.
On the lower left corner of the appointment manager, you can choose the number of days forward that you want to see the pended appointments. Most users will keep it on the shorter range, between 1 and 30 days, this is good to hone in on a shorter list of patients but at least once every two weeks choose the longer range of more than 100 days. You will likely find that this change in sorting will capture some patients that may have previously been missed with the shorter list.
The ability to put patients on a waiting list is a great opportunity to create a list of patients who need or want a short notice appointment. By building yourself a pool of short notice patients, you will be able to fill openings more easily. Wouldn’t it be great to have a short notice cancellation and know that you have a resource of patients there you can call? Some offices use the Waiting list for parking patients who haven’t rejected or accepted treatment. They are just on the listing waiting – for what I am not sure? If patients aren’t proceeding with treatment, mark your appointments accordingly and use the list for patients who need same day/short notice appointments.
Team communication is key to keeping your hygiene program healthy. Uniform communication through the office will link the clinical and admin team and the patients will hear that everyone is speaking the same language. Use the morning huddle to help the team’s day run efficiently, as well as ensuring an outstanding experience for every patient, and to make sure everyone is on the same page. The team should decide where notes should be kept in common places in Tracker. It should be easy for everybody to find the same information without going hunting for it and wasting time. This is important even in small offices. In a small office where one or two people are administrators, there is often a tendency to have a lack of notes. The reason is because they are the holder of all memory or information, so why bother to put in the note if you remember everything. The problem with this is that unexpected work absences occur, lotto max wins happen, and all that information is at home with the person who would normally be the provider of the information, so even if you know that Jim always prefers a call three hours before his appointment to remind him, that needs to go into Tracker in a common spot, in case you aren’t there one day to call Jim yourself.
It’s great that most offices connect with patients in the way that they most prefer, usually texting, cell phone or email these days. Patients who are more responsible will see the text and call the office right away to book. Unfortunately, many of us are busy and even with the best intentions that text reminding you to book has gotten buried by the time that you have some free time to make the call. This can lead to your system having very passive contact with a patient; it is easy to ignore a text or email. To have a system that is more reactive, you will want to mix up your tech touch points with personal touch points. This is the most effective way to have patient compliance. Patient preference can be set on the patient profile.
Every hygienist should have the same note template, and the template should be compliant with CDHO guidelines. As well, all hygienists should agree to the order of notes. The reason for this is if a different hygienist sees a patient, or a dentist or administrator need to look through the chart, you want to ensure that the chart is easily maneuvered, and information won’t be missed, or time wasted searching for the information.
Patient education through the office needs to be the same from the dentist to the hygienist, to the assistant, and to the administrator. How confusing is it for the patient to hear the “same” thing described three different ways. As a team, sit down and decide on a description for all the different scenarios that may describe hygiene education. It shouldn’t be a script per se, but the same points need to be described by everyone. The more often a patient hears the same information, the more likely they are to be compliant. We are all guilty of talking in short form when we describe hygiene treatment to patients, because we talk about it all day and we naturally shorten descriptions. Keep in mind that while many patients are listening to what you are telling them, it may not make sense to them. The administrators should be able to describe the need for patients coming every three months, as well as a hygienist or dentist. The patient may nod yes when in the clinical chair, but once they get up front or on the phone, they may wiggle out of that three month appointment if the administrator is not well versed in that area. When a dentist comes into the hygiene room to do a recall exam, there should be a verbal hand- off between the hygienist and the dentist. Having a stickie on the counter behind the patient’s head is not good enough.
Pre-Covid, it was a bit easier to talk a patient out of a potential cancellation, but now times are different and if a patient says they are sick we don’t have much re-course. Our best re-course now is to have the waiting list and booked list well populated with people who can come in the office sooner. You don’t want to move patients up from the same week because you are creating more issues for yourself, if you move patients too frequently, they will stop respecting their appointment times as it will be apparent that you aren’t respecting them either.
Ensure that your confirming methods are appropriate for your patients. The best combination is to confirm two weeks before their appointment, two days before their appointment, and then two hours before their appointment. Tracker’s eServices can definitely and easily automate this task for you.
We are all guilty of using minimizing language in a dental office. We do it to make a patient feel better: “it’s just a bit of decay” or “it’s just a small filling”. It helps us soften the blow of something wrong. Regarding hygiene appointments, if we use minimizing verbiage frequently, it causes patients to miss the value of an appointment.
- “I am just calling to book/confirm your cleaning”
- “You are coming in for your cleaning and checkup”
- “It’s just a cleaning”
- “It’s okay to call us closer and change your appointment”
- “It’s okay, no worries, no problem”
All of these inadvertently contribute to open hygiene chair time.
The value in hygienists booking their own patients back is immeasurable. A patient will feel more connected to an appointment if the hygienist books it and will feel that they will be letting the hygienist down if they do not keep that appointment. The patients have a trust relationship with the hygienists; they usually don’t feel the same connection with the administrators. Hygienists can easily fit this in before dismissing the patient.
If you are using Tracker properly, you won’t lose patients and you should only pre-appoint about 80% of your low-risk patients. There is nothing worse than looking ahead 3 weeks in your schedule and being able to point to patients and say: this one will cancel, this one will no show and this one will move. Why would you pre-appoint patients if you know their appointment habits already? A low-risk patient, has a steady schedule, has a good appointment history, a good financial history and is compliant with Dr. Diagnosis. A high-risk patient may have a very unreliable schedule (like Jerome and I), and they will have a poor appointment history, may have a poor financial history or poor compliance. Any one of these risks is enough to not pre- appoint a patient. If you choose to not pre-appoint a patient, please ensure that they have a pended appointment for their hygiene. Write in the reason they didn’t schedule (so you can repeat it back to them when you contact them), and let them know approximately when you will be contacting them – “we will contact you in early March to schedule your next hygiene appointment”.
We want to ensure that every patient experience in the office is a 5 Star VIP experience. We need to ensure uniformity in all touch points in the office, no matter who the provider is or who speaks with the patients. I feel that every office should have written protocols for each of these touch points. The protocols can be written as a team project and should be reviewed once a month or at team meetings to ensure that we haven’t inadvertently started taking any short cuts. The more specific the protocol is, the easier it is to follow.
There should be a Standard of Care Protocol across the hygiene department. This means that no matter which hygienist, or a temp hygienist, sees a patient, the patient is going to treated in the same manner with similar verbiage. Decide which indications or conditions would put a patient in each hygiene interval. All hygienists and Drs. need to be on the same page with these recommendations. The CDHO or American Periodontal Association will be able to provide you with a template for this and you can then customize it for your office.
Decide on all the steps that will make a 5 Star VIP experience in your office and detail it step by step from the first contact to the office to their dismissal, and ensure that each patient has that experience every single visit. There is no magic way to ensure your hygiene chairs will be full, but a series of small correct steps will have you on the path to success.
This blog is based on a previous webinar we held and can be found on our website. https://gotracker.com/membership-login
If you’d like to discuss further, please feel free to contact me!
Jerome Perreira