Six steps to making the dental hygiene department a profit center

By Debra Seidel-Bittke, RDH, BS
February 22, 2013

For many years, the dental hygiene department has been thought of as a loss leader. Furthermore, many dental professionals believe they must see more patients each day and complete more procedures during a patient appointment to become more profitable. If you are a dental hygienist, you may hear the phrase “increase profits” and cringe while thinking of working longer hours.

The good news is that this doesn’t have to be the case for you! Some hygiene departments are more profitable than others. I’ll tell you why and share the secrets to success in six steps. Times have changed, and the business of dental hygiene can mean profits for the entire dental team. When the correct systems are in place, a day in the dental office will feel less like a migraine and more like a mission accomplished

1. Understand the importance of the hygienist’s role
Hygienists play a huge role in the growth of a dental practice today. In fact, the hygiene department should be the second-largest profit center in the dental practice. Think of the dental hygienist as an ambassador for the dental practice. Indeed, the hygienist is in a very unique position, spending a large majority of one-on-one time with patients in the chair. The hygienist is first in line to present the risks and benefits of preventive and aesthetic dental treatments. The dental hygienist can set the stage to help patients accept treatment plans, large and small.

Furthermore, when a hygienist sees the same patients multiple times a year, he or she has a chance to develop personal relationships with these patients – and this means building more trust. This added trust will, then, make patients more likely to listen to the hygienist’s treatment plan suggestions and more likely to ask the hygienist for help in their decision-making process.

Examples of where a hygienist can – and should – get involved with suggestions and decision-making include:

• Choosing the best restorative options
• Deciding upon various cosmetic/aesthetic procedures
• Understanding preventive products, such as power toothbrushes, and knowing which one is best for them
• Choosing which mouth rinse to buy and what toothpaste is best suited for their oral condition

2. Foster daily teamwork
All successful businesses begin with a collaborative team. Even the vocabulary the world’s most successful businesses use will describe their employees and show the companies’ high regard for teamwork. Wal-Mart employees are known as associates. When you’re a guest at the Ritz Carlton, employees and guests are known as “ladies and gentlemen, serving ladies and gentlemen.”

There’s no reason your dental office can’t emulate (and profit from) these very same values. For starters, everyone should be on the same page. Each member of the dental team needs to be enthusiastic and well versed in discussing the benefits of preventive and aesthetic dentistry. Also, the doctor and the auxiliaries must share a practice vision and philosophy for patient care. That’s where dental professionals can make a difference. Expert dental coaches can analyze your dental office’s highest potential and create a custom, step-by-step plan that capitalizes on your practice vision and brings you more success than you thought possible.

Meanwhile, start with a morning team huddle to get your team on the same page, and if you don’t already, plan monthly team meetings to provide a time for collaboration and exploration of new ideas and systematic processes. This is where the right hand learns what the left hand needs to do, so to speak. Then, your team will have the ability to be in complete harmony, which leads to higher profitability. Taking time during team meetings to set the backdrop for a seamless day at the office creates added value to the patient services, and the team doesn’t feel dead at the end of the day.

Let’s not forget the value of dental team-to-patient teamwork. When the dental team takes time to review its patient communication skills and the team understands how to communicate the science behind the art of dentistry, patients see the opportunity for (and importance of) optimal health. This is when it becomes a winning situation for the patient and the dental practice. See a trend here? If you can build a relationship where the patient looks to the hygienist as a trusted advisor, patients are more willing to agree to an optimal plan of care, which means better health for them. And remember: Happy patients refer other patients to your office. It’s a win-win situation.

3. Move beyond the prophy
A critical item to discuss in your team meetings is changing your practice’s treatment approach paradigm. Many dental practices in this new era of preventive dentistry face challenges moving from the prophy to treating the patient’s total health. Many dental hygienists today still feel pressure to complete the cleaning when, in fact, the most important service they can provide is education and a treatment plan to reverse the disease process.

Diagnosing and treating based on what insurance will cover or based on what the patient wants, instead of what the patient needs, helps neither your patient nor your practice.

So here’s another example that demonstrates the value of your dental hygiene department: When the hygienists regularly move beyond the prophy, they add value to the patient’s services. Most patients see their dental hygienist more often than their physicians. And when you begin offering a variety of services, such as blood pressure screenings, oral cancer exams, fluoride treatments, xylitol products, periodontal exams, smile analyses, etc., you increase the value of your services and your patients start to see amazing potential to improving their overall health just by visiting the dentist. Plus, many of these services incur a small fee, adding to the profits of the dental hygiene department.

Afraid you’ll scare your patients away if you go beyond the prophy and present a treatment plan that’s in their best interest? You won’t, if you show patients you’re on their side. You can’t go wrong with stating the facts. Always present the scientific evidence to support your findings. Then, show patients their options, along with the risks and benefits of completing or not completing treatment. It is when you discuss the science and your expert knowledge of oral health that you add value to your services. The increase in profitability will come alongside when patients sit up, listen, and then take action to treat their disease.

4. Tap into the recare/continuing care system gold mine
Remember that myth that was busted at the beginning of this article – you don’t need to pack in extra patients each day to build profit? If you’re still wondering how this works, the answer is in your practice’s recare/continuing care system, with your hygiene department at the helm.

Imagine the hygiene department as an energy cell and the recare systems the mitochondria of the dental practice. When a well-developed system is in place, your practice will experience increased profits.
The key is in pre-scheduling. That is, before the patient leaves the hygiene room, the hygienist or hygiene assistant schedules the patient’s next appointment. The hygiene department has the best auxiliary to schedule the next appointment because they intimately understand the patient’s needs and desires for the next appointment and the necessary procedure to schedule. This is your ticket to success: You must have close to 95% of your hygiene patients leave with their next appointments already scheduled. And you should know the barriers and patient objections that may occur ahead of time so you can plan accordingly in your team meetings.

For example, many times patients will not know what they are doing in two weeks, and especially they may not know their schedule in four or six months. So, the hygienist and the hygiene team need a plan of action to communicate with patients who may object to scheduling a next hygiene appointment.
Short on ideas? Try this: Take time during a team meeting to role play and create a plan of action for various types of objections patients have toward scheduling a next appointment. Also, keep in mind that so many people these days carry smartphones with their calendars, so a patient with a device like this can easily check his or her schedule and add to it instantly.

One dental practice our team of experts worked with originally had 75% of their hygiene patients leave the hygiene appointment without scheduling a next appointment. With help and guidance, the team has taken on a new attitude. Here is an example of a patient dialogue after the team changed the way it communicated and viewed the appointment schedule.

Kris (hygiene assistant): Beth, I understand that you travel a lot, but I want to make certain that you return in three months for your regular maintenance appointment. Today, I found a few areas that are bleeding, and I am concerned that if you call us to schedule your next hygiene appointment, we won’t be able to accommodate your schedule. I want to suggest that you make your next hygiene appointment today so we can attempt to accommodate your busy travel schedule. If you find you can’t make this appointment, then you are welcome to call us a month before the appointment to reschedule. I know you prefer to come later in the day, and we have so many patients who want that time of day, so it is best for you to schedule this appointment today and only change if you find there is a conflict.

Beth (patient): Kris, I understand what you are saying. I am a procrastinator, and I can see how waiting to make my next appointment can most likely create more problems in my mouth. I really do not like hearing my gums are bleeding, and I believe that I can rearrange any travel plans or change my work schedule so I don’t have to change this appointment. From what I heard today about my mouth, I really want to take better care of my teeth and gums. I never knew how important the gums are to my overall health.

Kris: Beth, I am so happy that you understand how important your oral health is to your overall health. We can see you on Tuesday, November 12th at 3:30pm. Will this time work for you?

Beth: I’m looking at my calendar, and I don’t see any conflict with this date or time so let’s schedule it!
Notice how this type of communication between the patient and hygiene auxiliary allowed the patient to be in control. Beth felt involved in the process of scheduling her next appointment. Beth took responsibility for her health, and she was an active participant in the conversation.

This dental team also has changed to a blocked or tiered schedule, which can better accommodate new patient appointments, alongside the preventive care appointments, periodontal maintenance appointments, and scaling and root planing appointments, etc. Not all patients are seen at the same interval of time, but the office can accommodate patients in a timely manner with this type of scheduling system.

5. Improve cancellation rates
Scheduling the recare/continuing care appointment is only half the battle, though. The recare/continuing care appointment is the most canceled and failed appointment on the dental schedule. And one cancellation per day in the hygiene department will lead to what is called a loss leader. This means a loss in the hygiene and doctor productivity. Many offices experience a cancellation and patient appointment failure rate of 25%, but this need not occur when you use the strategies I suggest. In fact, a realistic goal to set when following these suggestions is 95% or better in scheduling effectiveness.

The most important strategy: Have written guidelines for patients that explain what will occur when they cancel an appointment at the last minute or fail to be present for their scheduled appointment. Some practices post these in a visible place in the office, in addition to having new patients sign that they’ve read and understand the cancellation policies.

Just make sure you write your expectations using positive words. Check out our example below of guidelines written in a positive manner:

We will always respect your time, and our team will make every effort to schedule appointments that accommodate the needs of all of our patients. In return, we ask that our patients make every effort to keep their reserved dental appointments. When a patient appointment is broken or an appointment is missed, it creates scheduling challenges for other patients as well as for our dental office.

Our dental office will charge a fee for cancellations and appointment failures without 72 hours notice. We understand that emergencies and personal situations do arise, so after a series of two failed or broken appointments outside of the 72 hour guideline, a charge will apply to your account before a next appointment is scheduled.

When effective communication occurs between the patient and the dental team, a change in the patient’s attitude occurs, which translates into improved patient compliance. Consequently, the dental practice will see a reduction in cancellation and appointment failures.

6. Measure your success
Seeing the fruits of your labor is extremely important to continued success. Knowing exactly how much your numbers have improved each month can guide you to know where more potential remains. Not to mention, seeing your improvements is a huge morale booster. Now you know that all your hard work was worth it!

Not sure how to track your progress? It is recommended that each month, the hygiene team or office administrator run and review (with doctor) a production analysis report. This report will analyze all dental hygiene procedures each month to determine what percentage of production the appropriate hygiene department codes represent. What better time to review the data that tracks the hygiene department’s effectiveness than during your monthly team meeting?

It’s exciting, actually. You’ll see that when you implement many of the assessments and procedures just described, you will experience at least a 30% increase in your hygiene department within the next six to nine months.

Services that may account for this increase in hygiene profits are fluoride treatments (utilizing the evidence-based science from CAMBRA), sealants, antimicrobials, xylitol products, oral rinses, toothpastes, 5% sodium fluoride for at-home use, and power toothbrushes.

A final word: The 21st century is a new era for dentistry, and particularly dental hygiene. Cleaning teeth is no longer the standard of care. In fact, I suggest removing this word from your dental practice terminology when talking with patients. Today’s dental teams must talk to their patients about prevention, and the dental hygiene appointment is actually a preventive care appointment.

If the patient has any level of disease, the time to treat is now! Take the classic example of a patient in the early stages of periodontal disease. Phase I of non-surgical periodontal treatment ends with the periodontal maintenance, which is a four to six week post-operative appointment to evaluate the disease state. The last appointment of Phase I non-surgical treatment is the first of regular periodontal maintenance appointments. The patient who does not have a healthy evaluation must return for more treatment in the Phase I level of treatment. In fact, this is the time where you may need to refer the patient to a periodontist.

If a patient is healthy at the final evaluation (the first periodontal maintenance appointment) then he or she will return consistently for the rest of his/her life every three to four months for periodontal maintenance. Periodically, a patient may have episodes when disease returns, and the hygienist will need to schedule the patient to return for scaling and root planing – and even antimicrobial therapy.
All that said, you must communicate with all periodontal patients that periodontal disease is episodic and share the idea of “once a periodontal patient, always a periodontal patient.” If the patient has a hard time taking the information seriously, explain that his/her situation is the same as when a patient is diagnosed with high blood pressure or diabetes (and various other disease conditions). The physician will always monitor the disease state, even when everything seems to be normal.

Most successful dental businesses have implemented these systems. No longer will you hear that the dental hygiene department is a “loss leader.” Expectations of the dental professional may be high, but remember, you don’t have to take this path of success alone. Begin with these few guidelines to get on the path to where you want to be. And remember, Dental Practice Solutions has many experts available to guide you along the road to success, so don’t ever feel like you have to walk the path to success alone. Dream big and happy planning, as you embrace this new era of dentistry!