No More 'Just a Cleaning, Please' — How To Build the Ideal Continuing-Care Department

By Amy Morgan, CEO, Pride Institute

Does everybody recall the Wizard of Oz tale in which Dorothy had to follow the yellow brick road through a series of adventures only to discover that she had the capacity to go home from the very start? I find that story very similar to the dentist who believes that she has to go through a series of systems adventures to attract new patients and increase productivity when all she has to do is recognize that her continuing-care department can provide her with all of that and more! How? Well, all you have to do is click your ruby slippers together three times and what will be revealed to you are the secrets of the ideal continuing-care department.

We all know that the traditional hygiene recall appointment has changed (and hallelujah for that!). Why? Even the term "recall" sounds like: "I am not human; I am a car with a part that isn't working, so I am scheduled for maintenance." In that maintenance visit, the frustration is that the mechanic always finds many other parts to fix, costing much more than planned. No hygienist or dentist wants to be perceived in the same role as that of a car mechanic! Today's continuing-care appointment is more than just a cleaning. It is the practice's primary tool to:

• Ensure your patients are receiving the most comprehensive dentistry possible

• Make certain that your patients remain loyal and committed to the practice's vision and values

• Create an experience that exceeds expectations so patients enthusiastically recommend your practice to family, friends, and colleagues, and serve as ambassadors for your level of service and care.

So what would an ideal continuing-care department need to look like in order to get the outcomes just described? First and foremost, the hygienists in your practice must, as part of their job description, know that they are your copilots in each patient's quest for long-term oral health. This means that they are responsible for delivering the clinical care of hygiene efficiently, effectively, and profitably, but they are also accountable for supporting and promoting restorative and esthetic needs that will benefit the patient and support the practice's long-term goals and strategies.

Think about the last interview that you conducted with a potential new hygienist. Were your questions all about periodontal maintenance and expanded clinical skills or did you place as much emphasis on customer service, self-direction, teamwork, and influencing? Inadvertently, we can create a limited job scope that reduces the effectiveness of that potential employee by more than 50% when we only focus on the delivery of direct hygiene production.

Once you have a hygienist hired, you want that hygienist to be aware of delivering state-of-the-art continuing-care processes that exceed clinical expectations. This can include focusing on questions such as: Are you actively involved in soft-tissue management? Are you utilizing Arestin®? Are you using the intraoral camera? Do you do sealants? Do you inspire patients to explore esthetic and functional alternatives such as implants, Invisalign®, teeth whitening, or crown and bridgework? An effective and productive hygiene department can — and should — produce 25% to 35% of total office production on an ongoing basis.

Beyond direct hygiene production, we at the Pride Institute consider the most important factor of an ideal continuing-care department to be the purposeful conversations that happen during the adult prophy, periodontal maintenance visit, or the quadrant of scaling and root planing. Purposeful conversations identify and address patients' motivators and concerns; educate patients about periodontal disease, oral health issues, and esthetic alternatives; build patient commitment for lifetime oral care; support patients' self-esteem and success; and encourage patients to refer new patients.

What could a hygienist say to identify motivators and concerns? It could sound like: "When you last saw Dr. Smith, you shared with her that keeping your teeth healthy and beautiful was very important to you. As your hygienist, how would you like me to support that goal?" What would it sound like to educate a patient about periodontal disease and overall oral health and esthetic issues in order to recommend restorative and esthetic solutions? It could sound as simple as: "I am about to call out a series of numbers which measure bone loss, gum erosion, and signal potential aggressive periodontal infections that would need to be handled with assertive therapeutic solutions. Anytime you hear me call out a number higher than a four, keep track on your hands because we are going to need to discuss what plan of action we'll need to take to address your health concerns." Or "Do you realize how Invisalign® could assist not only with the crowding issue on your bottom teeth and make them look straight and pretty, but could actually reduce the potential of future periodontal problems due to the crowding and the inability to be able to get to the tough spots?"

Now, if your head is spinning and you are already saying: "My hygienist would never a) be able to say this and/or b) be willing to do this," then my challenge is to you! I work very closely with our clients' hygienists internationally and I can tell you that these professionals want to be the very best and deliver the very best, and they are waiting for the structure and guidance to be able to continuously grow. Those who are not should not be working in your office.

A great step zero to begin to create the momentum for a stronger and more formidable continuing-care department is to have a hygiene philosophy meeting with your hygienists and team. The meeting would include: What is our vision in continuing care and does it reflect the outcomes we most desire? Is it a vision of periodontal therapy and long-term support of function and appearance concerns? If yes, this means that a random analysis of continuing-care charts would show proactive disease prevention and intervention happening on most of your patients through individualized plans customized to meet their unique needs, right? Or are you a "just a cleaning" based practice? Are 90% of your visits just for prophies? How much scaling and root planing are you doing? How much time do you devote to periodontal disease as well as patient education on long-term health and function? Do patients' charts and radiographs reflect continual deterioration? Do you have an abundance of emergencies on a daily basis from patients of record who may or may not have been diagnosed with prevention steps prior to the emergency during a hygiene visit? A deep discussion with problem analysis and solutions to address the above is essential for new, upgraded processes for continuing care.

Now, this might not be easy to look at but the truth shall set you free. If you don't want to be a supervised-neglect practice or the classic auto mechanic experience, you have an abundance of opportunities to make it better. Not only does attention to continuing care create a patient experience that is significant and memorable, it also creates a mission for your team to rally around. So, I am the good witch and I want you to click your ruby slippers three times and upgrade your hygiene department!