Do your hygienists complain about not having time? Are they constantly behind at every appointment? Don't blame them — blame your systems! To show that 60 minutes IS enough time, Kirk Behrendt brings back Miranda Beeson and Michelle Wakeman, two of ACT’s amazing coaches, with a framework to help you master the hygiene workflow. To learn how to take control of your time, listen to Episode 713 of The Best Practices Show!
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Main Takeaways:
Quotes:
“If there is a problem like that where there is a team member who is running behind, or running late, or doing notes at the end of the day, it's not that person that is the problem in your practice. It's that you don't have efficient systems established within that 60-minute appointment.” (6:20—6:33) -Miranda
“Nobody wants to be behind. That's not the goal of any hygienist that I've ever worked with in my entire career. Most of us want to run on time. In fact, it's one of the most stressful parts of your day, literally watching the clock and knowing that every hour you have another patient that you have to be fresh and ready and prepared for. So, if you have the ability to do that and do your job well in a timely manner, it's going to be hugely helpful. I mean, we all want to use the bathroom during the day. That's all a hygienist wants, is to have time to use the restroom.” (6:39—7:07) -Michelle
“During that diagnostic portion of the appointment, that first 20 minutes, that's really your time to get your patient seated. We're going to start off with your pleasantries. And I know one of the big issues that a lot of hygienists talk about is, ‘Oh, my patient is a talker.’ You know that you have that patient coming back and you're like, ‘Oh my God. Mrs. Jones is going to want to tell me all about her cruise.’ So, one of the ways that I have figured out around that is setting an expectation at the very beginning of the appointment of, ‘Hey, Mrs. Jones. I want to make sure that I have time to catch up with you, so I've set aside five minutes for us to catch up. And then, we're going to jump into your hygiene appointment today.’ That way, the patient knows, ‘Oh, she actually cares and does want to speak with me. However, I'm here for a hygiene appointment. I'm not here for a social visit.’” (9:00—9:44) -Michelle
“The other thing I can't emphasize enough is the importance of preparation. How much easier is it when you know exactly what procedures you need to perform for that patient? So, during your morning huddle, going over any issues that patient had previously so that you know, ‘I know we talked about a crown last time, so I'm going to update those intraoral photos for some co-education.’ After that, you're going to go ahead and call your doctor in. Once the diagnostics are done, you're ready for your hygiene exam.” (10:05—10:33) -Michelle
“Language matters. Make sure when that doctor is coming in you let the patient know that they're coming in for a hygiene exam, not a hygiene check. Most of the time, the doctors aren't checking up on their hygienists’ work. However, they are performing an exam. Let's give some importance to that examination. I've had patients in the past say, ‘Oh, I feel like you do all the work here,’ when the fact is that, no, I'm doing your hygiene appointment. However, the doctor's role is super important in making sure that they are doing all of the necessary diagnostics and exam to give you the best chance of fulfilling your oral health goals. So, make sure, as a hygienist, that you really talk about the importance of that periodic exam and what that doctor is coming in to do for you as a patient.” (10:36—11:18) -Michelle
“We are in control, as the hygienist, of this hour-long appointment time. And so, we're going to have to manipulate these segments to whichever way we need to see fit to make sure we still accomplish what we're set out to accomplish for that day. That goes back to preparation. If we know what we need to accomplish during this appointment and we know, ‘Okay. I had 60 minutes, but now I have 50,’ then I have to be the one who's in control of this time piece and start to figure out how to tweak where to push, where to pull. My patient is talking. I'm going to talk when I take my hands out of their mouth so that they can't until my hands go back in. That’ll save me an extra five later. So, there are little tricks and tips, for sure.” (12:55—13:37) -Miranda
“One of the efficiency tips in this segment is what Michelle mentioned, which is calling for that exam once the data is gathered. So, be prepared as much as possible with your chart prep, knowing what you need, and then calling for that exam once you have the diagnostic data. That gives the doctor 40 minutes — or possibly 30 if we're running 10 minutes behind — to join us throughout that appointment for their examination.” (13:38—14:00) -Miranda
“I believe that a three to five-minute window for a periodic exam is reasonable. Now, that is with a trusting relationship. The doctor can trust that I, the hygienist, have completed all of the steps within the diagnostic portion of the appointment to be able to provide them with the data that they need to have an efficient exam. If a doctor doesn't trust the hygienist is doing that, they're going to feel the need to cover all the bases over, and over, and over. I may say, ‘I've already reviewed the X-rays. We identified this, and we'd love your expert opinion.’ Trust me, the doctor might go through every X-ray again with the patient, which then prolongs it. So, there are a lot of pieces that come into making that three to five-minute exam work.” (14:15—14:59) -Miranda
“What happens when you do have that patient that has something out of the ordinary going on? I know in the past what worked really well was, if we're getting outside of that periodic exam window and we realized that, ‘Oh my gosh, this is probably going to run longer than a normal periodic exam,’ potentially rescheduling that patient for a consultation with the doctor. Still having them come in for that periodic exam, but then setting aside some time outside of your appointment window for them to come back and really revisit anything that's beyond what you would expect in a periodic.” (15:25—15:55) -Michelle
“If there's an overflow op and we know we're going to be pushing into the next appointment time, then maybe we can do the hand-off in the overflow op, and now we can get back to setting up for our next appointment, and the doctor and the assistant could complete the exam in another operatory, same day. It just depends on the situation — how much are we going to need to treatment plan, how much are we going to need to talk about today, and the patient themselves and their learning style.” (15:58—16:22) -Miranda
“If you have a team member . . . running behind and it's this one hygienist, 15 minutes behind — she's 15, 20 minutes into every next appointment, cannot run on time — instead of being frustrated, aggravated, venting to another hygienist in the practice about it, complaining to your coach about it, or your colleagues about it, have a conversation with that hygienist. Because like Michelle said in the beginning, hygienists don't want to not meet your expectations. We don't want to run behind. It's stressful for the hygienist as well. So, have a conversation to say, ‘Hey, what's going on? Maybe there's something that we could align better on.’ If the hygienist tells you, ‘Here's the thing. You come in in the last five minutes, and then your exams take 12 minutes. So, I'm running 15 minutes behind. But I think if we could align better, doctor, on how to navigate this exam issue, we might be in a better place.’ And now, you can come together, developing that team member and developing a system together to make sure that in the future it functions more efficiently.” (17:43—18:40) -Miranda
“The therapeutic hygiene section is where we do our “cleaning”. It's our cleaning time. If anyone knows me, they know that's not my favorite word for hygiene services. But we know it's the most universal explanation. That's when we have our therapeutic hygiene time. So, this is the working segment of the appointment. We're not really having as much conversation now as we were at the beginning. We were gathering data, we were getting to know each other, we were connecting. Most of this 20-minute segment is built around the actual, physical working time spent doing therapy — biofilm removal, calculus removal, managing the periodontal state, preventing periodontal disease. And so, a key to remember during this segment is that if it takes more than 20 minutes, it might possibly be something more than a recare.” (18:56—19:43) -Miranda
“This is one of the biggest things that we come back with when working with teams, is we talk about 20-20-20 and the teams are like, ‘Yeah, but what about that patient who's overdue who has calculus?’ And I have to say like, ‘Oh. Well, are they actually a maintenance patient, at that point? If they're bleeding in over 30% of their mouth, if they have subgingival calculus because they haven't been in in 18 months, or 24 months, or for some people even nine months, then are they actually a prophy today? Are they actually a periodontal maintenance still today, or has disease either activated or reactivated?’ And so, that's a piece that I think is really important for teams to think about. Whenever hygienists challenge back that 20 minutes isn't enough for the therapeutic time, I wonder, are we truly maintaining or preventing, or are we doing more? . . . Are we serving champagne and charging for water at this visit? Sometimes, I think we are. I think we're performing gingivitis services and we're performing periodontal services at these maintenance and recare visits and really breaking our backs, and then certainly running over on time.” (19:44—20:50) -Miranda
“Most hygienists that I have encountered are helpers. They want to help their patients. And so, they feel like, ‘Hey, I'm really helping this person by getting them caught back up.’ But what I would then ask is, what is our definition of what is healthy? Are we in alignment as a team on what healthy means? Because a healthy patient should be able to have a prophy or cleaning accomplished in a 20-minute time span as far as biofilm and calculus removal goes. If those things aren't able to be accomplished for whatever reason, then is that patient even truly healthy? But what does that mean within our practice? We have to know that first.” (20:55—21:34) -Michelle
“Wouldn't it be amazing if that hygienist who is struggling sees the hygienist’s partner in her practice who does amazing and says, ‘Hey, Jane. What do you do? Because I run behind all day, and I see that you're finishing early some of the time.’ Now, what we might find is that Jane is missing a few steps that I'm doing, and maybe I'm doing some inefficiencies that Jane has mastered. And so, we can learn from each other along the way.” (22:35—22:58) -Miranda
“The workflow matters. Your armamentarium matters. If you're using hand instruments 80% of the time and mechanical instruments 20% of the time, it's going to take you longer to provide therapeutic services than the reverse of that, using our ultrasonics and our Piezon units for the bulk of the biofilm and calculus removal . . . There are things that you can do within that therapeutic segment to help shrink that time down.” (23:45—24:10) -Miranda
“I always like to think of a hygiene appointment as, I have 60 minutes. But really, I have 50 because the last 10 minutes of that appointment are going to be my time to get my room turned over, take care of all of my sterilization duties that I need to take care of, also complete any charting, and get that patient rescheduled for their next appointment. So, really, that 20 minutes of logistics turns into 10 minutes of, you're completing your doctor exam, you're putting in their treatment, gathering any referrals, any of those little clerical duties that we're doing as hygienists at the end of the appointment — wrapping things up with the patient, making sure that they understand you're taking them up front. You're doing a fantastic hand-off to your business team so that they know what that patient's next steps are. And then, again, you still have 10 minutes where you're not scrambling to get your room turned over, and maybe you even get a minute to use the restroom.” (24:23—25:19) -Michelle
“[Hygienists] wait till the end of the day [to do chart notes], which then means it's partially filtering over into the next day. Because when it hits four o'clock — or for some offices, five o'clock — our brains are fried, and so we get one or two or maybe three chart notes done. And then, we say, ‘Okay, I'll do the rest tomorrow at lunch.’ And now, by the time we get to tomorrow at lunch, we have all of the morning charts from [yesterday] that we haven't done. And we all know it, and I've done it myself, where you get backlogged, and then that patient shows up six months later and you're like, ‘Oh, no. I didn't do a note on this patient last time.’ . . . I think most laws, and certainly of care, is same day. We need to have those chart notes in, same day. That's when it's fresh what we actually did, what the patient said, what's been recommended. We're going to dot all the I's and cross all the T’s. So, that same day is really ideal. As much as you can get built in in that day is the way to go. If we push it to tomorrow, we're just kicking the can down the curb.” (27:28—28:26) -Miranda
“I also want to bring up something that we talk about a lot in ACT, which is the 80% rule. I actually use this for my charting a lot of times where I would have a template. I would get my template put in, and you can set those up in most practice management software systems pretty easily. And if you don't know how, reach out to your support with that practice software. Once you have checklists set up, and templates, it's much easier to put in the things that you write over and over again, your system, how you go through things, what you did for the prophy. And then, you're able to select the things that apply to that patient.” (28:36—29:15) -Michelle
“Get as much as you can done within that patient appointment. So, do that 80%. It doesn't have to be perfect. And then, at the end of the day, if you take 10, 15 minutes to then review all of your charts to make sure that all of your T’s are crossed and your I's are dotted, you're being really efficient with your time. And I'd love for hygienists to be efficient with their time because I want them to be able to enjoy their work life, but also enjoy their real life. Go home and be with your family, or be with your friends, or do the things that bring you joy outside of work. Don't stay there doing notes all day.” (29:17—29:47) -Michelle
“I like to treat my patients like I'm welcoming someone into my home. If someone is leaving my home, I'm not just going to say, ‘Okay, bye. See you later.’ I want them to have an expectation of what the next step is, and they don't have that if I don't take them where they need to go, physically. And I'll agree with you. It's one of my pet peeves when I'm in an office and they just throw a sheet of paper at me and are like, ‘The exit is that way.’ . . . That sense of uncertainty, it's poor customer service, first of all. Secondly, so many people come into dentistry with a sense of fear, and we're not making them more comfortable. We're not serving their needs. So, let's make sure that we're providing them with a comfortable and five-star experience by visiting us, and taking them up front and also letting our business team know what's next. Let's bring them into the conversation too.” (30:40—31:29) -Michelle
“You might, as a hygienist, be thinking like, ‘Okay, this 20-20-20 sounds awesome. Sounds like a great idea. But how do I even get started?’ One of the things that I've done in the past is a time study. You can have another team member who has a few minutes sit with you during an appointment. You can print yourself off a checklist and keep track of things like that yourself. But think about the big things, the big milestones you have to accomplish in an appointment. ‘By this time, I should be done with X-rays. By this time, I should be done with my polishing. By this time, the doctor should have come in,’ and keep track of where you're doing those things in your appointment and do it for a week. Take that time study and see, ‘Where am I taking a few more minutes than I could? Where can I borrow a couple of minutes to give myself a few more minutes for this other thing that I need to make sure is accomplished?’” (32:54—33:48) -Michelle
“A super simple version of [a time study], tomorrow morning, if you're inspired after listening to this and you want to talk to your hygienist about it, or if you're a hygienist listening, just grab a Post-it pad and write 20-20-20. When you're going through your first appointment of the day, if you're done with diagnostics and you look up at the clock and it's within the first 20 minutes, put a checkmark. If it's not, write what time it was. You get into your therapeutic time, same thing. If you get it done within 20 minutes, put a check mark. If you didn't, write down what time it was. So, yes, Michelle is right. The right way to do it, the most ideal way, is to have a tracking system, something that you do throughout the whole week, something that can collaboratively collect all of that data, and then you can reflect back at the individual pieces within those segments. But if you just wanted to, tomorrow morning, give it a try, it could be as simple as paying attention to those three segments and where am I at.” (33:51—34:42) -Miranda
“It's not a personal thing. So, let's talk about the system and how to make it better, not the hygienist and where they're letting us down.” (34:49—34:56) -Miranda
“Most hygienists, we’re healthcare providers. We’re empathetic, caring people. We’re sensitive and emotional people, and we want to be doing the best for you. If we find out later that you were talking about us to someone else, or you're disappointed in something we've done and you didn't let us know, or something to that nature — we want the feedback. We just want it in a way that doesn't feel like an attack. And so, it's not about the person, it's about the system. So, you could go in tomorrow and say, ‘Hey, hygiene team. I think we need some systems for our hygiene visit. We need workflow development. Can we work on that together?’ And now, it's about this system that we don't have that we can collaboratively create, and not, ‘Hey, you guys are running behind and I'm not going to give you more time, so we've got to figure out how to make this work.’” (34:58—35:46) -Miranda
“This is my rule. It's not a rule scientifically based, but 75% of the appointment, we should be talking to the patient about clinical healthcare conversations, and no more than 25% should be about personal conversations, either our own or theirs.” (36:02—36:18) -Miranda
Snippets:
0:00 Introduction.
1:45 Why this is an important topic.
7:51 The 20-20-20 philosophy.
8:53 The first 20 minutes: The diagnostic segment.
11:18 Tips and tricks for efficiency.
16:53 Help your team with their development.
18:47 The second 20 minutes: The therapeutic segment.
21:36 Have your team do a cross audit.
24:12 The third 20 minutes: The logistic segment.
26:58 Use the 80% rule for chart notes.
29:48 Have a system for hand-offs.
32:48 Do a time study.
34:43 Don't make it personal.
35:57 Miranda’s 75-25 rule.
36:53 About ACT’s Profitable Hygiene Equation webinar.
Miranda Beeson, MS, BSDH Bio:
Miranda Beeson, MS, BSDH, has over 25 years of clinical dental hygiene, front office, practice administration, and speaking experience. She is enthusiastic about communication and loves helping others find the power that words can bring to their patient interactions and practice dynamics. As a Lead Practice Coach, she is driven to create opportunities to find value in experiences and cultivate new approaches.
Miranda graduated from Old Dominion University, and enjoys spending time with her husband, Chuck, and her children, Trent, Mallory, and Cassidy. Family time is the best time, and is often spent on a golf course, a volleyball court, or spending the day boating at the beach.
Michelle Wakeman, BSDH, Bio:
Michelle Wakeman, BSDH, brings nearly 20 years of clinical dental hygiene, administrative, managerial, and sales experience to the table. She has a passion for people and a natural aptitude for communication that has led her to develop meaningful relationships throughout her career in dentistry. As a coach, she seeks to help dental practices develop systems that enable them to enhance their patient experience, leading to better relationships among owners, team members, and patients, along with profitable outcomes.
In her off time, Michelle can usually be found at the ice rink supporting her son, Hunter, in hockey, the ball field cheering on her son, Carter, or the gym, reliving her days as a gymnast with her daughter, Leighton.