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Published by Viva Concepts, 2018-12-07 12:38:53

The Hygiene Department Dept

Copyright © 2018 by Gregory Hughes, Viva Concepts, LLC. All rights reserved. This book or any portion thereof may not be reproduced or used in any manner whatsoever without the express written permission of the publisher except for the use of brief quotations in a book review. Printed in the United States of America. First Printing, 2016

Overview of the Viva System
The Hygiene Department is paramount to building the practice. As studied in the Hygiene Residual Course, this department controls both the retention and residual income of the practice. Of the 4 business laws described below, retention is the “Spine of the Practice.”
4 Business Laws:
1) 2) 3)
Consumer Acquisition: Every business will always have to acquire new consumers to continue to expand. Why? Because existing consumers are lost every month from the company’s database.
Consumer Sales: Once a business acquires a consumer the business has to sell its service(s) or product(s).
Consumer Retention: Once the consumer has purchased something then that same consumer is entered into the company’s database for future purchases. This law is at the core of any business’ growth potential.
Consumer Experience: A positive experience with the service or product generates reviews and referrals. This is far more powerful than it appears as referrals are a source of new consumers that cost the business virtually nothing to acquire.
Consumer Acquisition Consumer Retention
Consumer Sales (Treatment Acceptance)
Positive Experience

Retention is the Spine of Every Business
The retention of every business determines its stability, future growth and expansion. Every business is dependent and operates on the 4 business laws of consumer acquistion, sales, retention and positive experience.
It is however vital to know that retention is the highest relative importance. One could almost say that business growth is dependent upon “retention, retention, retention, retention.
The diagram to the right is used to illustrate and remember, as an analogy, that retention is much like the spine of a human body.
Without a healthy workable spine, one cannot walk, run, excercise, play or even get out of bed. The business is no different.
To the degree the business does not have
a retention program, a single person responsible for retention (Department of Hygiene), then that business is “crippled” to the extent of retaining its consumers.
The first most vital step in establishing a retention program is putting in place a Department of Hygiene.
The first step to accomplish this is appointment of a Lead Hygienist to head this department. He/she is the person that is responsible for the retention of the patients of the practice. As such, this person, in my own practice was called, “The Queen.” For good reason. She built the practice through patient retention!

Increasing Residual Income
The ideal goal or objective for any business is to generate a higher level of residual
income over linear income!
The Hygiene Department is able to accomplishes this objective with an expanding retention program.
Annual Hygiene Department Revenue Growth
Year 1 Year 2 Year 3 Year 4 Year 5
Total Residual Income Increases Continuously Over TIME!
Linear income is the work-a-day world for 95% of general dentists.
Linear income is itself part of the working model for dentistry... but as you work and put in the time over the years, it is necessary to build your residual income and invest in your database to raise your hygiene residual income. The above graph illustrates how linear income goes to zero when
you stop working at any time. Residual income continues.
Years go by quickly and your most valuable asset in creating residual income is TIME.
Total Production $
Residual Income Linear Income
Residual Income Linear Income
Residual Income Linear Income
Residual Income Linear Income
Linear Income
Residual Income

Residual & Linear Income–Definitions
The Department of Hygiene will transition the business model to a higher level of residual income (also called returning income: see examples below). The illustration below give one a concept of the importance of establishing a Department of Hygiene. As seen below in the diagram with the red and green lines shown on the graph, the hygiene department (red line) produces residual income. And if well organized and established will out produce any single doctor him or her the best possible patient care in the industry...a practice based on wellness!
Residual Income: income that continues to be generated after the initial effort has been expended (also called recurring income). For a dental practice, patients receiving their bi-annual hygiene visits would be contributing residual income to the practice.
Linear Income: is “one-shot” compensation or payment in the form of a fee, wage, or salary.” The majority of practices in the US operate off of this type of income.
Examples of Linear versus Residual Income:
Linear: A patient comes in for an extraction and never returns. Residual: A patient coming in twice a year for re-care.
Linear: Buying an iphone for $800.
Residual: Paying $49/month to a service provider (i.e. AT&T) Linear: Selling a movie DVD for $15.
Residual: Netflix subscription for $12/month.
Residual Income Developes Exponentially over time.

Residual Hygiene Revenue Always
Residual Hygiene Revenue Always Out-performs Operative Revenue
Outperforms Operative Revenue
With the Correct Retention System & Disciplines Residual Hygiene Revenue Always Grows With Time
Operative Dentistry from Doctor Always has a Revenue Ceiling
The reason for this is covered later on this course on page 21.
The Hygiene Department is the "spine of the practice" as the entire focus is on retaining patients which in turn is the focal point of retention and building a residual-based practice.


Retention & The Benefits of Practice Expansion

Retention & Increasing Case Acceptance Growing the Active Patient Database
Definition of Database: A list of all patients that have received services. E.g. The loss of patients from your database is damaging to the overall expansion. The key factor for any business expansion is returning consumer (retention) which is called “recall or re-care” in the dental industry.
The most important aspect to improve case acceptance in any practice is through an understanding of the four business laws and how they interrelate. Specifically, when a patient enters a practice and receives his or her diagnosis, much of the diagnosed work is done at a future date due to patient limitation of finance, ceilings on their insurance, fear of doing the procedure and so on.
To fully grasp how the four business laws are interrelated let us cover some basic metrics (measurements) about the dental industry. The first metric, published by Dental IQ, the American Dental Association and Dental Economics, reveals the incomplete treatment in dental offices (sitting in the patient files) across the country to be between 60 and 65 percent.
All of a sudden the importance of consumer retention becomes extremely important.
Definition of retention: Customer retention refers to the ability of a company to retain its customers over some specified period. Patient retention is vital for long term practice growth. There are several reasons for this:
1) Retention becomes a critical factor in raising case acceptance as the work is done in subsequent visits. The important fact to remember is that CONSUMER RETENTION always increases CASE ACCEPTANCE.
2) The patients, who are in a hygiene retention program where they visit twice a year have a higher case completion due to the education and dialogue from the dental hygienist and staff.
3) The practice has already paid for the acquisition of the patient and the existing patient is always more likely to accept treatment due to improved trust with the doctor and staff.
4) Returning patients improve consumer acquisition as they begin referring family and friends causing higher word of mouth new patient referrals.

Growing the Active Patient Count
The diagram on the prior page illustrates what the four business laws accomplish. As seen by the arrows of each business law, the application of each law increases the size of the active database. Any business owner can be in control of the growth of their business by focusing on increasing the size of the active consumer database.
Definition of Active Database: The business definition for Active Database is when a returning customer pays the company a fee within a specified time period. An example, would be your mobile phone carrier, such as Verizon or T-Mobile. You pay a company (T-Mobile) a specified dollar amount within a specified time period (30 days).
For the dental industry, the Active Patient Count (also called the Active Database) is when a returning patient pays the office a fee for a service within a specified time period. The specified time period is based on the fact that patients know they should go twice a year for cleanings and an exam.
For example, if your practice has a hygienist 5 days a week, he/she will see about 8 patients a day, or 40 patients per week. With 50 working weeks in a year, this means there are 2,000 hygiene visits. In this same practice, let us assume the practice sees an average of 25 New Patients per month.
The 2,000 hygiene visits in our above example represent TWO different types of patients:
1. The New Patient (which is intermingled with recall or returning patients). 2. Recall Patients, which have returned to the practice.
To establish an accurate ACTIVE PATIENT COUNT the consumer must be a returning consumer (or recall patient). We have 2,000 hygiene visits in the above example. Let’s calculate the Active Patient Count:
2,000 total hygiene visits per year
- 300 new patients per year (25 new patients per month X 12 months = 300 New Patients)
1,700 returning or recall patients
Divide 1,700 returning patients by 2 and we see that we have 850 active patients.
It is divided by 2 as the average patient should have a cleaning twice a year (and x-rays once a year). We have taken the average of 2 times per year as this is a consumer definition. Some patients are perio and come 3 or 4 times, however, we are using average metrics (measurements) to establish a standard of counting the Active Patient Count.

Case Acceptance
Begins With a Mission Statement
Why is a mission statement so crucial to a business? Let us first define the meaning of the phrase “Mission Statement” as its importance to any business is paramount to its success.
Mission Statement, Definition of:
“A written declaration of an organization’s core purpose and focus that remains unchanged over time.” Properly crafted mission statements:
(1) Serve to separate what is important from what is not
(2) Clearly state WHY the business is there...
(3) Communicate a sense of intended direction to the entire organization.
The Mission Statement
The Mission Statement is an education step for every patient and is repeated many times. The Mission Statement is posted at reception, in every operatory, the hallway and even the bathroom. It is handed to patients in printed form on practice stationery and every patient is instructed to share the mission statement with their friends and family.
At the first appointment of each new patient hygiene visit, the hygienist uses the following dialogue as a guideline as a Mission Statement for the office:
Hello my name is _________. I want to foremost thank you for landing in our office. I want to begin with a bit of an orientation on the overall purpose we have for every patient we service in our practice.
Our practice is locate here in _________, and quite honestly, 90 to 95% of our patients live within 2 to 2 1/2 miles from our office.
That being said, if you look out into the community within that 2 1/2 miles, it is simply composed of neighborhood homes. If you go inside those homes what you’ll find is simply people—people like you and people like me...and inside those homes are husbands and wives as well as children and

grandparents, some ti mes nephews, nieces, aunts and uncles....many of them live in the same community or within a close distance. Those neighborhood homes are composed of families.
The reason we bring this up is because the family is the most important component of’s why everyone goes to work, its the important thing people care about, and in fact, it is the fabric that keeps society together.
The reason this is important is because our practice is a family-based practice. That being said, you’re probably about the age of my sister (or brother, father, mother, grandparent)... and the diagnosis and treatment you receive from our office, would be as if you were a sister, no more and no less, in other words, as if you were a family member.
For an elderly person, they would be treated as if they were a grandfather or grandmother...and it would be no different if it were a young the treatment would be the care we would give to our own children.
But there is an important goal we have for you, as well as every patient...and that purpose is to educate each person to level of reducing and eliminating your dentistry in the future.
We call this “A Wellness Program1.”
This purpose came about from a bit of research—which came from the derivation of the word doctor. The word “doctor” comes from the Latin word “docere”... which means, to teach, to know, or teach to know. I’m the person in charge of our hygiene education center.
The way we achieve this goal is by scheduling your hygiene visits twice a year...and every ti me you come for a hygiene visit, we always schedule your next visit 6-months in advance.... and as we progress on this program it means no future gum disease, no extractions, no root canals and if anything
does occur, we’ll catch it when it’s very minor.
We have a motto that we hope you like...and that motto is:
“Partners in your dental health.”
As a final note, if you ever have questions about any incorrect bill, an incorrect way you were treated, or a question about a dental concern for anyone in your family, or a dental emergency.... we would be privileged if you give us call so we can resolve the problem ... and our purpose for resolving it is very honestly because we plan on having you for a lifetime!
1 Wellness De nition: e concept of a practice assisting your patient to eliminate future den- tal work through patient education and regular recall visits.

= Mission Statement Hung on the Wall
Operative #1
Operative #2
Finance Coordinator Dr. Office
Hygiene #1
Hygiene #2
Hygiene #3
Staff Lounge
Bath Room
Sterilization, Instrument Preps, Supplies

Dental Hygienist Duties & Responsibilities

Dental Hygienist General Work Duties
Hygienist Duties and Responsibilities Compensation & Employee Handbook
The duties and functions of the Dental Hygienist are hereby issued to clarify the responsibilities of this position. The duties and functions are listed so the actions of what to do on a daily, weekly and monthly basis are known and understood.
While the key and vital duties are listed below, as a staff member in charge of educating and retaining patients, you will run into day to day situations that require ingenuity in maintaining the hygiene patient schedule. Patients are sometimes a bit late, or “no show” and on occasion a new patient may need to be “fit in for a cleaning.” As such, it requires a fluid attitude and team esprit as well as adjustment to make the day both pleasant and productive.
This team esprit is expected of every staff member.
The Department of Hygiene The Role of the Lead Hygienist
As covered in the Viva training, the foundation of every business is comprised of 4 business laws which work together to increase the size of the Active Database (or patient base). These laws are:
1) Consumer Acquisition (new patients)
2) Consumer Sales (Treatment plan acceptance)
3) Consumer Retention (Recall/re-care system)
4) Consumer Positive Experience
The missing element in the dental industry is the Department of Hygiene, also called the Retention Coordinator or the “Department of Retention.” This Department has a very specific person IN-CHARGE. The function of this department is fully under the responsibility of the Lead Hygienist. The Department Head can alternatively be named the “Hygiene Coordinator.” This depends on the preference of the doctor and the personnel he or she has that is capable of holding this position.

The Role of the Lead Hygienist
The Role of the Lead Hygienist is outlined below:
a. All duties, functions, production and personnel are under the control of the Lead Hygienist.
b. The functions that are done by this department are never shared or done by any other area of the office. The functions owned by the Hygiene Department are:
• All appointments are made in the Hygiene Dept, not the front office.
• All confirmations of appointments are done by the Dept of Hygiene, never the front office.
• All cancelled appointments are contacted and reappointed only by the Dept of Hygiene, never the front office. Cancelled appointments specifically and only called by the Hygienist of record for that patient.
c. The Lead Hygienist has the following duties:
i. Interviews and adds additional hygienists to increase the hygiene days to the practice (in coordination with the practice owner).
ii. Trains all hygienists in the department on hygiene protocol, rules, metrics, production targets and systems for appointing, cancellation policies, mission statements and distribution of care-to-share cards (the Viva gift box) with every patient treated.
iii. Establishes daily, weekly and monthly report forms to monitor production. This is done with the “Daily Production Monitor” which is also calculated to give an average weekly daily production and also calculated monthly to establish the average monthly daily production of each hygienist.
iv. Establishes periodontal programs to improve the oral health of patients and improve overall revenue for the department, i.e. Perio Protect trays, sealants, perio recall, etc.
v. Determines and proposes the addition of a Hygiene Coordinator to improve overall productivity of the Department and to facilitate the production of the hygienists within the Department.

vi. In addition to running his/her department, the Lead Hygienist runs her own daily hygiene production.
vii. Establishes and runs the Daily Hygiene Production conference. This is attended by all Hygienist, the lead dental assistant and Treatment Coordinator. Patients for the day are reviewed to determine a) incomplete treatment, b) the new or incomplete operative procedures that need to be brought up and “sold” or “reinforced” by the hygienist, and c) the finances addressed by the Finance Coordinator so the case can be “closed” and appointed for treatment in the operative department. The treatment coordinator runs the care credit or lending club, insurance, etc., and finalizes the financial arrangements. This meeting is limited to 10 to 15 minutes and is held daily at a designated time prior to the start of the day.
Structure of the Hygiene Department
The structure of the Hygiene Department is illustrated below, each circle in the diagram represents a DEPARTMENT within the practice. The Hygiene Department is utterly owned and controlled by the Lead Hygienist as seen below.

The Department of Hygiene may alternatively be headed up by the Hygiene Coordinator as seen in the diagram below. The choice of the Lead Hygienist or the Hygiene Coordinator is determined by the doctor and circumstances of the office. There are instances where the office has a strong Hygiene Coordinator (or one that can be chosen) to head up this department. The determination is based on the ability, skill and willingness of the individual to be fully responsible and present during the work days of the office. It is difficult if not impossible for a part-time Lead Hygienist to be in charge of the department.
In such cases, where there is not a full time Lead Hygienist, the doctor will adjudicate which structure is best for the office.

The Duties of Each Dental Hygienist
Foremost, the hygienist is responsible for patient education and retention of each patient. The philosophy of our practice is to retain patient in our hygiene education center to reduce and ultimately eliminate their future dentistry.
As an overview, our hygiene education center is a “Wellness Program” to eliminate both future dentistry and future dental cost for the patient. The following duties and responsibilities are performed to bring this about.
The hygienist is responsible for:
Understanding, reinforcing and using the mission statement set forth by the practice with every patient to improve patient care, education and retention. He or she sees that every hygiene patient treated, whether a new patient or existing recall patient, is retained by the practice by:
a) discussing and reinforcing the mission statement of the office—for the purpose of educating the patient to achieve the goal of eliminating their future dentistry,
b) scheduling their next re-care visit, by the hygiene, not the front office,
c) Cancellation Clause: discussing the hygiene cancellation policy to assist future scheduling problems of “no shows.”
d) Recovery of Cancelled Appointments: (See protocol below) The recovery of cancelled appointments is paramount to the Lead Hygienist as this is where the “Invisible Influence” of lost patients occurs (database leakage). Each hygienist is responsible for the first 2 steps of recovery of cancelled appointments: Step one: Calling the patient the day of the no-show, and Step two: sending a text message within 24 hours if there is no reply to the phone message.
e) Filling out and keeping track of daily, weekly and monthly hygiene production monitor, which is done by turning in a daily grid showing the list of patients and revenue produced from each patient.
Conducting oral diagnosis to locate pathology both dental and periodontal evaluations with periodontal probing, pocket charting and oral cancer evaluations.

3. Conducting and performing efficient scheduling with an average daily patient load of 8 to 12 patients (dependent upon root planning, curettage and anesthesia necessity of patients).
4. Continuous evaluation of the hygiene department workload to accommodate more efficiency with written recommendation for addition of a hygiene coordinator (Note: a position under the lead hygienist who conducts functions of x-rays, prepping and cleaning of operatories, sterilization, instrument set up, confirmation of appointments, scheduling of hygiene patient for next re-care, reinforcement of mission statement, performing polishing and keeping and reporting of hygiene production statistics).
5. Daily meetings with dental assistants and finance coordinator to review each recall chart to determine incomplete treatment so the patient is educated and scheduled by the hygienist for completion of treatment or newly found pathology.
6. Attends scheduled team meetings to coordinate with other staff and doctor.
7. Educate patients by giving oral hygiene as well as plaque control instructions postoperative instructions
8. Document dental hygiene services by recording vital signs, medical dental histories; charting in patient records.
9. Maintain safe as well as clean working environment by complying with procedures, rules regulations to protect patients as well as employees by adhering to infection-control policies and protocols.
10. Ensure operation of dental equipment by completing preventive maintenance requirements and following manufacturer’s instructions.

General Staff Responsibilities & Duty
In addition to the above listed duties, every staff member must understand that the office manager can call upon any employee to perform any duty within the office. If another employee or facility to the hygiene department is absent, you may be called upon to clean operatories, instruments, sterilization, pull charts, confirm patients or assist with the doctor, as a team member and as directed by the office manager.
While the above general duties are examples, any duty may be assigned to perform. It is the responsibility of each staff member to learn the different tasks and duties of all areas of the office related to service of the patient. This is called team effort and at any time another staff member may call in sick, have an emergency or go on vacation. As such, the office manager will assign needed tasks so the office runs smoothly.
Employee Conduct and Misconduct in the Office
The Dental Hygienist holds a vital position to create a kind, caring and superlative patient experience. He or she is the focal point of retaining patients to achieve the overall goal of the office—which is to educate our patients to the level of never needing dentistry in the future.
As such, it is paramount that personal emotions, upsets or “gossip” is never brought into the office or displayed with any patient or another staff member.
Misconduct, getting emotional with patients or other staff, or “fighting” or showing upset in front of patients or other staff is an immediate matter for reprimand and with repeated reports will result in dismissal from staff. The attitude and care is an atmosphere created by the staff and should always reflect the core values of superlative patient care and kindness toward one another in the work place.
As such, the dialogue and conversations with patients and staff should be of the utmost professionalism. The care, attitude, etiquette, dress and attitude toward each patient should emulate the attitude and care factor of the doctor’s core values.
Hygiene Compensation Revenue Share
The Hygiene Department is the focal point of achieving the highest patient-care possible. With a

returning patient, routinely keeping their six-month hygiene visits, affords the Hygiene Education Center the best possible opportunity to educate patients and eliminate gum disease as well as future dental care. As such, this department is crucial in accomplishment of the office goals.
Secondarily, the Hygiene Department is a separate and unique revenue center and requires management, patient disciplines and reporting of services and its overall daily, weekly and monthly production.
In harmony with accomplishing the goal of an educated patient to eliminate future dental disease, both periodontal and other dental pathology, the dental hygienist compensation is based on a shared revenue of production (which is dependent upon fees collected).
Compensation: Hygienist compensation is paid on 28% of collections of all hygiene services.
Total Daily Hygiene Production
This is the total hygiene production that results in collectible revenue per week divided by the number of Hygiene Days.
Definition of Hygiene Days: A full hygiene day is 8 hours of production per day. The average number of patients should consistently range from 8 to 12 patients per day.
National Hygiene Daily Production: The average daily production is $1,500 per day for a fee for service and PPO based practice. HMO (Health Maintenance Organization), PPO (Preferred Provider Organization) and Fee for service have an averages range of $1,200 - $1,400, depending on the volume of HMO. The above are averages. The average daily production for your office is set by
the Lead Hygienist in coordination and agreement with the doctor. An average daily production for a well-managed hygiene department should easily be $1800 or above. The skill of the Lead Hygienist, her organization skills, use of the Hygiene Coordinator and skill at diagnosis and treatment of periodontal disease brings the department of hygiene to landmark heights as a revenue center for the practice.
Expected average daily production in our practice/business is: $_________/day. This is an average and it is fully acceptable to be 10 to 20% up or down on any given day. However, the average daily production on a monthly basis will be within 10% up or down of the expected average daily production.
What revenue is included in the Hygiene Daily Production?

• New Patient Exam & X-Rays are not part of the Hygiene Revenue, they are new office revenue and count as part of the Total Operative Production of the doctor.
• All hygiene procedures; cleanings, RPCs (Root Planning & Curettage), sealants, teeth whitening procedures, all perio recall visits which always includes the exam and x-rays. The exam and x-rays are only counted on a returning patient as the discipline and efforts of the hygiene department is what brought about patient retention (a returning hygiene patient).
Sick Days: There are no paid sick days due revenue share (bonus system) established. The determination of sick days, to add them or not, is based on local state labor laws and contractual agreement between the doctor and the employee.
Vacation Pay: Established by agreement between the doctor and employee. Recommendation is 0 -12 months: No accumulated vacation pay 12-24 months: 5 days accumulated vacation pay. Paid vacation days on months 12 through 24 accumulate by the quarter (every 3 months). This means there is 1.25 days of paid vacation earned every 3 months. The 5 days of paid vacation are accumulated at the end of month 24. If vacation is taken prior to the accumulated 5 days, then the paid days are pro-rated against the number of months worked thus far. Vacation pay varies from state to state depending local state labor laws.
Vacation Pay Accumulation: Vacation days earned must be taken within 6 months of earning the paid days. If paid vacation days are not taken within 6-months of earning them, the days are forfeited and do not accumulate moving forward.
How paid vacations work: Paid vacations are paid according to the average weekly pay (revenue share) received by the dental hygienist. Example: If the average weekly paid revenue share is $1,490, then the 5 paid vacation days are paid at this amount.
The contractual agreement with the hygienist, hygiene coordinator and owner, as described above, are suggested or recommended agreements. The agreements however are up to the owner of the practice. The agreements on compensation are a critical aspect of growing any department and it is highly recommended to openly discuss and come to full amendable agreement regarding compensation. The relationship is long term and both parties are entering into a friendship and partnership to build the Department of Hygiene.

The Role of The Hygiene Coordinator

The Role of the Hygiene Coordinator
The Hygiene Coordinator becomes extremely critical in the expansion of the Hygiene Department. When the department begins to grow the Hygiene Coordinator is a service production addition for the Lead Hygienist.
The Hygiene Coordinator cannot be underestimated as he/she alone can dramatically expand, double and triple the overall production and revenue of the hygiene department. His/her functions are critical to understand and perform. As a foremost statement, the Hygiene Coordinator must be respected and his/her position comes directly under the authority of the Department Head (or Lead Hygienist).
The Hygiene Coordinator has one senior and only one senior. The Lead Hygienists coordinates her duties with other hygienists, and while the Hygiene Coordinator facilitates all hygienists, he/she cannot be run and ordered about by multiple “seniors.”
Her functions dictate what she does for all hygienist within the department. Her specific and most vital functions are as follows:
1. Being an ambassador to all patients who come into the hygiene department. He/she reinforces and/or delivers the mission statement to patients when the hygienist is running behind.
2. Prepping, cleaning, sterilizing hygiene rooms to receive patients.
3. Bringing patients to the hygiene department for service(s).
4. Appointing patients when the hygienist forgets or is pressed for time.
5. Confirming all hygiene appointments (this is automated with texting, emails) but may also require personal calls to move patients up or down to improve production.
6. Tracking all hygiene cancellations to obtain as many re-appointments as possible (this is the hidden leakage of patients from the hygiene database).
7. Dismissing patients and reinforcing the cancellation policy of the office through education and repeating of the mission statement to reduce future cancelled appointments.
8. Assisting the hygienist when available for charting of pockets and/or jumping in to do a prophy (if an RDA and/or if the patient is an adolescent or teen).

9. Filling the hygiene schedule and dynamically adjusting it throughout the day to accommodate cancellations and new patient flow in the office. He/she must be fluid in bringing about and modifying the hygiene schedule throughout the day.
10. Being tolerant of changes in schedules, cancellations and becoming a “solver” of problems which is in actual fact the normal routine of the hygiene daily production. The Hygiene Coordinator is an extremely skilled executive and as such, her skill is measured in terms of increased production, reduced cancellations and an overall increase in hygiene days added to the practice.
11. Adding days of hygiene to the practice through excellent control of “Cancellation Recovery.”
Cancellations & Database Leakage of the Hygiene Department
Hygiene appointment cancellations are the single largest “Hidden Influence” of lost patients in the practice. As a preamble to lost patients, no patient (new or returning) ever leaves the office without their next hygiene appointment.
The “Hidden Influence” of lost patients can be exposed by knowing the cancellation rate in the dental industry has a daily average 15% - 17% and higher. This means there is 1 to 2 cancellations a day. Here is the loss:
The average hygienist works 4 days per week. He/she sees an averages of 8 to 10 patients a day. With a 15% – 17% daily cancellation rate, there will be 1 to 2 cancellations every day. This means each week, there will be an averages of 4 to 5 cancelled appointments.
Without RECOVERY of these cancelled appointments and a SYSTEM in place to do so, this means the hygiene database will lose 5 patients per week X 4.3 weeks per month, which means the loss = 20 to 22 patients per month!
If the practice is seeing 20 to 25 New Patients per month one can now see the devastation of the leakage. In other words, the practice receives 20 to 25 New Patients while in the same month, the hygiene cancellations lost 20 to 22 patients! The loss is over 90% of the patients are going out the back door.

System for Cancellations Cancellation Recovery
The most critical function to monitor by the Lead Hygienist is the CANCELLED or NO SHOW appointment. This requires a “tracking system” in place to recover the cancelled or no show appointments. The system is termed “Cancellation Recovery.”
The system to put in place is quite simple, but powerful.
Foremost, and critical to recovery, is assigning ONE person responsible for the cancellation recovery. If two, three or more people “call cancelled appointments” the game is lost.
The person responsible is ultimately the Lead Hygienist. However, she cannot do the administrative functions due to her schedule. The Lead Hygienist uses the Hygiene Coordinator to put the “Cancellation Recovery System” into execution. The following are recommended steps:
Step 1: Step 2:
Step 3: Step 4:
Step 5:
Step 6: (Note:
All cancelled or no show appointments are ONLY called by the patient’s hygienist.
A text message is sent by the patient’s hygienist within 24 hours if no response to Step 1 above.
The Hygiene Coordinator makes a 2nd phone call to reschedule the patient.
If no response to Step 3, the Hygiene Coordinator then sends her own text message.
If no response to Step 4, the Hygiene Coordinator prepares a letter and envelope for the hygienist. The hygienist signs it and the Hygiene Coordinator seals and mails it.
No further action is done. The patient receives database mailers 4 times a year, plus a birthday mailer and these are your follow up to recovery.
See that the Hygiene Coordinator takes the Cancellation Recovery Course)

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