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Beware! 7 traps that are destroying your hygiene schedule


I have the pleasure of working with dental teams across the country I am the luckiest person! Almost without exception, team share concerns with me about the number of broken appointments and openings in the schedule. Sometimes the response is very reactive: “Let’s charge them a no-show fee!” I hope to work with them to begin approaching broken appointments in a more proactive manner: “Let’s build value for what we do so the patient would not dream of canceling in the first place!” Easier said than done, right? This is not an overnight process it requires training and, in some instances, a complete shift in thinking. First with the team, and then with the patient family.

To develop new habits that will build value for the hygiene appointment, I find it helpful to identify the traps that are devaluing these appointments. Some of these are seemingly obvious, but many times I find that teams have fallen into at least one of these traps and had not realized the effect they have on the hygiene schedule.

Routinely running behind. Even running just a few minutes behind on a day-to-day basis is disrespecting your patients’ time. And if you do not seem to respect their time, how can you ask them to respect yours? Identify potential bottlenecks in the schedule at morning huddle, and brainstorm ways to diffuse. If you find yourself behind (it happens!), do everything you can to get back on time. Communicate and help each other! This goes for the entire practice-not just hygiene.

Finishing the hygiene appointment early. If the hygiene appointment is scheduled for an hour, this is what the patient should expect. If the hygienist regularly finishes her hour-long appointments in 30 or 40 minutes and dismisses the patients, they may be left wondering if they received high quality care. Also, the next time they reserve time on their schedule to visit the office, they might only allow 30 or 40 minutes and may even cancel if they are concerned they will not leave in that time frame. Or perhaps they will arrive late, knowing the hygienist will finish quickly. If the hygienist finishes her procedures, she should spend the remainder of the appointment time on patient education.

Speaking of patient education, this is what the conversation should be centered on. And by patient education, I am not talking about oral hygiene instruction, although this is very important. I am talking about etiology of periodontal disease, nutritional counseling, the systemic link, biofilm, caries prevention, etc. If the hygiene visit is mostly social, the patient is not receiving information he or she needs to maintain excellent oral health. We have the responsibility as health care providers to provide this information this is why they come to you!

“But what if the patient is healthy?” you may ask. Perfect! Then you have the opportunity to help him or her prevent oral diseases! I ask all of my teams: When do you want your physician talking about how to prevent a heart attack-before or after you have one? Personal conversation is important for building rapport and trust but cannot be the focus of the appointment.

“Everything looks great! I’ll see you in 6 months!” I hear this from doctors and hygienists alike, and I cringe every time! If you are telling your patient time after time that there is no concern, nothing to re-evaluate and nothing for them to work on, eventually they begin putting off their regular visits with the hygienist. Give them a reason to return, whether it be to evaluate the radiographs you will take next time, re-evaluate an area of inflammation (no matter how minor) or check the restorative work the doctor recently completed. And telling them you want to see them to hear about their grandchild’s soccer tournament next time doesn’t count! This needs to be a clinical reason.

Instead of “I’ll see you in six months,” always reference the month the patient is expected to return. Think about it when you say ‘six months,’ are your patients counting out in their minds when that is? Probably not. However, if you are saying several times throughout the appointment that they will be returning in November, they will immediately begin thinking about the schedule: When are the kids off for the holidays? Are they leaving town? etc. Hygienists, communicate this to the doctor so that he or she can reiterate to the patient: “Sue, when I see you in November, Heather is going to complete a periodontal chart. She and I will evaluate that together and let you know if we have any concerns.” Boom! You just gave the patient the when and why of the next appointment and built value for it. And you built value for Heather’s expertise!

Take some of the credit you deserve! I believe praising the patient for the hard work they are doing at home is so very important. However, I will often hear hygienists giving the patient all of the credit for their improved oral health. Again, if they are hearing time and time again that they are doing such a great job at home, they may conclude that as long as they brush and floss every day, they can postpone regular dental visits. Remind the patient who brought them to the dance remind them of your partnership.

This is especially true for your periodontal maintenance patients. If you have ever provided this patient with periodontal therapy, remind him or her of the constant need for re-evaluation and tweaking of home care techniques to keep him or her healthy. Remind him or her that while the tissue might look healthy now, the very nature of perio is episodic and site-specific it can show up anytime, anywhere. Any attachment gain is tenuous, and you will always be sure to tell patients if there is an area of concern.

Stop talking about insurance! I agree we have to respect that patients have insurance and we should attempt to help them maximize their benefits, but you must understand that when you make even simple recommendations based on "coverage," you risk not providing standard of care. If you are telling Janet that she is due for bitewings because insurance covers them once a year or even offering to check before you make the recommendation, you devalue the hygiene appointment. If you make the recommendation for the necessary radiographs based on Janet’s dental history and let her know the doctor has asked for them today (in respect to the doctor’s protocol for radiograph recommendations), you are creating value. I ask my clinical teams not to bring up insurance at all. Let the patient bring it up.

Of course, if Janet asks about her insurance coverage, you should respectfully explain the recommendation has been made by the doctor (and why) and that insurance benefits are designed by employers. Some teams might even go so far as to ask patients if they would normally ask their employer if they should or should not do a procedure! Of course, this takes rapport and practice to avoid sounding condescending or patronizing, but I have seen it done with a bit of humor quite successfully.

As you can see, there are numerous habits we can fall into that inadvertently devalue the services we recommend and provide. It can take time to retrain patients to value what you are doing, but they won’t do so unless you begin talking to them differently and changing some of your own habits. As you go through your day today or tomorrow, and as you see each patient, think about the short list of common mistakes listed above and be honest with yourself. Are you falling into these traps? How can you adjust your verbal skills and approach with the patient's family to begin immediately creating value? Your verbal skills and behavior have a direct effect on the schedule, and you can affect change in the practice!

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