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Knowing the score: The difficult balance of employee engagement, practice goals and daily accountability


Dental team members are paid to perform daily, correct? So how do you balance the employee engagement with the accountability each day to the numbers and the goals of the practice? Dr. Tarun Agarwal explains.

Daily engagement and accountability from employees is a critical balance for any business. The majority of dental practices want everyone on the team to enjoy their work, do it well, provide quality patient care, be proud of the practice and meet necessary goals to make the business profitable. We often hear team members complain about micromanagement or obsessive focus on numbers with possibly even the words “Money Hungry” being used. Stories flow from practices all across the country. Heck, it has become the common story of the corporate chains.

Aren’t numbers the pulse of all dental practices? Are we really going to allow the business to be brutally affected by failure to discuss critical numbers such as collections needs, new patient numbers, recall reappointment and monthly service productions numbers? What about individual performance?

Team members are paid to perform daily, correct? So how do you balance the employee engagement with the accountability each day to the numbers and the goals of the practice? With that question in mind, we go to one of the most popular sources about “Knowing the Score” … Dr. Tarun Agarwal, aka T-Bone.

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Many CEREC users from around the world have taken in his training. Tarun is currently the owner of Raleigh Dental Arts and the vastly growing popular 3D-Dentists institute, where you can learn pretty much anything you want about 3D dentistry, practice management pearls, team leadership and modern practice techniques that are profitable in today’s PPO practice.

Click on the next page to read our first question and answer...


Q. Hollie Bryant: Tell me about “Knowing the Score.” What does mean in your practice?

A: T-Bone: Knowing the score is all about knowing where we stand as a practice. More specifically, it is where each team member knows where we stand each day.

Imagine you are playing a basketball game and you don’t know if you are down by 1, down by 2 or down by 3. Each one of those scenarios or situations will call for a different play. Do you need to take a 3-point shot or drive to get fouled? Do you need to take an open 2-point shot or a 3-point shot to win or tie? Imagine not knowing how much time is left in the game, or going up into your hurry-up offense in football if you’re not sure whether you really need to be doing it or not.

Knowing the score is about knowing where your practice stands on any given day at any moment in time. Specifically, what that means in my practice is more about each team member knowing what’s going on. For example, as the dentist, I look at what was our production, what was my personal production, what was our collections, what is our accounts receivable, and what are we expecting from the insurance company. One of the other things I look as a dentist is what is my diagnosis in the hygiene chair. Am I going in and having quick checks? If it’s at the end of the week, am I just tired and saying everything is a watch? Where am I in terms of my diagnosis?

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Now to give you some examples of how team members should be involved in “The Score”:

- Some of the scores I want my assistant to know is, of those patients that we saw on our restorative side, what percentage of those patients are scheduled for hygiene? Are we seeing patients and forgetting to ask them (or forgetting to schedule them) for their preventive care appointment with our hygienist?

- The other thing I like my assistants know is when is our next available two-hour appointment. Why two hours? Because two hours gives us flexibility to do complex treatment, whether that is a root canal/crown, an implant placement or two, a couple quadrants placement, a sedation case, or any number of things. How far out are we booked? Are we booked out with little things or are we creating flexibility in our schedule?

My hygiene department: Are we seeing these patients or are we scheduling them at all? Even if they are scheduled for hygiene, are they scheduled for their restorative needs? Are we allowing patients to talk us out of care? These are all numbers that I want tracked from my hygiene department.

In our hygiene department, I like hygienists to know what are they producing and where we are at with periodontal percentage. What percentage of their patients are they rescheduling for recall? I believe that number should be somewhere in the 90-percent ballpark. If they are not at 90 percent, why is that? How quickly can you get a list of those patients who are not scheduled? What is their treatment acceptance? Anytime you let a patient walk out of your office without an appointment, he or she is a potential patient who gets lost. And, more importantly, that’s one more patient that your office administrative team has to chase down or make an extra effort to find.

My treatment coordinator, for me, her score is going to be what’s in our pipeline. What cases are we tracking? What are our potential future cases so that we can see what kind of production we are tracking for the next six months? What is her case acceptance rate? How much treatment is she presenting? How much is scheduled that day? How much is scheduled a few months from now?

My front office team, they look at insurance AR and patient AR. They would look at things like the number of active patients without appointments, our potential in hygiene, and our outstanding treatment plans. Those are some of the things that knowing the score would be within my practice.

Knowing the score is so much more than knowing production and collections. It is about knowing individual scores.

The interview continues on the next page...


Q. Hollie Bryant: How critical is it to practice growth to keep everyone on the team “Knowing the Score” in your practice?

A: T-Bone: Again, your practice simply cannot grow without knowing the score. Here is the truth - and I don’t think enough of us understand this or enough of us pay attention to this (and that is me included) - knowing the score has to evolve and transform and change over time. You can’t simply keep track of production and collections. That is not enough. By the time you look at productions and collections, it has already happened. It is not future-focused. It is not looking at what the possibilities are. You can’t change what has already happened. What’s happening today, you can make minor changes. I want to know what the score looks like six months from now. At what level is our hygiene? Where are our active patients? What is our pipeline? We can’t grow without knowing that.

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Right now, our practice is really focused on sleep apnea, so one of our “knowing the scores” is how many sleep appliances are we doing and what is our goal. That goal has to evolve over time. How is marketing that we may be doing for that going? How is medical billing? That was another goal for us. As you set scores, you can create benchmarks and goals for yourself and for your team. When you create that, that’s how you create growth.

The interview continues on the next page...


Q. Hollie Bryant: How do you keep your team engaged and accountable without making them feel micromanaged?

A: T-Bone: This is one of the most difficult things that any of us face. You have to sit down and talk to the team about what the scores are about … and what’s in it for them. Because at the end of the day, everybody wants to look at what’s in it for me.

With our team, and within our practice, I try to ask everyone what his or her long-term goals are. What kind of financial situation do our team members want to be in? What kind of professional situation do they want to be in? They all talk about wanting to make more, wanting to do more work, wanting to move up, and I say that’s great, we would love to help you get there and create a position for you … but that means you will have to excel at what you are doing now. If you can’t excel at what you are doing now, you certainly don’t prove that you can excel at things in the future. And that is one of the things we track.

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In general, good team members want to know how they are doing. They want to know, “What is my benchmark and how am I doing compared to that?” And certainly you need a reward for that and that reward doesn’t always have to be monetary. That reward can be an extra day off. That reward can be as simple as a “thank you.” That reward could be maybe something that is special to them, like giving them time to take care of a family member or helping them with any charity that they may want do. So certainly there has to be what’s the benefit of keeping that score and what’s in it for them. And also what’s their reward for doing it. Your goals have to be such that there is a minimum benchmark of what keeps the job, and then there has to be a benchmark of where we want to be to have best practices, so you have to do that. Ultimately, you don’t them feeling micromanaged. You simply ask them a question, “How are we doing?” Tell me more about that. Are we reaching our goals? By holding them accountable, you have an easy way of looking at it. You can’t simply have them to tell you, “Hey, I am doing great. Here are the numbers.” They can fake it. You have to have a system in place or a program in place that allows you to quickly check where they are … and they have to see that you are checking that regularly. This way, they know that you are actually keeping track of it.

The interview continues on the next page...


Q. Hollie Bryant: What are some ways that everyone on the team can “Know the Score?”

A: T-Bone: That depends if you are talking here about specific scores that they can know, or more about how we create the score. In our practice, we are using Dental Intel. It’s a very easy system that automatically extracts data. Some of the things that I have struggled with in years past and as our practice has grown, has been taking away time from knowing the score and making sense of formulating the score. It is 2016. Why in the world are we spending time, running reports and creating Excel spreadsheets, and putting data in there to create the score? At the end of the day, the score should be taken for us and then we should focus our attention on how to digest that score as well as what to do about that score. What is causing that score and what actions needs to be taken to alleviate that score? The time shouldn’t be spent on creating the score, but more about what actions should be taken on the score.

Q. Hollie Bryant: What numbers are the most important for you to know each day?

A: T-Bone: Personally, I like to know what my production was, what my collections were, and where my patient and insurance AR is. I like to know when my next available new patient appointment is. I like to know when my next available two-hour block within my schedule is. I like to know how many active patients we have without future hygiene appointments. I like to know what percentage of our patients we are rescheduling for future hygiene. And I like to know what our diagnosis per hygiene exam is. You know if I can get that data, I can pretty much get a good pulse of what is happening with the practice today and tomorrow, as well as what things will look like three or four months from now.

We know patients don’t accept treatment right away. They typically take months to proceed with treatment. If we are diagnosing early today or if we are not having good new patient numbers, we will feel that effect not right now or maybe even the next few weeks but more than likely we will really feel that effect months down the road.

Maybe I need to look at some social media campaigns and marketing campaigns or maybe hire a third-party service to start calling all of our patients if that number starting to creep up with patients without hygiene.

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Q. Hollie Bryant: What advice would you share with doctors, managers and team members about “Knowing the Score?”

A: T-Bone: You have professional aspirations and financial aspirations. Knowing the score is paramount, to achieving those things. How do you know how you are doing without knowing the score?

Also, your score needs to change. If you think about basketball players, one year they are going to focus on free throws, making sure their free throw percentage reaches X. The next year, they are going to learn how to post-up or learn how to do layups so those scores need to change. Nothing to me would give someone the opportunity to ask for a raise, or to ask for professional advancement more than saying, “Hey listen. Here is how I am doing. Here are the national averages. This is what the practice looked like when I came in. This is where we are going. These are the multiple things that I am doing.”

You create your own success. As dentists, if you want to keep good people, you need to not allow them to become stagnant. Knowing the score is important because when you master one thing, then you know and you can prove that you mastered something, then move on to something else.

We have many different types of tracking systems. We have paper trackers and binders that worked 20 years ago and can still help many. We have white board tracking with our own custom tracking measurements in them. We can use our practice management system and run numerous reports and metrics from their standard selections but we have also know there are some dashboards available like Dental Intel that seem to be working toward changing the way that dentists run their businesses. Most want to spend their time practicing dentistry, but not so much managing a business and keeping everyone on the team engaged in the results of their work. This is a challenge that many face on a consistent basis. The constant and seemingly competing demands of caring for patients while also overseeing all of the aspects of a dental practice can be overwhelming. Dental Intel is a cloud-based dashboard allows the dentist and the team to easily see what has happened, is happening, and needs to happen in order to better care for their patients. Using the power of data, this dashboard gives the provider information they can act on, such as their reappointment percentage, case acceptance percentage, number of unscheduled active patients (complete with patient names and the date of their last appointment) and dozens of other important data points.

The focus of most all dentists usually is to grow and constantly find ways to improve the overall health of the dental practice. The resistant that many will say is “another software” and another invoice. Well, for the cost of a 3-surface filling each month, you can sync your management software and your entire team can be engaged and “Know the Score.” Whether it’s Dental Intel, a custom dashboard, some manual tracking or another dashboard, it’s time to create accountability throughout your entire dental practice. It’s time to “Know the Score.”

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