By Deborah Dopson-Hartley, RDH

Dental Hygiene is more than mere production numbers, oral hygiene instruction, and cleaning teeth. This department benefits the entire practice. Hygienists are clinicians, psychologists, educators, producers, managers, marketers, advertisers, and salespeople. I will discuss in the next three articles the aspects of this department, and how I've helped my doctor, Dr. Diane Wright, build our practice into a successful, insurance-free, solo, dream practice in the small community of Brandon, FL.

The job description of the dental hygienists is not what it used to be. With the increasing demands made by expanded functions, managed care, and the ever expanding state and federal regulations placed on us, we find there is more for us to do in the same amount of time or for production sake, less time. Yet, despite all the changes affecting dentistry, the majority of practices continue to allow hygiene to operate in much the same way it has fur the past 30-year-old practice model that treats hygiene as a cost center that's only geared to break even at best. However, as competition, insurance, and increasing cost pressures continue to squeeze the margins tighter and tighter, few businesses can afford to deep overlooking the tremendous value hygiene can mean to their practice. Maximizing the real potential of hygiene can make a big difference to the success of any dental practice.

To survive and excel in today's changing healthcare market, we must constantly define and redefine and focus and refocus our job descriptions, business strategies, and how we do our jobs.

My company, The Business of Dental Hygiene, is aptly named because that's how I view and operate my hygiene department - as a business-within-a-business. I understand there is more to dental hygiene than patient care and there is more to patient care than just cleaning people's teeth. That is not to say patient care is not an important issue - it's just not the only issue. What about taking care of each other, the business, and our doctors?

I am not saying patient care will suffer by the hygienist becoming business-oriented. Sacrificing quality care is no way to increase profitability, not in today's marketplace. However, there are ample opportunities for development, expansion, improvement, and growth in a profession that, let's face it, has not changed much in years.

Under using a hygienist's time simply does not make good business sense. To get the most of the time a hygienist has with a patient, everyone must have a clear and focused agenda of what is to be accomplished in that amount of time and who is the best staff member to perform each task.

The traditional hygiene program is the status quo, the way we have always done business. The question asked today is, "Does traditional hygiene have a place in today's business strategies?" Not if the desired goal is to bring about growth and increase productivity and profitability.

This is not to say the traditional hygiene program can not be incorporated into a new business strategy TEAM (Together Everyone Achieves More)-Hygiene.

TEAM-Hygiene focuses on the concept of maximizing an individual performance as a hygienist and his or her function as part of a successful team. Simply put, this strategy allows the hygienist more time, flexibility, and freedom to provide the more productive and profitable services of dentistry only a registered dental hygienist's time spent directly producing revenue and promoting treatment needs by using a full-time hygiene treatment coordinator.

Philosopher Tony Robbins said, "The differences in the results people produce come down to what they've done differently from others in the same situations. Different actions produce different results. Why? Because any action is a cause set in motion and effects move us in an ultimate direction. It's not what we do once in a while that shapes our lives, but what we do consistently and what we become in the end."

Suppose two hygienists are working two rooms and each room has two cancellations per day, or suppose there are one assistant working two rooms and each room has two cancellations per day?

The bottom line is, hygienists will always have multiple cancellations. Who of one room only, with the same amount would you prefer to have with 4 hours of free down time per day, a hygienists or an assistant?

Doctors, who would you prefer to help you with an emergency, seating a case, or making a new temporary?

Receptionists, who would you prefer to help you with the emergency postop calls, answering calls, and scheduling patients?

Assistants, who would you prefer to help you with...everything?

Doctors, do you think you could accomplish the duties for which many hygienists are responsible in one patient visit: clean and set a room; greet patients; make small talk to build rapport and get the patient to express his or her chief complaint; take the necessary radiographs; process, mount, and read them; formulate an answer; glove-up and start the exam by performing the oral cancer and soft-tissue screening; handle the accurate and legal periodontal charting; use the IOVC not only for education purposes but for legal documentation; after 20 minutes, begin the actual cleaning procedure, which is the real reason the patient came; remove all the stain and supregingival calculus painlessly, because the patient can see and feel that and is judging you; remove all the subgingival calculus too, painlessly of course; document every word said by the patient but you as well; as you are manipulating instrumentation, find all areas of concern, document these in the chart, formulate a treatment plan, explain this treatment in detail, because the burden of sales should not fall on the doctor, because the doctor's time is expensive and limited.

After the examination, document every word said and explain to the patient all the doctor's treatments recommended too. As you are dismissing the patient you can reiterate the necessary treatment recommendation to the front desk in front of the patient so he or she can hear it one more time.

Now rush back to your operatory to clean and set it for the next hygiene patient. Oops, the assistants are telling you there are too many instruments in the ultrasonic. Wrap and sterilize them because you don't have enough for the rest of the morning.

Many hygienists do all this with little or no help from anyone, working out of time for every patient, hour after hour. Could you do it?

If a person often feels the stresses of time, chances are good that's because they feel they just do not have enough time to do what they want to, at the level of quality to which they are committed.

My hygiene treatment coordinator has many job descriptions and her responsibilities are numerous. her main priority is the hygiene schedule, patients, and me. She is the room coordinator and traffic cop. In our office there is no "my room, my stuff." She cleans and sets rooms, X-rays, polishes, and gives oral hygiene instructions. She is there to gather that personal information that is so important in establishing rapport and trust. She's there to chat with the patients. When time permits, she takes the IOVC pictures. She is always the eyes-before-my-eyes-before-the-doctor's-eyes. This way nothing can be missed. She is there to expedite the doctor's exam and schedule the next needed hygiene appointments. If she understands dental procedures, she can explain treatment recommendations and accurately schedule the doctor's production so there is less bottlenecking and confusion at the front desk. her responsibilities don't stop there.

Understand, I do this too and often. I clean and set plenty of rooms and instruments. When a patient does not show, I still have a patient and she attends to other things for which she is held accountable, like the black hole into which patients sometimes slip. Recall is her next priority.

How nice would it be to have someone, anyone, completely responsible for this system? The hygiene coordinator needs about 15 hours per month to properly work these cancellations or broken appointments, I will produce less.

If the front desk does not make a firm commitment to keep the hygiene schedule full, your schedule will suffer weeks and months down the road. We know 85% of all restorative dentistry comes from recare, so if I am not seeing patients, I am not marketing dentistry, I don't have the time to market either. It's that vicarious, never-ending circle that seems to never change.

It can change and will change, if you are willing to make the changes. The rewards will be sweeter for everyone. I know from experience because I have lived and worked