By Deborah Dopson-Hartley, RDH

Do you view hygiene as an opportunity to help build and strengthen your business, or do you see hygiene as simply a treatment requirement and not much more?

Does your hygiene department have the time, support, education, and training it needs to be producing what it should? Or what it could, in both direct production and practice-building sales and referrals?

By now I hope that you have gotten the message. For a practice to be truly successful, the doctor needs to formulate a plan of action for the entire dental team, especially for the hygienist(s). Your hygienist is the one person in the office who spends extensive nonthreatening time with most of your patients.

The world of dentistry is constantly changing, and so must the way the business is run. Increased competition, insurance, and the dreaded managed care policies are cutting into profits.

In today's business climate of managed care, shrinking marings, and increased competition, maximizing the potential of hygiene can make a big difference to the success of a dental practice.

Dentists and hygienists from across North America have been asking me how I manage to solely produce more than $100,000 in net profit per year in hygiene revenue. "How can you do this without killing yourself?" they ask. "Surely that figure includes some of the dentistry sales, it can't be all from hygiene." I don't blame them for wondering. Yes, all of the $100,000 net profit comes solely from hygiene production. And yes, there is no way I could produce all that without a full-time hygiene assistant.

Back in the '80's when dental business consultants were preaching "accelerated hygiene," I tried it, and quickly began developing a serious case of carpal tunnel syndrome, not to mention burn-out. That's when I proposed and won the opportunity to use a full-time hygiene assistant the way I wanted and needed. From that point on, my production numbers have been climbing, and my carpal tunnel symptoms disappeared despite the fact that my patient load has increased significantly.

In response to the many doctors who question the need or value of a hygiene assistant, I present the following business case for a full-time hygiene assistant: In business, it is an accepted principle of the division of labor to pay lower wage workers to perform low-skilled tasks so the top-income producers and high-wage earners can focus on the jobs that no one else can do. In other words, give your top people the time to do what they do best: provide income-producing services and promote more sales of products and services.

I've heard a lot of resistance from doctors who think a hygiene assistant is a luxury. Many times these doctors choose to hire two hygienists to increase production. But what costs more? Two hygienists, making $25 an hour each, or a hygienist working with a $10-an-hour assistant? While the math is obvious, the actual return on the assistant can be greater because she improves the hygiene department's overall efficiency.

To get the most out of the time a hygienist has with a patient, you must have a clear and focused agenda of what needs to be accomplished and who is the best staff member to perform each job.

In addition to the increased hygiene production, having an assistant enables me to spend more time educating the patient on the value of hygiene and dental services. I consider promoting dental treatment plans to be one of my most important roles as a hygienist.

While adding a dose of friendly humor to the treatment, I expand our patients' education and raise their dental IQ. In the process, I earn our patients' trust and make their visits as pleasant and painless as possible -- increasing the likelihood that they will return and move forward with the dental care they really need. That's good for them and good for our practice. That's one of the true core values of hygiene.

This is important to the patient and the practice. If patients don't fully understand the need and value of a soft tissue treatment program, abridge, or cosmetics, they may not return for the work until there is an emergency. Most patients need encouragement to commit to having unpleasant, expensive, and often time-consuming dental work done.

Dentistry is not at the top of the list of things people want to do with their time and money. Patients are afraid of getting hurt, and they are sometimes even more afraid of the bill. They need encouragement, laughter, and an understanding of how important their treatment is for them today and in the future. They need to be distracted from the pain and the price so they will get the preventive care, the periodontal care, the restorative, and even the cosmetics they need for their health and happiness.

Patients will have the proper care performed if they understand how important it is to their dental health and future. We can help them feel good about taking care of themselves and their families.

Most of this sounds like pretty basic stuff, like this is what all good hygienists are supposed to do, right? So what is it about my approach to hygiene that creates such outstanding results? Am I the only hygienist who can produce more than twice what the average hygiene department produces each year? Am I the only hygienist whose patients love her so much that they won't allow anyone else to scale their teeth, and they want all their family and friends to see me? Of course not. There are thousands of great hygienists out there, providing quality hygiene care. But they may not have the proper education or training to manage the hygiene department the way it needs to be run. They may not have the freedom, flexibility, incentive, or motivation; they may not have the support they need from the rest of the practice to bring their hygiene program to the next level.

Without my treatment coordinator (hygiene assistant), I would often be forced to make what I consider unacceptable choices: to leave out part of my services, run late on another patient, or not complete the sales presentation.

That's where I was in my career about 13 years ago, when I reached hygiene burn-out. I loved the actual work of hygiene, but felt extremely frustrated because I knew my job could be so much more than I was being allowed to do.

Fortunately, at that time I went to work for a businessman who happens to be a dentist. Like me, he believed in the profitability of excellence. Equally important, this dentist gave me the priceless opportunity to explore and try new ways of doing my job.

As a result, I managed to reinvent my old job of hygiene into the career of my dreams. I built a program called Team Hygiene, because it involves getting every part of a practice -- front-office, back-office, doctor, and hygienist -- to work together to achieve maximum quality, production and profitability.

The Team Hygiene approach can work for any type of practice: solo, group, managed care, and fee-for-service. I've found that while all the techniques aren't for everyone, applying at least part of the program can still achieve amazing improvements in any practice whose members are interested in professional growth.

The TEAM Hygiene program is based on a combination of common sense, business economics, and leading organizational strategies that have been proven to achieve outstanding results in the real-business world of dentistry and hygiene. You can apply these principles to your practice and reap similar benefits with the right combination of open-minded leadership, determination, and motivation for the entire staff.

Utilization of Hygiene's True Values
Sam Walton said: "You can't put a dollar amount on the value of excellent customer service but if you could what would it be worth?"

Does every hygiene patient experience an exceptional experience? when patients compliment me or our office and sends referrals, it also says we are doing business right.

Every patient has a head pillow, a chair vibrator, and a blanket. I consistently apply Carmex to their lips and Oxyfresh Gel and topical anesthetic for their tissues. Instead of local anesthesia, I use the Noven Dentipatches. I use humor and laughter as entertainment because it makes people feel better about the appointment and about me.

I make the phone calls and write the personal notes. I give each patient an office brochure. After every compliment, I give the patient two of my business cards explaining that one card is for her to keep and the other one is to give away to anyone who would benefit from our expertise.

Everyone needs systems to determine if they are doing business right. I use tracking and monitoring. I want to know per patient if I not only meet and exceed my daily production goal of $1,300 per day, but my daily sales presentation goal of $3,500 per day and my daily sales scheduled goal of $2,500. I also want to know if the patients accepted treatment recommendation and if they scheduled ahead. If they did not schedule for recare, why not? Was it because they did not perceive value from the treatment I just rendered or understand the benefits and value of me and what I do for them? This is the single most important question that must be addressed.

I do usually exceed these daily goals because I do have a full-time hygiene assistant who allows me the time, freedom, and flexibility with patients. Your hygienist does not.

Doctors and front desk, please answer this: if I am in a sales presentation and time becomes an issue, what do you want me to do? Stop and go to the next patient and wait until the next recare appointment or leave either of you with this burden of sales or keep going?

The close of a sale is not the most difficult part of the transaction. It is the preparatory ground work that has been effectively laid. When the sale has been properly planned and executed, the close becomes a mere detail.

Please understand sales take time. Give your hygiene team the same tools that I have and you will get the same results because, according to Rita Mae Brown "Craziness is doing the same thing over and over again and expecting the outcome to be different."

The Salesperson
If quality speaks for itself then why doesn't it sell itself?

When considering the fact that hygienists spend more time with patients than any other person in the practice -- doctors included -- then doctors really owe it to the business to help the hygienist become the No. 1 salesperson for all types of dentistry.

I know "sell" is often considered a negative, four-letter word, especially in dentistry. Yet, we all know selling is not easy for most people. Not every one is a natural born salesperson. It just doesn't come naturally.

But, in my 23 years of experience as a hygienist, "sell" can be more like some very positive four-letter words, such as "love" and "care." We all care enough about our patients to help "sell" (educate) them on what they need and want for their happiness. Patients have so many true needs and desires when it comes to basic dentistry and cosmetics, that we need never have to worry about pushing unnecessary or unwanted services.

In fact, I believe we owe it to our patients to educate and encourage them on what they need for their dental health, and on what outstanding results they can achieve with aesthetic dentistry. Many of our patients suffer severe psychological distress caused by the appearance of their teeth. Nearly all would benefit by a big boost in their self-esteem that comes with a brighter and healthier smile.

With these thoughts in mind, here are some specific steps to take to improve the hygienist's ability to promote ideal comprehensive dentistry, and ultimately, to bring a steady flow of cases into the practice: to educate, motivate, and influence patients to pursue their dental wants and needs, we hygienists must know how and why doctors diagnose and do the things they do. How can we explain the procedure the doctors recommend if we do not truly understand it?

How many times has your hygienist discovered a problem during a routine maintenance appointment and under-diagnosed the treatment, leaving you, doctor, with the burden of education and sales of a much more expensive procedure?

How can hygienist improve the patient's dental IQ without improving her own? Attend as many doctors' seminars as she can so she can see for herself the truly marvelous advances in dentistry and how they are done. We then will have the same understanding, enthusiasm, and passion the doctors and their team have and then we can transfer those same emotions to the patients.

Three years ago, I had the special pleasure to attend the "Contemporary Aesthetic Diagnosis and Treatment Planning" course presented by Drs. Larry Rosenthal and Bill Dickerson at Baylor University. I witnessed the most complex and beautiful dentistry I had ever seen, performed by the participants, dentists. The complexities of each participant's case was so different and difficult. Yet each case was similar to patients I had in our practice but the treatment plans and materials used were entirely different. I had never seen anything like it before. It gave me a whole new insight and such a renewed passion for dentistry, that I felt reborn. What an educational high! Bring your hygienist when you attend hands-on work-shops and allow her to see for herself that which she does not understand so she can understand. then she will know how to near accurately diagnose true aesthetic cases.

I am part of the educational team for Dr. Rosenthal's Aesthetic Advantage Hands on Continuum series. I am the hygiene and team development coordinator for the aesthetic practice. After listening, learning and instructing with this magnificent team for 2 years, I've seen and learned more about dentistry than I ever thought I'd ever know as a hygienist.

With my new understanding of aesthetic dentistry. I've became more confident and competent to really look at and discuss smile designs with patients. Now I see every patient as a "canvas." As my new enthusiasm and passion toward aesthetic dentistry increases, so does patient acceptance.

Dr. Rosenthal once told me: "The eyes cannot see what the mind does not know, but once your mind knows, your eyes cannot help but see it every time." He was right. I can now see what my aesthetic dentist sees. I can prediagnose treatment plans with near accuracy because I understand the complete restorative aesthetic concept.

As a hygienist, I now have a new insight into the complexities of aesthetic dentistry. These hands-on workshops help me understand why I must assume a more aggressive role as the salesperson of the office. My doctor simply can't get up most times and I simply can't wait for her to get up either.

Aesthetic Hygienist

I understand why my education, marketing, and sales are so vital to the aesthetic dentist with whom I currently work and our aesthetic practice vs. the general cosmetic dentist I worked for before.

Aesthetic dentistry is extremely technique sensitive and timing is everything. There is no room for error!

For an aesthetic practice to be truly successful, the doctor must have total concentration to perform this difficult and complex work. There are times she simply cannot get up and check my recare patients. So I must carry the burden of education, motivation, and internal marketing on the recare patients.

It has become my responsibility to increase and improve the patients dental IQ not only about the restorative dentistry but about the concept of aesthetic dentistry.

So the aesthetic hygiene must seriously help carry this burden. We must become effective salespeople. But that is not enough. We must also get the patients to want the dentistry and say: "Yes, I accept and I will pay your fees in full," which is the hard part?

We all know that no one has money for what they need but everyone has the money for what they want. It is our responsibility to find the patients' needs, then turn those needs into wants, and those wants into desires, and then turn it all into production. then we have a win/win situation for everyone, the patients, the business, and ourselves.

Change is inevitable but growth is optional. One of the main objectives of monitoring and managing hygiene production and profitability and refocusing on the functions of the hygienist is to expand our business's universe. Remember when one thing changes, it leads to another. Few things will remain the same.

We all need to pull together to help improve the practice and profession of dentistry and dental hygiene. We owe this to the entire profession of dentistry.

Present and give your hygienist the opportunity, through education and training, to become the hygienist your business wants and needs. Give her the opportunity to become the hygienist she wants and needs to become.

It's time we all learned to work together as a true TEAM because Together Everyone Achieves More. And when the TEAM wins, everyone wins.

My approach to dental hygiene offers a solution to many of these changes. If you want to maintain a busy fee-for-service practice (as our practice is), an active hygiene program that builds referrals and dentistry sales will help you accomplish this. On the other hand, if you've decided to go with the flow and find your profits through managed care, increased hygiene production can make this course more feasible than ever.