Hygiene Vital Signs: The Heart of a Healthy Dental Practice

You're listening toThe Dr. Phil Klein Dental Podcast Thanks for joining us for this Podcast. I'm Dr. Phil Klein. Today we'll be discussing the hygiene department, which plays a major role in the health of a practice. Some may even say it's the heart of a dental practice. Knowing and improving your hygiene department vital signs can be critical to overall practice success. Our guest is Camille Luke, a registered dental hygienist with a master's degree in dental hygiene. She has been practicing dental hygiene for over 30 years, working in private practice as well as in education. Before we get started, I'd like to mention that Camille's webinar titled Hygiene Vital Signs, The Heart of a Healthy Dental Practice, is now available as an on-demand webinar on VivaLearning.com. Simply type in the search field Luke, L-U-K-E, and you'll see the webinar. Camille, it's a pleasure to have you on the show. Oh, thank you, Phil. It's a pleasure to be here. I appreciate you having me. Yeah, we're excited to have you. So typically the metrics evaluated in a hygiene department are called key performance indicators, which we're all familiar with as KPI, as the acronym goes. What is your reasoning for calling them vital signs? Well, we're all healthcare providers. As health care providers, when you typically assess a patient, you're assessing the health of that patient based on their vital signs. So you go to the doctor, they check your pulse, your blood pressure, your temperature, all those sorts of things. And this is going to show how healthy you are. Now, I feel it's the same with our hygiene departments and our dental practices as well. But obviously, I focus on the hygiene department. That's where my passion is. That's what I know. When you focus on the vital signs within a healthy department, you can see how healthy it is. When you reference key performance indicators, a lot of times when you're talking to hygienists just in private practice, that term doesn't typically resonate with them. But if you talk about vital signs, they understand what that is. They understand what the vital signs are with the patient, with the patient's health. And so if you can tie those pieces together with the health of their hygiene department, I think then you can really make a connection with them and help them understand how they can be empowered to make a difference, not only in their patient's health, but in the practice health and the hygiene department health as well. So when you're talking about vital signs, we're talking about the vital signs of a department within a dental practice. We're not talking about the vital signs of each individual patient. No, you're correct in thinking that. We're talking about the vital signs of the hygiene department. So how healthy is the business of hygiene within that dental practice? Right. That's what I wanted to clarify. So it's really the business end of it. Okay. So do you need any specific analytics as far as software to track the vital signs of a dental hygiene department? I don't believe that you do. They come in handy and it's a really great option to have. If you are just tracking the data, you can pull all of that data off of your practice management software. And even when I first started tracking the data for myself years and years ago, before it was even really the KPIs, I didn't even know what those were. But I wanted to make a difference within my hygiene department. And I wanted to show the doctor I worked for the difference I was making. And so I just started with a piece of paper and a pen and I just started writing down numbers. How many patients am I seeing in a day? How many of them are getting an adult prophylaxis? How many of them are getting a periodontal maintenance procedure or some other periodontal procedure? How many of them am I offering fluoride to? And I started tracking that without having any specific analytic software or running any specific reports off of my practice management software. And you can do it by plugging those numbers into an Excel spreadsheet or you can do it with a calculator if you know the right formula that you need to plug in. So it's really easy for a hygienist in private practice to kind of assess how they're doing and to see how they're making a difference with that practice. So what do you do with those numbers? Let's say you're tracking your dental hygiene department. Now, were you tracking everybody in the office or were you the only hygienist and you were just tracking your own work? At that point, I was just tracking myself. Because I was newer to the practice and it was a newer dentist. And I tracked these numbers because at my annual review, I wanted to ask for a raise. I wanted to show actually the difference that I was making within that practice. And he asked me, he'd never been exposed to this before at that point. And so he asked me. If after we went through all of this data, if I would help the rest of the hygiene team to improve where they were and to understand the impact that they had on the practice. And so then it translated out to others. But I started with myself. Okay. So we could have titled this podcast, how to get a raise from your boss, right? As a dental hygienist through improving the vital signs of your hygiene department. And that's really what your original goal was. Yes. Yeah, which I think is a good goal. I think it's a fantastic goal because that's your business. That hygiene department is part of the business of the practice. It's also your little business within the practice, especially if you were the only hygienist at the time. You want to measure what you're putting out because your dentist might not even know how hard you're working or how you've increased the production of the hygiene department since you came aboard, right? Correct. And once I did that and was able to show my impact, then I was able to also use some of those same numbers to advocate for a new ultrasonic scaler. better budget for purchasing instruments to perform these procedures. I was able to advocate for getting a new saddle chair to sit in so that I ergonomically could continue to perform these procedures at the level that I was performing them. And so utilizing those numbers to just empower the hygienist so that they can show the difference that they're making within the practice. So yeah, it could have been titled how to ask for a raise. Right. And you want to back up your request. I mean, if you ask somebody for a raise, they're going to look at you and go, yeah, I mean, we give you a raise every year, 2% or 2.5% inflation raise or cost of living raise. And then your answer is, well, that's obvious. I want that. But I think you should take a look at what's going on here in our hygiene department. And I have these numbers to show you. I think it's a fantastic thing. Now, you would think the typical dental software that's running a dental practice. like Dentrix, those kinds of software programs, wouldn't that be pretty basic to just say from January through March, this was my dental hygiene production, but now look at April 1st through the end of June. Look what I'm doing now. Shouldn't that be enough to show the difference that you've made or how does that compare to the vital signs you're recording? That could be enough to show the difference for some individuals. But I like to look at it, too, as far as are you providing the level of care that is commensurate with the level of disease that's in our communities? We know, you know, the periodontal numbers. of the level of disease that's in the United States. You know the amount of dental caries that is out there. And so I really like to tie those pieces in. And I guess you could focus it specifically on production, but I'm not a numbers person and I'm not. overly motivated by the dollar, even though I like to get compensated for the work that I do, I also want to know that I'm making a difference in the health of the patient. And so that's then why I tie in the numbers with the periodontal percentage and the fluoride percentage because of those vital signs are reflecting the health of the patients in the practice, which then in turn helps. the health of the practice itself. So that's where my mindset is at, is the patient care. Right. So when you do the vital signs for your department, give us an example of what you enter into a spreadsheet, for instance, related to the periodontal health of your patient and what you've contributed toward that. Okay. So as far as the periodontal health of the patient, so I'm going to be taking... the number of adult prophylaxis patients. So say I started out in January with a certain number of periodontal maintenance patients and then the adult prophylaxis patients, and then I'm going to get a percentage of how many of those patients were receiving periodontal care versus just an adult prophylaxis. So that's going to give me the level of care that I'm providing. as far as addressing the periodontal disease that's present. How much time do you spend documenting this information into a spreadsheet? Oh, well, anymore, I don't have to spend a lot of time documented into a spreadsheet because of all the analytics that are out there and all the reports that are out there. But it's really, really quick. When I was just doing a chair side for myself, it would... I don't think it even took me two minutes because I was able to just pull those numbers directly off of the computer. And like you were talking about with Dentrix, you know, you can show the reports of production, but you can also show the number of procedures based on a certain procedure code. And once you figure out how to extract that data out of there, it's so quick to put those numbers in. So how many dental hygienists do you think are working out there every day very hard and diligently helping their patients where their dentist who hired them, who they work for, don't really know how they've improved the productivity of the department, how they've improved the overall health of the patient population that's coming through their door? As far as a percentage of hygienists or percentage of practices that don't have that? Is that what you're asking? Yeah, that don't have that. The hygienists don't have a system to communicate data and metrics, what you call vital signs, to the dentist that owns the practice to say, hey, look what I'm doing here. Yeah, I would say at least in my experience, it's at least… 50%, if not more, because I talk to hygienists all the time and they don't understand some of those pieces. And until their doctor goes through some sort of practice management or, you know, consulting, some of them don't understand it. Now, there has been more of a shift with the DSOs coming on and being more of a presence. You know, they focus a lot more on that. But I would say just the general... dentists general dental practices I would say at least 50 percent if not more of the hygienists just don't have that transparency between their doctors as far as the impact that they're making on the practice and not to say that they aren't appreciated you know the doctors understand that that the hygienists are there and and generate revenue that helps support the practice but I think for the hygienists to feel empowered to go into the doctors and asking for the things that are going to help them provide better care and help them be more satisfied with their job. Because I've asked for things besides a raise. I've asked for travel to a conference, to a national conference. I've asked for additional benefits. I've asked for additional weeks of vacation. you know, that hadn't been there previously, even as an option, because I can show the impact that I'm making. So it's just going to depend on what is important to them as a hygienist. Yeah, I think what you did was fantastic. I mean, I think going in and asking for things and not having the numbers to back it up, you say you're not a numbers person, but in effect you are, because what you're backing up with your vital sign documentation is extremely important. It not only helps the dentist understand what you're doing in there. but it also helps you understand your impact on the patient and it could drive you to improve and do more of the things that you're finding are successful with your patients. And then of course, like you said, building your armamentarium as far as up-to-date equipment in your office, more ergonomic chairs, you could become even more productive. It's all benefits. It's all upside. It's a win-win for everybody, including the patient. So what suggestions do you have for helping to improve these vital signs for other hygienists that are out there that are going to? do this now that they've heard this podcast? Well, the first thing that I would suggest is to try and see where you're at. Get the information to show what are those numbers that you have in the last six months. And if you have... the ability to go into your practice management software, kind of see where you're at so that you can kind of get a baseline and then trying to make some incremental changes over time. But first you need to be prepared. You got to see where you're at before you know where you can go. And with that, you can start tomorrow. You can start with what is my day look like tomorrow? What are the patients that I'm seeing in my practice? Are any of those patients, if you do a really good chart audit or a chart review, are any of those patients that I could transition into periodontal therapy? Are any of those patients that have risk factors that would lead them to increase in progression of disease? Whether it is periodontal or... or decay. Like I said, we know what the decay rates are. You know, am I offering fluoride to all these patients? Is there even two patients out of my day that hasn't had a fluoride varnish treatment the last several times they've been in that would benefit from that based on their risk factors? And looking at... how those risk factors and their current disease status relate to the recommendations from the American Dental Association on caries risk and treatment recommendations based on that, and the Academy of Periodontology risk factors and treatment recommendations based on that. So tying all that together and identifying some of those patients that you want to have these conversations with ahead of time and kind of preparing yourself, just like you'd be preparing yourself for the conversation you want to have with the dentist. have to prepare yourself for the conversation you want to have with that patient beforehand and know the direction that you want to take it based on what is currently in their charts before you even have them in the chair. No, that's a tremendous point. By the way, any recommendations on a good floor at Varner? She mentioned that. Is there anything you like in particular? So yeah, there is actually. I like the enamel pro varnish from Premier. That's one that I really like based on the science behind it because it allows for a longer uptake of fluoride and having the ACPA in there, it really does. provide a better benefit for the patient I feel long-term. Fluoride is the biggest thing and it's so easy for prevention. And I think everyone will benefit from that and everybody should be having a fluoride treatment. But yeah, the enamel pro varnish is really, really key as far as what I can offer my patients for prevention. So in closing, Camille, tell us what a hygienist should think. about when approaching a dentist with the information they've gathered from building some documentation on the vital signs of their department? Really thinking about like where things were at when they started. So having a plan. So if you know that your annual review is coming up or you know that you are in need of something or something that you want to add in preparation of that, like having a plan in place to have the data that shows this is where I was and this is where I am now. And these are the gains that I made along the way. And just really feeling empowered, I guess, to advocate for themselves because there's not going to be anybody else out there that's advocating for them. And so really advocating for themselves to show that they bring value and showing that they're an asset to the practice based on that. You can be an asset to the practice in a lot of ways, but if you're an asset in the practice because you're providing the care that the patients deserve and that is relating to the active disease processes that are happening within your practice, I think is really, really key. And the conversation is going to vary based on the relationship between that dentist and that hygienist. So having that good communication and that Building that relationship, I think, is really, really going to be key to help them get the benefits that they're seeking if they're going in and asking for different things. You know, I was an endodontist full-time for many years. And when staff members came in to see me, when we did an evaluation, if they had come in with documentation that clearly showed me, you know, what they're bringing to the table. Even though I know they were very good, when a dentist is very busy, they're not focused necessarily on what the other person's doing in the practice. But when there's real hard data to support production increases and better patient health and bringing in new techniques into the department saying, you know, I took a CE course and I've implemented this new technique and it's been doing really well. We got a lot of word of mouth referral from a lot of my patients that are helping to build the rest of the practice. And there's data on this. You know, that's very exciting. That's very exciting to hear. You're prefacing what you're asking for with telling the dentist what you brought to the practice. You know, your contribution is just significant to the success of the practice. And that's why what you're saying is so important. Great podcast. It was loaded with information. And I think there are many hygienists who are listening to this podcast that are going to go to work tomorrow and think about documenting some of the vital signs in their hygiene department. very significant towards the success of the practice. And the dentist that hired them should know about it. Thank you so much. And we wish you the best of luck. We look forward to having you on future podcasts. Thank you so much.