Creating Your Vision for an Ideal Continuing Care Department

The traditional hygiene recall appointment has changed. No longer a quick session for scaling and polishing, today's continuing care appointment is one of the dental practice's primary tools to ensure that patients are receiving the most timely and comprehensive dentistry possible. Today's hygiene department is more periodontal-aware than ever before. In addition, it works in tandem with the dentist to provide patients of record with systematic, on-going restorative evaluation and treatment in order to intercept dental disease before it progresses.

The first step in creating a top-quality continuing care department in your practice is to define its vision, including how it supports your overall practice vision. For example, if your practice vision is to provide patients with the best care and services to prevent disease and promote long-term oral health, then the vision for the hygiene department will be to provide patients with the best hygiene care and services to prevent disease and support their long-term oral health. This includes building value into the hygiene visit by strengthening patient relationships, inspiring loyalty and referrals, raising patients' dental IQ, gaining their commitment and compliance with oral health goals, supporting restorative care, performing preventive maintenance as required by the patient's condition, rather than by insurance maximums, plus other services. Let's look at some of these ways to enhance the hygiene department.

Supporting Restorative Care

Sixty percent of a practice's restorative care can come from the hygiene department when you and your hygienist work together. The hygienist offers an extra set of eyes for detecting pathology and conditions important for the doctor's evaluation. He or she needs to know how you diagnose, i.e., your parameters for choosing a crown, onlay, or composite. Then the hygienist can prepare the patient for what you may find, and through active listening and objection-handling verbal skills, answer any concerns or objections the patient may raise. The hygienist may say something like this: “Mrs. Jones, I'm seeing some breakdown on tooth number 30, your lower right molar. Doctor might recommend it for additional treatment.” Then when you arrive for the periodic exam, the hygienist would indicate his or her observations in front of the patient: “Tooth number 30 appears to have a fracture. I told Mrs. Jones that you might be recommending it for treatment.” It is very important that you not shoot the hygienist down in front of the patient. You both must work together through ongoing meetings and daily debriefs to insure that the hygienist is on the same page with you. In this way, he or she can be invaluable in preparing the patient for restorative treatment and gaining treatment acceptance.

Building Value Into the Hygiene Appointment

Many patients view the hygiene visit as “just a cleaning” and fail to see the full importance of it. No wonder the industry average for hygiene cancellations and no-shows is 28 percent! At Pride Institute, we goal our doctors for a cancellation/no-show rate of under five percent. You can achieve this by building value into the hygiene appointment. This is done in several ways. First, the hygienist engages the patient in “purposeful conversation,” which means conversation designed to uncover the patient's dental motivators and concerns, including how patients feel about their teeth, their long-term oral health goals, commitment to oral health, dental IQ, financial concerns, etc. The conversation must include the patient's conditions and how they relate to continuing care intervals and any follow-up treatment. This approach supports the vision and values of the practice in preventing problems from occurring.

Another way the hygienist builds value is by explaining everything he or she does to the patient and why. For example, take the oral cancer screening. When it is done tacitly, the patient does not know that an additional service is being performed. The clinician needs to tell the patient what is being done and why it is important so that the patient appreciates the full value of the exam. The same holds true for periodontal probing. By educating the patient on how pocket depths indicate gum health and how gum health is essential to oral health, the patient begins to realize that the procedures performed by the hygienist are valuable and the hygiene appointment has great importance.

The hygienist needs to correct the patient's assessment when he or she fails to see value. If a patient says, “I don't need x-rays. I haven't had a cavity in years,” the hygienist responds with, “You see, Mrs. Jones, cavities aren't the only reason we take x-rays. They also detect bone levels, cysts, lesions, . . .” Or if the patient says, “The tooth doesn't hurt me, so how bad can it be?” the hygienist shows significant findings with the intraoral camera. Seeing the problem offers proof to the patient.

The hygienist also builds value through effective debriefing of the patient at the end of the appointment, explaining what has been done, what the patient needs to work on at home, and what will be done at the next appointment, stressing the importance of it. Pride offices send patients home with a “continuing care slip” outlining these things, with problem areas in the mouth circled on a diagram. The continuing care slip serves as an ongoing reminder of areas of special attention and concern between visits, and it serves as a focus for the beginning of the next continuing care visit.

Recommending and carrying homecare products is another way to build value. If the practice vision is to prevent disease, then carrying homecare products will help the patient to initiate behavior change, with the hygienist providing purposeful guidance. For example, if a patient has arthritis and cannot floss, or needs fluoride treatments, or needs to improve on brushing, having homecare products to recommend and demonstrate will get the patient started and strengthen compliance.

Improving Compliance

As a result of the purposeful conversations that the hygienist has with the patient, there is data in the charts that can be used to encourage the patient to come in, should he or she call to cancel an appointment. The appointment coordinator says to the patient, “Let me pull your chart, Mr. Smith. . . . I see that when you last saw Susan, she was concerned about bleeding in the lower right. How is that doing?” or “Let me check with Susan. She may have some concerns about your delaying treatment.” Pointing out to the patient conditions that need to be monitored reminds him or her of the importance of keeping the hygiene appointment.

Customizing Appointments

Customizing time slots is another way to meet the vision of providing patients with the finest care with an emphasis on preventive treatment. When the hygienist places the patient on a three- or four-month schedule, you'll want to avoid the patient telling the appointment coordinator, “My insurance only covers every six months,” and the appointment coordinator complying with the patient. Your hygienist needs to answer the frequency objection before passing the patient to another staff member to make the appointment. This is done by building value in general during every step of the visit and by explaining how insurance in many cases will cover only part of the treatment needed for long-term oral health.

The vision you create for your hygiene department needs to reflect the key objectives of your practice. Continuing care need not be limited to providing periodontal care; it can be greatly supportive of your other practice goals, as well, by reinforcing the patient's relationship to the practice, building loyalty and referrals, gaining commitment to home care, supporting restorative care, educating the patient, etc. You have a golden opportunity at the start of your practice to mold the hygiene department into a dazzling, efficient, top-notch asset to your practice, so go for it!

Amy Morgan , CEO of Pride Institute
Merry Greig Cosgrove, RDH, MS , is a senior trainer and consultant for Pride Institute

Originally appeared Dental Entrepreneur Spring 2005