In this week's episode, Phil Cole, CEO of KLAS Solutions, talks through the critical role of the hygiene department, which is often misperceived as a "cost center" when, in fact, it serves as the vital engine propelling the entire dental practice forward. Through a comparative analysis of two practices within the same area, we look at one practice's hygiene department merely meets payroll while the other exhibits a remarkable threefold production increase, effectively optimizing the doctor's schedule. The distinction does not stem from talent, but rather from a systematic approach that encompasses mindset, clinical protocols, and operational efficiency.

Throughout the conversation, Phil leaves some essential strategies, including an actionable 90-day implementation plan, to transform the hygiene department into a robust profit center. By the conclusion of this episode, Phil aspires to equip you with the requisite insights to elevate your practice's hygiene performance to unprecedented heights.

Takeaways:

• It is imperative to recognize that the hygiene department serves as the engine driving overall practice production, rather than merely a cost center.
• A significant discrepancy exists between two similarly equipped dental practices, where one excels in hygiene productivity, highlighting the importance of systems and standards in practice management.
• The success of a hygiene department hinges on the belief of its purpose, as viewing it as a profit center fosters investment and growth.
• Implementing a comprehensive periodontal program can dramatically improve patient outcomes and practice profitability, addressing the substantial gap in necessary care that many practices currently overlook.

To learn more about how KLAS Solutions can set your practice up for success, visit klasdentalcoaching.com!

There's a room in your practice most owners treat like a cost center.

It is actually the engine that drives everything else.

Two practices, same town, same fees, same two hygienists.

One department barely covers its payroll, the other produces at triple the rate and fills the doctor's schedule while it does it.

Same chairs, same hours, same people.

The difference is not talent.

Today I will show you what it is.

This is the dental business podcast brought to you by Class Solutions.

One team.

Five divisions aligned around your practice.

I'm your host, Phil Cole.

Today we are going into the engine room, I call it.

And by the end of the episode you will have the mindset, the math, the clinical program, the handoff and a 90 day install plan for the most underbuilt department in dentistry.

So let me set the picture properly before we start because the cold open that you just heard was the short version.

Two practices, in the same size town, same fee schedule, same two hygienists, four days a week each.

In a first practice, the hygiene is doing cleanings.

Patients come in, they get scaled and polished, the doctor waves from the doorway and everybody leaves.

That department barely covers its own labor.

And in the second practice, hygiene diagnoses, hygiene treats, hygiene hands the doctor a lead and tease it up.

Find it in almost every patient and every patient walks out with their next visit on the books.

Like we've discussed, that second department produces at a completely different level and it fills the doctor's schedule while it does.

It is systems standards in one specific clinical program that most practices are running at a fraction of what the patient is population actually needs.

We're going to walk through all of it in the order that you install it.

This episode is brought to you by Archi.

Archie runs the whole practice from one cloud based platform.

Charting, imaging, claims, payments and patient communication in one place.

So your front office stops living in six systems at once.

See itchy.com okay, so for segment one, let's start with the mindset.

Because the mindset drives every decision underneath it.

An owner who sees hygiene as a necessary expense, staffs it thin, schedules it tight, buys the cheapest instruments, and then wonders why the department does not contribute.

An owner who sees hygiene as a profit center, invests in it and gets paid back several times over.

Those are two different practices and the only thing that separates them was a belief.

So let us make the belief measurable.

Now the first number is hygiene production as a percentage of total production.

In a healthy general practice, hygiene should account for somewhere around a quarter to a third of total production or 30 to 40%.

Before you go pull that number, understand there are two ways to count it.

And practices argue about this constantly.

The narrow way counts only what is billed under the hygienist as a provider.

Profis, periodontal therapy, periodontal maintenance, radiographs, fluoride sealants, whatever your software attributes to her or him.

The broadway also counts the doctor's treatment that oriented from a hygiene visit.

Both numbers are useful.

The narrow number tells you whether the department pays for itself.

Though the broad number tells you what the department is actually worth to the practice.

Pick one, define it in writing and stop moving the definition.

Because a KPI you redefine every quarter is not really a KPI.

It's a swing or it's a mood swing.

I should say now the labor math, because this is where most owners have nearly actually done have never really done the arithmetic.

I should say say you pay a hygienist $45 an hour.

Your real cost is not 45.

Add payroll taxes and whatever you contribute to health insurance and retirement.

Add paid time off and your loaded cost lands 25 to 30% above the wage.

So let's say it's now 57 or $58 an hour on an eight hour day.

This is around $460 in labor before she has picked up even an instrument.

Then layer in supplies, sterilization, the ultrasonic, the room and your share of rent and front office time supporting that chair.

The working rule I use is that a hygienist department should produce roughly three times the hygienist's wage at $45 an hour.

That is a floor of about what I would say base bare minimum, $135 an hour.

Class Solutions we really look to be our bare minimum to be $175 an hour, which is right around, you know, $1,000 at the 135 on a solid eight hour day.

Strong departments run well above that, as I've just mentioned.

And so if you're sitting at six or seven hundred dollars a day, you're not looking at a lazy hygienist.

You're looking at a system problem.

And system problems have addresses.

Well, we are talking about wages.

A word about how you pay the department.

Because pay structure drives behavior.

Hourly is the default and there's nothing wrong with it.

Daily rate works when your days are consistent.

Percentage of production sounds like alignment and it creates a problem I've had to clean up more than once because the moment hygienist paycheck moves with their own Diagnosis.

Every number she reports carries a motive.

If you want an incentive in the department, tie it to the things nobody has to diagnose to hit reappointment percentage, for example, one time patient retention days on the books pay for the systems working, never for a specific procedure code.

The other structural decision is appointment length, and most owners get this backwards.

The instinct is to shorten the appointment so that you can fit more patients.

50 Minutes becomes 40.

The probing.

The probe, excuse me.

The probing gets skipped though, and the photos never get taken.

The doctor exam turns into a wave from the doorway.

The productions per hour falls while the patient count rises.

Give an adult recall visit the minutes the standard actually requires.

And for Most practice that's 60.

A 60 minute appointment doing complete work out produces a 40 minute appointment doing partial work every single time.

And it does it without anybody working any faster.

Then spend the money on the room.

Enough instrument cassettes that nobody is waiting on sterilization, a sharpening service or somebody trained to sharpen because dull instruments make appointments run long and make patients soar.

A good ultrasonic with the right inserts, loops and a light, an inner or camera in every hygiene room, which I'm going to come back to later because it is the highest return equipment purchase in the building.

All of that runs a few thousand dollars per room.

One open hour a day costs you more than the inside of two months.

Speaking of which, there are five common addresses for a department running under $1,000 a day.

One, the procedure mix is almost entirely profi, which we're going to spend real time on.

Two, the schedule has holes in it.

Three, appointments are too short to do the clinical work the standard requires.

Four, there's no protocol base on risk or fluoride and other adjuncts, so nothing gets offered consistently.

And then five patients leave without the next visit booked, which is huge, which drains the department six months later instead of today.

Let me show you how.

Let me show you what open time actually costs.

Because owners tolerate it in a way they would never tolerate a supply overspend.

One open hour a day, five days a week.

At that, $135 an hour is about $675 a week.

Across the working year, you are nearly $32,000 of production.

This simply never happened.

Nobody wrote a check.

Nothing showed up on a report as a loss.

It just quietly did not exist.

Two open hours a day and you are past 60,000.

Here's the same math from the other direction.

When a hygiene patient cancels at 9 in the morning and nobody fills the Slot.

This is not a lighter day.

That is $135 an hour of capacity you already pay for and it's gone.

Which is why a short notice list is not a nice extra.

It is a financial control.

Which raises a question almost nobody in this industry can answer about their own practice.

Are you even staffed correctly for the patient base that you have?

Here's how to figure that out.

Count your active patients and define active.

Honestly, my definition has patients seen in the last 18 months to 24 months.

If A hygienist sees eight patients a day, you need 375 hygiene days a year.

Divide that by roughly 48 working weeks and you need somewhere around seven and a half to eight hygiene days a week.

Two hygienists at four days each covers it, but barely with nothing left over for new patients or for anyone who needs a three month interval or a four month interval.

Now run that same calculation after you build the periodontal program we're about to talk about.

Because the answer changes.

Move 200 patients from a six month interval to a three or four month interval and you have added several hundred visits a year to a schedule that is already full.

That's not a problem.

That is growth showing up as a capacity question.

And it is a far better question than the one owners are sitting with.

Run the math on your own practice tonight.

It takes 15 minutes and it answers three questions at once.

Whether you are understaffing and turning patients away without realizing it.

Whether you're overstaffed and staring at open chairs.

And whether your recall system is quietly leaking patients.

Which shows up as an active count far below what your near new patient flow over the last five years should have produced.

One more cost that never makes it onto paper and that's turnover.

When a hygienist gives notice, you lose her days until you replace her.

And and in most markets right now, it is six to 12 weeks to find someone, if not more.

At $1,000 a day, eight days a month, a 10 week vacancy is around $80,000 of production.

Plus the recruiting costs, plus the patients who got rescheduled twice and started shopping.

That is what retention conversation is worth.

Have it before the notice, not after.

Now, the piece that changes the economics of the department more than anything else.

And the piece where I see the widest Gap between what patients need and what practices deliver periodontal disease.

Start with the population.

National survey data puts periodontal in roughly 4 out of 10 adults over the age of 30 and closer to 6 out of 10 once you get past 65.

That is periodontitis, meaning actual attachment and bone loss.

Layer gingivitis on top.

And that and the number of adults walking into your practice with an active inflammatory condition in their mouth.

Well, it's very large.

Now go pull your own numbers.

Take the last 12 months of hygiene visits and calculate what percentage where periodontal codes of any kind versus adult profis in practice after practice.

We see 5%, 8%.

We're lucky to see sometimes 12%.

And then the owner tells me his patient population is just healthier than the average doctor.

Your population is not the national average.

And I will grant that a practice is in a young professional part of town looks different from a practice serving a retirement community.

Demographics move the number.

Demographics do not move it from 40% to 4%.

So when the gap is that wide, you're not treating a healthier population.

You're.

You're under diagnosing and your patients are paying for it with their bone.

So let us build the program.

Four parts.

Diagnose, classification, treatment and conversation.

Part one, diagnosis, which means measurement.

Full mouth Periodontal charting.

Six points per tooth recorded in the chart, not called out and forgotten.

Probing depths, recession.

So you can calculate actual attachment loss, bleeding points, mobility, furcation involvement and current radiographs to read bone levels.

Comprehensive charting at least once a year on every adult patient and updated at every maintenance visit.

For anyone in the program, that single change is the hardest one to install and the most valuable because probing takes time.

And if you have your hygienist on 50 minute appointments with a doctor exam crammed in, probing is the first thing I guarantee you that's going to get dropped.

It gets dropped quietly.

It gets charted as within normal limits.

And after three years of that, you have a chart full of numbers nobody actually measured.

If you want the program, you have to give the department the minutes to do the clinical work, write it into the appointment template and defend it.

Two things make charting faster and both are worth buying.

Voice charting.

So the hygienist is not putting down an instrument to type and an assistant or software that captures while she probes.

Full mouth charting with good technology runs five to seven minutes.

Full mouth charting with a hygienist typing between quadrants runs 12 to 15.

You're buying back five to eight minutes on every adult patient.

Every day, in every room, which is another appointment per day per hygienist.

Now part two is classification.

The current framework from the American Academy of Periodontology and the European federation stages periodontitis 1 through 4 in grades at A, B or C. In plain language, the stage describes how much damage there is and how complex the case is to manage.

The grade describes how fast it is moving and how much risk the patient carries.

And that is where you factor in things like smoking and diabetes control.

Why does an owner care about a clinical classification system?

Three business reasons.

It makes your diagnosis consistent across every provider in the building.

Huge.

It tells you the correct maintenance interval instead of defaulting everyone just to six months.

And it gives you documentation that stands up when the carrier asks why you treated what you treated.

Consistency.

Here is the whole game.

A practice where every hygienist and the doctor diagnosed the same condition the same way is a practice with a program.

Everything else is individual preference, wearing the program's name.

Part three is treatment.

And this is where I want to spend a minute on the missing middle.

Most practices behave as though there are only two options for a patient in a chair routine, adult profile or scaling and root planing by quadrant.

So every patient who is clearly not healthy does not have attachment loss yet gets coded as a prophy because the team does not want to send them straight to the root plane.

That patient has a code.

It is a scaling procedure for generalized, moderate or severe gingival inflammations.

Full mouth performed after an oral evaluation.

Bleeding, swelling, heavy biofilm calculus, no attachment loss.

This is a real diagnosis with a real procedure and in most practices it is used almost never.

It's the single largest coding and care gap in hygiene and closing.

It means the gingivitis patient actually gets treated for gingivitis instead of getting a polish and a six month card.

For the patient with attachment loss, scaling and root planing and quadrant based and the code changes depends on whether you are treating four or more teeth in that quadrant or one to three.

Then four to six weeks later you reevaluate.

You do not skip the reevaluation.

That appointment is where you find out whether the therapy worked, whether the patient needs referral to a periodontist and what interval the case actually calls for.

Then the patient moves on to periodontal maintenance at the interval, their stage and grade support, which for a lot of stage three cases means every three months.

Let me put a hard operational rule around the reevaluation because it's the appointment practices loss most often or lose Most often I should say it gets scheduled the day the last quadrant is completed for from the chair before the patient stands up.

Not put on a call list, not left for the front desk to take care of.

If your software will show you how many patients completed quadrant therapy in the last six months and how many of those have a completed reevaluation, go pull that report this week.

In a department without the discipline, the answer is under half and every one of those patients is sitting in limbo with no interval, no diagnosis of record and no next step.

Here's the rule.

Practices break constantly once a patient is a periodontal patient, they are a periodontal patient.

They do not go back to a routine prophy six months later because the pockets look better.

Periodontal patience is the ongoing standard of care for a treated periodontal patient.

And flipping them back to a prophy is both a clinical mistake and documentation problem.

If your software shows patients bouncing between those two codes, visit to visit, well you have found a problem worth fixing and it better be this week.

You also need a clear line on referral and a periodontist who actually Talked to Stage 4 cases.

Aggressive Stage 3 Grade C furcation involvement.

You cannot manage non surgically sites that do not respond after therapy and re evaluation patients with medical complexity.

That raises the stakes.

Send those out, stay in the case for maintenance and set up a co management agreement in writing so both offices know who is seeing the patient at which interval and who is charting what a referral is not a loss.

A patient you held onto for three years while the bone left the building is a loss and it is the kind that follows you.

And while we are here let me be direct about the insurance piece.

Periodontal codes carry frequency limits, waiting periods and documentation requirements.

Some carriers want charting and radiographs submitted, verify benefits, submit a real narrative and and use a predetermination on larger cases so nobody gets surprised.

But understand the order of operation.

You diagnose the condition, then you find out what the plan pays.

Never the reverse.

The moment a benefit starts driving the diagnosis, you've handed your standard of care to an insurance company and and that is a decision you will regret more ways than one.

Related I get this question in every coaching engagement.

What if I'm heavily contracted and the reimbursement on peril therapy is really thin?

Well, there's two answers.

First, thin reimbursement on treatment the patient needs still beats a prophy fee on treatment that does not address the disease and the maintenance interval that follows carries the department for years.

Second, if you're running the numbers on a plan makes it impossible to deliver the standard of care profitably.

That is not a hygiene problem again, that is a contract problem and it belongs in a fee and participation review which is different Conversation and one Our coaching team runs with clients the Time Part four let's look at the conversation Because a diagnosis nobody accepts produces nothing, the move here is co discovery.

Read the numbers out loud while you probe and let the patient hear the difference between the A2 and A6.

Take care of photos and put them on the screen.

Shown the bone level on the radiographs.

Then explain it in the plainest language you own.

Bleeding means defection.

A deep pocket means you have lost attachment around that tooth.

Bone does not grow back on its own and the goal is to stop the loss where it is.

Three things not to do in my opinion.

Do not call it a deep cleaning as though it is an upgraded version of the same service because that framing tells the patient this is optional and priced by preference.

And don't apologize for the fee ever, because an apology is a confession that you're not sure it's necessary.

And do not present periodontal therapy as something to think about.

You would not present a crown on a fractured tooth as something to think about.

When the patient says her insurance will not cover it, the answer separates the two issues.

Your plan has a limit.

Your body has a condition.

Let's talk about the condition first and then work our way to paying for it.

When the patient says nobody ever told me she had this, the answer is straight one.

I'm telling you today.

Here are the measurements and here is what we are going to do about it.

Do not throw a previous doctor under the bus and do not get defensive.

Just own the moment and use this systematic connection carefully and accurately.

Periodontal disease is associated with diabetes, cardiovascular disease, poor pregnancy outcomes, and with diabetes the relationship runs in both directions.

Uncontrolled blood sugar makes the gums worse and active infection makes glucose control harder to handle.

That's the honest framing.

You're not curing heart disease with a scaler.

You are treating a chronic infection that interacts with the rest of the patient's health.

And that's a real reason this matters.

One more thing on this and is about your team.

Hygienists resists perio programs when they feel like they are being asked to sell and they are right to resist it.

The way you get genuine buy in is to make the standard clinical put it in writing and have the doctor stand behind the diagnosis every single time.

When a hygienist knows that the doctor will back her measurements in front of the patient and she diagnoses that confidently, when she has been contradicted in the room twice, well, she's going to stop.

Do not put a hygienist on the bonus tied to a specific code once again.

Because the day you do that, every number she reports becomes suspect to you and to her.

Now, calibration.

Pull your periopercentage by provider, not just for the practice.

And if one hygienist is at 40% and the other is at 8%, you do not have a talent gap, you have a calibration gap.

Fix it with a written protocol that says exactly what findings lead to what diagnosis.

Then sit down as a clinical team, review real charts together and probe the same patients until everybody arrives at the same conclusion.

Make that a standing meeting, not.

Not an event.

One hour a month, whole clinical team, three real charts on the screen.

What did we measure?

What did we diagnose?

What did we recommend?

What did the patient accept?

And where would two of us have called it differently?

Practices that hold that meeting for six months stop having a calibration problem.

Practice that hold at once, have a great afternoon and go back to their habits by April.

The doctor owns the diagnosis.

The protocol makes it repeatable.

The meeting keeps it honest.

Two metrics tell you whether the program is real.

The first is the percentage of your active adult patients who carry a periodontal diagnosis and sit in maintenance.

The second is your case acceptance on quadrant therapy, measured as treatment presented against treatment scheduled inside 30 days.

If diagnosis is climbing and acceptance is falling, the clinical side is working and the conversation is not.

And that is coaching problem with a known fix.

What does all this do for your economics?

Well, I'm gonna tell you two things.

First, a mix shift on today's schedule because the patient who needed therapy and got a prophy was producing a fraction of what her carry actually called for.

Run your own numbers on this.

100 Patients a year moving through quadrant therapy at your fees and then onto maintenance is a six figure change in their department.

And I have never once had to inflate a number.

Make that case.

Second, and this is the part owners miss.

A periodontal patient on a three or four month interval comes in three or four times a year instead of twice.

Most visits means more radiographs, more adjuncts, more doctor exams and more diagnosis.

The whole engine just spins faster.

A quick word from Archie.

If your team is bouncing between a server, a claims portal, and Three tabs to get one patient through the chair.

That's time for you, for your pain, for twice, Archie pulls it all in one cloud platform.

Book a [email protected] the second half of the engine is the handoff from hygiene to the doctor.

And this is the ten foot where diagnosed treatment either gets captured or walks out the door and is the least systemized 10ft in most practices.

The standard is simple.

Every hygiene patient gets a real doctor exam, which means the number to track is doctor exams per hygiene day.

And it should equal the number of patients that hygienists saw.

Eight patients, eight exams.

When the number sits at five, you're not doing dentistry on three patients a day times two hygienists, times the number of days you're open.

Do that multiplication once and you'll never let it slide again.

Why do exams get skipped almost never?

Because anyone decided to skip them.

The doctors deepen the crown prep and and running behind.

The hygienist doesn't want to interrupt.

The patient is late for something.

The exam turns into a head in the door.

Everything looks good.

See you in six months.

Nobody did anything wrong and the practice lost the diagnosis anyway.

The fix is structural, not motivational.

Build exam windows into the doctor's schedule.

Short holds at predictable points in the morning and in the afternoon, timed to when hygiene patients are ready.

At those specific moments, the doctor's schedule serves the hygiene schedule.

That is a scheduling decision, which is exactly why we did the scheduling episode before this one.

If your template does not protect the exam, no amount of asking your team to try harder is going to ever protect it.

Then there is the handoff itself.

And this is where you get real leverage for free.

A verbal handoff out loud in front of a patient in three parts.

So here's part one, the introduction.

This is Mrs. Alvarez.

She has been with us for nine years and she just got back from her daughter's wedding.

That takes eight seconds and it changes the temperature of the room.

Now part two.

Report the findings.

Here's what I measured today.

We took four bitewings.

Here are last year's numbers next to today's.

And I charted three sites over 5 millimeters in the upper right that were not there from her last visit.

Now part three, teed up.

You have the concerns for the doctor.

Doctor, I'd like you to take a look at the lower right second molar.

She has been sensitive to the cold there for a few weeks.

She says.

And I see something on the bitewing.

I want you to see as well, that's it.

Now the doctor walks in informed, looks at a specific tooth and confirms that the hygienist what the hygienist already said I should say.

The patient just heard the same findings from two clinicians she trusts independently within probably.

Well, once again the 92nd rule.

That is why the handoff converts.

It is not persuasion.

Once again the word that we always use.

It's consistency.

The doctor has a job in that 90 seconds too.

And it is not to start over.

Look at the specific tooth, say the hygienist's name and confirm her findings out loud.

I agree with what Sarah measured.

This pocket is deeper than it was last year.

And here's what I want to do about it.

Then stop talking and let the patient ask.

Doctors lose more treatment by explaining for four minutes than they ever lose by explaining their 40 seconds.

What kills a handoff faster than anything else is the hygienist who tells the patient everything looks great before the doctor comes in.

Never pre deliver good news.

Once the patient is heard, she's fine.

The doctor is now arguing with a member of his own team.

Train the language.

Findings go to the doctor and the doctor and the hygienist deliver the picture together.

One more habit.

And if you take only one tactical thing from this episode, take this interoral photos on every patient every visit.

A cracked cusp, a failing margin, an open contact, inflamed tissue.

Patients accept what they can see and they do not accept what they are only told.

A camera in every hygiene room is the highest return equipment purchased in the practice.

And it does not require anything to become a better talker.

Set a standard so it actually happens.

Minimum of four photos on every adult recall visit on the screen before the doctor walks in.

Two hours of training gets a hygienist competent with the camera.

After that it costs absolutely.

And about.

Well, I shouldn't say absolutely, but about 90 seconds a patient and it is the closest thing to free case acceptance in dentistry.

Now capture the treatment gets scheduled from the hygiene chair, now sent to the front desk with a hope attached.

The financial conversation happens face to face with a person who can answer questions not in an estimate that arrives in the mail 90 days later.

And if the finding is small and a doctor has room, do it that day.

Hold one open block a day for a treatment that comes out of hygiene same day.

Dentistry from a hygiene diagnosis has the highest acceptance rate in the practice because the patient is already in the chair.

They're already numb in to the idea and has not had 11 days to talk herself or himself out of it.

Then work the report.

Every single week, somebody pulls unscheduled treatment and works it.

Not a team.

A person by name with an hour on the calendar and a script.

Diagnosed and never scheduled in.

The most expensive report is your.

In your practice and in most practices is sitting there right now with six figures on it.

Sort it by dollar value, call the top 20, lead with the clinical reason and not the fee, and put a note in the chart every time.

Practices that work that report for one quarter routinely find 30 to $60,000 nobody had to diagnose again.

In our last customer, we had our customer put in our class dashboard and we immediately found $770,000 in that list.

While you're at it, ban the phrase we are going to watch it unless it is followed by something specific.

Watching.

Remember, it's not a diagnosis.

If you're watching a lesion, say what you're watching, say what you are measuring and say what you will decide.

Otherwise.

Watching just means forgetting in slow motion.

The last piece is keeping the chairs full six months from now.

And it comes down to four things what we've talked about before.

Reappointment, the confirmation system, intervals and an approach to adjuncts based on risk.

Reappointment.

First, measure it as the percentage of hygiene patients who leave with their next hygiene visit on the schedule, not on a call list.

On the schedule with a day target above 95%.

And the best departments I work with live in that mid-90s.

Two rules make that happen.

One, schedule from the chair.

The hygienist has the relationship and the momentum.

And the momentum dies in the walk to the front desk.

2.

Treat.

Just call me as a no, right?

And handle it right there.

We talked about that in our last episode.

Offer two specific times in the same sentence.

I have a Tuesday at 8 or a Thursday at 3.

Which one works better for you?

Most people cannot say no to a real question with real options.

And the ones who generally cannot commit get flagged for a follow up.

You actually own behind that.

You need a real reactivation system, a defined past do list, defined outreach steps at defined intervals, and one human being whose name is next to it.

Not the team.

A person.

Every practice I've ever seen with a broken recall system had a recall system that belonged to everybody.

Build the sequence and stop improvising it.

Text at 2 weeks past due phone call at 30 days from someone who knows the patient.

Second call, an email at 60 days with a clinical reason attached, not just a reminder that it's Been a while.

A letter or a personal note from the hygienist at 90 days.

Then a quarterly campaign to everyone past due.

Beyond that, track the recovery rate because reactivation is measurable and any practice with more than 1,000 active patients should be pulling 10 to 20 patients a month back into that schedule.

Now the confirmation system, because a booked appointment is not a kept appointment.

You got to track your hygiene cancellation and failure rate as a percentage of scheduled hygiene visits.

Under 10% is healthy over 15 and you have a schedule that looks full on Monday and is not full on Thursday.

Confirm on a rhythm two touches before the visit and make one of them from a person on high value appointments.

Then build the short notice list properly.

20 Or 30 patients who want it sooner.

Sort by who lives close and who works flexible hours.

Kept current the work and the moment a hole opens.

A department that fills every percentage of its holes gets Most of that $32,000 we talked about earlier back now intervals because this is where clinical judgment and capacity meet.

Stop defaulting every patient to six months.

Six months is a habit, not a standard.

Assign intervals by risk and by condition.

Three months for the periodontal maintenance patients whose stage and grade call for it.

Four months for the patients with heavy calculus, uncontrolled diabetes or a history that says he or she does not hold.

Six months for the genuinely low risk patients, 12 months for the rare adult with no risk factors and a decade of clean charts and document why doing that improves care and it changes your capacity picture.

At the same time, it also means the interval has to be documented with a reason.

If your software lets anybody set any interval with no note, you will have a department where the interval reflects how full the schedule looked that morning.

Then adjuncts.

And I want to be careful here because this is a topic that turns hygiene departments clinical fast the fastest.

The answer is a written protocol with clinical criteria, not a script.

Take adult fluoride varnish.

Write down who gets it and why.

Exposed root surfaces, dry mouth from medication, which covers a huge share of your patient.

Over 50 active or recent caries, orthodontic appliances, a diet heavy in acid or sugar, history of head neck radiation.

Now, your hygienist is not offering fluoride to everybody and feeling like a salesperson.

She's applying a clinical standard to a patient who meets the criteria.

And she can explain exactly why this patient and not the last one.

That is also what makes acceptance rate.

A fair number to measure is the criteria.

If the criteria is written, you know your denominator.

20 Patients qualified this month, 15 accepted.

That is 75%.

And you can coach it without criteria on acceptance rate.

It's meaningless because nobody knows what the patient was supposed to be offered in that first place.

Same logic across the rest.

Localized antimicrobial delivery in isolated sites that do not respond.

Silver fluoride where it fits.

Sealants, desensitizers.

And do not overlook the hygienist as the first person to notice.

Wear facets and a cracked cusp on a patient who is grinding, which is a night guard conversation the doctor never would have started.

Same with the patients asking about whitening.

The teenager whose crowding is getting worse and the adult who mentions his spouse says he stops breathing at night.

Your hygienist has 60 minutes of relationship with that patient.

The doctor has 90 seconds.

Train her to listen for the opening and to hand it to you.

Now a quick word as assisted hygiene, since owners always ask.

It works when you have two rooms.

A dedicated assistant who is not being pulled to the doctor's side and a hygienist who generally wants to run that pace.

It fails when it's a workaround for a department that is undergoing an understaffed or under diagnosing, I should say, and understaffed.

Do not add volume to a broken standard.

You got to fix the standard, then talk about the volume.

So five numbers run this department hygiene production as a percentage of total production, so you know if the engine is pulling its weight.

Perio versus profi by provider, so you know whether you are diagnosing honestly.

Reappointment percentage so that you know whether the chairs are full in six months.

Adjunct acceptance against a written protocol so that you know the standard is being applied.

And doctored exams per hygiene day, so you know that the handoff is happening.

Now our coaching clients watch those five on the class dashboard.

And if you would rather track them on a whiteboard in the sterilization area, that works too.

What matters is that you get looked into and locked into every month by someone with the authority to change something.

A number nobody reviews is just nothing more than a decoration.

Now let me give you the order of installation, because everything I just covered lands badly if you try to do it in one staff meeting.

So that we have the 90 day install day one through 30.

Measure and expose.

Pull five numbers by provider for the last 12 months.

Pull the unscheduled treatment report, count your active patients and run the capacity math.

Sit in on the hygiene handoff and say nothing.

You are not fixing anything this month.

You're just finding out where you actually stand.

Days 31 through 60 build the standard.

Write the periodontal protocol 1 page findings 2 diagnosis write the adjunct criteria.

Rebuild the hygiene appointment template with the minutes the standard requires and put the doctor's exam windows in the schedule.

Buy the cameras.

Start the monthly calibration meetings in days 61, 90 install and hold.

Run the new template.

Chart every adult patient photos on every visit schedule from the chair.

Include re evaluations, one named person on unscheduled treatment and one on reactivation, both with time in their calendars.

Then review the five numbers at day 90 against the day one baseline and coach the gaps.

That is a real project and it's worth saying plainly that it fails for one of two reasons.

The owner installs it and never measures it so it drifts back inside a quarter or the owner announces it as a production incentive instead of a standard of care and the team hears sales.

Lead with the patient, hold the standard and let the production follow it all.

Always does.

So here's your assignment for this week and it takes about two hours total.

First, pull the last 12 months of hygiene visits and calculate your perio percentage by provider.

Second, pull the unscheduled treatment report and read the whole thing out loud if you have to, just so that you can feel it.

Third, sit in 15 height 4 sit in on 5 hygiene handoffs I should say and just say nothing.

Just listen to what your patients are actually hearing.

Whatever those three exercises turn up is your project list and you do not need me to hand you that to you.

Now I'm going to make your rebuild.

All of that from a podcast episode you listen to in the car.

We put the whole thing in writing.

It is called the 90 Day Hygiene and Perio Install Plan and it is the same document we hand our coaching clients when we start this work inside.

If you get the week by week checklist for all three phases.

A baseline worksheet for the five numbers that you can write down where you stand today and where you hit at day 90.

The active patient capacity math laid out so that you just fill in your own numbers.

A one page periodontal protocol template that takes findings to diagnose.

An adjunct criteria template that you can adapt and sign and the agenda for the monthly calibration meeting.

It's free and there's no catch attached to it.

Email [email protected] with the word hygiene in the subject line and we will send it to you the same day.

If you'd rather not email, go to classsolutions.com and ask for it there.

If you're watching with us on YouTube, just put Hygiene in the comments too.

I forgot about that and my team will get it to you that way as well.

Before we close, a word from our class Solutions Coaching.

We just want to let you know that we do have the dashboards available for you so that all of these numbers that we're talking about today are something easy for you to grab with just a couple clicks of the button.

Now let me leave you with the thing underneath all of this Hygiene is not a department you manage.

It is the engine that decides how full your schedule is, how much dentistry you diagnose, how healthy your patients are, and what your practice is worth the day you decide to sell it.

Buyers and lenders read a hygiene department fast.

A practice with a real periodontal program, 90% reappointment, and consistent Dr.

Exams tells a completely different story and evaluation than a practice producing the same top line out of a schedule that empties every summer.

I value both, trust me, and the difference shows up in multiples.

If you'd rather not install this alone, reach out to us.

We can help you in different ways.

We hope that you enjoyed this episode and we will continue on our series next week.

Please rate, review and send this to any friends that you may know that could use this podcast.

This is the Dental Business Podcast.

I'm Phil Cole.

We'll see you next week.