678: Unlocking Time: Reclaim Your Hygiene Appointment with These 5 Masterful Tips – Angela Heathman
Are you and your hygienists always running out of time? Do you want a way to stay on schedule? If you're struggling with time, don't miss this episode! Kirk Behrendt brings back Angela Heathman, one of ACT’s amazing coaches, to share some time management tips for a smooth, stress-free schedule. Stop working through lunch to make up for lost time! To learn how you and your team can take control of your schedule, listen to Episode 678 of The Best Practices Show!
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Main Takeaways:
Track how long each task takes to complete.
Set expectations on how time should be spent.
Always prepare for your day with a morning huddle.
Embrace technology. It will save you time in the long run.
Have open communication between team members and doctors.
Use the bib as a “seatbelt” until you schedule the next appointment.
Quotes:
“Pete Dawson used to say this all the time: you could build a practice just by being on time . . . When you're not on time, it screams, ‘I don't care.’” (1:56—2:06) -Kirk
“If you're a dentist, please listen to this. You completely over or underestimate time all the time. You tell your team members, ‘Oh, that'll be an hour. That'll be five minutes,’ and it's never what you say it is. So, we, as your team members, are constantly running around, making excuses for your inadequate estimates.” (2:09—2:33) -Kirk
“The first step is actually knowing how long you're spending on different things within your appointment. I would recommend doing a little bit of a reflection exercise or a little time study to see, during my appointment time, where am I spending my time? How much am I spending during the exam? How much time am I waiting for the doctor? How much time am I spending during mechanical debridement? How much time am I spending reviewing medical histories, X-rays, patient interviews, all that kind of stuff? What we often find is that we aren't really estimating accurately. We might think that we can get through that medical history and that patient interview in a minute or two when it may be seven, eight minutes.” (2:46—3:33) -Angela
“If you're going to build a business that makes promises and keeps them — like a great dental practice — you have to know how long things take you. And then, if you don't like the data, you can work hard to improve your systems so that it gives you better data. That's a thought. So, a time study is a really important thing. Now, one of the things that people leave out of a time study . . . a lot of times, people don't do a time study from when the patient arrives and when they leave. Make sure you bookend it with that. So, you don't know that the patient came in 15 minutes early prior to the appointment, and we saw them 15 minutes after they were supposed to be seen. And then, the dentist — and again, I'm speaking mostly to the dentist — was in there for five minutes, and they don't have any idea what happened the rest of the time.” (3:45—4:40) -Kirk
“You bring up a really great point, and that is having open communication between the hygienist or the doctor. Sometimes, that amount of time gets pushed down from the doctor like, ‘You need to shorten your appointments,’ or, ‘Instead of having 60 minutes, now you're only going to have 40 minutes.’ And sometimes, it's just kind of dictated. But that communication needs to happen about why the doctor might be feeling pressed to shorten those appointments, and why the hygienist might be thinking that they need longer amounts of time.” (6:17—6:52) -Angela
“Far too often, doctors don't communicate with team members, and they don't understand the why.” (7:11—7:15) -Kirk
“When you can see the whole picture, you can see that efficiency, being on time, having systems, and keeping promises are really important to building a great dental practice.” (7:22—7:32) -Kirk
“The most important thing, in my opinion, is being really prepared for your day. Sometimes, we don't like to look at our day before we go in. But really, we need to be extremely prepared for it, knowing what patients are coming in, what procedures they're coming in for, if you need to take X-rays, if you need to do scans, photos, if they have family members that need to be reappointed, making sure you find out all that before the patient arrives. Because let's face it, you're going to have to find out all that information before the patient leaves your chair. So, as much as you can figure out before the patient even sits down in your chair is going to save you time.” (8:16—8:57) -Angela
“So many times, these great patients of yours share these thoughts, these concerns, these stresses to your team member who's answering the phone, but you don't even hear about it. They tell your team member, Nancy, at the front, all this stuff. Then, they come in, and they tell the same story to the hygienist, and then they repeat the story to the dentist, and they're thinking, ‘Does anyone listen to me here?’ So, I think it's really important that in the huddle you give space to make it about patient care in there.” (8:58—9:28) -Kirk
“The better prepared you are, the better these appointments go. You know what's going to happen. You can predict what's going to happen, for the most part. You can also call out when patients in hygiene owe you money and they have to make a stop at the front. And towards the end of the year, or the beginning of the year, or any time during the year, you might find out patients need additional restorative work, and they are here today, and you're talking to them today, and you have an adjacent column in the restorative room that's empty. So, what a great opportunity to not only make it on time, but make it more valuable to them and the practice. We see it all too often — people slow down, and they go farther. I know that's a contradiction in terms, and that's hard for people to understand. But the better you are, the slower you have to be sometimes. I'm not talking about slow in complacency, but I'm talking about making sure we do it right and not fast.” (9:31—10:26) -Kirk
“If you're preparing the day before and you find out that the patient does have a treatment plan, then you can give the doctor the heads-up at that morning's huddle that this might be a little bit of a longer exam, or I might page you a little bit earlier to do the exam. That way, the doctor can have a heads-up and not be surprised in their day either.” (10:27—10:49) -Angela
“I like doing the exams any time in the appointment after I've gathered my data. So, as a hygienist, I always like to page my doctor or alert them that I'm ready for an exam after I've done the data gathering. So, for me, data gathering means my patient interview, my medical history, my X-rays, my perio chart, my dental hygiene screening, anything that I can do assessment wise, and get that out of the way at the beginning. And then, what I'll do is I will page my doctor, letting the doctor know that I'm ready for an exam — not that I'm done with my appointment, but that I'm ready for an exam at that point. And then, what I'll tell my patient is, ‘I'm paging doctor for your exam, and he or she . . . will come in when they're available.’ And I would also tell them, when I hear doctors starting to walk down the hall, ‘I'm going to raise your chair up.’ That way, they could meet each other sitting up. That was the way my office liked to do it. The doctor liked to meet each other eye level with the patient. But I know every office is a little bit different.” (11:55—13:12) -Angela
“Think better about how you use your time. So, if you're doing restorative work and your restorative blocks are on Tuesday and Thursday mornings, what a great opportunity to pair them with perio blocks right next to them so that you don't have to get up as many times and you can stay in the focus zone.” (13:50—14:06) -Kirk
“If you have a dentist who's a chatty Cathy or a chatty Jim, which a lot of them are, these things never are five minutes. It's 15 minutes. We're talking about barbecue, and how the football team did this weekend, and it's raining outside, it was slippery on the way to work. Man, they chat forever. So, I like the idea of rapport second as much as possible. Come in and share with the doctor what you've already learned before the doctor says, ‘How's the game?’ because now you're going to sit there and wait for four minutes so that you can politely interrupt, and that's hard to do. But you just have to get creative with this. And then, also, if you’ve got a chatty Cathy who keeps chatting, and chatting, and chatting, and they're slowing down the other hygiene appointments, it might be a good idea to put your hand on their shoulder and say, ‘Okay.’ It's a nonverbal cue that I have to take him or her somewhere else, type of a thing.” (14:13—15:05) -Kirk
“I love it when offices embrace technology instead of thinking that it adds extra time to their appointment with all the photos, scanning, and things like that. Really utilize those things to make your appointment more efficient. You mentioned voice-assisted perio charting. There are applications that you guys can use. You put on a headset, and it records all your perio charting for you. You prep the patient with what they're going to be hearing before you start doing your measurements, and then the patient can be part of that experience as well. So, you're kind of talking to your voice recognition, but really, you're talking to the patient at the same time. And what that also does when you've prepped the patient in advance is you've taught them about what they're supposed to hear. So, you're kind of diagnosing at the same time. You don't have to set the patient's chair up and say, ‘This is what I found.’ Instead, they're hearing at the same time, not what you found, but what their measurements are and what their periodontal condition is. We always talk about a picture being worth a thousand words. These scans that you're taking, these intraoral photos that you're taking, consider them a time-saver if you can use that to show the patient and cut down on the amount of talking that you have to do by simply showing them. And it's amazing, they're able to almost diagnose themselves, if you will.” (15:22—16:56) -Angela
“Pay attention to how much you're talking. If you, as a dental team, are talking 80% of the time and they're only talking 20% of the time or 10% of the time, I can guarantee you, this is what they hear . . . They tune you out after a while, and they're just moving their head up and down. So, you want to make sure it's very interactive. Maybe use my name once in a while. If I'm a patient, that'll get me out of my non-thinking zone.” (17:00—17:28) -Kirk
“You, as a dentist, if you don't have any expectations on how the time is supposed to be used, people come up with their own expectations as they come into your practice. Now, I get it. Everybody has a different style, a different speed, a different demeanor. They should. They should always bring their individuality. But there should be, somewhat, milestones that you should be able to hit. For instance, if you have a hygiene appointment in an hour — so, think about this. If you have three hygienists and you don't give them any expectations, and you say, ‘Do your thing,’ they're all going to do it differently, which has challenges for you.” (17:39—18:13) -Kirk
“There needs to be a conversation on what that appointment flow should look like, and also how long things should take. For years, we've been teaching the 20-20-20 based on some courses that we took years ago with Rachel Wall, and that that appointment should be split into thirds where that first 20 minutes is the assessment. And then, I won't say the second because I've already taught you about exams on demand, so it doesn't necessarily have to be the second part of the appointment. But about 20 minutes of that appointment should be the mechanical debridement of that appointment. And then, about 20 minutes should be the exam, the reappointment, and everything. So, if you set that expectation with the team that that's what the flow of the appointment should look like, then when you're doing your time study and you're looking at the results of your time study, you can see like, ‘Oh, gosh. We're way over in our assessment. Our assessment is taking 30 minutes,’ or, ‘We're waiting for the exam for way too long and that's extending that 20-minute section.’ Or, what happens sometimes is that we're spending too much time in that mechanical debridement.” (18:17—19:36) -Angela
“It's an unpopular thing for me to say that it shouldn't take more than 20 minutes to do a mechanical scaling of a patient. But what I mean is that, in this appointment, it's for a healthy patient that we're talking about. Our regular six-month hygiene appointment is what we're talking about. If the patient truly is healthy, I would argue that that shouldn't really take very much time, that 20 minutes should be plenty of time to get that part of the appointment done.” (19:50—20:23) -Angela
“Not just because of time, but it does throw our schedule off when a patient comes in and we're scheduled for a regular prophy, and maybe we don't want to have that conversation about perio, or maybe they're borderline, or maybe they're perio and we haven't been treating them. And sometimes, as hygienists, we've been known to do more aggressive therapy on that patient during that appointment. Sometimes, our coaches call it a bloody prophy, where we're going as deep as we can into these six and seven-millimeter pockets, debriding them as much as we can. And then, we wonder why we don't have enough time. Or we blame the patient that, ‘Their mouth was a mess. It took a lot longer. They came in with a poor condition.’ But also reflecting — yes, that's the patient's responsibility. But it's also our responsibility to flip that appointment into an actual perio procedure then, and not just continue to do bloody prophy after bloody prophy if that's not actually what the patient's condition is.” (22:06—23:19) -Angela
“Hygienists have a great heart for taking care of people, and sometimes we take care of them at the expense of time or the ability to do it the way we should do it.” (23:28—23:38) -Kirk
“Schedule some time with your doctor, with your team. Tell them that you're challenged. They can't help you if your team doesn't know that you're stressed out and you're running behind schedule, and they won't be able to provide solutions for you either . . . It's not just the hygienists that are facing this. The dental assistants, the dentists, they're always stressed with time as well. So, I think using this as an opportunity to have some open conversations and problem solve as a team.” (25:14—25:47) -Angela
“Another thing that you can do to reclaim your hygiene time and better use time is for the future. You know that thing that they have around their neck called the bib? We like to affectionately refer to it as a seatbelt. So, don't take the bib off until you do one valuable thing . . . because here's the thing. You know how this is. You take off that “seatbelt”, man, they are like the best defensive lineman getting through the offensive line. They’ve got the swim technique. They’ve got the rip technique. They're going right through there, and they're out of there as fast as can be. When I've got a bib on you, it's clear you're not going anywhere. And if they touch the bib, go, ‘No, no, no, no, no. Don't touch it. No one touches the bib. Only I touch the bib.’ And so, what you can do is you can better protect the future time by making sure that you have this great patient tethered to the practice with their next valuable appointment. You get them locked in the schedule. Don't let them float to the front, and then float outside. No. If I'm a hygienist, I'm getting you in here. I'm going to keep you in here.” (25:57—27:04) -Kirk
Snippets:
0:00 Introduction.
1:20 Why this is an important topic.
2:37 Track how long things take to do.
6:17 Have open communication between hygienists and doctors.
7:32 Prep for appointments in advance.
10:50 Start exams strategically.
15:12 Use voice-assisted perio charting.
17:30 Set expectations on appointment flow and time.
21:51 Don't overtreat with perio maintenance.
25:01 Last thoughts.
25:48 The bib is a “seatbelt”.
Angela Heathman, MS, RDH Bio:
Angela Heathman is a Lead Practice Coach who works with dentists and their teams to help them accomplish their goals. She believes the hard work you do on your practice is just as important as the work you do in your practice!
Angela has over 20 years of clinical dental hygiene, dental sales, and practice coaching experience. When she transitioned from her role as a clinician to her role as a sales account manager, she realized both her passion for education and practice development. Angela holds a master's degree in dental hygiene education from the University of Missouri-Kansas City.
