Season 1 Episode 15 - The Seven Step System Every Dental Practice Must Know - T-Bone Speaks

Season 1 Episode 15 – The Seven Step System Every Dental Practice Must Know

Today’s episode of TBoneSpeaks we’re going deep on systems. Why? Because a system is really what defines your business. No matter how big or small your practice is, your system will determine what kind of service your patients will have, how efficient your team can work, and how far your business can go. We’ve seen systems do wonders for businesses like fastfood chains who have to attend to customers in a fast paced environment, and they are thriving. If you want to thrive, and learn how systems can take your dental practice to a whole new level, strap yourself in and listen to this episode.

Key Takeaways You’ll Learn From this Episode:

  • There’s no magic bullets to fix things
  • If you want to increase the profit of your practice you can’t just take pictures you actually have to print them
  • We’ve got to look at risk assessments
  • Anytime we’re having ups and downs in our practice I go back to the basics
  • Each one of these systems build into another system and each one of them keep your practice balanced
  • I can live with making it, I can live with missing it but I cannot live with what if.
  • Emotional dentistry is not necessarily more profitable because I can tell you this most emotional dentist don’t make more money than the bread and butter dentist but they generally speaking they have much better life and much better appreciation and greatest professional satisfaction.

Listen to the Full Interview:

The Morning Huddle

The morning huddle is one of the most important things that we do.  It also sets the tone and the energy for the day, sometimes when I’m in the funny mode or something didn’t go right you know unfortunately it sets the tone in a negative light but one of the tweaks that we’ve done to our morning meeting is everyday one team member, each day of the week, every day of the week our team member we start our morning huddle with one of our team member going through the win for the day

The Seven Step System

  1. Know the score for your team and for individuals
  2. Photograph
  3. Chart Review every day
  4. The morning huddle
  5. Risk assessments and the five key components of a hygiene exam
  6. Exam before cleaning
  7. Transfers

Full Episode Transcript:

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Full Episode Transcript

With Your Host

Dr. Tarun Agarwal

Welcome to T-Bone Speaks with Dr. Tarun Agarwal where our goal is to change the way you practice dentistry by helping you achieve clinical, financial, and personal balance. Now, here’s your host, T-Bone.

T-Bone:     Hello and welcome back for another episode of T-Bone speaks I’m your super-duper host T-Bone Dr. Tarun Agarwal hanging out here in Raleigh, North Carolina.

                   I have a great guest with me who is visiting our practice as a practice coach and also taking our 3D Dental Workshop this weekend and that’s Ms. Hollie Bryant.

Hollie, welcome to the show, how are you doing today?

Hollie:        I’m doing great this morning.

T-Bone:     You sure, you look a little frazzled.

Hollie:         No, the courses have been amazing and I’m learning so much and I’ve had a great week of hanging out with the team getting some stuff done.

T-Bone:     Alright, let’s see the energy ok?

Hollie:        I’m ready.

T-Bone:     Let’s bring the energy today alright?

Hollie:        [laughs] Let’s do it.

T-Bone:     Alright let’s do it.

Hollie:        Let’s do it.

T-Bone:    Alright so listen Hollie’s been doing work practice for nine months and helping me do some different things. I wouldn’t call it traditional consultancy because honestly that’s not necessarily where I want the help. Not necessary – I’m not saying I didn’t need the help, that’s not where I want the help, where I really need the help is I want to have growth toward something totally different. We’re trying to move our practice or at least myself in a direction to where I’m not having to do fillings and crowns and things that aren’t fun for me anymore.  things that you know I like and are important but they aren’t fun for me anymore and quite honestly I want to continue to move forward and for me to do that and maintain our PPO practice along the way, we’ve got to do something’s differently than most and so that’s what Hollie’s here to work with us on and we’ll get Hollie an opportunity at the end to tell you how you can get in touch with her and get the real scoop on me.

Hollie:        [Laughs] I’ll tell you all the secrets

T-Bone:     So Hollie, I’ve ask you today to talk about your seven commitments ok or seven system whatever you want to call it ok, because at the end of the day everybody is looking for system everybody want these and we keep searching and we keep finding somebody with twelve systems, somebody with  twenty four system  and somebody who gets it down to one system or ultimately at the end of the day I don’t think you know  no offense to you guys but I don’t think these systems all matter anymore I think it’s a matter of whether you do one two three or eight  things better  you want just hold yourself accountable and do these things.

So Hollie share with me where you stand and what we should expect to hear from you today?

Hollie:        Well, where I stand, well right now standing next to you

T-Bone:     You’re sitting actually.

Hollie:        Sitting next to you.

T-Bone:     Hollie, do you have a Facebook account?

Hollie:        Do I have a Facebook account Yes.

T-Bone:      Why was Chuck my co-host who has been in like God knows     where not have a Facebook accounts.  What you think?

Hollie:        Man, I think Chuck doesn’t want you to stalk him because you know there’s a private you know we’d look at Facebook all the time, we’re trying to check-out where he’s at, what city he’s in he’s really trying to be incognito.

T-Bone:     Chuck is in Apex, North Carolina, he’s not going anywhere.

Hollie:        See maybe that’s the other reason he does not have Facebook he doesn’t want anybody to know he is sitting in Apex North Carolina, not here today. What do you think?

T-Bone:     Well, I tell everybody where he’s at because he’s not here today.

Hollie:        Can we e-mail Chuck?

T-Bone:      You can if you guys go to www.schuckmckee.com and ask him why in the world are you not on Facebook and when are you going to return to the show so that we can bring some normalcy to what’s going on in here because without him I just do what in the world I want to do and I just kind of go crazy a little bit.

Hollie:        Do we need a new hash tag for Chuck?’

T-Bone:     No, not yet that is irrelevant he’s not even in social media he would not even know what’s going on.  So anyway, I digress and I’ve been squirreled okay, which is both our problems we both have ADD I think that’s why we both love each other.

So talk to me, talk to us, talk to the group let’s give them value they’ve taken time out of their life, give them an overview.

Hollie:        Overview, you know there’s no magic bullets to fix things, there’s some basic systems that we all need in our practice right?

T-Bone:     Yup, absolutely

Hollie:       For me the foremost first and-all-be-all best thing you can ever do is make sure all your team knows your numbers; they got to know the score every single day.

T-Bone:    Ok, give us an idea is what are some of those numbers they need to know?

Hollie:        Numbers you got to know- basic, for me the most important number, collections.

T-Bone:     Ok because production doesn’t matter that much.

Hollie:        It doesn’t matter at all to me.  It’s irrelevant.

T-Bone:     Well, you can’t collect if you’re not producing.

Hollie:        You can always collect if you’re not producing.

T-Bone:     Ok we have different conversation another day.

Hollie:        [Laughs] I can always take somebody’s money right?

T-Bone:     Well you got to produce at some point or you owe some people money. [Crosstalk]

Hollie:        But you got to collect but I want to know the collection, I want to know where I’d got to go.

T-Bone:     Do people really struggle collecting money?

Hollie:        Team member struggle collecting money, doctors’ struggle with team members they struggle collecting money but do your front office, renewance front office they loved to collect money because that’s where their job revolves right?

T-Bone:     Yes.

Hollie:         I pick up the phone, I collect money and I make appointments all the time so they’re really good at it.

T-Bone:     So they got to know the score?

Hollie:        They got to know the score.

T-Bone:     So they got to know collections anything any other couple other numbers they are really need to know?

Hollie:        I want to know what’s coming in the door I want to know what’s leaving, right?

T-Bone:     Be more specific, what do you mean by that?

Hollie:        New patients are important.

T-Bone:     Okay.

Hollie:        Because if I’m not getting them, obviously there’s something wrong.

T-Bone:     Right.

Hollie:        Because human nature isn’t to refer but if you’re really good to people and you ask them to do something for you, if they like you, oftentimes they’ll do it right?

T-Bone:     Yes.

Hollie:         So I want to know that there are some people coming in to the office.

T-Bone:     Ok

Hollie:        I want to know what’s leaving’ the office so for me hygiene recall, reactivation, pretty important because what if our back doors open?

T-Bone:     Not what if, how big is your back door?

Hollie:        How big is your back door that could be a whole lot of topic.

T-Bone:     We all have open back doors ok

Hollie:        How big is your backdoor?

T-Bone:     Anything else?

Hollie:        I’d like collection, I’d like obviously new patient numbers, I’d like hygiene recall I do. I do think we need to know production we have to know that we’re producing daily to make a goal because if I don’t produce what’s going to happen at the end of the month?  I’m going to fall short.

T-Bone:     Okay, anything else?

Hollie:        I want to know that we we’re being collected in a timely manner so is it out there in the books room?

T-Bone:     Ok, so you look at AR?

Hollie:        AR a couple of months along set of time.  What’s the period of time in sitting there?

T-Bone:     So I want to add one thing to knowing the score here and we implemented this week in my office thank you and that is we created a board that’s called “What’s in the Pipeline Board”

Hollie:        Absolutely.

T-Bone:     And to me that’s part of knowing the score ok. Now you may look at it differently, I look at it as knowing the score because at the end of the day what you’re doing today honestly it’s kind of over already. Okay, or you can make some minor changes to the day but you’ll not going to make big changes ok and what I like to do is too often what I find and me included is that we get into reactive mode versus proactive mode ok and then we notice that we’re slow and then we react and do the marketing and do whatever we have to do as do the pushing of the team members.

Now wouldn’t it be nice to be proactive and say you know what- If I look out two months from now I can see that I’m going to be slow so I can go and start now because honestly once you feel that you’re slow and once that you’re actually slow it’s going to be two to three months before you pick back up through your actions that you’re doing ok, so when I look up with the pipeline is we have a pipeline board and it tells me – so we track three specific things.

We’re tracking our ortho cases, our sleep cases, our perio cases and the fourth one is a complex general dentistry cases which includes implants, you know, I even called general dentistry in other words anything that over five, six thousand dollars that requires coordination of appointments, coordination of care, requires hand holding to the patient, requires somebody massaging and finessing that relationship so I can look at the board and I can see where we’re at.  Ok I can see how many like – you know I didn’t really know what Devon was doing, what – how good our hygiene team was doing in converting sleep until and converting sleep to the next step ok until I saw that board of how many sleep patients we have in the pipeline and I was like holy smokes it is a lot there and then what that also does allows me to allow something to stay top of mind that I can say I remember that patient, and everyday I’m looking at that board and I’m seeing it I’m looking at Devon- Devon you told me you’ll get Hollie taking cared why is Hollie still on that board what’s Hollie hold up Devon?  What do we have to do to help Hollie make a decision or stop or have Hollie stop streaming that’s a long to get off the board if she’s never going to move forward that’s totally ok. You know and so I’d really like that part of it.

Hollie:        Well, that in general practice whether it’s a dollar, two dollars you know two hundred dollars, people want to know what they’re presenting and they want to know when it’s actually getting scheduled and accepted and in your case if you do an                          implant it’s got to be planned out, you want to know, right?

T-Bone:     And that’s why I like the board because those kind of cases just aren’t “hey I need a filling crown, I need a root canal wham bam” Hey this is what I got let’s get this taking cared of there’s no coordination to care therefore for example.

Hollie:         Right

T-Bone:     But now suddenly for example when we had a patient who drives from an hour away who’s a little bit meek and a little bit afraid I need to get the dentistry done and then what I write down on his treatment plan we will do a resin and  he look up on  the Google and turns up to be it’s a trecep and he’s like and he  e-mailed me back and calls the office and said why is Dr. A. using trecep in my teeth right – so those are the people that need a massage and they need to be on the board because I need to see where  they’re at, you know quite honestly listen at the end of the day it’s embarrassing to admit but  I can’t remember everybody I don’t remember all my patients  anymore simply because life is too busy right?

Hollie:        Right.

T-Bone:     So if they’re on the board and they will stay on the board not just when they scheduled the first part of their visit but they will be on the board until their care is signed, sealed, delivered, completed, ok, and or they say listen take me you know the patient says I’m not doing it.

Hollie:        Right absolutely, so we know we got a tag numbers we got to know the score huge for me, number one.

T-Bone:     Yes, ok and I am a big believer you know just I don’t know what’s going to be number two here.  The analogy I used on tracking the score knowing the score because that’s a catchword that I use a lot knowing the score it’s like imagine playing a basketball game and you don’t know if you’re down by one, two or three because depending on what you’re down by and you don’t know how much time is left in the game you have no idea what kind of play to run.

So to me you got to   know the score not just you your team member have to know the score, the practice score and their individual score because just like players in any sport  they want to know – hey how  is the overall game going, what’s my team doing? But they also want to know where am I,  am I  going to beat my Russian record, am I going to beat my three point field goal presenter directed where am I individually because my individual record, my individual score plays a role in the overall team score.

Hollie:        Absolutely, we want to perform, we’re geared that way, right?

T-Bone:     Sure absolutely, so what’s number two?

Hollie:        So number two, number two is photograph.  I have a photograph system, it’s a if you want to increase the profit of your practice you can’t just take pictures you actually have to print them, you have to do [unclear] you have to send them home with the patient. So you want to raise your numbers? Print some pictures use your camera, pull it out. It works.

T-Bone:     Can I have one caveat to that.

Hollie:        Please!

T-Bone:     For me it’s not just about raising a numbers but remember I boil everything down to three life needs in the dental practice.  1) Is that we need more time, 2) we need more money and 3) we need more professional satisfaction so if the person listening say I don’t need more money, I don’t need more production, more profitability in my practice. I’m just happy, I’m just happy doing MOD fillings ok so if you’re tired of doing MOD fillings and you wanted to do crowns then take pictures ok.

Hollie:         Absolutely.

T-Bone:     Ok if you’re tired of doing single crowns and you want to do more quadrants take pictures, if you’re tired of doing quadrants and want to do sedation’s and do half mouth dentistry take pictures, if you’re tired of not doing any cosmetic work or   orthodontics take pictures, if you’re tired of your patients not  doing anything take pictures.

Hollie:        And we’re not talking about like the old fashion into all camera.

T-Bone:     Those I hate those things.

Hollie:        We’re talking about a full mouth.  Do you want to take pictures of the whole mouth. [Crosstalk]

T-Bone:     You’re talking about – essential orthodontics photo.

Hollie:        There you go.

T-Bone:     Ok absolutely and you know honestly speaking I’m a big, big fan of the DLSR camera but slowly but surely I’m getting converted to this little shofu camera not for me as the dentist and me as the real good photographer, not like professional photographer but the real good documenter that wants  to really have my stuff documented so I have many things to use it for but more about in the hygiene chair. I think that camera can produce very nice results it’s very small and very convenient for our team members.

Hollie:         And it has to be ease of used if that’s what you want.

T-Bone:     Yes, it sucks that the camera says say shofu on it because that by definition quadruples’ the price of the camera.

Hollie:        I call it shofu me.

T-Bone:     Yes.

Hollie:        Shofu me how it works, shofu me how to do my job well, quick and easy. [Crosstalk]

T-Bone:     So you know it cost a lot more but I believe it should but honestly its’ worth it, it’s irrelevant what the cost is.

Hollie:        Absolutely, so we hit one and we hit two right?

T-Bone:     So number three

Hollie:        Number three – we got to review our charts every day, everybody the same way, preparation.

T-Bone:     What do you mean review our charts?  So you mean prepare? Ok.

Hollie:        Prepare, but everybody has to prepare the same way. It’s not, you know hygienist, they look at their charts, right? All the  time, they know what we have but in our traditional world they look everyday, they write a bigger note pad full of notes about  all their patients they know  everything’s  going on.  So I have a chart review system super easy but it’s about accuracy.  We want to know if there’s technical things we need to be prepared for.

T-Bone:    So give me some ideas of what they should be looking for in the chart review.

Hollie:         Do we have our lap cases right? Important

T-Bone:     Ok, absolutely.

Hollie:        Absolutely it does.  Do they have a balance?

T-Bone:     ok

Hollie:        Do they have an insurance need?

T-Bone:     Ok

Hollie:        Medical, dental

T-Bone:     What do you mean by lack of information?

Hollie:         Lack of information or I need to collect the card, that’s an accuracy issue.

T-Bone:     We got to check the change- It’s January whatever.

Hollie:         It’s a change; do we have their e-mail address?

T-Bone:     Yes, because you want to communicate with people.

Hollie:        Absolutely, we want to be able to on going and people change their e-mail addresses like you know hey I don’t like this I’ve got too much [Crosstalk]

T-Bone:     It’s interesting to say that because I met a person with the AOL e-mail address the other day I should you should be embarrassed to give that out.

Hollie:         I don’t think New Guinea uses AOL anymore.

T-Bone:      So on a clinical side and on that what are we looking for in that chart review?

Hollie:        So on the clinical side we’re looking for obviously we said it –  do I have my materials for today and that can go even into a if you we’re doing an implant procedure, kind of bridge procedure.  Do I have what I need to do that procedure?

T-Bone:     How about this that can even go for something that happened to me the other day, we we’re doing an anterior composite and I don’t have the right shade to match that patient, right?

Hollie:        It’s going to be a big issue right?

T-Bone:     That sucks.

Hollie:        It’s huge.

T-Bone:     Now I’m trying to mix and match  you know I’m trying to look at little wheel and say well, I really want this shade what other shade can I put, what then can I put and our body can put on top of it.

Hollie:        And now stress changes. Everybody changes so accuracy is important, I want to – other things that fall under medical updates, medical need alerts, allergies things like that, that may affect treatment today.

T-Bone:     Pending treatment?

Hollie:        Pending treatment

T-Bone:     Unscheduled treatment

Hollie:        Huge.  If I have a treatment plan, but if I have a treatment plan how long have we been sitting on that one? How long we sit on it but also what about the fees or the fees that are attached to it?  Five years old?

T-Bone:     Probably, [Laughs]

Hollie:        That’s a whole other issue right?  So accuracy is super important and then we have opportunity.  We’ve got to know what our opportunity is today that impress by patient – is it their birthday, is it their anniversary until they refer someone to your practice you have to acknowledge them, correct?

T-Bone:     Absolutely, we want to thank them.  If you want the same behavior repeated then thank them for it.

Hollie:         It’s like I our cute little golden retriever.  Give them a treat they do something well, guess what they’re going to keep doing?

T-Bone:     That’s how I feel like my team treats me.

Hollie:        Like a golden retriever?

T-Bone:     Not even a golden retriever I think they treat me like a mutt.

Hollie:        Mutt but they do scratch one of your ears once in a while?  [Laughs]

T-Bone:     Occasionally just to get the dust off.

Hollie:        And they rub the head?

 T-Bone:    To get the enamel – so listen you know I was just thinking about this and I think the other thing that we could do in chart review from a business and sales perspective is I would love to know what’s the next step on each of these patients. ok.

Hollie:        Absolutely!

T-Bone:     So the next step maybe just- listen this patient has no work to do, no needs.  Their next step is we need to maintain them on recall.

Hollie:         And that’s in your chart review it will be – do they have a recall appointment.

T-Bone:     Ok.

Hollie:        Do they have a – what’s their next visit is it 60 minutes with the doctor?  We put a crown in or is it three hours because we’re going to close this case up and move on to veneers.  Where we going?

T-Bone:     Ok so even that like for example and they’ve given you an example the next step to me would be like – hey listen this patient has crooked teeth they got nothing else going on in the mouth, their next step would be to see if they’re interested and taken their oral health to another level beyond just being healthy but also being super healthy by having straight teeth.  You know in that way when I go in for my hygiene exam I can be mentally prepared,  listen  it’s unlike to this patient that have anything going  on I can focus that conversation towards hey have you ever thought about – are you interested in or how did you know what was possible.  Ok so that was number three.  So 1) was knowing the score; 2) photography 3) was a daily chart review.

Hollie:        Daily chart review. Number four is going to three leads the four. 4) is your morning huddle, every day because If I…

T-Bone:      Do people really not doing morning huddle?

Hollie:         There are many people that don’t do morning huddle.  Many, many people don’t huddle in the mornings or they say they’re going to huddle, the doctor doesn’t show up, team member don’t show up or eating breakfast at the huddle.  [Crosstalk]

T-Bone:     How is that, Oh God?

Hollie:        Yes that means I’m chewing my food talking to you and getting paid to do both, right?

T-Bone:     Yes.  My mom taught me not to chew if my mouth full

Hollie:         Right, and oh by the way and I’m talking [Crosstalk]

T-Bone:     Not to chew if my mouth full – Not to talk with my mouth full.

Hollie:        [Laughs] I hope you chew everything with your mouth full. But then and on top of that I’m on my Facebook and I’m checking my phone, just one more thing doctor hang on and then I’ll talk, right?  That’s a bad morning hurdle but people don’t do it, it’s missing, it’s a missing link out of a practice so if I know the score right, if I’ve reviewed my charts and I’m taking pictures what do I do with all that information.  I need to be able to bring it to the huddle and have a plan.

T-Bone:      Now this huddle doesn’t need to be a forty five minute meeting of the day.

Hollie:        Oh please God know.

T-Bone:     It means about ten minutes.

Hollie:         Absolutely

T-Bone:     Digest, give me the facts.

Hollie:        Don’t read the schedule

T-Bone:     Just the facts ma’am.

Hollie:        We all can read and write.

T-Bone:     Like Hollie, listen, I got this going on Mrs. Jones last time, I remember last time she came in she was interested in these so she had a question about her husband so I’m going to give you a heads- up that when I’m done with her or sometime at around that eleven o’clock she’s coming in at eleven I need you to be prepared to sit down with her so make sure that you’re free at 11:45 to 12:00 o’clock so that you can sit down and talk with her.

Hollie:        Absolutely, and then by the way guys up front make sure you thank her, she just referred her whole entire family here.

T-Bone:     Yes, or hey she send me an e-mail after her last visit Dr. A. about  saying  hey you know I was really sore in my muscle in that area you know could you make sure that you addressed that with her.

Hollie:        Super important opportunity [unclear] opportunity to make sure that customer is satisfied right?

T-Bone:     Yes so to me the morning huddle is one of the most important things that we do.  It also sets the tone and the energy for the day, sometimes when I’m in the funny mode or something didn’t go right you know unfortunately it sets the tone in a negative light but one of the tweaks that we’ve done to our morning meeting is everyday one team member, each day of the week, every day of the week our team member we start our morning huddle with one of our team member going through the win for the day, ok?

So what is the win, for example there maybe last week Devon in our office say our win for today is last Thursday we planted a seed nine months ago for a lady to do Envisalign and she called and she’s ready to go and the documentation was there I knew where she stood, I knew I didn’t need to bring her for a consult, i knew I need to bring her straight for records because everything was documented.  So that’s a win.

Hollie:        A huge win.

T-Bone:      Right, so that lifts the team up and then I dived in and bring them back down.

Hollie:         [Laughs] or you, you know do your dance form.

T-Bone:     Yes of course you know and so just to give the listeners an idea of my morning huddle from my perspective ok because everything is not about doing it at the Hollie way or T-Bone way or XYZ way it’s about what fits with your personality ok.   so I want to start with that win, i don’t want to provide that win I want the team member to pry that win, I want each per person in the team to be responsible for different day to provide their win so that they know what day there is like that Devon                       knows her day is Monday, Liza knows her day is Tuesday, Megan knows her day is Wednesday, Heidi knows her day is Thursday right and April knows her day is Friday right.  So that way each person will be responsible for their wins so they can                    have some ownership in that.

I’d like to review our knowing the score that’s where we view our dashboard numbers and we take a look at that and I can say hey listen hygiene team yesterday we only had 60% re- appointment, we know our goal is 90% what happened ok because I call it over hear, when you tell  somebody over hear, make them over hear it, that  let them know that you are looking and to let them know that they’re responsible for that and it’s amazing how the next day it will be 90% because they just don’t feel like hearing my mid blow about that right?

Hollie:        Right

T-Bone:     Then will go through each team member who is responsible for their column.  Devon has her column, Liz has my column, April has Dr. Case column, Megan has her column, Angela has her column and the front office team each has their column I’ll go speak now for a huge piece – Devon what you got for me today, Liz what you got for me today, ok what you got for us today and they go through the deal, they don’t read off the paper work they give us the facts and the furious and then I’ll have done my preparation for the morning meeting as the business owner and leader and I’ll say Liz tell me about this – what happened there? You know that’s my cue of saying to Liz why didn’t you tell us that because that’s an important piece of information.  That’s a way of coaching what information I want them to give me.

Hollie:        Absolutely, and what you just did was you were- they were giving you accuracy.  They were being accountable for things that might be out missing what they need what’s so critical to make that appointment go so successful today.

T-Bone:     You know and the other thing and maybe this is unique in our office.  I like to review what’s going on this week – hey whose visiting us, is this a course week because if I say hey it’s a course week they know, oh God. you know he’s got XYZ going on he’s got to  be here  every evening, Liz knows  hey I’ve got to make sure that I got these things lined up I know I got to make sure that I point them in the right direction.  The front office team though hey, he’s going to be here on Thursday but he’s not going to be available for us because he’ll be preparing getting XYZ ready so I’d like to say hey XYZ is visiting, I may say hey my parents are coming in to bring us lunch today or this week or XYZ reps coming in this week not just about the day but to kind of give them that sense of what’s going on because that way they can all get prepared.

Hollie:        And they’re also giving you a little bit of   sense of what’s going on as far as hey doc you’re book out now for four weeks.

T-Bone:     Yes, that’s the other thing that we end – I’ll go through and I say Liz when’s my next appointment and not my next appointment, my next hour and a half block. [Crosstalk]

Hollie:        That’s a big, big appointment time.

T-Bone:     Yes something that I can do something

Hollie:        Production

T-Bone:     I could care less about my half hour block because there is not much I could do with half an hour that’s of good production value ok.

Hollie:        Absolutely.

T-Bone:      So I go Liz when’s my next appointment when she says six weeks from now I said ok so that means either we got to call my schedule and get rid of the things I don’t like to do or don’t need to be doing or I got to start adding some Thursday morning or I got to do something right?   And same with hygiene, you know we’ve got out of that happened a little bit and one day I asked I said what’s going on in hygiene and they said we don’t have any appointments for new patients for six weeks.  I said how do we let it get like that?

Hollie:        And because for your system is I need to see my new patient within a week right?

T-Bone:     Yes I want to give them the opportunity to be seeing within a week.  [Crosstalk]

Hollie:        So I got from a week?

T-Bone:    To six weeks yes that’s no good right?  So then I said ok so next time this happened you got to let me know in advance you don’t need me to ask you about this, I don’t need to be- because I don’t review every little thing, every single day but I have my days where I’ll be like I haven’t seen a lot of new patients this week and what I came to find out is we’ve been putting recalls in all those blocks right and now we don’t have blocks for new patients.

Hollie:        But recalls are important right?

T-Bone:     Yes they’re important but we have to create our day.

Hollie:        Absolutely

T-Bone:     Ok, so that’s number four, is that number four?

Hollie:        Is that number four, we have knocked – out four.

T-Bone:     Ok five.

Hollie:        Number 5. I am a five hygiene screening kind of girl.  There’s five screening you got to do it, it’s a system we know we’ve got to look at risk assessments, we’ve got to look at oral cancer, we’ve got to look at perio. We’ve got to look out restorative so that’s for the doctors to do bite, for the doctors that do airway, for the doctors that do whatever it is for you because I want that to be generic right so we got those things and the fifth one for me is always going to be an elective. Does that make sense?

T-Bone:     Yes, of course to me obviously.  You’ve been doing a bad job.

Hollie:        [Laughs] so we do our five systems.

T-Bone:     So repeat those again for me.

Hollie:        Ok so repeat those again, we’ve got our risk assessment, first thing obviously medical history, blood pressure this entire important thing.  We go on to perio or oral cancer, restorative, light airway, good?

T-Bone:     Yes make sense.

Hollie:        Alright, I’ve got to do my screenings that’s number five; Number six for me…

T-Bone:     So Number five was the five key components of the hygiene exam

Hollie:        Is actually number five.

T-Bone:     Ok number six now.

Hollie:        Five lessen to six is exam before cleaning and doctors get a little…

TBone:     That’s a little freaky for me by the way.

Hollie:        It’s a little freaky for doctors.

T-Bone:     Well, I ‘m so disorganized I just do exams whenever I can.

Hollie:         I have doctors say exam, I just got to puff over but an exam the most profitable.

T-Bone:   But I don’t like to do exams I don’t mean to interrupt, actually I do. I don’t like to do exams even though I say and we preach, listen at the end of the day there’s no rule that you have to do the hygiene exam at the end of the visit.  Our rule is when you have time go and do it the only caveat I will  say that is  I will not do  a hygiene exam before my hygienists is gathered the data, ok? So in other words at least fifteen minutes into the appointment by that point my hygienist should have look in the mouth seen areas of concern, taken our record kind of have some chit chat with our patient, I don’t want to come in and just do all of that and have to be called back in so I prefer for my hygienist to at least go ahead and do all that stuff and then at that point I can come  in any time after that.

Hollie:        So that’s your five screening and now if a doctor, I have doctors  daily who tell me I feel like I’m losing control  or I feel like my hygienist went down this whole path and got me in this rabbit hole she talk about this and this and I really need to go this direction with that  patient, and I said so, do your work let him pre heat the oven talk about some stuff do  all the screening and then you do  the exams then you go into the cleaning.

T-Bone:     So in other words what you are saying is, you give the diagnosis and then you give the hygienist the time to build the value for the direction that you want to go in.

Hollie:        You did it.

T-Bone:     So in other words if go in there and I joke about I have a conversation with the patient about you know updating -straightening their teeth, their airway so all the fillings starts to break down now my hygienist need to hammer that hope.

Hollie:         She’s got a good half an hour to hammer that home.

T-Bone:     Yes, how long will it take to clean teeth for God sake?

Hollie:        Right but then now you see the condition of the mouth instead of walking and saying wow great job. [Laughs]

T-Bone:     I know when it’s a good job or not a good job I see the blood tags and the prophyla.[Crosstalk]

Hollie:        Then you know there’s better problem, when the hygienist has sweat running off of her brow.

T-Bone:      Yes, so that’s six out of seven, so what’s number seven?

Hollie:        So then my number seven is lucky number seven transfers. If I’ve got all this information but I don’t share it with the next person I don’t verbally in front of my doctor, in front of my administrative team share the information me, you patient  all the time.  Patient front office or administrative team and we’ve got to have that little triangle and myself right?

T-Bone:     Right, absolutely and the patient yes,

Hollie:        And what I’m saying is I trust her and  you’ll trust her and here’s the information I’m trusting her with.

T-Bone:     Yes so XYZ doesn’t go to different direction than the previous person.  You know the analogy I use to this is-  I always go back to sports not because I’m a very sport person but I am a little bit but not physically anymore but it’s a relay race, you can’t throw the baton to your next person you have to legally you have to do a hand off, correct?

Hollie:         Absolutely!

T-Bone:     So you can’t throw the baton and tell the patient so and so at the front will take you there. Ok will take care of you just go up there, that’s BS on my book you better own the patient have  the dignity respect for that patient and say Heidi I’d like you to see Hollie today we went ahead and completed the visit, I went ahead and post the treatment for today that was already completed I’ve already gone ahead and scheduled her next sixth month visit we need to go and schedule, Heidi we need to go and schedule Hollie for a small filling, tooth colored filling on the lower left hand side and Dr. A said he’ll need about an hour to take care of that ok and that’s a great transfer right?

Hollie:        Absolutely!

T-Bone:     And you do with the patient you physically walk the patient to the front, you physically walk the patient to the back, you physically walk the patient wherever, like in a perfect world if my patient have a need to go to the  bathroom I want to walk them to the bathroom you know. I’m not saying you walk them all the way there, but walk them out the door, sorry  and point them in the right direction ok, so that way it’s common courtesy.  They’re visiting your house, they’re visiting your home you know they don’t know where the hell the bathroom is, you know point them to that direction you know and be waiting for them when they come out of the bathroom not right at the bathroom door, but somewhere along the way because honestly our office is a mazes right and the patient don’t even –  I have patient walk in to my room like, “oh I was looking for the hygienist” I’m like why are you just wandering around?

Hollie:        And where’s my hygienist?

T-Bone:     Yes, and why are you wandering around where the hell is my hygienist and how long the crap did you take that the patient went away for a while? [Crosstalk]

Hollie:        [Laughs] How long have you been standing there listening to me to talk to my patient that I’m working on right now?

T-Bone:       Exactly, so I want them to always accompany the patients, it drives me crazy when patients are left in rooms alone for extended periods of time.  It drives me crazy when I’m at a doctor’s office and that happens to me. I’m like “what the hell is going on right, how long this going to be, seconds feel like hours.

Hollie:        And T-Bone you know, just so that everybody gets these – there’s probably a hundred smaller systems that are all wrap-up in these.

T-Bone:     Of course, of course that’s consultant talk, that’s ok [Crosstalk]

Hollie:         You know but it comes down to those basic principles of how you want to do business right?

T-Bone:     So to me, all that stuff is starter level, ok we get the stuff done but here’s the beauty of it. Anytime we’re having ups and downs in our practice I go back to my analogy again it’s going to be – when I’m having trouble with my golf swing, I don’t work on my swing, I work on my fundamentals, how far away am I from the ball, what’s my posture like ok, what’s going on? Am I too far away and what’s my temple look like. It’s never about, oh I’m on plain, I can’t tell if I’m on plain you know I can’t tell those things. So when my practice when things feel like they’re out of control I don’t know what’s going on right or wrong?  It’s the perception correct, what I like to do then is sit down and say you know what let’s take a look at these seven basic functions are they going well, and ok usually nine times out of ten when something’s are right one of these seven systems  has fallen through and it’s basic right and then you graduate from these and then we can go to another thing and we can get these you  know we can have seven systems that applied to these part of the practice right as you implement sleep or as you implement TMD as you implement medical billing ok there’s other system there but ultimately the fundamental to me the basics of the  practice are you got to have your systems not yours Hollie but somebody ‘systems whatever, you are the listener you got to have your non-negotiables  about what’s important to you.

Your score maybe something different than my score ok but   you got to have a score, each person in your team has to have a score that they can feel great about, feel bad about, have areas of improvement.

Hollie:        But you are obviously see how each one of these systems build into another system and each one of them keep your practice flowing, keeps it profitable right?  Gives you balance. [Crosstalk]

T-Bone:     See you got to have balance, you got to have the team, the business and the patient in mind, right?

Hollie:        That is your moral compass.

T-Bone:     Yes you got to have all three in mind.  Everything you got to do have to fit all those things. it can’t just be oh my patient benefit from this but now my business suffers ok It can’t be hey my team benefit from this but now my patients suffer, It can’t be hey my profitability benefits from these but that sucks for my team and my patients.

Hollie:        You got it.

T-Bone:     It’s got to be balance in all three areas maybe not equally all the time but it got to take each of those three components into consideration. What else you got for me Hollie?

Hollie:        Man, seven system start there. It’s fundamentals.

T-Bone:     Where can people get in touch with you?

Hollie:        Do you want them to get in touch with me? [Laughs]

T-Bone:     Well, that’s up to them. I mean.

Hollie:        That’s a lot of energy, that’s a lot of energy

T-Bone:     Sometimes it’s draining.

Hollie:        It can be draining.  What do we say it’s got like a some people call it Tasmanian devil some people call it good Tequila.

T-Bone:     Yes Tasmanian devil implies that you live in a mess and live, you know, I would say that’s not true completely ok, you don’t live in a mess at all. I think what it is, is no one and I was thinking about this last night as I was you know- just thinking about everything that’s going on because I’m tired again right is no one wants to be uncomfortable and no one wants to be held accountable for those things that they are uncomfortable with ok and to me what I look at is you’re  one of the few people that will give me my crap straight up right – hey listen you’re doing this wrong, you’re wrong about this, let’s get this fix, use your potential, you’re holding yourself back and you know my hot buttons you know that when you say to myself you know XYZ is being able to do this why the hell can’t you do this I’m like ok. It’s not about whether the numbers – I’m not so worried about that but more about ok you’re right ok we’re at the same state why I’m still doing these and I’m not ok you know those are the things that are super important to me and that’s where I hate you sometimes because you make me uncomfortable, ok.

You make me feel in a way I don’t want to say bad about myself that’s how I feel, ok.  You give me the truth and my gut reaction is you know I don’t feel bad for myself, or bad about myself I feel disappointed that I’m not achieving my potential because that’s important to me you know, and it’s tough so I always thank you for that stuff.

Hollie:        And then the icing on the cake you know is that you get to dream a little and look at it and get driven by your goals and you know that adrenalin start building up inside because you know where you’re going to go.  You have a good plan and you have a good vision for what you want for your life and those are your non-negotiables, those are your I’ll get there because I’m got to bet on me.

T-Bone:     I’ll always bet on me, I like that statement.  I tell you what, I’ll always bet on me win, lose or die I’ll always bet on me because you know what, I can control myself, I can live – like if I were a basketball player I will take the last shot, ok? Because I can live with making it, I can live with missing it but I cannot live with what if. Ok, I cannot live with what if I took that shot instead of that person. I can never live with that. I can always live with, you know what I failed it but I failed because I’ve given my try.  I can live with I won because listen I took ownership of that look what happened. I can never live with well it didn’t work because it just didn’t work. Whatever it was I can’t live with that.

Alright listeners so here’s what I’m going to tell you my little messages today my ra ra or sometimes my bo boo messages of the today – dream what you want. To me we’re doing dentist workshop. To me it’s one they’re all great workshop but to me it’s one of our signature workshop because it’s honestly one of the most “expensive procedures” we can do in our practice and it’s honestly probably one of the most life changing experiences.

The twelve people that attended these weekend because that’s our class size, were able to meet Brenda one of our patient that we’re doing a case on that we did a case on last time and Brenda was able to tell them you know we didn’t plan it this way Brenda just gave them the low down, listen I don’t have a lot of money this is a boat load of money  but I’m tired of not smiling, I’m tired of not feeling good, I’m tired of not feeling good about myself, I’m tired of not having this thing, I’m tired of not being able to eat, I’m tired of like all these things.

Hollie:        And I think we got emotional when she was talking about not having family pictures in her history, of not having pictures in her mom’s history of not having family pictures.  This is a great course my mind is getting blown of how amazing it is.

T-Bone:     That’s sexual in nature maybe.

Hollie:        It could be [laughs] it was awesome

T-Bone:      It’s part of the moving to the right ok.

Hollie:        Absolutely

T-Bone:      Because to me you got to move to the right, you got to have the dental dentistry because the general dentistry feeds events dentistry when you get good at advance dentistry you can suddenly get into emotional dentistry and that’s where you can really get that loving feeling for what you do.

Emotional dentistry is not necessarily more profitable because I can tell you this most emotional dentist don’t make more money than the bread and butter dentist but they generally speaking they have much better life and much better appreciation and greatest professional satisfaction.

So you know keep moving your practice to the right, if you could do me a few favors.

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Thanks so much for listening to T-Bone Speaks with Dr. Tarun Agarwal. Remember to keep striving for excellence and we’ll catch you on the next episode.

Thank you everybody and I appreciate your time.

Thanks so much for listening to T-Bone Speaks with Dr. Tarun Agarwal. Remember to keep striving for excellence and we’ll catch you on the next episode.

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About the Author Tarun Agarwal

Dr. Tarun Agarwal represents the next generation of leadership for the dental profession. As a respected speaker, author and opinion leader, he is changing the way general dentists and their teams practice.

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