Episode 136: The Hygienist’s Role in Case Acceptance

Carrie Webber, Owner, The Jameson Group

Below, we’ve compiled some of the key points discussed in the Jameson Files Episode 133. To enjoy the full conversation with our very own Carrie Webber and Becky Speers, you can watch on YouTube or listen to our podcast on iTunes, Google Play, or Spotify

Carrie Webber: Thanks for being with us today! We have a fantastic guest, and I’m thrilled that she’s joining me. She is one of my teammates, Becky Speer, one of Jameson’s incredible business and clinical advisors who has been with us for well over a decade now. And prior to joining the Jameson team and helping doctors and teams across the country with their business and hygiene systems, she was practicing hygiene in Oklahoma. Not only that, but she was practicing hygiene in a dental practice that worked with Jameson.

Let’s talk about case acceptance techniques.

Becky, what I want to talk about with you today is the hygienist’s role in case acceptance by helping to educate patients and support the diagnosis and treatment the doctors are recommending. When it comes to the hygienist’s role in case acceptance, what are some areas that you find on a regular basis that practices can benefit from refining, especially our hygienists in terms of building up skills to help educate and motivate more patients to say yes to treatment they want or need?

Hygienists must be given time to educate for best case acceptance.

Becky Speer: One of the first things to look at is the amount of time a practice is giving their hygienists with every patient. We know that it takes time to build that relationship. So when it comes to recommending treatment, we need to gain trust from patients, and we have to know that we have the time for that in the schedule. As I know from being in so many practices, the shorter those appointments are the more patient education has to be dropped. I mean, you have to take radiographs, you have to do intraoral photos, you have to do the prophylactic part of the appointment. So those won’t be dropped. If there’s not enough time, it’s the communication that gets dropped. So I think first and foremost, we have to make sure that we are giving our hygienists the amount of time they need to do.

Carrie Webber: I’ve heard that. But what do you do when the practice is saying, “How are we ever going to give them more time? And what would be the value in that?” What would you say to practices that are struggling with that decision?

Becky Speer: Well, many times I’ll ask them, “What are the procedures that are performed by your hygienist with every patient every time?” Because we don’t have a list a mile long of what hygienists do during a hygiene appointment. And I discover that many of the things being left out are the intense patient education, the intraoral photos, which are key. because a patient really needs to see what it looks like in their mouth. We also need to make sure that we have time to use the visual and kinesthetic tools. You know, I want to show them what a partial looks like or what a bridge looks like. 

So we have to be given the time to educate the patients. And if doctors are not having hygienists take the intraoral photos and spend the time to educate the patient on what they see could be needed treatment, then when the doctor comes into the treatment room, he or she is having to spend more time in that treatment room with that patient.

Patient education helps with case acceptance and saves time.

Carrie Webber: I think that’s a really great point. If we’re not taking the time to do those necessary photographs and have those conversations, educating patients and helping them process that information and understand the diagnosis, we may be taking more time in the long run and keeping the doctors away from their restorative schedules. What else do you see, Becky? What are some other areas in terms of educating, supporting diagnosis and treatment, that hygienists may not be, taking to that level?

Becky Speer: Well, I think that you have to be sure that your hygienists are comfortable with talking about possible treatment. A younger hygienist just out of school a year or so is a little more nervous with talking about needed treatment because they haven’t done it before. They’re not sure what the doctor is going to recommend. And so we start teaching them to take the intraoral photos, talk about the fracture that they see in the tooth, and tell the patient, “The doctor doctor may be talking to you about a new filling or possibly a crown.” They don’t need to say what the doctor will recommend, but they should prepare the patient for possible scenarios.

And then the doctors have to be taught how to respond to that when they come into the room, because if a young hygienist has made a couple of suggestions, they have to make sure they don’t come in and squash everything the hygienist just said. So if the hygienist has suggested the doctor could recommend a crown, but the doctor doesn’t feel that’s the right treatment, they should say, “You know, I can see why you talked about a crown here…” and then you go into why it’s okay to do this other treatment.

So the doctor is not only educating the patient, but also educating their hygienist. And I think that is key when it comes to making sure that we’re getting the doctor and the hygienist to partner together in a way that is not reducing the patient’s trust in that hygienist’s professionalism and knowledge.

Carrie Webber: I like that because it’s really important for hygienists to understand their doctor’s philosophy and to understand how they provide treatment. What are some ways that you see in terms of best practices to help doctors and hygienists get on the same page as quickly as possible, so that they’re more effective in their approach with the patients and with case acceptance?

The doctor needs to train the hygienist on how he diagnoses cases.

Becky Speer: Well, there are a couple of things they can do to kind of speed up that learning process. One is they can start talking about cases. The doctors hopefully have photos of all their cases. So they could simply sit down with a hygienist and start talking about the photo on the screen and not necessarily having to have the patient in the chair at that time. He can sit down and start going through cases with the hygienist and just talking about situations where he or she would be diagnosing a crown versus a resin or a new filling.  

Also, we know we learn very well by listening to the doctor when he’s in our room, when he’s diagnosing, when he’s recommending treatment, when he’s talking about the way he’s going to do it and how much time it’s going to take. Obviously, the best hygienists are soaking that up so they can use those same verbal skills with an explanation. 

Carrie Webber: Right, we need to be intentionally doing that. Do you find, across the country, that the time is there, but these things aren’t being done or not being done well? What are the areas that might need attention in terms of awareness of what is the best flow and how to be more intentional on that?

Photos are important in case acceptance.

Becky Speer: One big thing with the intraoral photos is the flow. When do I take it? Am I going to wait till the end of the appointment? And the answer is no, because we want our doctors to come in their natural break. We have our teams doing all of their diagnostics at the beginning of the appointment, because we want that prior to the doctor coming in. 

I have worked with some hygienists that are comfortable with the camera, but they just don’t use it. They assume the patient didn’t need it. And we strongly suggest that you need to be using it on every patient, every time. And so we tell the doctors who walk into a room and there are no photos up to say, “I’ll be back as soon as you get the studies taken.” It has to be a set protocol as important as the radiographs.

It is literally going to speed up the case acceptance rate of the patients, especially new patients. If they can see what’s going on in their mouth, they can better appreciate the explanation. It’s just such an amazing tool, perhaps the most impressive tool to a patient in the dental practice.

Verbal Skills That Impact Case Acceptance

Carrie Webber: You were saying earlier that one of the most impactful aspects of your development as a young hygienist was the development of your verbal skills. From your standpoint, what are those critical conversations and communication skills that we want team members to be practicing and becoming more comfortable with? Are there some particular conversations or verbal skills that you feel make a big difference in building that trust and acceptance with patients from the hygienist’s standpoint?

Ask for Objections

Becky Speer: Absolutely. One of the most impactful verbal skills I learned is how to be comfortable asking the patient, “Can we get that scheduled for you? Do you see any reason why we can’t go ahead and schedule this appointment for you?” And we know that’s asking for commitment, but it opens up so much dialogue. You never know, without asking a question, if the patient has an objection. And some people are uncomfortable with that because if the patient objects, they’re not sure how to respond. 

But we teach that objections are a gift. If the patient gives me an objection, that means they want to have the treatments you recommended, but they’re not quite sure how they’re going to do it, because of their work schedule or money or whatever. So we want to make sure we understand what the objections are before we take the patient to the business team, because if we send them up there and they have clinical questions, it will just slow down the whole process. So that’s probably one of the most impactful things, but also knowing how to talk through those objections, asking the right questions, and understanding the patient’s goals. 

Tie Into the Patient’s Goals

If I find that Mrs. Jones’s number one goal is to keep her teeth forever, then I say, “Mrs. Jones, if we can get this fracture taken care of with the crown doctor Jameson has recommended, you should keep this tooth forever.” And I can tie everything I do to that. Obviously that will change a little bit with the different objections, but it’s so helpful to know what questions to ask so that I know what they’re thinking. I’m not trying to figure that out myself.

Carrie Webber: And you have also talked about utilizing the goals patients have shared and using that in your conversations. in the hygiene appointments. You had said, even if they were long-term patients, you would check in with them from time to time and say, “Mrs. Jones, you know, you’ve shared with us that your goals were to keep your teeth for a lifetime. And I certainly have noted that. I’m always aware of that as we take care of you. Tell me, have your goals changed in any way? Is there anything new about your goals for your mouth, your teeth and your smile, that would be important for me to know?” And I thought that’s so powerful, because that is not a one-time conversation. I loved how you made an intention to revisit that conversation and see if anything had changed. When did you start doing that? And what is the power in having that continuous conversation with long-term patients that you have found?

Continue the Conversation

Becky Speer: Well, I certainly started doing that when I was working in a Jameson practice. And I think that things do change for our patients. You know, you have patients say things like they want to keep their teeth forever, but they’re fine with the way they look aesthetically. But then, you know, you revisit that in three, four, five years, and maybe they’ve got a reunion coming up. Maybe they have someone new in their life, and there’s something they want to change now aesthetically. And if you don’t ask that question, you might not find that out, since some patients aren’t as comfortable bringing up those things. 

Another thing I see when I go into practices is hygienists that are uncomfortable asking questions about aesthetics. You know, “How do you feel about your teeth, your mouth, your smile?” Or using smile forms the patient can fill out. When that does happen, it opens up many conversations about options for new aesthetic treatments. So I think it’s so important to stay in touch with your patients.

We build such long-lasting relationships. We’ve seen the patient, their kids, their kids’ kids, and we feel like they’re a member of the family. Hopefully we’re documenting all the little special things they tell us so that we can make sure to bring those up when they come back. “You know, what, tell me more about that. You mentioned that once…” And if you don’t ask those questions and start those conversations, time goes by. We only get to be in their space a couple of times a year.

I also think that it elevates our position in the practice. I see hygienists who have been practicing longer, and they tend to get complacent in those conversations. They’re thinking, “I’ve seen this patient for 10 years. I don’t have to ask this question again.” But we know things change for our patients. So we know it elevates our professionalism with that patient, but it also keeps us interested in our job. It keeps that passion going and keeps us from becoming complacent.

Role Play With the Team

Carrie Webber: For sure. You can engage in so many different brainstorm sessions with patients, and that allows you to talk about the connection of our oral health to everything else or whatever. It’s an opportunity to educate our patients to that next level for their long-term care. So I love that. And it’s just, so how do you help hygienists become more comfortable with those conversations? How do you recommend hygienists and other team members gain confidence in engaging in those kinds of conversations?

Becky Speer: First and foremost, role play. And we always laugh about this in consults, but rarely do I leave that we don’t role play something. And so even if Jameson is not coming into your practice, when something new has happened in science, talk about the changes and talk about how you’d want to have that conversation with your patient. Then start practicing on each other. It makes you more comfortable. You’re teaching your team about it as you’re doing that, and they’re asking questions that your patients are going to ask. Again, we just have a small amount of time with the patient and we spend about 70% of that appointment educating as we’re working. We have to utilize every minute we have with them to make sure that we’re giving them the information they want and need. So role playing and teaching that in real time with the team is really going to make everyone more comfortable with having that conversation.

Summing up the case acceptance conversation.

Carrie Webber: Absolutely. So we’re talking about team meetings or departmental meetings where you have time to work on these skills. Also having doctors and hygienists meeting together to get on the same page about philosophy and how you diagnose and how you treat so that everyone in the practice is speaking the same language. Making sure we have the same goals with the patients, and we feel comfortable and confident in engaging in those kinds of conversations.

Are you taking the time and planning? Are you proactively having these kinds of meetings and having this kind of training and then practicing these types of skills so that you get really clear on how you can get from where you are now to where you want to be. Are you leading more patients to a point of case acceptance, saying yes to the treatment they want or need, staying active in your practice, and staying loyal for the long run? That’s the role that a high-performing hygienist can play in being the frontline advocate for the patient’s long-term care.

So I just love all of the recommendations you made, Becky. Not only how you help practices today, but how you implemented it yourself as you were practicing, prior to your work with Jameson. So, thank you for being with me and for contributing so many great gems of wisdom for our listeners today.

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