This transcript with our Jameson Files host Carrie Webber has been lightly edited for flow. To enjoy the audio, you can watch on YouTube or listen to our podcast on iTunes, Google Play, or Spotify.

Jameson Hygiene Coaches Discuss Pain Points in Your Practice

Carrie:

Welcome to the Jameson Files. I’m your host, Carrie Webber, and I am so excited today because I have more members of the Jameson team as guests with me. I have Becky Spear and April Welker. Both are Jameson advisors, both business and clinical advisors for the Jameson team. And so, thank you ladies for being with me.

Becky and April:

Thank You.

Carrie:

Absolutely. We are here together at the Jameson offices doing work on our own personal skills and development, just like we do with all of our clients, helping you to be better and better every day. We do the same thing. So we gather together, and we meet, and we work through areas that we can improve so that we’re bringing our very best to our clients across the country. 

And the cool thing about Becky and April is, like I said, they’re business and clinical advisors. So these ladies are both hygienists that have worked clinical and dental practices. April’s actually still a working hygienist out in the world. And so they bring to the table in their work with our clients, not only the perspective of those business systems that are so important, but the clinical systems and how to truly have a high performing clinical team and hygiene team in your practices. So what I really wanted to talk about today is from your perspective in the work that you do with practices across the country and what you’re seeing in the industry as a whole, what are the trends in hygiene specifically, what are the pain points that you feel like practices are struggling with, and where are those opportunities that practices need to perhaps put some attention on that could really help improve their practices from that perspective?

The New Periodontal Classification System Helps Patients Understand the Value of Care

Becky:

Right now, I think one of the big things that we are teaching in many of the practices that we go to is staging and grading, which is the new periodontal classification system. It’s not a new periodontal classification system, but we are finally starting to get that into our practices, getting the documentation to be correct, because we know how important documentation is. And it also is a system that is creating some urgency, and it’s more understandable, I think, for the patients, and I think that’s why they came up with this. 

Carrie:

I like that. So it really plays a role in educating patients on the need for treatment and that focus on their ongoing health.

Becky:

Right. You know, we could say stage one to four in the past, you know, you’re stage one, stage two, or I shouldn’t say stage, it was class, class one to class four, but now when you tell somebody stage 1, 2, 3 or four, we’re used to hearing stages in the medical world. And so I think that’s what they’ve done by bringing the staging and grading into dentistry. Now people who are already familiar with that terminology are hearing that in the dental office as well.

Carrie:

Such a great point. And any opportunity to help patients see the urgency of the need for treatment and the disease that’s happening in their mouths is helpful. Do you find that when you’re practicing, does it make a difference in terms of patient education? 

April:

Absolutely. I think that’s a great point, Becky, too. And I think anytime a patient hears they have a stage of any type of disease, they’re listening more. They want to hear what’s going on. They are ready to sometimes accept it or not accept it, but they’re more likely ready to hear what the treatment is going to be and move forward with getting that care that they need.

Proper Time Management Aids in Communicating the Value of Care

Carrie:

What are you finding as you’re practicing, April, are those obstacles that you feel you need to have tools or skills to overcome when it comes to the patient’s understanding of the value or urgency for their ongoing care?

April:

That’s a great question, Carrie. And I think it’s really important for us as hygienists to take time to listen to the patients and to understand what they really need and what their goals are. And sometimes I think we get in a rush and we don’t have time, and we try to get through these appointments. But sometimes the patient just needs us to slow down a little bit, hear what’s going on, and really make a full complete treatment plan based on what their needs truly are.

Carrie:

In a previous episode, we were talking more on business and leadership with two other members of the Jameson team, Suzanne and Brenda, and something that we talked about from the business side– and you said that we’re not prioritizing that time for education and communication and listening– was time management. And something that we hear from time to time when we’re trying to introduce adding something or doing something more intentionally in hygiene appointments is, “I don’t have time for that.” What do you see? Do you see time management as an obstacle? And, what are things that hygienists or clinical team could pay attention to and be more intentional on to help manage their time and appointments more appropriately?

April:

So being clinical, some of the things that I’ve had to work on over the years and learn is just to cut my chitchat down a little bit. 

So we need to prioritize the most important things of the appointment. And I think sometimes we forget how important documentation is, and we skip over that, or we go to something else. And I think really looking at the appointment as the entire appointment and really prioritizing and finding a time for these things. And sometimes we do have to add more procedures or different things that we’re doing for the patient’s care, but really taking a step back and just looking at, what am I doing? How can I improve? 

And then two, don’t be afraid to ask your fellow hygienists for help. Coming together and having these calibration meetings is really helpful to make sure that, well, I didn’t know you were doing this, or I’m doing it this way. And really coming together as a hygiene team is so critical. And it’s important.

Carrie:

I love that.

The 20-20-20 Rule for Hygiene Time Mangement

Becky:

I agree. I think those are all good points. You know, some hygienists actually have to get a piece of paper and time themself. You know, there’s the 20-20-20 rule that we’ve talked about over the years. And so first of all, we’ve got to see what’s putting us behind. And many times it’s not the diagnostics, it’s like you said, it’s the chitchat. And so, obviously, it’s all about building the relationship as well. So there is definitely room for chitchat, but we’ve got to make sure that the oral hygiene instruction and the home care instruction is not the part that’s being left out because it’s not literally a procedure. And that’s what I see. I see that getting limited as we add things. So I think it’s really about timing and really knowing where you are in that appointment so that you are managing your time, just like with any other appointment,

Carrie:

Becky, can you give a brief refresher and reminder of what you mean by 20-20-20? 

Becky:

Sure. So the 20-20-20 rule is basically the first 20 minutes is diagnostics. The middle 20 minutes is the hand scaling, air polish, rubber cut polishing. And then the evaluation comes with the last 20 minutes. Your time to turn over the room, check out the patient, and get ready for your next patient, documentation as well.

Carrie:

So that middle 20, for those of you, when we’re thinking about managing time, Becky said that the doctor evaluation ideally, is falling in that middle 20, so that the hygienist, you have time to get any kind of diagnostic information, and take the photographs, or any of those pieces, already start preheating any conversations that need to be had. There’s some due diligence that’s done and is ready before the doctor comes in. 

And we want that in the middle because by the time you get in the final 20, what’s happening, right? The patients are starting to check out and move on to their next scheduled piece of their day. 

When you think about time management, it really does become that, as you were saying, really thinking through, what is my process and what do I need to be accomplishing? And also remembering why are those pieces important?  So if we’re finding ourselves saying we don’t have time to do things that would be integral pieces of patient education or helping them move forward with needed treatment or dealing with disease, we’re actually sacrificing something that could be the make-or-break piece of that patient’s decision-making process. Do you find that with your patients today? 

April:

Absolutely. Right. The patients need time to process this information too. And as you’re saying, that last 20 minutes, they’re already checked out, they’ve been sitting in the chair, they’re waiting, and they’re ready to go. And so the patient education piece is so important from the beginning to the middle, right to the end. And so yes, I completely agree.

Carrie:

And I think it’s a fine line, right? The chitchat. It’s such a fine line because relationship is so important with our patients, so that they have that trust and relationship and commitment to their ongoing care. And we have the very important things that we need to make sure we’re accomplishing in those appointments. 

Becky:

Absolutely. I think that when I go into practices, and hygienists truly are running behind and they’re using the entire hour, it’s that middle 20 minutes where that patient isn’t a regular prophy quote unquote. We’re spending too much time scaling. We’re not educating, we’re not moving them into the proper staging and grading and giving them the correct treatment. So I think it’s really important to think about, what is this patient, what category are they in? So that I can determine whether I should be able to complete this today.  Because for the years we have worked, can I get it all done in an appointment? And based on that we did or we didn’t, regardless of whether it was gingival disease, active therapy. 

Carrie:

Great job of bringing it all back to staging and grading. 

Assisted Hygiene as a Solution to the Hygienist Shortage

So I want to kind of jump to another piece in hygiene. And this is something that we find ourselves as advisors working across the country. This is the ongoing conversation and that is the supply and demand issue of finding hygienists. And  I feel like we keep hopefully anticipating that we’re coming through that. We’ve been dealing with that for two years now, really since the pandemic. So through that, a lot of changes have happened, and that still continues, from what I see, to be a big issue. They don’t have enough hygienists to see the patients or they’re so booked out in hygiene. That’s becoming a problem as well. What are some solutions in those interim times that you’re finding are working well for practices that may find themselves in a season of need for a place for hygiene patients?

Becky:

I think you’ve done some assisted hygiene yourself and, you know, that’s certainly one option. It’s really a good option because if you can’t find somebody, you need someone tomorrow. And we’ve got this empty room where there once was a hygienist, what can we do to manage? And I’ll let you speak to that because I know that you’ve actually done that. 

Carrie:

That’d be great. 

April:

Absolutely. And I think it definitely has been challenging to find the right people and to figure out the scheduling and how do we take care of this demand. And a lot of offices are now finding that they’re scheduling at 8, 9, 12 months and they can’t find time for new patients anymore. And so they’re referring treatment out that usually would stay in their practice as well. It’s really important to figure out how to correctly navigate assisted hygiene. That’s probably one of the most critical pieces if you’re going to attempt this type of system in your practice. There’s a couple steps that I would say are really important if you’re going to start this process. And one would be to have a meeting. Offices before that kind of jump into it and get excited and they want to do assisted hygiene, but they haven’t met with the hygiene department, they haven’t met with the business team, and they haven’t met with the whole practice to really figure out, is this for us? Is this gonna work? How are we going to make it work? 

And then the second piece would be the scheduling component– that’s critical to making sure that we’re not triple and quadruple booking and that we’re dovetailing the appointments correctly. 

And then the third piece that I would add would be to find a skilled dental assistant that is dedicated just to the hygiene department to really help those hygienists be producing well what they need to be doing, to really be ahead of the schedule to be able to give the patient care that they want to give their patients. But they really need that final third piece to make that all come together.

Carrie:

Yes. Such great points. And the scheduling piece is so key for implementing it well, and it’s sticking because it’s just like when we’re scheduling restorative. Nobody can be in two places at the same time, so if we’re scheduling side by side all the way throughout the day, you’re setting yourself up for burnout to run behind schedule, to have ineffective appointments. And so you’re setting yourself up to fail. And meeting as a team is such a great point, determining together how we are going to implement this and do it well because it does take everybody understanding. Because it involves business team assistants and hygienists and the doctors, quite frankly. I mean, how are we going to do doctor evaluations through that as well? We need to be very intentional about how we start to apply that. And, you know, really great assisted hygiene is not doubling the schedule. It is adding more hygiene patients to the schedule. But let’s be realistic on what a really great executed, assisted hygiene schedule looks like.

Becky:

Absolutely. I mean, you have to create it just like you would your ideal day. And I think that if you’re going to do it long, or even if you’re not gonna do it long term, putting the doctor in assistant time, but it’s hygiene in assistant time. So if anybody double books, it’s very obvious on the schedule because usually if we’re talking about this, we’re implementing it in a few days, right? And so making sure that we’ve taken the same time that we would take if we were filling the restorative schedule, I think is going to be key. 

And then scheduling to production as well. Having our pre blocks in there so that we have room for active therapy. All of those things are going to be critical, especially if you want to keep that hygienist, right? You don’t want to be looking for another one. So it’s really important to have those conversations, set out expectations, and talk about how it can work. Because not everybody has any idea what it looks like. They think it’s two columns of patients all day. And it’s not. That doesn’t benefit the practice, the hygienist doing it, or the patient.

Carrie:

No. And I think that’s what’s happening in a lot of practices. We’re doubling down. And I think those practices are feeling it and not in a good way.  Just an unrealistic setup in the hope that this is going to be the end-all, be-all. It is a help. But you know, you have to base everything on vision of the practice and what patient care is ideally for your practice, and we don’t want to sacrifice the patient experience and the patient relationship. And if you double down, you’re going to be too busy and too stressed out to even be able to give the attention that you would need for that to be the reality in your practice. 

So time management. Staging and grading. And staying on top of the evolution of hygiene. These things now occur, and it is not class anymore, it’s stage, and there are reasons for all of these types of evolutions. So staying on top of your profession, always being passionately curious about how you’re going to be better and better and better for your patients and for you yourself professionally, the 20-20-20, and if you are really suffering from that supply and demand issue of hygienists or lack of being able to find hygienists–the studies are saying that 8 to 9% of hygienists left the profession after the pandemic. The ADHA and the ADA are saying those numbers. And so this is a very real issue that a lot of areas in the country are dealing with.

So how do you adjust your model to support the need that you have for patient care in whatever situation you find yourself in? And it sounds like assisted hygiene has been very successful for you and for many practices throughout the country. So if that interests you and you’re not doing it now, make sure you do the work to be trained on how you do it right from the beginning. It’s easier to set it into place correctly the first time than try to fix an incorrectly set broken system in the practice. Don’t we know that indeed? 

There’s so much to stay on top of in hygiene and if there’s something that we can help you with in streamlining your clinical aspect of your practice and the hygiene aspect of your practice, these are two of the people on our team that are doing amazing work every single day with dental practices across the country. So ladies, thank you so much for being with me.

Becky and April:

Thank you.

Carrie:Thank you for joining us on this episode of the Jameson Files. Visit us online. You can subscribe to this podcast on iTunes, Google Play, or Spotify. See you next time.