Where Hygiene Leadership is Born

Years ago, at the start of my career, I was so excited to embark on a career in clinical hygiene and felt confident that I had found my calling and I never thought about doing anything beyond clinical practice. Of course, that was in the beginning…. Over the course of 20 years, I worked to hone my clinical and interpersonal skills for exemplary patient management and delivery of comprehensive care. I spent my whole clinical career in one practice working for a great doctor who always said that I had an “ownership mentality” to my practice. This wasn’t only because of my professionalism or dedication but more importantly for my understanding of the “business” of dental hygiene. I took responsibility for every aspect of my practice, including clinical protocols, supply and schedule management, and staff relations. Over the years, we both shared much success, and I was always grateful to him for giving me the autonomy to run my end of the practice and to develop such very valuable skills; skills that I would later utilize working in a different capacity.

In my latter years of clinical practice, I was given an opportunity to take on a part-time educator role for a dental pharmaceutical company. I was able to do this in combination with clinical practice. It was in this role that my eyes were opened to a professional life beyond the operatory and where I realized that I possessed skills that were transferable. And so, it all began…. I held that position for 2 years, expanded to speaking engagements, and then transitioned out of clinical practice and into a full-time consultative sales position.

After sales, I began my first hygiene leadership position in a small emerging DSO. At the time, I remember thinking that group practice might be the wave of the future, and that instinct was clearly spot on. Not only was this a new type of role for me, but it was a relatively new role in the industry.

“Challenging” is an understatement to the road I had ahead. I was a “pioneer” of sorts as there was no one I knew in the industry in this type of role who I could really model at that point. I had to build from the ground up in a group with 25 practices, all of which had nothing in common other than being part of this group. Every practice functioned independently in their own way. Instituting structure and a standardized program were not met with glee from the partner doctors or hygienists. I was like an attorney who had to make a convincing case for conducting clinical operations very differently. My clinical convictions, belief in the provision of comprehensive care and patient advocacy, and lots of time and persistence helped me to build my relationships and credibility. I eventually won them over.

I continued to build over the years, and that company was acquired by a large DSO where I was eventually promoted to a national role with a team to lead. There I got to really implement my programs and systems on a large scale. After that, I did this all again after a relocation, working for another large DSO also on a national scale.

Key Components of a Hygiene Department

The Concept

The overall idea in constructing a successful hygiene department is to implement a high-quality standard of care that will fully utilize the hygienists’ skillset and lead to optimal treatment outcomes for patients while yielding a revenue stream and profitability. Communication and collaboration between the clinical and operational departments is essential. Once this alignment is achieved, a clinical training plan compilation can follow.

Dependable metrics and reporting systems must be created to measure the business and clinical success of the program. These metrics can also be utilized to forecast growth, coach, and to monitor continued improvement.

Definitive Clinical Pathways

Collaboration with organization clinical leaders and industry authority guidelines should be referenced to set the standard of care. Will you utilize any adjunctive therapies such as locally applied antibiotics, antimicrobials, or institute newer technologies such as lasers, or AI software? You will be deciding what to treat, when and how. What will the fees look like, and insurance coverage be? Once the guidelines are set, then a training plan can be developed. The program itself must be sustainable and scalable in anticipation of future growth.

Once the plan is in place, the who, how, and when must be confirmed. Will the training be live, virtual, or a combination of the two? Will the whole hygiene team be trained at once or incrementally? The didactic component of this training is the first step, not unlike hygiene training in school. Hygiene students undergo both didactic and clinical training; this is no different. We are just taking those skills they already possess within their scope of practice and developing them further for enhanced patient care.

Practice Administration and Operations

In any dental practice the back office and front office must be aligned and work synergistically. It is a whole team philosophy. The front office staff and especially the practice manager must be apprised of the clinical changes occurring in the back office. Guidelines for fees and collections, scheduling practices, insurance filing, and treatment plan presentation are part of the equation. Without solid operations, the program will not be successful.

Behavior Change

Once the initial didactic training is accomplished, we move on to tackle behavior change. Change and implementation are a process that take time, which varies individually. There is no “one and done” here as the process for the trainer and trainee is ongoing. I usually inform new hires that I will be a presence in their professional life in some capacity if they are practicing within our organization.

Ironically, it is often more experienced hygienists who may take longer to adapt to change than a less experienced hygienist. For a hygienist who has been practicing a certain way for the past 20, 30 years or more, changing the way you do things and adapting to different clinical approaches can be challenging. They must now see their patients, who they may have been treating for years, with a different set of eyes. Once they do get their mindset adjusted, they can often be very successful because they have had years to hone their patient relations and patient management skills.

Less experienced hygienists, those more recently trained, may adapt more easily, as they were trained in more current science, and their habits are less engrained. New grads are great to work with and adapt well over time, but they have many hurdles to overcome adjusting to real-life clinical practice. However, from a training perspective, this is such a positive scenario to essentially guide them to implementation while they gain their experience. You get them off on the right footing from the start.

The key to training is to have appropriate expectations and use a step-up approach. If you set the expectation to implement too many initiatives at one time, hygienists can become overwhelmed and will not perform at the desired level. I usually have a targeted approach with one or two aspects of the program. Perhaps you start with probing and documentation and some modicum of adjunctive therapy such as fluoride. As the training progresses additional products and services can be added.

Being a Change Agent

Instituting change is not for the faint of heart. It is not always received positively and there is much psychology involved for the trainer as many people are averse to change. Often the automatic reaction is to find some kind of negativity around the changes such as, “I feel like a salesperson” or “You only want me to do this for the money.” Psychologically, this is their rationale to dismiss the idea of going through those changes and dealing with the challenges those changes may pose for them.

The trainer and trainee relationship are at the core of motivating hygienists to make those changes. Thinking about the different roles I have held over the years, good relationships were always at the root of my success. Relationships and credibility are foundational to the process and develop over time. Once that relationship is formed then trust and accountability will follow.

Sales vs Service

When faced with objections, the response should generally be that this is not “sales,” it’s service through education. Patients are informed about their condition, how best to treat it, and the consequences of no treatment. The dollars are never a part of our conversations. It is well established that when the patients are treated consistently with their condition, the dollars naturally come. Persistence is key for the messaging by the trainer to inspire and motivate.

Expectations

Undergoing the training process is one thing but understanding what you are expected to achieve is another. At the outset hygienists must know what the goal is and what that looks like. Providing metric analysis for KPI benchmarks is crucial. Just as crucial is how to get there and setting the expectation that it will not happen overnight. This will play out over time and the trainer is there to guide them along.

Compensation

Setting up a hygiene compensation plan is essential to the total equation. The plan should be predicated on clinical compliance and provide an additional incentive. With this, the patients receive optimal care, the practice is supported, and the hygienist is motivated.

Support and Advocacy

Developing better clinicians is a gift for both the trainer and the trainee. Building confidence and professional satisfaction impacts that hygienist’s outlook and attitude. Recognition of exemplary performance helps to build advocacy. These hygienists can feel good about what they are doing, and their efforts are distinguished. They then become a voice and support the program. It is very impactful when you see a positive attitude from one of your peers. That positivity and advocacy are part of the building blocks of a positive culture within the department.

Infrastructure

As an organization grows, the demand for training also grows. Because this is a very hands-on process, with much time invested in every team member, at some point the trainer will require additional support. Recognizing those team members who possess leadership skills and the desire to train is the core of the process. Creating a career path within the organization will help with retention and provide more opportunity for the team. A tiered approach makes the most sense where a hygienist may start out as a chairside mentor and with performance can progress to a field position depending on the size and needs of the organization.

For the Hygiene Leader

Although there is collaboration with other departments within an organization, hygiene leadership can sometimes be a solitary profession. After all, everyone needs some support. I have been very fortunate to have great relationships with a group of my peers in the industry for most of my leadership career. These leaders have traveled the same path as me and have had very similar experiences. The transparent sharing of ideas, methodologies, and techniques has served as a wonderful support system for me, and I am grateful that they are part of my professional life. I have had a great run and am not finished yet!

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