Finding the Right Hygienist Every Time
How should we approach change with any staff member in our office, and how can we increase our hygiene production, profit, and satisfaction in a few days? Today is the perfect time to improve your leadership and your bottom line.
Change is uncomfortable for all of us, but especially to our staff, when based on our past, we have been less than stellar in pulling it off. Always remember that staff tends to listen to one thing: WIIFM (What’s In It For Me). Regardless of the plan or the change you want, we must take the time to spell out the benefit for that staff member it affects. Most of them just want to know “why” they should do this. So, just remember before asking anything from anybody, you need to spell out the benefit. In fact, it should be benefit, benefit, and then the request.
So, let’s take a look at moving our worn out, marginal hygiene departments into the Super General Dental Practice realm. Straight up, a little review. We need our hygiene department producing at least three times what they are paid, one third of the total office production, and having at least two new patients per day per hygienist with twice the number of hygiene hours as doctor hours, and a recall percentage of over 70%. The reason for going to a commission-based pay system, is that it will give your hygienist(s) the possibility of having unlimited earning potential, while helping us control our overhead by only paying for the actual production they contribute. Like an associate, hygienists can control what they produce if they get paid for their effort. We need to move to a “eat what you kill and clean” culture. A hygienist actually can control what they produce and earn by being more efficient and effective. If you think about it, most dental practices are paying hourly with the ripple effect of encouraging breaks, sick days, vacations, and one patient per hour, along with a poor recall percentage which results in an underperforming hygiene department. Why fall into the trap of creating a position and system that rewards mediocrity without pushing them to the earning potential and excellence they always really hoped they would have? From the hygienist’s perspective we are faced with overcoming their desire to focus on the “security” of knowing exactly what they will take home their next pay period. Most of us find the fear of change far greater than the potential reward. In this case you need to be very transparent and clear as to what and why you need this for your office. I would approach your hygienist with the idea that you have decided to pay her more (benefit), in the same way doctors are paid, turn over more control of her area to her (benefit), and show her she can partner with you to increase her production (benefit), recall, and job satisfaction (benefit). We usually will give the existing hygienist a three to six-month period where we are willing to pay her the current pay schedule or a straight commission, whichever is greater. While a hybrid pay system is an option where they have a base pay and a commission, you run the risk of backing away from the one strategy that will encourage full participation and commitment to a watered-down strategy that still encourages mediocrity and high overhead. Ultimately, at the end of this transition period, the hygienist will be on straight commission, just like every doctor I know. They have a period of several months to become comfortable with the results of controlling their schedule while developing their work ethic to a whole different level of commitment and execution. Your job is to help them see the potential and upside while minimizing the perceived negatives. Stay the course, commit to sound business strategies, and help your staff to a future of unlimited pay while controlling your overhead.
I have had lots of calls about hygiene on commission and how to implement it because their practices were losing money in the hygiene department. Hopefully, you are seeing a new possibility and how to build a new reality for a profitable dental practice. Hygiene is one of those key points in every highly successful practice I have ever seen. Great practices have great hygiene departments. Great hygiene departments in any practice are created by first finding and onboarding great hygienists.
If I want to catch big fish or hunt for a trophy buck, I have to look in the right places. I have to fish with the right bait. I have to hunt at the right time of day in the best location I can find. Good hygienists are pretty easy to find. Great hygienists are very difficult to find. Committed hygienists are your ultimate goal. Keep in mind that you are looking for someone that has great people skills, is self-motivated, and has the life-time commitment of wanting to learn more and solve problems. I know we started off trying to convince you that hygiene on commission was the only way to pay “producers” but we also have to find the right type of hygienist to fill that position.
Far too many times we choose a “wait and see” approach. Lots of times we are surprised when one of our hygienists decides to quit for $2.00 more an hour pay in the office down the street. Maybe you’re just caught off guard when someone decides to move. Regardless of the reasons, we should never hire anyone when we are desperate. Desperation spawns “settling” for staff that are not a good match in order to get our offices back to some semblance of normality, only to find months later that a poor hire has sabotaged all of the other positions in the office. It is being caught unaware that fuels this repeated scenario in most offices. You, as the leader and owner, need to always be looking for employees to improve your team. I am not saying that you should not have tenure in the form of long time high performing hygienists, but you should, through interviews and constant training, try to improve the quality of your staff. Doing this ensures that everyone who makes up your team will strive to work at the highest level of excellence in their performance.
Secondly, I see too many offices, when faced with replacing a hygienist, looking in all the wrong places. Certainly, Craigs List, Indeed.com, and headhunters are a base level search option, but most of the time they fall far short of you being able to get across the desk from a great hygienist. If you want the best, you need to look in the best places. I have always found that going online to the State Board sites for your area will give you a great option if the state is an open records state. If they are, you should be able to view a list of every assistant, every hygienist, and every doctor licensed in your state. It normally will have the person’s name, address where the license is renewed, any state board problems, and when their license was issued. The lists are normally presented in a spreadsheet which allows you to home in on any particular area that you feel is important. If you are not in a state that makes this possible, the publisher of Dental Economics, Endeavor Business Media, also publishes RDH Magazine and will sell you a similar list.
Finding the right person may include locating someone that will not have to drive a long way to work with you. Because you can see where their licenses are renewed, you can also see the zip code and be able to determine the approximate drive time that person might have. I would limit it to a 20-30-minute drive. Perhaps you are looking for someone younger or older? That might be reflected in the year the license was issued. Perhaps you want a male over a female? Most of the time their names would help you. Keep in mind that you want the best candidate that meets or exceeds your vision and job description.
Your next step would be to craft a letter with your job opening. This takes time and effort to tell your story in such a way as to attract those who would come closer to meeting your needs. I always sent the letters in a non-business envelope, hand addressed, with only my return address on the outside of the envelope. I did not want them to know it was from a dental office. The envelope should look personal and pique their curiosity to open it. Your first line will make or break your letter as well as the format and what you say. Keep in mind that the letter is designed to give them enough information to “pre-qualify” themselves but not answer every question about the job. It is written in such a way as to solicit a call back or visit to your office.
Keep in mind that you are not just looking for someone that is down on their luck and out of work. I want someone that is blowing and going but looking for a better opportunity. This type of person is not scanning the want ads or Craigs List every day. I need to impress them with the offer and make them feel like we are a good fit for their future. NOTE: One of the things I always did was to make sure that the letter was just one page, had a PS, and on the reverse side of the single sheet of paper we printed a collage of scanned photos of the office and team. We need to be “remarkable” (different from every other dental office) to find the best candidate for the job.
I can’t emphasize enough that you need to “craft” the letter and form a systematic protocol for attracting qualified hygienists with the desire to have control of their future in an office with unlimited earning potential (hygiene on commission).
Some of us are so excited if we get one applicant when we are desperate to fill a position in our offices. You are different. You understand that in this search for a stellar hygienist, we have to be selective and persistent. You are not going to allow yourself to settle for just another person to clean teeth. Make sure you have reread the previous thoughts before moving on. I want to present an argument for making sure that when you find those candidates that you ask the right type of questions. I want to do this as a numbered list and also give you some thought and considerations of why these questions and their answers are integral to finding that committed, people person, self-motivated hygienist with an ownership mentality. You should be able to identify the candidates that are up to the task. As an aside, I want to remind you that in our offices the staff always had the final hiring go-ahead with any position. This even included the doctors who became partners in my offices. I cannot over emphasize that building a coherent team that is committed to your vision requires a high level of communication before you hire, during the process of vetting, and into the working interviews. Learn to partner with your staff to ensure that if they say yes to a candidate, they are also committing to making sure that the new hire will be successful during the onboarding process.
Here is quick list of questions I would ask any hygienist before considering them for a position on my office. Many of these questions are “quantitative” in nature. If you see some uncertainty in the answers, go back over the questions and get more clarity. If they do not know, then it is probably the wrong person for the job.
- How many patients per day did you typically see in your previous office?
I would hope to see a number between 8-10 in a typical general dental practice.
This is a perfect time to ask general questions about the demographics of their current/past patients: Age, income, kids, range of services, etc. You can compare this to the demographics on www.zipwho.com to see if the office is different from the actual population for that location.
- What was your average production per day in your previous office?
Keep in mind that we are looking for “net adjusted production”, and not gross production. Some hygienists do not consider the decrease in reimbursement that we receive from an insurance company. They may not even know the difference. Bad sign if they don’t actually understand this side of the business of dentistry.
Goal would be about three times what they are paid.
- How were you compensated/paid in your previous office?
Hourly, salary, per diem, hybrid, etc. Once a month, every two weeks, twice a month. Benefits: Insurance, vacation, education, uniforms, etc.
- Were non-emergency new patients first seen in hygiene or in the doctor’s chair in your previous office?
This will lead to further questions and insights into how the previous office processed new patients. Change is sometimes difficult for staff, and you need to know how they were utilized in their previous offices.
- Who cleaned and reset your room? Who sterilized and prepped your instruments in your previous office?
Expectations are important and speak to entitlement and their view of the hierarchy in the office they worked. Every hygienist can easily clean and sterilize their equipment and instruments. I like the saying in Gold’s Gym: Pick up your own weights, you mother doesn’t work here. We are looking for a committed team member that does not see themself above doing whatever it takes while offering to pitch in with other team members and their jobs. The last thing you need is a prima-donna in your midst.
- Who did you help when you did not have a patient in your chair?
Take the time and expand on the question. The talent in asking these questions is to make sure that you do not dumb this down in a way that any of these questions could be answered in a yes or no fashion. Draw them out and get them to talk about their last job. You are trying to understand their relationship with other staff members as well as their view of what a “hygiene” position should look like.
- Who filled your schedule in your previous office? How did you help that person?
We are looking for the extent that they performed their duties and how they interacted with their fellow teammates. How much did they take on in their schedule? We are looking for someone that accepts the responsibility and accountability for their own performance.
- In your previous office, how much time was typically scheduled for an adult prophy with exam and x-rays?
We are looking at their expectations: If they were paid hourly, they probably had one patient per hour. Can they understand time and money when it comes to scheduling a patient? Is there any reason that it was exactly an hour? Was time built in for a doctor who consistently fails to check the hygienist in a timely fashion so more time is added to compensate for the doctor’s bad behavior?
- In your previous office, if new patients were seen initially in hygiene, how much time was booked on the schedule for that appointment?
Certainly 90 minutes would be an upper level of time for an adult. If the doctor sees them first, this will indicate that they have not been involved in helping patients want what they need.
- In your previous office, did you see many children?
What is the time set aside? Was the office attractive to having a wider range of ages and services? How do they feel about working on kids?
- Were you allowed to discuss problems you see in your patients’ mouths before the doctor arrived for the exam?
We are now looking at the behavior and overall competence in partnering with you, doctor, in helping patients say yes to treatment recommendations.
- What kind of documentation did you have to prepare for the doctor prior to the exam?
They should document all existing conditions. Cancer screening. Probing on every patient. Blood pressure. All needed treatment should be recorded prior to the doctor entering the room and the hygienist should have discussed what the doctor might suggest as treatment as well as answering any questions the patient might have.
- Tell me about your hand-off of patients to the front desk team at your previous office.
This is key to patient follow through and a skill set that needs to be developed in your office. There needs to be specific protocols for this, and it is necessary to understand how they functioned in their previous office.
- At what point during the hygiene appointment did you let the doctor know you were ready for an exam?
Communication systems, protocols, and doctor/hygiene coordination will help you see if their past plays into what you do, or will there be extensive changes made?
- In your previous office, did you schedule the patient in your chair for their next cleaning appointment or was this done at the front desk at check-out?
Recall and reactivation are key to a successful hygiene department. Ideally it is the hygienist’s responsibility to ensure that every patient schedules in their room before going to the front desk.
- How many new patients did you see per day/week/month?
This will speak directly to the productivity of this hygiene candidate as well as the “business” and growth of the previous office. Your job in moving a hygienist to commission is to supply them with about 25-30 new patients per month per hygienist. Without this exposure to new patients, the transition will not work well.
- How many scaling and root plantings did they do per week or month?
We want to make sure that the hygienist has the competence to explain and have patients follow through on high level hygiene services. Supervised neglect will be the default position of the majority of candidates because they fear confrontation.
- Why are you looking for new employment?
We need to know what made them leave their previous office. What areas caused this: Doctor, staff, systems, patients, etc.? I would say that many times their reasons for leaving are common and revolve around leadership and pay. Make sure you are not one more office they visited and then left for the same reasons. This is a point of no return. Make sure you explore their reasoning as well as her thought processes in your office.
We have only scratched the surface, but I think you can see how important the questions and their answers are to you being able to offer them employment in your office. What follows below is our comprehensive interview process as well as the interpretation of answers while considering personality profile and implications that come from their answers. We have individual interview questions for every position in the office, but here is the one designed for a potential hygienist.
Michael Abernathy, DDS
972.523.4660 cell
[email protected]
Interview Questions for Prospective Hygienist
Name: Date: ____________
Of all of the jobs you have ever had which one did you like the most? Why?
Of all of the jobs you have ever had which one did you like the least? Why?
When participating in group activities, what role do you typically play? (Leader, supporter, idea generator, organizer, motivator)
What was your best contribution to any group with which you have worked?
What was the greatest dental technological or clinical change you have ever been through?
How did you handle it?
How did you feel about it?
What is your greatest strength?
What is your greatest weakness?
There are no right or wrong answers to the following questions. Please give the response that first comes to your mind. (Circle the response the prospect gives. Notate when they responded without hesitation and when they had to think first. If they are unable to choose between two options make a note about their response.)
As a hygienist, is it more important to you to appear knowledgeable or enthusiastic?
As a hygienist, is it more important to you to be discerning or gentle?
As a hygienist, is it more important to you to be professional or have a sense of humor?
As a hygienist, what gives you the most personal fulfillment: performing excellent work or helping people?
When facing challenges at work, are you more inclined to focus on what is positive about the situation or focus on the results?
Is it more important to you to be a good communicator or team player?
What would you prefer to do, take on a challenging dental procedure or meet new people?
Would you rather be known for your ability to lead your co-workers or train them?
What is more important to you, being organized or innovative?
Would you rather be thorough and perform tasks yourself or delegate them?
What excites you the most, starting a project or finishing a project?
Would you rather spend your time maintaining relationships with co-workers and patients or trouble shooting problems?
When you are asked to lead a project, are you more inclined to be assertive or ask your co-workers questions?
When you are asked to lead a project, is it more important to you to make decisions quickly or reach a consensus of your team?
As a team member, is it more important to you to be dependable or goal oriented?
As a team member, is it more important to you to be punctual or a hard worker?
As a team member, is it more important to you to be loyal or open to change?
Please complete the following phrase: I am the most satisfied working as a hygienist when…
Please complete the following phrase: I get frustrated working as a hygienist when…
Which goals are you the proudest of achieving?
What do you need from your work to keep you motivated and interested?
Here are the top attributes your team requested in descending order:
| Must have… | Important to have… |
Verbal and Nonverbal Clues
When prospects are being interviewed, have someone observe and watch for the following verbal and nonverbal clues:
Analytical Driver
| Verbal Behavioral Clues
Pace of speech: slower Quantity of speech: fewer statements Volume of speech: softer Emotion in voice: monotone Subjects of speech: tasks Descriptives: facts/data
Non-verbal Behavioral Clues Use of hands: relaxed or cupped Body posture: leans back while talking Eye contact: indirect while speaking Facial expression: controlled |
Verbal Behavioral Clues
Pace of speech: faster Quantity of speech: more statements Volume of speech: louder Emotion in voice: monotone Subjects of speech: tasks Descriptives: facts/data
Non-verbal Behavioral Clues Use of hands: pointing at others Body posture: leans forward to make a point Eye contact: direct while speaking Facial expression: controlled
|
| Amiable
Verbal Behavioral Clues Pace of speech: slower Quantity of speech: fewer statements Volume of speech: softer Emotion in voice: inflections Subjects of speech: people Descriptives: opinions/stories
Non-verbal Behavioral Clues Use of hands: relaxed or cupped Body posture: leans back while talking Eye contact: indirect while speaking Facial expression: animated |
Expressive Verbal Behavioral Clues Pace of speech: faster Quantity of speech: more statements Volume of speech: louder Emotion in voice: inflections Subjects of speech: people Descriptives: opinions/stories
Non-verbal Behavioral Clues Use of hands: pointing at others Body posture: leans forward to make a point Eye contact: direct while speaking Facial expression: animated
|
Interview Questions for Prospective Hygienist with Interpretation of the answers.
Name: Date: ____________
Of all of the jobs you have ever had which one did you like the most? Why?
If there are similarities between their best job and your position, that is a good sign. If there aren’t any similarities, then this is a concern.
Of all of the jobs you have ever had which one did you like the least? Why?
If the job they disliked the most is just like yours, RUN.
When participating in group activities, what role do you typically play? (Leader, supporter, idea generator, organizer, motivator)
Leader = Driver
Supporter = Amiable
Organizer = Analytical
Idea generator, motivate = Expressive
What was your best contribution to any group with which you have worked?
This illustrates the best they have ever done for a team and shows what contribution they can make that they personally find valuable.
What was the greatest dental or technological change you have ever been through?
These answers reveal how the candidate handles change.
How did you handle it?
How did you feel about it?
What is your greatest strength?
Consider this answer in light of the position they will be fulfilling. If it is important to that job, then this is a plus.
What is your greatest weakness?
Consider this answer in light of the position they will be fulfilling. If it is important to that job, then this is a huge minus.
There are no right or wrong answers to the following questions. Please give the response that first comes to your mind. (Circle the response the prospect gives. Notate when they responded without hesitation and when they had to think first. If they are unable to choose between two options make a note about their response.)
As a hygienist, is it more important to you to appear knowledgeable or enthusiastic?
Knowledgeable = Analytical
Enthusiastic = Expressive
As a hygienist, is it more important to you to be discerning or gentle?
Discerning = Analytical
Gentle = Amiable
As a hygienist, is it more important to you to be professional or have a sense of humor?
Professional = Driver
Sense of humor = Expressive
As a hygienist, what gives you the most personal fulfillment: performing excellent work or helping people?
Excellent work = Analytical
Helping people = Amiable
When facing challenges at work, are you more inclined to focus on what is positive about the situation or focus on the results?
Focus on positive = Expressive
Focus on the results = Driver
Is it more important to you to be a good communicator or team player?
Good communicator = Expressive
Team player = Amiable
What would you prefer to do, take on a challenging dental procedure or meet new people?
Challenging dental procedure = Driver or Analytical
Meet new people = Expressive or Amiable
Would you rather be known for your ability to lead your co-workers or train them?
Lead = Driver
Train = Amiable
What is more important to you, being organized or innovative?
Organized = Analytical
Innovative = Expressive
Would you rather be thorough and perform tasks yourself or delegate them?
Thorough and perform tasks yourself = Amiable or Analytical
Delegate = Driver or Expressive
What excites you the most, starting a project or finishing a project?
Starting =Expressive or Analytical
Finishing = Driver
Would you rather spend your time maintaining relationships with co-workers and patients or trouble shooting problems?
Maintain relationships = Amiable
Troubleshooting problems = Driver
When you are asked to lead a project, are you more inclined to be assertive or ask your co-workers questions?
Assertive = Driver or Expressive
Ask questions = Amiable or Analytical
When you are asked to lead a project, is it more important to you to make decisions quickly or reach a consensus of your team?
Make decisions quickly = Driver or Expressive
Reach a consensus = Amiable
As a team member, is it more important to you to be dependable or goal oriented?
Dependable = Amiable
Goal oriented = Driver
As a team member, is it more important to you to be punctual or encouraging?
Punctual = Driver
Encouraging = Amiable
As a team member, is it more important to you to be loyal or open to change?
Loyal = Amiable
Open to change = Expressive
Please complete the following phrase: I am the most satisfied working as a hygienist when…….
If the response is a frequent occurrence in your office, then there is a good chance this person will be happy on your team.
Please complete the following phrase: I get frustrated working as a hygienist when…….
If the response is a frequent occurrence in your office, then there is a good chance this person will not be happy on your team.
Which goals are you the proudest of achieving?
This response is a window into their value system and highest level of performance.
What do you need from your work to keep you motivated and interested?
This response is a major clue as to whether they will flourish in the position you are hiring them for or whether this will just be a job.