Even if true, most successes occurred in the PAST in vastly different economic, employee & patient marketplace environments.
Many “gurus” are NOW owned by the insurance
industry… & will guide (mislead!!) you along a path of lower insurance billing. (Lower insurance billing means higher profits for the insurance industry.) SO PLEASE, PLEASE, PLEASE BE CAREFUL!
You must look at your practice… & your current employee marketplace…apart from the past & other areas.
Over our past 3+ decades of unprecedented & unparalleled practice incentive observation…failures where the incentive amount is too low…along with
the above-mentioned failure to proactively invest in… & add open MORE…prime time hygiene appointments…have been the largest cause of
incentive system failures.
Please look at the big picture of amazing growth & prosperity that otherwise will not occur… & please don’t be cheap!
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GENEROUS EITHER! If Incentives
Make Staff & Managers TOO
WEALTHY, They Stop Trying!
Over the past 3+ decades of observation & documentation in thousands of offices… &
particularly with the management of chrisad…beyond a certain point, too much generosity can lead to
elevated complacency & LAZINESS!
IMPORTANT: Staff & managers quietly & unannounced adopt a “Country Club” attitude & stop trying harder.
Here too, staff will NOT approach you & say, “Hey, I think I’m making so much money now that I’m not
going to work any harder to attain higher goals. I make more money now than I ever thought was
possible.”
However, AGAIN, it pays to quantify what people DO… & generally disregard what they SAY.
As you read this, you might say to yourself, “Doesn’t EVERYONE want to make more money year over
year??” That’s what I thought. Shockingly, not all.
We always must be reminded that in the arena of
human behavioral influencing, what YOU reading
this personally want & think is not always what OTHERS want & think!!!
It’s amazing. More than a little depressing. And surprising.
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Some people seemingly quietly hit a ceiling of lifestyle satisfaction.
Beyond a certain point, they will not work harder to achieve greater goals.
With most incentive systems, it takes many years to reach this point. However, you must be
VIGILANTLY cognizant of this likely eventual effect.
QUANTIFY what employees (associates, too!) & managers do...BUT generally disregard what they say.
It may never happen with many staff & managers.
But with others, it might occur at a higher or lower financial level. Just be aware.
So what to do?
This is the tough part. As employees’ & managers’
incomes accelerate, it is always wise to have
replacements redundantly trained & ready to step in.
Obviously, the last resort is to simply FIRE the
overpaid & underperforming manager or staff. These are usually valuable employees. They are just sitting too fat & happy.
On a case-by-case basis…in addition to additional training & mentoring…it makes sense for the incentive plan to be modified such as to DECREASE
compensation if certain goals are not met.
Please see the optimal managers' compensation
configuration at the end of this book.
While you should ALWAYS check with your local
employment laws, this is generally legal as long as it 36
does not impact the base pay level that existed before the incentive was initiated.
After that… & you have tried everything else…simply let the too wealthy Country Club employee or
manager go… & replace them with an employee or manager starting at a lower compensation level.
4. Examples of Un-Incentivized Staff’s
Subtle Undercurrent Interrupting
Prime Time Patient Flows:
All staff, hygienists & doctors must row the boat in the same optimal direction… & be rewarded appropriately for doing so.
This is the only solution!
Here are various examples of commonly encountered misbehavior:
1. Many hundreds of thousands of chrisad Secret Shopper calls suggest that very rarely…unless micromanaged & actively counteracted/micromanaged by chrisad & the practice owner/management…are prime time appointments
proactively offered by phone staff to potential new or returning patients…OFTEN even after an abundance of prime time hygiene appointments are in fact added in the practice!
2. Saturday & Sunday appointments are particularly UNPOPULAR with staff. A few years ago, an audit of 20,000 Secret Shopper calls found that the word “Saturday”
or “Sunday” was NEVER ONCE mentioned over a 9–10
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month period…even though at that point 200–300 of our client offices offered those appointments.
3. Commonly, we will find a practice where 7am or 5:30pm weekday hygiene appointments are (very oddly) completely available & wide open. Very commonly, staff will selfishly suggest that, “no patients around HERE want these appointments,” or similar. Typically, the owner/doctor knows that the practice is open & available early & late… & (incorrectly) believes that these prime time hygiene slots are being abundantly offered to patients over the phone & in office. HOWEVER, THEY ARE COMMONLY NOT
BEING OFFERED! Our Secret Shoppers callers will soon uncover the fact that the receptionist offers our “random sample” caller the practice opening times of 9am to 5pm Monday thru Friday or similar. We assume that this is the same policy for returning hygiene appointments as well.
Obviously these are hours that best suit the STAFF…but NOT THE PATIENT! The result is usually the loss of 100%
of the best insured, wealthier working patients!
4. We recently found a practice where we saw a string of Saturday hygiene appointments 100% filled over a 7–8 week span…but one Saturday was left COMPLETELY
OPEN…with no patients…that was NEVER offered to our Secret Shoppers. The owner-doctors were NOT HAPPY
when they found this. A quick investigation found that one staff member was getting married on that open Saturday… & many staff were invited…so the underground “mafia”
communication channels apparently suggested that no
“bothersome” patients be scheduled on that Saturday… & thus interfere with their fun! We found a similar upsetting dynamic with Mother’s Day afternoons… & Super Bowl Sundays.
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5. THE VERY SUBTLE POWER of “UNDERGROUND
STAFF COMMUNICATION CHANNELS” CANNOT BE
IGNORED: Think MAFIA! One of our great clients has 5
offices & a centralized new & returning patient call center that is located no closer than 4–5 miles from any one office.
The call center staff do not physically, socially…or otherwise…intermix with the five offices’ staff members.
They don’t know one another. Nevertheless, the call center staff tell us that they receive many requests a day from associate doctors, hygienists & other staff at ALL offices to NOT put a patient into a particular (usually) prime time slot…or move patients OUT…when they don’t want to see patients. Remember: This off-site call center staff does not even know the office staff! Think what damage occurs when ALL of your staff are all under one roof!
6. Additionally, we frequently find that staff enters false patients into the prime time schedule so that patient no shows will occur more often during the prime time periods that they do not want to work. They hope that practice owners & management will be more likely to conclude that prime time demand is different in their area (IN FACT, it never has been…anywhere!)... & they might be more likely to go back to the old way!
7. Again, apparently tied to subtle STAFF
UNDERGROUND COMMUNICATION CHANNELS, we
have uncovered cases where a given NEWLY ADDED prime time hygienist’s schedule does not fill up at all…while all of the existing/established hygienists' schedule filled 100%.
AGAIN, THINK MAFIA! While we can never compel
anyone to admit this, the only explanation for this PHENOMENON is that the established hygienists…who were paid on the basis of commission…did not…(in their mind!) want the new additional hygienist to siphon off new 39
or returning patients…thereby potentially reducing their income.
We believe that in these cases…unbeknownst to the owner/management…the established hygienists apparently persuaded the scheduling staff to steer patients away from the newly added hygienist. When this occurs, we have heard them suggest that this was due to the fact that “she’s a bad hygienist” “is rough”…or similar hogwash…but there may be other more subtle staff communication approaches used.
This has even been the case where the hygienist is paid by the hour & is NOT compensated by incentive. In these cases, the hygienist likely has a scarcity mentality & apparently believes that if their schedule is not full, their hours will be reduced or they will be laid off! Really!
Generally, staff resists working or filling these prime time hours because it (very understandably!) interferes with their personal lives…or those of their friends at work. It represents change & the unknown.
Very few individuals are comfortable with this. It is not always the dental world or dental lifestyle that they expected or envisioned before entering dental school, hygiene school, assistant school or otherwise when they first sought dental office employment.
The world changed… & doctors, hygienists, receptionists & other staff RARELY like it. They commonly (judging by their actions) think that…by resisting…they can change the thinking of the public so that the public will no longer want prime time hygiene.
However, no one can change the course of a river. Staff privately tell us that, “If we give them a Saturday appointment, they… & everybody else…will ALWAYS want 40
Saturdays. What are we going to do during the middle of the day, middle of the week?”
The answer is that it is inevitable that dental practices will eventually end up like a restaurant: No matter how much the restaurant owners want it to be different, you can’t influence someone to come in for a great steak dinner at 10:30 in the morning!
So please, don’t try to fight Mother Nature. The sooner the practice EMBRACES these realities…rather than try to fight them…the faster they will grow… & the more prosperous they will become!
5. This Long-Proven & Basic, 3-Point Incentive System Is a Great Practice
Growth Stimulator & a Wonderful
Practice Manager…
We have suggested for decades that a great incentive system is the best managerial system. In business, the larger your enterprise gets…. & the more you (the owner) are away… the more difficult it will be for you to micromanage every aspect of your staff’s behavior.
But if everybody in your office FAILS to “row the boat” in the same direction, it is unlikely that you will grow much larger!
You’ll just end up rowing your boat around in circles… & your practice will stay in the same place!
Great managers have found that it is difficult…if not impossible…to push a rope uphill! Outstanding employees MUST
know in advance… & with certainty…that they WILL BE
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proportionately compensated for their additional focus, actions & dedication!
A great incentive compensation system is an ethically correct way of stimulating & proportionately rewarding positive staff behavior…even when the manager or doctor-owner is away!
It is defined by being so simple that everybody in your office understands it… & can explain it in a sentence or two… & all staff knows exactly where they stand on a daily basis.
It must be instantly understandable via updated daily break-room charts & /or video screens so that staff can immediately project exactly how much more MONEY will be on their paycheck at the end of the month!
The ACID TEST for a BAD incentive system: If staff cannot competently explain how the system works…or how much they will likely make at the end of the month at a given point during the month…they cannot possibly be stimulated to work toward the incentive goals! (Ask them!)
Another distinct sign of an incentive system needing an urgent upgrade is when staff fail to hit their bonus for three or more months in a row.
The system that we suggest below is the product of three-plus decades of fine-tuning & perfecting in thousands of practices located in every U.S. state & many additional countries. These principles have been proven in hundreds of our most successful practices over the past two decades… & a version of it has been used at chrisad for the past 35 years.
It has been part of the growth process of virtually all of our fastest growing & largest practices…some growing to the $70 million a year & $1 million per chair per year levels…with the owner/doctor (obviously) out of the chair.
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While the system below is tried & true…we are going to suggest an evolved (however less tested) but seemingly more successful…version of this system later in this publication.
The tried & true optimal incentive system is very simple: Per the sample “Production” graph below, the practice calculates the average of the past three months in the following three vital areas.
If one, two or all rolling averages are exceeded during the current (fourth) month, everybody in the office gets a bonus! By
“everybody,” we mean all staff except Doctors & Hygienists.
If the bar is not surpassed, nobody gets a penny. The system automatically rolls into perpetuity & is compiled… & paid…at the end of every monthly pay period:
$ 5 Per $1,000 ABOVE the PAST 3-Month Rolling Average of Production (or % increment)
$ 5 Per New Patient ABOVE the PAST 3-Month Rolling Average of New Patients
$ 5 Per 10 Filled Hygiene Appts. ABOVE the PAST the 3-Month Rolling Average of Filled Appts
Simple, isn’t it?
Accountants love this because the incentive is only paid if &
ONLY AFTER growth occurs!
Again, the $5 is just a suggestion.
The dollar amount(s) you set your incentive at should be established by you at higher or lower dollar amounts in accord with the size of your practice & local economic conditions.
Remember, it is like an AUCTION. The dollar amount has gotta be meaningful to your staff…but not break your bank. Again, be 43
sure to run projected financial scenarios before presenting it to staff. You have to ensure you can live with it.
This simple & powerful incentive system inherently perpetually & gently pushes everybody ahead in a growth mode… & rewards in direct proportion to the growth that occurs!
Staff can receive bonuses in either one, two or three of the above areas! Combine all three & in most cases it adds up to some significant coin!
Rather than a demoralizing pie in the sky goal, staff is never asked to achieve a production level they have not already recently attained! Another benefit of this approach is that it takes the “greedy” & “manipulative” doctor out of the system: This incentive system is inherently gently self-managing & adapting!
Whatever your new-patient rate, the number of filled hygiene appointments ALWAYS has the potential to increase six months later by around 95% of those patients who came in six months earlier (minus the average 3–4% of locals who die or move out every year). Just make sure that patients are properly pre-appointed into hygiene six months later…with 100% of all patients in the practice pre-appointed…80% of those into prime time!
Add into the hygiene recall schedule the new patients that are attracted during the current month… & you will see why we have stated for many years that hygiene production should always be increasing every month!
With this hygiene appointments filled portion of the incentive system, your true hygiene growth potential is far more likely to be realized! As we will discuss further below…as the patient behavioral world evolves…it makes increasingly less sense to incentivize mid-day mid-week hygiene fill rates (see below)… & 44
super incentivize increased weekday evening (strictly after 5:30pm) & weekend hygiene fill levels.
However, in order for this hygiene growth to occur, the practice inherently must regularly & fluidly add hygiene capacity…usually in the form of an additional hygienist every 6–12 months who primarily works prime time hours… & far more cost-efficiently…by adding assisted (two-plus patients per hour) hygiene!
Think about it: When all three incentive components are at work, each of the three operates as a synergistic web of dynamic forces that causes the other two components to rise!
For example, if new-patient flow increases, the practice should experience resulting growth in general dental production & the number of hygiene appointments filled. If more hygiene appointments are filled, the doctor should be able to extract more restorative production from this… & new-patient referral should be the byproduct… & so on!
We use production rather than collection because only a small minority of staff can influence collection…while ALL can pick up the phone, reactivate, confirm &/ or stay late to boost production!
We suggest you adjust your production incentive amount to account for typical collection rates (reasonably collectable production)…while (as we’ll explain below) ADDITIONALLY
stimulating & very liberally rewarding the person(s) in your office responsible for collection as they exceed recent Rolling Average collection norms!
While no incentive system is perfect, the approach outlined herein is the best that there is… & should slow the alarming number of maverick staff that we’ve documented will tell patients, “The office is closed”…when the doctor believed it was open… & other similar selfish behavior.
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Do you ever wonder what happens to your end-of-day emergency calls? How many answering machines do patients get when your staff is chatting with friends? We know. You gotta pay them more to care.
Please beware: One huge surprise & disappointment we’ve encountered over the past decade or so is that once this great incentive system is in place, management must still very closely monitor & measure staff progress & performance in order to guide, train & re-train to ensure that they are doing what it takes to earn a significantly larger paycheck!
You cannot possibly sell a can of soup if it isn’t on the shelf: Again, management will need to regularly invest in the increased prime time hygiene & other capacities (more operatories, hours, staff, hygienists, doctors, etc.) that will allow the practice to continue to grow. If they don’t, it won’t.
Also, BEWARE! We understand your natural tendency to want to fine-tune & otherwise tweak this plan. Be careful: some seemingly innocent tweaks can be fatal to your effort!
You may believe that your LOCAL marketplace or staff situation is different & you must therefore revise the plan. Please be careful: It never has been different.
The very simple plan outlined herein is the product of decades of postmortem examinations of hundreds of failed incentive plans that utilized seemingly innocent…but fatally caustic…components.
However, any step that your practice takes toward initiating an incentive plan is a positive one! If need be, the following two tweaks are acceptable:
Some practices cautiously start by installing only one or two of the three above suggested components… & add others as they become comfortable with the process. Usually the production component is initially added.
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In other cases, practices (unwilling to take the actuarial leap of faith that assumes collection will always proportionately follow production) have averaged collections & production to place more immediate emphasis on collection.
6. Here Is an Evolved, Likely MORE
POWERFUL Incentive System: As
Super Lucrative Prime Time ONLY
Hygiene Exams Increase…All Else Falls
Into Place!
The system discussed in this section was pioneered by a brilliant client that had used the above three element, three-month rolling average incentive in his past office’s system for many years. But for his NEW SCRATCH office, he correctly reasoned that “as hygiene goes, so goes the practice.”
He understood that the patient public no longer viewed mid-day, mid-week hygiene appointments as being an option. Particularly the wealthier working or student majority.
He knew that adding more hygiene checks would
NECESSARILY result in more production & more referral. The more the merrier.
When these hygiene checks were mostly comprised of PRIME
TIME SUPER PATIENTS…the practice’s return on the exam investment would be 2x–3x higher.
So why not ONLY incentivize prime time hygiene fill rate increases?
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This practice quickly grew to $1.35 MILLION per chair, per year…mostly while the owner doctor was thousands of miles away…vacationing.
We must ACTIVELY & AGGRESSIVELY COUNTERACT the extremely PERVASIVE subtle, long-documented, active & powerful staff (including hygienists & associate doctors) subtle undercurrent (I am being kind!) to keep patients out of the prime time period.
ACCORDINGLY, tightly focused proactive mechanisms must be employed to AGGRESSIVELY COUNTERACT this
propensity… & instead, persuade staff to ENJOYABLY offer, fill
& work these EXTREMELY valuable appointments.
Starting around the year 2000…by every way that chrisad can document & measure it…patients have grown to become increasingly less & less likely to take off work or school for their preventative exam/cleaning visits.
This occurs in all walks of life & in all states, provinces & nations where we care for clients… & is especially impactful among the wealthier & better educated who are working or in school.
It has been well documented that…with very few
exceptions…NEW & RETURNING patients WILL NOT TAKE
OFF WORK OR SCHOOL FOR HYGIENE…BUT WILL in fact take off work or school for major, LIFE IMPACTING
restorative care that was DIAGNOSED DURING the HYGIENE
visit.
However, they WOULD NOT HAVE taken off work or school for the hygiene visit in the first place.
If no hygiene visit…THERE WOULD BE NO RESTORATIVE.
Why? Patients we have interviewed have suggested that “it’s just a cleaning,” that it doesn’t hurt or bleed… so is “not urgent”…or similar.
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Pressures at work or school are SO INCREASINGLY INTENSE
& SEVERE that it is (apparently) not OFFSET by what patients view as the discretionary or cosmetic need to have a regular cleaning or checkup…especially when there is no apparent discomfort, problem or urgent need.
In essence, the BEST patients want to come in when the staff, doctors & hygienists at the practice do not want to work.
This Three-Month Rolling Average incentive system upgrade DISPROPORTIONATELY & ONLY rewards staff for NEW & returning patients INCREASES ONLY during PRIME TIME
periods: It does not make ANY sense to incentivize staff for offering & filling midday, mid-week hygiene appointments that are VERY unlikely to be accepted…or kept... & if they do, result in lower production.
In effect, as hygiene goes, so go goes the practice.
The practice culture must be shifted.
As hygiene growth occurs ONLY in prime time…higher producing new & returning wealthier/working patients flow into
& back through the practice in FAR GREATER NUMBERS.
All incentives & compensation approaches must push all staff in the same direction. The primary intent of this upgrade of our long established three-month rolling average incentive system is to dissuade staff from (selfishly) pre-appointing returning hygiene patients…as well as new patients…into time slots when the patient MUST work or attend school.
Moreover, we must reward staff for appointing patients into time slots when they (likely) do not want to work.
This rolling average incentive system upgrade assumes that trying to fill or increase the number of your hygiene appointments during the middle of the day…middle of the week…is A COMPLETE WASTE OF TIME!
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There are a number of additional incentivization systems & mechanisms that have been used to optimally steer & reward such desirable staff behaviors. We will discuss each below. You may elect to employ one of more of these systems…or perhaps use them all.
In any case, it pays to have all corners of the practice richly rewarded for doing what they really don’t want to do.
Again, unless everybody is rowing the boat in the same direction, progress is frequently impeded as the “boat” pinwheels around in circles due to one or more stagnant or (worse) counter rotating
“oars”!
Again, please be sure to run profitability calculations for all reasonably foreseeable growth scenarios BEFORE implementing your system & introducing it to staff.
Remember that production amounts per wealthier, working & better insured patient (diagnosed & accepted) in prime time hygiene will be 2–3x higher than amounts from patients checked during the middle of the day…middle of the week…who are more likely to be retired, unemployed or not have insurance.
Please remember: No amount or quality of our marketing can add more new or returning patients ( & thus production) unless more desirable appointments (for them to flow into!) are FIRST
proactively added… & offered.
So to repeat, in all cases, the practice must FIRST make the staff’s incentive award POSSIBLE by PROACTIVELY, regularly & DISPROPORTIONATELY adding a MASSIVE abundance of OPEN & immediately prime time hygiene appointments.
Prime time hygiene must be proactively staffed using what is…for many…a counterintuitive approach.
Many practices erroneously wait until the midday hygiene appointments are 100% full before adding appointments.
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However, these midday, mid-week appointments will NEVER, NEVER, NEVER FILL!
Don’t fight your patients! Please embrace these new practice realities!
At the time of this writing, we have as clients around 1,500
dental offices in eight nations.
We have never seen a midday, mid-week hygiene schedule that remained full.
ANYWHERE!!
This midday schedule falls apart even more radically as economies improve & more patients are working…or children go back to school.
Increasingly in the U.S./CANADA… & as had been the case for many years in many nations…dental offices have stopped opening for hygiene mid-day, mid-week altogether. Why lose money??
In their evolving & /or struggling world local economies, local patients would NEVER consider missing work, missing a commission call…or upsetting their boss…especially for just a cleaning!
It is important to understand that YOU CAN’T SELL THESE