systems
outlined in this
paper rely on
increases in
new patient &
returning
patient hygiene
flows. As staff repeatedly fail to meet their bonus…they will likely increasingly become more demoralized.
Again, hygiene patient flows cannot sustainably grow…nor can new patient volumes or production…unless prime time hygiene appointments are FIRST added.
If the potential new or existing patient is not enthusiastically offered OVER THE PHONE an abundance of multiple prime time appointments within 24 hours…new patient flows, production & referral have been proven to ALWAYS drastically slip.
Into the future, the cancellation & no-show rates during mid-day, mid-week hygiene will continue to escalate… & THERE IS
NOTHING YOU CAN DO ABOUT IT…except to give in, ADD
& fill prime time hygiene!
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In fact, a practice must EMBRACE the FACT that a great practice must PROACTIVELY & REGULARLY always add AN
ABUNDANCE….or a predictable/calculable amount…of more prime time hygiene appointments in order to recapture the recently new patients from 6, 12, 18, 24 months earlier.
Just do the math. Remember that many come back 2x per year.
Before setting your specific prime time incentivization award amounts, according to chrisad research, it is safe to assume that these new & returning prime time hygiene patients will on average be 2–3x more valuable per hygiene exam.
You will likely find that you can be far more liberal in your incentive compensation amounts during these prime time hygiene periods.
Again, please don’t be cheap!
MAKE YOUR BONUSES VERY LUCRATIVE &
MEANINGFUL FOR STAFF!
Remember: We are compensating staff in order to disproportionately offset their EXTREME inconvenience tied to working when they don’t want to work. We are changing cultures & behavior here!
CAUTION: If one section of the office is being disproportionately incentivized for working prime time hours… & the other NOT…the section that is NOT will often disrupt & sabotage the hours that they do not want to work… & are not receiving increased compensation for.
Without regard to the incentive compensation system(s) you are employing, the larger the amount offered, & the more multi-layered the systems are…pointing ALL staff in the same direction…the more excited, focused & wealthy your staff will be… & the MORE FUN EVERYBODY HAS…as your practice skyrockets.
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This newer evolution of our long proven three-month rolling average incentive system influences management & staff to ensure that more prime time hygiene appointments are proactively added… & filled.
This prime time hygiene addition will (preferably) initially occur by cost-efficiently assisting hygiene…particularly during the peak demand prime time periods early & late… & weekends.
This incentive component also rewards staff for optimally, systematically & aggressively taking the initiative of making confirmation & reactivation phone calls with the intent of bringing back more hygiene patients filling the hygiene schedule…particularly those wealthier, working & better insured that will only return during prime time!
Prime Time ONLY INCENTIVE
SYSTEM Strengths:
- Pays Staff MORE for Filling Lucrative Prime Hygiene
- Owner/DDS Doesn’t Pay Unless OFFICE FIRST Earns MORE $
- If PRIME TIME FLOWS are negative versus average of prior months, no bonus
- This System NEVER Asks Staff to Accomplish Goals Beyond What They Had Previously Achieved.
- Never Does the “Greedy” Doctor Have Any Say in What The Goal Is… & Can’t Screw Around With It!
- This System Is Based on “Top Line”…Rather Than Commonly Manipulated “Bottom Line” Numbers!
- If Numbers DIP…System Automatically Softens the Blow of the Decline & Makes Next Month Easier 54
FAILURE:
- DDS Owner Fails to Invest in Added PRIME HYGIENE
Capacities!
- Staff Get Too Wealthy…Thus LAZY!
- DDS Owner Sets Incremental $ Amounts Too Low
- Staff Doesn’t See or Understand Updated Charts.
- Failure to Pay Double/Triple $ for Managers & /or Lack of Hygiene Coordinators
Please remember to glaringly & conspicuously place your massive
& VERY VISIBLE, daily updated chart of “Prime Time ONLY
number of hygiene patients seen” INCREASES on your break room (or other) wall for all staff to unavoidably see!
Small printouts or buried computer downloads are easy to miss or avoid!
We want everybody in your office ENGAGED & AWARE every minute of every day… & rowing your boat in the same optimal direction!
Again, it no longer makes ANY sense to incentivize staff for offering & filling LOW VALUE midday, mid-week hygiene appointments that are VERY unlikely to be accepted…or kept.
The world’s best patients want to come in when the staff, doctors
& hygienists at the practice usually do not want to work.
Please use these approaches to influence staff to make a cultural shift, embrace these new realities & enjoyably look forward to filling & working early mornings, later evenings & weekends!
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7. Why Your Rolling Average Bonus System Should Be Based on Monthly
Production… & Not Collection:
This Rolling Average bonus system will both subtly & overtly cause positive staff behavior that would not have otherwise occurred…but REWARDS must be immediate, exciting & predictable!
Staff must see instant & expected rewards for their action…or commonly the desired behavior will not occur!
Staff do not want to wait many months (especially for insurance payment, etc.) to receive their bonus for action they’ve taken today. They become uninvolved, disinterested & disconnected!
If the reward doesn’t happen for many months, the system doesn’t provide a real incentive to work today!
We use production rather than collection because only a minority of staff can influence collection…while all will pick up the phone
& stay late to boost (reasonably collectable) production!
As is explained in more detail below, it is very important to train, stimulate & very INDEPENDENTLY liberally reward only the person(s) in your office responsible for collection as they exceed recent Rolling Average collection norms!
Please embrace a perspective of prosperity & growth…rather than one of doom & decline!
Remember to look at this as being a glass half full rather than a glass half empty situation! Please do not be guilty of bending down to look for pennies, when $100 bills are falling out of your pocket!
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In a general sense, most practice team members cannot affect collection…but all can positively influence production. Why would we tie an incentive to a practice component that most staff cannot possibly have anything to do with?
Production is a figure that is related to what was purchased or agreed to by the patient today. It is the only figure that can be positively affected if the receptionist picks up the phone at 4:57pm.
Would a collection-based bonus stimulate your assistant to explain how important that implant is to the patient…while you have left the operatory…on the last day of the month?
The excitement, immediacy & predictability of basing your Rolling Average bonus system on production (versus collection) FAR, FAR outweighs the slight uncertainty that the practice may not collect the amount produced.
Remember: Your collection rate can be statistically predicted by examining past collection performance. Simply use this number when determining your incremental bonus dollar amount!
For instance, if you were envisioning paying each staff $10 for every $1,000 in increase…but have a 90% collection rate…adjust the incentive amount to $9!
If you are worried, for instance, about your production vs.
collection % dropping because you are focusing too much on production (we haven’t seen this), you can place a “side bet” (see later section) incentive ONLY for the collection folks to surpass their statistical norms of collection…or pay THEM a bonus when they surpass a pre-set collection goal.
A number of great practices using the Rolling Average incentive system over the years have predictably tweaked the above recommendations & averaged the production amounts with the collection amounts.
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While these modified systems appear to be working well…they would work even better if the goals were more directly tied to the staff’s immediate production-based actions…rather than being watered down & defused by the collection averaging calculation!
As wise as this hybrid approach may appear, in the mind of the staff, 50% of the goal is predictable & certain… & the other 50%
is tied to the uncertain ability of usually only one person to collect money…usually from the insurance companies! Why allow this area of uncertainty if it tends to leave staff less excited, disinterested & uninvolved?
8. How Do You Determine the Proper
Rolling Average Incremental Increase
Bonus Dollar Amount?
Determining the proper incremental increase bonus amount is probably the toughest part for most practices. Chrisad cannot tell you the exact bonus amount that will work for you in your specific practice overhead, practice type, marketplace or growth situation.
We CAN tell you that…as a general principle…you need to both make it substantial enough to stimulate your staff…while not breaking your bank.
Don’t be cheap! Adopt a perspective of prosperity! Err on the side of offering a larger dollar amount rather than a smaller dollar amount! Make it exciting & attractive!
Remember, bonuses are only paid out AFTER you grow above current growth levels.
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If you properly maintain the incentive system, a year from now staff can be shooting for a goal that is 30%...or far higher…than they are today! But without the incentive system…you wouldn’t have been growing at the 30% rate!
Avoid a dental school micro-focused tendency of minimalism!
For instance, please don’t negatively view paying an Associate Doctor 30%! In fact, you RECEIVE 70% (a lot of money!!) that you otherwise would not have had!
What does it matter if you pay out $25,000 in bonuses if the doctor-owner grows by $100,000/month… & there was no other way this growth would have occurred? This still represents a net gain of $75,000!
A ratio of 1:10 is a good place to start. This means for every $10
of growth that the practice enjoys…the collective staff is paid an extra $1.
We strongly suggest running the numbers on a number of reasonably foreseeable practice growth scenarios & determining what works best for you, your budget & your sensibilities.
Preliminarily Suggested Incentive Incremental Payment Amounts: $5 Per Staff per New Patient New-Patient Inflow Increases Above 3-Month Average
$10 Per Staff per $1,000 increase Production Increases Above 3-Month Average
$5 Per Staff per Patient Returning Hygiene-Patients-Seen Increases
Some of our client practices have three employees…others have 300! You must get out your calculator & a piece of paper … & run the numbers for your practice to ensure that you are not overpaying…or underpaying…in foreseeable scenarios.
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In short, the dollar amount paid as a bonus (per incremental increase) must be looked at in light of all relevant overhead, staffing, local employment & other regional factors.
Please remember, bonuses are almost always subject to state, local
& federal taxes!
Again, avoid hourly or salary increases…but instead give managers & staff increased bonus incremental amounts.
For instance, if a given employee was receiving $5 for every new patient above the rolling average…you could raise an exemplary employee’s incremental Rolling Average bonus to $7 for every new patient. Rather than subjective…this would tie the employee’s next year’s earnings to their performance!
If any aspect of your incentive system eventually becomes inappropriate for your situation, you may wish to modify or otherwise adjust it to better fit your situation. Please note that it pays to clearly communicate this to the staff early on…in writing…as you initiate your bonus plan…or bring on new staff members.
Also, while you can upgrade/modify your incentive system over the years & months as need be, once you initiate it…it will be difficult & demoralizing to remove it entirely.
IMPORTANT: Traditional arbitrary & expected annual hourly or salary raises CAUSE STAGNATION & are in no way exactingly tied to performance. Such is ALSO the case with traditional FIXED hourly or salary paid employees! Why work more for the guaranteed same pay???
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Various Specifically Targeted &
Focused Incentives Intended to
IMMEDIATELY DRIVE Specific
Positive Staff Behaviors:
Please remember, the more immediately & directly connected that the incentive or compensation system is to the behavior that we are trying to stimulate…the more likely the desired behavior will occur.
Traveling with new chrisad staff & interns, we will regularly visit our largest & fastest-growing clients… & ask them to describe their current incentive systems. More often than not these successful clients will suggest that in addition to the basic rolling average system…every time they needed to influence staff behaviors…they added a new incentive.
Many have recently suggested that they currently have dozens of incentives in play. Here are a few suggestions of additional targeted incentives you might consider:
1. Use Incentive “SHOCK THERAPY” for Great Results TODAY! Reward Appointment Staff EVERY DAY for Filling THE CURRENT DAY’S Prime Time Hygiene
Schedules: This will SHOCK your practice & result in IMMEDIATE GROWTH!
The bottom line is that if your appointment staff are not incentivized for filling Prime Time schedules, these appointments…that WEALTHIER, WORKING & BETTER
INSURED SUPER PATIENTS will usually ONLY
ACCEPT & FILL… are WAY less likely to be filled.
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Again, it is safe to assume that there is no work ethic in your practice. It is also always the case that there is more NEW & RETURNING patient demand than there are appointments filled.
In all cases where chrisad is actively marketing, we are creating an INVISIBLE WALL of MASSIVELY increased new & returning patient demand…the BEST & most of which will ONLY accept hygiene exam appointments that do not require them to take off work or school.
So the trick is simply opening the conduit through which these WORKING & BEST new & returning patients must pass. Making sure they are properly appointed, make it in the chair… & are retained in hygiene 1–2x per year for decades.
Too often, our clients will add these evening & weekend hygiene appointments…but they do not fill.
This does not happen naturally. Demand has been documented to be many fold (perhaps 7x) greater for these evening & weekend appointments that don’t force patients to take off work or school.
Almost always…unless properly incentivized…these super valuable appointments are being not offered, emptied out or otherwise BLOCKED!
Sadly, we document this behavior in many hundreds of practices per month.
If not properly incentivized, these super valuable NEW & RETURNING PATIENT appointments are more likely to be quietly blocked, sabotaged or emptied out.
No matter what they say…either openly or quietly…STAFF
typically DO NOT WANT WORK THESE HOURS. So they quietly shut it down. This behavior is best described as an underground mafia.
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More must be done to PROACTIVELY counteract this dangerous propensity.
An immediate solution to this problem…that can be implemented TODAY…is to offer all staff a LUCRATIVE
fixed dollar amount for every hygiene patient in the chair after 5:30pm & WEEKENDS.
In ADDITION, if ALL chairs are filled, your appointment team receives an even greater bonus.
The award is compiled & paid out on a PER DAY basis.
EXAMPLE:
Each Appointment Staff is awarded $20
for every hygiene patient in the chair after
5:30pm weekdays or SAT/SUN. This is
paid ONLY if the new/returning patient is
actually in the chair & has a
cleaning/exam. (With this plan, the
practice cannot lose.)
If all chairs are filled on that given
day…each staff member receives an
additional $100 for the day.
Yes…while not always practical…it is MORE
DRAMATICALLY MEMORABLE if the award is paid in
CASH at the end of the day.
At a minimum, keep a highly visible scoreboard & ensure that all incentivized staff ARE 100% AWARE what bonus they received that day… & how much BONUS AMOUNT
they will additionally be receiving on their next paycheck.
Generally, the reward is offered to any & all staff who are responsible for making appointments & reactivating.
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I understand! “John is telling me to pay out a ton of money!
Is he crazy????”
Well maybe…but ABSOLUTELY NOT in this instance. Just do the MATH!
This will result in IMMEDIATE INCREASED LEVELS
OF PROSPERITY that otherwise would NOT HAVE
OCCURED!!!
EXAMPLE:
Your properly incentivized 2x front desk staff fill 20 hygiene appointments after 5:30pm on a
WEDNESDAY, at $880 per new/returning
patient hygiene check.
(NOTE: U.S. AVERAGE PRODUCTION is
$880 per hygiene exam)
These 20 patients have a probable VALUE of
$17,600. NOTE: This is conservative. Evening & weekend patients have a probable value that is