that your best
patients will
ONLY come in
for.
In most dental practices, most appointments (around 75–80%) are discretionary & preventative (cleanings).
Except for the retired & unemployed minority… & those on vacation…the vast majority of locals…especially the wealthy, working BEST PATIENTS…will ONLY COME IN for
discretionary preventive care when it does not interfere with work or school.
So the trick is to configure practice opening hours that keep both patients & staff happy…while infusing into the practice the very best of local patients!
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A number of our
brilliant clients have
successfully
experimented with a
number of schedule
configurations that
make working early,
late or weekends
something for staff
to look forward to.
In general, these involve fewer DAYS worked per week…with more days off…but longer hours worked per day…usually with breaks in the middle of the day. Many shut down (lower/no profit) mid-day, mid-week hygiene.
Schedules where fewer days are worked…but longer shifts…are increasingly common. Staff love these as they can get four days off with three days per week working.
If they take the early shift (EXAMPLE: Monday, Tuesday & Wednesday) the first week… & the later shift (EXAMPLE: Thursday, Friday & Saturday) the second week…they can get SEVEN DAYS OFF in between working!
Not a bad deal!
Staff love it.
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The configuration of the schedule becomes a powerful incentive.
It is wonderful & respectful to empower staff to create their own schedule to fit into their lifestyle & personal scheduling demands.
A small…but growing…number of practices are adopting extremely flexible hospital, restaurant, hotel & airline type schedules.
With these seemingly
progressive & somewhat
experimental…but long-
proven in other industries…all
management cares about is
that the shift is filled with
competent workers.
The more senior the staff
is…the more they have the opportunity (higher priority) to choose better shifts.
But they only get paid for the hours that they work.
Want a vacation? Take 2–3 weeks off…but just make sure your shift is covered.
Wanna save up for a new house down payment? Work all shifts for multiple weeks if you want.
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13. The Documented Advantages of
Paying Hygienists by the Patient
Unfortunately, we have long documented that even the most ethical individuals will perform even better when incentivized to do so. Sadly, after 43 years of overseeing & documenting the behaviors of tens of thousands of dental office staff…as well as teams of many other companies worldwide…it has become irrefutably certain that when it comes to behavior, we must always follow the money.
Regarding Hygienist’s method of compensation, we’ve documented for years that DANGEROUS PERIO/STM
diagnosis SOARS when the hygienist is paid as a percentage of production/sales… & the number of patients seen for hygiene
& EXAMS SLUMPS as they are paid by the hour.
So what is a better approach?
The majority of our great forward-thinking clients understand that hygienists (justifiably) wanted the security of hourly pay…but would be happy to see MORE than one patient per hour if they were compensated in relationship with their extra effort.
Experiments where the hygienist is guaranteed a reasonable local pay level (example: $50)…or around 80% of that wage (example: $40-plus) per patient seen…whichever is higher…have been EXTREMELY SUCCESSFUL!
So in this example, the hygienists would be paid $90/hr. when they saw two patients per hour…$130 hr. if they see three!
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In a general sense, the more hygiene patients that the doctor checks…the more restorative & other major work that will be found & the more patient referral that will occur.
The wealthier that these patients are...working… & with better insurance…the more likely they are to accept more. These WAY
BETTER patients will refer more like them.
Please never forget that hygiene is the backbone of the practice growth system!
As hygiene goes…so goes the practice.
So OBVIOUSLY, the key is to influence hygienists to see more patients during prime time hygiene.
Again, we know that if we pay the hygienist a dollar percentage commission…they are more likely to diagnose (time efficient) period/STM. This leads to the loss of the patient & negative referral…at best.
The most efficient approaches that we have seen will pay the hygienist per patient seen…per shift.
Usually a guarantee of local daily rate is offered (for their emotional security)…or an ADDITIONAL, slightly lower per patient amount…whatever is higher.
We want hygienists to look forward to seeing 2–3 patients or more per hour (why not add 10 minutes of pedo to fill out the schedule?)…with a DEDICATED assistant.
We want hygienists to earn $150,000 a year (particularly if they are working early, late & weekends!!)…just as long as the owner doctor makes 10x–20x more money as a result.
Please read our “Hygiene” book for more details in this regard.
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With regard to influencing the hygienist to work more prime time hours…the owner doctor & the practice management team usually need to lead the horse to water.
Guide them to success.
Often manipulated, self-serving ( & mentally distorted) dental industry & practice folklore may suggest that prime time patients are horrible, no good (especially those “horrible” weekend hygiene patients), cancel all the time & so forth.
While these prime time periods are never perfect…the public clearly wants them FAR, FAR more!
Once the hygienist sees that they can fill & keep their prime time hygiene schedule WAY more easily filled with now very profitable patients… & make more money for doing so…they usually begin to enjoy their prime time hygiene periods a great deal more.
Again, ever notice that there are STILL holes in your FUTURE
hygiene schedule…even though those holes were apparent many days or weeks earlier?
Particularly appointments during PRIME TIME!
If you have not noticed these…please look more closely!
Staff want these appointments…when they don’t want to work…to DISAPPEAR!!!
SELFISHLY, they want you to think those hours don’t work here or, “Around here, people don’t want evening or weekend hygiene appointments” or “This market is different!”
BULL CRAP. (I am being polite!)
As we mentioned above, providing staff with properly configured incentives to fill the MOST VALUABLE appointments always helps.
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Clients have experimented with offering all receptionists & schedulers $200 for a 100% filled Saturday hygiene schedule.
Maybe $150 for a 90%-plus filled schedule.
This all works in theory. HOWEVER, almost amazingly, these are occasionally not filled…particularly if some staff (doctors & /or Hygienists) are not properly paid/compensated/incentivized or motivated to be there!!! Remember: Think MAFIA!
YES…unless properly compensated/incentivized to offset their inconvenience for working prime time…associate doctors ( & even partners!!) & Hygienists will (subtly) screw up the prime time schedule! SABOTAGE!!!
So AGAIN…please remember that ALL staff must be
disproportionately incentivized to offset their inconvenience for working when they don’t want to.
If some staff are NOT, we suggest offering all staff…perhaps even including hygienists & doctors…(for example) $200 each for a filled 10-hour, 50-patient Saturday schedule.
This can apply for evening & mornings as well.
Follow the money: It is not the world the way it should be…by any & all ethical standards.
It is…HOWEVER…the world the way it IS!
We must influence staff to make a shift, embrace these new realities & enjoyably look forward to working early mornings, later evenings & weekends!
It ABSOLUTELY no longer makes ANY sense to IN ANY WAY
to incentivize staff for offering & filling mid-day, mid-week hygiene appointments that are VERY unlikely to be accepted…or kept… & if they are kept, produce 1/3 per exam!!!!
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Remember: We are compensating staff in order to disproportionately offset their EXTREME inconvenience tied to working when they don’t want to work.
As everyone in the practice rows the boat in the same direction… & receives the same lucrative rewards that offset the inconvenience tied to coming in when they don’t want to…everybody wins…especially the patient!
Proven Advantages of Paying Hygienists
By the Patient:
It is impossible to push a rope uphill. Compensating the hygienist by the patient incentivizes the hygienist to PROPERLY pre-appoint, reactivate & fill THEIR schedule.
We are thrilled to pay our hygienists $150/hr. ($50 per patient) if it means our doctors will be checking three more patients per hour (particularly prime time!) at an average U.S.
production level of around $800 per hygiene exam! Moreover, ask yourself, would you pay $150 to receive $2,400 that otherwise would not have occurred???
Disadvantages of Paying on the Basis of a
Percentage of Production:
Generally, paying hygienists as a percentage of production has stimulated the diagnosis & presentation of PERIO/STM!! In particular, the diagnosis of STM (period) soars. STM is usually a lower workload but higher-priced procedure. Chrisad’s extensive audits & analysis of traditional STM diagnosis suggests that patients DEFECT at high 90%-plus levels after PERIO diagnosis. Our researchers mined 100,000 online conversations to find that PERIO/STM was the No. 1
complaint. While STM must be performed when appropriate, 93
when greed is involved & tied to hygienist’s production-based pay increases, far more HARM results than GOOD!
Disadvantages of Paying Hygienists On an
Hourly Basis:
Paying the hygienist by the hour…even if at a WAY higher HOURLY RATE rate than other local hygienists receive…will generally result in complacency. In effect, the hygienist is paid to sit around & play Facebook. Why would they reactivate or SEE PATIENTS (or properly pre-appoint) if it means that they would work harder for the same pay?
It isn’t the world the way we want it to be…HOWEVER, it is the way that it is. Sadly, finding a work ethic in today’s employees is very rare. It must be directed & stimulated…by showing them the money!
14. Innovative NEW Compensation
Approaches Toward Radically
Improving Any Associate
Doctor’s Performance:
Decades of chrisad research, direct from practice DATA & experience points to the fact that INCREASINGLY…the BY FAR
most valuable SUPER PATIENTS…with the most money & best insurance…will (essentially) ONLY come in for hygiene visits 94
before or after
work (or
school) on
weekdays… &
all day
Saturdays &
Sundays.
However,
associate doctors
(at least
One of many hundreds of examples of an ALL
initially!) rarely
chair, ALL hygiene Saturday or Sunday schedule.
understand the
extraordinary
value of seamlessly checking all chairs…all hygiene…filled with these BEST PATIENTS…weekday mornings, evenings & weekends.
These SUPER PATIENTS will ABSOLUTELY NOT take off work for hygiene…but WILL take off work for restorative care diagnosed during hygiene exams.
We must lead the horse to water. We need to influence & incentivize associates to do things that they may not understand
& might object to. However, as they complete these COUNTERINTUITIVE tasks, the associate’s personal income… & the income of the practice…will SKYROCKET!
As a long-standing general managerial rule, the more immediately compensation is paid for behavior that we are trying to stimulate…the more likely the desired behavior will occur.
Many…if not MOST… associate doctors tend to
INTUITIVELY…BUT in fact DESTRUCTIVELY…perform TOO
MUCH RESTORATIVE CARE during prime time periods.
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They intuitively view this prime time restorative work as providing immediate compensation to offset the inconvenience tied to working during prime time when they want to be off work… & their spouses, families & friends might want them around. They incorrectly believe that these patients will not come back mid-day, mid-week for their critically important clinical care…so they perform restorative immediately.
HOWEVER…REALLY…by performing restorative during prime time, THESE ASSOCIATES & THE PRACTICE ARE
LOSING A TON OF MONEY!
All of this is, unfortunately, confusing & counterintuitive to most associates doctors…( & even some practice owners!!). So they must be trained (conditioned in a PAVLOVIAN SENSE) to be successful.
Again, a well-established fact of dentistry is that wealthier working (or students) patients will NOT take off work for “just a cleaning”…but WILL take off work for the urgent restorative care diagnosed DURING the cleaning.
So cleaning EXAMs come FIRST. Without cleaning exams, there can be little or no restorative, cosmetic or larger cases. So to perform restorative during the same time when the best patients will ONLY come in for their cleanings & exams CLOGS THE
SCHEDULE & CHAIRS…thus reducing the amount of restorative diagnosed.
The MATH: Associate Doctors…at first…unwisely tend to want to perform a crown prep during prime time. This occupies a chair for 60–90 minutes… & uses around 30–40 minutes of the associate’s time. Let’s just say (for example) that this crown is worth $1,000 to the practice… & $300 to the associate.
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HOWEVER, performing this restorative during prime time ROBS THE ASSOCIATE DOCTOR of the opportunity to
check scores of Prime Time BEST PATIENTS!
While this associate is performing the $1,000 crown prep (net to associate $300)…he/she SHOULD have been spending that same hour or so performing exams on 4 or 5 -plus cleaning patients that have an average (U.S. average) value of around $800
each….or $3,200-$4,000 (net to the associate $960–$1,200…or more!)
Plus, for the associate to jump back & forth from exam to restorative reduces the efficiency & competence of each function… & the physically ABUSED doctor may end up in the hospital with a bad back…or worse!
How to Break Associate Doctors of This
INTUITIVE HABIT:
Obviously, associates (at least at first) strain to understand the connection between their personal income tripling… & checking huge, uninterrupted streams of the best Prime Time SUPER
PATIENTS!
Strict rules, repeated mathematical explanations & tedious micromanagement… & other “reasons WHY”…can influence the associate to check hygiene patients all mornings, evenings & weekends.
At least for a while.
But how are you, the practice owner or manager…going to micromanage while you are away from the office, relaxing in the BAHAMAS?
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FOLLOW THE MONEY: While it’s useful to explain
“WHY”…however to get the job done, it usually pays to ALSO
throw money into the equation. We must lead the horse to water! Train associates to be successful.
We wanted you to be aware of some of the new approaches that many of our ADVANCED practices are employing to more rapidly grow their practices while guiding the associate to a FAR
more productive career.
Most of these were invented & pioneered during chrisad’s many intensive SELECT ACADEMY courses…with most being the ideas of our BRILLIANT CLIENTS! (thanks!)
a. PAY THE ASSOCIATE $50 per each Prime Time Hygiene exam!
With each PRIME
TIME hygiene
exam being worth
a much HIGHER
(appx.) $1,200 on
average...why not
pay a
comparatively
This brilliant client writes an
small amount to
“IOU” to associate doctor for
work accepted, deposit paid &
ensure that more
appointment made. See note
Prime Time exams
written on bottom left of the
schedule!
are actually being
done? Early adapting practices are VERY successful with this approach…a few growing by nearly $2 million a year. Dollar amounts that practices are using vary from market to market. $35 per exam is common. But like all incentives, they are like an auction: You can only tell that 98
the dollar amount you offer is enough if the desirable action is actually stimulated…or not!
b. PROVIDE THE ASSOCIATE WITH AN “I.O.U.” at
the end of their Prime Time shift! Here, as the treatment recommendation has been accepted, appointed
& deposit paid, the patient is statistically virtually certain to complete treatment & pay fully. However to ensure that the associate doctor understands the amount that they will be receiving as a result of all those prime time hygiene checks… & to ensure that they look forward to doing many more…a few leading-edge practices are
handing the associate doctor a statement (slip of paper) of how much the will be receiving on their next paycheck as a result of their hygiene exams & case presentations that day. Others write the amount on the bottom of the computer screen (see photo at left). One such practice recently reached the $1 million/month level…on just 12
chairs.
c. PAY THE ASSOCIATE THE AMOUNT THEY ARE
OWED AT THE END OF THE SHIFT: Many resist this approach because it is at once unorthodox & somewhat costly/logistically cumbersome to achieve. Still, the more immediate that the compensation is to the behavior that we are trying to stimulate…the more likely the desired behavior will occur. Cash in hand is a pretty big motivator…so this may be worth the hassle. Remember, if an associate checks 30 patients at a (lower than normal) rate of $500 per exam, this means $15,000 to the practice & $4,500 to the associate doctor. While this approach has not yet been proven in practice…what wouldn’t you pay to regularly 99
achieve this level of production with one…or even many dozens of associates?
As a general rule, an associate that is paid MORE will be happier, more productive & stay longer. Recruitment costs & the costs of downtime costs without associates must be considered. SAFETY NET: In all compensation approaches…for associate or other practice staff…if all or some of the projected amounts that are expected to be received do NOT occur, there must be an eventual adjustment made to the associate’s paycheck.
PLEASE REMEMBER: We must base our practice future on probabilities…NOT rare exceptions. This is why the majority of practices have learned to NOT make associates wait months for their rewards… & NOT pay associates on the basis of collections…but more immediately, on the basis of production completed.
15. Associates Will Usually Produce at
Higher Tiered Levels If Incentivized
to Do So:
We Suggest That You Pay Associates a Bigger
% The More They Produce…
Make It a GAME!
Update each ASSOCIATE’S PROGRESS DAILY ON
A SCOREBOARD!
RANK THEM AGAINST ONE ANOTHER!
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IT’S PAVLOVIAN: Like a Bartender or Waitress/Waiter…associates will soon figure out they will earn increasingly more money if they
produce more!
Suggested Tiered Associate Pay:
$0–$45,000/mo. @ 30% (AVERAGE
ASSOCIATE)
$45,000–$60,000/mo. @ 33% (only for $ within
this tier)
$60,000–$90,000/mo. @ 37% (only for $ within
this tier)
$90,000 +/mo. @ 50% (only for $ within this tier)
EXAMPLE: Tiered Pay: (ASSOCIATE’s Pay if
production is $100,000 mo.)
$ 45,000 @ 30% = $ 15,000.00
$ 15,000 @ 33% = $ 4,950.00
$ 30,000 @ 37% = $ 11,000.00
$ 10,000 @ 50% = $ 5,500.00
$100,000 $ 36,450/Month
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16. Consider the Extraordinary Cost of Staff Turnover:
What does it REALLY cost to attract, interview & fully train a new employee before they are capable of performing daily tasks at an acceptable level?
How much does staff & doctor turnover distract the owner/doctor(s) from their productive goals? What about the stress & emotional disruption of a short-staffed office? What impression does this leave on the patients? How does this atmosphere affect acceptance, referral & retention?
What about the new employee that ends up not working out that you have to get rid of a week later…then start the hiring process all over?
Do you pay finder’s fees to Dental Staffing companies? What does it cost in terms of recruitment marketing & related media to locate new employee leads?
Wouldn’t it make more sense to (in the first place) provide an environment where all staff benefit by improving their job skills or performing them at a higher level so they won’t quit or get canned?
Why not reward employees more for more optimally adhering to practice protocol…rather than making them work harder for the same pay?
While it is impossible to calculate the accurate average cost for new-employee acquisition & training, I am certain that the TRUE
COSTS associated with the hiring & training process FAR exceed the amount paid out by even the most outlandishly lucrative of practice-staff bonus systems!
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17. You Should Be Aware of Our
Private Chats With Your Staff:
As with most of your patients & the general public… money is a huge issue with your staff, but almost always, they are too proud to admit it. As we have suggested, our marketing/advertising industry has documented for over a century that…particularly when it comes to money or financial subjects…it is wise to not pay much attention to what individuals say…but to very closely monitor, document & study what they do.
Commonly we’ll encounter the snooty & financially independent receptionist or office manager who suggests they are so wealthy & financially secure that a bonus would mean nothing to them.
HOWEVER, when offered such an incentive, these same people work far more diligently than the rest of the staff!
Document what they DO. Downplay what they SAY!
When we talk with your staff…in private…with our agreement to keep the discussions anonymous & private…they frequently angrily question why they should work harder to make the
“rich doctors” more money…when they don’t make a cent more.
A number of years ago, I recall visiting an office in Texas that was in the process of being purchased by one of our clients. The receptionist didn’t know who I was…or what I did. After a few minutes of small talk, I asked her how many new patients the practice had brought in last month. She said, “Last month we brought in seven new patients…but the month before was even better…we added only five.”
These non-incentivized staff commonly don’t smile & they don’t seem to care. Accepting new patients is commonly an unwelcome chore for them.
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While they will put on a big show for their employer, in their mind, more new patients & practice growth simply means more work for the same pay!
What if your staff received a few extra bucks if they worked a little harder to pick up that phone & appoint at the end of the day…or fill evening or weekend hygiene?
Everybody in the practice must row the boat in the same direction, speak with the same optimal voice…with the same goal in mind… & proportionately benefit when they reach or exceed the practices’ growth goals.
Don’t worry about picking up pennies while $1,000 bills fall out of your pocket!
So what if each of your five staff receives a $1,000 bonus ($5,000
total) if they worked together to grow the practice by $30,000+ a month? Isn’t that a net $25,000+ in your pocket that otherwise would not have occurred?
In fact, when we talk with staff in private about bonuses & incentives, ALMOST ALWAYS, their eyes light up.
Change is never easy…but a great incentive system can ease the pain! Our marketing approaches usually ask our clients’ staff to make a great many necessary…but unpopular & uncomfortable changes.
A great incentive system can grease the wheels of practice success!
For example, before & after work or weekend hours allow the wealthiest local patients to flood into your office & accept care without the extreme expense & inconvenience of taking off work.
On the other hand, this leads to a number of staff personal inconveniences.
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They will tell us in private (for instance) about how their spouse is now unemployed & they have trouble getting their child to school if they come in to work earlier than 9am.
As these once inconvenient changes are seen as leading to a greater bonus…the evolutionary process occurs with much less resistance.
In another example, we frequently ask staff to suggest to the patient how great the patient’s insurance is…when the staff member may in fact absolutely hate insurance companies. This great incentive system helps facilitate these optimal communication upgrades.
The likelihood of staff burnout is significantly reduced when staff are proportionately rewarded for effort & hard work.
It is like a ray of sunshine! Almost always, the numbers go up… & the staff’s smiles come back…as they (along with the practice owner) become the financial beneficiaries of their enhanced focus, dedication & hard work.
18. The Patient-Perception Dangers of
Your Incentive System:
We must work to avoid the patient’s perception of money focus!
There is absolute danger in a practice that is perceived by patients to be money-focused, using high-pressure sales approaches…for instance! There is a very real risk that a bonus system can cause in-practice divisiveness.
Our remedy? Repeatedly train staff in the principle that most financial gains don’t come from a money focus…but rather are a direct result of a patient-care focus.
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Remember that hygiene fill level-based incentives are not sales incentives. They just reward staff for getting the best patients in the chair…NOT SELLING THEM CLINICAL PROCEDURES!
19. This Above Great Rolling Average
Incentive Systems & Other Incentives Are Perhaps the Best Practice Manager!
Your bonus system should be a great management instrument…as well as an outstanding staff-stimulation device! In addition to stimulating the staff toward more positive, focused action, the properly configured incentive system provides a strong backbone for immediate & accurate practice statistical analysis…from your office computer…or while sitting in the Bahamas.
It is no coincidence that the three elements providing the backbone for this viable Rolling Average incentive plan are also the most important statistical indices that management & doctors must use to optimally manage their practice!
In essence, the better your bonus system is…the less you have to manage! It is also the case that the stronger the bonus system is, the less reliance the practice has on a general manager or office manager.
The more your bonus/incentive structure stimulates key, fundamental growth & security components, the more you can rest assured that your staff is doing what it takes to achieve your common practice-growth goals.
If your staff stimulates 30% growth this year, you should feel very good about paying them a healthy percentage of that growth! This 106
Rolling Average system automatically rewards them… & automatically raises the bar.
But remember, without this incentive, the growth probably would not have occurred! If it doesn’t occur, you don’t have to pay them!
Your office becomes focused, invigorated & self-directed… & you will have a greater level of peace of mind while you are away from the practice for a day, week or year.
With this strong Rolling Average bonus/incentive system, staff needs to be managed less, will automatically focus on the same goals as you have, & will achieve established common goals without you (or an office manager) needing to babysit & watch staff every day!
In short, everybody in the office is on the same page… & works together as more of a team. They all row the boat in the same direction! When you win…they win! When they win…you win!
It’s only fair!
20. USE DRAMA to Your Advantage!
Make Sure Doctors, Hygienists & Staff KNOW They Received Their BONUS!
As we have mentioned above, another problem with incentives is that, when buried in a confusing & complex paycheck, deserving employees don’t know that they have earned & been paid their incentive!!!
If employees don’t realize they have received a reward, how can we expect that reward to drive positive behavior???
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Many practices have taken extra steps to ensure that employees understand how much of a bonus they have received. It pays to be a bit dramatic. Some pay the bonus in CASH! (of course they paid all necessary taxes & so forth!!).
Others insert a note in the paycheck envelope outlining the amount paid & why! Others hand out checks by hand directly to the deserving employee during company meetings.
MAKE SURE THEY KNOW they received their bonus!!!!!!!!
21. Examples of When You Need an
Incentive System
The most common & urgent situation when an incentive system is needed is where a practice (or part thereof) is stagnant or declining… & morale is low…without regard to the management systems or marketing being initiated… & has a significant turnover problem.
The simple & proven viable Rolling Average bonus system outlined in this paper can very predictably JOLT a stagnant or complacent practice out of its slumber!
In these cases, the practice (or part of a practice) has simply run out of gas or has fallen into a rut & simply needs a jump-start to get out of the production, new-patient or hygiene-retention (or other) level they are at.
In many practices over the years, we have experienced what appears to be glass ceilings of practice stagnation! By this we mean that one or more areas of the practice new-patient or production growth levels are immobile or declining…over months or years…with no seemingly apparent explanation. As this Rolling Average system is installed in your practice, the staff usually promptly breaks through the glass ceiling.
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The Doctor-Owner… & even staff…usually never determine what the glass ceiling or impediment was. However, it really doesn’t matter as long as the incentive system keeps the (likely) sub-psychological roadblock from reoccurring!
The Rolling Average system is also integral to a situation where the senior doctor-owner (for instance) is intending to step away from the practice more. It creates an environment where the practice tends to better manage itself without daily managerial oversight.
Also, frequently the staff is simply physically & /or psychologically burnt out & requires improved focus & related incentives to make the changes that will allow them to catapult your practice…as a team…to the next level. Your Rolling Average incentive system will help! What do you have to lose?
Problems That Can Be Fixed With Optimal Incentive Systems:
- Staff that Block or empty out prime time hygiene
- Front desk that fail to offer open after work or weekend appointments
- Associate doctors who tend to want to perform
restorative during prime time hygiene periods
- Hygienists that tend to sit around & seemingly don’t care when there are no patients in the schedule
- Staff that manipulate the schedule so that they can leave early weekends & evenings
- & MUCH MORE!
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This Bonus?
Bonuses that are only paid to certain individuals or departments could be divisive & should be used with caution. We want everybody to row the boat in the same direction!
For instance, if the front office only gets a new-patient bonus, what incentive does the assistant staff have to pick up the phone
& appoint the potential new patient calling in? Without a bonus flowing to them for a particular action, some staff may feel slighted… & in fact, not care to act!
In fact, they may view picking up the phone as more work for no more PAY!
For that reason, the entire staff should be rewarded using either of the whole practice Rolling Average bonus systems described above.
A hygiene-recall (or fill level) bonus that includes assistants, front desk & other staff members will stimulate those key staff members to properly pre appoint (100% pre-appointed…80% of these into prime time) reinforce how important it is for the new patient to come back at six months & tell them how much they are looking forward to seeing them.
Yes, you can establish side bonuses in specific areas that need attention… & there are some practices that confidentially pay some departments or individuals a higher amount for the same overall accomplishment…but the main thrust of the best system must be to keep everybody on the same page & have a common bonus… & row the boat in the same direction toward a higher goal!
DANGER: What About Employees Who Work Part-Time?
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Watch out for nickel & diming employees!! This is the area where so many incentive plans fall apart as a result of overly complex formulas! So how do you ethically account for some of your staff who are part-time or who have been on vacation?
While a number of complex formulas exactingly allocate the bonus in proportion to the amount of hours worked during the given pay period, if your staff does not understand the computation…or the effect it will have on their pay at the end of the month…it cannot possibly excite, stimulate or motivate them toward the desired result! THEY WILL FAIL!!
RECOMMENDATION: The solution is to keep it simple & not worry about the pennies!
Remember, we must take good care of our staff & keep them happy! Aside from ethical considerations, your staff interacts perhaps 20 times more frequently with patients than most doctor-owners! Treat them the same way you want your patients treated when you leave the room!
These Rolling Average incentive systems will stimulate & reward a positive change in staff behavior that without the system…would not have occurred.
Remember, it is only paid AFTER the practice grows… & the total of all bonuses paid usually will not exceed 10% or so of only the increased amount (not total production)!
Keep it simple! Here too, we must make it easy on the staff…so that they will make it easy on you! Many suggest paying 50% of the incremental bonus to employees who normally work 50% of the full pay period or less… & 100% of the bonus to those who work 50% of the normal pay period or more!
That’s fine…not too complex. But I would err on the side of less complexity & tentatively simply suck it up & pay part-time 111
employees the same bonus as full-time employees. I would want to motivate part timers to do a better job!
HOWEVER, if this resulted in too much whining by full timers…I’d move to the above 50% or less part time method of compensation.
If they go on a normal vacation, they should receive 100% of the incentive. If for some reason they are on an extended leave, you may…at your discretion…want to suspend the bonus. Here & in all cases suggested in this paper, be sure to check with local human resources laws…particularly in the case of maternity leave.
Please remember to err on the side of paying out more in bonuses rather than less! Don’t be cheap! It will ruin morale & cost you 100x more than the pennies you think you are saving!
You may want to adjust the 50% definition of full-time…versus part-time…employees slightly on a case-by-case basis. But make a rule, make it fair… & apply it across the board!
23. The Acid Test for an Ineffective
Incentive Plan:
As we have touched on, your staff needs to understand your incentive system… & know how they stand in the game…each & every day…if they are going to play to win! They must understand what is going on & know what the score is every minute of the game so that they know where & when to place the emphasis!
They all must be rowing the boat toward the same goals… & as a result regularly receive their bonuses! Here’s how to determine if your current incentive system is in need of the upgrades we are suggesting in this paper:
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Ask Staff to Explain the Bonus Plan in a Nutshell! Ask a random staff member to briefly explain their practice bonus system to you. If they can’t do so…or can’t explain it to you in a sentence or two, your system is probably too complex & needs to be simplified. If they don’t understand it, they cannot possibly get behind it…nor be adequately stimulated by it.
Randomly Ask Staff How They Are Progressing Toward Their Monthly Bonus Goal. Ask a random staff member how the practice is progressing toward its incentive-based goals for the month. Perform this at a place in the office where the person being questioned cannot see any bonus/progress charts. If they cannot tell you generally how they are doing toward their month-end goal, they cannot possibly be working toward the goal or be stimulated by it! This means that the current system is either too complex & not easily understood, the data is unavailable/not visible…or you have a (very rare) wealthy or terminally stupid staff member who simply doesn’t care! You need to make sure that daily progress is visible…usually via a large & simple (hourly or daily updated) video screen or chart in the lunchroom.
(Remember: in the case where you have staff that doesn’t care, they are usually spat out by other team players.) Staff Must Receive a Bonus at Least Once Within the Past Three Months! If your staff hasn’t received their bonus during at least one of the past three months, the goals are inherently too high…or the staff was not properly trained as to how to achieve the bonus. Or, as is commonly the case, the practice owner failed to add the sufficient patient processing staff needed to achieve the bonus. All this can be very demoralizing & actually VERY
counterproductive!
If your current plan fails in one of the three above areas, it could be doing more harm than good! Get rid of it & upgrade it in accord with the Rolling Average recommendations outlined herein!
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The beauty of the Rolling Average system that we are suggesting in this paper is that it is always inherently attainable…while it cushions the positive or negative impact of each month’s goal.
Because it averages the periodic highs & lows of the practice, it never sets a goal that is drastic, unreasonable or unattainable!
Staff is inherently never asked to exceed a goal that has not been attained in the recent past…over the previous three months!
Finally, the “greedy” doctor-owner is not involved in the goal-setting process: The goal is determined by the past actions of the staff!
24. Is It a Bad Seed Employee…or the
Same Employee Who, If Compensated
OPTIMALLY, Would Be Your Star?
Please open your mind to a new way of thinking! Employee behavior can be TRANSITIONAL. They can behave BETTER if trained & incentivized to do so. If managed & compensated differently, how many weak employees could be cultivated & transformed into happy & productive, long-term team members?
Is the problem with the teacher…or with the student?
Unfortunately, too many of our clients tend to hire the employee at the lowest compensation rate possible…work them to death… & are surprised when they leave.
The process can become like a hamster wheel of repeated heartache & disruption. They unwisely expect there to be a work ethic!
The doctor-owner or manager will typically complain about this individual staff person’s behavior in the weeks before they leave 114
& will frequently define them as a loser or similar. But what if the bad seed knew they would receive ever-increasing pay if they helped the practice grow? Would the outcome have been different?
What about your trusted & wonderful long-term office manager or receptionist who has (likely deceptively) been keeping your office relatively stable for the past decade? She wears nice clothes, has good manners, comes from a respected local family… & the patients love her! She too may have also suggested she is financially set.
But isn’t it also the case that your office attracted 600 new patients last year…which should have required your adding another full-time hygienist THIS YEAR…but in fact your hygiene hours this year are the same…or fewer?
What if she were paid more as the hygiene portion of the practice fluidly grew in terms of hygiene appointments added & filled?
Would she need to be constantly reminded to call patients you haven’t seen in a while to fill hygiene?
As we have suggested, (unfortunately) the key to practice success has very little to do with relative clinical superiority… & a huge amount to do with how the practice is managed for success.
Please remember, you can assume that your staff is commonly embarrassed…or afraid to lose their job…if they suggest that they want…or need…more money!
There are a number of key & fundamental components to managerial excellence. Chrisad & various academics have promulgated each…ad nauseum:
Treat Your Employees With Courtesy & Respect: Please treat your staff the same way you want them to treat your patients. Your combined staff usually has more than 20x the 115
contact with patients than you…the doctor-owner! Again, treat employees the way that you want your patients treated!
Measure Key Practice Stats: If you can’t statistically measure it…you really can’t manage it! Don’t guess! Get to the heart of the key components of your practice by collecting true & objective numbers. Again, to quote Henry Kissinger, “Trust but verify!” Trust what staff says is occurring in your practice…but always verify statistically that it is in fact occurring!
Pay Staff in Proportion to Their Causing the Practice to Grow: Initiate & utilize an easily understandable, performance-based staff Rolling Average bonus system that rewards everybody in the office…but only as they help the practice grow & prosper beyond recent levels.
The point here is that if you are rotten to your employees & are a generally bad manager (particularly in the area of statistics)…your new incentive system might help…but not as much as it would if the practice were optimally managed!
Please remember that, similarly, even chrisad marketing cannot surmount what the patient-consumer views as a closed door…or a
“rat” on the operatory floor!
If you are churning through 2–3 hygienists or other staff per year, new-patient flow is stuck at about the same level from year to year…or you have the same number of hygienists (or fewer!) this year as you had three years ago…the bonus system outlined for you in this paper will likely help solve the problem.
Remember, employee turnover is extremely disruptive & is very, very expensive! Staff will rarely openly beg you to give them an incentive system. But when this incentive variable is inserted into the practice, it is like a switch is being turned on in your practice.
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You’ll care for more patients more enjoyably…while the staff will personally prosper in direct proportion to their dedication to the growth & welfare of the patients… & the practice!
Will your bad seed employee be transformed? The answer is likely a resounding “yes”…but the only way to find out is to adhere to our suggestions & implement the incentive system in your practice right away!
25. An Excellent, Long-Proven
Manager’s Incentive…Proven at
chrisad… & in Many Client Offices
Everyone in the office must row the boat in the same direction… & managers must be even more aggressively & lucratively rewarded for ensuring that the boat stays the course & avoids rough waters.
With this long-proven managerial incentive system, the manager is ensured a raise into the future for every annualized percentage of growth that the business/practice achieves. This goes on forever…and it doesn’t matter if the manager is paid (for example) $400,000 if he or she drove your practice to $20 million a year.
Please remember, this would likely not have occurred had it not been for the incentive system!
The amount paid is up to you. Again. It’s like an auction! It needs to be meaningful & juicy… & foreseeable for the manager. It can’t break your bank. Every practice situation is different.
The example agreement below is from chrisad. It has been used successfully by us for 25 years. It is also used by a number of 117
clients. It is at least partially (probably more) responsible for chrisad’s 3–4x growth over the past couple decades.
As with ALL incentive systems, the only REAL flaw is when the manager is paid TOO MUCH (the amount varies by individual) that they get TOO FAT & HAPPY… & would rather sit around the country club drinking MINT JULEPS all day than driving your practice ahead!
SEE OPTIMAL MANAGER’s INCENTIVE SYSTEM:
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26. If Your Incentive System Falters, Please Don’t Give Up…Fix It!
There is a tendency for practices to simply give up on bonus/incentive systems if they don’t work out during the first try. Please don’t give up so easily! Fix the problem! Get rid of the bug! If you are stuck, PLEASE give us a call! As always, we’ll do whatever it takes to help.
Again, please trust us when we tell you that nothing worth having ever comes easy. There is no free lunch! Nothing is perfect…nor ever will be. However, having a viable practice bonus system in place is certainly a goal worth striving for.
A workable incentive system is an integral part of the largest & most successful businesses in the world. It is a permanent & essential part of any successful dental practice.
As you implement & achieve your Rolling Average or other bonus system, much of the management responsibility will be taken off your back & placed where it belongs…with the people in your office who can make the elements related to production happen.
Please view managing & continually fine-tuning your incentive system as a long-term process! While the above Rolling Average incentive systems are currently the best known & most extensively proven approaches…you may need to modify & upgrade your system as time goes on…or as various practice dynamics or marketplace evolutionary situations dictate!
Yes, your staff will try to defeat the intent of your system by manipulating the system to trigger more money for them. They are only human!
While we have uncovered & defeated dozens of these manipulations through the years… & while these simple & 121
transparent Rolling Average systems have not been compromised…there may be future staff manipulations we have not yet neutralized!
Don’t get mad…but do take prompt action! Simply modify the system so the rip-off never occurs again! Again, this is an opportunity to use money as an ethical & positive motivation tool in order to achieve un-envisioned practice growth & security.
Remember, with this bonus system that pays only on the basis of increases, unless you really screw it up, the money will be paid out as a small portion of an increase that you would not have otherwise enjoyed!
It is worth the work! For you as the owner, it means less management, less stress & more production…whether you are there or not!
While no incentive system is perfect, this approach should slow the alarming number of self-serving staff that will break practice rules & unilaterally adjust practice protocol just to make life easy for them.
Remember: We’ve documented hundreds of cases where staff will tell patients the office is closed…when the doctor believed it was open! Could something far more subtle be happening in your office? Do you ever wonder what happens to your end-of-day endo calls? But what if they made more money for following the practice rules?
Please beware! As we mentioned above, one huge surprise & disappointment we’ve encountered over the past decade or so is this: Management must continually monitor & measure staff & general practice-growth progress. Doctor-owners ( & chrisad) must train & re-train to ensure they are doing what it takes to allow staff to earn a significantly larger paycheck!
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Once this great Rolling Average incentive system is in place, it can stall out due to lack of staff training…but more commonly, the doctor-owner’s failure to add hygiene, staff, doctor or operatory capacity that would have allowed the practice to continue to grow…with all staff continuously receiving bonuses.
Also, if chrisad-recommended patient-communication touch points are not optimal (as indicated by poor Secret Shopper calls), the system will similarly falter.
The great Rolling Average incentive system is an ethically correct way of stimulating & rewarding positive staff behavior…when the manager or doctor-owner is away!
If everybody in your office fails to row the boat in the same direction, it is less likely that you will grow much larger! In the absence of a strong incentive system, typically you’ll end up rowing your boat around in circles… & go nowhere!
Please remember, your great staff incentive system must be so simple that everybody in your office understands it, can explain it in a sentence or two… & all staff know exactly where they stand regarding their upcoming bonus on a daily basis.
It must be instantly understandable via break room charts (updated daily!) so that staff can immediately predict & project exactly how much more they’ll make at the end of the month!
This Rolling Average system passes or exceeds all of the above tests! Please begin implementing this outstanding system in your practice right away! It is the right thing to do… & will stimulate enjoyable & “automatic” growth…as well unimagined prosperity…that otherwise likely would not have occurred. jc 123
