Brett Churnin, May 2010

How does a Dentist set up their Hygienist for success?
When my Hygienist arrived in Australia over 20 years ago, proclaiming – “I’m a Hygienist – who wants to take me on?”, she was told in no uncertain terms – “you might as well go home….there’s no place for dental Hygienists in Australia!”

Thankfully, the tide has turned, and Hygienists are now in high demand.

And yet, some resistance still exists. Patients who have been seeing their Dentist for their regular clean for many years may be reluctant to see someone new. The core of this resistance is a simple and powerful word – TRUST. Patients need to know that they can trust this new pair of hands in their mouth. Dentists also need to know that they can trust that those same hands will take care of their valuable patients.

And how do we move patients to a place where they feel that seeing the Hygienist on a regular basis is their best option for the long-term health of their teeth?

1. Embrace resistance
When a practice takes on a Hygienist for the first time, it’s a new concept for everyone. Human beings do not always embrace ‘change’ with open arms, so some space needs to be allowed for the natural resistance that can come up – for the patient, for the team, and for the Dentist. The best approach to this resistance is to not be stopped by it, but rather deal with it, talk about it and understand it, so the practice can work to move beyond it.

2. Business as usual
While people may think that having a Hygienist is a big change for everyone, the practice actually needs to convey to the patient a sense that it’s ‘business as usual’. This is the way things are now – our patients see the Hygienist for their professional clean, scale and polish, and see the Dentist for their regular examination. No extra cost, but a lot of extra care and attention.

3. Build the Hygienist’s profile
Experience tells us that when resistant patients finally see the Hygienist, they often end up being their biggest fans. But how does a Hygienist prove themselves to someone they haven’t seen yet? The patient needs to know how the Dentist and the team feel about the Hygienist. If the Dentist and team members convey confidence in the Hygienist to the patient, it makes it much easier for the patient to like and trust the Hygienist. The team should be able to say to patients that they themselves have used the Hygienist and thought that they were great. A simple statement such as “we are so happy to have our Hygienist here. We all have the Hygienist work on our gums and we don’t know how we managed before” can make a huge difference to how the patient will feel (and only if it is said authentically).

4. Manage expectations
If a patient does not know what to expect from their time with a Hygienist, they will have a tendency to create assumptions and expectations that may not be aligned with reality. Unfulfilled expectations can lead to patients being upset or disappointed, even resentful and angry. The patient’s expectations of what the hygiene appointment is about can be strongly influenced by what is said about the appointment (and about the Hygienist) before the hygiene appointment itself.

5. Demonstrating We Know You (WKY)
To differing degrees, we all want to feel ‘known’, ‘seen’ and ‘understood’. If a patient has been seeing the same Dentist for many years, they come to feel the Dentist knows and understands their particular dental idiosyncrasies and has come to know certain elements of their life. Starting a whole new relationship with a new clinician can be scary for a patient. Hygienists can make that process easier for patients by demonstrating that they know something about that patient’s dental and personal history. For example, the Hygienist should make a WKY comment early on after meeting the patient such as “I understand from Dr Smith that you work in real estate and your specialty is…” Then follow that statement with a question that has the patient speak about something that they are interested in. As the patient gets used to speaking with the Hygienist, the uncertainties will melt away. Several things are achieved by doing this:
1. The patient gets the sense that their relationship with the Hygienist is an extension of the relationship with the Dentist and the practice as a whole.
2. The patient gets the message that the Dentist and Hygienist are on the same page, working together for the benefit of the patient.

6. Focus on the Damaging Results of the Existing Condition (DREC)
Common oral health education traditionally focuses on the benefits of seeing a Hygienist regularly, or the advantages of flossing and brushing every day. Instead, practices should try focusing on the DREC and asking questions about: What can happen to patients’ teeth and gums when they don’t come regularly? What happens when they don’t brush and floss? These are the subtle messages that should be embedded in a patients mind. Only when they are clear of the DREC can they truly make an informed decision about treatment and compliance.

7. Moments of truth
Whether we like it or not, patients are making constant (albeit often subconscious) judgments about the practice and the team. Each time they come in contact with a practice or someone from the team, the patient is adding to their overall opinion of the practice. Each of these judgments is called a “moment of truth”.

For example: A real moment of truth occurs when the Dentist walks into the Hygienist’s room: does the Dentist just walk in and ignore the Hygienist? How does the Dentist talk to the Hygienist? Is there a decent level of respect between the Dentist and the Hygienist?

Patients are hypersensitive to the way that the Dentist and Hygienist relate to and communicate with each other. To maximise the patients’ experience and give the Hygienist every chance for a successful integration to the practice, a practice needs to assess all the moments of truth a patient will experience when seeing a new Hygienist or meeting a Hygienist for the first time - from the introduction right through to the scheduling of the next appointment.

Conclusion
Human emotions are molded by a variety of experiences and will vary widely from person to person. However, there are some fundamental principles that can be followed to improve our relationships. It is possible to direct a patient’s experience so that they feel more nurtured, known, heard and respected. Most people simply follow their intuitions on how to manage the process of introducing a Hygienist, but if practices aim for consistent excellence across the whole practice, the leader of the practice should incorporate protocols that can be followed by all team members.