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4Blocks: Producers (Docs and Hygienists)

4Block Roles

PRIMARY PRODUCERS Acronym: FCTD: Face-to-Face, Comfort, Treatment, Diagnosis

F and C: Face-to-face and Comfort
The responsibilities of the your primary producers all center around the extremely sensitive relationship you have with people who are in your direct care. Face-to-Face, as you will never tire of hearing, is what a good relationship is based on. In turn, a good relationship is what trust is built upon. A warm and sincere, "How are you?" is a guaranteed good beginning. Make a personal connection by making reference to patient notes. Ensuring comfort is another, deeper way to communicate your integrity as well as your intention and commitment to care for your patient. One aspect of comfort that must be understood is communication. Your willingness to communicate what is happening out of their sight in terms the patient can understand is huge currency for trust. By the same token, speaking to them in a way that makes sense to them and doesn’t elicit a fear response is just as important as keeping the dialogue open in the first place. Placed last in this list so it isn’t skimmed over is listening. A patient who feels well-oriented in the process of their care, who knows they are being listened to, and knows they will be heard is a patient who doesn’t have to work hard to trust you. There is, of course, physical comfort to look after. If you hurt someone or make them uncomfortable as you treat them, no amount of words will undo this. Conversely, if you are consistently and sincerely concerned about their comfort after you have established a good Face-to-Face connection, the patient will be able to feel your concern and this will cement in their minds the fact that you are there to listen to them and care for them. This is the seed of patient loyalty and it’s earned as simply as it’s lost.

T and D: Treatment and Diagnosis

Properly handling treatment and diagnosis are the ways you communicate your integrity to the patient in the sense of being properly trained, skilled and knowledgeable about your dentistry, which is, after all, the main event and the reason your patients come to see you. When you’re treating the patient, let them know what you’re doing in terms that they understand. When you’re diagnosing them, explain what the diagnosis means as far as what should be done and what their options are. Form a relationship with each patient, establish and protect their comfort on all levels, perform good treatments and diagnoses and make sure that the patient can rest assured they are being taken care of. That’s the four blocks for primary producers in a nutshell.

Hygienist 4 Blocks
You handle a lot of tasks, duties, and situations working as a Hygienist each day, but you know you’re doing your part to help patients and the whole team when you:
1) Connect warmly with people on a human level to build trust and have extraordinarily constructive interactions with patients and keep warm and open communication going with the whole team.
2) Understand and provide for the emotional and physical comfort of patients in your care.
3) Consistently perform treatments with a commitment to excellence and attention paid to details of preparation and execution that make excellent treatment possible.
4) Investigate, document, and present diagnosis to the patient as part of a team approach that helps the patient choose the best course of treatment and helps the practice thrive as a business by giving excellent patient care.

Face-to-Face
Everyone in the practice needs to practice good Face-to-face. If we connect warmly on a human level to establish trust and open communication, we can give exceptional care to patients and support each other as a team. Working in hygiene is no exception. The better you can connect with your patients this way, the better you can attend to their Comfort, Treatment, and Diagnosis.

To help you master your role, you will be given Effective Actions to focus on from time to time. To give some examples in no particular order, here are some 4Block tasks centered around F=Face-to-face that you will master working as a Hygienist
Leading the conversation as you help the patient through their appointment.

Using plain language instead of dental jargon
Establishing and maintaining rapport with patients
Making positive comments about the team
Asking open-ended questions
Connecting on a personal level

Sample EAs:
1) Every time you make a reference to past personal notes, swipe.
2) Every time you make a positive comment about a doctor, swipe.
3) Every time you make a positive comment about another hygienist, swipe.

Comfort
Making patients comfortable and giving them pain-free treatment is absolutely crucial to your role. This requires making a human connection and paying attention to “the person attached to the teeth.” Keep patients informed of any sensations they are about to experience, and remain attentive to their nonverbal signals of discomfort. The trust you build with your face-to-face with patients is cemented by your apparent concern for their comfort.

Providing pain-free treatment Informing before treating
Explaining any sensations
Allowing patients to have breaks

Sample EA:
1) Every time you ask how the scaling feels and the patient gives a positive response and says to continue, swipe.
2) Every time a patient compliments their cleaning, swipe.
3) Any time you can prove to a patient that they don’t need freezing, swipe.

Treatment
The nuts and bolts of treatment, the procedures themselves, documentation, and so on, are a matter of course in your role. Your warm, personal connection with patients and obvious commitment to their care and comfort during treatment are a key way you take care of patients, support the whole team, and help the practice succeed as a business.

To help you master your role, you will be given Effective Actions to focus on from time to time. To give some examples in no particular order, here are some 4Block tasks centered around T=Treatment that you will master working as a Hygienist:

Maintaining sharp instruments
Gentle, prudent treatment of soft tissues
Updating charting and files
Informing before treatment

Sample EAs:
1) If you finish treatment on time, swipe.
2) Every time you make a purple personal note in the patient record, swipe.
3) Every time you treat a patient from a doctor’s schedule that wasn’t prebooked, swipe.
4) Every time you talk to a doctor about pulling treatment from that day’s schedule, swipe.

Diagnosis

Helping patients make the right decision about the course of treatment is one of the most important ways you care for patients, support the team, and contribute to the success of the practice as a business. You accomplish this using a team approach by working off the trust you build during the visit, documenting photographic evidence of areas in need of treatment, and presenting the evidence in plain language.

Delivering the 3-Line Summary
Taking intraoral pictures. Every patient, every time.
Explaining treatment options and asking patient for direction Informing patient of areas of concern
Presenting intraoral pictures on-screen

Sample EAs

1) Every time a patient accepts a restorative treatment with no predetermination, swipe.
2) Every time you suggest a night guard, swipe.
3) Every time the patient and dentist accept your diagnosed restorative treatment, swipe.
4) Every time you take, share, and discuss an intraoral photo with the patient during treatment, swipe.

F2F: Professional Skill, Not Personality
First things first. If you're working here, we like your personality and you have demonstrated the capacity for good Face-to-face. When you're asked to take a look at how to improve F2F, your personality is not being criticized. Your personality is your personality. F2F is how you connect with patients. Rather, we're asking you to consider how to take what works for you and figure out how to apply it methodically and predictably. Taking your natural F2F and analyzing and organizing your approach will help you naturally and comfortably interact with more types of personalities and people. It will expand your repertoire and help you keep the distinction between the personal and the professional comfortable and clear.

You, Doing Your Best To Connect
The two most common reservations about working on F2F are:
1) discomfort about being intentional with your communication, and 2) feeling you are somehow "not being myself."

First, we all intentionally seek to communicate effectively. We want to understand and be understood, and we learn how to do this efficiently because it's important for everything in life. Second, you are always "being yourself.” F2F is you, being yourself, intentionally connecting to a patient in order to care for them. It's a courtesy, it's a kindness, it's professional, and it makes all the difference in the world.

Remember What Works
As you know, it can take a few different areas of questions before you find one that engages the patient: weather, holidays, vacations, jobs and hobbies, current events, pop culture, etc. It's good to be organized about your conversation starters so you can cycle through them until you find what works. You probably wouldn't make a list of all the greetings and conversation starters you use with your family and friends, but doing just that is exactly the kind of thing that helps you use F2F as a tool in your dental skill set. You don't necessarily need to make a list on paper, but taking inventory will help you look at F2F as a skill rather than an aspect of your personality. Making that distinction will free you from any concerns about your ongoing effort to perfect your F2F and adapt to new types of patients, personalities, and people.

Be Yourself, Relating to Someone Different From Yourself
Sometimes a quiet patient is just nervous, but whatever the case, you aren't working against your nature to notice someone's communication style and match it in order to make a connection. Matching how fast or slow the patient speaks, how many words they use, and their overall energy level has the same effect as speaking someone else's language. It helps patients understand you and gives them confidence that you can understand them. It's a fair deal: if you meet the patient on this level, the conversation will flow more naturally, both of you can have a more pleasant interaction, and the patient will be much more comfortable and easy to work with.

F2F TnT: Nonverbals Body Language and Posture
Never underestimate the importance of your body language. Nonverbal communication is the key to creating a clearly positive first impression to set the stage for the rest of your F2F. On the other hand, you can unknowingly put off negative signals if you’re not paying attention to your posture and facial expression. People automatically make a snap judgement about others based on their posture and facial expression, so it’s important to put some thought into these aspects of your presentation to be sure you’re “saying” what you mean to say.

Nonverbal Essentials
Patients react best to an open expression with warm eye, natural contact and a smile. For posture that radiates (and inspires) confidence, hold your back straight, your head high, your arms open (not crossed) and your shoulders back. These are subtle but effective communication cues, and they can be learned, practiced, and improved. Developing awareness of how you present nonverbally will help you get the best reaction possible from patients. This will help you build rapport, open the lines communication, and ultimately, take better care of your patients.

Smile!
It’s simple, but it bears repeating: Smile! it’s contagious

How to Radiate Positivity
One way to get in the headspace for positive interaction as you prepare for your day is to consider that, because people will react to how you present yourself, you can make a choice about how the day is going to go just by deciding to focus on projecting positivity through your nonverbal communication and the perspective you take on the day. Doing this will help you get the reactions from others that will help you turn your mood around. If you decide to project a positive attitude, you will not only do your part to nurture a positive environment in the office, but you will feel better, too. Use the fact that a positive attitude will help your day go more smoothly to help you “fake it ‘til you make it.”

The 3Line Summary
The 3Line Summary is a big deal. It shows patients how competent we are, it''s the key to treatment acceptance, and it's the key to getting the patient out on time, which is something patients will not compromise on. Because it's so important, we leave nothing to chance. In this module we share some general scripting for the 3Line Summary. They are blueprints you can modify as needed according to the specific findings. Some of the summaries are longer that the 3 lines, but they still flow as they cover the following areas:
oral hygiene
soft tissues
outstanding treatment
positive findings

Large treatment plan
"Dr. Dave, this is Mary and Mary has not seen a dentist for number of years due to a bad experience. Mary knows there are a lot of areas of cavities and broken restorations, however Mary would prefer to replace bonding on her upper teeth to feel more confident and comfortable. Let's bring Mary in for the bonding and show her a great experience without pain. I prioritized all the other areas in the treatment planner and discussed it with Mary."

Standard Recall 3-line summary
Mary is doing a great job brushing using her electric toothbrush. However, she needs to floss more between her molars, where we have some inflammation and bleeding. I checked soft tissues, and Mary's cheeks, tongue, and the back of her throat are healthy. You repaired the 24 at Mary's last appointment, and the fill feels great. Mary knows that the 36 crown is still outstanding and I showed her an intra- oral picture of the fractured tooth. Mary is now ready to go ahead with the crown.

Child Recall Summary
This is Dr. Bob. He will count your teeth just like I did. How many teeth did we count? Sarah did awesome today, we tickled teeth and painted on some bubbles. Sarah is doing a great job brushing by herself, however mom and dad still help at the end. Sarah reminds mom every night to use little flossers to remove all the sugar bugs. Sarah has really good spacing between her teeth, but her tonsils are a bit enlarged. Please check the deep grooves on her baby molars. I showed mom and dad the intra-oral pictures of these deep grooves that might need to be sealed.

Elderly recall Summary
Mrs. Young is really doing well cleaning her remaining teeth. Both the upper and lower dentures fit well. Mrs. Young takes her dentures out at night as instructed. I recommended the use of a sulca brush, since her arthritis is preventing from flossing. I showed Mrs. Young a picture of exposed root surfaces that need to be sealed to prevent cavities and sensitivity to cold. Can we do these fills today to save Mrs. Young a trip back?

Patient with excellent oral hygiene
Mary is our perfect patient. She brushes with her electric toothbrush and flosses regularly. Her gums are perfectly healthy with no bleeding. I checked soft tissues, and cheeks, tongue, and the back of her throat are healthy. There is no outstanding treatment. However, I have noticed some "pot holes" on Mary's molars. I showed Mary pictures of these "pot holes" and recommended sealing them. I explained to Mary that this will strengthen the teeth and prevent any sensitivity. Do we have time to seal them quickly today?

Final Note: Know your audience
While you deliver it to the doctor, the 3-Line Summary will also be overheard by the patient. It should be, and you should consider this when you choose what to say. Hearing the summary you deliver to the doctor helps the patient review their diagnosis and prepare to listen to treatment options.

F2F: Talking About The Team

Talking About the Team

There are many opportunities to talk about how great the people you work with are, and patients love to hear it. From the patient's perspective, It's unpleasant to think that they lucked out when they got you or the checking dentist because everyone else is second-best. Even if it's only relative, there's nothing good about causing a patient to think about a bad dental experience while they're here. Instead, reinforce with the patient how competent and caring everyone on the team is.

There are opportunities when you transfer the patient, when you're informing them about what's happening next, or in the course of telling a story: "Doctor X is so great, they do my kids' teeth." "That's Susan, she's a great assistant. Her patients just love her." Talking up your teammates is a small thing that makes a huge difference for the patient, you, and the atmosphere in the practice.

We all work hard to make sure that everyone treats to the same high standard here. The more you talk about how great everyone on the team is, the more the patient gets a positive impression of the behind-the-scenes reality of the team. This gives them confidence that they will receive the best possible care no who their next appointment is with. Keeping in mind the the patient only knows what they see and hear, you can see why just a little bit of attention paid to answering the unspoken questions like: "Did I get a good one? Will they hurt me? Who can I trust here?" are a powerful way to help a patient feel confident and comfortable.

EXAMPLES

Seeing a new dentist in hygiene
1. "Dr. Habib will be coming in for your checkup. He has been with us for number of years and is great. Patients really like him. He has been trained by Dr, Bob and provides excellent care. Sometimes we make fun of him because he looks so young, but he is very experienced.

2. Dr. Dave is our new dentist and is a great addition to the team. He was well trained by Dr. Bob and his team, and he is eager to provide you with the same level of excellence. Patients really like him. You are in great hands with Dr. Dave.

Seeing a new hygienist

"Hi Mary. I know you saw Donna for many years. I have been working with Dr. Bob and alongside Donna for the past 10 years and will take very good care of you. I am well experienced and very gentle. You are in good hands, please let me know if there is anything I can help you with."

New Patient
This is your first time to our office? Welcome! We have a wonderful group of dentists, hygienists and other staff who will provide you with excellent care. Before we begin, what is your main concern or priority today? What can we do to make this appointment a comfortable one? Are you more concerned about your smile or just the cleaning? Are you in any pain?

F2F: Patient Transfer
F2F establishes, builds, and maintains the connection required for the trusting relationship necessary to a good patient experience. That trust can be harmed or completely destroyed if we aren't careful when we transfer the patient from one team member to another.

The final transfer from the operatory to the front desk is especially crucial. Think about it from their perspective: they have been sitting in an unnatural position for an hour or more. They may be anesthetized, uncomfortable, and a little disoriented. In a word, they are vulnerable. It's important that this vulnerability is understood, anticipated, and handled with care. It is unacceptable to send a patient down the hall to stand in line to pay unescorted, or hurriedly ushered and abandoned. Under no circumstances should the patient be unsure of whether they're in the right place or not, or be left to ask for themselves what to do next.

When the patient transfer is handled correctly, it solidifies the all the warm connections the patient has made throughout their visit. If it is handled incorrectly, it will overshadow the positive aspects of their visit, and the patient may not return. The patient should experience a single unbroken chain of warm, supportive interaction. Hygienists or assistants, walk with the patient back to the front desk. Make warm conversation. When you get to the front desk, bid your warm farewell. Front desk, you will have noticed the approach of the patient already, and this is your cue to initiate your part of the transfer.

By remembering how important the final patient transfer is, you preserve and build on the warm, trusting relationship each team member has worked together to build with each patient, and you ensure that our patients have a memorably pleasant experience each time they come to us for care.

Problem Patients

The difference between you and the run-of-the-mill dental professional is that you will never have a problem patient. That’s because you have everything you need to handle any situation, and, really, a “problem patient” is just someone you don’t know how to handle. They aren’t a problem if you know what to do. Try to understand their situation. Put yourself in their shoes. Are they actually unpleasant, or are they just nervous? Are they going through a rough time in their life? Just relating to the patient can help here. Stop and talk about it. There won’t be good care done while the patient is in a bad mood anyway. If it takes the whole visit to talk through their problem, that’s fine. If someone comes at you negatively, as a professional you have the ability to change the energy in the interaction. Treat them with more kindness than they give you. Be patient. Be unflappable if they seem to be trying to provoke you. Joke about not liking you, "I always give my hygienist a hard time, too." If you can hang with them and prove that you understand that, even if you don’t come out and say it, underneath it all, they’re just nervous and acting out, these difficult patients often become the most loyal ones.

Comfort is about taking responsibility

To discuss Comfort, let's start with the myth of the "problem patient." There's no such thing as a problem patient, just a patient you don't know how to work with. The root of this attitude is taking responsibility for the patient's Comfort, and this is the key to mastering Comfort. To blame the patient to is to give up responsibility, to make their comfort their concern. And they will be concerned. They will bodily and emotionally tense up, their blood pressure will rise, and they will become hypersensitive. Someone with a tendency toward anxiety can have a panic attack as they sit there in fear of not only what might happen during scaling, but whatever more invasive treatments they may have to do. But there's no reason for a patient to feel this way as long as we can anticipate this. By anticipating questions and concerns, we let patients know that they are in a safe situation that you are in full control of, and they have a solid sense of control through your warm, responsive connection and consistently informing as you perform. Letting the patient know that you are at least as concerned for their comfort as they are removes their need to worry, tense up, and expect pain. But this requires more than just saying it. This is where F2F is necessary in order to accommodate patient's Comfort.

F2F, Trust, and Comfort
Use your F2F to establish a warm connection from the moment you greet the patient. Let them see you warmly interact with staff or patients you recognize in the waiting room. Be sure you are using open, confident body language. Walk with them down the hallway and talk positively about the weather. When you sit them down in the chair, ask them first about their concerns for the visit. Talk for as long as necessary. If it takes the whole visit, that's okay. The next appointment, you will have a much more comfortable patient from the outset. That's how valuable it is to connect with the patient so you can build the trust that creates open communication. You can't ensure their comfort if they don't open up. The trust we refer to is a real thing: they must reach a point with you where they no longer fear that you won't be concerned, attuned, and attentive enough to prevent hurting them as you work. That's what we're talking about when we talk about trust. By involving the patient in the process by talking, asking, and informing before you perform every step of the way, you will have much more success in maintaining a high level of comfort and avoiding hypersensitivity that interferes with treatment. For extreme cases, topical anesthetic can be used, but due to potential complications, it's best to avoid using local anesthetic. Often, the discussion about using anesthetic is a perfect opportunity to relate to the patient and talk to them about how unnecessary it is in most cases.

The Eyes Have It
You can tell a lot about the patient's state of mental and physical comfort by watching their eyes, and for this reason you must always watch their eyes. But the patient doesn't know that, and it wouldn't comfort them even if they knew. You still must directly communicate with the patient verbally that you are on the same page with them in order to maintain that necessary level of trust and comfort.

Cold Steel
The nature of delivering Comfort to patients is understood better when you keep this simple, but contradictory fact in mind: We scrape people's teeth with cold steel in order to help them.
Hurting them does not help them. We do not scrape them past the point of comfort for the sake of removing all calculus. When we run into a patient's threshold of comfort–which is before their threshold of pain–before we can fully scale an area, we have to work with the patient to talk them through what sensations to expect, and to assure them that you won't hurt them. It's better to leave an area for the next visit than it is to push someone past their comfort zone.

Wants, Needs, and Comfort
We give the patient what they want above all else. What they need in terms of hygiene follows from first giving them what they want. By saving a problem scaling area for another visit, you are finishing that appointment without hurting them. Each appointment you finish without hurting the patient increases their baseline trust, which improves their comfort threshold. We aim to develop lifetime patients. There is plenty of time to get their scaling done.

Treatment - Docs and Hygienists:

Team Treatment Planning

To accommodate our patients best, it is important to handle hygiene checks in less than 4 minutes. This means that treatment planning requires a coordinated group approach. There's an art to it.

Here are the outcomes of the treatment planning conversation:
1) Help the patient understand how we are going to address their main concerns and how treating those concerns fits in with any other necessary treatments.
2) Help the patient understand that we will do everything we can to make it affordable.
3) Finally, the patient needs to trust that we are going to take great care of them.

What the Patient Wants
First and foremost, we need to be clear about the patient's primary area of concern. This is what the patient wants, and we want to give them what they want.

The hygienist uncovers this as they talk during that part of the visit and explains this to the doctor in the 3-Line Summary. The doctor then understands what the patient's priority is and can understand it in relation to the rest of the diagnosis.

Whether there's pain, aesthetic concerns, or any other reason, what the patient sees as most important is what we treat first. For example, we may have discovered that they need four fillings, but they came to the appointment focused on getting whitening done. We put together a treatment plan that includes everything that needs to be done, while respecting the patient's priorities. This is a win-win, because the patient will be feel more positive about the rest of the treatment plan if they know they're getting what they already knew they wanted.

Set up an appointment to take care of the patient's primary concern, and set an appropriate benchmark for taking care of any other issues uncovered. "We'd like to have you come back in so we can take care of your whitening. We think we can really get you in great shape with that. And we'll look into those other areas we talked about and make a great plan for taking care of those then."

Docs, plan to make a plan, and leave it at that. The hygienist and assistant will handle the details before and after your check. It will often work out that treatment will be combined into the same visit, so while to you the difference is negligible, the patient having their priorities respected makes a very significant difference to their satisfaction with us as a practice. If we respect what they want, we will have many chances to treat them in the future.

Affordability
Second, we take care of the patient and create trust and a positive experience when we bring up the topic of affordability before they do. By letting them know that we understand that affordability is often the only block to accepting treatment, we are engaging the patient in a way that illustrates empathy, our understanding of the experience from their perspective. The doctor covers the bases categorically and lets the patient know that the whole team is on the specifics: "We'll make this affordable for you. Marnie [my assistant] will look into that. We'll maximize your insurance and take great care of you."

Confidence, Coordination, Care and Trust
Handling treatment planning seamlessly as detailed above and elsewhere in the Platform, with perfect coordination, shows the patient that the whole team is on the same page and working together to take care of them in every way. This gives patients confidence in our ability to care for them, gets them out on time, and this nurtures and strengthens the trust they need in order to accept that the treatment plans we offer are actually what's best for them. Without that trust, we're not caring for patients as well as we can.

Treatment: Standard Treatment
Sharper instruments means fewer strokes. Same goes for having a standard of treatment: a single standard just makes things better. We sharpen our standards for best practices for treatment methods so that all hygienists are treating patients in the same way. This is important for a number of reasons.

First, it's important that you know that it's not because we specifically dislike some of the individual approaches some hygienists use. It's about supplying a predictable, consistent experience for our patients. The same goes for our policy of taking every opportunity to talk about the team with patients. We don't want them to feel like they might "get one of the bad ones" on the next appointment. There are no "bad ones" here! Let's not lend that impression. In a busy world, the reality is that patients value schedule flexibility above all else, all things being equal. Our policies of having a single hygiene treatment procedure and talking up the team both help us make it clear to our patients that all things are as equal as humanly possible; they can expect great care regardless of when (and with whom) they make an appointment.

HYGIENE: SUCCESS COMES FROM PREPARATION

Preparing for your day

Setting up the Operatory

Arrive early to prep for your day, at least 20 mins before your first patient. Organize and tidy up your room, clearing clutter from the counters. Turn computer, dental unit, Cavitron, and x-ray unit on. Open blinds. Organize and sharpen your instruments. Check that Cavitron is working and water is on. Make sure your intraoral camera is working. Be sure your room is stocked with all hygiene aids (toothbrushes, floss, sulca brush, proxabrush, etc.). Have gloves and masks ready for the day. Check hand mirror, patient glasses, and overhead light for cleanliness. Make sure your room has high-speed, burs, articulating paper, and Tooth Slooth for the dentist.

Arm Yourself With Information

Review your day by checking every patient's chart Check medications, allergies, and personal notes. Check treatment completed at last appointment and outstanding treatment. Check previous billing (does the patient have insurance remaining?). Check what x-rays are necessary and if re-charting is due (every 3 years). Indicate in patient description line what estimate is needed for the day (i.e. PAN? RC? or BWs?). Hygiene office will determine this first thing so you can proceed. If you have openings in your day, check the doctor's schedule: do any of their patients need a cleaning? You can also check if any staff is due for a cleaning to fill your day.

Look at your day to see where you might run behind or be able to take a break Check with your PDA where they might need help with side patients.

Take a deep breath and begin your day with a smile!

A Patient With Concerns

Opportunity and Risk

When a patient comes in with a concern, especially when the patient comes from another office which caused and/or failed to take care of those concerns, we have an amazing opportunity to do something great for them. But this opportunity comes with a risk: if we handle the situation well, we are almost guaranteed to earn an advocate.

On the other hand, if we handle it poorly, we are almost guaranteed to earn a very upset patient who now attaches all the negativity toward these concerns to our practice. They will not return, and they will refer their friends and family away from us. When a patient comes in with concerns, the stakes are higher.

The Outcome

When it comes to understanding how to arrive at a customer service or patient care outcome, it’s useful to first understand what that outcome is. To connect to the emotional reality of the situation, in GP you will often be asked to consider what the patient will be thinking on the car ride home, or what they will say at the dinner table that night. This exercise helps you understand more concretely what you need to cover in your patient interactions.

So here is what we want the patient to say about their experience. We’ll use particulars from a real situation involving a patient who came in with concerns about their wisdom teeth after having been referred to us by their friend, Jill:

What a great office and team. I can see why Jill has been a patient here so long. The doctor, the hygienist, and everyone there were all amazing! I now understand what has been going on with my impacted wisdom teeth. The plan is to have them removed. Dr. Don will be talking to Dr. Jim and Dr. Habib to see if this is something we can do at the office. They can use sedation to make sure that I am comfortable and feel no pain, as they really understand that I am a little worried about pain from this procedure. The team very clearly understood that I am concerned about the cost. They assured me they would do everything to maximize my insurance, and it would not cost me a penny out of my pocket! It makes me feel good that they showed so much care for my comfort. They were more interested in looking after me than in getting as much money as they could. Everyone should go here!

That’s what we want their inner dialogue and conversations to sound like after they leave their appointment. You can do what it takes to make it happen: Be sure to address the concern they came in for and explain what you will do about it. Make a full diagnosis. Especially if a patient came to us after mis-care, there may be oversights or unacceptable treatments that the patient will appreciate knowing about at this time. Use plain, non-dental language so they will understand what you're telling them, even if it is complicated. Make sure to address their concerns for pain-free, comfortable treatment. Take away their concerns about being able to pay: bring up affordability so they don't have to.

Study this outcome and these steps to help you focus your interactions and ensure that you do and say everything the patient needs to see and hear to feel this way. Our patients deserve it, and when we make them feel this cared about, they reward us by remaining our patient and referring the people they care about. Your 4Blocks training material can help you understand how to use your skills in F2F, Comfort, Treatment, and Diagnosis to achieve these results. Ask your mentor for more specific guidance.

Side Note: Referring to a Specialist

In this example, it’s worth pointing out that the patient needs to feel that being referred to a specialist is not a dismissal or a cold administrative handoff. In the second paragraph, the patient is expressing their understanding that there are special conditions involved in their care. From what they are saying, we know that if this patient was told tomorrow that the best option is to go to a specialist, they will understand that this is only so they can get the best possible care. Nothing less is acceptable. Patients must feel cared for by us, even we send them elsewhere for treatment. When referring to a specialist, make sure the patient understands that it is in the interest of their best care, and not arbitrary–or, worse yet, for the sake of our convenience. The only way to ensure that the patient clearly understands is to speak to the matter directly.

Conclusion

Keeping F2F and your 4Blocks in mind will help you always focus on making a human connection and building trust in each area of interaction with a patient while prioritizing giving the patient what they want. A patient with a concern wants to be taken care of from a human, dental, comfort, and financial perspective. All of our patients deserve great care, but the stakes are higher with these patients, so use this and other modules to make sure you have a plan.

Doc 4Blocks

There are so many tasks and techniques involved in being a great dentist. How can anyone be expected to keep track? How about assigning a manual as thick as a dictionary and testing on it regularly?

No. You've already been to school for dentistry.

4Blocks handles training differently. It doesn't revisit what you already know, it outlines the outcomes that we know patients need in order to have an extraordinary care experience.

By structuring role expectations around patient and team outcomes, each team member can use their own judgement to do what they need to do to take great care of patients and perform as a happy and successful team. Here's the 4Blocks for dentists. In this, we refer to Growth Card. Growth Card how we share Effective Actions, or EAs. EAs are specific outcomes that happen when many smaller pieces and steps were executed well. Effective Actions help team members focus on specific areas to give our patients consistently excellent care experiences. An example EA for a dentist is when a patient goes so far as to compliment your needle technique. It takes superior execution to make this happen, and a comfortable rapport between patient and doctor. If your patient compliments your needle technique, you're doing something–several things–very right. Aiming for this outcome and others like it are how a practice stays focused on providing extraordinary care day in and day out, year after year. That's what Effective Actions and Growth Card are all about.

Doctors 4Blocks - FCTD

F=FACE TO FACE

Everyone in the practice needs to practice good Face-to-face. If we connect warmly on a human level to establish trust and open communication, we can give exceptional care to patients and support each other as a team. As a Doctor, and part of a clinical team, you must serve as an example of how to do this successfully.

Greeting patients, warmly asking “How are you?”
Making personal comments from notes Superior presentation
Making positive comments about your assistant
Arranging post-op follow-up calls

Sample EAs:
1) Every time you reference a Purple Personal Note with a patient, swipe.
2) Every time you tell a patient to expect a post-op call from the assistant or doc, swipe.
3) Any time you make a positive comment about your assistant, swipe.
4) Any time you remember to greet the patient with an appropriate touch, swipe.
5) Every time the patient laughs sincerely, swipe.

C=COMFORT

A successful practice is built on patient comfort. Providing for and protecting the comfort of each patient builds on and deepens trust and allows the patient to accept our diagnoses and recommended treatments as being in their best interest.

To help you master your role, you will be given Effective Actions to focus on. To give some examples in no particular order, here are some 4Block tasks centered around C=Comfort that you will master in your role:

Applying expert control of instruments and a light touch
Practicing flawless injection technique: needle selection, administration site, etc.
Combining quadrants for restorative and scaling
Using mouth props and rubber dams when appropriate

Sample EAs:

1) Every time a patient comments positively on your needle technique, swipe.
2) Every time a patient accepts a mouth prop, swipe.
3) Every time a patient accepts a neck pillow, swipe.

T=TREATMENT

As a dentist, you have a commitment to performing excellent, caring treatment. As a producer in the practice, you have a commitment to hitting your benchmarks and performing your duties efficiently. Keeping your clinical abilities sharp and focusing on patient comfort are how you bring value to patients, support the team, and contribute to the success of the practice.

To help you master your role, you will be given Effective Actions to focus on. To give some examples in no particular order, here are some 4Block tasks centered around T=Treatment that you will master in your role:

Maintaining superior four-handed efficiency with assistants
Documenting and presenting intraoral photos.
Every patient, every time. Aiming for an unprompted “Wow” from the patient to before and after photos
Meeting and exceeding your production benchmarks

Sample EAs:

1) Every time a patient reacts enthusiastically to their post-op photos, swipe.
2) Any time a patient compliments your technique or the treatment experience, swipe.
3) Every time a patient leaves on time, swipe.
4) Every time a patient is seated on time, swipe.
5) Any time that you do additional dentistry not on the original treatment plan, swipe.

D=Diagnosis

Your ongoing mastery of clinical abilities and people skills will enable you to develop efficiencies that allow you to diagnose dentistry accurately and present it persuasively to ensure that patients understand their options for treatment while staying on track with your production benchmarks.

To help you master your role, you will be given Effective Actions to focus on. To give some examples in no particular order, here are some 4Block tasks centered around D=Diagnosis that you will master in your role:

Performing all hygiene checks in less than four minutes
Using intraoral pictures to present treatment options
Prescribed and presenting treatment without dental jargon
Treating the patient, not the insurance: commitment to facilitate, book, explain, and financially coordinate with the patient according to their needs
Tracking dollars diagnosed per exam

Sample EAs

1) Every time you diagnose and book dentistry in a hygiene check.
2) Any time you complete same-day treatment, swipe.
3) Any time you explain completed treatment using intraoral photos, swipe.
4) Any time you do a hygiene check in 3 minutes, swipe.

Docs and Hygienists: Treatment: Team Treatment Planning

To accommodate our patients best, it is important to handle hygiene checks in less than 4 minutes. This means that treatment planning requires a coordinated group approach. There's an art to it.

What the Patient Wants

First and foremost, we need to be clear about the patient's primary area of concern. This is what the patient wants, and we want to give them what they want. The hygienist uncovers this as they talk during that part of the visit and explains this to the doctor in the 3-Line Summary. The doctor then understands what the patient's priority is, as well as the rest of the diagnosis.

Whether there's pain, aesthetic concerns, or any other reason, what the patient sees as most important is what we treat first. For example, we may have discovered that they need four fillings, but they came to the appointment focused on getting whitening done. We put together a treatment plan that includes everything that needs to be done while respecting the patient's priorities. This is a win-win, because the patient will be more positive about the rest of the treatment plan if they know they're getting what they already knew they wanted.

Set up an appointment to take care of the patient's primary concern, and set an appropriate benchmark for taking care of any other issues uncovered: "We'd like to have you come back in so we can take care of your whitening. We think we can really get you in great shape with that. And we'll look into those other areas we talked about and make a great plan for taking care of those then." Docs, plan to make a plan, and leave it at that. The hygienist and assistant will handle the details before and after your check. It will often work out that treatment will be combined into the same visit, so while to you the difference is negligible, the patient having their priorities respected makes a very significant difference to their satisfaction with us as a practice. If we respect what they want, we will have many chances to treat them in the future.

Affordability

Second, we take care of the patient and create trust and a positive experience when we bring up the topic of affordability before they do. By letting them know that we understand that affordability is often the only block to accepting treatment, we are engaging the patient in a way that illustrates empathy, our understanding of the experience from their perspective. The doctor covers the bases categorically and lets the patient know that the whole team is on the specifics:
"We'll make this affordable for you. Marnie [my assistant] will look into that. We'll maximize your insurance and take great care of you."

Confidence, Coordination, Care and Trust

Handling treatment planning seamlessly as detailed above and elsewhere in the Platform, with perfect coordination, shows the patient that the whole team is on the same page and working together to take care of them in every way. This gives patients confidence in our ability to care for them, gets them out on time, and this nurtures and strengthens the trust they need in order to accept that the treatment plans we offer are what's best for them. Without that trust, we're not caring for patients as well as we can.

F2F: Greetings Face To Face Is a Tool

We use the 4Blocks to keep things clear, but excellence requires understanding how all aspects of your execution contribute to the overall result. Your ability to prescribe treatment that is accepted comes from your ability to make the patient feel comfortable and connected to. So never underrate F2F. It isn't a superfluous "nice-to-have," it's the first step to great care; consistently connecting with the patient supports everything else you do. Comfort requires a relaxed patient who trusts you. Your demeanor and ability to make a patient feel understood and cared for is the only tool you have for that job. Like any tool, using it requires developed skill.

When you focus on developing F2F, greetings are a logical place to start. Greetings When it comes to getting a handle on your F2F, greeting the patient is a worth some focus. Your time is very limited in hygiene checks. Perfecting your ability to unhurriedly greet the patient and make a sincere, warm connection in the time allowed is a challenge that must be mastered to take excellent care of patients. Until that greeting has happened and the connection has been made, focus on the person, not their teeth. This is an important rule of thumb that will serve you well. From the more formal "Nice to meet you __. May I call you __?" with a new patient, to deepening the rapport using purple notes, to reaching back and reactivating past conversations, to eventually greeting a patient with the sincere reciprocal familiarity that develops over many visits, the patient deserves nothing less than the warmest appropriate greeting. Greeting the patient is your first and most important touchpoint. Protect it. Don't be drawn into talking behind the patient or get interrupted before you are able to greet the patient. Cards can be dropped silently to share information, but the patient must feel that they are the only person being cared for in these moments. If they don't feel that way, we will not be able to build the necessary trust to do our best to care for them.

Comfort: Injections

An important bit of patient perspective is that patients expect injections to be uncomfortable. That's logical enough, but what it means is that no news isn't good news. Unless you regularly hear positive comments about your injection technique, it most likely makes the patient uncomfortable. This is why it's part of your 4Blocks that you aim to get your injection technique to the point where you're getting unsolicited positive comments about your injections. Listen to Dr. MacInnis describe the proper techniques for different injections and let your mentor know if you would like more information or a one-on-one demonstration to make sure you're on the same page with GP injection standards. There are some video lessons in the GP knowledge library, and more will be made upon request.

Comfort Means Efficiency

No dental patient wants to spend more time in the dental chair. Chrisad and other independent research organizations keep finding this out. That means that efficiency is key. Efficiency means less time in the chair. You will never be asked to slow down. Getting work done in fewer visits is more efficient. Once an area is frozen, it's best to get everything done in that area.

Tools for Comfort

For multiple procedures requiring longer patient time in-chair, mouth props and rubber dams make a big comfort difference. Mouth props are great at preventing trismus both during and post-op. Patients who haven't been able to compare the difference might need a nudge to try one for the first time. Recommend them to patients and let them know they can take it out at any time. Try rubber dams, but don't anesthetize the patient just to use them. There are less extreme methods for controlling the tongue.

Treatment Planning

Working with a team approach to treatment planning requires some adjustment. You only have 3 minutes to diagnose. You can't make a complete treatment plan in that time. When you come in the op to do your hygiene check, the hygienist will key you in to the areas of concern. The hygienist will have already discussed both the results of the exam and the patient's own concerns, and will have set the patient up to understand the treatment they will need you. They will deliver all of this information to you in the 3-Line Summary. Confirm and refine the diagnosis, but be careful not to undo in a moment what the hygienist has spent the whole visit preparing the patient to understand and accept. You won't be making a total, comprehensive treatment plan, but you will be deciding on next steps. As you examine the patient, think about what you can do at the same time as the patient's chosen concern, if there are any, and set an appropriate benchmark for getting it done.

Mindreading is Easy... and Comforting

When you can anticipate the patient's fears and concerns and handle them preemptively, you can actually remove them. Know what the patient is concerned about, and let them know that you will take care of all of their concerns before they bring them up. This single bit of mind-reading that takes only a moment and a few sentences makes all the difference. Take care of their financial pain, their aesthetic pain, and their physical pain.

1) Look after the patient's main area of concern when it comes to treatment: money. "We will make this affordable for you. We have a great treatment coordinator who will take care of you." If you can tell them how much it will cost right there, do it. That will be a major relief to the patient.
2) Speak to their physical concerns. "We're going to take care of that sensitivity for you. And I've got a needle technique... You won't feel a thing!"
3) And speak to their aesthetic concerns. "We're going to get that looking great." A team approach to treatment planning allows patients to get out on time understanding and accepting the treatment they need.

Additional Treatment: Treat the Patient, Not Their Insurance

This is about taking care of the patient through an attitude of volume dentistry. If you see something else while you're doing a procedure, do it. Show the patient what it is, and get their consent, obviously, but do it. They'll thank you doubly. Whether it's covered fully or not at all. The whole team is set up to deal with this situation so that the patient understands that we care about them and not their money. This creates a loyalty that's well worth whatever is written off in that single day and it's a policy that the best practices in the world know helps them grow like they do.