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Monday, December 1, 2008

Newsletter Archive- Managing Risk

Dental Office Waiting Area
Dental Office Waiting Area in Juneau, Ak
Platinum Strategies for Protecting Your Million-Dollar Practice

By Linda Harvey, RDH, MS, LHRM
Horizon Consulting Group, Inc.
Dentistry has experienced significant changes that have dramatically impacted the delivery of care. Innovative communication tools and technology offer exciting advancements, yet they also present new risks. Whether you seek to maintain or attain a million-dollar practice, risk management is an important tool that can help protect all of your assets.
Designing and building a risk-proof practice doesn’t happen overnight. It begins with a clear vision of what you plan to accomplish. Next design risk management as a core operational function to tie all the vital clinical, business, and financial functions of your practice together. Remember to view risk management as part of the ongoing maintenance process.
Traditional versus the new risk paradigm.
Risk management has historically transferred risk and minimized loss through different types of insurance coverage. However, current events, new regulations and rapidly changing technology contributed to the need to redefine risk. These changes paved the way for Enterprise Risk Management (ERM), a progressive approach to risk management that incorporates traditional loss exposures, yet is significantly more comprehensive.
Platinum strategies for implementing ERM
This new model recognizes that risk management begins in the planning stage and remains part of the core structure of all of your systems and processes. Successful dental offices strategically and proactively integrate risk management throughout hiring, team building, financial planning, communication, and documentation procedures. The four platinum strategies below can help you develop a comprehensive program for your practice.
Platinum Strategy #1: Discover the six domains in your practice management program where there are underlying risk management considerations.
ERM expands risk beyond the traditional categories into six areas known as risk domains. These domains relate to six key areas in your office. They are:

  • Operational
  • Financial
  • Human capital
  • Strategic
  • Legal and regulatory
  • Technology

  • Risks rarely occur as a single isolated event. In fact, they are quite interwoven. The ERM domains are fluid and frequently overlap, thus any given risk may exist in more than one domain. For example, you can expect an employment issue (human capital) to impact operations and finance.
    Platinum Strategy #2: Identify recordkeeping habits that could make or break your defense.
    With the growth of electronic records, recordkeeping has become more important than ever. Electronic record systems require a substantial investment of time, effort and money. The transition from paper to computer must be planned and executed properly otherwise, unforeseen gaps in documentation may occur. As a result, quality of care is compromised as well as your legal defense should a suit be filed.
    Whether paper or electronic, simple details such as the words you choose when writing progress notes may or may not convey your intended meaning. Subtle differences in the meaning of words or the manner of expression may affect quality of care, patient safety or the outcome of litigation. How well your notes are written can mean the difference between having patient-centered defensible records or self-serving defensive records. Good recordkeeping habits must prevail.
    Platinum Strategy #3: Recognize subtle communication patterns that can turn potential legal complaints into platinum customer service experiences.
    Increased emphasis is also being placed on team communication and dynamics. Given the fact staff interact with patients far more than you do, training in risk communication has never been more crucial. Risk communication is consists of good customer service skills, expertise in handling difficult patients and understanding the subtle difference between a complaint about quality of care versus a threat to sue. How you (or your staff) say what you say makes a difference.
    Verbal communication with patients must also be captured in writing. Recall those times when you discussed concerns, obtained informed consent or had an after-hours telephone call with a patient. When key patient-related information is discussed, the conversation must be documented. Over time your memory will fade and a judge or licensing board is far more likely to believe the patient.
    Platinum Strategy #4: Leverage teamwork and develop a “no-losers” policy to ensure a culture of safety.
    Providing quality care in a safe environment is directly related to the strength of your risk management program as well as the culture of your practice. The culture of a practice consists of the attitudes, beliefs and norms of a team. The culture of your practice is also directly related to your leadership abilities.
    A culture of safety refers to the beliefs, attitudes and support processes that exhibit how patient safety is valued in your practice. Developing a culture of safety involves nurturing a positive environment where everyone can freely discuss safety concerns and offer solutions. This culture is based upon trust and respect, rather than blame and finger pointing. Having a “no-losers” policy signifies everyone is a winner when it comes to supporting a culture of safety.
    Your million-dollar plan As you identify, evaluate and select new products and equipment for your practice, you must continually identify and evaluate risk to protect your practice. Now is the time to ask yourself whether your risk management strategies are reactive in nature or are they well-built into the infrastructure of your practice. Prevent sleepless nights spent worrying about your practice by building a solid foundation.
    Linda Harvey, RDH, MS, LHRM
    Linda Harvey teaches dentists how to protect their million-dollar practices through effective risk management and patient safety. She holds current licensure in both healthcare risk management and dental hygiene. Linda’s programs complement management consultants whose clients need a specialist in risk management.
    Linda is co-author of the Dental Risk Prevention series and is a featured writer in trade journals, publications, and newsletters. Her courses are approved by the Florida Board of Dentistry to fulfill disciplinary sanctions. She works with private practices as well as facilities that are AAAHC and Joint Commission accredited.
    Clients internationally utilize Linda’s training systems, so they can focus on what they do best -- providing exceptional patient care. Linda can be reached at RiskTeam@LindaHarvey.net or www.LindaHarvey.net.

    Monday, September 1, 2008

    Newsletter Archive- The Use of Lasers in Hygeine

    A “LIGHT” Era in Dental Hygiene — The Use of Lasers in Hygiene

    By Jeanne Godett, RDHEF

    The use of lasers and laser calculus detecting probes in my hygiene practice has shed a new “light” on the possibilities for improved patient care. Because of these technological advances, my job as a hygienist has never been more exciting and rewarding on a daily basis.

    One exciting innovation is the DIAGNOdent® Perio Probe, a new laser tool that can detect calculus that cannot be seen or felt by standard root planing and scaling. Since calculus fluoresces differently than healthy tooth structure, this device’s laser emitted from the end of the perio tip not only detects deposits, it then sends a quantifying signal to the display indicating that calculus has been found.

    For some patients, this new technology offers renewed hope for treatment they had to forego previously because of other health concerns. One patient’s story illustrates the success that we have achieved by implementing this technology. Our 32-year-old female patient reported a clean health history. BCP was the only medication, no known allergies, no recent illness, surgeries and/or hospitalizations, no artificial joints, valves, or prosthetics. Her blood pressure was 110/81, pulse 87. She did indicate, however, a family history of diabetes. Her lower left molar had chipped, and part of her restoration had fallen out. A periapical X-ray was taken along with a bitewing X-ray. The examination indicated that the patient had periodontal disease and the foundation for a permanent restoration was in jeopardy. “Laser light” came to the rescue in this complicated case. The tooth was prepped and temporized while the periodontal infection was treated.

    We treated the upper left quadrant first due to the severity of the infection present, after placing anesthetic into the vestibule. We detected calculus in this quad by using the Perio Probe and removed the calculus using micro-ultrasonics, hand instrumentation, and then repeated micro-ultrasonics. Because of the bactericidal properties of the diode laser in the periodontally infected pocket and its ability to decrease the pathogenic microbial population, we completely disinfected the whole mouth using the GENTLEray® 980 laser prior to any treatment. After reprobing and getting no calculus readings on the Perio Probe, we removed the diseased and infected epithelial lining and restored the tissues to health. Because the diode laser has an affinity for melanin and hemoglobin, we were able to selectively remove the diseased epithelium and disinfect the pocket, leaving only the healthy tissues to rebuild. The upper left quadrant had 8 mm pockets on the distobuccal of Tooth No. 14 and mesiobuccal of Tooth No. 15. These pockets were treated with Arestin® (LAA) and retreated in 21 days. Only the laser was used to decontaminate these sites. The patient then returned at two-week intervals for retreatment of the infected sites throughout the mouth until disease remission was achieved. After three months, the patient returned for a reevaluation appointment and full-mouth reprobe. Although there was more bleeding than I would have liked, the pocket resolution was incredible. The only area that needed retreatment was the distolingual of Tooth No. 32. Arestin was applied in this area to maintain health until third molars are extracted. We advised the patient to have a physical evaluation and be tested for diabetes. The patient’s home care included a Sonicare® toothbrush, CloSYS™ toothpaste and mouthrinse, along with daily use of Johnson & Johnson REACH® access™ flosser and tongue scraper. She was placed on a 12-week bacterial load monitoring interval, to be adjusted as necessary to maintain health.

    This is just one example of the success that we have experienced with our new laser technology. As a hygienist, I am grateful to the out-of-the-box thinkers and inventors of these laser and probe products that help treat infection. Those of us who have the pleasure of using lasers are witnessing bone regeneration and health improvement for our patients. We can now watch tissues heal.

    As one of the clinical instructors in the comprehensive hygiene course at the Las Vegas Institute, I am privileged to work with hygienists from all over the country and expose them to the latest technology in laser and probe products. Laser technology has ignited a light from within, putting excitement back into my career.

    Jeanne Godett, RDHEF, has been making a professional difference in people’s lives for more than 25 years. Her insatiable desire for continuous improvement in her professional skills has taken her from a proficient RDA, to the UCLA School of Dentistry’s RDAEF certification, and on to an RDH degree from San Joaquin Valley College in Visalia, becoming the 17th RDHEF within the state of California. Jeanne’s focus on providing the best patient care at the highest level of value-added services for the practice led her to expand into the area of consulting. She routinely meets with hygienists throughout the United States and Canada providing instruction, guidance, and productivity guidelines related to hygiene and the use of lasers. Today, she is also the director of LVI Global’s laser program and clinical instructor for their comprehensive hygiene program. Jeanne is able to share the knowledge she has gained over the years to many new and revitalized members of the dental profession. For more information on the LVI comprehensive hygiene or laser certification courses, please contact: LVI @ (888) 584-3237 or www.lviglobal.com. You may contact Ms. Godett at jghygiene@aol.com.

    Newsletter Archive- Are You Listening to the Correct Expert?


    Are You Listening To The Correct 'Expert'?
    by Tony Patrick

    Dental Office Exam Room - EnviroMed Design Group
    Dental Office Exam Room - EnviroMed Design Group
    More than likely you understand that surrounding yourself with a good team greatly improves your chances of success. In your office the members of this team can include dental assistants, hygienists, lab technicians, office managers, and various other staff personnel. In addition, your business team typically includes an accountant, an attorney, and in many cases, a practice management consultant.
    The question is: Would you ask your hygienist for tax-saving strategies? Or, would you seek the advice of your accountant for ways to improve procedure acceptance rates? Probably not. And, the reason for this is simple. A team member’s expertise in one area does not necessarily translate into another. That is why, when analyzing the optimal size and layout of the office, the best way to finance a project is to restructure your existing debt, or simply determine how much debt you can afford. The best practice is to engage the services of experts who specialize in dental office design and commercial finance. Do not let your loyalties, or the egos of existing team members sway you from seeking expert advice.
    Here’s an example. A Finance Geeks client was recently offered financing from two separate lenders to finish out a new leased office space. After reviewing the information with his accountant, he was advised to move forward with the 7-year loan versus a loan of 15 years, simply because the interest rate was 1.50% lower. When the client suggested that the resulting cash flow would be tight because of the higher debt payments, the accountant advised that he should forego his retirement contributions in order to service the new debt until his practice grew and cash flow sufficiently increased.
    What?! Delay retirement contributions?! Delaying a $3,000 per month retirement contribution for just 5 years results in over $1,000,000 LESS in a retirement nest egg 20 years later. This is the cardinal sin of wealth creation and can result in the loss of millions at the time of retirement. I am certain that this accountant is very good at what he does. Otherwise, the client would not continue to keep him as part of his team. However, this is a prime example of what can occur when advice is solicited from the wrong expert.
    Determining the actual cost of building a dental office and deciding on the correct debt structure are only reasons why you should surround yourself with a team of experts during the office project. To be honest, I could probably list another 50 reasons but they all boil down to one resounding theme: “You don’t know what you don’t know.” Unfortunately, many dentists find this out only after they have accepted advice from the wrong expert or have made numerous mistakes on their own that have cost them several thousands of dollars. In many cases, the doctors will never recover financially.
    What is the optimal square footage for your office based on your practice performance? What is the REAL cost of building that office? How much can you afford to borrow for your project? Is it better to lease or own? If building an office, how much land do you require? What are the required set-backs? What is the estimated cost for your office and equipment? What is the financial GAP for your project (and, believe me, you’ll have one)? These questions and more need to be answered before you move forward with your project. Do you know the answers? One of my favorite sayings is “intelligence is no substitute for experience”. If you’ve tended to be successful at everything you have done, you may be at risk for thinking your success in one area will be applicable in another. Expansion projects involve the highly specialized areas of design, construction, real estate and banking. Hiring a team of Experts to take you through the process may be the edge you need to come out on top and will help you avoid the numerous $100,000 mistakes that are possible. For more information on hiring a team of experts to help you explore your options and empower yourself with knowledge BEFORE potentially exposing yourself to enormous financial risk, consider EnviroMed Design Group’s Project Evaluation Service. Click here for more details.

    Friday, August 1, 2008

    Newsletter Archive- A Simple Spring Cleaning

    Dental Office Waiting Area- EnviroMed Design Group
    Dental Office Waiting Area- EnviroMed Design Group
    A Simple Spring Cleaning can Help Ease the Stress of Relocating to Your New Dental Facility - AND Improve Your Practice Profitability

    Mary Wiebusch, CDA, Practice Administrator

    Whether you are ready to begin the design phase of your new office or still in the early research phase, the time is right to do a little “pre-move” spring cleaning! With very little effort, you can probably uncover visuals and brochures that you have forgotten about. You can also assess what is valuable within your current daily practice and what you should discard to make room for new technologies and products. You may discover inconsistencies within your documentation regarding comprehensive patient recordkeeping. A critical objective within spring cleaning is to promote a refreshed and renewed attitude regarding patient care. The goal is to bring passion back to your patient communication and education. The net result will be increased patient retention, case acceptance and increased profitability.
    Our JP Institute Educators typically note numerous areas in every office that would benefit from a careful evaluation. The following areas should be evaluated during your spring cleaning…

    Chart Analysis

    Pull ten charts at random for each hygienist and doctor. Review the documentation or software templates. You may find that one or two key items are missing from all records. The number one priority is to discover what areas need refinement. The next objective is to formulate what is needed in order to make the refinements occur. As an example, if your team is spending significant time with case presentation and determines there is not enough time to include thorough documentation to support the comprehensive health of the patient, you may need help. When quality time is being spent on the clinical needs of the patient, reviewing pending treatment and other tasks are not completed as meticulously as they could be, a support person may be needed. Depending on the current size of your office and number of hygienists and doctors, this may be remedied with intermittent help from current team members or it may require a full time addition to the team. When carefully orchestrated, asset allocation of team members can be one of the most resourceful strategies in your business plan to increase efficiency and profitability.
    CHART ANALYSIS
    CHART ANALYSIS FOR DATE


    Please mark each item listed with a “Y” for yes, “N” for No, or “N/A” if not applicable.
    ________Health History Update signed and dated at last hygiene visit.
    ________Health History Update signed and dated at last doctor visit.
    ________Periodontal Screening documented at last hygiene visit.
    ________Bleeding tendency recorded at last hygiene visit.
    ________Comprehensive Periodontal Evaluation completed annually on all patients.
    ________Oral cancer screening documented at last hygiene visit.
    ________Blood pressure recorded annually.
    ________Current Radiographs present in record:
    ________BWX (within 1 year of last visit)
    ________FMX (within 3 –5 years of last visit)
    ________PANO (within 3 – 5 years of last visit)
    ________Notes re: patient’s current co-therapy recorded at last hygiene visit.
    ________Informed consent prior to periodontal therapy recorded with a patient signature, OR
    ________Patient’s verbal informed consent prior to periodontal therapy recorded.
    ________Patient’s decline for diagnosed treatment recorded and signed, if therapy was declined.
    ________Patient’s current periodontal condition can be determined from documented data.
    ________Patient’s current diagnosed interval for hygiene can be determined from documented data.
    ________Treatment rendered reveals a patient with disease without a diagnosis and / or treatment plan.
    ________Patient has incomplete restorative or aesthetic or periodontal treatment.
    ________Date restorative treatment was diagnosed is documented.
    ________Clinical indications for restorative treatment documented. (Caries, fractures, open margins, etc.)
    ________Initials of provider recorded.

    Technology

    Evaluate all of the technology and equipment in your operatories. Ask yourself the following questions: Is this equipment in good working order? How often is it used? Do team members need additional hands on training to use this equipment effectively? Do you run behind when you use this piece of equipment? How can we improve our time management? Is using the equipment adding value to our patient’s experience? Are we increasing the clinical health and value of our services? Are we increasing case acceptance? Is this equipment easy and efficient to use?
    This spring cleaning will assist you in determining if new or upgraded technology is needed or should be integrated into your new office design.

    Co-Therapy Tools

    How many gadgets do you have that get patients involved in their own care? Are they all being used? How much space do items that have not been used for more than a year occupy? Now is a great time to assess these tools and determine whether they are in fact valuable for patient compliance or just taking up valuable space. We all have our favorite gadgets and The JP Institute is no exception. Over the last 29 years we have been exposed to numerous co-therapy tools. The JP Institute maintains that the best tissue results and patient compliance is achieved with use of the Philips Flexcare power brush. You will dramatically reduce the space required to stock co-therapy tools by providing the opportunity for your patients to purchase a Flexcare. Patients will value this home care device because they invested in it, and many just like the technology of using a power brush. As an aside, power brushes are the absolute best co-therapy tool, and a must for any aesthetic dentistry.
    Many offices choose to include the gift of a Sonicare to the patient who is completing a large restorative or aesthetic case. The brush, used daily, is a reminder of your office each time the patient uses it! Using the correct verbal skills is important whenever you give the patient a gift. In this case you could say “Mrs. Jones, we are so happy to provide you with this Flexcare power brush as a gift. We appreciate you being such a wonderful patient. This very special gift is one of the most powerful tools you can use to keep your teeth and gums healthy. Because you have trusted our office to support you with optimum dentistry, we would like to review with you what it will take to achieve your goal of a healthy mouth for life!” At that point you would review co-therapy, re-care intervals, and naturally any other treatment pending.

    Instruments

    How many dull and over-sharpened instruments do you own? As part of your spring cleaning, be sure to inspect hand instruments, EMS Piezo tips, and micro-ultrasonic inserts. Do you have your instruments color banded with tray set-ups? Are you finding bundles of old, unusable instruments just taking up good useable space? Proper instrumentation is crucial to patient results and to the time management of your appointments. Expediting your appointment to allow more time for patient education and case presentation is the key to ensuring long-term patient retention. Proper instrumentation with well-maintained equipment will give you the benefit of both.

    OSHA and Environmental Supplies

    Deep down at the very back of the cabinet underneath the sink lives a plethora of opened sterilization supplies that were just the thing to use until the next best product showed up on your doorstep. Take an inventory of what you have, and then get rid of the expired products, bottles and jugs you are not currently using.

    Visuals, Brochures, and Hand Outs

    You are getting close to completing your spring cleaning project! You are digging through the last drawers and shelves that house a massive amount of patient education materials. As mentioned earlier, there may be some fun surprises waiting for you at the bottom of the drawers. That perfect brochure on implants that you had forgotten you purchased is waiting to be found. Once again, it is important to discern the value of the handout to the patient and to your practice success. If you are not sending visual documentation of the diagnosed procedures home with your patients, you have uncovered another missed opportunity of perceived patient value. Handouts of published articles pertinent to the patient’s diagnosis are also wonderful additions for those analytical types. A hanging magazine wall file works great to organize those loose articles that benefit patients understanding of the dental services that you provide.

    Celebration

    Once you have completed your spring cleaning it’s time to celebrate! Your office will run more efficiently AND be more profitable. Another added benefit: you will have less to pack and move when you relocate or remodel! Enjoy the results of your spring cleaning!
    Back to the Beginning: As you advance through the process of planning your new dental facility, it is imperative that you have a well-structured plan of action. Enviromed’s Start Up Kit is a great place to begin. Utilizing the experienced Enviromed Team will ensure that you design an efficient space while saving many dollars by preventing unforeseen pitfalls. The JP Institute’s expert, custom designed curriculums can assist you by maximizing your current profits and increasing your case acceptance that will allow you to have the practice of your dreams!

    About the Author

    Mary Wiebusch, CDA, Practice Administrator
    Her passion for practice administration progressed from her 30 years of diverse talents as a CDA. Merging her strong clinical background with her experiences as a Program Director of dental assisting, she has become proficient in communications, case presentations and office management. As an experienced leader, coach and trainer, Mary has expanded her career as a trainer for The JP Institute, providing training in the ‘business reality’ of dentistry. Through the JP Institute, she offers solutions designed to develop a profitable and enjoyable dental practice combining clinical and practice management refinements.
    The JP Institute offers continuing education training for the entire dental team. JP specializes in analyzing and refining practice philosophies, business systems, hands-on implementation of clinical skills, technology and product integration.

    Tuesday, July 1, 2008

    Newsletter Archive- Hailey's 7 Leadership Lessons: Lesson #7

    Lesson #7: Follow Up Daily, Measure and Ask: Are We Meeting Our Goals?
    By Suzanne Black; President, The Coaching Center, LLC
    Urgent Care Waiting Area
    Urgent Care Waiting Area
    In Lesson #1 we talked about the importance of creating a vision. Lessons 2-6 all focus on what it takes to reach that vision. Lesson #7, our final lesson, completes the circle of what is necessary to make the vision a reality. It is about measuring our progress.
    Some of us are better than others of us about setting daily goals and checking our progress. Some of us get up in the morning and make a to-do list. We monitor our lists throughout the day, checking off completed items as we go. At the end of they day, we know what we have done and what we still need to do.
    Others of us are more random and spontaneous. We don’t like feeling limited by a list. We want the freedom to change direction, be impulsive, and explore multiple options. For us, lists are boring and constraining.
    While freedom and spontaneity are good in some circumstances (international leisure travel, for instance) daily follow-up and measurement are necessary for the successful accomplishment of business goals. Disciplined assessment is important.
    So, what can you do to insure that you are accurately assessing progress toward goals?
    First, make a point to keep goals in the forefront of everyone’s mind. List-makers know that out of sight is out of mind. Keep a list of your goals on your desk in plain sight. Post your goals on the walls in your business to remind your employees of your goals. Each day, at the end of the work day, ask yourself: Did we make progress today in meeting our goals?
    Second, create ways to measure your accomplishment. For instance, if one of your goals is to create a more comfortable atmosphere for your patients, you need to know how you will evaluate your progress.
    How will you know if your patients feel more comfortable? You need to clearly identify markers for progress if you expect to accurately measure progress.
    Third, now that you have created ways to measure your goals, use them! Measurement tools don’t work unless you use them. Schedule regular meetings where individuals are assigned to bring in measurement data. Discuss findings and how you will continue with good results or work to improve on results that aren’t as positive.
    Fourth, practice management by wandering around. Effective leaders know about the bad news barrier – the line in the hierarchy at which the bad news stops in its movement up the ladder. The only way you will know if you are meeting your goals is to walk around and talk to employees and clients. Be seen, be heard, and listen!
    Accomplished goals are your steps toward reaching your vision. Keeping goals in the forefront, creating ways to measure progress, measuring it, and wandering around will guarantee that your goals are met.
    Intentional action is the difference between success and failure of a vision. These past weeks, we’ve given you Hailey’s Seven Leadership Lessons – the tools for success. Now it’s all in your hands.
    Go out there and do it!

    Newsletter Archive- Hailey's 7 Leadership Lessons: Lesson #6

    Lesson #6: Be a Servant Leader and Show How Much You Care. Ask: How Can I Help You with Your Assignment?
    By Suzanne Black, President, The Coaching Center, LLC
    Dental Office Front Desk - EnviroMed Design Group
    Dental Office Front Desk
    When was the last time your boss asked you: What can I do to help you? It’s not a question most of us have ever heard coming from our bosses. Most bosses lead like Dilbert’s boss, in the cartoon, Dilbert. The boss gives the orders and Dilbert follows obediently questioning the directive every step of the way. Servant leaders are different. Hailey’s 6th leadership lesson guides us to be servant leaders.
    Servant leaders are directed by a few key attitudes that make them atypical. In fact, some of the key tenets of servant leadership are directly contradictory to traditional Dilbert leadership models.
    What do you need to do to become a servant leader?
    First, you must genuinely care about your people. While traditional leaders ask themselves how their subordinates can serve them, servant leaders tend to put others first. They continuously ask (themselves and others) how they can help.
    Second, as a servant leader, you must see yourself as a steward of a valuable resource – your people. Servant leaders take the time to coach and train employees. While traditional leaders might simply terminate a subordinate who isn’t meeting expectations, servant leaders will try to understand why the employee isn’t as successful as he or she should be and assist them in meeting expectations.
    Third, you must value justice and equality. Servant leaders will take the time to know employees and understand the unique gifts of each employee. Servant leaders are more likely to support diversity efforts and programs that encourage success for employees from diverse backgrounds. They recognize that promoting diversity is good for people and good for business.
    Fourth, you must understand that indebtedness is a part of leadership. When supervisors view leadership as service, they recognize that both leaders and followers owe each other certain things. They recognize the mutual commitment they have to their relationship and are willing to be responsible to each other as they work together.
    Fifth, and perhaps most important, you need to understand your own ethics and values to be an effective servant leader. Servant leaders lead and are led by a clear moral compass. This moral compass will help you create a positive ethical climate in your organization. Servant leaders are open to others and willing to examine their own attitudes and values.
    But the question remains, why be a servant leader? The answer is simple. If we empower our employees to do good work, it only stands to reason that we support their efforts. In the long run, service to others will win over self interest. Successful team members who are led by servant leaders will out-perform self-interest-only team members every time. Really!
    Some of the ideas for this article came from: Leadership: A Communication Perspective (4th Edition), Waveland Press, 2004.

    Newsletter Archive- Hailey's 7 Leadership Lessons: Lesson #5


    Lesson #5: Delegate, Empower, Measure, Inspect What You Expect and Have Specific Outcomes.
    By Suzanne Black; President, The Coaching Center, LLC
    Dental Office Waiting Area - EnviroMed Design Group
    Dental Office Waiting Area
    As we learned in Leadership Lesson #4, no person is an island. Counting on others is necessary for making your vision a reality. Hailey’s Leadership Lesson #5 focuses on delegating, empowering, and overseeing progress toward successful outcomes.
    The first part of the lesson tackles delegation. In order to be an effective leader, you must know when to delegate and to whom to delegate. While you might trust your fourteen-year-old with the lawn mower, you might not trust your nine-year-old with the lawn mower. However, your nine-year-old might be great in the kitchen and you would trust him to cook dinner – but perhaps not with a complicated recipe. This metaphor can be used with team members -- each person has her or his individual skills and talents. Understanding and delegating appropriate tasks will improve the likelihood of success.
    Letting go is the hardest part of delegation. Can I really trust him? Will she do an effective job? Questions like these swim around in the heads of leaders considering delegating. Delegation is hard because most of us don’t trust one another. The number of Americans who believe that most other people are trustworthy dropped from 55% in 1960 to just above 30% in 2003 – and that number may be even lower now. In other words, the average manager trusts only 3 of 10 team members!
    Delegation, then, requires a leap of faith. If you delegate appropriate tasks to appropriate individuals, you will be confident in your decision and success will likely follow. That success makes it easier to trust the next time you need to delegate. The positive cycle is created.
    Delegation won’t work without empowerment. You wouldn’t ask your fourteen-year-old to mow without a good mower or your nine-year-old to make dinner without the proper utensils. Think about the “tools” your team members need to complete the tasks you’ve delegated to them. Tools can be tangible resources (e.g. money) or intangible (e.g. power). Without the correct tools, they are bound to fail.
    Ongoing coaching of team members is also critical. Measurement and inspecting outcomes becomes important. Just like you wouldn’t send your fourteen year-old out to mow without a mower, you wouldn’t send him to do the task without explaining how to mow and how you expect the lawn to look when he is done. On-going coaching is important, especially when the task is new. Measure and inspect what you expect on a regular basis. Once is not enough support for most people.
    When you delegate, empower, and follow up, you transform. Transformation occurs in team members because they have increased ownership over the outcome. Transformation occurs in you because you are no longer a leader who simply tells people what to do. You have now become a leader who creates change – in people and your practice.

    Newsletter Archive- Hailey's 7 Leadership Lessons: Lesson #4

    Lesson #4: Surround Yourself with People that Commit to Your Vision
    By Suzanne Black; President, The Coaching Center, LLC
    Dental Office Entry - EnviroMed Design Group
    Dental Office Entry - EnviroMed Design Group
    Athletes know it. Presidents know it. Musicians know it.
    They know that their success, to a large part, depends upon surrounding themselves with people who commit to their vision. Without a great quarterback, the running back can’t get the touchdowns. Without great advisors, the president’s policies will fail. Without backup singers, the musician’s music won’t sound as sweet.
    Hailey’s Leadership Lesson #4 is to surround yourself with people that commit to your vision. Why is this important? There are several reasons.
    First, no person is an island. In order to accomplish what you want to accomplish, you need help. Surrounding yourself with individuals who are committed to your vision will guarantee that you get the help you need to make your vision a reality.
    Second, surrounding yourself with people that commit to your vision guarantees that you conserve energy for appropriate tasks. When you surround yourself with individuals who aren’t committed to your vision, energy is spent unnecessarily. Faced with cynics, leaders spend a lot of time convincing others of the value of the vision. When that happens, time and energy are detracted from making the vision a reality.
    Third, when you put together a team committed to a shared vision, it is easier to attract the right people to your organization. When the vision is clear and shared by all, it is apparent to potential employees. When the vision is clear and shared by all, individuals who interview potential employees understand who will fit and who won’t fit.
    Perhaps the most compelling reason to surround yourself with people that commit to your vision is because a shared vision creates synergy. Researchers who study emotions have know that emotions are contagious. In other words, if someone around you is displaying negative emotions, you are likely to catch some of those negative emotions. It’s kind of like a virus – a little exposure might not affect you – but prolonged exposure will! When people don’t commit to your vision, their negativity will contaminate you and others. As hard as it may be to say goodbye to those who can’t support your vision, it is essential for success rid yourself of that negative energy.
    The good news is that positive emotions are also infectious. When you surround yourself with people who are committed and positive about the vision, that positive energy is shared. Gloomy Gus’s will bring you down. But excited team-players will buoy you up every step of the way.
    Surrounding yourself with people who commit to your vision makes sense. When you surround yourself with people who are committed to your vision, you possess more than just their hands, you also possess their hearts.

    Newsletter Archive- Hailey's 7 Leadership Lessons: Lesson #3

    Lesson #3: Always Practice Active Listening. Ask for Feedback
    By Suzanne Black, President, The Coaching Center, LLC
    Dental Office Lighting - EnviroMed Design Group
    Dental Office Lighting - EnviroMed Design Group
    “You’re not listening!” Ever heard that complaint? Most of us have. And it is no wonder that many of us have heard the complaint – contrary to what most of us believe, listening is very hard work. And, it is essential to excellence in leadership.
    Hailey’s leadership lesson #3 addresses the importance of listening: Always Practice Active Listening. Ask for Feedback.
    When asked, most people will tell you that they think they are pretty good listeners. Statistics indicate otherwise. According to the International Listening Association, 85% of what we learn, we learn through listening, yet we remember only 20% of what we hear. 75% of the time that we are listening, we are distracted, preoccupied or forgetful. Fewer than 2% of us have ever had any formal listening training.
    When we examine what is involved in listening, it’s no wonder that many of us have challenges with effective listening. Listening is actually a four step process. In the first step, we hear – simply take in the sounds. In the second step, we sort – retaining the important sounds (what someone says) and letting go of the unnecessary sounds (background noise). Third, we add meaning to what we have heard. We apply what we know about the topic, the speaker, and even the setting to the words we hear. And finally, we must recall what was said. Effective communication only occurs when the sender and the receiver “hear” the same thing.
    Distractions are prevalent in our culture and they can make listening even more difficult. Cell phones, I-pods, televisions, computers – all can distract from careful listening. Likewise, mental distractions such as thinking about something you must do later or thinking about something that has just happened, can function as distractions. To listen actively, you must rid yourself of the physical and mental “noise” that prevents you from being an effective listener.
    Active listening and asking for feedback go hand in hand. Listening leads to learning. When you want to learn more about yourself from others, ask for feedback.
    Requesting feedback can feel threatening because soliciting input about how we are doing can make us feel vulnerable. It is much easier to wander down the road of life comfortable in our own vision of ourselves than to hear what others think of us. But feedback is essential to growth. You must be open to both positive and negative feedback and avoid the tendency to get defensive when you listen. You may also be pleasantly surprised at the positive things you hear!
    The following suggestions can be helpful when you solicit feedback. First, listen with an open mind. Second, breathe. Breathing will help you maintain an open mind. Third, take notes on what is being said. This will give you accurate information to reflect upon as you consider the feedback. Finally, take some time to understand the feedback. Ask questions for clarification; repeat back what you hear. You may conclude after considering the feedback that the comment is completely inaccurate, OR has a grain of truth, OR is “right on.” Whatever you conclude, you now have the data, and this information is powerful in developing yourself as leader.
    The Chinese character for listening includes images of ears, eyes, AND the heart. Effective listening and seeking feedback will improve your understanding of others and of yourself. By doing so, you will become a more effective leader. You’ll be amazed at the things you can learn when you open your eyes, ears, and heart to others.

    Newsletter Archive- Hailey's 7 Leadership Lessons: Lesson #2

    Lesson #2: Share the Vision Clearly, Creatively, Continually, Mastermind with Others.
    By Suzanne Black, President, The Coaching Center, LLC
    Dental Office Corridor Remodel - After - EnviroMed Design Group
    Dental Office Corridor Remodel - After -
    EnviroMed Design Group
    You’re on the golf course. You’ve gone for a quick round at twilight – the last person out in a group of one – just you and the course. On the fifth hole, you hit a shot and know immediately that it is a great shot. Everything about it feels right. As you watch, the ball hits the green and moves with impressive momentum on the uphill slope of the green moving toward the cup. Your ball slows but still has some momentum and is edging slowly toward the tiny hole on the green. You stand in disbelief as it drops in the cup! It is astonishing – something you’ve hoped for your entire adult life. But your excitement is suddenly interrupted by the reality of your situation. You’re alone. No one has witnessed your hole-in-one.
    Like a hole in one on the golf course, your vision will become more “real” if you share it with others.
    What does it mean to reveal your vision to others? According to Lesson #2, the vision must be shared clearly, creatively, and continually while masterminding with others to make it a reality.
    Let’s examine each element of that lesson. First, you must be clear. In order to communicate your vision to others, you must know how to “speak the language of the others.” For instance, giving instructions to a five-year old is different than giving instruction to an adult. When you communicate your vision clearly, consider your audience and use the language and symbols that will mean most to them.
    Second, you must communicate your vision creatively. Great leaders know that words alone are not enough to communicate vision. Actions speak louder than words. Former CEO of Southwest Airlines, Herb Kelleher, knew this lesson well. Not only did Kelleher talk about his love for his company and it's people – he acted on his words by displaying affection and care toward his employees and customers. The communication of vision can come in the form of words, but actions and other symbols also convey the vision in a powerful manner.
    Third, your vision must be continuously communicated. You must become obsessed with your vision and communicate that obsession to others. People pay attention to obsessions. Say it, write it, act it – over and over again.
    Fourth, mastermind with others. Energy that is enslaved is wasted energy. Synergistic solutions emerge from interactions and work with others. Share your vision with others and see how freely the energy flows.
    Henry David Thoreau said: I know of no more encouraging fact than the unquestionable ability of man to elevate his life by conscious endeavor. Our ability to create a vision and have a mental picture of our future is a characteristic that is uniquely human. Yet many of us are hesitant to share our vision. Don’t waste this opportunity. Get out there and share your vision clearly, creatively, continually, while you mastermind with others to make your vision a reality.

    Newsletter Archive- Hailey's 7 Leadership Lessons: Lesson #1


    Hailey’s 7 Leadership Lessons

    Lesson #1: Create and write down your Core Values, Vivid Vision Vibrating Vibrantly (V4), Mission, and Goals
    Dental Office Corridor - EnviroMed Design Group
    Dental Office Corridor
    By Suzanne Black, President, The Coaching Center, LLC
    It’s happened to all of us. You are driving in a new city looking for a particular spot. All is going well when suddenly you realize that you are lost. You can’t find the street you are driving on anywhere on the map. Just a minute ago, you knew exactly where you were!
    For most of us, the initial panic of being lost turns to resolve as we pull over to the side of the road, unfold the map, and figure out where we took that fatal wrong turn. We orient ourselves to our new location and get back on the road.
    Getting lost can happen on the road of life as well. We are cruising along, knowing where we are and where we are going when suddenly we realize that we are lost. Perhaps our work life is off track -- or our family life -- or our spiritual life. Lesson One of Hailey’s 7 Leadership Lessons is all about getting back on track. Even if you aren’t lost but want to go a different direction, Lesson #1 will help you get there.
    What is Lesson #1?
    Create and write down your core Values, Vivid Vision Vibrating Vibrantly (V4), Mission, and Goals.
    According to Lesson #1, being on track involves understanding what you value. Reflect on two questions to determine your values: First, what do I care about? Second, what do I spend my time doing? The answers to these questions will give you a sense of your current values. It might help to segment your life as you answer the questions. What do you care about and do in your job? What do you care about and do with your family? Etc. For instance, you might write that you care about and spend a lot of time in your job talking to people. That response gives you a clue about the extent to which you value relationships.
    Take some time with this activity. What you truly value isn’t always readily apparent.
    Also, you may find that your answers conflict – that what you care about is different than what you do – e.g. you care about your family, but spend most of your free time with household responsibilities. If so, Lesson #1 will provide you with an opportunity to get yourself back on track.
    The second part of Lesson #1 is to create a vision that is vivid, vibrating, and vibrant. Once you have determined what you value, you can identify your vision (where you want to be). The important part of vision is realizing that seeing is believing. In order to get where you want to be, you must create a mental image of your future. Write the image using colorful language (vivid). Fill that image with pulsating energy (vibrating vibrantly).
    Third, identify your mission. The mission is your plan – your grand scheme of how you will get to where you want to be. For instance, if you identify that you value positive relationships with clients, your mission will be to create those positive relationships. If you discovered that you value your family, but don’t spend a lot of time with your family, your mission will be to spend more quality time with family members. While vision helps you identify where you want to go, mission and goals help you get there.
    Finally, set goals. Goals provide you with concrete steps to get to your destination. A goal for improved client relationships might be: Each year I will take my client to lunch on his or her birthday. Ask yourself: What steps do I need to take to reach my vision?
    Whether your are lost in a city or lost in life, understanding what you value, where you are and where you want to be, and then crafting a plan to get there is key to finding your way. Hailey’s Lesson #1 will give you the help you need to realize your dreams

    Thursday, May 1, 2008

    Newsletter Archive- Digitizing Dentistry

    Digitizing Dentistry

    Brian Kroeger, Director of Technology Services

    EnviroMed Design Group

    The American Dental Association estimates that 91% of the dentists in the United States have at least one computer in their practice while fewer than 10% use them to record, enlarge, store, and transmit x-ray images of a patient's teeth. There was a time in the recent past when there was a valid reason for this. The imaging equipment was bulky and expensive while providing marginally diagnostic images. A now expansive market of equipment manufacturers and the maturation of the specialized dental technical support industry have vastly improved the size, effectiveness, and total cost of ownership of these systems.

    What all this means to you is that there are now convenient and relatively inexpensive ways to greatly improve the profitability of your practice. With digital x-ray equipment, you can clean up your office by getting rid of the chemicals and making space for a more efficient system. The space formerly occupied can house a digital panoramic x-ray or a phosphor plate scanner, speeding up the amount of time it takes to get a good diagnostic image. In addition, a digital x-ray system proves its efficiency when it is needed to retake images, because you can note any errors immediately and correct the shot with the patient still in the chair. Using digital imaging facilitates quick processing of insurance claims and allows you to easily share diagnostic images with specialists and transfer patient images to another provider.

    In addition to digital imaging, chartless offices are becoming more and more common. This system has the benefit of speeding up file retrieval and improving organization. Your patients can fill out forms from their homes on your website, speeding up the check-in process. However, the strongest benefit in a chartless system is the safety of your records. If in the event of a tragedy, a well-backed up network makes it possible for you to have up to date records so you can continue to practice and access your patient's records the very next day. Since all of these systems are HIPAA compliant, they also offer far superior protection for your patient's personal information; something a few shelves full of file folders cannot provide.

    Modern offices integrate entertainment, providing patients maximum comfort and relaxation during procedures. Treatment rooms feature high definition televisions where your clients can watch television and movies. Chair mount headphones offer music on demand. A digital dental office also allows you to provide Invisalign to your patients, perform voice-activated periodontal charting and provide superior patient education.

    These things are all available to you now at a much lower cost than you think. You will find that most software and equipment is easy to use and requires a minimal learning curve. The most timid of assistants will find themselves pleasantly surprised and definitely relieved at how easy it is to work in a digital dental practice. You will too.
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    Once you have made the decision to go digital, what do you do next? It is necessary when beginning this process to formulate a good plan. Consult a technology expert proficient in the dental industry and indicate what your wants and needs are for your office.

    Speak to fellow colleagues who have made the move and find what they recommend. Ask them what they would do differently if they were making the move again and what things they would do the same. Contact the company that provides you with practice management software and see which products and systems their product supports.

    Most importantly, find a technology expert who specializes in the dental industry to perform the upgrade and integration. Ask any technology provider for a list of references and other offices they have digitized.

    Making this move can be scary, but following the above suggestions will ease you into a modern dental practice. Before long, you will reap the benefits a digital dental office provides.

    Saturday, March 1, 2008

    Newsletter Archive- Cost Segregation Study

    What is a cost segregation study? (Part 2) - Bob Durfey, PE, EnviroMed Design Group

    A cost segregation study separates the costs of a building into various class lives to establish depreciation schedules for income tax purposes. The study may also be used for determining insurance requirements or to validate (or invalidate) property tax assessments. The conclusions of a study cannot be relied upon to avoid IRS penalties. To best grasp cost segregation, one needs to know about and understand depreciation and how the Tax Code has evolved over the last 20 years to where it is today.

    IRS Publication 946 defines depreciation as "an annual income tax deduction that allows you to recover the cost or other basis of certain property over the time you use the property. It is an allowance for the wear and tear, deterioration, or obsolescence of the property." The key to depreciation is "over the time you use the property." Being able to allocate a shorter "time of use" to an item will provide larger depreciation amounts sooner, and thus more deductions for income tax purposes. It is to be noted that taking a larger depreciation sooner means that the deductions will be used up sooner. The advantage is that there is earlier use of the money from tax savings.

    The tax codes in force during the 70's and early 80's provided tax benefits for building owners by establishing shorter and/or accelerated depreciation schedules for items that were deemed non-structural elements of a building. This component depreciation breakout also provided investment tax credits for some of these items that were deemed to be personal property. Then along came the Tax Reform Act of 1986.

    The Act eliminated component depreciation and established recovery periods which placed non-residential real estate into a 39 year category with land improvements generally in a 15 year category. This was the system in use until the Hospital Corporation of America brought suit against the IRS in 1997 to restore a form of component depreciation by allowing property to be classified either as section 1245 or section 1250 property. Section 1245 property is personal property such as furniture, fixtures and equipment.

    The HCA ruling allowed certain related systems such as plumbing and electrical items that support FF&E to be considered 1245 property. It excludes a building and it's structural components. Section 1250 property is everything else excluding land and land improvements.

    Confusing? You bet! Check out the newsletter archives where the methods, qualifications and format of a study will be covered.