“Increased production solves most of your problems...”

It’s an old saying Dr. Milton Cook remembered hearing and understands well. “With the increased cash flow, you can invest in technology,” Dr. Cook said. “You don’t have to worry about replacing or buying new equipment. You can hire staff. You can fix most of the problems you have in your business.”

Located in Smithfield, Virginia (population 8500), Dr. Cook bought his practice in 2003, making him a third-generation dentist at his location. “This practice started in 1897,” Dr. Cook said. “When I bought it, it was one dentist, a hygienist that worked one or two days a week and one receptionist and one assistant.” Taking the old saying to heart, Dr. Cook quickly built up hygiene to where, prior to joining Team Training Institute (TTI), he had one full-time dentist, a part-time associate, three hygienists, three front desk, and three assistants.

But then he hit a plateau. “It was stressful personally trying to keep everything straight from staff to overhead to patients to patient satisfaction to cash flow,” Dr. Cook said. “I was trying to manage it all. I was spinning my wheels on the management side, trying to keep the ship straight, so to speak. I’d never worked for anybody else or had any specific training in management.”

Seeking help on how to run the practice and looking to bond his team, Dr. Cook signed up for Hygiene Diamonds training after his Henry Schein dental supply representative recommended they see Wendy Briggs.

After attending the half-day training in late September 2019, Dr. Cook didn’t hesitate when he made the decision to join TTI. “I was looking for some help on the business side as far as how to set up systems, how to define roles, how to define job descriptions,” Dr. Cook said. “I knew I really needed that help, so I didn’t hesitate a whole lot when Michelle, my office coordinator said, ‘I think we should do this. I think it’s a good program and we’ll benefit from it.’”

Dr. Cook increased production by128% in 6 months despite being shut down for 2 of them.

Their production increased from $100,000 per month to $126,000 per month by the end of October 2019. When their TTI coach came in early December 2019, their production increased to $128,000, even though they were closed for a week during the holidays. By January 2020, their numbers jumped to $165,000. In February, production increased again to $185,000 after hiring a full-time associate halfway through the month.

In March 2020, they were on track to double their production, when COVID-19 forced Dr. Cook to shut down on March 17th. Despite the partial month, they produced $114,000–more than what they used to do in a whole month.

On May 1st, Dr. Cook reopened his office. By May 28th, his numbers had reached $228,000, a 128% increase in just six months’ time–four months if you subtract the two months he was shut down. In addition, patients are benefiting because he and his team are focused on taking better care of the patients he already has. Here are the big takeaways and “aha moments” that made the difference:

1. Remove Your Capacity Roadblocks

While others were looking at how to pull back, furloughing employees and cutting costs during the forced shut down due to COVID-19, Dr. Cook looked for ways he could expand his practice.

“We have literally doubled since taking on TTI,” Dr. Cook said. “As the owner of the practice, what I have learned is the true definition of capacity blockages. What capacity really means and what is preventing you, what roadblocks you have capacity wise.”

“During March and April when we were shut down, I added two new operatories,” Dr. Cook said. “And I hired another hygienist. I knew coming back that we were going to be packed because we were rescheduling 20, 24 people a day. I knew I was out of capacity as far as doctor chairs and doctor time availability, so I expanded chairs to provide for that. I think the expansion has a lot to do with my increased production,” Dr. Cook said. “And that’s what Dr. John told me at the retreat. He said, ‘You have a doctor capacity issue, you just can’t get them in.’”

2. Keep an Open Mind

Michelle Keckler, his front office coordinator and lead hygienist was interested in doing team bonding but had reservations before attending the Hygiene Diamonds training.

“Whenever they talk about consultants coming in, I immediately would put up a wall,” Michelle confessed. “I’d think, all they’re going to do is tell me, ‘You’re doing this wrong; you’re doing that wrong. You’ve got to see more patients--shorter appointment times.’ That was always my fear. But Wendy wasn’t like that. The surprise to me was that there were so many small things we could focus on that we were already doing, but not to the capacity we needed to do them and that could make big changes. We left that day with a lot of aha moments from the information Wendy had given us and we were all ready to jump right in as soon as we got back to work.”

“It’s really homed in on the whole team aspect because, at the end of the day, we cheer for each other’s accomplishments,” Michelle continued. “Because it’s all for the greater good. And that’s the goal—that the office will profit and do well. That goes from the front office to the dental assistants, to our insurance coordinator to the hygienists.”

3. Let the Patient Decide

Explain things to patients, especially when the patient can benefit from the treatment, even when their insurance may not cover it. “Wendy explained that it should be left up to the patient to make that decision,” Michelle said. “We shouldn’t do that for them or assume we know how they want to proceed with treatment.”

4. Add Same-Day Dentistry

Before TTI, Dr. Cook only did same-day dentistry in emergency situations. The simple change of allowing patients the option to take care of problems immediately made a big impact, cancellations decreased and production increased. “Asking a patient, ‘Do you want to get that taken care of today while you’re here?’” Michelle explained. “So many people respond ‘absolutely!’ And that was something very simple we weren’t doing. We were automatically scheduling them back for another appointment.”

Same-Day Dentistry also encourages patients to follow through on the care they need. “Just the other day, when we told a patient we can do it right now, she said, ‘Are you serious?’” Michelle said. “When we said yes, she said, ‘Wow! Now I can’t even wait and try to think of a reason why I can’t do it.’”

“Same day dentistry is what really drives our practice,” Dr. Cook said. “Hygiene, now that it’s profitable, is a big component. It makes up anywhere from 30% to 50% of our production on any given day. And then our same-day treatment is another 30% of our production.”

5. Offer Sealants and Fluoride to All Patients

They are now protecting more teeth too. “We are doing a whole lot of sealants now because we really never offered it to adults at all before,” Dr. Cook said. “We’ve always offered fluoride and had a decent fluoride acceptance rate in the mid-sixties. Our goal is to bump that up even more. When we started offering sealants to adults, we started seeing a lot of acceptance from adults on that. A couple of hygienists will do 20 to 25 in a day.”

Despite initial reservations about the time it would take, everyone in the office stays on schedule. Anything they don’t have time for, they plan for the next visit. Dr. Cook and Michelle agree that the hygienists who were the most worried, ironically are now the best implementers and the most profitable.

“There was a concern by hygienists when we first started,” Dr. Cook said. “Like, ‘I’m not going to have time to take the extra X-rays and talk to the patient about it. I’m not going to have time to do four sealants on somebody.’ And they’re doing 20 now. It’s interesting to see that when you get them emotionally involved in the process that they really take it to heart.”

6. Do Whatever it Takes

To handle the pent-up demand, Dr. Cook did Hygiene Blitz days every Friday and kept his practice open for the full week after re-opening. To ensure he had a full schedule, he followed Dr. John’s advice and had someone answering and working the phones every day during the shutdown. “I had staff here during the entire break rescheduling people for whatever our anticipated open date was... Sometimes that meant scheduling for a day that we thought we were going to start off and then the week before the governor would say we’re not opening, so I had to move them again.”

7. Create Systems

“I am working on creating systems so that the next person coming through will be able to follow it easier,” Dr. Cook said. “And I’ve established a management team just at the last monthly meeting. That is brand new and we’re starting to work that out. I’m learning delegation.”

8. Transition Staff to Leadership Roles

“I learned you can’t do everything,” Dr. Cook said. “You need to give responsibility to people and make them responsible and accountable.” Dr. Cook is building a management team and transitioning staff to become lead persons in charge and make decisions on their own without requiring Dr. Cook to tell them what to do.

Michelle, who had never done any kind of management before, found TTI coaching gives her confidence in her new role as front office coordinator. She also says, it “feels good that Dr. Cook is putting a lot of trust in her.” “Dr. Cook came to me a couple of years ago and said, ‘I need your help,’” Michelle said. “But I was basically doing the things that he told me to do. With TTI, our business coach has outlined what a typical office manager should do and given me reports I should be running, things like that.”

9. Be Flexible

Being open to doing things that are not the norm is important. “A mantra that TTI talks about that I like is, ‘Never say no, always try to say yes.’ In other words, don’t put up roadblocks for people to get treatment or have treatment done or to come into the office. There’s a TTI video I’ve watched and it’s about taking away all the roadblocks and then you’ll have as much work as you want.”

In one example, a patient was upset because his insurance co-pay was higher than he expected because it was out of network. After some back-and-forth offers to reduce the co-pay the patient still was unhappy. Dr. Cook forwent the co-pay altogether, a move he wouldn’t normally do. “The patient said, ‘I really appreciate the way you handled this and I’m going to go find another insurance so I can keep coming here.’” Michelle said. “You could potentially save a whole family worth of patients, and he could bring you more patients—for just a hundred plus dollars co-pay.”

“Without TTI, we would still be doing the same that we’ve always done--spinning our wheels and not growing,” Dr. Cook said. “For me personally, it’s rescued me from getting burned out from dealing with everything.”

“Before TTI, the hygienists had gotten into a mundane, day-to-day of seeing patients,” Michelle said. “TTI has encouraged them and gotten them excited again about doing hygiene. Plus, Dr. Cook is doing the production-based compensation, so it gives us a real goal to aim for. Coming back from the pandemic, if we had not started this before, I think we would be in bad shape right now.”

Dr. Cook is continuing to apply the steps of the TTI process. “I did not need to reinvent the wheel to make a successful practice,” Dr. Cook said. “The TTI systems out there are proven to work and can show you how to do that. You just have to believe in the process.”