70: The Road to Alignment Between Dentists and Hygienists

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Hello, everyone, and welcome to another episode of DSO Secrets. I'm your fearless host, Emmett Scott, and we are here with some of the best people in the industry. I'm so excited. They were, like, willing to jump on. We've got Heidi Arndt, COO of Strive Dental, Josie Sewell, VP of Education at Dental intel, and Kathy Whiteley, who is the clinical training Director of staff at Community Dental Partners. Ladies, thank you so much for being on today in such short notice. I really appreciate it. So one of the things we're seeing is like this really big tension between dentists and hygienists. And I'm speaking globally, not individually. There's practices that this is really not even an issue. But as I have seen this on social media and politically and personally, etcetera, I just thought we got to take this on. Like, we've got to open up the conversation. We got to see where this happened. Maybe this is a little. My personality. I knew it was going to be your guys's personality. We can't let it just kind of sit there. So I want to just start with maybe just some basic education for those who, you know, we've got business leaders in this space as well. They're confused by this. I remember when I walked in and, you know, I always tell Dr. Evans that he drugged me into a civil war. I didn't know DSOs were evil and this was good and all of those things. So for some of our business leaders out there who are trying to understand this dynamic, and maybe we'll just go around here, the zoom, and start with you, Josie, but what's kind of the typical dynamic between dentists and hygienists? And maybe specifically, we'll talk about, like, what is the best dentist typically want? What does the best hygienist typically want? And then Heidi and Kathy, you guys can kind of feed in on some of the holes there as well. So. So, Josie, we'll start with you.

Thank you so much for having us. And I'm honored to be here with especially these wonderful ladies. You know, as a dental hygienist, I remember when I started practice, I had amazing relationships with the dentists that I worked with. And I felt a lot of, like, mutual respect and admiration and collaboration with them. And then as I started to get into leadership positions, I was the president of the New Mexico Dental Hygienist association for a while. And it was fascinating to me to get into more of that political landscape that you're talking about to find that there was this civil war, so to speak, between dentists and hygienists. And we did a lot of work to try to bridge that gap and think we did a good job. But, you know, it's something that I think has happened or has been around for a while. But I think that the stress and the worry and the anxiety of everything that we've been through has probably heightened that a little bit. So, to your point that, you know, in individual offices, there's probably some people who have great relationships that are sitting back and wondering, what are they even talking about? But on a whole, in general, we do typically tend to see some of that kind of back and forth, arguing back and forth. And, you know, I think that nobody is right and nobody is wrong necessarily. We all want what is best for each of us. For hygienists in particular, I think one of the things that we continue to struggle with is that our profession is regulated by another profession, so to speak. Right. That the ADA specifically speaks for us. And yet we have, like, the adha, and we want. You know, there's always this argument about access to care and expanding what we do for our license or being able to do it without a dentist present. And, I mean, there's all of this going on, but I think a large part of it is just really struggling with the communication between the two groups. And as we're all working from home, my son with autism just walked in, thought I locked the door. So I'm gonna pass it over to one of these.

Okay, great. Well, I think you brought up some great points, which is awesome, too. Cause we're all, like, juggling a thousand things right now, which magnifies stuff where maybe we had more patience. We were doing a little bit better on our communication. Maybe there were some rifts that were getting created. And now with a crisis, our capability to navigate some of those conversations goes down dramatically. So I do want to set the stage, though, like, so, Heidi like for the best dentist and the best hygienist, what typically is it that they're looking for from one another?

Well, I think it truly comes down to supporting each other. And as Josie was saying too, is we have to understand both sides of the table. And when it comes right to it, I think if I were looking for the ideal dentist to work for, as they have a similar philosophy, care to have clear communication so during this time that we've been apart, you know, closed down our practices and been gone, is to be communicated with. I'd love to have known what is our plan for reopening if we don't have one. I understand, but updating me on what's happening from a dental standpoint, because there's a lot of information swirling out there. If any of you are on these Facebook groups, they're insane. There's a lot of opinions, there's a lot of things. And some people take that as the ultimate truth and believe kind of left

the world of like science. Right. And. And part of it is there's even unknowns. If you're, if you're looking and kind of chronicling, you know, what the CDC said on this day versus that day versus that day, it feels like it's moving if you're following osha, et cetera. So it leaves a lot of white space for people to fill in the gaps. And to your point, on social media, we're more than happy to fill in the gaps. Right, yeah.

Well, and I think it's just true with this whole COVID 19 thing. I mean, we have people over here, we have people over there, even outside of dentistry. So we really have it in dentistry as well. So your question was ideal relationship.

Yeah, just even on a day to day, like, we'll take the COVID 19 because I think there's principles within that that you're already starting to hit on that probably feed up and maybe exposes to where the problems start, you know, way before you have any kind of crisis or so forth. But like, yeah, in that ideal situation, what is the best dentist doing? And one of the things I'm going to pull out that you said is they're communicating on a regular basis. Right. Whether that's the best dentist. And I would say this is from the hygienist perspective. The best dentists are giving feedback to the hygienist on a consistent basis on what the plan is, where you're going, why that's the plan. And I would guess that they're listening to some feedback too.

Absolutely.

Yeah.

And I think just general respect, I mean, ideal situation is respect between the doctor and the hygienist. Communication and philosophy of care is one that's near and dear to my heart. So those would be the three that I would choose for a most ideal relationship. And I think it's important too. And I've always said this, the hygienist has to understand that the dentist is a business owner. And we have to respect the fact that there are stresses when you look at anything from a business standpoint, not that it should make up for clinical, but you have to understand the big picture. So I believe that the hygienist has to be understanding of that.

And, you know, that's a really good one. That's a really good one. As I get feedback from clinicians, again, way before this, some of that disconnect in partnerships. And again, I think we can take this outside of dentistry. When you have a quote unquote partnership where one person feels like the buck stops with them and they're managing P and L and the other person isn't, you know, but still wants to be part of that partnership, it can always create a little bit of tension of like, do they fully appreciate what they're asking for? Do they fully appreciate what that means? Right. So, Kathy, I mean, you've been working up until just a couple months ago, like you were in the trenches, etc. So, yeah, you can really speak to this. Like, what have you felt and what's worked well for you and where were those points where you're like, didn't work so well?

Yeah, I think going along with what Josie and Heidi said, both it comes down to communication, but really that alignment factor is just key. I think Heidi said it well. You kind of have to think like a business leader. You have to think like the doctor. That's always been my mentality working in private practice is that a hygienist should be thinking ahead, thinking like the doctor. And I think if you do that, you can have really, really good alignment. But I think on the flip side that doctors to be really successful could kind of step back and think on the hygienist level too. I think I've definitely been in practices where the alignment has been really, really well and practices where that alignment didn't work as well. So I've seen both sides of it. But being on the same page and being aligned is key.

It's interesting because it's got some crossover. And then, Josie, I'll let you kind of take this. It's got some Crossover that I love that actually business owners on DSO sides and clinicians have to figure out as well. Right. There's always the trump card, which it sounds like can be utilized in this relationship too, where the clinician says, hey, listen, I'm the doc, Ultimately, I establish standard of care, you know, either put out or shut up or whatever, you know, and we're moving forward, which is technically true, but may not drive the ultimate result that the dentist is looking for. Right. For alignment, team support, et cetera. And at the same time, as you guys hinted at, there has to be that respect that, hey, ultimately, their dental license, their standard of care, they're moaning the practice, their financial piece is there, you know, can you get both parties to see that? So, Josie, go ahead.

Oh, I was just going to say, you know, we've touched on it on a high level, but sometimes I think just calling it out very simply and blatantly, a hygienist wants to feel like a partner, right? They want to feel like a partner in care. And particularly where I've seen most dentists and hygienists argue or disagree or become bitter, it's as simple as having a standard for their perio protocol and the hygienist feeling supported in what they're recommending because so many times they will spend an incredible amount of time educating a patient, doing all of the assessments. They start talking about perio, and dentists will come in and be like, oh, it's fine. So, you know, like, as much as we're saying clinical, you know, being aligned in clinical care, like bringing it down just a little bit more where, you know, they go to school for two years to learn how to. Or more. Right. To learn how to do those assessments and to do that. And so they just, they want that respect for that for sure. And dentists want the same thing. They want that treatment advocate, they want that person who will support them and recommend their treatment and be a partner with them. So it really comes down to having a standardized, like their standard of care and getting on the same page and calibrating, which actually solves a lot of the issues.

Yeah. Not only is the schooling there, but let's be honest, when you've been doing some activity for 5, 10, 20 years, you start feeling like you kind of understand some components of that. Right. And so having your voice heard, having that alignment. And I think one of the things that crises do is it amplifies everything, as we've said. And so if these little things, we'll call them little things, those Tactical things haven't been addressed, then how in the world do we have trust on the bigger things that need to happen as well? Now, Heidi, you're in a position now as coo, so you're getting to really see kind of both sides of this. You can live in the empathy of the hygienist. You're also, you know, running P and L and trying to make things happen. You know, what's some of the thoughts that have run through your mind as you've seen some of the alignment and misalignment and how have you all tried to solve some of that?

Yeah. So it's interesting. We started calling back our staff this last week, and it's been interesting for the most part, they all want to return to their family, which is the family that they worked with and work. Family is very, very important. However, there is a fear of safety. It's interesting, though, I'm only hearing safety concerns from hygienists and assistants, not from the doctors. So there's definitely a divide there. And I haven't been able to put my finger on it exactly why there is such a divide, why my doctors feel it's safe to go back, and my assistants and hygienists do not. But the one thing we've been trying to do is really communicate with them that we're on top of all of the standards out there, and we're doing everything to ensure we have a safe environment for our patients and our staff. And that's the thing that we keep talking about, is the safety of it. Obviously, this, the business side of it, there's a concern of the ramp up. You know, how quick can we ramp up? How many staff members do we need? What is it? What's the reality of it? And I think there's just so much unknown of that. And that's where I would want my staff to be flexible with me to understand that it's not just as easy of bringing everybody back to the world that we had before, because it's not the same world. So there's a lot of balance going on. And I, you know, from our behalf, is we just have to continue to communicate with them.

Yeah. And if we can be, you know, gentle with everyone out there, whether it's the staff, hygienist, doctor, you know, business owners, et cetera, none of us can say, oh, well, last time we led through a pandemic, you know, here was the formula that we used. Or this worked well, this didn't. Right. We're all really new to this Rodeo, you know, we all have to say this is our first rodeo trying to take this on. And so, yeah, I think you bring up a good principle there, which is kind of flexibility, etc. One of the things I see doesn't work really well is kind of this, well, you just got to get over it mentality. Right. Like that kind of shortcut. And as you said, there's a bigger divide on your perspective of COVID 19 and so forth. And I found that the only, I guess, bridge, and I'm curious your thoughts on how this might apply is to have empathy to both sides. Right. So, I mean, Kathy, as you think about staff coming back, how would you apply that principle or what have you seen that's working or not working?

Yeah. Heidi, I actually loved your comment about safety. I mean, so there's a lot of talk about safety. And I think if we really think about it, safety is not something that is new that we're feeling. I feel like safety has been around for a long time in our profession. We all want to feel safe. I remember. And this has nothing to do with aerosols. This has to do with just a different kind of safety. I remember a few years ago, doctor had a patient who was talking sexually explicit and I had mentioned it to my doctor and I had no idea what my doctor was going to do about it, but he immediately went in and dismissed the patient from the practice. He didn't question me. He didn't. He didn't wonder if I was telling the truth. He just took action because he trust. He had confidence in me. And he knew that he was never going to have an employee feel unsafe. That was super powerful. And I think we all from years going back, not just aerosols, but we want to feel safe in the environments we work in. We want to have confidence. We want our doctors to have confidence in us, and in turn, we want to have confidence in our doctors.

Wow, that's just such a great example. And I think it opens our mind too, that when we try to reduce this down to aerosols or a mask or something like that, we might have to step back and say, okay, where have we dressed safety in general? Well, and where have we not done as well? And where are we going to step this up? Josie, anything you want to add to that?

You know, as you were talking, I was just also thinking about safety, as in, can I be open and honest with my doctor? Right. So sadly, in poor leadership or poor management, the people we feel least safe from are those that maybe it's A toxic work environment or something like that, where maybe it's a leader who doesn't allow us to be open or honest or share our concerns. And so if we feel like we haven't been able to share concerns in the past, now, again, we're just talking about this, you know, exponential, difficult, complex thing that we're dealing with. So, you know, with the empathy part, many of the business owners have had to work through, you know, that change curve, right, Those stages of grief to get through things and get out on the other side. And team members maybe haven't been through that, you know, deciding and integrating to get to the other side, because they do need to feel heard and they need confidence and they need vision and purpose for the future. And we're just expecting them to be like, why are you over there? Like, you should be over here. Because we've had to get through that, because we've had to solve those problems. When you're in a leadership position.

That's such a great point on leadership. How many times I always say, do we outrun our coverage? You know, to use that football analogy, right, the guy who catches the ball is always the fastest one on the team. That's why you have him catch the ball. But he has to wait for the rest of the team to get into that V so that we can, you know, that he can get as far as he possibly can. And how many times, Josie, to your point that we, as the leaders, have been consuming data, we're the fast entrepreneur, et cetera. If we outrun our team, we might find ourselves in this situation, the only one showing up to the practice, which is going to be pretty painful.

And if we couldn't trust them before and just saying, hey, this is frustrating for me. How can I trust to talk now about something that affects my career, my family, my health?

I think some of that, too. When I don't have that trust, what I find I often do is, okay, I can't tell the real reason. So now I start layering back to other reasons, which makes it more difficult, right, for all the parties involved. So if the real thing, like you said, Josie, is, man, I'm still processing through this. I'm trying to navigate family, kids, whatever else, I still don't have a plan around here. In the ideal situation, I could open up, talk that through. Not having that. I'm layering in other items that now the leader has to kind of work through to get to the details. Heidi, anything you'd add to that?

No, I agree. I thought what Josie's point was so well stated because that is the root right there, what I think everybody is experiencing right now. And if this is a huge issue, it's pretty evident that there's been a lack of leadership on many levels. So I keep coming back to, there's so many lessons learned in all of this. It's amazing to me to reflect and think about all that everyone is going through and what lessons we can gather from it.

Yeah, I think too, and we won't totally dive into this, but on a political front, you have dentists that I think have felt insecure from the perspective of hygienists, kind of moving upstream into some of their capabilities. And I think that hasn't been addressed. And so instead of maybe addressing that, they've countered it with poor communication, creating blocks to the conversation, almost concerned that there's not enough pie to go around and that if they allow hygienists too much into the partnership relationship that they could take over. Now, I don't think Dennis have processed it that self aware, but in the conversations I noticed that that has come up is. Okay, wait, no. If we start letting hygienists help make decisions, help determine some of these things, you know, one, they're not sensitive to my P and L issues and number two, are they going to take over, you know, my career and I'm going to find myself sitting on the curb with hygienists running, running the shop. Any thoughts or words to that? One's a good button, isn't it?

Yeah. So I think you, you know, a lot of people say that hygienists cannot be a partner or be part of those discussions, but they've never allowed them the opportunity to have those discussions. I remember the first time I was introduced to the P and L and to information that, you know, affected the health of the practice. So KPIs and P and L, it was eye opening to me. It gave me a better appreciation for what the, what the decision makers were up against and helped me be part of the solution versus pushing back on what I thought the issue was. So I think we always think that, you know, they're making a decision based on money. But if we don't understand what that picture looks like, who am I to say that? So I think the hygienists, if they want to be a partner, they need to be part of the solution. But we need to give them the opportunity to understand they need to see

all the constraints that you're working against as well. Some vulnerability yeah. And have that clarity. I know as an employee, I always thought there was revenue minus my cost, plus a little bit more, and the rest went to the owner. I mean, I didn't know how else to calculate it other than that. So when I asked for raises, everything else, I'm like, how is this not possible? How is it, you know? And I think as we get exposed to P and ls, we're like, oh, now we know why that's not possible. And that's a challenge. Okay, so what's the road back? We're going to solve all the world's problems right here in a 45 minute podcast. But what are some things, you know, whether that be communication, cadence, Because I've heard a lot around that, like, you know, Kathy, start with you and then, and then we'll go around. But what do you think solves this, so to speak? Because at the end of the day, to me, the way you gain control of the future is to be honest about the past. Right. So if I can be honest, like, hey, this has been going on, I need to step it up. What would be some things to take control of the future?

Yeah. So I think, again, I think hygienists want to feel that respect and doctors want to feel that respect too. But I think if you have that mutual thought that we're better together, then I think you go a long ways in bridging that gap. I know, Emmett, you said at the beginning that some doctors will have that mentality that this is my practice, this is how I want to run it. But I also see on that flip side, a lot of hygienists, especially through this Covid time, have been very demanding on their expectations. So my thought going forward, especially as we come out of this Covid time period, again, we're learning a lot from it. But how can doctors welcome and help hygienists to feel that, to come back confident and secure and coming back? And I think I've seen some doctors come back to their hygienists and say, what can I do for you to feel safe come back? What can I do for you to feel confident in coming back? And I think hygienists can do the same for the doctors. What can I do for you to make this a easy transition? And what can I do to make it better for the staff and be a leader with you coming back?

Wow, that's powerful. Josie, what would you add to that?

You know, just really, really well said, Kathy. I think as much as if we imagine we're sitting on either side of the table as much as possible for us to come around, right. And come alongside and be on the same side of the table. So remembering that, hey, you know what, we both went into this because we wanted to take care of people. You love your patients and you want to take care of them, and I want to take care of them too. Right now we're getting there in two different ways. Right. And we're trying to get back to that. I want to get back to work. I hope that you want to get back to work. Let's just figure out, you know, what we need to do. To Kathy's point, you know, what do you need for me to feel safe and being able to talk through that? But the more that we can come alongside and remember what we're focused on and what we want out of, you know, all of this to be on the other side of it, then we can work together. Just knowing that we're going about it two different ways and providing them the information, you know, that they. That they need and what you've been through to work through all of those issues, even sharing some of that research, Right? So like Heidi said, giving them the opportunity to look at it in the same way that you did. And, you know, the other thing that I think about is we have, you know, if you think about who the loudest voices are right now, and a lot of those loudest voices are the people who are the most scared, and then we're all listening to the rest of them. So for hygienists that do feel safe, who have been back to work, who do feel like they have all of these things figured out for them to speak up and for them to share so that the rest of them, the rest of us can learn from them going through that too.

Yeah.

How many are just, to your point, so nervous and so scared that they. They do. They need someone to take them by the hand? And maybe not a dentist, right. It's even co hygienists and say, hey, I know the path back because I've seen some communication where it's like I'm looking for to create the path back and. And maybe there's some background there that. That we don't fully know, but it's hard to give someone a path that they don't know yet, and maybe that lack of trust. So I love what you're saying, Josie, is there's an opportunity for colleagues to get involved in this and really at the dentist level, like, hey, what worked for you? Because you obviously solved it. And also at the hygienist level, hey, you're feeling confident. I'm not. You know, where are we? Where can we get aligned? And where can I understand what I need to be communicating upstream? Heidi, what would you add to, like the communication cadence or the road back and maybe taking it even past COVID 19? Like, what are the lessons learned from this that we need to be doing even when it's not about PPE and that kind of safety?

Well, I always think there needs to be common communication between the team members. So I'm a huge fan of always having a regular set meetings every month to talk with your team about the most important things to both sides of the table. What's important to the operations side, what's important to the clinical side of the business. And be able to have that open discussion between both sides. You cannot ever let that communication stop because when it does stop, it becomes not important. That's what the individuals are thinking on both sides. It's not important anymore to anybody. So that has to continue. Even when we close down, we need to have that communication and constant communication. So I know we're looking at opening up in the state of Texas. I'm not sure where every other state is and what their plans are, but if I could do it all over again, I probably would have increased our communication in this downtime versus letting it be still. I kept it on kind of a almost a monthly basis, which we've only been out for like, what is it, almost two months. But I wish we would have had weekly discussion with them. So if I could do it over again, I would have had the communication much more consistent and constant.

Yeah. Again, if there's probably any big takeaway, we've all learned from this. If you're a leader and you have halfway of a mindset of wanting to lead into the future, it's wow, the power of consistent communication. Right. And I think to a point you all have brought up, if you don't make that a regular cadence, then what happens is one, emotions build up and when you're finally having the communication, it's so much more difficult. Versus hey, Thursday, 4 o', clock, time for that meeting Again, nothing. That's fine. Next Thursday, 4 o'. Clock. Yes. We need to tweak this, tweak that. How much easier is it than, you know, going forward? So I think that's a great takeaway. Anything else you guys want to close on? I mean, the principles. If we just all listen to this a couple times, the Principles you all have hit on. And I think, you know, the deep components that have created some divides within practices individually, like, there's some great takeaway. So, first of all, I want to thank you all for that and being vulnerable, because that. That helps. But anything you all want to close on.

I just have one more comment.

Oh, sorry. I think having your staff be part of the solution. So I know there's fear from the hygienists, there's fear from assistance. Create a solution. What is the solution to it? How can we make you make it a safer environment for you to return to? I will say that we did that with our doctors, and that's probably why they're not fearful about returning, because they help create the systems and protocols that we're walking back into. We should have included the hygienists in that discussion.

Wow, that's awesome. Yeah. And it's so natural to do that, right? To kind of include a certain set of team members and not the other, because you kind of need them to lead and then to go, oh, my goodness, we missed. We missed on this, and I should have known better. Good. Kathy, any other final thoughts?

Yeah, I was just thinking. I do feel like leaders get lost a lot of times in the mix of running their practices or running their businesses. And sometimes their staff, I just don't think really appreciates what they're doing for them. So if I could. Any takeaway from this experience is just to have gratitude as staff members are coming back on board. Have gratitude for those experiences and those stresses that your employer is feeling, your leader is feeling and relate to them and help them. I think everybody needs a. That a girl, that a boy every now and then. And if you have a moment to tell your leader thank you for what you've done on my behalf, I think that would go a long way in bridging that gap and just recognizing that they've been in the trenches and that their work is hard.

Thank you, Josie.

You know, these ladies actually hit on both points that I wanted to say, and it was, you know, even if we. My rule of thumb has always been, even if I know exactly what needs to happen and to do it, I come with my team with 80% and I let them fill in the 20%. So that that way we've worked together and they take that ownership of it. So allowing all team members in some way to participate in that and also being able to delegate. Right. So that you, as the owner or the leader, don't have to feel like you take it on, but giving clear expectations and allowing people to participate and delegate. What we've learned through all this is how much we need each other. And so let's find ways to work together and to appreciate each other and to build those relationships because the only way that we can get through this is relying on each other. So it's important to do that.

It's awesome. That's a great way to wrap this up. Thank you all so much. I appreciate the feedback. For those who have other thoughts or comments, please join us over on our private Facebook page at DSO Secrets. And until next time, keep smiling.

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