A dynamic duo: Collaboration between dentists and hygienists

Most states require hygienists to practice under some level of supervision from a dentist, but hygienists and dentists often agree that this relationship does not guarantee collaboration. Collaboration is “the action of working with someone to produce or create something.”¹ It is an interdependency of work, individuals, and teams. In a typical dental practice, the roles of dentist and hygienist are often very separate. The nature of dental hygiene practice is solitary, and much of our time is spent one-on-one with patients. Dentists and hygienists have different areas of focus, practice philosophy, and outcomes.

Many offices do not have a system in place where the dentist and hygienist meet regularly to discuss patient care, goals, treatment options, and more. In some cases, we’re not in the room with the patient at the same time. In the least collaborative arrangements, patients may not even hear the same information from each of us, which leads to frustrated providers and confused patients. This can greatly impact trust, job satisfaction, and patient treatment acceptance, all necessary elements for a practice to thrive.

Depending upon their relationship, the dentist and hygienist might be akin to silos, which are self-contained structures, and information and ideas are not shared between silos. “Siloing” describes a lack of information sharing between different divisions of the same company. It’s a mentality that several studies in business and health care show reduces efficiency, productivity, and morale.²

The benefits of collaboration are far reaching. The expanded pool of knowledge and experience, differing areas of expertise, and different styles each clinician brings leads to an environment of problem solving, as well as more comprehensive and coordinated patient care. With a coordinated partnership, there is less duplication of information and greater assurance that patients hear a consistent message from a well-calibrated team.

Studies have also shown that employees who feel they’re part of something and are being utilized to their highest potential have greater levels of career satisfaction and loyalty. When people feel appreciated and included, retention rates and productivity increase.³

How can we better collaborate?

Find the right partner.

Beyond a willingness to work together in a more symbiotic and collaborative way, it is good to have a shared vision, values, and philosophies. For example, some clinicians are conservative and have a watch and wait approach, compared to others who focus on prevention strategies and treating disease early. Clinicians who pride themselves on teasing through current evidence, and who favor new treatment modalities and advances in technology, would likely not partner well with someone who prefers the tried and true.

Have clear communication and expectations.

The best partnerships lay groundwork for how they will work together. What are the office’s values and goals, and how are you working toward them together? How does that translate to patient care? This must be clearly communicated for successful collaboration. It is important to discuss what it meant by “partnership” to ensure you’re on the same page.

What is expected of each of you? Consider the following:

Create a clear and consistent process of care for expectations during hygiene appointments and exams. Have this in writing.
Have clear treatment guidelines and calibration among clinicians.
Understand each other’s communication and work styles and be aware of each other’s challenges and frustrations.
Know the dentist’s willingness to educate and the hygienist’s willingness to learn restorative philosophy and treatment options.
Establish clarity on when and how the exam will be done (is it after assessments, at the end of the appointment, when the doctor is available?) and the time spent. Also, have a well-orchestrated handoff of information in front of patients.

Have a well-orchestrated handoff.

In a previous article, I outlined the elements of a successful handoff.⁴ It is important to formulate a blueprint as a team. A stellar handoff includes:

Collection of thorough assessment information and diagnostics, patient complaints, oral health goals, and patient satisfaction with his/her function and aesthetics.
Discussion of observations with the patient, education and engagement regarding current dental conditions, and discussion of potential treatment the dentist might recommend. For example, the hygienist and patient may have discussed evidence of a cracked tooth and the patient may have seen photo evidence. The patient is prepared for possible diagnosis and treatment recommendations that the dentist may discuss.
After the dentist greets the patient, he or she asks the hygienist for an overview before starting the exam. This allows the patient to hear the information a second time, which helps with understanding and acceptance of treatment recommendations. It also avoids redundancy as the patient does not have to share the same information twice. An added benefit is that the exam takes less time and helps keep everyone on schedule.
This discussion in front of the patient, with the patient as participant instead of observer, is a perfect example of patient-centered care. Research has shown that patient-centered care and moving from an authoritarian role to a partnering role creates positive outcomes, including increased patient commitment and dental literacy.⁵

Develop mutual respect.

Respecting each person’s role and expertise is an integral part of a true partnership. No one person or role is more important than another in a collaborative relationship. Recognizing we have different areas of expertise and learning from each other is invaluable for growth. Trust is also important, along with honest and open communication, even when disagreements arise.

Establish accountability and measure outcomes.

It is important to regularly evaluate the collaborative partnership to celebrate the successes and identify areas for improvement. Having expectations, goals, and protocols in writing helps stay on track.

Dentists and hygienists have different areas of expertise, but they ultimately want what is best for their patients. When we combine efforts, we can accomplish this goal. Collaborative arrangements allow hygienists to practice to the best of our ability and training, which often increases career satisfaction and growth.

It takes a team to run a successful practice. A coordinated, well-calibrated team that communicates, respects each other, and works together for the good of the practice and patients will thrive on many levels.

References

Oxford Learners Dictionary. https://www.oxfordlearnersdictionaries.com/us/definition/english/collaboration
Gleeson B. The silo mentality: how to break down the barriers. Forbes. December 20, 2021, https://www.forbes.com/sites/brentgleeson/2013/10/02/the-silo-mentality-how-to-break-down-the-barriers/?sh=39084a808c7e
Ylitörmänen T, Turunen H, Mikkonen S, Kvist T. Good nurse–nurse collaboration implies high job satisfaction: a structural equation modelling approach.” Nursing Open. 2019;6(3):998–1005. doi:1002/nop2.279
Whiteley JC. Passing the baton: the value of a stellar handoff. December 1, 2018. https://www.rdhmag.com/article/16408092/passing-the-baton-the-value-of-a-stellar-handoff
Rosengren DB. Building Motivational Interviewing Skills: A Practitioner Workbook. The Guilford Press. 2018.