Dental hygiene appointments are so much more than “just a cleaning.” Comprehensive care involves many components beyond scaling and polishing. In many cases, hygienists see a patient more than any other member of the dental team. We build relationships and see conditions and patterns as we collect important patient information. We inform patients about our findings and prepare them for what the dentist may recommend. How do you translate all this information to the dentist? Are the messages you’ve been sharing with patients echoed to the dentist or are you misaligned?
Here’s an example of a patient with poor oral hygiene. You worked hard to remove the heavy biofilm, calculus, and stain. You delivered solid information to the patient to help facilitate change. The dentist then told the patient that everything looked good because he or she didn’t know how poorly the patient presented at the start of the appointment. Similarly, the dentist may have observed an area of concern when the patient was last seen, but you did not reiterate that information at the hygiene visit.
If the dentist does not have any knowledge of the information you shared with the patient, and if you did not know what was most important to the dentist regarding that patient, you’re like silos. Siloing is a lack of information sharing between different divisions of the same company. Several studies show that it can reduce efficiency, productivity, and morale.1
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This happens more often than it should in dentistry, and it’s frustrating for everyone. It can feel akin to a turf war. From a patient perspective, it’s confusing to hear different things, and this can impede their treatment acceptance. Lack of consistency can also lead a patient to minimize something important or feel a lack of trust because of the contradictions.
Where the handoff helps
This is where devising and fine tuning a solid handoff can improve communication and increase patient outcomes, dental literacy, and commitment. It also decreases frustration and fosters an environment of mutual respect and teamwork. Studies have shown that employees who feel they’re used to their highest potential have greater levels of career satisfaction and loyalty, and feel they are part of something bigger. When people feel valued, retention rates and productivity increase.2 Here are five components of a stellar handoff.
Create systems: Work as a team to create systems that clearly outline what procedures and conversations are expected in the hygiene room. It’s important to have consistency. I refer to it as “the process of care.” As an example, have you ever worked in a practice where each hygienist structures the appointments differently? Every provider should be allowed to be an individual, but the components of a routine visit in the same office should not differ from provider to provider.
If one hygienist focuses solely on scaling and periodontal assessments while another performs a full range of assessments such as airway evaluation, cancer screening, risk assessments, and more, it’s not only confusing to patients who may see both providers, but it eliminates the necessary consistency for a handoff and continuity of care.
Another helpful component is clear communication of treatment guidelines. In the most cohesive offices, the providers are calibrated. For example, what is the office protocol on periodontal treatment recommendations? At what point does the dentist recommend referrals or certain types of treatment? This helps communicate a consistent message and avoids confusion and contradiction. It’s important to also involve the business team in this messaging and handing off patients to them at the end of appointments is critical for seamless and well-coordinated care.
Design a handoff blueprint: The dentists and hygienists should coordinate on what the handoff will look like. They should consider preferences, communication style, timing, and allocating appropriate time for the handoff and exam.
Inform patients: The hygienist’s time with the patient is the time to share ideas. Involve patients in what is happening, why it’s important, and show them evidence (photographs, charting, a hand mirror). Part of this involves telling the patient not only what you see and why it’s a concern, but also that this will be brought to the doctor’s attention for diagnosis and treatment options.
Hold a pregame huddle: For the next phase, the hygienist privately gives the dentist a brief synopsis of the key areas of focus. Prepare the dentist by including complaints, refusals of treatment, required diagnostics, or any perceived barriers or objections you may have observed.
Pass the baton: Finally, hand off to the doctor in front of the patient. This is where you provide the doctor with a concise and thorough summary of the appointment. This allows the patient to hear the information a second time, which helps with understanding and acceptance of treatment recommendations. Forty to eighty percent of health-care information is immediately forgotten but hearing the information again can help.3 Additionally, patients hear the information a third time when the dentist performs the exam.
Make it a stellar handoff
The timing of this is what separates a stellar handoff from a mediocre one. After greeting a patient, the dentist should ask the hygienist for information before starting the exam. “You’ve just had a comprehensive visit together. Would you bring me up to speed?” This is where the hygienist discusses what was done and discussed in terms the patient understands. It may sound like this:
“I performed perio maintenance and took new bitewings. Janet had no complaints with the function and look of her teeth. The head and neck exam and oral cancer screening did not reveal anything suspicious. The plaque and calculus deposits were moderate, and the gums were very inflamed from that; the pockets are getting deeper. I’ve left the gum chart up for your review as well as the x-rays, where we can see more bone loss around the roots of the teeth. We talked about how you were concerned last time where the old filling was breaking down. Janet also reported occasional pressure sensitivity on that tooth, and we talked about the possibility of a cracked tooth or clenching and grinding. Janet, do you feel like that covers everything?”
When we hand off this way, we’re part of a cohesive team. When systems are in place, it can lower exam time. Patients are often more committed to necessary treatment. Last, it allows the team to capitalize on each other’s strengths and make the best use of time. Patients like to see the mutual respect and collaboration and how closely the team works together for their best interests.
References
- 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.2 019;6(3):998–1005. doi:1002/nop2.279
Kessels RPC. Patients' memory for medical information. J Royal Soc Med. 2003;96;(5):219-222. doi:10.1258/jrsm.96.5.219
