Q: I want to build up my Hygiene Department, but I’m not sure where to begin. Where should I start?

Building a super-productive Hygiene Department is a B-I-G topic on which I could spend well in excess of 10,000 words answering your question! That said, I want to give you a couple of key points to use as a “quick start,” to get things in motion and start seeing results!

Let’s start off with assessing the current condition of your Hygiene Department with the “Hygiene Formula.”

The Hygiene Formula

To determine where you start, we’d use the Hygiene Formula Here’s how it works:

a. Take your total number of charts. _______

b. Multiply “a” by 2. This is the number of potential yearly visits _______

(This is based on a patient needing at least two hygiene visits per year – obviously some need more, but we keep it at two to make things simple)

c. Subtract 40% from “b” above. Put “b” minus 40% here. _______

We’re subtracting 40% to account for attrition – people move, leave the practice, etc. This number should be lower – but again we’re being conservative.

d. Divide “c” by the number of weeks worked per year. _______

(There are 52 weeks in a year. Most doctors work 50 or less. Take a look at how much time off you take and work out how many weeks you work. “d” gives you how many recall visits you should be seeing each week).

e. COMPLIANCE PERCENTAGE: For this you’ll need your average number of actual recalls, how many patients you see each week on average for a recall visit – note this is NOT number of hygiene visits which might include New Patients or Scaling/Root Planning. This is only patients in for a 6, 4, or 3-month recall (so yes, periodontal maintenance would count in this number). We now divide number of ACTUAL recalls per week by “d” above for recall compliance percentage.

(Related: Patient Reactivation: How to Successfully Get Overdue Patients Back on the Hygiene Schedule)

Here’s an example:

Dr. Smith has 3,000 charts. She has one and a half hygienists seeing 40 recalls a week. The rest of the time, they are seeing new patients and scalings.

Here’s how it pans out for her office:

a. Total number of charts. 3,000

b. Multiply “a” by 2. This is the number of potential yearly recalls. 6,000

c. Subtract 40% from “b” above. Put “b” minus 40% here. 3,400

d. Divide “c” by number of weeks worked per year. 48 weeks so should be 71/week.

e. Divide number of ACTUAL recalls per week by “d” for recall compliance percentage.
This office is seeing 40 recalls, divided by 71 = 56% as a compliance percentage. Which is NOT very good – that said – I’ve seen much worse. We’re looking to be in the 80-90% range!

(Related: 6 Steps to a Productive Hygiene Department)

This indicates that the practice is losing a TON of patients out the back door. And keep in mind – we’ve already subtracted 40% to account for attrition and with that we’re still at 56% compliance!

Adding Hygiene Days

After you do the Hygiene Formula, you’ll have an idea of how aggressively you need to address patient reactivation (getting patients who are overdue or inactive back into the chair for recall), as well as how many hygiene days you should be adding per week.

Depending on your new patient flow, you should be adding at least one hygiene day per week for every 6 months to a year that your practice is open. For example, if you opened a scratch practice two years ago, you should have at least 2-4 days per week of hygiene (one hygienist working 4 days per week). If you’ve been open 10 years, you should have 10-20 days of hygiene per week (2-5 full-time hygienists). Again, with more new patients you’d be at the higher end of the expected hygiene days projections. To that point, we have clients that have one or more full-time hygienists within the first year of opening from scratch.

And the best way to add hygiene days is to simply open a day up in the future (at least 6 weeks away to be safe) and start scheduling patients for that day.

Make One Employee Responsible for the Schedule

And when it comes to scheduling patients, the wrong thing to do is to assign this to “everyone.” If it’s “everybody’s” responsibility it winds up being no one’s.

You must hold one person accountable to set up schedules, such as a Scheduling Coordinator, to keep everything organized. This person can check the statistics, like number of hygiene visits per week, active patients, cancellation rate, the hygiene formula given above, etc., and be proactive about growing the hygiene schedule and troubleshooting if the statistics are worsening.

(Related: Should You Hire a Full-Time Scheduling Coordinator?)

We have training for this employee is available on our online training platform at www.DDSsuccess.com, so you can get them started on online courses that will teach them exactly how to run the schedule and ensure your Hygiene Department is growing consistently.

Hygiene Department Production

Besides the Hygiene Department being responsible for adding a ton of case presentation opportunities to the doctor’s schedule, it should also contribute significantly to the overall production of the practice. When your Hygiene Department is functioning and every patient you have is being maintained and cared for, we expect hygiene to produce an average 1/3rd or more of the overall production of the month.

This breaks down into an average daily production of $1,500 per day. This, by the way, is not our number – it’s the actual average in the United States in a PPO practice, and it’s much higher in a practice that functions out of network. If your hygienist is not producing this average it will usually be for one of the following reasons:

  1. Too few of the practice’s patients are compliant with their hygiene visits.
  2. The Hygienist is treating all of the patient’s conditions, i.e. limited scaling, gross debridement, etc., but is not charging the patient for this and is just charging for a prophy.
  3. There is no standardized periodontal and/or hygiene and diagnostic protocol outlined by the doctor which ends up with patients that are clinically in need of more aggressive treatment than just getting “cleanings.” You might also have patients not having X-rays taken on schedule, etc. The doctor should set policy for this in his or her practice as a guideline for the hygienist(s).

In addition, you want to make the hygienist responsible for meeting their daily production goal. Even if you’re setting it at the national average of $1,500. A busy hygienist with a booked schedule has no difficulty meeting this goal.

(Related: 5 Simple Ways to Boost Hygiene Production)

The hygienist may have to do some homework and make a list of all the things that they are legally allowed to do to treat or assist in patient care, and then with a proper periodontal protocol laid out by the doctor – in writing – and proper scheduling – and being prepared for their patients (has reviewed the chart, knows what x-rays/treatment they need, etc.) it should be easy to meet this quota. They don’t have to do anything unusual with these patients – if they are booked efficiently, the work is there.

What if the doctor thinks they can do hygiene quicker than a hygienist and save the hygiene salary?

This is a common question I get regarding this topic. And the answer is it depends on how many patients charts you have and how many new patients you see. You must run the hygiene formula and see how many recall appointments you would have to see per day in order to truly do right by your patients. Consider that some of your patient base might need perio maintenance appointments and scaling as well. Determine realistically if you can handle this and still have enough time to educate patients on needed treatment. For the most part, we have not found this to be very workable.

(Related: 9 Ways to Fill Last Minute Hygiene Openings)

Unless you have a small patient base, I would usually suggest sucking it up and hiring a hygienist. The patients are there and it’s going to be very limited if you’re doing your own hygiene visits. I’d like you to be freed up for procedures that only the doctor can do, while patients remain active in your practice and maintain their oral health in your Hygiene Department. It may seem like a headache to hire more employees, but trust me, if it’s organized correctly from the get-go it’s much less of a headache than trying to do your own hygiene – from both a time and monetary perspective.


Now, of course, this is just a small amount of information on a huge topic, but I hope this can help jumpstart your Hygiene Department! If you want to learn more about building up a highly profitable and successful Hygiene Department, I couldn’t recommend DDS Success enough. With online courses, it’s easy to train your entire staff from the comfort of your office, see their progress, and get everyone on the same page! If you have any questions at all, feel free to email me at sabrib@mgeonline.com.


One Response to “Jumpstart Your Hygiene Department”

  1. ruben albarracin

    I love the way to make us understand and learn the possibility to make a significant improvement.THANKS.


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