As if you didn't have enough to deal with in trying to get patients to value the care you provide. In a comment on a recent post, a dentist relates the story of how she had to deal with a hygienist who continually did an inferior job. The hygienist responded that she had passed her Boards and had worked for another dentist during school. “If it was good enough for them, why isn't good enough for you?”

This is a tricky situation, and I'd like to take a little more room than usual here to address it. The issue here is likely her level of passion – and you can't legislate passion; you can only try to inspire it. But you certainly can't let comments like that go unchallenged. You've worked hard to set a standard of care in the practice, and you can't let anyone – whether an associate, a hygienist, or the person who answers the phone – compromise the standards you establish.

So the real question here is, can this hygienist be made into a good performer? The evidence suggests that it's quite possible. According to a study I have quoted many times, most people – about 58 percent – want to be successful, and given the right education, motivation, and systems can be made accountable to the process and to their results. At the other ends of the spectrum you have the high performers (the naturally hard-working and the naturally gifted) at 34 percent. Only about 8 percent of people are genuine low performers who lack the ability to succeed, and I don't think anyone who can successfully graduate from hygiene school belongs in this category.

We all know that a dentist with 20 years of experience and development can do things a dentist fresh out of school can't. But we also know there are some dentists who resist that ongoing development and don't advance much beyond their graduation-level knowledge unless they're pushed by outside circumstances, like developments in technology. The same thing applies to hygienists. I think the team member in question needs to be exposed to a good team-based continuing education program, where she can see the gap between her current standards and what others are doing, and where she can find that tension we all sometimes need to keep us focused on what we can be.

So here's my suggestion to this dentist: Sit down with the hygienist and have a real heart-to-heart about standards of care, where you explain that her Board certification means only that she has exhibited the minimum standards allowable (just enough to be safe), but the standards in your practice are much higher, and your role is to help her develop into an outstanding care provider. Then outline and begin implementing a plan for her continuing education.


Commenter's Profile Image Steven Roth
November 28th, 2010
Once upon a time i had a hygienist who didn't know what she didn't know. Now she is a world class hygienist. I can attribute four items with helping create the change. 1- taking her to excellent CE courses 2- restoring her mouth to excellence- in this case with porcelain veneers- which she has used to help sell many cases 3- Having her come in and watch us do treatment when she is not busy 4- Showing diagnostic photos at every morning huddle for many years and discussing what they mean