Peak Dental Services believes its path to ownership for dental hygienists will benefit team members, the organization and patients.
By Graham Garrison
A patient often spends more time with the hygienist than anyone else in a dental group practice. Thus the hygienist, perhaps more than any other member of the practice, has the greatest opportunity to solidify the relationship, experience and, ultimately, loyalty to the practice, said A.J. Peak, CEO of Peak Dental Services.
Those aren’t just sentiments. Recently, Peak Dental Services, a leading dental services organization with over 50 locations throughout Colorado and Texas, announced a new ownership package for all the organizations’ hygienists. The intent of the ownership package is to honor the importance of their hygiene team, and expand their financial goals within the company.
For the first time, Peak Dental Services will be providing hygienists with ownership opportunities similar to Peak Dental Services’ dentists.
“When the time came to make the choices for the ownership package, Peak Dental Services made a bold move and offered ownership in Peak itself, not just in the doctor or hygienist’s dental practice,” said A.J. Peak at the time of the announcement. “It is disingenuous to limit the ownership package to the dental practice because our providers’ prosperity would be limited to those 4 walls. Now, all our doctors and hygienists can grow their wealth with us as an owner of the whole company.”
Solidifying the patient relationship
There are many ways that hygienists play a key role in the dental group practice. Peak cited three in particular. First, patients generally spend more time with the hygienists than anybody else in the practice, so it solidifies the relationship, experience and, ultimately, loyalty to the practice.
Second, and consistent with number one, patients look to the hygienist to discern the recommendations of the dentist. “Almost more than anybody else, the hygienist helps in most of the conversations where patients accept treatment because of the trust built,” he said. They often look to the hygienist as a third-party guide to what the dentist recommends.
Third, if you don’t have capacity, then you’re not able to fulfill consumer demand. To fulfill that demand, you need hygienists for obvious reasons.
Equity in the organization
Because Peak Dental Services is so passionate that the customer experience begins with and is often carried out by the hygienists, leadership wanted to offer the equity program to them on the same terms as the dentist owners. “Ultimately, we wanted to back up our words on hygienists being a critical, if not one of the most important, individuals delivering a distinctive patient experience,” Peak said. “You need hygienists to deliver that. They often spend the most time with our patients.”
Patient experience is the organization’s number one core value. And as a part of that, in a really tough economy, “Why wouldn’t we,” is what leadership asked themselves. “If hygienists really are the key ingredient to the patient experience, at the board level we asked: ‘Why wouldn’t we?’ Nobody had an objection, it was just meditating on how quickly we could do it.”
There were lots of discussions on how the ownership package would be designed. Leadership asked themselves why would they design it differently for hygienists versus the dentists? “We really believe that they’re a critical stakeholder in the company and our success, so why would we make it different?”
There’s a minimum investment threshold, and a quality investment threshold criteria that hygienists must meet. “We’re not letting poor performers in the sense of quality be allowed to be a stakeholder in the company,” Peak said. Essentially there’s different criteria that they’ve got to fulfill to have a stake in the DSO. But once they do, they’re an equity holder.
About 10% of Peak’s hygienists signed up for the program in its first offering, which coincidentally was the organization’s initial goal. The ownership package was brand new and to Peak’s knowledge, has not been offered in the industry before. “We didn’t make it any easier or harder than it is for the dentists,” Peak said. “In some ways, I think that gave it credibility, but it also took some courage for them to invest just like the dentists. We held them to the same standards on that end, and so we’re pretty excited about that.”
Peak Dental Services has built and aligned their hygienist team on curriculum that’s backed by research. All of Peak’s hygienists go through what they call HE120 Hygiene Excellence. It’s a six-hour seminar with 120 days of follow-up homework just to make sure they’re aligned with the latest clinical research based upon risk factors and agents.
“The fact that we ask all hygienists to go on that 120-day journey is unique,” Peak said. “And there’s things that we may not elect to offer patients because we don’t see double-blind research to back the efficacy of those solutions, and sometimes it’s stuff that our peers are doing pretty heavily and we don’t because we don’t see the efficacy behind it in the research. All the hygienists that join us have by region a hygiene mentor that spends time with them to help them through the systems and how it works.”
Peak Dental Services will only open the window to enroll once a year. They are reopening the window around March-April of this year, and have had many more hygienists since the first window inquire about the package. “It will be interesting to see what happens, given the early adopters.”
The organization is already seeing benefits from the hygienists’ investment in the company. Hygienists that joined are part of the monthly owner updates. They’re often the very first that get involved with decisions.
Annually for owners there is a retreat. This past year, Peak’s ownership team went to Vail, Colorado for the weekend. Their owner hygienists were in the front row seats contributing to the discussion in where they are going as a company, what things they need to work on, what new technology or new systems they may want to get involved with, etc. “They have an active voice that really doesn’t differ from the owner dentists,” Peak said.
In regards to the owner dentists, Peak estimates that 90% immediately were on board from the start with the package, and 10% took some time to think about it. “That 10% just wanted to think through what it would mean,” he said. Ultimately, it was a unanimous decision of the owner dentists.
“As a board, we were wildly supportive. Our financial sponsor, Varsity Healthcare Partners, which only invests in healthcare, provider-based businesses, is wildly supportive of it.
We would’ve rolled it out even sooner, but we wanted to give the doctors time to digest it and make sure they supported it.”
Several Peak Dental Services hygienists who signed on to the ownership package provided their take on why they found the opportunity valuable:
“Given the opportunity to become a hygienist owner with Peak Dental Services has given me a vested interest in the company’s performance; which has increased my drive and enthusiasm to perform.” – Celeste Ebell
“I am so grateful to work for a company that truly values its hygienists! I invested because this is a tremendous and rare opportunity to grow my personal wealth and invest in a company I believe in.” – Emi Green
“So excited to be a part of this empowering and innovative Hygiene Owner Program with Peak Dental Services. Congratulations to ALL Hygiene Owners and Peak Dental Services for their Leadership!” – Nancy Rogers, RDH, BSE
Peak believes the doctors, hygienists, board and financial sponsor have all been pleasantly surprised by the results. “There were a lot of What Ifs,” he said. “But I think everybody is incredibly mature, professional, and did exactly what we wanted it to do. We wanted to share in the upside and the ownership mindset and a contribution to key decisions on that front. We’re really looking forward to opening the window this year, and hopefully it continues to expand.”
The ownership package has benefited the organization’s culture because of the credibility it reinforces. “If we say that hygienists are critically important, then I don’t know how more I can back it up than to say you can be side by side with me as a founder in enjoying the upside, and we can all work together to create a good outcome and build a strong company together,” Peak said. “So it’s the credibility that we’re in this together and we’re going to share in it.”
These are unprecedented times post-COVID. Peak Dental Services is not forcing the ownership package on people. It’s a personal decision. “For some it’s a family decision if they want to, but we wanted them to know that it’s there if they want it.”
Indeed, post-pandemic the bar is now higher for every business across all economic sectors. Peak Dental Services has tried to either meet or exceed those expectations, whether it’s financial, making sure people feel like they’ve been heard or that they’re responsive to feedback. “We are where we are,” Peak said. “If the bar increases, then we’ve got to meet those demands. Sometimes it might be an economic demand, sometimes it might be scheduling flexibility, sometimes it might need to be more increased responsiveness or involvement in the decision-making on a piece.
“The thing I’m most proud of is the equity program,” Peak continued. “Nobody is perfect, but being willing to do that and our financial sponsor being wildly behind it, and the dentists being behind it, that, for me, was a big landmark. It was a credible act to say, ‘Hey, this is what you mean to us, and this is how we are in this together.’”