When one PPH stops being enough
Production per hour. It's exactly what it sounds like: how much revenue the practice generates, converted to a unit of time. Miles per hour, but for a provider. You already knew that.
PPH is useful in more ways than one. It helps you think about the big operational questions. Should I have extended hours? Should I add an operatory? Am I getting the most out of the hours I already have? It's also a natural foundation for team incentives. Same number, both jobs.
Most of the time, one number is enough.
Then I started working on a simple incentive structure, and the same number started telling two different stories at once.
A hygienist sees a full day of patients. Several of them are on the office's in-house discount plan, so their cleanings and a handful of other procedures are adjusted to zero. Other patients come in with marketing gift cards, which adjust their appointment production down. The production line on those appointments drops, and at the end of the day the hygienist misses their goal. So do the team members whose incentives are tied to their number. Did anyone work less hard? No. The work happened. The collection didn't.
The Doctor Team has its own version of the same problem, from a different angle. How many hours did they actually work? Did they straddle two operatories in the morning and then sit in one chair in the afternoon? Did they come in an hour late, or leave early because Friday is an early close? Hours on the schedule and hours actually producing aren't always the same thing.
Two speedometers, not one
The fix isn't to pick the right version of PPH and ignore the other. The fix is to build both, and to know which one you're looking at.
One version tells you what the business actually made. Collections, adjustments and all, divided by the hours on the schedule. That's the number you use for financial planning, operational decisions, and understanding true practice performance.
The other gives your team credit for the work they actually did. Procedures completed, time spent in the chair, effort applied, regardless of what was collected or how the schedule looked on paper. That's the number you use for incentives, for goal-setting, and for the end-of-day conversation with your team. The collection difference might not seem like a lot to you, but on some days it will probably be the difference between hitting goal and not, so it means everything to your team.
Both numbers are right. They're just answering different questions. Building both, and knowing which one you're looking at and when, is a great way to show your team you're in it with them, and helps build buy-in.
This is exactly the kind of work Pareto does. Critical thinking applied to the situation and end goal, and custom visuals built for the specific question the practice is asking. Something as seemingly simple as "did we hit our goal today" takes a lot of thinking to share simply.
A simple way to put the team number to work
Once you have a PPH that fairly reflects your team's actual work, the next question is what to do with it.
It's easy to think of incentives only in terms of the providers. But every member of your team has a hand in whether the daily goal gets hit. They fill the schedule, minimize cancellations, drive case acceptance, prevent attrition, and schedule future appointments. The work may happen without the dental tools, but it lands on the same daily number. Tying their incentive to whether the team hits goal connects everyone to the same outcome. And the second speedometer, the one that measures effort, is what makes sure "hit goal" reflects the actual work, not just the cash that came with it.
What I appreciate most about well-designed incentive systems is how simple the good ones can be. Keep the rules simple and the progress visible. The system I'm going to describe came from an actual practice, which got it from another practice. That says something about how good ideas move through an industry when people are paying attention.
The whole thing fits in one picture.
That's it.
The elegance here is the alignment. The DA Team's incentive is tied to the Doctor Team's performance, giving them a direct stake in the patient experience and doctor efficiency. The Hygiene Team earns its incentive on its own daily goal, which hygienists shape directly through their clinical recommendations. TxCo is connected to both. Everyone is rowing in the same direction, and everyone knows exactly what the target is.
But knowing the target isn't enough on its own. The part that makes this work is visibility.
A rolling three-month incentive calendar does exactly that. Every day lights up green when a goal is hit, or stays clear when it isn't. It syncs to the practice management system several times a day, so the goals and production numbers are always current. Three months so the team can see and feel what happened last month, see the current month in motion, and understand what the next month looks like and what it'll take to turn it green. Of course, the following month comes more into focus as the current month's end approaches.
| Monday | Tuesday | Wednesday | Thursday | Friday | |
|---|---|---|---|---|---|
| 2026 | |||||
| Mar | |||||
| 1 | 2 Neither | 3 Hyg | 4 Neither | 5 Neither | 6 Hyg |
| 2 | 9 Hyg | 10 Hyg | 11 Neither | 12 Neither | 13 Both! |
| 3 | 16 Neither | 17 Neither | 18 Closed | 19 Hyg | 20 DDS |
| 4 | 23 Neither | 24 Neither | 25 Hyg | 26 Neither | 27 Neither |
| 5 | 30 Neither | 31 Neither | |||
| Apr | |||||
| 1 | 1 Neither | 2 Hyg | 3 Neither | ||
| 2 | 6 Hyg | 7 Neither | 8 Neither | 9 Hyg | 10 Neither |
| 3 | 13 Hyg | 14 Neither | 15 Hyg | 16 Hyg | 17 Neither |
| 4 | 20 Neither | 21 Neither | 22 Hyg | 23 Hyg | 24 Neither |
| 5 | 27 Neither | 28 Hyg | 29 Neither | 30 Neither | |
| May | |||||
| 1 | 1 Neither | ||||
| 2 | 4 Neither | 5 Neither | 6 Neither | 7 Neither | 8 Neither |
| 3 | 11 Neither | 12 Neither | 13 Neither | 14 Neither | 15 Neither |
| 4 | 18 Neither | 19 Neither | 20 Neither | 21 Neither | 22 Neither |
| 5 | 25 Closed | 26 Neither | 27 Neither | 28 Neither | 29 Neither |
And the goal itself moves with the day. If a hygienist calls out, or a doctor leaves early, the daily target adjusts to match the hours actually worked. The calendar isn't graded against the schedule on paper. It's graded against the day the team actually had.
That visual accountability changes the energy in a practice. A green day feels like a win. A stretch of clear days is visible before it becomes a problem. And when the calendar is public, when the whole team can see it, it becomes something people care about rather than something management tracks.
A well-designed incentive program tells the team something specific: we know what good looks like, we can measure it accurately, and we recognize it when it happens. That kind of clarity is motivating in ways a bonus check on its own never is.
It also tends not to stay simple for very long. Once a practice starts running the daily calendar, the next question is usually about sharpening accountability. The aggregate target gets hit, but the picture inside it isn't always what you would hope. That's where the system has to grow up, and where Pareto starts doing its more interesting work. I'll get to it in the next insight.