Mass confusion abounds

Case Profile: On the bright side, 60 patients a day - and 85 new patients a month - are seen in this office located in the far suburbs of an east-coast metropolis. Its three general dentists and two hygienists together generates annual revenues of $1.4 million. However, dimming the picture is the fact that office systems, as well as staff structure and function, are still that of a small practice.

Sally McKenzie, CMC

Case Profile: On the bright side, 60 patients a day - and 85 new patients a month - are seen in this office located in the far suburbs of an east-coast metropolis. Its three general dentists and two hygienists together generates annual revenues of $1.4 million. However, dimming the picture is the fact that office systems, as well as staff structure and function, are still that of a small practice.

Symptoms: Despite the recent hiring of a $37,000 office manager brought in to alleviate the chaos, mass confusion abounds in processing the large volume of patients. Systems are breaking down left and right, customer service is coming up short, and stress is at an about-to-erupt level.

Observations: Whoa, Nellie! This front desk is like a race horse with no jockey to pull back the reins ... anything goes. Picture this: four business employees all doing scheduling, all answering phones, all posting out patients, all doing consultations. Doctors` appointments are still scheduled in a gargantuan book that hogs over 48 inches of counter space ... and that`s not counting another two feet or so for the hygiene book. Although the practice has a very good dental-software system equipped with an excellent scheduling package, the "girls" only enter appointments on the computer "when they have time." The real reason is that the four of them don`t know diddley about how to operate the system. I`m not blaming them, mind you; just commenting. It shouldn`t come as any surprise that there are no job descriptions for any member of this quartet and, of course, no accountability either. As for the new leader of the pack - the one being paid "37 thou" - it doesn`t appear that she`s got the know-how or inclination to streamline front-desk operations. To the contrary, it seems that her perception of her job is: replenishing the paper supply in the copy machine, restocking reams of paper in the supply cabinets, collecting money from other staff for lottery tickets and scheduling interviews for prospective employees ... because the office is "short-handed." To add insult to injury, she also is the prime instigator of social conversation among employees, thinking nothing of interrupting what they`re doing to "get to know them a little better."

Discussion: This is one of those cart-before-the-horse situations. Manage-ment systems that the doctor/owner had put in place years before worked OK when the practice was producing $500,000 a year. After moving to a new facility, the practice grew and grew some more, but being caught up with this newfound success, no one noticed that the systems and staff capabilities had not grown along with the patient base and revenues. Now that the practice has almost tripled in size, business employees have to be on split shifts to accommodate the following hours: Monday - Thursday, 9 a.m. - 8 p.m.; Friday, 8 a.m. - 5 p.m.; and Saturday, 8 a.m. - 2 p.m. In addition to losing team spirit because they`re never together, the first shift doesn`t know what the second shift is doing. One more iron in the fire: despite all its growth, this practice has a patient retention rate of only 67 percent.

Treatment Plan: First things first. Let`s adapt the office hours to a more workable routine which will foster teamwork, maintain continuity of job responsibilities and reduce payroll expense by eliminating the need to hire a "second shift." Here`s what I recommend: Monday - Tuesday, 7 a.m. - 4 p.m.; Wednesday - Thursday, 10 a.m. - 7 p.m.; Friday - Saturday, 8 a.m. - 5 p.m. Dr. A will work M - Th (32 hours), Drs. B and C will work M - Th plus alternating Fridays and Saturdays (40 hours each). Both hygienists and all business staff will work the same hours as B and C, thereby allowing time for early-morning planning meetings and the opportunity for more of a team environment. This schedule also offers the convenience of many more nonwork-time hours for patients.

Now we get to the nitty-gritty of those job descriptions. First, a practice processing 50 patients a day needs a full-time scheduling coordinator who can take approximately five minutes per patient to schedule the next appointment; and a financial coordinator who can take approximately five minutes to post charges and collect money. Processing the patient load, they will each use 250 minutes of their 480-minute day, leaving each job description four hours a day to deal with nonpatient tasks such as answering the phone, directing calls and electronically filing insurance claims.

Next, instead of leaving the recall system to a hygienist with 2.5 openings per day, patient retention should be delegated to a full-time patient coordinator. With 1,925 patients in the recall system, this job description is well justified, and should significantly improve that measly 67-percent retention rate. The patient coordinator will be accountable for scheduling hygiene patients to a specific goal per day, contacting current recall patients as well as past-due patients, and monitoring patient retention.

The fourth job description will be a treatment coordinator who will be primarily responsible for presenting treatment plans to patients. This will free up the doctors who are currently spending up to 30 minutes per patient on these presentations. The treatment coordinator also will review daily charts the night before to make note of any Phase II treatment or any treatment that is planned but not scheduled, and will prepare treatment-plan reports monthly. In addition, her responsibilities will include: new-patient interviews, billing on a weekly basis, measuring accounts receivable as well as accounts over 90 days past due, generating accounts-receivable and aged accounts receivable reports, and reporting on them at monthly planning meetings.

Adherence to these job descriptions will eliminate chaos at the front desk and should streamline operations dramatically. Professional training will be provided for each employee and will include methods for measuring the results of their efforts. Employees then will be accountable for reporting this information at the monthly two-hour meetings. I think the team can look forward to continued success, a new pride-of-work ethic ... and a whole lot more job satisfaction all around.

Sally McKenzie is president and chief operating officer of Dental Partners, Inc., a full-service, in-office dental management and practice-acquisition company. She continues to serve as president of McKenzie Management, a division of Dental Partners, Inc. Sally can be reached at (800) 288-1877; e-mail McKenzie@earthlink.net; or visit her web site at www.mckenzie-mgmt.com.

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