No front desk? No problem!

June 1, 2000
When your office rides the new wave of "front desklessness," you`re not getting rid of your front desk; you`re improving it.

When your office rides the new wave of "front desklessness," you`re not getting rid of your front desk; you`re improving it.

Larry Emmott, DDS

"Front desklessness" is a term that has been popping up in dentistry for the past few years with increasing frequency. It is a concept that has the tremendous potential to change the business of dental practice, but it is also a concept that is fraught with misunderstandings and hazards.

When some people hear the term "front desklessness," they envision an office with no greeters and no window in the reception room. They picture a bare room with chairs around the walls and maybe a spy camera in the corner to see who`s there, much like a holding cell. Other people think "front desklessness" is a way for dentists to scrimp on staff. Administrative staff members who work at the front desk just think it is ridiculous. "Who`s going to do the 1,001 things I do every day?" they ask.

"Front desklessness" doesn`t match any of those images. It is simply a different, technology-driven way of performing the duties of the front desk.

How it works

Dr. Omer Reed, known as one of the most creative thinkers in dentistry, first coined the term "front desklessness." If you visit his office in Phoenix, he essentially has no front desk. What he does have, however, is a completely computerized practice-management system with treatment-room computers.

To understand how this concept works, you must first look at the human systems now used in dentistry. Why do we even have a front desk? The front desk is the data center of the office. If you asked your front-desk team members what they do, they would tell you certain things. First they answer the phone - a lot. If they are not talking on the phone, they are speaking face-to-face with the most important person in the office - the patient. Whether the patient is on the phone or in the office, he or she will have questions about scheduling, finances, and/or treatment.

In order to help patients with these needs, the front-desk person must have access to the data - the schedule, financial records, and the charts. If the schedule, financial records, and/or charts are on paper, they can only be in one place at one time and accessed by only one person at a time. In the past we managed this paper data by grouping it in one place - the front desk.

So what happens with this system? The front-desk person begins by checking out a patient. They have a pleasant conversation, discuss fees, take a payment, and are in the process of making an appointment when the phone rings. They break off the conversation and start dealing with the person on the phone, making another appointment and peeking under the open page to try to find another open time, while not losing the half-made appointment of the patient in the office. This phone call is half-completed when another patient strolls up from the back. This second patient also needs to check out, make an appointment, etc. An assistant accompanies this patient to the front to tell the front-desk person what to schedule. The assistant sees the patients are two-deep with the front-desk person on the phone. The assistant doesn`t have time for this, so he or she leaves. The second patient waits rocking to and fro, glancing at his or her watch behind the first patient who is listening to the phone conversation. Then the other line rings. "Hold please." "Hello, dental office, hold please." Two people on the phone and two people in the office waiting - and they all need to make an appointment! That`s a typical day at the front desk.

As long as the data is on paper, there is no other way to do it. Even if there were two people working at the front desk, only one could be "in the book." Transferring the data to a digital, electronic form changes everything so that the data center is the computer and not the front desk. Front-desk duties can be handled from anywhere as long as there is a computer.

Changing roles

Let`s apply technology to the human system and see what happens. Why answer the phones at the front desk? If all that is really needed is access to the data, the phones could be answered wherever there is a computer - at the front, in the back, or even in a different building! Answering the phone at the front desk takes that staff member away from the most important person in the office - the patient he or she is speaking with one-on-one, face-to-face.

What about making an appointment? If you use an electronic schedule with treatment-room-based computers, why not schedule from the treatment room? Who better to make the appointment than the chairside assistant? He or she has just heard the dentist and the patient discussing the treatment and knows exactly what needs to be done next. The assistant knows if the patient is a gagger or a golfing buddy who needs extra time, and knows if there is lab work involved, or any of the other clinical considerations that would affect the appointment time. Make the appointment!

How many appointments are lost as the patient goes from the back to the front and changes his or her mind? Worse yet, how many appointments are lost or mismanaged because the hand-off from back to front is rushed or nonexistent?

The dental hygienist`s role changes as well. It is easy for the hygienist to make an appointment and avoid the need to walk the patient to the front so he or she can wait in line to schedule. However, the best part of "front-deskless hygiene" is improved patient care. Who better - and what better time and place - to schedule the next continuing-care appointment than the hygienist chairside, while the patient is motivated to improve his or her dental health? The hygienist knows exactly when the patient needs to come back and knows exactly how much time this patient will need. The hygienist knows if the patient is a gagger or a smoker who needs extra time, or a healthy 21-year-old who needs very little time.

Another great plus is that patients are motivated. They are acutely aware of any problems the doctor or hygienist may have found. They are usually anxious to take proper care of themselves. There will never be a better time to schedule the next appointment. Compare that to the typical motivation a patient experiences when the smiling elephant recall postcard shows up six months later. Do those patients still believe there is a need? After all, nothing is bothering them! They must find time in a busy life and then make the effort to call and schedule. The old "send a card and hope" system will never be as effective as scheduling chairside right when the patient is anxious to make an appointment.

Another great service for both the hygienist and chairside assistant is instant access to patient data. What do you do when a patient asks, "When is my husband due, and what do the kids need next?" You can`t really give an answer with a traditional front-desk, paper-based data center. You can have the patient go and wait while the front-desk person finds the family charts and looks through them for the answers. With electronic data and chairside computers as the data center, the answer is easy and instantaneous. The result is better communication, better service, and, ultimately, better dental health for our patients.

"Front desklessness" does not mean that the office does not do the duties of the front desk; it just means they are performed differently and are technology-driven. The duties of the front-desk people change. Instead of working as phone answerers and money collectors, they are now greeters. They become the concierge of the office, elegantly guiding people through the dental experience.

Some dentists have actually taken a chain saw to the front desk. They assign all of the business administrative duties to clinical assistants or hygienists. Each assistant takes his or her assigned patients through the entire dental experience from greeting to collections. "Clinical assailants" actually take payments and swipe credit cards in the treatment rooms. They even carry cordless phones on their hips to answer the phone wherever they are. This extreme form of "front desklessness" will work. There are offices doing it this way, but it probably isn`t for everybody. Most dentists will opt for a modified form.

With a modified system, the office still has at least one administrative team member. That person could be an office manager, treatment coordinator, or business assistant. This person`s duties could include the greeting or concierge function. He or she could be the new-patient coordinator or could be a financial coordinator setting up arrangements on major cases.

How to become "front deskless"

The first step to going "front deskless" is to develop a technology infrastructure. This starts with a complete, integrated, practice-management software program. At a minimum, the practice-management program must include patient data, finances, scheduling, and charting. These features also must be integrated, meaning the information or data will automatically pass from one function to another.

The second step is to network the system throughout the office with treatment-room-based computers. This allows the seamless electronic transfer of information. Each computer station is now a data center and can do all front-desk functions.

The third step is training. Every team member - including the dentist - must become a mouse master. You will never get full value from your technology investment without training. One of the biggest technology mistakes often made by dentists is to go golfing on the computer training day. Worse yet would be for the entire office to go without training. One of the biggest advantages of "front desklessness" is cross-training. It eliminates the artificial barrier between clinical and administrative teams and ensures that anyone can do the tasks necessary to keep the office running.

It is not unusual for a dental office to develop a "computer maven" - the only staff member who knows anything about the computer. The maven makes all entries, closes the day, sends statements, runs insurance, makes appointments, and is the only one who really understands and knows how to use the computer. What would happen if the computer maven quits? Nobody else knows how to close the daily accounts, process insurance, or send statements. How much turmoil will that cause? How much will it cost you in lost business, stress, and patient frustration by the time you hire and train a replacement?

A complete computer system with chairside workstations and some sort of "front desklessness" is great insurance against people-related maven catastrophes. With multiple computers and treatment-room entry, everyone is cross-trained and learns the system. According to dental computer consultant Steve Seltzer, 3 to 5 percent of the gross production of a typical general practice is lost revenue due to human errors and omissions. This is work you are doing that is never billed out. Meanwhile, chairside workstations with direct entry of treatment by the dentist or clinical staff recaptures nearly 100 percent of this lost production, Seltzer said.

Once this technology infrastructure is in place, everything else - paperless charts, electronic scheduling, and "front desklessness" - starts to make sense. It also naturally leads to the use of many of the other advanced high-tech options we see in dentistry, such as digital radiography, digital photography, cosmetic imaging, and digital patient education. "Front desklessness" itself is not a goal; it is a natural result of using technology effectively. As is the case with all high-tech advances, the goal should not be the technology itself; the goal is to treat the patients we serve more effectively. Using a complete, integrated, patient-based, practice-management system with chairside entry and "front desklessness" is a very effective way to use technology and improve the service we provide to our patients.

The future is coming, and it will be amazing!

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