How to fix a scheduling system breakdown

Many dentists continue to rely on a scheduling system that should have been replaced years ago. Some practices see no reason to improve their scheduling system because there are openings at certain times during the week that leave room for additional patients. Other practices are so busy they can't schedule patients within a reasonable amount of time-not realizing that, if it weren't for their inefficient scheduling system, they could see even more patients in less time, increase production, and reduce stress.

Roger P. Levin, DDS

Many dentists continue to rely on a scheduling system that should have been replaced years ago. Some practices see no reason to improve their scheduling system because there are openings at certain times during the week that leave room for additional patients. Other practices are so busy they can't schedule patients within a reasonable amount of time-not realizing that, if it weren't for their inefficient scheduling system, they could see even more patients in less time, increase production, and reduce stress.

When a practice's schedule breaks down, overall performance suffers, and the practice's true potential will never be reached. Even if production and income are growing, they could be growing faster and more consistently-with less stress-if a better schedule were in place.

Beyond broken

A practice's schedule serves as its time manager, regulating the daily activities of dentists and their teams. An inefficient system results in uneven workloads, higher stress, and lower production than the amount of time invested would indicate.

Even if a practice has a scheduling system that was excellent at one point, it will eventually become outdated due to:

• Staff changes

• Altered working conditions

• New technologies

• Added services

• Improved skills

• Bottlenecks that begin obstructing workflow

Over time, such changes are inevitable, which is why I always advise dentists to review their scheduling system (as well as all their other management systems) at least every three years, and whenever there is a major change in the practice.

How do you fix a broken scheduling system? In most situations, you simply cannot. There are so many moving parts and connections to other systems that piecemeal reapirs become extremely complicated, difficult, and ineffectual. Dentists who try this approach are likely to give up and continue working with their existing system, even though it severely limits their growth and satisfaction. It is far better to create a new, highly efficient system from the ground up.

Where to begin

The first and foremost goal of a scheduling system is to achieve a specific production number for the year, not just to fit patients into time slots. Determining how to reach that target requires a certain amount of statistical analysis and the use of a series of mathematical formulas. Begin with these values:

• Number of chairs

• Number of assistants

• Number of days per week the office is open

• Number and types of procedures

• Speed of the doctor, assistants, and hygienists (based on procedural time studies)

• Number of hygiene chairs

• Number of hygienists

Other elements will come into play, but these will get you started. All of the above factors have to be understood and measured in order to build a proper schedule. Time is quantitative, so developing efficiency depends on quantitative analysis rather than generalizations. To reach your production numbers, you must come up with the right scheduling numbers.

The Levin Group Data Center reports that a typical dental practice has the potential to grow 30% or more without increasing fixed expenses. This means that many practices currently work at least one day a week for nothing (i.e., production, income). Looked at another way, these practices could eliminate more than one workday every week and maintain the same amount of production if they had a proper schedule in place. This illustrates the principle that work expands to fill the time available.

Set a conservative target of increasing production by 15% during your first year with your new system. Divide the total dollar amount you want to generate by the number of days worked per year. This is your daily production target. Further divisions (e.g., between chairs, between doctor and hygienist) will give you more specific targets to use in creating your ideal schedule.

Special considerations for the dentist

As the primary producer in your practice, you must have a personal schedule that moves you efficiently from patient to patient, without rushing or downtime. To ensure that your practice scheduling system accomplishes this, you must answer two questions:

1. How "fast" are you?

Dentistry is not a race and, beyond a certain point, speed is not a virtue. Nevertheless, you must have an accurate idea of how long, on average, it takes you to complete all of the procedures you are likely to perform in your practice. One dentist might take 90 minutes for a first crown preparation appointment, while another may only require 60 minutes. The point is not how long it takes, but knowing how long it takes. Don't guess or assume you know the answer. Conduct procedural time studies (for doctors and hygienists) so that appointments can be scheduled accurately.

2. How can your time be coordinated with hygiene appointments for maximum efficiency?

Increasing the number of hygienists can reduce doctor production because it can be difficult to keep up with all the hygiene checks. However, by using new scheduling principles, such as checking all hygiene patients within the same time frame, or alternating checks at the beginning with checks at the end of hygiene appointments, you may be able to maintain a high volume of hygiene appointments without interfering with your productivity.

Measuring the results

Once a new schedule has been established it is important to measure the results. For example:

• Are the doctor and hygienists running on time? If not, the procedural time studies may be inaccurate. Some dentists unconsciously work more quickly when they know they're being timed. They may also be inattentive to the time, or may be spending too long talking with patients or staff during procedures.

• Are no-shows, last-minute cancellations, or unfilled openings causing the practice to miss the daily production goal? If so, you will need to address those problems with scripting and system modifications. Persistent shortfalls may indicate that your targets are not viable.

• Do you understand which parts of the schedule are more important than others? All hours are not equal in a dental practice. Dentists do not bill by the hour. There will be more productive hours and less productive hours. The key is to front-load the daily schedule with the most productive appointments to ensure that the practice can achieve its per-chair, daily, and annual production numbers.

• Do you have trouble appointing patients for major procedures in a timely fashion? This may indicate that the scheduling coordinator is filling your schedule with minor procedures. One rule of business is that, when you have a larger opportunity, move on it as fast as you can.

New scheduling system, new economy

The dental economy has been altered dramatically-and permanently-as a result of the Great Recession and other major game changers. Most commercial businesses responded to the recession by reengineering a number of their management systems in order to grow effectively in the new economy. Dentists should follow suit, beginning with scheduling, the most critical system in every practice. By conducting a quantitative analysis of current practice performance, then designing a new, highly efficient scheduling system that reflects current conditions, dentists can increase production without working longer hours.

Even if you create the ideal schedule, plan on reviewing it periodically, because any major change-including significant growth facilitated by the new schedule itself-may make it necessary to go back to the drawing board.

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