Scoping out time management strategies

Nov. 25, 2013
Getting things done efficiently while maintaining quality patient care is the hallmark of a highly productive and profitable practice.

By Linda Drevenstedt, MS, RDH, and Jennifer McDonald

Getting things done efficiently while maintaining quality patient care is the hallmark of a highly productive and profitable practice. When dentists and team members execute excellent time management, they have a deep sense of satisfaction. Patients hate spending any more time in a dental office than absolutely necessary. Therefore, excellent time management is also great customer/patient service.

These proven time management protocols can help you GET IT DONE!

I. Manage the doctor's clinical schedule

Overbooked dentists lead to rushed patient care and stress. It's not physically possible for the doctor to be in two places at once. You can create a schedule that meets goal without overbooking.

Your software program should allow for proper tracking of the doctor's time, assistant's time, and total chair time. This visually represents the doctor's time as he or she moves from room to room in a well-planned manner. In the Time Audit Instruction Sheet (see link below) the doctor time is represented by a "+" and the dental assistant time is represented by a "/". Follow the "+" allotments for each procedure and to see the doctor's patient care time properly outlined. The doctor is not in two places at once.

You'll need a time audit to properly implement this system. Analyze the amount of time it really takes to complete a procedure that includes 1) time for the hygiene exams, 2) time the dentist is needed, and 3) time the assistant spends caring for the patient without the dentist. For a copy of the Time Audit Instruction Sheet, visit http://www.dentistryiq.com/articles/2013/10/time-management-strategies.html.

2. Manage hygiene exams

If the hygiene department is the lifeblood of the practice, why does it feel like an imposition and disruption? Plan the day's hygiene exams. During the morning huddle, identify the best exam times. Mark the time on the schedule. The dental assistant can then direct the doctor to the hygiene operatory at the appropriate time during the restorative procedure.

Use green to yellow to red signal lights. Another method is for the hygienist to let the dentist know when he or she is ready for the dentist's exam after completing the evaluation part of the appointment. All radiographs, intraoral photos, oral cancer screening, restorative review, and periodontal screening should be completed prior to the green signal to the dentist. Once the hygienist has completed ultrasonic scaling and is ready to polish, he or she can give the yellow signal to the dentist. Lastly, after all is completed and the patient is ready to be dismissed, the signal should be red. It is poor patient care to leave the patient and hygienist anxiously waiting for the dentist.

3. Reduce redundancy

Dentists can spend a lot of time presenting treatment plans. In a full consultation, the doctor time should be 20 minutes or less; then the treatment coordinator should take over. Longer consults result in lower treatment acceptance.

The dental assistant should review the day's treatment with the patient and set the proper expectations for the visit, and review the informed consent and postoperative care instructions before the doctor enters the room. The assistant should also display the radiographs and images associated with the patient's scheduled treatment. The doctor should answer any questions the patient might have before starting treatment.

4. Delegate to the letter of the state law

Thank goodness dentists are picky perfectionists by nature. However, in their desire for the perfect margin or perfect temporary, dentists may fail to train and delegate allowable procedures. If you want to get more done, produce more, and have a team with a high sense of satisfaction, train and delegate everything that is legal in your state. If you cannot "teach," as many dentists tell me, then hire someone who can teach your assistant to make great temporaries. Guess what? Even if you can make the temporary faster, you manage your time better if you focus on procedures that require the dentist's level of care, skill, and judgment.

5. Plan the treatment thoroughly

Completely and thoroughly document findings in the treatment plan. Make notes in the patient's record during the exam process that describe the reason for the treatment. The treatment plan should include treatment phasing and assigning appointment priorities. Spending time during the initial examination to thoroughly gather and record detailed information allows future visits to flow more efficiently. Now your treatment coordinator is thoroughly prepared to help the patient plan treatment visits.

6. Post clinical notes efficiently

Update the clinical notes while the patient is in the chair, and this will prevent the need to stay late to complete charts. The dental assistant and the hygienist should be able to complete chart entries while taking the information during an appointment. Your software should have templates for chart entries that you can edit to fit your practice. The template is associated with the ADA code. Once the code is posted, a template prompts the user to enter specific information about the procedure. This is an ideal way to guarantee consistent protocols for SOAP notes and data gathering. Specialists should also consider dictation, which has come a long way.

7. Learn the "90-second crown prep"

Learn from Dr. Omer Reed the process for an efficient crown preparation in minimum time. Check out YouTube or Vimeo. Next, take a course on completing a root canal, preparing a tooth, and seating a crown -- all in one appointment. You save the patient time (good internal marketing) and save you the revisit. Third, find someone who does it faster than you to coach you over-the-shoulder, or go to the mentor's office to break out of your time drag paradigm. Yes, Virginia, quality can be done quickly!

8. Insist that your hygienist use the ultrasonic

The paradigm of efficient time management in hygiene is the use of the ultrasonic as the primary instrument, including with children. The efficacy is equal to hand instrumentation. Eighty percent of the hygiene scaling should be done with the ultrasonic, and it should be used first in procedure steps. Find a way to use warm water for sensitive patients. The piezo, if used properly, is very gentle. Many hygienists are stuck in old techniques from their school days and have not entered the age of ultrasonics, so if you want to send your hygienist to a great ultrasonic course or you want some in-office training, email me at [email protected].

9. Plan your treatment

Are you planning cases in the evenings, weekends, or during lunch? Schedule a couple of 20-minute time blocks for treatment and case planning on a Friday morning. Have the team place the chart or treatment planner on the doctor's desk with a note identifying the patient's return date for review of findings. The team should have everything ready for the doctor's review (images, model, new-patient telephone slip, exam records, etc.) If the case will be planned with another doctor, the administrative team should schedule a phone appointment with the other doctor, unless it is an emergency. This prevents the doctors from playing phone tag.

10. Have a tertiary care chair

In busy practices, an expanded duties dental assistant (EDDA) assigned to a chair that is lightly scheduled or not scheduled at all can be a timesaver and profit builder. The EDDA can recement temporaries, triage emergencies, see pedo patients for recall (if allowable in your state), and see in-office bleaching patients. In one practice where this was implemented, the EDDA chair produced more than the hygienist's, and the dentist's time was reduced for a hygiene exam.

11. Hire a bookkeeper

Hire a part-time bookkeeper at $25 to $30 an hour rather than doing it yourself. Your pay rate to do this chore is $300 to $500 per hour. In the average practice, this is a three- to four-hour per week job. Have your team match lab slips and invoices, dental supply packing slips and statements, and have them ready for the bookkeeper. You retain check signing privileges.

12. Get a payroll service

Even if you are a one-dentist practice with three to five employees, a payroll service is a timesaver and morale builder. Employees like direct deposit. No more waiting and hoping they can have their check in time to get to the bank at lunch on payday. Payroll services have come a long way. You or your office manager can simply enter hours, and you protect the data entry person from knowing the salary of the team. The payroll service prepares the quarterly reports and tax deposits and sends them off.

13. Focus, focus, focus

Attending CE courses is fun and provides the doctor with much needed peer interaction. But dentists often get scattered attending many courses and retaining little proficiency in any new procedures. If you're going to invest in a CAD/CAM, take part in the CE for a year or more to become proficient. I see too many dentists run to the next thing and never become proficient at the last thing. Online webinars save travel time and bring the team up to a high level of understanding about the new procedure, technique, or material. See DentistryIQ for a comprehensive online learning university at INeedCE.com.

Be time-aware during your day. Often the staff knows better than you where you need to be to remain efficient. Make it a goal to get out on time every day for lunch and at the end of the day. Listen to the team's suggestions and implement them. Everyone will be proud and fulfilled after an efficient and productive day.

Linda Drevenstedt, MS, RDH, is an insightful consultant with real "in the trenches" experience as a dental hygienist, dental assistant, and practice manager. As a consultant, she shares her wisdom of 30 years in dentistry with her audiences and clients. Contact her at [email protected]. Jennifer McDonald has been providing management and technology solutions to dentists for more than 20 years. She is managing partner of Dental Management Advisors, a dental consulting firm that specializes in assisting dental professionals to achieve excellence in leadership and management. Reach Jennifer at (888) 215-5864 or www.dentalmanagementadvisors.com.

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