Cathy Jameson, M.A.
Do you control your appointment book? Or, does it control you? Appointment-book control: you want it - but you`re beginning to wonder if it`s a reality or a myth! So many times when we begin consulting with and coaching a dental team, we hear this message: "We are a slave to our schedule. We don`t control our days; they control us."
Surveys about stressors in the dental practice carried out by our consulting firm (Jameson, 1997) indicate that scheduling is the second-greatest cause of stress in practices. Conflict among team members and staffing problems flew away with the honor of being first on the "stressor" list. When asked to be more specific about what areas of scheduling caused the most stress, "running behind" emerged as the biggest culprit.
Obviously, you are working with human beings. Not all things are going to go as planned all the time. There simply are times when you will get off schedule. You must look at your schedule to determine if you see places in your day when you can catch up - or if you need to do some rescheduling so that all patients throughout the day are not negatively impacted by unexpected delays.
However, there are things that you can do as "preventive management" - things that can become a part of your scheduling system, so that running behind is not something that happens as a result of mismanagement. Let`s look at some preventive-management options.
Causes and Solutions
Cause: Hygienic Evaluations - Providing hygienic evaluations in an expedient manner can be difficult. Engineering these critical evaluations into a full restorative day for the doctor can generate stress for all team members.
Let me illustrate with the following example:
The doctor is involved in four third-molar extractions and is just about to get that last difficult tooth out of there. He gets a "buzz" on the intercom from the hygienist indicating that her patient is ready for an evaluation.
The doctor can`t get up - he can`t leave the extraction case. No way! However, as much as he tries to concentrate on the patient in the chair, a little piece of his mind wanders to the hygiene room because he now knows that everyone will be impacted by this delay.
Who will be impacted? Well, let`s see:
(1) The hygienist who needs to get her patient out of the chair so that she can clean her room and seat the next patient. She`s already 10 minutes behind and dreads the domino effect of the cumulative minutes.
(2) The patient in the chair who needs to go back to work and is getting irritated by the wait. She may begin asking if she really needs that exam.
(3) The patient in the reception area is starting to get huffy. He glares at his watch and begins slapping magazines down on the counter. He left important work at his own office to be here. He was on time - and wants you to be, too.
(4) If looks could kill, the business administrator would be dead! The patient thinks she is supposed to be able to keep everyone "on time." The administrator gets up, goes to the clinical area and seethingly says, "What`s going on back here? Can`t you hurry up? Get this guy out of my reception area!"
(5) The business administrator asks this of the clinical assistant - not daring to ask the hygienist! She thinks the clinical assistant should be able to "keep the clinical area flowing," and she now adds stress to the assistant.
(6) No one is under more stress than the doctor. He knows everyone is backed up because of his situation, and there`s nothing he can do but focus on that extraction case and do his very best to expedite the procedure - without compromise.
Solution: Have the doctor provide the hygienic evaluations at his/her convenience, rather than at the end of the appointment. Most hygienists will rinse a mouth of polish to accomplish this strategy. The doctor isn`t evaluating the hygienist`s work. She is going to do a great job. The doctor is evaluating the patient`s condition.
If necessary data needs to be gathered, simply establish the following protocol: once the data (X-rays, probing readings, etc.) has been gathered, turn on the hygiene light. The light being on serves as a signal to the doctor and/or the clinical assistant that the doctor can go in to do the exam at any time.
What if the hygienist finds some area of concern after the doctor has performed his/her evaluation - perhaps after the stain has been removed? If this should occur, ask the doctor to return. No patient will ever be upset or think ill of you for having the doctor return for a second evaluation. This will not occur often. However, if it does, you will be proving your commitment to quality and uncompromisable care. And who would be upset by that?
If the practice has two hygienists, both evaluations often can be done at the doctor`s natural break. Then, when the doctor goes back to the chair, there will be no interruptions.
Will this work every time? No! There will be times when the evaluations will fall at the end of the hygiene appointment. But, with careful consideration and forethought, this will be the exception rather than the rule. If you haven`t done this before, you will have a difficult time getting yourself used to it. However, like any habit, practice makes perfect. Give it a try!
Cause: Improper time allotments - I encourage you to take the "guesswork" out of your scheduling. After all, the appointment book is the heartbeat of your practice. As such, it deserves care and attention. Simply guessing how much time you need for a procedure or for a patient isn`t good enough. You run the risk of undershooting - which will lead to throwing the schedule off course and will make you "run behind." Or, you run the risk of overshooting - which means you will schedule too much time. In this case, you will finish early and you will not be using everyone`s time efficiently or effectively.
Solution: Do an analysis of each of your major procedures. Detail what you are doing and what your staff is doing. By carefully evaluating each of your procedures, you can begin scheduling both the doctor and the assistant (or the hygienist and assistant) where appropriate. This careful use of each person`s time will not only be less stressful, but will be much more productive. Wasted time due to inaccurate scheduling is a major flaw in most dental offices.
In addition, by detailing each of your major procedures, you will see if you are scheduling too much time or too little time for a procedure. You will be able to see if there are places where you can consolidate parts of the procedure and where you can delegate responsibility. Certainly, you need to delegate responsibility when and where possible, according to your state statutes.
Once you have determined the doctor time and assistant time for each major procedure, give this information to the scheduling coordinator so that it can be entered into the computer. If your practice is not computerized, transfer this data into the paper appointment book to use when a patient is scheduled.
You may be hyperventilating over this. Your staff may be thinking, "We could determine the proper time allotments, but it wouldn`t do any good anyway. The doctor talks so much to patients that we run over all the time."
Of course, you want to include some personal time with the patients! If you are a "talker," then schedule this into your procedure-analysis sheets. I would rather you have this included in the necessary time allotment than constantly running behind schedule.
However, even though patients love to talk to you, don`t go on and on and on. They have to get back to work, school, the kids, etc. So, once you feel you have been socially graceful and information has been collected, end the appointment.
Cause: Doctor scheduled opposite the doctor - Nothing is more stressful than needing to be in two places at once - or more than two places, in some cases! When patient names are placed in the appointment book arbitrarily - or by the "guess and by golly" method, crossover is inevitable.
Solution: Once you have identified the doctor time/assistant time and once you begin placing this pertinent information into the appointment book, you quickly can see the whereabouts of the providers at any time. If a provider is in one room treating a patient, then, obviously, he/she cannot be in the other room with another patient.
Needing to be in two places at one time is an ultimate stressor - and it`s impossibility! Not scheduling someone opposite themselves requires careful orchestration of each provider. Good scheduling is good time management. Good scheduling is required for stress control.
Cause: Late patients -The question often is asked, "What do we do if a patient is late?" This will cause us to run behind."
Solution: Sometimes, people have personal issues that prevent them from being on time. Certainly, if someone has a legitimate reason for being late, you do the best you can to either speed things up, see the patient and complete the treatment, or, if the patient is too late, you may need to reschedule him/her. In the latter case, your business-office assistant might say:
"Mrs. Jones, we understand the problem you have had this morning. However, since you are 30 minutes late, the doctor will not be able to start and complete your treatment in the remaining time. We have other regularly scheduled patients, and I`m sure you can appreciate the fact that we don`t want to cause all of them to be late. So, let`s go ahead and reschedule you."
Most people will not be upset. They will appreciate your respect for your other patients. If you have any other openings during the day, try to reschedule these late patients during those times. Do what you can do to meet the needs of a patient, but do not compromise everyone else - including yourself!
Many offices teach their patients that it`s OK to be late because the office runs late all the time. Patients think, "Oh well, it won`t matter if I`m on time. They won`t be on time, so why should I hurry?" So, be honest with yourselves and ask, "Are our patients late because we constantly are late?" If the answer to that question is "yes," then have a team meeting and figure out ways to get on time and stay on time (for the most part). Let your patients know that you respect their time, and then you can ask them to respect yours.
Cause: Interruptions - Interruptions from the front to the back can cause time "glitches" and time-wasters. These, of course, can cause you to "run behind."
Solution: A "good morning" meeting can offset many interruptions during the day. When you identify scheduling concerns, emergencies, questions relating to a patient`s treatment, etc., during the morning meeting, that can eliminate the need to ask so many questions of each other during the day. Remember - each time you interrupt another member of the team, you run the risk of throwing things off schedule throughout the day.
In addition, your paperwork - the treatment plan, the routing slips, the written information/communication - needs to be so clean that the front-desk person rarely has to go back to the clinical area and vice versa. Your paperwork should be in the business office in advance of the patient, so that the business administrator can prepare for checkout.
Your written communication should let her know what you did today, the fee, what you need to do next time, the fee for that, the time needed for the next appointment (including the doctor/assistant time), and the time needed between appointments - if appropriate.
Still another type of interruption is personal telephone calls. The business administrator needs to take complete messages (written in a message book that has duplicating ability) and post those messages. Then, it should be everyone`s responsibility to get their own messages and return those calls during nonpatient time.
The doctor needs to let the business administrator know which phone calls are considered vital. These are the times staff should interrupt the doctor during treatment. Nearly everyone respects the fact that if the doctor is with a patient that he/she cannot be interrupted. But, if the messages are posted clearly and completely, the doctor and other members of the team can return calls in those nonpatient time periods - i.e., during lunch or at the end of the day.
Cause: Room not properly prepared - This results in the assistant having to get up and get additional materials, etc.
Solution: Do thorough and complete treatment plans as a part of the comprehensive oral evaluation or as a part of the periodic evaluations. In these treatment plans, specifically list the treatment to be provided, including the tooth number, the surfaces, and the material to be used.
Then, when this treatment plan is placed in the business office for financing and scheduling, the appropriate data will be in the hands of the financial coordinator and the scheduler. This information is placed in the appointment book or on the computerized scheduler. Then, when the assistant is preparing the room for a patient, she will see what the procedure will involve and be able to set the operatory up properly.
Doctors, more than any other member of the team, seem to get "super stressed" when they run behind schedule. However, this "glitch" can raise the blood pressure of all team members. In your own team, spend a quality team meeting determining the reasons you run behind in your own practice. Use this article as a springboard to creatively develop solutions for your particular situation. Then, commit to putting your plan of action into place. Try your ideas out for awhile. Evaluate them. Which ideas are better? What still needs attention? What areas do you need to refine? Then ... just do it!