Scheduling: the command control center of the practice

by Roger P. Levin, DDS, MBA

Scheduling is the most important operational system in any dental practice. In fact, effective practice management means that all other systems must integrate with the schedule. All too often, dentists race off to attend continuing-education courses, improve their clinical skills, purchase new technology and equipment, or upgrade offices without ever addressing the schedule. The simple fact is that production will be more dependent on the scheduling system than any other single system in the practice. As I have often stated in my seminars, “No practice ever exceeded the production placed in the schedule.”

Time management

Scheduling is the productive use of the doctor’s and staff members’ time. Because time is finite, it can be assessed quantitatively and then managed. The first step in evaluating time is to determine how it is used. If a practice has eight hours scheduled in a given day, then the success level of that practice will depend on what happens in those eight hours.

As an example, let’s look at a Levin Group client, who we’ll call Dr. A, and another doctor - we’ll call him Dr. B - with a similar size practice in the same region. Both practices are:

 Open the same number of days a week

 Have the same number of staff, the same number of treatment and hygiene rooms, and the same computerized software systems

 Possess very similar technologies

 Have the same number of active patients (within 10 percent of each other)

 Participate in the same insurance programs (within 5 percent of each other)

 Located in very similar socioeconomic areas

These practices sound very similar and you might assume they have very similar financial profiles. However, Dr. A’s practice has double the production of Dr. B’s practice, and more than double the profit. How can this happen? The answer: we assisted Dr. A in completing a comprehensive scheduling assessment, enabling his practice to grow significantly while reducing stress levels.

Our experience of consulting with more than 8,500 practices demonstrates that more than 90 percent of dental practices can increase the capacity of their schedules by 30 percent or more. The increased capacity is based on results using mathematical formulas to create a schedule with an increased capacity which is acceptable for each practice. In no situation does a practice need to add more hours or days in order to achieve increased capacity. When comparing two practices where one has double the production of another (such as the example above), success is based on how the time is organized, taking into consideration ancillary factors such as flow between treatment rooms. Implementing a new scheduling system and understanding patient flow and service mix are the keys.

The principles of scheduling

We have developed a series of guiding principles for scheduling which every dentist and front-desk person must understand to increase efficiency and practice profitability. Using data gathered from 8,500 practices over the past 20 years, the Levin Group Accelerated Scheduling Program instructs practices to take the following steps:

1) Set the annual production goal for the practice.
The dentist must determine what the annual production goal will be. We recommend the goal be set approximately 15 percent higher than the previous year. The 15 percent growth rate is based on current economic conditions, the demand for dental services, and the type of services provided. A practice which is growing less than 15 percent a year is in danger of flattening out. It should evaluate the potential causes, such as insurance participation, declining reimbursement in insurance plans, fewer referrals, or lower average production per new patient.

2) Determine the number of days the practice will be open to treat patients.
Simply add up the total of full and partial work days. The total number of days represents the amount of time available for patient care. This will be a major factor in the level of production a practice can achieve. Determine the number of days the practice will be available to treat patients in the next 12 months.

3)Establish daily production based on annual goal.
Divide the total annual production goal by the number of days the practice will be available to treat patients. This determines the daily goal for each practice. Many dentists have heard about the daily goal. Many have even incorporated the concept. Unfortunately, it is rarely implemented properly. The problem is that most practices evaluate whether or not they have achieved the daily goal at the end of the day. This is generally unacceptable, because at this point, it is too late to make any alterations to improve the situation. Practices get into the habit of hitting or missing the daily goal without taking any subsequent action. While the front-desk staff may be scheduling to target daily goal production, the system inevitably begins to break down.

To achieve the daily goal, the entire schedule must be modified. If the practice is to produce $3,000 to $5,000 a day, every aspect of the scheduling system must be geared toward making this happen. This process lessens the chance that variables will result in a practice downturn. These variables can include lower patient flow, a decrease in case acceptance, or the introduction of a lower-paying insurance plan. A poor scheduling system will only exacerbate these issues and cause the practice to miss its daily goal.

Levin Group recommends establishing a daily goal and assuring it is completely understood by all scheduling coordinators and front-desk staff. The Levin Group Law of Standard Deviation™ states that 95 percent of practices should be within 10 percent of the daily goal over 90 percent of the days.

4) Implement a new scheduling system.
While it is beyond the scope of any one article to completely describe scheduling systems, it is important to understand the general direction you should take. The first step in scheduling is to create a template for the day. In the past, consultants talked about blocking the schedule. While this was an excellent concept in the past, it is far more important to think about creating a daily template based on achieving production goals. At this point, some professionals worry that their practice will become too focused on money. The schedule is not simply about money. Production is a goal which allows the schedule to be creative. Using a series of mathematical formulas, it can be fine-tuned to be as ideal as possible for that practice. In other words, the practice is not chained to the schedule. Instead, the new scheduling system is designed to achieve the goals and objectives set by the dentist and team.

5)Create a scheduling template.
Understanding how each day should operate is the basis for creating a scheduling template. The general goal is for each day to have great similarity. This is true for general practice and almost all specialties, with the exception of oral surgery. Even endodontic practices, with their high level of emergencies, can create a fairly predictable schedule following these guidelines. Unless the schedule is dedicated to achieving the daily production, it is unlikely that the practice will reach its production goals at the end of the year. This usually means a decrease in practice profitability, giving the dentist less opportunity to invest in the practice. In addition, the doctor will be unable to meet his or her annual savings and retirement-planning goals.

We recommend that each day have a rigid structure. Mornings should be reserved for larger cases only. The goal is to complete 65 to 70 percent of all daily production in the morning. While there are numerous reasons for this recommendation, such as dentist- and staff-fatigue levels, it also is a matter of mathematics. By completing 65 to 70 percent of the daily production in the morning, the practice will have focused on the larger or more complex cases. Bear in mind that a large case is not signified simply by a $10,000 fee. Single-unit crowns, bridges, porcelain veneers, and dentures all represent the larger cases for most dental practices. Very few practices are routinely performing $6,000 or $10,000 cases. Instead, most practices reach their production levels on what we could refer to as “bread and butter” dentistry. Practices should schedule by production, and these larger and more complex services should be placed in the morning.

No minor procedures should be seen in the morning. For example, suture removals and occlusal or denture adjustments represent minor procedures which should not be performed in the morning because they disrupt the schedule and distract from the goal of achieving the morning production. By lunch or midday, the practice should begin to focus on simpler procedures. In general practice, an example might be single-tooth or even multi-tooth restorations.

6) Use “bunching” to your advantage.
When scheduling, another concept to consider is ¿bunching.¿ This is the practice of doing similar procedures at the same time. Levin Group time management studies have shown that similar procedures, bunched together in the schedule, create greater efficiency. Try to put similar procedures in the morning or afternoon where possible. For example, it is far more efficient to see two or three crown and bridge patients than to see one patient for crown and bridge, followed by a root canal, then followed by a denture patient. The same is true in the afternoon. If the practice is going to focus on restorations at mid-day, try to schedule as many similar procedures as possible. While this article does not deal with the concept of multi-room scheduling, understand that part of the scheduling system will depend on patient flow throughout the office.

7) Know when to schedule new patients, consultations, and minor procedures.
The midafternoon should be reserved for new patients and consultations. New patients are especially important. In fact, 40 percent of production in a general practice comes from new patients. Practices seeking to increase production often bring back hygiene or new patients to present comprehensive treatment plans. New-patient exams and treatment presentations should be scheduled for midafternoon.

Finally, the end of the day should be reserved for minor procedures only. As already mentioned, these are less fatiguing procedures, but they still require time. Another reason to schedule these at the end of the day - in addition to allowing the practice to wind down and prepare for the next day - is that minor procedures have a 4 percent higher no-show rate than other dental appointments.

Become a master of the schedule

Scheduling is a mathematical system which can be designed to fit any practice and increase production in more than 90 percent of them. In my next article, I will explain some of these scheduling principles in more detail. These principles are based on research studies conducted by Levin Group. Practices which are willing to evaluate the procedures included in their service mix and understand the amount of time necessary for each procedure will be able to build the schedule based on a daily goal. They will continue to have tremendous success. Those practices which do not follow this rule will often stagnate and remain fairly flat, regardless of new education, team-building, or even new technology. The object is to become a master of the schedule, allowing your practice to grow.