Why you need a daily huddle

Feb. 1, 1999
In medicine, it is called "record rounds." In the corporate world, it is a "daily briefing." In football, it is the "huddle." Whatever you call it, successful organizations know that, in order to get the most out of every day, you must "begin with the end in mind." Engineering the day for maximum efficiency creates an environment with minimum stress. As a practicing hygienist for more that 30 years, I know how stressful dental days can be. The very nature of the work we do in dentistry contribut

Here are some basic rules that ensure planning meetings will remain productive after adjournment.

Annette Ashley Linder, BS, RDH

In medicine, it is called "record rounds." In the corporate world, it is a "daily briefing." In football, it is the "huddle." Whatever you call it, successful organizations know that, in order to get the most out of every day, you must "begin with the end in mind." Engineering the day for maximum efficiency creates an environment with minimum stress. As a practicing hygienist for more that 30 years, I know how stressful dental days can be. The very nature of the work we do in dentistry contributes to both physical and psychological stress. Consider the typical work environment in dentistry:

Y A small treatment room. It`s beautiful, modern, and clean; but no matter how you measure it, it is small!

Y We then go to work in an even smaller space - the mouth - with even tinier teeth.

Y The field is dark, wet, sometimes tender or inflamed, and bloody. Often it moves, sometimes only slightly. But other times this field actually jumps!

Y We are concerned about the comfort of the patient in our chair. While attending to the clinical procedure, we also may be considering ways to present a treatment plan to the patient.

Y Simultaneously, in the back of our minds, we are considering the team, the office, and the schedule. We always have one eye on the clock! Are we on schedule? What do we have to do to get back on schedule? Will the next patient be late and create havoc in the day`s schedule?

As a dental management consultant for the last 11 years, I have observed this daily scenario thousands of times in dental offices all across North America. It has become very clear to me that the dental teams that have a "daily planning meeting" function on a more even keel and, more importantly, are significantly more productive.

During a recent case in what has become a typical scenario, I recommended a 10-minute morning huddle to a client. The doctor hesitated and then said, "Please don`t ask me to do another meeting. We`ve tried this before, and it really did not do much good." I asked him to try my outline and agenda for the meeting for one month. If he could show me at the end of that period that there was no benefit, I would not mention it again. He agreed.

This is a very successful dentist with a highly productive practice for more than 20 years. At the end of the first month, the doctor reported that his personal production had increased by almost 18 percent. He attributed it directly to the morning meeting, citing in particular the auditing of his patient records and concise discussion of the schedule. During the month, he and

Agenda for the planning meeting

Y The meeting is not the responsibility of the dentist.

Y This is a team meeting with a designated facilitator who makes sure that it starts on time and ends on time. In many offices, the scheduling coordinator or office administrator assumes this responsibility. In other offices, the position is rotated monthly, giving all team members the opportunity to learn to facilitate.

Y Everyone comes to the meeting with their charts, a pen, and a highlighter.

Y End the meeting with a celebration; rotate through the staff and ask each person to contribute a quote, passage, or a brief story from a favorite book or periodical. An uplifting message is a wonderful way to begin the day. Sharing that special moment with each other also builds team relationships.

The outline of a basic agenda below is for a 10-15 minute daily briefing session.

The scheduling coordinator facilitates by:

1) Providing each staff person with the day`s schedule (their day sheet).

2) Identifying changes in the day`s schedule, as well as options in routing patients between doctors and hygiene to fill any openings. For example, if a patient presents needing a restoration and the doctor has an open time, the hygienist will say to the patient, "Mr. Smith, Dr. Jones has had a change in her schedule today and I believe that she could see you today for your necessary dental work. That would save you a trip back. Let`s check and see if this will work."

The doctor and clinical assistants may route overdue hygiene patients into hygiene with the same type of dialogue: "Mary, I see that you are overdue for your dental prophylaxis, and I have been advised that our hygienist has had a change in her schedule. I want you to go ahead and do that today. The health of your gum tissues is very important to your overall health."

3) Helping by alerting team members about tomorrow, the week ahead, etc. This might include the announcement: "I have three openings in the hygiene schedule for Friday," or "We do not have the necessary productive dentistry to meet our goals this month." These alerts often prevent the patching and watching that continues to occur on a daily basis!

4) Inquiring about where to schedule emergency patients.

5) Highlighting new patients on all day sheets. The emphasis encourages extra-special attention by all staff members.

6) Reminding staff members to highlight their routing slips for overdue family members who can be scheduled. Most dental software systems generate a routing slip or patient care form. Depending on your software and the amount of data that you enter, this one piece of paper is worth its weight in gold, because it provides you with a concise profile of each patient. It includes personal information such as name, address, phone numbers, employer, and family members, as well as financial and insurance information (including current balance) that you have entered. Utilization of the recall tracking and scheduling module in the computer will list the date of last recall or current date due along with other family members` due dates. Use this information to activate and schedule overdue family members.

7) Reviewing cancellations. Applause and accolades should be given for the number of patients who tried to cancel, fail/break that the scheduling coordinator did not allow to do so.

The financial coordinator (if appropriate in your practice):

1) Reviews the previous day`s production and collections. The following questions need to be answered: Did the practice reach the daily goal? If not, by how much? What needs to be done to catch up? Presents the potential dollar value on the day`s schedule.

2) Identifies patients with large balances or problem accounts that can be addressed during the day`s treatment.

The doctor and clinical assistants are involved in the following ways:

1) The assistant audits charts for pending treatment. Advise of all "undone" dentistry by using a routing slip. If treatment plans are entered into the computer, the router will print the unfinished dentistry. Highlight the recommended procedure on the router and be aware that the camera will be used with this patient. Schedule the treatment today or, if time permits, begin today.

2) They discuss medical-history reviews, special needs patients, TLC, as well as any other issues and concerns noted, including lab-related issues.

3) The doctor addresses the need for support or help. Who will be where, when? In addition, where will intraoral cameras be used?

4) They clarify how new patients were referred, as well as for what purpose.

The hygienist:

1) Reviews the charts and patient concerns, as well as confirms premedications.

2) Identifies the patients requiring full-mouth periodontal charting.

3) Identifies the patients requiring full-mouth radiographs, panoramics, and updated disease-detecting radiographs.

4) Reviews treatment plans for undone dentistry and periodontal treatment recommendations.

5) Indicates needs for intraoral cameras.

6) Designates doctor exams (assistants should highlight on their day sheets so they know when the doctor needs to be moved to do hygiene exam).

7) Designates which patients are due for a status exam or new-patient examination. These are the patients who come in regularly for routine care and have received a five-minute hygiene-check exam for the last 15 years. You will be amazed at the amount of dentistry that will be discovered, scheduled, and paid for when the appropriate amount of time is designated. It takes more time than a routine hygiene visit to ask the questions, to listen to the patient, to show the audiovisuals and the before-and-after photos, to perform a comprehensive evaluation and really bring things up to date. By the way, this is a great way to fill a doctor`s cancellation or open time. The assistants had identified previously recommended dentistry that had never been completed. The doctor said he was astonished to discover a large amount of unfinished dentistry. During the busy day-to-day rush, he had assumed that all of the patients were up-to-date with their dental work.

I see millions of dollars of this unfinished dentistry in every dental office. In addition to the doctor?s production above, hygiene production had increased by 37 percent. The hygienists were auditing patient records for overdue FMX, uncompleted dental treatment, tooth whitening, and other hygiene services, as well as identifying patients due for full-mouth periodontal examinations.

As you review the Obasic rules of the planning meeting,O please keep in mind that the daily huddle does not replace regular staff meetings. The purpose of the daily meeting is to engineer the day to run as smoothly and as stress-free as possible. Finally, end the meeting with a thank-you to everyone and a reminder of one of my basic rules for building a great team. We agree to OcatchO each other doing something right everyday!

For those who get to sleep late ...

Some dental teams have flexible schedules with staff members who start work at different times. Here are some of the creative ways that dental teams throughout the country make such schedules work:

Y Tape record the meeting on a cassette recorder. Staff members who arrive late can listen to the tape.

Y Designate a staff member to record the minutes of the meeting either in a notebook, with note card, or on a meeting team board. This is excellent for all team members to review.

Y Have the briefing meeting during the first 10 minutes after lunch and before stating the afternoon schedule. This meeting lays out plans for the next morning.

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