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Are bottlenecks sabotaging productivity in your practice?

Nov. 1, 2019
Are you aware of any bottlenecks in your office that may be lowering your productivity or profitability? Even more importantly, is there a possibility that some of the bottlenecks do in fact exist and you are not aware of them?

Are you aware of any bottlenecks in your office that may be lowering your productivity or profitability? Even more importantly, is there a possibility that some of the bottlenecks do in fact exist and you are not aware of them?

What do I mean by bottleneck? A bottleneck is a location in space or a specific flow of traffic (through various personnel) in the practice where the process is slowed down or stopped. The term comes from the top of a beer or soda bottle, which is designed to keep the drink from spilling down the front of people. This is a good thing for beer or soda bottles; in business, however, bottlenecks that slow down customer service or product fulfillment can be incredibly costly. 

The age-old question in dentistry is, “Is it OK to make patients wait to be seen?” The general answer is, “No, but _________ (insert some form of justification for ‘life happens’ here).”

As long as we are treating patients, there will be surprises in procedures that can lead to something taking longer than expected. That I won’t argue; however, I will challenge you to look at how you can create systems, procedures, and policies that can dramatically reduce patients’ wait times and not create these issues internally.

Case in point, look at the typical sequence of events for new patients: they call, they schedule, they arrive, they are seated, they are seen by the doctor for a procedure, they pay, they make their next appointment, and they leave.

Very simple. What could possibly go wrong? Here are some examples of what can go awry. 

  • Patients call and are put on hold. 
  • Worse yet, they call, and the phone isn’t answered. 
  • They schedule but can’t get in for a week or two, or even longer. 
  • They arrive and have to wait excessively long to be seated. 
  • They are seated and have to wait to be seen. 
  • They are seen by the doctor for the procedure, but the doctor is interrupted to see other patients before the procedure is finished. 
  • They are ready to pay but must wait in line. 
  • They are ready to schedule their next appointment and must wait while the scheduler is on a phone call. 
  • They leave. 

How does waiting affect patient attitudes?

In a study by Velaro, an enterprise-grade live-chat solution for websites, 2,500 consumers showed that 60% of people will hang up if made to wait more than 60 seconds on hold.1 

A 2016 study in the Journal of Dental Hygiene by M.R. Ingelhart et. al. reinforces this point. The study concluded, “Long waiting times prior to a scheduled dental appointment have a negative effect on patients’ satisfaction with their visit, the evaluations of the patient-provider relationship, and the patients’ intentions to return.”2

The problem here is not just managing the dental procedure; it’s also managing the practice and the patient. What does this mean? It means you must have good systems and policies in place while keeping the patient informed of what is happening.

Ask yourself, “Do I like waiting?” I’m not sure how you feel about it, but I don’t like to wait. If I have to wait, I take it as a sign that the owner and staff do not appreciate my business. 

Resolving this issue requires leveraging the power of your team. Everyone in the office must be aware of where and when systems break down that lead to patients waiting. The situation must be corrected as soon as possible by any team member. 

Sadly enough, I’ve often seen where the doctor is the biggest offender! Tardiness can be from arriving to work late in the morning or late after lunch, or from long social conversations with a patient while others wait. To my fellow doctors: we must ensure that we set a great example for our teams. 

Ultimately, all staff members must agree that making patients wait is unacceptable. This approach sets the stage for crafting office policy and procedures. I’ll provide a few suggestions below, but if this agreement is in place, the rest becomes easy. 

Incoming calls—Do not answer the phone any later than after the third ring. We never allowed calls to go to voicemail while we were in the office. If at all possible, don’t put patients on hold without turning them over to a team member who can help them.

Scheduling—I got new patients into the office within 24-48 hours. People might be anxious about seeing the dentist. Do them a favor and don’t give them excessive time to think about it and talk themselves out of it.

Patient check-in—We tried to get our patients into the treatment area as soon as they walked in the door. That meant that we didn’t double-book. We allowed time in the schedule for the staff to clean and set up their treatment rooms between patients. This may have cost us time throughout the day, but it helped assure that we ran on time. 

Seating—If the doctor was not immediately available, our policy was—if at all possible—never leave a patient alone in the treatment room. From the patient’s viewpoint, talking with someone makes it seem like they’re not waiting.

Clear-cut policy—If someone is on the doctor’s schedule, you must have strict scheduling policies in place. I’m all for running multiple chairs with expanded function assistants, but there must be policies for how procedures are scheduled, and these policies must be followed. If you’d like to read the policies I used in my office, you can download them free of charge at schedulingpolicies.com and customize them for your office. 

Patient payment—If there’s a line, then have another staff member facilitate helping others leave. With large procedures, my patients normally paid in advance. This helped free up the financial secretary throughout the day to handle simple co-payments for hygiene and small procedures. 

Next appointmentWe liked to schedule patients for multiple appointments so we rarely had delays during appointment scheduling.

In my practice, we did everything humanly possible to run on time. We started to scramble if we were even five minutes late. In many cases we tried to get patients seated before their scheduled times. These policies don’t apply just to new patients—they are for every patient in your practice! You work hard to market your business. Don’t blow it by making patients wait!  


1. How long will you wait on hold for customer service? [news release] Baltimore, MD: Velaro; October 2, 2012. http://www.prweb.com/releases/2012/10/prweb9964730.htm.

2. Inglehart MR, Lee AH, Koltuniak KG, Morton TA, Wheaton JM. Do waiting times in dental offices affect patient satisfaction and evaluations of patient-provider relationships? A quasi-experimental study. J Dent Hyg. 2016;90(3):203-211.

GREGORY A. WINTEREGG, DDS, is an internationally recognized practice management speaker and author. After transforming his small-town office into one of the top practices in the nation, Dr. Winteregg joined MGE Management Experts as a partner in 1994. Since then, he has personally consulted and lectured to tens of thousands of dentists. Visit mgeonline.com or call (800) 640-1140 to learn more about MGE and the upcoming calendar of CE events across the US and Canada.

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