On-Time Doctor Time Scheduling

What is the single greatest limiting factor for most dental practices in both practice growth and treatment quality?  What causes you and the staff the greatest amount of stress each day?  You guessed it… the scheduling system.  Practices tend to grow to their level of maximum competence, or should I say slight incompetence and then stop growing.  Also, the frustration and stress level in an office is often determined by the scheduling system.

Practices that stay on time give the impression to their patients that they can handle more growth, yet those who fail in the timeliness of each appointment make an implicit statement to their clients that they are at their maximum capacity.  Seeing patients on time has innumerable benefits for practices, not the least of which are happy, stress free days for doctor and staff, while leaving room for smiles as you take good care of the customer.

 There are seven key ingredients to designing a Template Module scheduling system.

1.      Plan for success in building the puzzle pieces:

The vast majority of practices that stay on time are those who have developed a Template or Module Scheduling System that identifies and plans out how to meet all patients’ treatment needs.  The airlines do it, factories do it, and so must the dental office create a road map that if followed each day will lead to success.  Planning always takes time, energy and hard work, but the results of proper planning leads to significantly greater success. 

To create a workable plan or Template Module an office must begin by determining four things:

 1) Develop a code for each type of procedure the office must regularly see each day to meet the patients’ treatment needs and the need for growth.

 2) Determine the total for each procedure.

 3) Determine when does the doctor time come into each procedure and for how long at each step along the way.

 4) Match up all similar doctor time / assistant time procedures into one unifying code.  A bonding of 3-4 teeth may take 30 minutes with 10 minutes for the assistant to prep the patient, 10 minutes of doctor time to bond, and ten minutes for the assistant to finish up.  This B30 appointment code may be effective for many procedures like fitting and cementing two bands and cementing an appliance, etc.  Match up as many procedures as possible into a few codes as possible to give your receptionist greater flexibility in scheduling patients.

2.   Design the Plan with a Template Module:

      Once an office has identified the puzzle pieces it is ready to build the plan with a Template Module.  These modules are specific days with specific codes that will make the best use of the resources of doctor, assistant and chair time.  The codes must be strategically placed throughout the day to balance customer satisfaction and the needs of the practice not to see long procedures during the peak after school hours.

 3.   Make sure you have enough chairs:

      In order to have an efficient schedule the office must have at least one more chair than is scheduled to see patients.  This gives the assistants room to catch up when things get behind and can save or better utilize a significant amount of doctor time.  On my recent consulting trip to France I found two offices needing an additional chair.  In the first office the doctor worked out of one chair and I observed that she lost 3-5 minutes at the beginning installation of the patient and another 3-5 minutes dismissing the patient.   In order to speed things along, the doctor would do much of the clean up of the chair and area while the assistant walked the patient out and retrieved the next patient.  By adding a second work chair we were able to increase the number of patients seen each day by 50% simply by allowing the assistant to do assisting work and the doctor to do doctor work.

 4.   Manage the doctor time: 

      No matter how obvious it is that the doctor cannot be at two places at one time, managing doctor time conflicts is difficult, and actually impossible in a “fill in the blank scheduling system.”  Over the past 25 years I have been a large part of popularizing the concept of “Doctor Time” scheduling that is used in a majority of orthodontic offices and available for use in most of their computer programs.  The concept is simple… plan out an entire day of all necessary procedures with the doctor time built into them and make sure that the doctor is not needed at more than one place at one time.  This is easier said than done and often requires the experienced consultant to coach the dental team towards healthy standards and habits.  For the growing practice the challenge may well be impossible as the doctor time is 8 hours needed for a 7 hour work day.  Proper planning requires good decisions as to where the doctor can delegate more, speed up or improve efficiency.  Again, an experienced consultant may be necessary to identify the obstacles to growth and help the team overcome them.

 5.   Manage the assistant time:

      Nothing eats away at assistant time more than a doctor who cannot, or will not get to her chair in a timely manner.  While consulting I often ask the question, “If you could have the doctor at your chair the instant you needed him, how much time would you save each day?”  Would it astonish you to know that the typical answer is 2 hours and sometimes I hear 3-4 hours of lost or less productive time?  Most of the time any scheduling problem is not that the lack of assistants, but that their time is poorly planned.  One should assume that there is one assistant to handle one chair each day.  The idea that an office can schedule more chairs than it has assistants usually only means that one or more of the chairs becomes a waiting chair with no assistant or doctor working on these scheduled patients.   In most cases I recommend assigning one assistant per chair scheduled, at least during the slower time of the day when seeing long appointments.  When only short appointments are coming in the assistants can grab the next patient and work on them without concern as to which chair they were scheduled as they are all similar appointments.

 6.   Build in growth:

      Any office that wants to grow must plan for the growth in its Template Modules by planning the extra New Patient Exams and start appointments each month.  These extra planned codes may not fill, or at the last minute may be used for other procedures, but if the growth is not planned, the office often reaches a plateau and stops growing. 

 7.   Build in emergency time:

      Every schedule seems to get off time when emergency patients are not properly planned for.  Into the Template Module should go a certain number of reserved codes, or saved codes, S1, S2, S3, that may be used for patients who break their braces, or have a need for an extra visit.  Assuming that all lights will be green on your way to work only happens one out of five times, the same is true for emergencies.  Assume that you will have each day a number of emergencies that has been averaged from the previous months.  Proper planning will eliminate much frustration and wait time for other patients.

  8.   The secret ingredient is commitment:

      Now that you have a game plan it does not work itself.  The receptionist must fill it in properly and rely on the patients to take their fair share of the longer appointments during school hours.  The assistant must work to the time allotted her in each code and be at the chair when the doctor arrives.  The doctor must focus on staying on time and make a commitment to being at the assistant’s chair within five minutes of the time she requests the doctor… unless he/she is working on another patient.  Talking on the telephone must come secondary to moving around the operatory and keeping the chairs on time.  Finally, patients must be asked to cooperate in arriving on time, not missing appointments and not breaking their appliances. 

 For some days, commitment can overcome a poorly designed Template Module, but when the Template Module is poorly planned and executed every day, then frustration turns to apathy and both doctor and staff may give up on trying staying on time.  Obviously if you have given up on your schedule you have reached your maximum and your potential for growth is being squandered.   The only way to reach your peak performance and greatest potential is to plan for it with On-Time – Doctor Time Scheduling.

Ken Alexander, Founder