Natalie Beaton, Consultant [email protected]

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Text of Natalie Beaton, Consultant [email protected]

  • Natalie Beaton, [email protected]

  • HOUSEKEEPING 101This entire presentation is available on my website: www.joyfulchange.netYou will need to have PowerPoint to view it.Please fill out your class evaluation forms!

  • GOALS FOR TODAYDefine Doctor time scheduling Identify typical problem areas in non Doctor time and Doctor time schedulingDetermine office goals for schedule

  • GOALS FOR TODAYDemonstrate how to gather data needed to create Doctor time scheduleReview tools for evaluating dataDiscuss steps needed to design new schedule

  • GOALS FOR TODAYDiscuss ways to educate patients and parents about how the scheduling works and how they can helpTalk about how to make it work: working with a Doctor time schedule and a real time day

  • Doctor can glide effortlessly between patients in a well-choreographed display of relaxed efficiencyKaren Moawad

  • Pieces together an efficient, intelligent framework to work with by considering when the Doctor is needed, how long the Doctor is needed in every procedure and ensures there is adequate time throughout the day. This means the Doctor is needed at ONE PLACE AT A TIME!!

  • Procedures are scheduled at specific times of day which are controlled in the construction of the scheduleSchedule is more balanced and patients are more equally distributed

  • Open GridPartially Defined

  • WHEN A SCHEDULE IS NOT WORKING.The office frequently does not start the day on timeTo the patients it feels disorganized and unpreparedRuns over at lunch and at the end of the day Comments are overheard by patients or frustration is noticedNeeds Doctor in numerous places simultaneouslyLots of waiting in chair and time with doctor can feel rushed

  • WHEN A SCHEDULE IS NOT WORKINGIs often running SIGNIFICANTLY LATEDisrespectful of patient time and very stressful for staff and DoctorDoes not have time available when needed (no room for growth)Exams and starts are waiting weeks to be seenSchedule lacks flexibilityPatients sense stress when change is required quickly

  • WHEN A SCHEDULE IS NOT WORKINGCauses conflict between team membersOur body language gives us away!

  • PATIENT CONTRIBUTIONSEVERYBODY wants after school/work timePatients show up late or early (How can we ask them to be on time when we are not on time in seeing them?)Patients show up with surprise breakageSome patients simply require more timePatients who have missed or cancelled on short notice want prime time re-schedule

  • HERES THE PROBLEMYou can have: the most beautiful office and create amazing smiles but if your schedule is not working, what the parents and patients will remember (and will share with their family dentist and all their friends) is that they were regularly kept waiting and each visit felt chaotic.

  • SCHEDULING GOALSWork on (NOT just seat) patients on time Have the correct amount of time for the procedure that is scheduledHave a steady pace throughout the day, week and monthHave enough of all types of procedures to see patients as neededHave treatment progress in a timely fashionBuild in target production and collectionHave room for growth

  • SCHEDULING GOALSHave patients and parents satisfied with the scheduleAllow time for non-patient responsibilities throughout the monthAllow time for training and cross training during non-patient timeAllow time for schedule review and maintenanceDuring a crisis time it doesnt matter how it happened, it matters how we fix it. All staff should have a How can I help you? attitude!

  • SCHEDULING GOALSDaily review of schedule prior to start of day at Morning MeetingIdentify potential problem areas and discuss solutionsIdentify best places for comfort care appointmentsPre-plan for glitches as much as possible (ie. Perpetually late patient or difficult patient)Identify any all hands on deck timeLearn from yesterdayStart today on time and with enthusiasm!

  • LIFE IS SHORT-CREATE A SCHEDULE THAT ALLOWS YOU TO ENJOY THE DAY!PATIENTSDOCTORPARENTSSTAFF

  • We take time to complain daily about whats not working with the schedule but do not or will not set aside the non-patient days needed to fix the actual schedule.

  • Why Arent We Fixing It?

  • Fixing the schedule begins to seem insurmountableEveryones perception of what is not working with the schedule is differentThe current non functional schedule creates daily chaos and theres no time to think, let alone fix thingsYou are not going to fix the schedule until you take time to do so but you are not going to feel like you have time to fix it until it is fixed and running more smoothly BUT IT IS NOT GOING TO FIX ITSELF!

  • In most offices the template doesnt get addressed until its inadequacy is actually becoming painfulIt doesnt need to be that wayOnce youve done the initial-and somewhat daunting-job of creating a good, workable schedule, regular maintenance and moderate tweaking can keep it flowing smoothly.Pat Rosenzweig The Scheduling Template: Forgotten But Not Gone

  • PROCEDURE CODESTIMINGSSHAPESCOUNTSPUZZLE BUILDINGSCHEDULING RULESPRODUCTION/SCHEDULING GOALS

  • Francis Bacon

  • PRODUCTION/SCHEDULING GOALS

  • PRODUCTION AND SCHEDULING GOALSWhat is your practice philosophy and lifestyle goal?How many patient days per month do you want to work?How many hours per day?How much time per month do you want to designate as non-patient time?How many clinical chairs do you have available with a staff member per chair?

  • PRODUCTION AND SCHEDULING GOALSWhat are your production/collection goals?How many starts will it take to reach your goal?How many exams will it take to produce those starts?If conversion is an issue what is the new patient to treatment protocol?What is the Exceeds Treatment Time protocol?What is the Retention Dismissal protocol?

  • Defining Your Marketing GoalsWhat do you want to achieve?(Marketing Goal)How do you want to be perceived? (Office Image)What do you want to provide?(Office Mission)

  • PROCEDURE CODES

  • PROCEDURE CODESLook at your current procedure list to see if it can be simplified (Watch for duplications or codes that are no longer being used)Number of procedures and amount of information in procedure can depend on if electronic charting is being usedTry to name things in such a way that they group togetherExample: RECS:FULL, RECS:INV, RECS:PROG, REC:PH I, RECS:FINAL

  • PROCEDURE CODESOther grouping examplesEX: under 7, EX:7+, EX:ADDEL:HERBST, DEL: RPE, DEL:RETDB PH I, DB FULLBB FULL, BB UPR, BB LWR

  • TIMINGS

  • TIMINGSHave each assistant time each procedure three timesStopwatchTiming sheetsDO NOT include wait timeBe sure to include time for notes, cleanup and setupHaving details as to what is being done will help develop a procedure protocol for each procedureUse timings to determine if there are training issuesExplain to patients that you are working on improving the schedule to be able to run on time and offer the maximum amount of patient convenient times

  • TIMINGS

  • SHAPES

  • SHAPESLook at timing sheets for each procedure to determine if everyone is using same protocol for each appointment type or agree upon protocol as neededPut similarly shaped appointments togetherThe fewer shapes you need, the more flexible your scheduleKeep track of any scheduling rules that come up in conversation

  • SHAPES

    EX:PH2 EX:RDY EX:TRANS EX:CH-9

  • COUNTS

  • COUNTSPast versus future countsAllow room for growthIf you add one start; what appointments need to get added in to meet the scheduling needs of that patient?How many exams do you need to add to the existing figure to get the increased # of starts?Divide by average number of days you want to see patients per monthDont forget non-patient time needs

  • SCHEDULING RULES

  • SCHEDULING RULESEvery office will have different rules. Whats important is that the entire team be aware of the rules and why they are in place.This is your schedule and you have to work with it. What has worked in other offices may not work in yours.Be fact based about your timings. It doesnt matter how fast another office does the same procedure.

  • SCHEDULING RULES TO CONSIDERDebands should go in least desirable times. They will come in!Use early morning and late afternoons for regular adjustments. Goal is to have 80-85% of all appointments during desirable times.Hold slots for Comfort CareHold start slots: Rule might be that its OK to override start slot one week prior

  • SCHEDULING RULES TO CONSIDER

    Looking at Adult conversion (20-30% is average)Limiting Adult Exams to least desirable time and total # availableScheduling based on last visit with family dentistQuoting fee range over phone for adults

  • SCHEDULING RULES TO CONSIDERDefining Comfort Care (List at Front Desk)Short (CC1): ligs off, seps out, pokey wireMedium (CC2): one band or bracket off, etc.Long (CC3): If their next adjustment is scheduled within the next three weeks, schedule a longer Comfort Care and take care of both things. This will open up a regular adjustment slot for someone needing to re-schedule (and the doctor is going to have you do the regular adjustment anyway).

  • SCHEDULING RULES TO CONSIDERShorter exams for younger patientsFiguring the age cut off based on past information and Doctors treatment approach to Phase One.Exceptions to rule

  • SCHEDULING RULES TO CONSIDERType up new list of rules and continue to add to list as situations come up that had not been thought ofKeep scheduling wish list for the next time grids are re-written or fix on current grids if possible

  • PUZZLE BUILDING

  • You have your procedures list merged with the shapesYou know exactly how many of each shape you need in a days templateYou know the shapes that you need on a less than once a day basisYou know exactly where your Doctor time falls in the shape and therefore where it falls in the proceduresNow you are ready to try to get it to fit together!!!

  • PUTTING TOGETHER THE PUZZLEStart with Exams and then longer bonding proceduresMark the start of the appointment with the shape code then draw an arrow to the end of the appointment. Mark in the Doctor time on the right hand side of the column.Constantly be counting across so that you do not exceed the Doctor time availableKeep running total of shapes you have already been able to fit into templateReview scheduling rules as you go along

  • PUTTING TOGETHER THE PUZZLEFill in smaller spaces using shorter shape codes, scheduling rules and countsIf you need less than one of a code a day include it on alternating templatesConsider working non-patient time into grid Examples: ordering, TC Will Call follow up, cleanup chair prior to lunch and end of day, Power Treatment Planning etc.

  • HOW MANY TEMPLATES DO WE NEED?If Monday and Tuesday are the exact same start, lunch and finish time consider separate grids to vary the times that procedures are available.Consider having a longer lunch once or twice a month for Doctor lunches (You might have Tues reg lunch and Tues long lunch)Consider a template that includes a time for a monthly staff meeting or block on an individual basis

  • HOW MANY TEMPLATES DO WE NEED?Consider having a template for a non-Dr day for Comfort Care onlyConsider a half day a month where the entire team works on marketing projects onlyYou may want an exam, start or a deband day template so you will have it when neededYou may have different start and finish times in the summer

  • HOW MANY TEMPLATES DO WE NEED?You dont want too many templates but enough to meet the needs of the practice and to have the ability to offer a variety of time slots for procedures

  • Count, count, count and count one more time

  • PROCEDURE CODESTIMINGSSHAPESCOUNTSPUZZLE BUILDINGSCHEDULING RULESPRODUCTION/SCHEDULING GOALS

  • OFFICE POLICIES AGREEMENT

  • OFFICE POLICIES AGREEMENT

  • OFFICE POLICIES AGREEMENT

  • OFFICE POLICIES AGREEMENT

  • How can we use Doctor time to piece together the best possible day in advance realizing that it is only a guideline of what the actual day will turn out to be?

  • REALISTIC DOCTOR TIME SCHEDULINGIn reality no day is perfectPatients will arrive late or earlyProcedures will take longer or shorter than scheduledThe doctor will be at the chair longer or shorter than the amounts of time we estimatedThere are times that the doctor will decide, for clinical reasons, to do more than what was originally scheduled in that slot.Lets not even talk about phone callsDOCTOR TIME IS A GUIDE ONLY!!!!

  • THE ROLE OF CLINICAL COORDINATORDirects Doctor as to where to go nextEvaluates how to best deal with late arrivalsDecides where Comfort Care appointments will fit in, in the least disruptive wayWorks out how to catch back up when running behindAssigns tasks to keep schedule flowing smoothlyKeeps track of what didnt work in schedule for discussion at Morning HuddleMakes all schedule related decisionsIs the person everyone goes to with scheduling questions

  • Well-designed training in techniques and verbal skills are an important foundation to building a new scheduling system.

    Karen Moawad: The Business of Orthodontics

  • CLEARLY DEFINED PRACTICE SYSTEMS

  • CLEARLY DEFINED PRACTICE SYSTEMSHaving consistent systems for every aspect of the schedule will decrease stressStop re-inventing the wheel! Stop guessing what will work best.Be prepared ahead of timeFind things consistently-from chair to chair and room to roomDo procedures consistently the sameKnow that team members will provide consistent answers to questions KNOW that every patient will get consistently great care

  • Carefully use Morning Huddle to plan the dayUse a Clinical Coordinator for better efficiencyLook for ways to help each other (cross training is essential)If we know that a day will rarely turn out the way it looks on the paper schedule why are we so frustrated when things change? EXPECT AND ACCEPT CHANGEIn the time it takes to discuss why something CANT be done, it could be done.Have a good time with the day just the way it is!CLEARLY DEFINED PRACTICE SYSTEMS

  • IF YOU SEE ONE PERSON OR AREA AS RESPONSIBLE FOR HOW THE SCHEDULE WORKS,YOU WILL NEVER HAVE A SMOOTH SCHEDULE (WITH OR WITHOUT DOCTOR TIME SCHEDULING).

  • BUILDING AND MAINTAINING A GREAT SCHEDULE IS A SHARED JUGGLING ACTBY THE ENTIRE TEAM!

  • When we accept tough jobs as a challenge to our ability and wade into them with joy and enthusiasm, miracles can happen! Arland Gilbert

  • Natalie Beaton, [email protected]