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 TODAY
Define Doctor time scheduling
Identify typical problem areas in non
Doctor time and Doctor time
scheduling
Determine office goals for schedule
GOALS FOR TODAY
Demonstrate how to gather data needed to
create Doctor time schedule
Review tools for evaluating data
Discuss steps needed to design new
schedule
GOALS FOR TODAY
Discuss ways to educate patients and
parents about how the scheduling works
and how they can help
Talk 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 efficiency”Karen 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
schedule
•Schedule is more balanced and patients are more
equally distributed
Open Grid
Partially 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 noticed
Needs Doctor in numerous places simultaneouslyLots of waiting in chair and time with doctor can
feel rushed
WHEN A SCHEDULE IS NOT WORKING…
Is 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 seen
Schedule lacks flexibilityPatients sense stress when change is required
quickly
WHEN A SCHEDULE IS NOT WORKING…Causes conflict between team
membersOur body language “gives us away”!
PATIENT CONTRIBUTIONS
EVERYBODY wants after school/work time
Patients 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” breakage
Some patients simply require more time
Patients who have missed or cancelled on short
notice want prime time re-schedule
HERE’S THE PROBLEM
You 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
scheduled
Have a steady pace throughout the day, week and month
Have enough of all types of procedures to see patients as
needed
Have treatment progress in a timely fashion
Build in target production and collection
Have room for growth
SCHEDULING GOALS
Have patients and parents satisfied with the schedule
Allow time for non-patient responsibilities throughout the
month
Allow time for training and cross training during non-
patient time
Allow time for schedule review and maintenance
During a crisis time it doesn’t 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
Meeting
Identify potential problem areas and discuss solutions
Identify best places for comfort care appointments
Pre-plan for glitches as much as possible (ie. Perpetually
late patient or difficult patient)
Identify any “all hands on deck” time
Learn from yesterday
Start today on time and with enthusiasm!
LIFE IS SHORT-CREATE A SCHEDULE THAT ALLOWS YOU TO ENJOY THE DAY!
PATIENTS
DOCTOR
PARENTSSTAFF
We take time to complain daily about what’s not working with the schedule but do not or will not set aside the non-patient days needed to fix the actual schedule.
Why Aren’t We Fixing It?
• Fixing the schedule begins to seem insurmountable
• Everyone’s perception of what is not working with
the schedule is different
• The current non functional schedule creates daily
chaos and there’s no time to think, let alone fix
things
• You 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 doesn’t get
addressed until its inadequacy is actually
becoming painful…It doesn’t need to be that
way…Once you’ve 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 CODES
TIMINGS
SHAPES
COUNTS
PUZZLE BUILDING
SCHEDULING RULES
PRODUCTION/SCHEDULING GOALS
Francis Bacon
PRODUCTION/SCHEDULING GOALS
PRODUCTION AND SCHEDULING GOALS
What 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 Goals
What 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 used
Try 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 examples
EX: under 7, EX:7+, EX:ADDEL:HERBST, DEL: RPE, DEL:RETDB PH I, DB FULLBB FULL, BB UPR, BB LWR
TIMINGS
TIMINGS Have each assistant time each procedure three times
Stopwatch
Timing sheets
DO NOT include wait time
Be sure to include time for notes, cleanup and setup
Having details as to what is being done will help develop a procedure
protocol for each procedure
Use timings to determine if there are training issues
Explain 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 needed
Put similarly shaped appointments together
The fewer shapes you need, the more flexible your
schedule
Keep 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 month
Don’t forget non-patient time needs
SCHEDULING RULES
SCHEDULING RULESEvery office will have different rules. What’s 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 doesn’t 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 Care
Hold start slots: Rule might be that it’s 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 #
available
• Scheduling based on last visit with family dentist
• Quoting fee range over phone for adults
SCHEDULING RULES TO CONSIDER
Defining 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 CONSIDER
Shorter exams for younger patientsFiguring the age cut off based on past
information and Doctor’s treatment approach to Phase One.
Exceptions to rule
SCHEDULING RULES TO CONSIDER
• Type up new list of rules and continue to
add to list as situations come up that had
not been thought of
• Keep 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 shapes
•You know exactly how many of each shape you need in
a day’s template
•You know the shapes that you need on a less than once
a day basis
•You know exactly where your Doctor time falls in the
shape and therefore where it falls in the procedures
•Now you are ready to try to get it to fit together!!!
PUTTING TOGETHER THE PUZZLEStart with Exams and then longer bonding procedures
Mark 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 available
Keep running total of shapes you have already been able to fit
into template
Review scheduling rules as you go along
PUTTING TOGETHER THE PUZZLE
Fill in smaller spaces using shorter shape codes,
scheduling rules and counts
If you need less than one of a code a day include it on
alternating templates
Consider 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 only
Consider a half day a month where the entire team works
on marketing projects only
You may want an exam, start or a deband day template
so you will have it when needed
You may have different start and finish times in the
summer
HOW MANY TEMPLATES DO WE NEED?
You don’t 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 CODES
TIMINGS
SHAPES
COUNTS
PUZZLE BUILDING
SCHEDULING RULES
PRODUCTION/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 perfect
Patients 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.
Let’s not even talk about phone calls…DOCTOR 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 didn’t 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 SYSTEMS
Having consistent systems for every aspect of the schedule
will decrease stress
Stop re-inventing the wheel! Stop guessing what will work best.
Be prepared ahead of time
Find things consistently-from chair to chair and room to room
Do procedures consistently the same
Know 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 CHANGE
In the time it takes to discuss why something CAN’T 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]