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If a practice is not profitable, a revaluation of quality chairside time will help bolster a routine in a rut.
"The hygiene schedule is CRITICAL. 'Hygiene drive practice growth'." - Lee Harris, DDS
With any for-profit business, time and money are inextricably linked as the two most important resources. It is important for practice owners, as well as salaried dentists, to determine exactly how much each hour worked is generating for their bottom line. Doing simple mathematics to reveal exactly how much each hour is valued helps to determine if changes are necessary.
Unfortunately, delivering high-quality treatment is not enough to ensure a profitable business. As the head practitioner, dentists need to be aware of the time they spend away from the operatory. A lack of scheduling optimization or staff utilization can waste the most valuable and limited resource — your time. Ensuring that primary and secondary practitioners are allotted the resources they need to be successful will create a better workflow and greater harmony within the office.
Depending on the size of the practice, there should be one, or several, designated scheduling coordinators to ensure continuity in the scheduling of all procedures. Lee Harris, DDS of Harris Dental Solutions Inc. recommended that “one front office person be accountable for the schedule, but all front office staff should be trained according to specific protocols developed for the office to maximize production and efficiency while minimizing patients waiting.” An improperly scheduled appointment can easily become disastrous if there are not enough time units allowed for its completion.
Even worse, giving the doctor or hygienist too many scheduling units can lead to unwanted idle time. “Each dental office will have different guidelines for appointment scheduling depending upon number of doctors, type of practice and many other factors” Harris added.
It is important to be acquainted with the laws in each state outlining services that can legally be rendered by registered dental assistants and dental hygienists. Harris emphasized “auxiliary use should be maximized; anything within the scope of [their] license” should be recognized and implemented into regular practice. For example, having the properly certified dental assistant apply fluoride treatments to pediatric patients can free up the hygienist to move onto the next patient.
Alternately, Harris suggested hygienists “should always perform anesthesia procedures when allowable by law” to prep the patient before the dentist arrives to the operatory for treatment. These minutes saved add up at the end of the day and can alleviate the stresses associated with a backed-up schedule.
In today’s hectic environment, cancellations and late arrivals are inevitable and have become a part of most healthcare practices. Having multiple patient appointments overlapping in the schedule is a controversial topic that some practitioners reject altogether. Harris did not recommend overbooking “unless the office has a no show or cancellation issue”. However, with proper planning and open office communication, this method of time utilization can be successful. If certain patients are chronically late or canceling, plan for them to be unreliable and make sure all staff members are onboard to help in the event appointments begin to overlap.
Another option for filling cancelled appointments is having a designated “short-notice appointment list for those patients nearby” said Harris, adding “I also recommend [being] aware of other patients in the schedule that may be due for hygiene”. A reliable and curated list of patients to fill both the hygienist’s and dentist’s schedule in case of cancellations may minimize lost chairside time.
Certain treatments that require significant chair time or repetitive treatments may not be the most lucrative choice for all offices. An orthodontic case that generates significant production is tempting to overtake; however, it also entails numerous appointments that require attention from the front desk and clinical staff.
Similarly, an office with a limited number of operatories would be ill-advised to dedicate a chair to an in-office whitening treatment when the patient can have custom trays made in less time. Harris reminded general dentists performing specialty-level care that they “must be able to produce the same outcome” as a specialist in the community — another factor that suggests referrals may be more advantageous in certain situations.
Besides the dentist, the hygienist is the highest paid and most trained employee in the office after the dentist. Making sure the hygienist has enough patients, without overwhelming their schedule, will capitalize on this resource. Additionally, much of the treatment rendered by the dentist will come from hygiene. Harris described the hygiene schedule as a “critical” element to the overall success of the practice; adding to it that the “dental hygienist will develop a better relationship with [the] patient than the [dentist].”
A repetitive, positive experience with the hygienist will make patients feel more comfortable coming to appointments regularly. Patients who fail to come for their check-up appointments will not be alerted to their dental needs, often until it is too late.
Delivering great dentistry is only part of the profitability equation. It is essential that all members of the dental team assist the dentists in increasing treatment quantity without compromising quality. If the practice is not profitable, there is significant ‘down time’, or the schedule is not running smoothly, a revaluation of quality chairside time will help bolster a routine in a rut.