natalie beaton, consultant joyfulchange@comcast.net

Natalie Beaton, Consultantjoyfulchange@comcast.netwww.joyfulchange.net

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, Consultantjoyfulchange@comcast.netwww.joyfulchange.net