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5.30.08 Issue #325 Forward This Newsletter To A Colleague

Nancy Caudill
Senior Consultant
McKenzie Management
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Accountability for My Performance? Who Has Time?

Dr. Jason Wright—Case Study #279

Dr. Wright was distressed over what appeared to be tasks not being completed by team members in the office, both clinical and business. He wanted to put new systems in place to measure performance and to give each team member an area where each was accountable for the results of his/her department. In order to move the practice in this direction, the following information needed to be gathered and addressed:

Practice Statistics

  • 800 active patients
  • 2 clinical assistants
  • 6 hygiene days
  • 2 business assistants
  • 1 doctor working 32 hours a week
  • Average daily gross production: $7,500 per day


  • The assistants were unclear about their job descriptions. One assistant was more adept at chairside assisting with the doctor and anticipating his chairside needs. At the same time, sterilization tasks were not getting accomplished in a timely manner by either assistant because they each thought “the other assistant” was completing the task. Both assistants were working into their lunch hour or working overtime. There wasn’t a policy in place pertaining to “who stays and who goes” when Dr. Wright ran late. In most cases, there was only one patient in the treatment room but two assistants, one of them working with the patient and the other “standing around” trying to look busy.


  • Both business assistants enjoyed working together and sharing the same tasks. They commented that they both “do what needs to be done.” When asked about follow-up on collections and unscheduled recall they admitted that neither of them worked those areas consistently.
  • Job descriptions were not in place so many duties were duplicated or not accomplished at all. Without defined duties and accountability, they choose what they would or would not do on a given day. Neither business assistant had a clear understanding of the dental business systems that are key to practice success. (Advanced Business Training through McKenzie Management was recommended.)
  • When questioned about incomplete tasks, the response from both business assistants was, “I don’t know when I would have time for that.”

The business team was only following the directions that had been given to them by the doctor upon their hire. In their eyes, the job was getting done to the best of their ability.


  • Assign the more skilled assistant to remain with the doctor as he moves from treatment room to treatment room. Her/his responsibilities are to maintain rapport with the patients, write clinical notes for the doctor’s review, assist with all the chairside duties, answer any questions regarding treatment and/or recommended treatment, and dismiss the patients to the Scheduling Coordinator. She/he is also responsible for clinical supply inventory.
  • The less skilled assistant will be in charge of seating patients and verifying the treatment scheduled, the setting up and breaking down of the doctor’s treatment rooms, sterilization of all instruments, keeping the lab and sterilization areas clean, stocking of all the treatment rooms, unpacking supply boxes, checking off invoices and assisting the hygienists when available for perio-charting or other support.

Assigning specific duties to each assistant gives clarity to job duties. Should there be a need for overlapping duties, these issues should be discussed at the morning meeting when preparing for the day. The morning meeting is the time to discuss who will stay through lunch and who will stay at the end of the day.


  • Specific job descriptions must be given to each business team member. The Scheduling Coordinator is responsible for keeping the doctor scheduled to the daily goal, checking all the patients in and sometimes out. She is also responsible for all unscheduled treatment plan follow-ups by phone and by mail. Treatment plan acceptance rates should be monitored and reported on at the monthly meeting. She is also responsible for preparing the charts with routing slips and confirming all the appointments for the doctor.
  • The other business team member is the Financial/Insurance Coordinator. Her/his job duties would include follow-up on outstanding insurance claims, financial arrangements with patients and follow-up on past due accounts, sending weekly statements and posting payments from the mail. This position is often the Hygiene Coordinator, responsible for the maintenance of the recall and patient retention systems, including the follow-up on all past-due hygiene patients and reporting this information at the monthly meeting.

Having specific tasks and accountability for the outcome of these tasks is the only way to measure the success or failure of office systems. Accountability for completion of daily tasks is paramount to the efficiency and productivity of the practice.

Dr. Wright came to the understand that he needed to be accountable for the success of his dental team by seeing that systems were in place to measure performance based on job duties and accountability to the practice vision and goals.

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