Why Your Schedule Isn't Working
The headline on the article read: “Never say, ‘I don’t have time’ again.” Yeah right, I thought. This article was going to enable me to restore all the lost moments and hours in my day. And it was going to do so in 700 words or less. As you might expect, it didn’t quite achieve that, but it was a valuable reminder that our time is dictated by the priorities we choose.
Day-to-day we are responsible for our time and where we focus our energies. Yet don’t we all prefer to blame the external forces - like the scheduling coordinator who seems to enjoy watching you sweat as you race from room to room, or the sudden departure of an employee whose vacancy leaves you scrambling, or the emergency case that walks in the door at 4:55 p.m. on Friday.
Dentists and dental teams know all too well the daily drill of life and work under seemingly relentless pressure and managing the latest round of unexpected events while balancing an ever-present sense of urgency. Tensions are high and tempers flare because with all the racing and running, there should be a decent payout in production and profits. There should be, but there isn’t. They don’t measure up to the perceived output of time and energy. But why? If you and your team feel you are constantly racing through your day, yet perpetually spinning your wheels, there are a number of factors that could be playing into this continuous state of inertia. Look first at the obvious: the daily schedule and who is managing it.
“Who” is important, not because you are going to point fingers but because you must have accountability. Let me explain. You have “Cari” and “Jill” taking care of the majority of the business duties in your practice. You reason that it makes sense to have both of them “in charge” because you view this as insurance, if you will. If one is out or quits, the other just takes over. It may seem counterintuitive, but if there are multiple people responsible for managing the appointment schedule, no one is truly responsible for its success. They are looking to “fill in the blanks.” They aren’t looking to achieve a specific goal, yet how they “fill in the blanks” sets the financial course for the entire practice.
It’s far more effective to designate a scheduling coordinator. This person, through training and experience, becomes highly skilled in scheduling to meet specific daily goals. The schedule becomes “their baby,” they can take ownership of it and have pride when it delivers on its objectives. Of course, another person is trained and can step in when the scheduling coordinator is out ill or on vacation, but accountability rests in the hands of the designated scheduling coordinator.
Now before you trot off and anoint “Debbie” as your scheduling coordinator and assume that all will be right in your now expertly-scheduled world, you must communicate your expectations. You must realistically consider the amount of time it takes you to complete procedures. You must establish realistic goals. And if you really want to improve your scheduling outcomes, you must professionally train this employee to maximize your schedule.
Practices that are consistently able to schedule to meet ambitious production goals are maximizing the clinical team, the available treatment rooms, and the scheduling procedures. The assistants are trained to perform every procedure legally allowable in their state. Treatment times are overlapped by 10 minutes at the start and conclusion of each appointment. Not only is the doctor’s time scheduled, so too is the assistant’s.
The scheduling coordinator knows exactly how much time to allow for each type of procedure. S/he doesn’t guess how much time to allocate. S/he doesn’t simply schedule to keep the doctor “busy.” Rather, the doctor(s) and the clinical staff have evaluated each standard procedure and have determined the amount of “doctor” time and the amount of “assistant” time necessary. Examining the clinical procedures is essential because it enables the clinical team to carefully consider what could and should be delegated to maximize efficiency and practice profits. Ultimately, the scheduling coordinator is scheduling to meet specific goals, not merely “fill in the blanks.”
Next week, scheduling your “dream day” - don’t let it become your nightmare.
For more information on this topic, visit my blog: The Lighter Side
Interested in speaking to me about your practice concerns? Email email@example.com
Gatekeeper Closing the Door on Dollars?
Is your “gatekeeper” driving up your overhead? This person means well and has your best interests at heart - or so s/he thinks - but consider how gatekeepers commonly view their responsibilities and how these “well intentioned” actions affect your practice. First and foremost, your gatekeeper not only lives by the rules, s/he feels compelled to enforce them. It is difficult to comprehend that others may not value these “rules” as they do, so gatekeepers give little if any consideration to the reality that for every action there is an equal reaction... and not necessarily a positive one. Are any of the “rules” below costing your practice?
Appointment Rule: Patients must be in the office at their appointed times. If they don’t show, the financial policy says that they will be charged a fee.
Enforcement: The gatekeeper promptly sends the invoice with the fee explaining that the patient did not cancel the appointment in a timely fashion, therefore the office must charge them a fee.
Reaction: The penalized patients don’t return. They also share details of their negative experience at your office with hundreds of their friends via one comment posted to Facebook or Twitter. Fewer patients mean lower revenues and higher overhead. If you are lucky, an offended patient or two will call and complain. However, the gatekeeper doesn’t want the doctor bothered by the complainers, so the doctor may or may not get the message.
Solution: Never charge a fee to patients that do not show in your practice. Rather, institute a recall system that ensures appointments are confirmed in advance, and patients who are not in the practice at the appointed time are notified according to a carefully crafted script.
Protocol Rule: When new patients call the office they are to be scheduled for a comprehensive visit with the doctor first.
Reaction: The practice is losing new patients. Some patients relent and follow the rule. Others agree only to cancel the appointment or simply not show. Most simply call a different practice.
Solution: The patient wants what the patient wants. As a service provider, practice success is contingent upon attracting and keeping happy patients. Simple requests and patient preferences should always be honored.
Payment Rule: Payment is expected at the time of service.
Enforcement: The gatekeeper makes it abundantly clear that the practice takes cash, check, or charge.
Reaction: Patients feel that the practice’s priority is money, not patients. Moreover, inflexible payment procedures make it very difficult for patients to accept larger treatment recommendations.
Solution: Practices need clear financial guidelines, but they also need options, such as treatment financing plans like CareCredit. Options encourage patients to not only keep appointments for preventive care, but also to pursue necessary and desired treatment.
“We” Rule: “We can’t do that here.” No, we don’t take that insurance. No, we don’t offer evening appointments. No, the office isn’t open on Saturdays. No, we don’t schedule appointments before 8 a.m. No, we are not open between noon and 1 p.m. No, we don’t honor other practices’ coupons or special offers. No, we can’t schedule all three of your children on the same day. No, I couldn’t possibly get you in this week. No we don’t have any openings in hygiene for six months. No, we don’t text appointment reminders. No, we don’t have our patient forms posted on our website. No, we don’t have a website. And on and on and on.
Reaction: Patients feel it is simply too difficult to work with your practice. If you are telling patients you “can’t,” we “don’t” or I “won’t” you are sending the wrong message. It’s not about your rules, your preferences, or your way of doing things.
Solution: “Can’t,” “Don’t” and “Won’t” are three four-letter words that should be struck from your vocabulary. Always emphasize what you can do. “We take a variety of insurance plans. In addition, we offer convenient payment options.” Pay attention to what the gatekeepers are telling current and prospective patients in your practice. And finally, never forget that the most successful practices are following the only rule that matters - treat patients as you would want to be treated.
Interested in speaking to Gene about your practice concerns? Email firstname.lastname@example.org
Front Desk Burnout Costs Too Much to Measure
I am leaving my job after 18 months because I just can’t take the pressure anymore. I was trained by the previous office manager who left for the same reasons; all I get is criticism and no appreciation. I am not going back to dentistry.
Regards, Betty Burned Out - Office Manager
According to data from Ross Blake of Webpronews, the Society for Human Resource Management (SHRM) estimated that it costs $3,500 to replace one $8/hour employee when all costs - recruiting, interviewing, hiring, training, reduced productivity, etc. were considered. SHRM’s estimate was the lowest of 17 nationally respected companies who calculate this cost! Other sources provide these estimates: It costs you 30-50% of the annual salary of entry-level employees, 150% of middle level employees, and up to 400% for specialized, high level employees.
Do a quick calculation: Think of a job in your organization where there has been some turnover, perhaps supervisors. Estimate their annual average pay and the number of supervisors you lose annually. For example, if their average annual pay is $40,000, multiply this by 125% (or 125% of their annual pay, a reasonable cost estimate for supervisors). This means it costs $50,000 to replace just one supervisor. If this company loses ten supervisors a year, then 10 times $50,000 equals $500,000 in replacement costs for just supervisors. This is the bottom line cost. The top line cost? If the company’s profit margin is 10%, then it costs $5,000,000 in revenues to replace these ten supervisors.
The cost to the practice that is hardest to measure is the perception of patients, especially those who had formed a relationship of trust with the exiting staff member and the morale of the remaining staff who have to now adjust to another new team member. The mood in the office after someone has left is often somber and palpable to patients coming in for treatment, resulting in lower treatment acceptance and possibly the tipping point to patient retention in the practice.
As Senior Training Instructor of dental personnel for ten years, it is apparent to me that an employee is only as good as the training and education they have received to do their job, coupled with whether their temperament is suitable to do the work they are hired to do.
Dentists are typically not good at training front office systems, nor are they proficient at the dental software that manages the data of the practice. Taking the time to learn what good office systems are and learning the software enough to train the basics to a new staff member is imperative to being the CEO of your dental practice.
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