industry articles

Causes of Scheduling Stress

by Cathy Jameson

 

Tired of running behind schedule? Stressed out as you realize people are waiting and you’re behind schedule? Rushing one appointment so you can get on to the next? Wondering why, at the end of the day, it feels like you’ve been running a chaotic zoo more than an orderly business?

Scheduling can cause stress of great magnitude! The management issue of ‘running behind’ seems to affect all of the dental teams I’ve coached and researched over the past few decades. You feel uncomfortable when others are held up or inconvenienced. This strong feeling of responsibility for so many others—for personnel and patients alike—weighs heavily on you when you are unable to stay on schedule.

Rest assured that organizational and management systems that function effectively with one another are essential for the control of stress in the dental environment. Each of the 25 systems within your practice must work with every other system. One system can't be ‘out of whack’, or the flow of your practice will be interrupted. Without a doubt, scheduling is one of the most critical systems that must be in place if stress is to be controlled. If you don't control your appointment flow, who does? Patients! If your patients control your appointment flow, what results? Chaos! Chaos breeds stress!

The day of simply putting names into the book or filling in lines is over. Managing your schedule affects the productivity, profitability and stress control of each and every one of your procedures. Scheduling is the heartbeat of the practice. Thus, it deserves the greatest care and attention. The person responsible for making and confirming appointments must have the ability, training, time and desire to engineer each day. That training and subsequent attention will be able to help you avoid the top ten causes of scheduling stress.

(1) LATE PATIENTS.

Patients are trained to be late when the office consistently runs late. Waiting is one of the main patient complaints about dentists. In our fast track world, people want and need to stay on schedule. Your respect of patients’ time will gain the same respect for your time.

Do your best to understand the times necessary for each procedure and each appointment. Stay within that time frame. If you are ten minutes past the patient's scheduled time, acknowledge this to the patient. You will offset some negativity if you will graciously accept the responsibility for the delay. For example: "Mrs. Jones, Dr. Jameson has needed to spend more time with his patient than he had anticipated. He would certainly do the same for you. It will be approximately ten minutes before he can see you. Thanks so much for your patience. Can I get you anything – water, a new before & after album to look through?"

(2) IMPROPER SCHEDULING OF TIME.

One of the most critical aspects of excellent scheduling is having a clear identification of doctor time/assistant time/decontamination of room time. Having this information clearly identified in the appointments gives the scheduling coordinator clear guidelines for the following:

  • (a) When the doctor is captive
  • (b) When the assistants are captive
  • (c) Length of time the room will be occupied
  • (d) Length of time the patient will be in the office.

Take one staff meeting and dedicate this meeting to the designing of procedure analysis sheets. These sheets will identify the following:

  • (a) The steps of each procedure
  • (b) Who's doing what
  • (c) How long each step of a procedure takes.

With this information the scheduling coordinator can properly interface one appointment with another. Then you can:

  • (a) Practice excellent time management
  • (b) Maximize the skills of each team member
  • (c) Prevent patients from spending too long at an appointment because of inappropriate scheduling.

Use a procedure analysis sheet to provide your scheduling coordinator with the data he or she will need to appropriately engineer each appointment. Remember, these are NOT written in concrete! However, they will prove to be an excellent roadmap!

(3) WRONG SOFTWARE OR INSUFFICIENT TRAINING.

Use an appointment system with 10-minute units. High tech dentistry and the excellent talent and skill of assistants allow for more efficient management of time. Be careful selecting your appointment management software and, once selected, maximize training so your scheduling coordinator can provide succinct planning for each active chair.

(4) EMERGENCIES.

Placing the coding for the doctor and the assistant in the appointment system will show you where you can schedule emergencies. Emergency patients need to be seen as quickly as possible. However, you do not want emergencies to have a negative effect on your regularly scheduled patients.

Therefore, emergencies (for the most part) should be palliative. Do a quick analysis, prescribe the necessary x-ray, get the patient comfortable and reschedule for the appropriate time. There are exceptions, of course, if you and the patient have the necessary time and if the patient is comfortable with the financial responsibility, you’ll certainly want to proceed with treatment.

(5) DOCTOR SCHEDULED OPPOSITE DOCTOR.

The doctor must have carefully assigned time allotments and responsibilities so that he or she is not scheduled in two rooms at once. There is NO WAY that a doctor can be in two rooms at once! That seems like a silly thing to say, I know, but in thousands of practices across the world, we find that scheduling problem to be common. Instead of allowing that scheduling overlap, keep the dentist(s) moving smoothly and carefully from room to room with clear allotments of when they’re to be where. The doctor is given the desired amount of time for each aspect of each procedure. Thus, he or she is able to sit down, concentrate on that procedure, get it done and then move on when the clinical assistant takes over.

(6) IMPROPER DELEGATION.

Each state has its own unique rules, regulations and laws determining which aspects of a procedure can be performed by the clinical assistant. Abide by those guidelines at all times. Study your own state guidelines and see what can be delegated. Then do so!

Steps for proper delegation are as follows:

  • (a) Determine assignable steps of each procedure using the Procedure Analysis Sheets.
  • (b) During patient time, explain what and why you're doing each step. Demonstrate what you want the assistant to do, and explain why. (Caution: At the chair, be aware of your verbal skills. Be kind and diplomatic, and not too technical.)
  • (c) Spend non-patient time in hands-on training.
  • (d) Next, spend time at the chair with the patients. Have the assistant perform the new task while the doctor carefully guides.

    (Tell the patient what you're doing, and ask permission to teach during the appointment. They'll know how carefully everything is being done and will appreciate your special attention.)
  • (e) Then, let go. Let the assistant take over when appropriate. (This may be the most difficult of all steps!)

    Note: Once you have delegated, trained, and let go, change the necessary steps on your procedure analysis sheets. Your scheduling coordinator must know when both the doctor and assistant are occupied in order to "interfac" properly.
  • (f) Evaluate on a regular basis to make sure things are going smoothly. Clinical assistants want to do all that they can legally do! Given more responsibility, they will stay in the profession longer and will enjoy their work even more.

Feedback is essential. Don't assume that they know they're doing a good job. Tell them. In addition, if you want something done differently, share that also. They want to know. How can they improve if they don't know there is a problem?

(7) NO DETAIL IN THE SCHEDULE.

The schedule must be specifically deteailed such as the following.

Name:John Jones
Specific Procedure:Crn Prep #14
Telephone #:369-2501
Fee:(0495)

With this information in the schedule and on the posted schedules, the clinical assistant can have the room properly prepared before the doctor arrives. In this manner, both can sit down, concentrate and not be disturbed by getting up to get something.

In some instances, the particular material needs to be identified to prevent inaccurate tray/room set up. (i.e. Amalgam or composite)

This detailing serves everyone on the team. 1.) The clinical assistant can be prepared. 2.) The scheduling coordinator can schedule for the daily production goal. 3.) She can confirm easily. 4.) She can answer patient questions about what's going to be done should this re-information be necessary at the time of the confirmation. (5) The doctor knows what he/she is going to be doing on each patient before entering the treatment room.

(8) INTERRUPTIONS OR POORLY WRITTEN COMMUNICATION BETWEEN FRONT AND BACK.

Your paperwork and/or all electronic files should be so carefully constructed that your business team never have to ask questions like the following of you and your clinical team:

  • 1. "What did you do today?"
  • 2. "How much was it?"
  • 3. "What do you want to do next time?"
  • 4. "How long do you need?"
  • 5. "How much time do you need between appointments?"

If you are asking these questions and if there are constant interruptions, study your paperwork and the flow of your patient dismissal. It may need to be redesigned. Your business administrator should not have to leave the patient during dismissal to come back to ask questions of the clinical team.

(9) PERSONAL TELEPHONE CALLS AND INTERRUPTIONS.

Personal telephone calls need to be handled before work, at lunchtime or at the end of the day. Facebook updates, Tweets, mobile phone texts and other easily accessible distractions need to be clearly understood as unacceptable interruptions to the workflow of each day.

For good old fashioned phone calls, those can be screened carefully and diplomatically. Place the completed messages on a message board or in assigned message baskets. Make sure the person receives their message. The doctor can let it be known for whom he/she can be called to the phone. There will be some exceptions, but these need to be identified.

If your doctor receives many calls during the day, he/she may find it more time-efficient to schedule half an hour each day for management, perhaps the 30 minutes after lunch. People can be informed that the doctor takes or returns calls at that time.

Come up with a basic expectation for the rest of modern communication so everyone is clear on what is and isn’t acceptable and how to help one another be successful and on schedule.

Some practices have had great success by requiring all mobile phones to be checked in at a central location when they’re on duty. That way everyone can check messages and respond on breaks, but isn’t tempted during work time. It also makes it easier for their friends and family to get out of the habit of contacting them during the work day. Many practices have also locked out Web sites that cause inefficiencies (like Facebook and Twitter), while others have set a computer up that’s not connected to the main server (for extra virus protection) and allotted certain break times when such sites are a commonplace favorite stop for team members. This also allows team members to make updates to a practice-associated page which becomes a valuable marketing tool. Work together to discuss different options and then make a decision about what’s best for the practice.

(10) TALKING TOO MUCH ABOUT UNRELATED ISSUES OR NOT PAYING ATTENTION.

Knowing your patients on a personal level and knowing special things about them is important for practice/relationship building. However, when discussions of non-dental issues have a detrimental effect on the schedule, this can have a negative impact on other patients. Someone eventually loses.

Therefore, do an appropriate amount of "personalizing", and then be about the business of talking about or performing the dentistry. That's why everyone is there.

Focusing on the business at hand is called "compartmentalization". They expect to see you as a professional so while friendliness is a plus, you’re most respected as a healthcare provider and not just a buddy. This focus will keep you on course, streamline your time management and enhance your patient relationships.

IN SUMMARY

I have identified ten reasons for poor scheduling or for running behind schedule, a major source of stress for many practices. I have suggested a few solutions for those ten problems and look forward to speaking with you more on the November 9th webinar "Scheduling for Productivity, Profitability and Stress Control". Dentrix customers, register now by clicking here: www.dentrix.com/resourcecenter. Not a Dentrix customer yet? Visit www.dentrix.com now.

Cathy Jameson is founder and CEO of Jameson Management, Inc., an international in-office consulting firm helping improve dental practices. For more information, call 877.369.5558.