Adaptive Doctor Time Scheduling For a Real Time Day

1. Adaptive Doctor Time Scheduling For a Real Time Day Natalie Beaton, Consultant joyfulchange@comcast.net www.joyfulchange.net

2. HOUSEKEEPING 101 • This entire presentation is available on my website: www.joyfulchange.net • You will need to have PowerPoint to view it. • Please fill out your class evaluation forms!

3. GOALS FOR TODAY • Define Doctor time scheduling • Identify typical problem areas in non Doctor time and Doctor time scheduling • Determine office goals for schedule

4. 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

5. 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

6. What is Doctor Time Scheduling? Doctor can “glide effortlessly between patients in a well-choreographed display of relaxed efficiency” Karen Moawad

7. What is Doctor Time Scheduling? 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!!

8. What is Doctor Time Scheduling? 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

11. Non Doctor Time Schedule Open Grid Partially Defined WAITING………

12. SIGNS THAT YOUR SCHEDULE IS NOT WORKING WELL

13. WHEN A SCHEDULE IS NOT WORKING…. • The office frequently does not start the day on time • To the patients it feels disorganized and unprepared • Runs over at lunch and at the end of the day • “Comments” are overheard by patients or frustration is noticed • Needs Doctor in numerous places simultaneously • Lots of waiting in chair and time with doctor can feel rushed

14. WHEN A SCHEDULE IS NOT WORKING… • Is often running SIGNIFICANTLY LATE • Disrespectful of patient time and very stressful for staff and Doctor • Does not have time available when needed (no room for growth) • Exams and starts are waiting weeks to be seen • Schedule lacks flexibility • Patients sense stress when change is required quickly

15. WHEN A SCHEDULE IS NOT WORKING… • Causes conflict between team members • Our body language “gives us away”!

16. 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

17. 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.

18. OFFICE SCHEDULING GOALS

19. SCHEDULING GOALS • Work 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

20. 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!

21. SCHEDULING GOALS • Daily 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!

22. LIFE IS SHORT-CREATE A SCHEDULE THAT ALLOWS YOU TO ENJOY THE DAY! DOCTOR PATIENTS STAFF PARENTS

23. 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.

24. Why Aren’t We Fixing It?

25. 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!

26. “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”

27. PUZZLE BUILDING SCHEDULING RULES COUNTS SHAPES TIMINGS PROCEDURE CODES PRODUCTION/SCHEDULING GOALS

28. "Things alter for the worse spontaneously, if they are not altered for the better designedly" Francis Bacon

29. PRODUCTION/SCHEDULING GOALS

30. 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?

31. PRODUCTION AND SCHEDULING GOALS • What 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?

32. Defining Your Marketing Goals What do you want to provide? (Office Mission) How do you want to be perceived? (Office Image) What do you want to achieve? (Marketing Goal)

33. PROCEDURE CODES

34. PROCEDURE CODES • Look 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 together • Example: RECS:FULL, RECS:INV, RECS:PROG, REC:PH I, RECS:FINAL

35. PROCEDURE CODES • Other grouping examples • EX: under 7, EX:7+, EX:AD • DEL:HERBST, DEL: RPE, DEL:RET • DB PH I, DB FULL • BB FULL, BB UPR, BB LWR

37. TIMINGS

38. 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

39. TIMINGS

40. SHAPES

41. SHAPES • Look 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

43. SHAPES

44. COUNTS

45. COUNTS • Past versus future counts • Allow room for growth • If 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

47. SCHEDULING RULES

48. SCHEDULING RULES • Every 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.

49. SCHEDULING RULES TO CONSIDER • Debands 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

50. 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