Adaptive Doctor Time Scheduling For a Real Time

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

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

GOALS FOR TODAY ØDefine Doctor time scheduling ØIdentify typical problem areas in non Doctor time and Doctor time scheduling ØDetermine office goals for schedule

GOALS FOR TODAY ØDemonstrate how to gather data needed to create Doctor time schedule ØReview tools for evaluating data ØDiscuss steps needed to design new schedule

GOALS FOR TODAY ØDiscuss ways to educate patients and parents about how the scheduling works and how they can help ØTalk about how to make it work: working with a Doctor time schedule and a “real time” day

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

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!!

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

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

SIGNS THAT YOUR SCHEDULE IS NOT WORKING WELL

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

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

WHEN A SCHEDULE IS NOT WORKING… Causes conflict between team members Our 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.

OFFICE SCHEDULING GOALS

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

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 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!

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

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”

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

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

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 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?

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)

PROCEDURE CODES

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

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

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

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

SHAPES EX: PH 2 EX: RDY EX: TRANS EX: CH-9

COUNTS

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

SCHEDULING RULES

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.

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

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 (CC 1): ligs off, seps out, pokey wire Medium (CC 2): one band or bracket off, etc. Long (CC 3): 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 reschedule (and the doctor is going to have you do the regular adjustment anyway).

SCHEDULING RULES TO CONSIDER Shorter exams for younger patients Figuring 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

The Fun Begins! • 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 PUZZLE Start 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

MAKING SURE IT WORKS Count, count and count one more time

USE MANY DIFFERENT EYES TO CHECK FOR MISTAKES

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

EDUCATING THE PATIENT AND PARENT

OFFICE POLICIES AGREEMENT

OFFICE POLICIES AGREEMENT

OFFICE POLICIES AGREEMENT

OFFICE POLICIES AGREEMENT

REALISTIC VERSUS STRICT DOCTOR TIME SCHEDULING

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 SCHEDULING In reality no day is perfect Patients will arrive late or early Procedures will take longer or shorter than scheduled The doctor will be at the chair longer or shorter than the amounts of time we estimated There 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 COORDINATOR Directs Doctor as to where to go next Evaluates how to best deal with late arrivals Decides where Comfort Care appointments will fit in, in the least disruptive way Works out how to catch back up when running behind Assigns tasks to keep schedule flowing smoothly Keeps track of what didn’t work in schedule for discussion at Morning Huddle Makes all schedule related decisions Is 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

CLEARLY DEFINED PRACTICE SYSTEMS Carefully use Morning Huddle to plan the day Use a Clinical Coordinator for better efficiency Look 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!

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 ACT BY 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

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