Nearly everyone has problems and concerns on the job, and sometimes you're just too close to a situation to solve something yourself. Share your concerns with Team Troubleshooter, and the experts will examine the issues and provide guidance. Send questions to [email protected].QUESTION: The office I work in has multiple hygienists. The office typically allows for one-hour recall appointments. One hygienist schedules 50 minutes, but her patients may not always be with her for the next appointment. The office policy is to treat patients for the full appointment, even if they’re 10 to 15 minutes late. The front desk cuts down appointment times to squeeze in patients. When appointments are cut there is not a floater or assistant to help with turning over the room.
I explained to the doctor that one-hour appointments are necessary. I’m aware providers work at different paces. I’m also aware of the difference in care by providers in my office. I pride myself on providing comprehensive health exams, oral cancer screenings, patient education, and more. I don't want to cut corners. It’s a huge problem for me when a patient is late and it's unfair for both of us. I brought all this to the attention of the doctor and was told that if the hygienist wants 50 minutes, her appointments should stay in the schedule that way. Unfortunately, that does not happen. Alerts are routinely dismissed and the front desk does not read the treatment notes for time needed by hygienists. The doctor is aware that this occurs. When I provided the doctor with literature that supports the importance of other providers not cutting or the front desk not squeezing in patients, I was told the articles aren't “real life.” I’m very frustrated. Thanks for your advice.
ANSWER FROM ANGELA CLAYTON,Clayton Consulting Services Inc:
It sounds like the challenges you’re experiencing in your practice revolve around scheduling effectively and efficiently. I commend you for bringing your concerns to the doctor’s attention. I’d suggest you be persistent and talk again. Be sure to explain again specifically the issue you’re having with the scheduling and the negative impact this is having on the practice, and what you think is a good resolution. Present the following information and suggestions to him or her and ask if you can all work together to create a more efficient and productive system for the entire team, which will benefit your patients.
Before you meet again with your doctor to discuss these challenges, review the important reasons for creating and maintaining an efficient and effective schedule.
1. To provide necessary treatment for patients in an efficient manner.
2. To effectively use the time of the patient, doctor, and auxiliaries while maintaining optimum quality standards.
3. To use treatment rooms and care providers effectively and efficiently.
4. To produce revenue so the office can obtain maximum profitability.
5. To establish a communication system for scheduling that effectively facilitates enrolling patients in an efficient schedule.
6. To schedule real time for procedures, segmenting delivery of services by doctor time and hygienist time.
7. To avoid stress for the patients, dentists, and team.
8. To promote promptness of service. This means seeing patients within 10 minutes of their scheduled appointment time.
9. To have the practice team in control of the schedule.
10. To leave the office on time for lunch and at the end of the day.
Now consider the following: There has been a significant paradigm change in hygiene over the past several years. In the old paradigm, the gold standard was hand instrumentation, and the ultrasonic was for gross debridement of heavy calculus. Now the standard is to use the ultrasonic for 90% of scaling, including recall patients.
Present these three ideas to the doctor to help the office resolve the challenges you’re facing.
1. Reserve the correct amount of time for each appointment—Front office team members often try to squeeze patients into odd leftover time slots, and hygienists go bonkers. On the other hand, hygienists sometimes like to schedule 40 minutes for young patients. Standardize the time for patients. Most of the computer programs allow you to customize the recall time in the recall screen for each patient. This way if a patient cancels and does not reschedule until later, the front office knows the amount of time for the appointment.
Patients who require more than the adult standard, which should be 50 to 60 minutes, should be charged more for the extra time. If you need an extra 10 minutes due to someone’s smoke stain, lack of homecare, or “impossible tongue,” then charge for that extra time. Just because a preteen becomes an “adult” in the insurance game does not mean that the preteen should get 60 minutes for an appointment.
2. Know your real time for procedures—Conduct a two-week time audit to be sure you know the correct chair time for all procedures. The time should include the real time for your room change, including the OSHA-regulated steps. Once the time audit is complete, post it and use the correct times. If you’re unhappy with the real times, work toward more efficient delivery.
3. Re-evaluate your office protocol regarding late patients—If your office insists on treating patients who are more than 10 minutes late, you’ll want all team members trained on how to communicate with patients when they’re late. Tell patients that you have X amount of time reserved for them, and you now have X amount of time remaining for their appointment. Tell them you’ll be happy to seat them and get started on their radiographs and have the doctor come in for the hygiene exam, but you’ll be able to perform their prophy only if time permits. Starting late on patients is a true schedule killer and underproductive.
I hope this helps you start solving some of the office’s problems. Good luck!
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