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Mastering Computer Scheduling: Ensuring Profitability While Creating the Perfect Day

Dentistry Today October 1, 20048 Mins read650 Views

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While performing a practice analysis for a potential consulting client, I had the opportunity to observe the appointment coordinator scheduling in the computer and then entering the same information in a manual book. I inquired as to why she was doing double entry. She explained that the doctor does not use the computer, and he likes to look at the remainder of the week at the end of each day. She also commented that they both were fearful of missing something important by giving up the book. A closer look pointed out that adequate training had not taken place to ensure that they received an in-depth understanding of the software program. This lack of training, combined with a mindset that only the book provides a total picture, created labor-intensive steps that were a waste of time.

All business administrative staff having a history in dentistry can recall the insecurities that had to be faced when giving up a manual system that had worked reasonably well for decades. Not forgotten are the growing pains that were endured as a new and better scheduling system slowly evolved.

Although computer scheduling has been available for the past 25 years, it has only been in the past 10 years that the scheduling software programs have surpassed the capabilities of the manual book. Older programs were extremely slow, inflexible, and labor intensive. They were limited in scope and did not link up with other crucial systems, such as the financial ledger, treatment plan, and insurance data. Simple tasks required accessing multiple screens, and changing an appointment was very complex. Unscheduled treatment and cancelled appointments were often lost. In short, it was easier to utilize a manual book.

Fortunately, these challenges have been resolved. Currently, less than 10% of all dental practices schedule in a manual book. Computer scheduling has proven to be highly effective and time efficient. Effective scheduling requires attention to the 3 basic phases that serve as the cornerstones of this system. Every practice will evolve through these phases with time and in the order indicated:

(1) Meeting the initial need to fill the schedule and ensure that patient flow is adequate.
(2) Providing the procedure mix needed to create a productive day, while meeting the treatment needs of the patient.
(3) Implementing time-efficiency scheduling, which maximizes the utilization of the clinical team and facility. Patients are not double-booked, but overlapped according to doctor availability.

CONSIDERATIONS WHEN EVALUATING A SOFTWARE PROGRAM
In the evaluation process, it is important to assess the software’s capabilities in 5 vital areas that impact your ability to schedule at the highest level of efficiency.
(1) Training and Support: Without quality training and effective ongoing support, full implementation of a successful system is in danger. Unfortunately, many dentists cut costs in this area, causing major losses in efficiency due to lack of knowledge. It is imperative that references are checked to ensure that the system has a long-term reputation for sound training and support.
(2) User Friendly: Evaluate how quickly the staff can perform the necessary tasks. Software programs can vary greatly in their ability to streamline the steps needed to complete a task. A labor-intensive system can cause wasted time and a backup of patients waiting for appointments.
(3) Reports and Systems Integration: Determine how quickly and easily you can retrieve information needed for a snapshot of the success of your scheduling system. A few of the overview functions that support scheduling are as follows:

•Patients due for continuing care
•Status of production for any time frame or provider
•Status of goals
•Identification of unscheduled treatment by patient or procedure
•Status of new patients
•Status of substantial procedures scheduled and/or needed for any time frame
•Daily, weekly, and monthly overview of open time
•Identification of patients with financial and/or cancellation alerts
•Access to the quick-call list or tickler file
•Identification of medical alerts

It is essential that medical alerts, diagnosed treatment, financial information, and insurance details be integrated with the scheduling software. All of this information impacts how the patient is scheduled and provides immediate information needed for effective patient interactions.
(4) Smooth, Seamless Experience for the Patient: Check-in and checkout must be time efficient and error free. Confidence in the doctor and staff suffers when errors impact the scheduling system and appointing is a lengthy and/or confusing process.
(5) Ongoing Feedback: The ability to see all aspects of the schedule as it unfolds was a major benefit of the manual book and a definite drawback to computer scheduling in older systems. Very effective programs are now available to show you the status of the day, month, and year in relationship to production by provider, procedure mix, and open time. Constant awareness on a daily basis and quick and easy access are essential.

SCHEDULING IN THE TREATMENT ROOM VERSUS THE BUSINESS DESK
The decision not to install computers in the treatment rooms is often based on lack of space as well as financial and staffing limitations. There is not a right or wrong approach to this decision, and many factors can impact which is appropriate for each individual practice. Although “the paperless office” is often discussed as the ideal, few practices have accomplished this goal in its true form. Most are a hybrid of this concept and continue to maintain physical paper charts and share scheduling tasks between clinical and business staff. This type of practice enjoys the flexibility of scheduling the patient when and where it is most appropriate at the time.

When scheduling is conducted in the business office, a manual treatment plan must be generated in the treatment room and then entered into the computer by the business staff. It is crucial that all aspects of an effective treatment plan be documented on this form. Without a comprehensive plan, information needed to generate the support systems cannot be entered, which compromises the scheduling system.

If the computer is present in the treatment room, treatment plan entry takes place during the exam. Scheduling in the treatment room is very effective when adequate staffing is available to remain after treatment to make the necessary entries. It is obvious that a small staff and a limited facility do not offer the time and space to make this approach feasible.

SCHEDULING MULTIPLE PROVIDERS
Most software programs have the ability to identify each provider by character (usually a number or letter) and/or color. Immediate feedback as to the status of each operator’s schedule is most effective when identified by both methods. This is especially helpful if the program can quickly identify open time for a specific provider by day, week, month, or year. This system also allows end-of-the-day reports to be generated by provider, which allows valuable input for analysis.

STABILIZING DAILY PRODUCTION
Wide swings in daily production create stressful days for the entire team. This oscillation is an indication of excessive short-notice cancellations and/or that the only scheduling criteria utilized is filling time. A full schedule that comes together by chance or is patched back together after multiple cancellations can create a high-stress/low-productivity day.

Creating a productive, low-stress day relies on scheduling an appropriate procedure mix. A mixture of (1) high-production procedures, (2) moderate-production procedures, and (3) low-productive to nonproductive procedures will ensure that all patients receive treatment in a timely manner. These 3 categories of procedures are often referred to as rocks, sand, and water. To schedule this mixture effectively, a template of the ideal day must be created, and procedure blocks entered into the system’s scheduler. It is important to customize the ideal day to support financial needs and to ensure that it is reasonable and obtainable.

Example:
•2 units of crown and bridge
•2 seats or deliveries
•3 hours of composites and/or RCT
•2 new-patient exams
•1 hour miscellaneous

Successfully meeting the requirements of the daily template ensures that production goals are met and the daily production swings are controlled without sacrificing patient needs.

Rock, sand, and water procedures are blocked and identified by a specific color outline or solid color block. To protect the integrity of the ideal day, it is recommended that the blocks span a 6-month period in advance of the current day. The most effective program will allow the appointment coordinator to move these assigned blocks to any position during the day as the schedule unfolds. However, difficulties can arise if the program repeats the change in all future templates. Also, some programs allow movement vertically, but not laterally to another column.

To compensate for these challenges, a change in the blocking system is necessary. Procedures can be blocked by the “fictitious appointment” method. For example, to block a rock procedure, schedule an appointment for “Mr. Rock” at the desired time each day. Do the same for each category of procedure to be blocked. Since the program identifies these entries as actual appointments, moving them around is easy. When searching for an opening for a rock procedure, select the next appointment for Mr. Rock, and substitute this entry with the patient’s name. Obviously, this type of blocking requires extra steps that can be avoided by purchasing a comprehensive scheduling program with effective blocking features available at your fingertips.

TIME-EFFICIENCY SCHEDULING
Once the schedule is full 5 to 7 days forward and ideal day scheduling is in place, time- efficiency scheduling is the next step to take production to its greatest potential by maximizing the utilization of the facility and clinical team.

In order to implement this system, the doctor must utilize a minimum of 2 treatment rooms and 2 clinical assistants. Appropriate procedure steps are delegated to the assistant, which shortens the time the doctor is treating the patient. When doctor time and assistant time are identified, appointments can be overlapped according to doctor availability, which is the most effective use of the doctor’s time.

Most comprehensive scheduling software programs ident-ify doctor and assistant time, if the scheduler has been prepared to provide this information. The most effective systems will identify doctor time, assistant time, and anesthetic time. Hygiene exams and other short procedures can be scheduled during anesthetic time, so visual feedback of this scheduling opportunity is very helpful. Programs vary as to the characters used to identify these 3 components. Symbols, letters, or numbers are all commonly utilized and can be very effective. For example: + = assistant time, • = anesthetic time, and / = doctor time; or 1 = doctor time, 2 = assistant time, and 3 = anesthetic time.

To create an accurate time-efficiency schedule, it is crucial that the system be customized to meet individual time allotments and the level of delegation to the assistant. Evaluating each procedure and assigning responsibility to the appropriate individual can accomplish this. This information is then entered in the program scheduler. As appointments are made, the system will automatically code each appointment, which guides the placement of subsequent appointments according to the doctor’s availability. Systems alerts occur to prevent double-booking the doctor. Further customization can occur by overriding the scheduler when a procedure requires an adjustment in time (Table).

CONCLUSION
Purchasing a software program that provides all of the concepts discussed in this article and ensuring that the staff receives the training needed to utilize these concepts are the keys to maximizing your efficiency, and therefore your productivity. Gone is the stress created from a haphazard day created by a schedule that functions inadequately due to lack of knowledge or system preparation. Today’s computer scheduling has opened the door to creating a daily environment that greatly enhances the quality of the work experience for the entire team and ensures that the desired rewards are within reach.

Ms. Bernhardt is the owner and director of Christene Bernhardt & Associates (CB&A), a practice management firm that provides services in consulting, educational systems, staff training, and workshops for the dental profession. Since 1984 her team has provided in-depth, customized consulting services for hundreds of dentists throughout the United States and Canada. Hands-on programs are customized to the needs of each practice. The CB&A database of practice statistics provides cumulative knowledge and insight as well as clear measurements for success and growth potential. She can be reached at (888) 454-3131 or christene@christenebernhardt.com.