Lately, I’ve had the pleasure of speaking to a number of stellar study clubs and organizations. In preparation, I ask the members to complete a short worksheet. Their responses help me learn about the group so I can tailor my presentation to their special needs and interests. One issue which is almost always on the list is THE SCHEDULE.

 

Groan!

 

We can’t live without it and we can hardly live with it.

 

Even in the best practices, the issue of the schedule can be a major source of friction. The people in “the back” think the people in “the front” don’t understand enough about how to make things run smoothly to create a schedule that will work. The people in “the front” wish the people in “the back” would simply work the schedule as planned and pay attention to the time. Unfortunately, both perspectives are at the same time correct and incorrect.

 

Principles of Scheduling

 

1. Two dimensions won’t do in a three-dimensional world.  An effective schedule must account for three sets of variables: people, places, and time. But in most cases, the computer and the appointment book show only two conveniently: places (Operatory One, Two, etc.) and time. Unless we identify all the people who are required in each place at all times, we can easily end up with excess or insufficient staff for the work to be done. This notion may seem obvious, but it’s rarely respected, and the actual events often play out differently than the printed day sheet. I frequently see teams shifting into hypergear at one point only to be idle an hour later. I don’t think these circumstances are due to the clinical staff’s poor work habits. On the contrary, the schedule just failed to account for what combination of people would be required in what place at what time. It isn’t easy to do, but it can be done.

 

2. No one (not even the dentist) can be in two places at once. How many times during the day will the dentist be required to leave a principle operatory or surgery to attend to a matter in another part of the office? Hygiene checks or periodic exams during a hygiene appointment may require up to 15 minutes each hour per hygienist. That’s potentially two hours or more a day. If the doctor is going to leave another procedure to visit with a patient during a hygiene appointment, that time must be built into the schedule because it will not come from thin air. In many cases, patients and hygienists are kept waiting because examination time was not built into the doctor’s schedule. Shifting the patient to another chair to wait alone and without any transition is not an acceptable solution. I know that many dentists see exams as an annoying interruption, but pretending that they won’t take time is no solution. Either shift to annual exams scheduled with the dentist and facilitator (eliminating periodic exams from the hygiene appointment) or allot proper time in the dentist’s schedule.

 

3. “I can name that tune in.....”  When asked the amount of time required to do a procedure, most dentists will underestimate by a meaningful amount. How meaningful? That changes from one dentist to another. But the staff usually knows how much time the procedure really takes. Of course, there are exceptions, but you must be sure that the time you allot for a procedure is accurate, because if you’re wrong, it will add up throughout your day. That’s what keeps people working through lunch and into the evening, impairing morale. Fantasyland scheduling hurts everyone, especially the patients who are kept waiting. If the dentist enjoys social conversation, allot time for this activity. Yes, you will be less productive, but “beast of burden” scheduling can destroy the joy many dentists get from interaction.

 

4. Don’t pad the schedule. Many team members will arbitrarily add a unit or two because they know the dentist often runs late or they (Yikes!) want to create an easier day. Please don’t fall into the trap of adjusting for a slow dentist by padding the schedule. Talk about the reasons for running late and figure out a clean and honest way to deal with it. If padding is happening to keep the day light for the staff, it must be addressed directly. The schedule must serve everyone not just the convenience of the staff. Of course, we want to have lunch and leave at a predictable time, but padding is dishonest and a form of theft.

 

5. New patient time is never to be violated. Do not schedule anything opposite a new patient for any team member who will be required to support this initial experience. The facilitator cannot be interrupted with any other agenda. Once the dentist joins the process and the clinical evaluation is begun, she can- not be beeped, buzzed, tapped, whispered to, passed notes, or alerted by the light system.  Allocate the proper time for each person involved with new patients and build everything else around this important event.

 

6. If you’re happy when a cancellation occurs, find out why. It may mean that you’re being worked too hard. Dentistry is microsurgery for many straight hours each day. It’s physically and mentally demanding and cannot be done at the pace of many schedules. Make a schedule that allows each person to be fully present for each patient and not so strung out that mistakes are made, aspects are overlooked or corners are cut just to get through the grueling schedule of the day.

 

7. A day is not a day is not a day. Not every day can or should look alike. We encourage people to template their schedule as follows: Figure out how many days you will work during the year. Template a series of three or four well-planned days, each configured differently and for maximum effectiveness and efficiency. For example, many dentists prefer to do more challenging comprehensive dentistry at the beginning of the week and in the morning hours. Shorter procedures might be best done when grouped together either in the afternoon or at the end of the week. Big picture work like new client evaluations, consultations, co-treatment planning sessions, and second opinions might be best done on a non-handpiece day. Cementations, try-ins and the like might be grouped together for another type of mind-set. Look at these issues and create a separate schedule for a Day One, Day Two, Day Three and Day Four configuration. (You may have more or fewer day types.) Then figure out how many Day One’s you want in your year. A Day One could be on a Thursday. The important thing is to get out of the box which says that every day must be alike.

 

8. Scheduling for “production” misses the point. Too often, a drive to “fill the schedule” or meet production goals gets in the way of helping people make the best choices for themselves. A healthy schedule is naturally created, not forced. Dialing for dollars or cramming procedures into spaces where they don’t fit just to reach arbitrary production goals is a big mistake. When dollars come before service to our patients, people quickly catch on to your motivation. Templating a schedule allows production to be created in ways that serve the patients first and also the practice.

 

9. Emergencies If it is important for you to accommodate patients with unexpected and acute dental needs, you must reserve time for them in your schedule template. You cannot steal time from patients with planned and scheduled dentistry. It is unfair, erodes confidence in you and your team, and teaches people that your schedule is arbitrary. Sometimes this reserved time will not be used. When that happens, take a break and have a cup of coffee. This is far better than squeezing people in where there is no room or making patients who have made a commitment to planned dentistry pay the price.

 

10. Pre-block time for important procedures and events. If you want to ensure that new clients are seen within a week of their call, you must reserve time for them.  It is not to be used for any other purpose even if it is scary and you need the time for someone with a toothache or a look see or a crown prep or something else that seems pretty important at the time (Whew!). Also reserve time for new patients’ first hygiene visit so they won’t have to wait six months or for a cancellation (How do you think they learn that cancellations are okay? We teach them.) If you want to make certain you can always accommodate a patient who is ready to move ahead with significant dentistry, block time for those procedures and do not use it for anything else until the day before.

 

This can be unnerving, but, if you’re like many others we know, you will rarely have this time go to waste. Focus on what you want to have happen and make a schedule which will accommodate it. Then let the other things fill in around your preferences.

 

Create a Planned and Purposeful Schedule. Hold yourselves accountable to honoring it. Make it first work for the clinicians who will be engaged in the procedures. Then figure out how to best serve the patients. Everything else will follow from there.