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Episode #547: The Cost of Open Chair Time, with Christina Byrne

An empty chair is more than just an empty chair. It will tell you the strength of your systems, where you can improve, and the true cost of each vacant seat. By tracking and understanding your open chair time, you can start making better business decisions! To help you simplify the process, Kirk Behrendt brings back Christina Byrne, ACT’s director of operations, to talk about ACT’s tracking tool, where to get it, and how to get your team to use it. To start running a better, healthier practice, listen to Episode 547 of The Best Practices Show!

Episode Resources:

Links Mentioned in This Episode:

ACT’s tracking tool:

Main Takeaways:

Help your team understand the cost of having an open chair.

Tracking numbers and a healthy culture go hand in hand.

Before anything, start tracking your open chair time.

Hiring a hygienist is not always the solution.

Filling chair time is a team effort.


“[Open chair time] is one of those things that people don’t understand, really. Oftentimes, we’ll talk to a team, and they’ll say, ‘I can’t get a patient in for six months. We’re totally booked. We need to hire a new hygienist. We need to do this.’ And what they fail to do is look backwards and see how much open time they had. And so, the why of tracking this is so important to the practice because if you don’t look back and if you don’t track the capacity in that way, you are going to make really bad business decisions. You’re going to hire that other hygienist, and you’re going to find out it’s going to be so costly to have another person in there who can’t see patients because you’re not filling the schedule, or patients are falling off the schedule.” (3:12—3:59)

“If you’re taking PPOs, one opening and you’re ruined for the day because you’re really only getting about 60% of those dollars anyway. And one of the things we do know about practices is when they’re calculating how much PPO is in their practice, the majority of those patients are coming into hygiene. They might not be doing all their dental work, but they’re for sure coming in for that “free cleaning” twice a year. And so, that’s a huge loss to the hygiene department and to the practice, in general.” (5:40—6:14)

“We have to start with tracking [open chair time]. Most offices are not tracking it. They’re just thinking from their perspective, ‘We can’t get another patient in for seven months, eight months. I don’t have an opening until October.’ So, what I like to do is have practices first be proactive and set it up every day, how many hours was I available to see patients, and how many hours did I actually see patients? And not from the time I punched in. It’s, when are you available? So, if you start at 8:00 a.m. and that’s when you start seeing patients, and you take an hour lunch and you’re done at 5:00, you have eight hours available to see patients. So, if you don’t have all eight of those hours filled, you need to do that math and do that calculation on a daily basis and figure out, where am I right now, moving forward?” (7:03—7:53)

“When I was doing hygiene clinically, if I had an opening or a patient didn’t show, I was like, ‘That’s awesome. I can write my notes. I can sharpen instruments. I can stock my room.’ I loved it. I thought it was great. Now that I understand the business side of it, I’m like, ‘Oh my gosh, I’m terrible.’ I have to apologize to Dr. Tingzon if she’s listening because I didn’t realize. Now, I know. And I understand the cost of that opening in that room.” (8:09—8:38)

“If I’m going to have a conversation with your hygienist and he or she says to me, ‘I feel like I’m working really hard. I have to talk to doctor about getting a raise,’ I’m going to tell them, ‘You can’t just go into that meeting with a feeling. You have to go into that meeting with data.’ And if that hygienist is incentivized to increase his or her compensation, then they should start tracking their numbers and making sure that their chair is filled so that they can go to the doctor and say, ‘Look, doctor. For the last three months, I have been at 95% capacity, and I’ve been doing great with these patients. I have a great mix of services. I’m diagnosing more perio.’ Then, that hygienist is in a position to actually earn what he or she is asking for. So, it actually is a win-win, doctor. If you are going to plan to have those conversations with your hygienist, give them the tools so that they can come to you. I think you’ll be happy to give them an increase in their compensation if they are showing you that they’re increasing revenue to the practice.” (10:08—11:15)

“If there is a cancellation, it’s not always [the hygienist’s] fault. However, all cancellations start at the chair today. So, if I have you in my chair today, I’m going to do everything I can to increase your predictability of coming in at your next three, four, or six-month interval based on my conversation with you, based on what we discover, how we talk about what’s necessary, any treatment that you need, any areas of bleeding or recession, anything that we want to check the next time you come in. So, I’m building value for that next visit — and every visit beyond — with what I do today. So, in that sense, it is [the hygienist’s] responsibility to [fill chair time].” (11:35—12:18)

“A healthy range is somewhere between 92% and 95% capacity. So, over the course of a week, a month, however you want to track it, there are times when you need to do things in the operatory. We’re not saying it has to be 100%. But I would say 92% to 95% is industry standard for what’s a healthy capacity. And that’s for doctor too. You’re not off the hook either, Doctor. This isn’t just about hygiene capacity.” (13:25—13:54)

“There is nothing wrong with sharing numbers. One of the things we often do is we internalize those numbers and we think that it’s because we’re bad. But the number is just reflecting how strong your systems are. So, if your capacity is low, let’s take a look at some of our systems. Let’s look at our handoff system. Let’s look at our preclinical conversation system. What do we do when we’re handing off a patient? Do we just say, ‘Oh, yeah. The patient had bitewings and a prophy today’? Or are we going in and saying, ‘Mrs. Jones was talking to me about this tooth that she has on the upper right, Doctor. So, I took a PA, and I took an intraoral photo, and I showed her this fracture. I told her that sometimes when you see something like that, you might recommend a crown.’ Now, I’m building trust with the patient, and I’m actually building a lot of respect with my doctor because I am partnering in that patient’s care. And the patient is like, ‘Wow, this is really different.’ They’re going to be incentivized to come back.” (15:43—16:42)

“People think you can either have one or the other. You could have a healthy culture, or you could track numbers. But you can’t do that. You [need to] have both. When we don’t track anything, when everything is unknown, that’s not healthy. People are worried. They don’t know the health of the practice. Are we going to have a job next week? When you’re tracking numbers and you’re showing that — you’re not condemning somebody or picking on somebody because they don’t have the number. You’re saying, ‘Hey, let’s talk about this. Let’s talk about how I can help you to improve. What could we do differently? How can I support you? Is there any training that I can help you with that can help you to improve this number?’ So, instead of looking at it as a negative, it’s such an opportunity for growth.” (17:45—18:30)

“If I look six months out and my schedule is full, but my capacity is only at 75%, what’s happening? Am I not building that value for that next visit? It doesn’t even have to be something from our perspective as a clinician. What does our confirmation or our reminder system look like? Are we reaching out to patients? Are we providing them with the value of coming in and making sure that what they’re doing is valuable to them too? We have to look at it from their perspective. Most people have that, ‘What’s in it for me?’ So, we have to find out what that is for our patients so that they feel incentivized to come in for that next visit.” (19:40—20:22)

“I’m not saying it’s just the hygienists’ responsibility. It’s everybody’s responsibility. If I spend time chairside and I’m talking to the patient about bleeding, or perio, or whatever the case may be, and the doctor comes in and he or she is like, ‘Oh, no. This is fine. She’s good. We don’t have this,’ that’s not helpful. So, everybody has to be on the same page as far as where we’re going and what our philosophy is.” (20:29—20:57)

“You have to know: do you even have enough hygienists? Do you not have enough hygienists? Do you have too many? This might be a good opportunity. If you need 13 days of hygiene but you’re only using nine, then that means you have so many patients who cannot get into the schedule. And if you still have a capacity issue, then it’s chaos. So, then you need systems to make sure that the patients are actually showing up for the appointments. And once you do that, then you can either add hygiene days or you could start to consider, if you are a PPO practice, this might be a good time for you to start thinking about dropping some of those PPO plans. Because rather than hire a new hygienist and go through all of that, maybe you can still satisfy everything that you need in the practice by eliminating some of those PPO plans and getting your full fee for some of those patients.” (24:39—25:35)

“The knee-jerk reaction is always like, ‘I’ve got to hire a hygienist. I’ve got to add a new room.’ But we have to look at the data and we have to do some homework before we make those decisions.” (29:28—29:37)

“The first thing to do is download the tracker and start using it. Now, I’ll say, start using it after you talk to your team about why it’s important and why it’s valuable to track this stuff. And it’s not as a punishment to anybody. It’s a way to understand where we are today so we know what we need to do to improve.” (31:32—31:51)

“Get your data aligned first and see where you are. Because if you don’t know where you are, you don’t know where to go from there. And also, make sure that it’s a team effort, and it’s collaborative, and nobody is out to get anybody, that we’re all here to help each other and we’re trying to make everybody’s job easier.” (35:27—35:48)


0:00 Introduction.

1:57 Christina’s background.

2:34 Why understanding open chair time is important.

6:54 Things to know about the cost of open chair time.

9:38 Getting hygienists to track chair time is a win-win.

11:17 Is it the hygienist’s responsibility to fill chair time?

13:13 Healthy and unhealthy capacity ranges.

13:55 ACT’s tracking sheet.

15:02 Numbers reflect the strength of your systems.

16:55 Track numbers to have a healthy culture.

19:15 Capacity will help diagnose root problems.

21:16 Determine how many days of hygiene you need.

24:31 Why you need to do the math for hygiene.

25:36 Be smart about how you expand.

27:53 Part two of the formula.

30:01 Building emotional intelligence into the formula.

31:07 Recap of the tracking process.

33:23 How dentists can track their capacity.

35:14 Last thoughts on open chair time.

Christina Byrne Bio:

Christina Byrne has been involved in dentistry since 1985. Over the years, she has held many positions on the dental team, including dental assistant, business office, and dental hygienist. Christina’s extensive knowledge of the front office and clinical procedures is a great asset, and she loves to impart her knowledge to guide dental teams do the best they can to achieve a Better Practice, Better Life!


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