Part 2:
Scheduling Patients
This is the earliest I’ve ever been late.
Yogi Berra
Traditionally, dentists have approached appointment control in a dental practice simply. They schedule patients one after another, usually for a standard amount of time such as one half‐hour. The appointment may specify the type of treatment to be done, for example alloys. When a staff member seats a patient, the dentist will quickly review the patient’s record and select the teeth they will try to restore in that half‐hour appointment. With the constant pressure to “produce,” the dentist often works over the half‐hour, rather than select an amount of work they may finish early. Thus, what occurs is that the dentist gets off schedule with the first patient. They either must do little work on patients at the end of the day or work over at lunch and closing. This results in a practice where everyone rushes all day. Overtime is common. Everyone is nervous. There is low work satisfaction and high auxiliary turnover.
PURPOSES
Appointment control is a system carried out for the convenience of the dental office. A treatment plan is a listing of the procedures that will be done for a given patient. The appointment plan organizes those procedures so the office staff can schedule more efficiently and prepare for and execute those treatment procedures. Appointment control systems are valuable for several reasons.
An effective appointment scheduling system helps promote the office’s smooth operation. It does this first by ensuring that dentists and staff members use their time efficiently and effectively. Second, it encourages dentists to see patients on time for their dental procedures. Finally, an effective appointment system helps to balance the patient treatment load and service procedure mix. Simply stated, a properly operated appointment system increases patient satisfaction and staff productivity.
A proper appointment control system is versatile. The dentist and staff should continually observe and receive responses from the practice. Dentists can adjust the appointment control system to meet the changing needs of the practice quickly. This system is for small or large offices. The appointment system described here works in large, expanded‐function practices or small, individual practices. The important principles that underlie the system are that dentists do the following:
- Schedule the appointment for the time needed, not for a standard amount of time for all visits. All appointments do not take one hour. Some take considerably less, others more.
- Schedule procedures with the appropriate staff person. Dentists should schedule dental prophylaxes with the hygienist and basic restorative procedures with the EDDA, as permitted by law.
- Schedule dentist time separately from chair time. A patient’s total visit may take an hour. Of that, the dentist may only spend 30 minutes with the patient. If dentists schedule correctly, the dentist can see another patient while the staff complete procedures on the first patient.
PREREQUISITES
Before starting an effective scheduling system, the office (dentist and staff) must meet several prerequisites.
WRITTEN TREATMENT PLAN
The first requirement of any effective appointment control system is a formally written treatment plan. This treatment plan is the basis for the entire scheduling system. The office schedule will reflect the accuracy of the treatment plan. Without a formal treatment plan, the practitioner must rediagnose each time the patient is seen.
PROPER DELEGATION OF RESPONSIBILITY AND AUTHORITY
In any practice, the keys to appointment schedule control are duty delegation and preplanning. To delegate effectively, the dentist must know the laws in the state they practice in regarding the delegation of duties to auxiliaries. As described in the previous part on duty delegation, dentists want to delegate any procedure to the lowest level legally possible.
For effective schedule delegation, dentists must give the receptionist enough information to schedule patients efficiently. Only the dentist can provide this information. If a dentist supplies this information each time they appoint the patient, they should make the appointments themselves because it is time‐consuming. What the dentist needs are means of preplanning for each patient visit. That is called process appointment planning (and it will be discussed later).
The practitioner must delegate to a staff member the authority to keep the appointment book. In the traditional system, the dentist essentially does the scheduling, either by escorting the patient to the front office and telling the receptionist how long and when the next appointment should be, or by giving the receptionist standard appointment lengths (such as 30 minutes for a restorative visit) without regard for the actual time anticipated for the procedure. Either of these approaches is inefficient and inappropriate because the dentist, and a staff member, is doing the clerical duties of scheduling patient appointments.
APPROPRIATE APPOINTMENT BOOK
The third requirement of the system is that the appointment book accurately represents the scheduling needs of the office. If a dentist is using a computer system, they should be sure that the system adapts to the office’s needs rather than requiring that the office adapt to the needs of the computer system. Before dentists can use the scheduling module of a computer system, they must set the preferences to meet their office needs. Setting up the computer program includes these steps:
- The dentist should “outline” the appointment book before making any appointments. Outlining sets up the appointment book “matrix” so that staff know what times are available for appointments. The dentist should mark off the times the office is closed; mark off holidays and note when the office is closed for staff meetings and other administrative functions; and show “buffer periods” if the practice uses them (e.g. for emergency patients, new patients). Professional meetings and other professional obligations should also be noted. The dentist should note local school holidays, because many teachers and parents want to find appointments on those days.
- There should be one (and only one) column for each operatory. (There can only be one patient in the chair at a time.) It is assumed that the auxiliary stays with the chair. So, if there is an EDDA chair, the EDDA stays in that operatory.
- Proper time increments should be set. Dentists should be sure that the time increments in the schedule are the same as in the appointment planning process. These must reflect the smallest increments of time for which a dentist is comfortable scheduling patient visits. Initially, a dentist will probably use a 15‐minute interval. As they become more familiar with how long it takes to do the various steps of the procedures, it may be shortened to 10‐minute intervals to schedule more efficiently. Some experienced offices use 5‐minute intervals.
- The dentist should schedule dentist time separately from patient chair time. Dentists must schedule both the time the patient is in the chair and the time that the dentist is captive with that patient.
APPOINTMENT PLAN
The last prerequisite is that the dentist takes a few extra minutes at the time of preparing the treatment plan to organize and sequence the treatment procedures into a plan for the appointments. This requirement is fulfilled by using a worksheet called an appointment plan. The appointment plan is completed just after the dentist formalizes the treatment plan. This plan is how dentists preplan the treatment to be done at each visit, duty delegation (if appropriate), and the length of time required to complete each appointment. Using this method, dentists indirectly control the receptionist’s appointment choice.
Appointment plans are helpful for grouping procedures together. Dentists can combine several different procedures or parts of procedures to reduce the number of patient appointments. Quadrant dentistry is much more efficient than single‐tooth operations. The appointment book should reflect this.
Dentists can schedule appointments for the time needed. A simple occlusal alloy and a difficult pin‐retained build‐up obviously will take different amounts of time. The appointment plan allows the receptionist to schedule appropriately for those procedures.
Appointment plans help to organize multiple visit procedures into discrete units. This helps staff to have proper instrumentation, materials, and other needed items ready for the procedure. Staff members can schedule specific patients or procedures for specific operatories. If, for example, radiologic facilities are only available in one operatory, the receptionist can, through proper appointment control systems, ensure that they schedule procedures involving radiographs for that particular chair.
TREATMENT TIME CODES
A time code is always written as three digits separated by two dashes (e.g. 1‐1‐1). This is a three‐digit time code. In any time code, both the first‐ and third‐digit positions refer to an auxiliary. The time code designates:
- Who the primary operators are.
- Their sequence of operation.
- How much time each operator needs.
- Total chair time.
The middle or second digit always refers to the dentist. Thus, in a three‐digit time code containing no zeros, the auxiliary operates first, the dentist second, and the auxiliary again operates at the end.
Set Time Increments
Dentists must have a consistent increment of time. It is recommended that one increment or unit is equal to 10 minutes for the experienced practitioner, and one unit is equal to 15 minutes for the less experienced practitioner. In this discussion and example, one unit is equal to 15 minutes. Thus, the digit “2” equals 30 minutes. Consequently, the time code 1‐2‐3 would mean the following:
- The first operator is an auxiliary needing 15 minutes (one 15‐minute time unit).
- The second operator is the dentist needing 30 minutes (two 15‐minute time units).
- The third operator is the auxiliary needing 45 minutes (three 15‐minute time units).
- Total chair time is 90 minutes.
When the first operator is the dentist, use a zero in the first digit position (e.g. 0‐1‐2). A single 10‐minute block is required for operatory set‐up, breakdown, and disinfection, even if the designated auxiliary is not required during the visit.
Develop Standard Time Codes
To schedule dentist, assistant, and total chair time, a dentist must have a notion of how long the typical procedure will take to complete. A copy of this should be given to the receptionist. Unless the receptionist is instructed otherwise for a particular procedure, they should use these time codes to schedule appointments. For example, if Mrs. Jones has a particularly difficult alloy or a quadrant of composites to complete, note the three‐digit time code needed for this appointment on the appointment plan.
Box 21.9 should be completed with numbers from a particular practice. Box 21.10 is given as an example only. A dentist’s frequent procedures and time requirements for each procedure will differ from this example. These time codes will also change over the practice life as skills, abilities, staff, and the physical office change.
- Code is an abbreviation for the step in the procedure. For example, “E2M” means “Endo, 2nd visit, Molar.” A dentist can decide which procedures the office commonly uses and an appropriate abbreviation for each. If the dentist generally takes 12 visits to complete a denture, then develop 12 procedure steps for dentures. If the office commonly does other procedures, add them to the list.
- Treatment is a description in words of the step code.
- Delay is the number of days between the previous visit and this visit. If, for example, the office routinely needs 10 days to get lab work back on crowns, a “10” is put in this column for the second crown visit.
CONSTRUCTING APPOINTMENT PLANS
The appointment plan has columns containing the procedures, time code, and date completed. The first step is to make a diagnosis and construct a treatment plan as usual. Then complete the appointment plan.
Decide Appropriate Operatory (Staff Person)
The dentist needs to decide which operatory the procedure will be done in. This is an indication of which auxiliary type will see the patient. If, for example, the office employs an EDDA who is trained and capable, then dentists schedule the patient in the EDDA chairs, freeing themselves of the time required to place and carve the restoration.
The dentist should estimate how long each standard procedure takes to complete, filling in a time code for each type of staff and each procedure. Each time unit should be the same as the appointment book (5‐, 10‐, and 15‐minute intervals). The three‐digit time code reflects how long:
- The staff member has to set up the operatory, meet, greet, and seat the patient, and begin initial treatment procedures, such as removing temporaries.
- The dentist will have with the patient.
- The staff member has alone with the patient for completing work, patient dismissal, and operatory breakdown and clean‐up.
The three‐digit time code also defines who the treating auxiliary is:
- Units (traditional) is the three‐digit time code the office uses for this procedure if it is done with a traditional chairside dental assistant.
- Units (EFDA) is the three‐digit time code the office uses for this procedure if it is done with an EFDA. Dentists should not bother with this column if the state Dental Practice Act does not allow these auxiliaries in the office.
- Units (hygienist) is the three‐digit time code the office uses for this procedure if a dental hygienist does it.
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