The dental practice should be controlled through the appointment system but not by it.
Today, the prediction that Bill Gates once made that someday there would be a computer in every household is quite realistic. And in today’s dental practice, you will find that there is likely to be a computer terminal in every treatment room as well as in the business office. For the dental hygienist, this direct access to the appointment scheduler allows for more freedom in scheduling appointments and managing the hygiene schedule.
The appointment system, which contains lists of all the scheduled patients and events for the dentist and the staff, is the control center of the office and an important factor in the success or failure of a dental practice. The practice should be controlled through the appointment system but not by it. Each dental practice should have a scheduling coordinator who maintains the schedule and keeps patients in the dental chairs. In a dental practice in which there is more than one business assistant with no real defined duties, these individuals are likely to perform the same basic functions in the business office, such as answering the phone, collecting money, opening mail, filing, verifying insurance, and making appointments. When no one person is held accountable for any particular assignment, as long as the schedule is full, collections are good, and the practice overhead falls within defined goals, then inefficiencies in the business office are not noticeable. That does not mean that there are no inefficiencies; however, these inefficiencies are not glaringly obvious.
An efficient arrangement for the business staff would be to have one person designated as the scheduling coordinator and one person assigned as the financial coordinator, unless this latter role is fulfilled by a management company. With this arrangement, each staff person can be held accountable for specific assignments, such as scheduling and collections. Job performance, whether good or bad, can then be measured by the amount of downtime (5% or less) and the percentage of collection (a goal of 96% or more).
Poor management of the appointment system can result in mounting tension among staff members, and it can turn the reception room into a waiting room of discontented patients. Basic scheduling concepts are listed in Box 11-2. The entire staff of a dental office should analyze the practice and determine an organized system of appointment control that maximizes productivity, reduces staff tension, and maintains concern for patients’ needs.
Box 11-2 Tips for Efficient Appointment Management
1. Put one person in charge of the appointment system.
2. In a traditional appointment book, make accurate and neat entries.
3. Accommodate the patient as much as possible, but maintain control of the appointment schedule.
4. Always have a patient being treated in each dental chair.
5. Avoid scheduling repetitive procedures over long periods.
6. Be aware of production goal criteria.
7. Be aware of scheduling in “power blocks.”
8. Schedule the workload according to the staff members’ body clocks.
9. Assign clinical tasks only to legally qualified personnel.
10. Avoid leaving large blocks of time between appointments.
11. Establish guidelines for problem situations.
12. Make sure that the practice is controlled through the appointment system rather than by it.
The Electronic Appointment Book
There are a variety of companies that provide electronic appointment scheduling systems, including Curve Dental, Dentrix, Easy Dental, and Eaglesoft. It is not feasible to provide instructions for all of these programs, but the concepts of appointment scheduling are similar for all of them. If a user learns one system, then he or she should be able to adapt easily to scheduling with the use of almost any other software product. The websites for these companies are listed at the end of this chapter.
With an electronic appointment system, appointments can be entered, canceled, rescheduled, and moved easily with one keystroke. Electronic scheduling can be goal oriented, with the use of state-of-the-art technology to set production goals for the practice. With income a consideration (rather than just filling the book), the dentist can begin to maximize profits while controlling where and when certain procedures are performed.
Common electronic software scheduling packages generally have a number of components, including the following:
• Finding the next available appointment: This feature allows the staff member to find an open appointment time in a matter of seconds. It lets the person scheduling the appointment search on specific days, during specific hours, and for selected providers; it then provides a list of available appointments so that the patient may select what works best for him or her. Figure 11-1 shows a screen that will enable the appointment coordinator to search for an available appointment.
• Daily appointment screen: Most software programs allow for a wide variety of setup and viewing options for the office schedule. This allows the office staff members to select the options that work best for them. Generally these views show the treatment rooms in a column format with each patient’s name, his or her treatment information, and a list of resources needed for each time unit (Figure 11-2). An expanded view will offer more details about the appointment. There is often an easy way to advance from date to date or to show the schedule in a weekly format (Figure 11-3).
• Patient information window: In most systems, the patient information screen (Figure 11-4) shows many types of information, including demographic, financial, insurance, recall, and appointment details. Patient information that can be entered on this record includes the patient’s complete name, marital status, gender, age, date of birth, and work, cell, and home phone numbers. There is often an easy way to view the patient’s current balance, pharmacy and medication histories, examination history, treatment plan, financial information, referrals, medical alerts, treatment completed, and appointment time preferences, each of which are updated on the patient screen after being entered in different areas of the program.
• Locate appointment feature: Most scheduling software allows the user to search to see whether a patient has an existing appointment. This is very valuable when a patient calls and thinks he or she has an appointment but cannot remember the date (Figure 11-5).
• Goal tracking: The dental staff can set monthly goals by provider and enter these goals into the system. The software can then report a summary of the scheduled production, the monthly goal, the percentage of the goal that was attained, any new patients, the total number of appointments, and the production totals so that the staff can track how they are performing toward the meeting of the goal (Figure 11-6).
• Short call list: Electronic appointment books allow for the excellent tracking of any appointments that were canceled and not rescheduled, for patients who want to come in earlier if an appointment opens up, or for patients who want to be called if there is a cancellation. Figure 11-7 illustrates a short call list of people who can be contacted quickly to fill an opening in the appointment book.
• New calendar year: Electronic appointment books usually will automatically load each year’s calendar based on the preference set. The calendar is perpetual but, at the beginning of each year, the calendar should be reviewed for possible changes.
Designing the Appointment Book Matrix
An appointment book matrix, which is an outline of the appointment book, functions like the matrix of a restoration: it provides support (see Figure 11-8 for the components of an electronic appointment book). This is the framework around which appointments are made. A new matrix should be completed before each new year begins. The use of color-coding in the electronic system allows the scheduling coordinator to use a variety of colors for various activities. The matrix should include the following elements:
• Columns: Columns are provided for each of the treatment rooms. They may be numbered or assigned by the name of the operator, the dentist, or the hygienist. Each of the columns is divided into increments of time, which are usually 10 to 15 minutes long. Each increment is referred to as a unit, so an hour may be divided into four or six units, depending on the time increment of the column. The 10-minute unit has become generally accepted for expanded function practices. The illustration in Figure 11-8 shows columns in which each unit is 10 minutes in length.
• Holidays: Holidays can be noted in the electronic appointment book, and they may be part of the template set up by the office staff.
• Lunch hours: Computerized scheduling will follow the template and will automatically insert lunch hours. Figure 11-8 indicates that the lunch hour for this particular practice is from 12 to 1.
• Buffer periods: Again, the template can automatically insert a buffer period, which is a small amount of time set aside to absorb the hectic workload of the day or to allow for emergencies. A one-unit increment of time set aside in the morning and again in the afternoon allows time for unexpected emergencies or buffers during an already hectic day. The buffer period may have a special color designated for it, and it should not be inserted during the busiest period of the day. Note in Figure 11-9 that there is a color-coded unit for a buffer period in the morning at 11:45 am and again in the afternoon at 2:30 pm.
• School calendar: A school calendar may be obtained from the local school districts so that students and faculty members may be scheduled during school vacation periods. These data may then be entered in notes attached to the day in the electronic appointment book.
• Professional meetings: Most dental societies provide a yearly schedule of professional meetings. These meetings may be entered in the matrix with the time blocked out and the information about the meeting inserted.
• Staff meetings: Morning huddle time need not be part of the matrix, because it is routinely done each morning. However, time should be set aside regularly (e.g., weekly, once or twice a month) for all members of the staff to meet and discuss office activities and goals. This time should not be scheduled during the lunch period or after office hours but should instead be integrated into regular office hours and indicated on the schedule (see Chapter 2 for suggestions about scheduling staff meetings).
• Vacation days: There may be times when the entire staff will be on vacation, and this time should be blocked out. This type of scheduling should be done with as much advance notice as possible.
Appointment Time Schedule
Time allocation for each type of treatment should be determined by the staff and a template provided so that all those responsible for appointment management understand the number of units that need to be scheduled for each type of treatment. Basically, the same type of treatment should take the same amount of time (e.g., a full gold crown preparation on a molar may take a dentist two or three units, 30 to 45 minutes, depending on the type of unit). However, not every patient is the same. What may take three units with one patient may require four units for another. An average amount of time for each type of procedure should be determined; when a complex procedure is anticipated, the dentist needs to identify this with the appointment scheduler so that a time adjustment can be made.
After the average time is determined for a variety of services provided, then a schedule can be designed and provided to the entire staff so that everyone is familiar with time allocations. Care should be given to consider the time needed to clean and prepare a treatment room when making this schedule. Once the appointment lengths are determined, appointment types can be added to the computer, which are then templated for these times, to make scheduling consistent and easy.
Important Factors to Consider when Scheduling Appointments
The administrative assistant must deal with a variety of situations when scheduling appointments. The management of the appointment book requires a well-defined treatment plan, an established appointment sequence, and an ability to maintain strict control over the appointment book while still meeting the needs of patients.
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