Time Dilemma

ByRDH, BS, MBA

Dear Dianne,

I have been a hygienist for three years. But I swear, the stress is making me old before my time! I work with a great doctor and co-workers. That's not the problem. The problem is that I simply cannot stay on schedule. We schedule 30 minutes for children, 40 to 50 minutes for adults, and one hour for periodontal patients.

I run behind every day with almost every patient. Sometimes patients get irate, and I've even had patients leave before I could get them into the operatory. The doctor has talked to me about the need to stay on time, but he runs behind as much as I do. Sometimes, he is the reason I run behind. It's not unusual for me to wait 10 to 20 minutes for the doctor exam.

Other things that cause me to run late are late patients, patients who want to chitchat, periodontal probing, and having to do my own sterilization. I really hate working into my lunch hour, and I never get to leave when everyone else leaves at the end of the day. The stress of running behind is wearing on me, and sometimes I wish I'd chosen a different profession. Please, can you help me figure out how to run on time and get rid of this stress?

Melinda, RDH

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Dear Melinda,

If I asked 10 hygienists what causes them to run behind schedule, at least seven of them would say that waiting for the doctor exam is the problem. So let me address that first.

If you wait until you are finished with your patient to summon the doctor for the exam, I can almost guarantee that you will be kept waiting. It's rare when a doctor can immediately drop what he or she is doing and come right that moment.

Here is how to fix this problem: Do not wait until you are finished to summon the doctor. Seat your patient, update the medical history, take the blood pressure, do the tour of the mouth, take any necessary radiographs, perform any necessary periodontal charting, and then summon the doctor. If the patient has soft debris, you will need to polish first so the doctor's visibility will not be impeded. This gives the doctor 20 minutes or so to come and do the exam.

When the doctor shows up, say to your patient, "I'm going to stop, let Dr. Smith do his exam, and then we'll finish." The tradeoff is that the doctor may not get to inspect a totally spick-and-span mouth, but you won't have to run overtime waiting for the exam.

It is not necessary for the doctor to "inspect" the work you've done. His purpose is to diagnose any restorative or soft tissue pathology that you have already identified and confirm the need for treatment. As soon as the doctor steps into your operatory, immediately stop what you are doing, and let the doctor do his exam. Never say, "Could you give me about two more minutes?" Take the "warm body" every time! (If you are in the process of polishing, rinse out the paste.) Implementing an "interrupted check" system will solve the problem of running behind because of waiting for the doctor.

Looking Ahead at Next Appointment

The time increments for different patient populations that you shared in your post are typical for most offices. Therefore, I do not recommend a different scheduling protocol. However, I do recommend that you become proactive in deciding just how much time will be needed on the succeeding visit. For example, if you need to take radiographs and perio chart at the next visit, then allow extra time for those procedures, usually about 10 minutes. If the patient does not need adjunctive services at the next visit, then schedule a little less time. Think ahead.

Some people are naturally organized, and some are not. I don't know where you fall in the organization continuum, but there are some things you can do that will make turning your operatory more efficient. Using tray set-ups is one of the best time-savers. You need enough plastic trays to cover the typical number of daily patients. Come in a few minutes early to prepare your trays. Line them up and place the disposables you use with each patient: tray cover, saliva ejector, 2X2 gauze, prophy angle, dental floss, patient napkin, etc. Then stack your trays in an area that will not be subject to aerosol contamination.

After you've disinfected and removed/replaced barriers, all you need is a fresh tray and your instrument cassette. If you save a couple of minutes with this technique, this would add up to about 20 minutes over the course of a day.

Scheduling Concerns

A couple of scheduling concerns should be considered too. First, you should not be scheduled with more than two back-to-back 30-minute appointments unless you have help turning over your operatory. There is simply not enough time to perform your procedures and turn over the operatory, and there is no "wiggle room" to catch up.

Second, if your patient is late for his visit, seat the patient and prioritize what you can accomplish in the time you have remaining. You may have to re-appoint to finish or delay radiographs to the next visit. I do not think it is a good idea to reschedule patients who arrive late, especially if the patient is usually on time. Who knows? The next patient may disappoint, which would give you more than ample time to complete the late-arriving patient. Remember, always take the warm body!

Another strategy that I recommend is that the last 20 minutes before lunch and the last 20 minutes at the end of the day should be blocked as flex time. This will help you to get out in a timelier manner at lunch and day's end. You might have to tighten things up earlier in the day to make flex time a reality, but it is very helpful.

Since I cannot observe you in action, it is impossible to comment on your process. Are you a social butterfly that engages in too much chitchat? Do you check your Facebook page throughout the day? Do you have to get up and retrieve instruments or supplies during the middle of an appointment?

Finally, there could be a systemic problem with scheduling. From your inquiry, it sounds like the doctor runs behind schedule too. One thing is for sure, if the schedule is not controlled, the schedule will get out of control! When there is no method to scheduling, chaos reigns.

You have to figure out what is causing you to run behind and solve it, because it is disrespectful to keep your patients waiting. Most patients feel anything beyond a 10-minute wait is excessive. The fact that you have actually had patients leave the office out of frustration over not being seen on time is a serious problem. In the current economic situation where demand for services is generally down, we have to ramp up our level of customer service to keep our existing patients happy. Respecting our patients' time by being prompt is one aspect of high-quality customer service. 

All the best,
Dianne

DIANNE GLASSCOE WATTERSON, RDH, BS, MBA, is a professional speaker, writer, and consultant to dental practices across the United States. Dianne’s new book, "The Consummate Dental Hygienist: Solutions for Challenging Workplace Issues," is now available on her website. To contact her for speaking or consulting, call (301) 874-5240 or email dglass coe@northstate.net. Visit her website at www.professionaldentalmgmt.com

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