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Who's replacing cancellations? Hygienist wonders if it's her job to keep the schedule full

Aug. 23, 2016
Hygienist wonders if it's her job to keep the schedule full when cancellations occur.

By Dianne Watterson, RDH, BS, MBA

Dear Dianne,

I work in a single-doctor practice. The doctor has been in practice for 20 years, and I have been a hygienist here for five years. I am paid an hourly rate. There are two nice ladies at the front desk who spend a good deal of the day chatting. Every time I walk up to dismiss my patient, I feel like I'm interrupting their conversation. What bothers me is that neither one seems concerned about trying to fill cancellations in my schedule. At our last staff meeting, the doctor made a comment about "low production" on my schedule.

Open time in my schedule is a problem, but is it really my responsibility to maintain my schedule? I think it is a waste of my time to be on the phone calling people in an effort to get them scheduled, yet it seems like this is what they want me to do. My greatest concern is that my hours will be cut because of too much open time. Any thoughts?

Dear Kelly,

Several key pieces of data would be helpful in this situation. First, I'd like to know how many active patients are in the practice. We know it takes from 800-1,000 active patients to keep one full-time hygienist busy. The second thing I'd like to know is the downtime percentage, which should be 5% or less. Here is the formula for determining downtime percentage:

Tally all of the available units of time that the hygienist is available to see patients in one month. If the practice is on a 15-minute time increment, there will be four time units in an hour. An 8:00 a.m.-5:00 p.m. day with an hour for lunch would mean 32 time units per day. If the office is on a 10-minute time increment, there are six units in an hour. An 8:00 a.m.-5:00 p.m. day would have 48 time units.

Tally all of the open time units in the schedule for one month. Do not count lunch as open time. Also, do not count time that has been blocked off for training or staff meetings.

Divide the available unit total into the open time unit total (big number into the small number). Move the decimal two places to the right. This is the downtime percentage. Round up anything that is .5 or higher.

The third question is this: Do business assistants have defined job descriptions? With two people at the business desk, one should have the primary duty of scheduling coordinator and the other financial coordinator. They will have some duties that overlap, such as answering the telephone and check-in/check-out duties. However, each person should have a primary duty, and maintaining the schedule should be someone's primary duty. Maintaining the schedule is the most important job in the office. Without patients in our chairs, production stops and there's no money to collect. We can measure the scheduling coordinator's effectiveness by a number, which is downtime percentage. We can measure the financial coordinator's effectiveness by a number, which is collections percentage (should be 98% or more).

If the business assistants are socializing excessively, their job performance will suffer, including keeping the schedule as full as possible. Working on recall should be a daily task, especially in practices with a large number of patients. It's easy to be content when the schedule is full, but when too many patients become inactive, the result is increased open time. Recall systems are like houseplants; they require frequent attention in order to remain healthy.

Since the practice is 20 years old, it is reasonable to assume there is a large, active patient base. But that could be a false assumption, as I have seen practices grow old and frail with declining numbers of patients due to many variables, such as managed-care participation (or nonparticipation), urban decay, increased competition, etc. Poor business desk systems can contribute to practice decline. Business assistants are not magicians, and if there is an insufficient number of patients, they will not be able to keep the schedule full no matter how hard they work.

I agree with you that the best place for the hygienist is chairside. When there is downtime, the hygienist should be willing to do whatever is needed anywhere in the practice. The key is to keep downtime to a minimum. Once you know the real downtime percentage, you can set a goal to improve that percentage.

Does the practice have a protocol to deal with people that disappoint? All patients who miss their appointments without notification must be notified. A letter on office letterhead is more formal and projects importance. Here is a sample:

"This letter is to inform you of your broken appointment on _______. This time could have been used for another patient awaiting an appointment. We understand that circumstances may occur to cause these disappointments. Many dental offices charge a fee for broken appointments. However, we have opted to send you this letter with the hope this will not happen again."

Here is a sample letter for a second broken appointment:

"There seems to be a problem coordinating your busy schedule and ours. Unfortunately, it has been recorded that you missed your scheduled appointments on _____ and _____. A broken appointment affects three people: (1) the doctor or hygienist who was prepared for your visit; (2) another patient who is awaiting time to receive needed dentistry; and (3) you, because your dental needs have not been met. If you wish to remain a patient in this practice, your full cooperation is needed to see that this does not happen again."

When a patient becomes a chronic offender in missing appointments, the doctor should seriously consider dismissing the patient from the practice. This requires careful consideration of all the facts.

The first two letters should be on office letterhead and signed by the scheduling coordinator. Any dismissal letter must be signed by the doctor and should follow the rules of patient dismissal for your state.

The doctor has to get actively involved in leading the practice. It is his or her responsibility to see that people are properly trained and competent to fulfill their job duties. This is especially important at the business desk. It sounds like the doctor needs to delineate some expectations and start measuring effectiveness. Whether doctors want to admit it or not, business assistants are running the practice. What I see as a consultant in some offices is that the hygiene schedule gets a low-priority position in the daily scheme of things. When I ask the question, Whose job is it to try to fill openings in the hygiene schedule? the most common response is, "Well, we both try if we have time ..." The problem is something else always takes priority. The bottom line is that the schedule has to be priority No. 1.

My advice to you is to gather some pertinent data and approach the doctor with a plan. Show the doctor that you are indeed concerned about your schedule, and you want to contribute to improving systems at the business desk. Maybe then he will take steps to see that suggestions for improvement are implemented.

There are other considerations, such as improving verbal skills with patients on the phone and in person. I will address that in a future column.

All the best,


DIANNE GLASSCOE WATTERSON, RDH, BS, MBA, is an awards winning speaker, author, and consultant. She has published hundreds of articles, numerous textbook chapters, an instructional video on instrument sharpening, and two books. For information about upcoming speaking engagements or products, visit her website at Dianne may be contacted at (336) 472-3515 or by email [email protected].