Dianne Glasscoe Watterson, MBA, RDH
I’ve been a dental hygienist for a little more than a year, and I’ve found a great office with wonderful coworkers and a fabulous doctor. My problem is constantly running behind schedule. Some days, I’m running a full patient behind either at lunch or at the end of the day. It seems like I’m always the last one to leave the office, and I rarely get a full lunch break. The business assistant told me the previous hygienist hardly ever ran behind. I usually get one hour with each patient except children, who have 40-minute appointments. Sometimes the doctor keeps me waiting, but I have to say that he’s usually good about coming in within 5–10 minutes of my exam request. I feel like I’m constantly apologizing to my patients for their waits. Can you give me any tips to help me solve this problem? I really do want to see my patients promptly!
Thank you for writing to me about this problem. I can assure you that many of your colleagues deal with running behind schedule and it can become a huge source of stress. The key to your problem is figuring out what is causing you to run behind. Knowing that you get one hour with most patients tells me that this is not a scheduling problem. I believe that there are inefficiencies occurring during the patient visit, such as spending too much time exploring and scaling, not using power scalers, or inefficiencies in operatory turnover. Since I have not observed your process directly, let’s look at the primary reasons for running behind schedule and some strategies for correction.
Waiting for a hygiene exam
If you wait until you’re completely finished to summon the doctor, you’re just asking to be kept waiting. Further, if you use up the entire allotted appointment time before you summon the doctor, you will be behind schedule. It’s rare when a doctor is able to immediately drop what he or she is doing to do a hygiene exam. A better strategy is not to wait until you’re finished to summon the doctor. Incorporate an “interrupted exam” protocol. The sequence is:
1. Greet and seat the patient.
2. Update medical history.
3. Take blood pressure reading.
4. Do a tour of the mouth.
5. Take any necessary radiographs.
6. Perform any necessary chartings.
7. Summon the doctor.
This gives the doctor 20 to 30 minutes to get to your operatory for the exam. Other than a chairside emergency, I know of no valid reason that a doctor should keep a hygienist waiting longer than that. If the patient has a heavy buildup of soft debris, polish first so the doctor will have an unimpeded view of the teeth. When the doctor appears, tell the patient, “Here’s Dr. XX. I’m going to stop long enough for her to check you, and then we’ll finish up.”
Inefficiently setting up and turning over operatory
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 setups is a great time-saver. You need enough plastic trays to cover the typical number of patients each day.
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 is not subject to aerosol contamination. After you’ve disinfected and removed or replaced barriers, all you need is a fresh tray and your instrument cassette. You will save valuable time with this technique, and it will add up over the course of the day.
Being a social butterfly
A friendly disposition is a wonderful trait for a hygienist. But hygienists can become a little too chatty and lose track of time. Try to keep the conversation focused on dentistry. A good rule of thumb is 80% dentistry, 20% chitchat. Stay focused on your work and cognizant of your time.
Being disorganized at chairside
I’m referring specifically to not having everything you need within reach. Valuable time is expended every time you get up to run back to the lab or sterilization area or turn around to retrieve something from a drawer or cabinet.
Spending too much time on periodontal charting
Periodontal charting is a valuable component of a dental hygiene visit, and every adult patient needs a six-point probing and recording once a year. It may take up to 15 minutes for a hygienist to perform a comprehensive charting and recording solo. The best way to make the process efficient is to have a second person plug the numbers into the computer chart as they are called out, or by using one of the computerized charting methods now available, such as Panda Perio or Florida Probe. I’m especially fond of VoiceWorks by Florida Probe.
Of course, there are other reasons for running behind, such as not starting the day on time, poor schedule control, patients who are late for appointments, computer glitches, or a generally slow work pace. Everybody develops their own work pace over time, and unfortunately, some clinicians work slowly.
Apologizing to patients for making them wait should be the exception, not the rule. Many patients resent having to wait more than 10 minutes, and it makes the office appear unorganized and unreliable. I feel it’s disrespectful to keep patients waiting an inordinate amount of time. There are situations where not only should the staff apologize, but should offer the patients a tangible consideration, such as a discount or gift card.
My challenge to you is to objectively assess your process by timing yourself as you go through the various aspects of the dental hygiene appointment. By doing this, you will identify areas where improvement is needed.
Here is a breakdown of the various tasks in a typical visit: (1) set up operatory, (2) review patient record, (3) seat and greet patient, (4) take blood pressure, (5) review medical history, (6) perform oral cancer screening and head and neck exam, (7) expose any necessary radiographs, (8) ask patient about dental concerns, (9) discuss plaque control and oral hygiene instructions, (10) discuss dental needs, (11) perform periodontal charting, (12) perform prophylaxis, (13) signal and wait for doctor, (14) dispense oral hygiene aids, (15) identify areas of caries and other pathology, (16) relate concerns to doctor, (17) schedule patient’s next appointment, (18) document all observations, patients comments, and treatment recommended in patient chart, (19) dismiss patient, (20) perform aseptic techniques in operatory and prepare instruments for sterilization, and (21) set up operatory for next patient.
Once you identify the problem areas, you can take corrective action and use the time you have more efficiently. You and your patients will all benefit!
All the best,
DIANNE GLASSCOE WATTERSON, MBA, RDH, is an award-winning author, speaker, and consultant. She has published hundreds of articles, numerous textbook chapters, and three books. Dianne’s new DVD on instrument sharpening is now available on her website at
wattersonspeaks.comunder the “Products” tab. Visit her website for information about upcoming speaking engagements. Dianne may be contacted at (336) 472-3515 or by email at [email protected].