Always running behind

Sept. 1, 2006
Dear Dianne, I work in a great office except for one thing — we never, and I mean NEVER, get out on time at the end of the day.

Dear Dianne,

I work in a great office except for one thing - we never, and I mean NEVER, get out on time at the end of the day. Also, I rarely get a full lunch break. I usually work at least 15 minutes or more into my lunchtime.

This really frustrates me! Although I like my co-workers and the doctor I work with, I’m considering leaving the practice because of this issue. Do you have any tips on how we can resolve the problem of always running behind schedule?
Bur under my saddle

Dear Bur,

I’ve experienced the same frustration in certain offices. However, before it can be solved, we need to identify what is causing the problem. Does the doctor have a low energy level, a proverbial turtle on sedatives, with a basic speed of s-l-o-w? Are you or the doctor too chatty and tying up productive time with socializing? Are you disorganized and taking too much time with appointments? Are you being scheduled properly? Is the doctor so overbooked that he/she can’t find time for hygiene checks, thereby keeping you waiting?

Let’s examine various reasons and a few solutions for running behind schedule.

Poor schedule control by scheduling coordinators - Allowing insufficient time is a schedule wrecker. Sometimes scheduling coordinators have trouble filling an opening with a patient who needs exactly the same amount of time as the opening. Cheating 10 minutes here and there might help plug an opening, but it also might cause clinicians to run behind. It is important to eliminate downtime as much as possible, so you may have to prioritize the events of the appointment in relation to the amount of time you have.

Not specifying the proper amount of time - Some doctors are guilty of this on a daily basis. Doctors and hygienists need to be realistic about how much time certain procedures actually take. A simple time and motion study is a great way to check this. For the doctor, I recommend having someone time the top 10 procedures to see exactly how long they take. Start timing when the patient is seated and end when the patient is dismissed. It would be a good idea to time several of the same procedures for an average time. Do the same thing for the hygiene department.

Hygienists need to think ahead to determine how much time they need for subsequent appointments. For example, if it took one hour for a prophy, bitewings, periodontal charting, and other necessary assessments, consider that on the next six-month visit, you will not take bitewings or chart a six-point probing on each tooth. Therefore, the next visit would probably take 40 minutes. Be realistic in your scheduling.

Another big time waster in hygiene is doing periodontal chartings solo. It takes the average solo hygienist 12 minutes to do a six-point probing and recording with a written system. It takes about three minutes with someone else recording the readings as the hygienist calls them out. Voice-activated systems are wonderful, and I wish more offices had the technology. But, in the absence of high-tech charting, part of someone’s job description should be to record periodontal chartings to save time. Do the math - 3 patients X 9 extra minutes (12-3) = 27 minutes!

Always waiting on the doctor for a hygiene check - If you wait until the end of a visit to summon the doctor, you are asking to be kept waiting. Work out an “interrupted check” system where you seat the patient, do all necessary assessments, take radiographs, and then summon the doctor. This gives the doctor 20 to 30 minutes to get to your operatory. Stop immediately when the doctor appears, and tell the patient you are going to stop long enough for the doctor to examine him/her, and then finish.

Patient is late for the appointment - For the chronically late patient, you or the scheduling coordinator should apply the “lateness factor” by telling the patient 15 minutes earlier than the appointment appears on the schedule. For example, if the appointment is at 10 a.m., the patient should be told 9:45. This gives you a little insulation against wrecking your already busy schedule. If the patient arrives at 9:45 (which will probably not happen), that’s great! At least you will not have to “rob” your next appointment to accommodate a late patient. Apply this technique only with patients who have proven their lateness. Also, a note should be recorded telling anyone calling the patient to say 9:45 and not 10.

For the patient who is uncharacteristically late, prioritize what will happen during the appointment. Trying to do everything you had planned to do in half the time is stressful. Do as much as you can in the time you have. You may decide to dispense with the polishing and bitewings, but my advice is to seat the patient and do something. Have you ever dismissed a late patient, only to find that the next one doesn’t show up? Seat your patient, let him/her know you are glad he/she made it, and do what you can.

No flex time built into the schedule - I recommend that the 20 minutes before lunch and at day’s end become flex time. This allows loose ends to be tied up, helps you get a full lunch break, and gets you out on time in the evenings. You might have to tighten things up a bit earlier in the day to arrange this time in your schedule, but I think you’ll find it worth it. Working into lunch or after hours should be the exception, not the rule.

These are just a few tips that should help you solve this frustrating problem. The important thing to remember is that you can’t solve a problem until you know what is causing it. Identify the problem, and you will be on your way to resolving it!

Dianne D. Glasscoe, RDH, BS, is a professional speaker, writer, and consultant to dental practices across the United States. She is CEO of Professional Dental Management, based in Frederick, Md. To contact Glasscoe for speaking or consulting, call (301) 874-5240 or e-mail [email protected]. Visit her Web site at