The 3 most common battles within the dental practice ... and how to overcome them

Working as a consultant to dental practices around the country, I have seen way too many times a solid dental business torn apart at the seams because of inner struggles.

In this article, I want to expose the three most common battles I have seen, as well as offer my suggestions on how to eliminate those problems if you’re currently struggling with them.

1. The struggle of the schedule
The appointment book is the one thing in the dental practice that affects every team member and every patient. Think of it like a kitchen in a fine restaurant. There are many cooks in that kitchen and, if someone on that team doesn’t follow the recipe, it can create chaos behind the scenes and customers will receive a different end result then they were expecting.

The problems I find in the dental practices I work with are completely avoidable, with a little planning.

Front office: “Get your hands out of my appointment book!”

My response to this is, “Well, it’s not your appointment book. It belongs to the entire office, but you can take back control of it.” Multi-tasking within the office is a great thing, but you must give your team direction. You, as scheduling coordinators, need to tell them what can be scheduled and where. Map out the appointment book for your clinical team so they can see over four to eight treatment rooms at a glance and schedule an appointment easily and correctly.

Most practice management software systems have a way of coding different areas of the appointment book so that the team can quickly see open spots that fit the parameters of an appointment that needs to schedule. Some examples for coding are emergency time, crown seats, ortho checks, and other nonproductive appointments.

These nonproductive appointments are important to block time for because they should not be scheduled in high productive time blocks. If a clinical team member does not know where to schedule a crown seat, he or she will just stick it wherever … and you know that will cause a problem between the front office and the back office.

Back office: “All the front office is concerned about is the production goal, and I need to get this patient in this week.”

This is a tough one because taking care of your patients’ needs and making sure the office reaches its production goals are both important. Like I said above, it’s not your appointment book; it belongs to the entire team.

This applies to the clinical team as well. If you have a patient in your chair who requires an appointment this week and there is not a preblock that fits your needs, then it is up to you to talk to your scheduling coordinator. If you and your scheduling coordinator can look at the appointment book together and she understands the importance of scheduling the patient in this week, then the two of you can come up with a solution together. The scheduling coordinator can make adjustments in her goals and the preblocks for the rest of the month to make up for the disruption in the initial plan.

There will always be exceptions, even when you have your schedule mapped out. When the front office and the back office can discuss it, the magic can happen and the teams can schedule together harmoniously.

2. Pass the baton without dropping it
The patient hand-off reminds me of a relay race where one wrong move can ruin it for the entire team. Decide as a team how this drill will play out and practice, practice, practice.

Front office: “It drives me crazy. They just drop off the patient and I have no idea what to schedule or what we did today.”

Unless the clinical team is checking out the appointment in the treatment room, collecting money for today’s visit, reviewing treatment plan estimates for the next visit, making financial arrangements, and scheduling the next appointment, there needs to be a systematic approach to passing the patient off to the front desk. The front office needs the information not only to take care of the patient’s needs, but also so patients can hear that everyone is communicating the same information.

• What was done in the visit today? - The front office needs to know what procedures were done so they can create the insurance claim, add any necessary attachments to the claim, and collect the patient’s portion of the appointment.
• What is next? - Are you referring the patient to a specialist? Does the patient have a new treatment plan that needs to be reviewed? Does the patient just need his or her next hygiene visit scheduled?

These two pieces of information are critical for a proper hand-off between the front and back office. Even though we all know this is important, this is where one of the most frequent missteps occurs in the dental practice. Don’t keep the front office guessing. How can we fix it?

• Use patient routing slips or visit forms - Now, if you know me, you know that I am not a big fan of using paper. However, a well-designed form can be a very useful tool and, if you shred it at the end of the day, it doesn’t clutter the office. This form can be a great nonverbal way of communicating these two critical pieces of information to your front desk, especially if the clinical team member is running late and can’t spend a lot of time at the front desk. On the Patient Route Slip from the Dentrix software, the procedures that were scheduled today are listed, as well as the patient’s current treatment plan so the clinician can easily circle what was done and then number the treatment plan. The front office quickly knows what was done today and what is coming next in the order of the treatment plan.

• Verbal hand-off - A verbal hand-off is great because the patient can hear the communication between the clinician and the front office person. The patient can observe the transfer of information and know that it was communicated accurately. However, since there is nothing written down, the front office team member must have a good memory and stay focused so she can take care of the patient’s scheduling.

Back office: “I don’t have time to fill out a routing slip; the front office can read the chart and get the information.”

Please don’t keep the front office guessing. If there were X-rays on the appointment for today and the front office doesn’t read it in your note, they will question it. It is the front office’s job to make sure all those details are addressed so that nothing is missed. Let’s avoid those questions by communicating the details with our front office team during the hand-off, even if it takes an extra one or two minutes.

3. Tug O’ War over treatment planning
I feel very strongly that there needs to be clear expectations set in the office about who enters the treatment plan, who presents it, and who schedules it. The ADA did a study with malpractice attorneys and the number one reason dentists are sued is because of lack of treatment planning. Let’s review a couple of typical scenarios.

Front office: “They bring the patient up to the front and say, ‘Ms. Taylor is ready to schedule her crown’ and walk away. Then I open up the treatment plan and there’s nothing there or I don’t know why she needs a crown. It’s so frustrating.”
 

This is a common problem among dental offices. At your next team meeting, talk about these issues. Here are my recommendations.

• Who should enter the treatment plan procedures? - The person who is in with the doctor during the exam should be the one entering the treatment plan into the patient chart. It is the doctor - and the doctor alone - who has the credentials to diagnose and you cannot perform treatment without a diagnosis. This diagnosis must be documented and, if you leave this up to your front office, they will inevitably need to hunt down the doctor for the diagnosis, so it’s best to do it right the first time.
• Who is responsible for presenting the treatment plan? - The person who schedules the appointment reviews the treatment plan and fees and makes the financial arrangement. In my opinion, if the patient doesn’t have a financial arrangement, the patient doesn’t get in the appointment book. If you’re squeamish about discussing fees, then leave it up to your front office.
• Who schedules the treatment? - If you know that the patient has a firm financial arrangement, and your appointment book is mapped out so you know an appropriate place to schedule, then go for it! I’m a huge fan of cross-training and multitasking if it is within your security rights at your office.

Back office: “I don’t have time to treat my patient, write up my clinical note, turn my room over, and enter the treatment plan and schedule the next visit.”

You might not like this answer, but you better find time. Writing up the treatment plan with the diagnosis is one of the most important clinical charting requirements along with the clinical note of what was performed today. You’re putting your office and your doctor at risk when you neglect to make this a priority. How can your team assist you with making sure the patient’s treatment plan gets documented?

• Everyone in the office should be cross-trained on how to turn a room over. Have someone clean your room for the next patient or seat your next patient if the patient is already in the office.

• Have your front office team schedule the next visit. I would rather you give up an administrative task than delegate the treatment planning to your front office.

• Call the front office to help with periodontal charting if you’re running behind during your hygiene visit.

• If the doctor is available, ask him or her to enter the treatment plan into the patient chart. It is OK to delegate to the doctor. He or she wants to help but just needs to be asked.

• If you’re using computers in your office, try using a voice-activated charting system such as Dentrix Voice Pro.

When there is turmoil between the front office and the back office, your patients can feel it. They can sense the frustration and see it on your face when you’re disappointed in one of your team members. Work on these issues during team meetings and create systems in your office that address these issues. Set standards in your office so that patients walk away feeling like your office is a well-oiled machine.

Author Bio
Dayna Johnson, founder and principal consultant of Rae Dental Management, helps dental offices improve patient care, increase collections, and reduce staff headaches by implementing efficient management systems. With over 20 years of experience in the business and technical side of dental offices, Dayna’s passion for efficient systems is grounded in both personal understanding and professional expertise.

She can be reached at dayna@raedentalmanagement.com, or visit her website at www.raedentalmanagement.com. If you’re a Dentrix user, you can check out her blog with front office tips and ideas at http://thedentrixofficemanager.blogspot.com/.