Episode 839: Effective + Efficient Appointments in 4 Steps

Uncategorized May 21, 2024

Tiff and Dana are back with more tips to perfect your patient experience and office systems. This episode focuses on maximizing appointment efficiency from both the doctor side and hygiene side. The consultants walk through four critical steps:

  1. Taking an inventory of your appointment process

  2. Consider timing with a fine-toothed comb

  3. Implement block scheduling the right way

  4. Schedule the next appointment for what the patient actually needs

Episode resources:

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Practice Momentum Group Consulting

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The Dental A Team (00:10.414)

Hi everyone, I'm so excited to be here. I've got my girl Dana here with me today. It's a beautiful Friday afternoon here in Phoenix while we're recording. Dana, you are what, two hours below me, two hours away from me. How is it down there where you're at? Beautiful, sunny, awesome day. Oh, I love it. This is my favorite time of year. I think it's just the most beautiful time to be in the desert and here in a couple months.


maybe even a couple weeks, I might be saying something different. But I truly do love the dry heat. So I'm so happy to be here. Dana, you impress me constantly. You just got off the road and you have been on the road like crazy the last few weeks. How are you doing? How are you feeling? You've been in offices literally all over the country. You had your toes in sand on the Virginia beach the other day. Today you're in a sunny...


desert, how are you doing with all of it? You've been traveling more than normal. Yeah, more than normal. But doing really good. I think I love in office pieces getting to connect with teens getting in there getting to see how they do interact with patients. It just brings like a fuel to the fire, even though sometimes traveling can be a little bit daunting. Yeah, yeah, for sure. I love that. I do always feel like I get like a like a runner's high.


after being in offices and like reinvigorated and just ready to like take over the world, it feels like. What are, there's some things I wanna chat about today. One of them is appointment efficiency tips. That's what this is gonna be wrapped around. So it's gonna be a lot of really actionable information for everybody. But what were you seeing while you were in offices? Is there anything that kept, I mean, you've been in quite a few practices recently, like I said, all over the country. So is there anything that you saw that was like routinely coming up?


that trends that a few practices were dealing with while you were out there? Yeah, I think I've seen a lot of like patient flow, time management, maximizing like the 60 minutes that we have with patients. So it actually is kind of great that we're talking about appointment efficiency because I do feel like in a lot of practices, we do see some struggles in there, some hiccups, right? And sometimes it just takes a little tweak and things run a whole lot more smoothly. Totally agree, totally agree.


The Dental A Team (02:28.142)

And I think we are running into that space of like coming up on summertime. And so it is like, what are, what can we do? And we've got so many people that have vacations. So we've got, you know, a lot of cancellations in the schedule, a lot of people calling out, but then on the flip side of that, we have a lot of patients that are like, Hey, I have vacation time. Let me use it. Or we're going to be gone. Let me get this done before we leave kind of situation. So I totally agree. I think being on the road, I was on the road last week and we definitely worked on a lot of like flow and efficiency pieces. I think that's something that dental hygiene does really well.


with our clients and with our listeners is to really always look for that efficiency piece. How can we make the most out of the time that we have? And caveat for my team members listening, that doesn't always mean that we're adding things to your appointment, right? We're asking you to quote unquote do more. It just means how can we be super effective with the time that we have and give the patients the best experience that they possibly can have with the time that we've got while they're in our practice. So,


Following in line with that appointment efficiency tips, I think that's something that every practice thrives with and comes to dental 18 -4 systems, right? And this is a huge undertaking. How do we ensure that our appointments are going as efficiently and as effectively as possible? And Dana, I know you are a hygienist. I think this is super, super key for you to speak on hygiene behalf. And then I was a dental assistant by trade. And so,


I kind of have an idea for how the doctors movements are, where our doctors are at, how those doctor side appointments can go, but then also like shuffling him or her over to hygiene too, to get that worked in and all of those pieces streamlining. Now I have to tell you a story. I have an office near and dear to my heart. I actually just spoke to them this morning and my in office visit I did with them, my first time being in their practice years ago, I remember walking in and I thought, I looked at their schedule and I was like,


Holy cow, like this man's been practicing dentistry for a long time, but his appointments are really long. He's like two and a half hours for a crown prep. And I'm like, for anybody who's, you know, been out for as long and practicing for as long as he has two and a half hours, not knowing the crown in office seemed like a really long time. So I was like, I'm going to watch this. And, and lo and behold, I start watching and I go to the back office and I'm observing their dental assistants. And I noticed that the dental assistants are standing over the patient with two suction.


The Dental A Team (04:50.286)

And so we've got a high speed and a slow speed section going at the same time. And their doctor is sitting with the drill and a mirror and every 30 seconds, he's pulling the mirror out, wiping it on the bib, putting it back in because he can't see. And then also he's got there constantly in the, in the mouth with the two sections and he's got everything he needs on his tray. So he's with one hand like grabbing and throwing, grabbing and throwing the other hand with the mirror and they're dissectioning water or not. And I was like,


I think I can help here. I think I can help. So I pulled them out of the chair and I said, like, has anyone ever taught you how to assist? And like, nope, not really. We went to school, but we didn't have hands -on training. And this is what we did. And I said, the doctor, I'm like, why are you not asking for what you want? And he's like, I don't want to step on toes. I assisted that morning. I had them watch me. I assisted every appointment they had that morning. Flip -flop, they assisted in the afternoon. I watched them. By the end of the day, we had, we.


started shortening the appointments to what they were, right? So by the time the patient left, we shortened it. I stole the tray back from the doctor and I was like, don't touch these instruments. Don't be grabby and don't throw things. And by the end of that day, we had three and a half hours of open time on that schedule, just unused time in between patients. And the practice on his wife, the office manager, her mind was just like blown, right? It was mind blown. She's like,


what we could do so much with this time. And I'm like, yeah, so all these patients that are booked out three, four, five weeks, because you don't have time to get them in, start calling them in. We've got two really trained assistants. And the point of that story is just within that itself is a ton of appointment efficiency tips. Because if you're not, if you're a dental assistant and you've got one section and you've got an air water tip, like your air water tip should be over that mirror if the doctor is using that mirror to look at it too.


He should, he or she should have a clean mirror constantly. You can air it, you can air water it when it gets kind of gunky, right? Some things just kind of fly on there. You can clean it off. And then you're also going to make sure that that left hand is always available to be grabbing things off of their tray, switch over the high speed to the left hand and you're grabbing things off your tray where your composite is, your brushes, all those things are over there and you're passing with your hand. So that's called.


The Dental A Team (07:07.854)

two handed dentistry, right? Or four handed dentistry if you're including the doctors, but you're using both of your hands constantly. And that's how we know how to schedule appointments. If we're not efficient chair side, I wanted to talk block scheduling today and that's something Dana that I think you're really fantastic at implementing with practices is the block scheduling. But if we're not sure where our doctor's at,


or what our assistants are doing, or we're not super efficient chair site or know how long things take, block scheduling doesn't work. We've got to have that dialed in so well that it's easy for them to say, this is where that appointment goes. So chair site efficiencies, like look for those spaces. Are dental assistants using both sections? Do you need them to use both sections? Sometimes during a surgery, yeah, you do need that, right? I need the slow speed section for.


fit and I need that high -speed suction with the surgical tip for the socket. So yes, absolutely. But depending on that treatment, like what should they be doing? Where should the things be placed? Tray size, like are your instruments? I know a lot of hygienists do this where they know which scaler they're going to need next, like from start to finish of the appointment. So their trays are set up in order of which scaler they're going to need. And a lot of hygienists got, Dana said, daisy.


Dana, I've seen like not even look at their tray to pull their instruments their heads just in in the mouth, right? Their eyes are in the mouth and if dental assistants are thinking that same in that same vein What is my doctor going to need next? It's much easier and I used to just pull from the front and move to the back pull from the front move to the back So the next thing you need is right there Dana, do you like is that how just within the appointment before we even talk about block?


scheduling and how to schedule things like how do you see those are some dental assisting pieces, but on the hygiene side, what did you use to do that in that made you super efficient or what have you implemented with practices that helps kind of tighten up that space there? Yeah, and I think it really is truly just figuring out ways that you can buy even if it's 10 seconds, right? If I don't have to look at my tray and say, okay, where is my


The Dental A Team (09:23.726)

Gracie, right? Or where is my 1314? If I know automatically where it is every single time, I just bought myself five to 10 seconds. Well, every time I transition an instrument, I just bought myself back a minute, a minute and a half, right? And that makes a huge difference in a 60 minute appointment. So it's always looking for those little bits of pockets of time. If I can prep a patient with something before I do it, right? So if I am peri -returning and I say, hey, if you see...


If you hear one, twos and threes, those are normal. If you hear fours, those are kind of my warning lights, right? Like that we're progressing towards disease. Anything after that, five, six, seven, I've already prepped the patient. So then when they sit up, I just bought myself a window of time because they kind of already know where we're going. If I am talking about home care, right? And I can tell the patient maybe needs some floss help. I can do it as I am flossing their teeth. Do you feel this? How I come over here? Do you feel, instead of having to sit the patient up and having a,


a whole explanation of it. And there are patients where, yeah, you do have to sit them up and do that. But when you can buy back windows of time, if I'm applying for it and I'm messaging up to my front, hey, patient ready to check out treatment plan in, if I'm sitting there waiting for an exam and I'm typing notes and I'm doing my OHI as I'm there with the patient, all of those things buy you back seconds, minutes, lots of time in there to be able to do other things like scanning, to be able to take intraoral photos, to be able to...


you know, present a treatment at the end. So when you can look for those opportunities in employment, even in hygiene side, right? Same thing on doctor's side. I only want doctor doing what only the doctor can do. So if you as the assistant can get in there and do something, jump in there and do it because again, we're just looking for those little bit of windows of opportunity that equals maximum efficiency. Yeah, I love that. And I love what you said about like gaining yourself back that minute and a half.


even like at the beginning, that minute and a half, you guys, I don't know if anybody's ever done a one minute wall sit, but they kind of suck. A minute is a really long time in the grand scheme of things. And so what could you get done in a minute? What could you do with the relationship building in a minute? We're talking about the treatment even more in detail with the patient, answering the questions that they need that you don't typically have time for, that you're like trying to rush them out for. How can we give back to the patient?


The Dental A Team (11:45.486)

with that time that we're saving, I think that's brilliant. And I love the idea of talking as you go. I used to love to do that you as a dental assistant, there are so many spaces you guys in hygiene, obviously, it's super, super important and clear to be like, you're in the mouth, talk about their mouth, like talk about, I love conversation. And I love building the relationship. But if there are things to talk about in the mouth, that's your opportune time, because you're there, you're in it, your patients expecting it.


and they're now thinking about it as you're going. Dental assisting side, making sure your patients like Dana just said, making sure they're prepped for what's coming. I used to love to make sure my patients understood what's coming. We're gonna do the scan now. Like this is what it's gonna be like. Let me pop it in there because what happens a lot of times are we're gonna do the PAs. It might feel this. I remember I put something in somebody's mouth and they're like, oh, oh, what is this? Get that out of my mouth. And I'm like, but I only have so much time. Like I can't explain this. But I thought, okay, well.


have I prepped them for the fact that there's a giant wand, right? A scanner feels to us like it's super small and it's really cool. And like, it's just this magnificent little wand. It feels really big in your mouth. If you haven't had a scan done, go get one done. It feels really big in your mouth. So making sure that they're prepped for things like that on both sides. Dental assistants should be doing scans on new patients.


you've read care appointments, they can help with that too. But also, right, obviously, crowns and ortho stuff like that, but making sure that they're crafted love that those are huge efficiency tips. So I would take inventory of your appointments, what you're doing already. And then maybe, maybe what you're doing already, what you think you're doing, that maybe you're not, or that you're not doing consistently, and then what you could do to alter change some of those appointments and doctors, if you're noticing.


Next week you go into the office and you're noticing that your dental assistants maybe aren't like on top of what you need next. Talk them through it. I have a lot of handsy doctors is what I like to call them. And they love to just grab because it's faster. In that moment in your mind, it is faster quote unquote to grab, right? But for the long haul, if you think about a seven hour day of patience,


The Dental A Team (14:01.294)

If you could save that 15 seconds, 10 to 15 seconds, every time you have to go grab an instrument, add that up throughout the whole day, every appointment, every time you grab something, it adds up to hours. I promise you that. So take inventory and figure out what your timing looks like. Where could you be more efficient chair side? And then that leads into that block scheduling. And Dana, I think truly, I think you do an amazing job.


training this, you have so many practices that are using block scheduling, you're my go -to girl for it, you know that I call you for that, especially for Eaglesoft practices trying to get their blocks in and like Dana's your girl. I am Densho Ikefalle, open dental, I can help you with, Eaglesoft that's Dana. But Dana, will you take us through, once we get that, because I think that kind of taking inventory of your appointments, figuring out your timing, go hand in hand.


And then once we have the timing down Dana, what's next steps for block scheduling to really help make it the most efficient as possible? Yeah, I think then next comes your X's and slashes, right? Or knowing when maybe you could overlap your doctor again to maximize production in the day. So just mapping out for teams that they know, hey, this is where doctor could hop to another room. Same thing with assistant team. So it helps you maximize your team members.


including your doctor. So mapping out in each appointment type, what portion of that is assistant time, what portion of that is doctor time, same thing if you're doing assisted or accelerated hygiene, when should the assistant be in there, when should the hygienist be in there. So again, when we are scheduling, we are maximizing it from the very beginning. And we are utilizing whatever provider time we have available in the schedule. Yeah, I love that. I love that. So.


Take an inventory of the appointment, figuring out what, like how long your appointment is. And actually let's add a caveat here. It's something that I think many doctors that I've worked with, many of my clients tend to forget to look for is also the assistant time within your appointment. So just like the accelerated hygiene assistant time, you've got to account for that as well. So it starts with finish. So when did the patient get that? When did the patient leave? So your chunk in the middle is super important. We need to know that for the Xs and slashes.


The Dental A Team (16:17.966)

But overall appointment timing for the blocks to make sure that they're scheduled correctly, we need that start and end time, and then your time for your Xs and slashes. Xs are typically doctor time, slashes are typically assistant time. That's just the way of the world, and it makes it very easy if everyone in dentistry follows the same thing, because everybody's learned it that way. I know some of the softwares do colors. So I think Open Dental does like white and colored.


So white would be assistant time colored would be doctor time. The point in those is that we need to be able to see where doctors at so that when we overlap, we're overlapping assistant time with doctor time. I have a huge pet peeve. Dana, tell me if it's just me. It could be my assistant side. It could just, I thrive on efficiency and I thrive on zero wasted time. I, one of my biggest pet peeves and I love all of you who are doing it this way.


And if you prefer to do it this way, by all means, I'm not saying to change it. I'm just saying it's less efficient. I hate when I look at a schedule and I see a slash and a slash at the end of the appointment, the last 10 minutes and the first 10 minutes. So there's a slash and a slash and then the X's are like somewhere else. And I'm like, okay. Or if we have two assistants and we've got a slash, we can put a slash with an X.


So when doctors finishing here, my assistant on the second appointment is prepping the patient for the doctor to come in. So there should never be an X and an X together. That's the rule. But a slash can be with an X. A slash can be with a slash. A slash can do anything at once as long as we have enough assistance to make up all the flashes. But when a slash and a slash is together where it could have been a slash and an X, it drives my mind crazy because I think, okay, I could have brought that patient in. I could have brought in every single patient at least.


10 minutes early, if not 20 minutes earlier than where they're at, adding up to a whole nother appointment by the end of the day, I promise you. And when my clients come at me and they're like, I can't get limited appointments and I have nowhere to put my crown seats, where do I put these adjustments? I'm like, well, there's a lot of time here. So Dana, is it just me? Am I being crazy or is that a normal thing? Nope, that's a normal thing.


The Dental A Team (18:41.71)

And I think that we do it right because I think we're constantly looking for like that buffer of time and I feel like we've got to maximize it, especially when we have the assistance. If you have the bodies, but make it as tight as we can, right? Because they can pivot and help each other. And I think sometimes we forget that and we end up with slash and slash and we're just looking to make sure two X's are next to each other. And that's great. We don't want two X's next to each other, but two slashes next to each other when we have two assistants is wasted time. Yep.


Yeah, any inefficiencies and honestly, I think we get into a space where we start treating our dental assistants, which they are amazing. You guys, I was a dental assistant by trade, so I'm not knocking anything, but we start looking at it as if they are the providers too. But if I had two dentists, right, I'm not scheduling them that way. So I'm thinking, I've got two assistants, like how can I maximize my doctor's time?


I, this is me from my I hope he listens. Sometimes he listens. My doctor that I worked for for years, I would sit up front and my back was to the space where people would walk into the front area, right? And I was forward facing with the patients. I could feel him behind me. And I'd look at the schedule. And I'd be like, where is he supposed to be that he's not? Or what did I mess up that he had time to come and ask me to do whatever this is that's gonna this next?


project that's gonna fly out of his mouth. What did I do wrong with the schedule that he's not in a room right now? Or if I saw him in his office, I'd be like, what's going on? You should be why are you not in a room? Why are you not busy? You guys that's when the chaos comes in, right? It's like doctors asking me to do a million things. Keep doctor busy. If doctors busy, doctor doesn't have time to ask you to do a million things. So watch your schedule, block correctly, and keep your doctor busy doing like Dana said,


only the things that only a doctor can do. Okay, there are plenty of things that the rest of us as a support team can do. Keep your doctor doing the things that only he or she can do, because the rest of us can't do those things. So I love that. So take inventory of your timing, take inventory of how your appointments are going. Are there areas where you could save time in something to add it back to your patient experience somewhere? And I consider scanning.


The Dental A Team (21:05.55)

a patient experience plus. When patients understand their mouth, when they can see it, when they can understand what's actually happening, that increases your patient experience. Yes, it'll increase case acceptance diagnosis, like all of those pieces, your ortho cases, totally on board with all of that. But more importantly, your patient's understanding their mouth is huge. So I consider scans patient experience. So it gives you time for patient experience.


Figure out your efficiencies, figure out what your timing looks like and where your excess and flashes should go. You can then implement blocked scheduling really easily. Your blocked scheduling should equate to what your daily production goals are, however it needs to happen. And if you need tips and tricks on that, like that's a whole, like she literally, I'm telling you guys, Dana trains on this constantly. That is a whole training. So if you do need more tips and tricks, please don't hesitate to reach out. We work with practices constantly on implementing blocked scheduling. It's very,


very second nature to us. But I'm not going to spend all the time going through all of it today. So check your efficiencies, chair sides, how can you make that appointment more efficient? How can you add back to the patient experience and look at what your timing and your X's and slashes are. The last piece that I want to make, I don't know why I've been hammering in on this so much lately, Dana, but it drives me wild. I want everyone to schedule their next appointment for what they actually need. So if I'm


a dental assistant, and I'm scheduling an appointment, I'm not just, I see it all the time in the little description, it says crown and nothing's in there. And I'm like, how do you know your timing is right? Do you need a buildup? Do you need, are there fillings next to the crown? Like what are we actually scheduled for? So schedule what you're doing. If you're doing a same day crown, your seat should be in there as well. Schedule for what you're doing. Hi, Dennis. I implore upon you. This is coming from my front office part.


and from my office manager heart. And I would assume this would make your life easier as well. I can't imagine that it wouldn't. Schedule for what you need at the next visit. Right, Dana? If you took x -rays today and you know you only take them once a year, right? You take fight wings once a year. If you're not doing them six months, you know next time you don't have to take those x -rays and vice versa. If you didn't do them today, you know next time. I'm, I like to say I'm a lazy human. I love the path of least resistance. I want easy.


The Dental A Team (23:31.63)

I want to fish it. And I am telling you right now, I hate taking x -rays. So if I were a hygienist, I would be doing it just so I knew I didn't just stack a whole day full of patients that needed x -rays. And I would be like every other patient maybe would need x -rays, but I would sprinkle them in where I needed to, where I wanted to, and build the day that I wanted to work rather than feeling every day like I was coming into something I'm being told to do, I guess.


Right, that could be my stubborn nature as well. I'm a stubborn lazy tourist. It shows. Dana, is that crazy? Or did you do that as a hygienist? Like, how did you work that to make your days the most efficient in your hygiene world? Yeah, I don't think it's crazy at all. Honestly, I don't think you can plan for your day if you don't know what you're doing in your day. Right, you can't plan for your patient.


if you don't know, and we talked a lot this entire time about finding those pockets of time, you won't be able to find those pockets of time if you aren't prepared for what you're doing with your time in the first place. So if I look at a patient beforehand, right, and they're not due for x -rays, I'm gonna prep to scan them. But then if I get in there and they're actually due for x -rays, right, well then I'm not prepped or prepared to do all that I need to do for that patient. And so I think, same thing like you said, a crown. Nothing drives me more crazy when I see crown too. I don't know if there's a buildup.


Also, we know we need PAs for insurance purposes. Put that in there so we're not forgetting it, right? All of those little things just help us run more efficiently, run more smoothly. Now my billing department's not hunting me down to make sure I took that x -ray, right, for them to submit. Then they're not appealing because we didn't have it. It truly, truly, truly, those little things, when we plan and prepare and prep, makes our day go smoother, be more efficient, and make sure that all the parts and pieces we have for each and every patient, each and every visit.


we're ready and we can be as proactive as possible instead of that like reactive, right? Well, I just spent five minutes on health history because I didn't think I needed x -rays and then I get in there and oh darn, this patient needs x -rays. Now that pocket that I built on relationship, right? I might've sped through a little bit faster because I knew I had that. So you can't plan if you don't know what you're doing with each and every patient. I love that. Thank you. I love the PA idea too. I have so many practices that are like,


The Dental A Team (25:49.742)

How do I get my dental assistants to remember the game? Put it in the appointment. They're looking at the appointment already. So they're going to do everything that's in there. They have to set it complete anyways. So beautiful. I love it. Thank you, Dana. This was a good one. So we need to take inventory of our appointments. How can we be more efficient chair size? What's our timing look like once we know our efficiencies are dialed in? Xs and slashes, where are the dental assistants? Where are the doctors? Remember, line those Xs and slashes up. Never an X and an X. Rarely a slash and a slash.


Block scheduling that rolls you right into block scheduling and how to do that and then schedule for what you need every single time this helps you be more prepared, your doctors be more prepared and your your front office support team is more prepared as well. They know exactly what's going on and your timing will be more efficient just knowing what you're coming up against. All of those pieces. I think this is fantastic. Dana, thank you so much. I love picking your brain.


I know you do this a ton with practices, so I know you have some awesome ideas. So thank you for being here with me, Dana. And I hope everyone took some good nuggets. I was writing notes as Dana was talking. If you're not driving, I hope you were writing notes as well. If you were driving, listen back through. There were some awesome tips in there. And if you love this content, like I know you did, please drop us a five -star review. Help our community know that this was a good...


implementable podcast for them to listen to and we appreciate seeing it. So if you need any information, like we said on the block scheduling, hello at the dentalatm .com, we work with our clients constantly. We work with our group clients, our virtual clients, all of those people constantly on how to implement things just like this. So if you need a little bit of extra work, just reach out to us. We're here to help you know, we love our community and you guys will catch you next time.



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