Scheduling
Appointment Scheduling System: A Vehicle for Increased Productivity
Brenda Goldstein, MPH
Copyright 2001 Journal of the California Dental Association.
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Operations management is the design and control of systems responsible for the productive use of human resources, equipment, and facilities in the development of a product or service. Applying those concepts to appointment scheduling can coordinate efficient use of resources. The focus of this paper is to assist the dentist and dental team in creating an appointment scheduling system that maximizes productivity and profitability.
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One of the keys to profitability in a dental practice is the productivity and efficiency of the appointment scheduling system. Being busy is readily accomplished, but being efficient and productive is another matter.
Each dental practice is unique in its patient base, philosophy, and practice approach. How a dental practice incorporates these variables into the appointment scheduling system helps to determine profitability. By efficiently utilizing the time of the dentist, staff, and patients, value can be created. Applying the concepts of operations management to the appointment scheduling system can coordinate efficient use of resources to maximize productivity and profitability.
The focus of this paper is to assist the dentist and dental team in creating an appointment scheduling system by using the concepts of operations management. Operations management is the design and control of systems responsible for the productive use of human resources, equipment, and facilities in the development of a product or service.1 Dental services are a mix of tangible and intangible attributes that constitute a dental service package. An appointment scheduling system supports and controls the practice, which provides dental services.
The purpose of an appointment scheduling system is to manage time for the dentist and the staff. Time must be utilized to its fullest potential to pay the cost of overhead and generate profits. Time must also be controlled to minimize stress on clinical staff and to provide a smooth and accessible schedule that is almost invisible to patients.
The dental practice must create an appointment scheduling system that is consistent with the operating focus of the practice, user-friendly, structured to cope effectively with variations in demand, and cost-effective. Prior to creating an efficient and effective appointment scheduling system, the dentist must define the production goal for the practice.
To do this, the dentist must begin by looking at the prior year’s production figures. How much profit did the practice make? How much would the dentist like to make this year? Calculating the costs of running the practice and adding the profit the dentist would like to generate creates a total income figure. This number can then be broken down into monthly, weekly, and daily figures. The daily figure is the average amount the practice needs to make every day to meet the overall production goal.
Once the production goal has been determined, this information needs to be communicated to the staff. Each member of the team needs to understand and support the concept of a production goal before moving forward.
The appointment scheduling system must blend together the highly profitable dental work, the recall work, new patients, emergencies, and no-shows. Each of these categories should be assigned production values. Taking these production values into account, the number of each type of procedure or patient that should be scheduled each day to meet the daily production goal should be calculated.
Since most dental procedures are fairly standardized, the team should be able to break down the sequence for each procedure the dental team performs. Each team member has a different responsibility for what happens when a patient comes in for a particular procedure. These procedures need to be broken down, based on the dentists specialty, and each one worked through with the team. The team needs to negotiate to come to a consensus on the steps and time it takes to perform each procedure. All must agree on the allotted time for each procedure the office performs.
Given that the dentists’ time is the most valuable, it is essential that his or her time be used for the most productive procedures. To maximize the use of the dentist's time, all activities that the dentist is not legally required to do should be delegated to the staff.2 The dentist should design his or her ideal day.3 At what time of day does the dentist prefer to perform certain procedures? Is the dentist most productive in the morning or afternoon? These questions need to be asked and the answers incorporated into the allocation of procedures for creating the ideal day.
The hygienist’s time is quite valuable as well. The hygienist should be actively involved in incorporating the hygiene exam into the appointment scheduling system. The balance between new patient exams and recalls should be taken into consideration when creating the production goal. The hygienist’s work is the backbone of the general practice and the hygienist’s time should be factored into the ideal day as well.
After these steps are completed, the existing appointment scheduling system needs to be evaluated in light of the production goal. Because almost everyone in the dental office -- from the receptionist to the dentist -- is involved in the success of the appointment system, everyone should be aware of and contribute to defining and evaluating the existing appointment scheduling system.
Factors That Affect Scheduling
Because of its complexity, the appointment scheduling system is one of the most time-consuming management systems in the practice. Scheduling is the responsibility of the whole team -- not just the person administering the appointment system. There are a variety of factors that should be taken into consideration that affect the production goal and the appointment scheduling system.
Emergencies
The dental team should plan for emergencies. Historical data should be reviewed to determine if the office has a pattern for receiving and handling emergencies. If there is, emergencies need to be incorporated into the daily schedule and accounted for as part of the production goal. The dental team should decide how to handle emergencies. These procedures are to be incorporated into the coordination of the daily schedule. When an emergency patient arrives at the office, the front and back office staff must coordinate to ensure that the pain can be relieved and the patient either be seen that day or be re-appointed for another day.
No Shows
Also affecting the daily production goal are patients who do not show up or who cancel on short notice. Broken-appointment and no-show ratios should be analyzed. This can be done by looking at the previous month’s scheduled production and calculating the amount of production that was canceled. The amount of canceled production divided by the originally scheduled production will give the percentage of broken appointments. In addition, it should be determined how many of those changed appointments were scheduled and how many voids were filled. If most of those changed appointments are filled, the time spent on filling those voids was probably substantial and stressful.
Working with the dental team to come up with solutions for these events before they happen will aid the team in reaching the daily production goal. Some possible solutions are the creation of a quick-call list of patients who live and work close to the office and can come in on little or short notice. The appointment scheduling system should keep such a list.
Repeat Offenders
Repeat offenders are people who are notorious for canceling at the last minute or who are constantly late. This human factor should be taken into account when developing the production goal and creating the appointment scheduling system. One solution is to schedule the repeat offenders for the last appointment of the day. The office should also implement a policy regarding charges for missed appointments.
Down Time
Down time is not profit-producing time, but it can be productive. There are many things the dental team can accomplish during down time that still keep the day productive. For example, the dentist can get caught up on his or her treatment planning, laboratory work, and chart audits. The dental assistant can maintain the office’s clean, neat professional appearance. Back-office staff (hygienists or registered dental assistants) can catch up on instrument sterilization, tray set ups, and inventory control. Staff should be cross-trained in a variety of functions to ensure that they are working efficiently during down time.
New Patients
New patients are essential to a thriving dental practice. When creating the production goal, time should be allocated for new patient exams. Reviewing prior year’s data on how many new patients came in to the practice and estimating how many new patients are desired for the coming year will assist the team in setting the production goal.
The Electronic Scheduling System
A well-thought-out, effective appointment scheduling system that takes into account all of the above factors will increase productivity, decrease stress, allow flexibility for complications and emergencies, improve appointment availability, increase efficiency, and meet the dental practice’s production goal. However, today’s dental practice cannot fully compete in the future unless the appointment scheduling system is automated and connected to the main practice management system.
A practice management system is a set of software packages that is designed to help perform in a shorter time and with greater accuracy many of the clerical, administrative, and accounting tasks traditionally carried out manually. A practice management system that incorporates an automated appointment scheduling system will eliminate many of the routine administrative scheduling duties, leaving more time for patient care. A well-maintained system will provide accurate data on which to base decisions for future developments and may even improve the practice’s image.4
The technological advances that have been made to date in the field of dental appointment scheduling systems are encouraging. An electronic appointment scheduling system is a necessary tool for the dental team to increase productivity and achieve its production goal.5 Many dental offices are looking at incorporating on-line or Web site appointment scheduling for their patients. On-line appointment services may help to increase productivity and customer loyalty while significantly reducing scheduling costs.
Providing patients of record access to a practice’s Web site for scheduling recall exams or cleanings may facilitate patient "buy-in" into the appointment-making process and may reduce the no-show rate. This will allow patients to schedule appointments at their convenience and become more committed to keeping their appointments. Many on-line systems provide appointment notification. On-line appointment scheduling will also allow the patient to electronically update pertinent information such as new address, change of insurance carrier, etc.
In creating an online system, the dental team controls the scheduling parameters and the information-gathering abilities of the system that the patients access. The information gathered online should be monitored regularly, then entered into the existing practice management system.
Conclusion
Establishing and maintaining an effective appointment system requires coordination of provider time, active communication, and attention to detail. Properly done, a well-run appointment system will move a practice to a higher level of productivity and performance by generating new benefits for the patient, the practice, and the dental team. The appointment scheduling system will increase production by making the practice run more efficiently while maintaining a high level of patient service.
An effective appointment system will be well worth the time spent creating it. Staff should be involved in the process so that they feel a sense of ownership in the new system. Once everyone understands and is committed to the system, the new appointment schedule will provide the way for greater efficiency, greater productivity and profits for the practice.
Author
Brenda Goldstein, MPH, is a seasoned health care executive working as the director of operations for a physician practice management firm in Los Angeles. Ms. Goldstein is also a student in the Executive MBA Program, Marshall School of Business, University of Southern California. Her expected date of graduation is May 2001.
References:
1. Chase RB, Aquilano NJ, Jacobs FR, Production and Operations Management, Manufacturing and Services, 8th ed. Irwin McGraw-Hill, Boston, 1998, p 5.
2. Levin RP, Practice success: Efficient scheduling. Dental Economics Jan 1997.
3. de St. Georges JM, Scheduling to make the most of the practice day. Dentistry Today Feb 1996.
4. Turner PJ, Weerakone, Basic Computing for Dental Practitioners: Practice Management Systems. Dental Update October 1998, pp 332-8.
5. Levin R, Business systems: The key to dental practice success. J Cal Dent Assoc 28(5):358-65, 2000.
To receive a printed copy of this article, please contact/Brenda Goldstein, MPH, 1117 S. Orange Grove Ave., #1, Los Angeles, CA 90019 or at bgoldstein@preferredipa.com.
