Our patients and their parents are judging us on
many levels. Most of these reasons are not related to
teeth, their smile or how accurate their bite is. They
assume that they will get a beautiful smile when they
trust you with their child’s or their own orthodontic
treatment. The areas that matter most to them are:
- Are they seen on time for their appointments?
- Is your office in a convenient location?
- Are all your employees friendly?
- Does your office provide good communication?
- Is their treatment completed on time?
- Does your office have convenient office hours?
- Do they experience few emergencies?
Most orthodontic offices run daily and monthly
financial and administrative reports to measure
growth, monetary tracking and other practice monitors.
Running a set of clinical reports on a monthly
basis will allow you to evaluate your treatment, your
clinicians and your schedule. Running these reports
will only help the practice if the information is accurate
Ask yourself these questions:
- Is your clinic running on time? Are your
patients being seen on time?
- Are your clinicians consistently able to complete
procedures in the allotted time?
- Are your estimated completion dates being met?
- Is your percentage of emergency visits at an
Many times I work with offices that have a “feeling”
of what is happening in their office. Were your
answers based on your feelings or one person’s perspective?
Or were they based on actual facts and accurate
information? You can more accurately provide
answers by running your monthly clinical reports.
Actual times and accurate data will give you a better
perspective on which to base your decisions. The
clinical reports I recommend running monthly are
your emergency tracking report, patient flow report,
patients beyond ECD (estimated completion date)
and treatment efficiency monitors. Once you have
this information, you can answer the questions listed
based on what is truly happening in your clinic rather
Emergency Tracking Report
If proper coding is used consistently, a report of
all emergency visit codes will give you insight into
possible areas of concern. There might be two codes
used to track this information – one for patients
who call into the office with breakage or a problem
and schedule an emergency appointment, and the
second for breakage found at the chair during a
scheduled appointment. Each of these gives a different
view of the areas of concerns to address. If
the number of emergencies is very high, this will
most often lead to extended treatment times as well
as the reduction of the per visit fee. This report
might reflect the need for clinical training, bonding
protocol review and other areas of improvement for
The number of emergencies seen in a practice
should average five percent or less. If your report
shows that number to be higher than desired, it is
time to provide training and put consistent protocols
in place to reduce this number. Consistency in the
clinic is a key factor in the reduction of emergencies.
It is critical to make sure clinical protocols are developed
and consistently delivered by each clinician. As
I work with clinical teams to reduce bond failures, I
will ask about their bonding protocol. I am typically
assured that the practice has strict protocols and all
team members know and follow them. A portion of
my first day in an office during a clinical consult is
spent observing the team as it delivers patient care
with a full schedule. The number of inconsistencies I
observe are often reflected in the rate of bond failures;
the higher number of inconsistencies, the
higher number of bond failures.
For multi-office practices, I also look at the number
of emergencies based on percentages per office.
One office might have a higher number due to the
equipment in that location. Is the compressor functioning
well? Are the air/water lines allowing water to
come through when you are drying the teeth during
a bonding procedure? Is the ambient light allowing
the adhesive to start to set prior to the doctor arriving
at the chair?
If the number of emergencies is higher than
acceptable it is necessary to dig deeper to get some
true information to evaluate. The computer reports
will tell us which clinician saw the patient for the
emergency visit, not the clinician who is responsible
for the additional appointment. To fully evaluate
each emergency or repair appointment, a paper trail
is needed. Gathering the following information will
help determine areas for improvement:
- Which office was the patient seen in at his or
her last visit?
- Which clinician saw the patient?
- Was it a loose bracket, band, wire poke or other
- Which tooth – for loose bands and brackets?
- Which bracket – for offices using a variety
- Was the adhesive on the tooth, bracket or both?
- Date and type of bond – for offices using direct
- Was it a wire poke or wire slide?
Once we have this information we can make
some educated decisions about solutions.
Patient Flow Reports
One of the ways our patients judge us is by being
seen on time for their appointments. This means
seating each patient on time as well as finishing each
procedure on time. The patient flow report will give
us that information if the team is checking the
patient in and out on time. We can track this back to
which procedures are taking longer than our schedule
is designed for. This report can also be tracked by clinician,
which pinpoints which members of the team
might need more training. Many times I find that a
clinician is unaware of the actual time he or she is
taking for procedures. Having actual data will be
much more helpful than “you are always running
behind.” Give the clinician some real numbers that
can give him or her a goal for improvement.
This report will only track the total time a patient
is in a chair. It will not account for time that is spent
waiting for the doctor to come to the chair. Assuming
that the clinician just needs to speed up and get more
efficient in the procedure might not be an accurate
solution. It might be due to the doctor time in the
schedule not being accurate or in the correct place in
Your patient flow report will allow you to evaluate
your clinicians as well as your procedures. Do all clinicians
need extra time for specific procedures? It
might be time to review the timings for your procedures.
Have you changed bracket systems, bonding protocols or treatment applications? If so, the schedule
might not reflect correct time for these new procedures.
If one clinician is not able to consistently
complete a specific procedure in the scheduled time,
additional training might be needed. It could be helpful
to have a clinician who is able to complete the procedure
in time work with those who cannot. Making
sure each clinician is prepared for the doctor when he
or she comes to the chair, has good chairside organization
(all adhesives, extra instruments, disposable
items, etc.) and is fully trained will allow him or her
to move through the appointment most efficiently.
Patients Beyond ECD
Having a high number of patients beyond their
estimated completion date can be a huge struggle for
many practices. Getting this number down to an
acceptable level of five percent or less of your patients
will help you meet your financial goals and free up a
clogged schedule. The morning huddle is a good
time to have these patients brought to everyone’s
attention. The clinicians who see those patients can
evaluate their treatment and compliance and help get
them back on track.
The tracking report for patients beyond their estimated
completion date should also be reviewed on a
monthly basis. Are there financial concerns involved
with these patients? Patient compliance issues? A set
protocol should be developed to allow the team to
address these patients. The estimated completion
date should be reviewed and adjusted if there are
missed appointments, compliance issues or treatment
changes that are extending treatment. If the estimated
completion date cannot be met, I recommend
a scheduled consultation with the patient and parent
to discuss the treatment options.
If compliance is the reason for not meeting the
estimated completion date, it might be time to discuss
options. Are there fixed forces that can be used to
remove patient compliance from the treatment? Is it
in the patient’s best interest to discontinue treatment?
Treatment Efficiency Monitors
This report will tell you how many procedures
are completed during a patient’s treatment. It will
include all scheduled procedures that are completed
and all emergency visits. In order for a practice to be
financially sound we must look at treatment from
this perspective. When we tie this to the treatment
fee, this will help us determine if our financial goals
are being met. If the per visit fee is not at an acceptable
level we can look at options. One of the biggest
contributors to a case that is not financially sound or
profitable is the high number of emergency visits.
With consistency and training, this situation can be
There are other options that might help your
office decrease the number of visits in a patient’s
treatment. The first is making sure that each appointment
is as efficient as possible. Each appointment
must make the necessary progress to move the
patient through treatment in a timely manner.
Would moving to a self-ligating bracket allow you
to extend the weeks between visits? If repositioning
too many brackets is adding visits it might be
beneficial to look at indirect bonding or computerized
treatment planning to achieve more accurate
In order to fully evaluate treatment times I monitor
not only the total treatment time in months but
include number of procedures and number of emergencies.
If your computer system does not include
enough information to fully evaluate treatment I
would recommend using a treatment efficiency monitor
that is filled out at each patient’s deband appointment.
This monitor will track the type of treatment,
total treatment time, the number of appointments
and the financial outcome of the case.
Now that you have accurate information to base
your responses on, I ask you to answer those same
questions again. The key to a successful practice is
meeting the needs of the patients. Once we understand
their needs, we can use this information to
make sure we are not only meeting their needs but
also excelling at every level. Running your clinical
reports is the first step. Using this information to
improve your practice and your team will take you
to the next level of clinical excellence! I challenge
you all to get there!