Take Back Your Time by Charlene White

Orthotown Magazine

Analyzing the minutes spent in certain areas of your practice can make a big difference

by Charlene White

Every minute counts

It is very important for a practice to focus on clinical efficiency. This is not only based on the efficiency of treatment but also includes that of the clinical team.

Quite often, we hear that everyone wants raises. Many assistants complain, “We’re understaffed and underpaid. We need more clinical assistants.”

Before we as consultants jump in and increase everyone’s salaries—and decrease the doctor’s income—we need to analyze the situation and confirm the efficiency of the clinical system.

I’ll use real statistics in the following example, which I found very interesting and think you will, too:

At the end of the previous year, the doctor was frustrated by the high percentage of the time the clinical team were late coming into the office. They had a big discussion, and everyone agreed that on Jan. 1, things were going to be different.

It started out well, and then everyone slipped back into their previous habits. I want you to know, too, that the doctor in this case is always on time; it’s important for the leader to set the example. Let’s look at the statistics and information gathered.

100-day study

The first thing we did was analyze more than 100 days, looking at the percentage of the time each clinical team member was on schedule. We found the following:

  • Clinical assistant 1: Late 35% of the time.
  • Clinical assistant 2: Late 36% of the time.
  • Clinical assistant 3: Late 25% of the time.
  • Clinical assistant 4: Late 3% of the time.
  • Clinical assistant 5: Late 3% of the time.
  • (Just a note: The administrative team as a whole was late only 2% of the time.)

Another important statistic to evaluate is how many patients each clinical assistant sees on average per day. The national averages are:

  • 8–10 patients per day is low.
  • 11–12 is the low end of the average.
  • 13–15 is good.
  • 16–18 is excellent.
  • 19 or more is outstanding. (I rarely see that number.)

In this practice, we evaluated the patients seen per day by each clinical assistant:

  • Clinical assistant 1: 9 patients
  • Clinical assistant 2: 10
  • Clinical assistant 3: 13
  • Clinical assistant 4: 9
  • Clinical assistant 5: 14

The TC is calculated separately; average is six patients per day. Overall, the clinical team averaged 56 patients per day, not including exam patients.

The following will help you determine how many clinical assistants you need to run efficiently:

  • If clinical assistants are averaging 18 patients per day, you would need three clinical assistants.
  • 16 patients per day, you would need 3.5 clinical assistants.
  • 14 patients per day, you would need four clinical assistants.
  • 12 patients a day, you would need 4.6 clinical assistants.

Every practice should have specific guidelines regarding the average chair time for each clinical procedure. For example:

  • Adjustment: 20 minutes.
  • Records: 30 minutes.
  • Pan and repo: 40 minutes.
  • Deband: 50 minutes.
  • Bond full: 60 minutes.

If one assistant is routinely taking 30 minutes to complete an adjustment, it creates a patient flow problem. The daily procedure report by assistants should be reviewed daily. Assistants should be trained and evaluated during their reviews. They should receive copies of their own performance reports. If they are not able to meet the practice guidelines, they need to be moved to another position or taken off the team.

Clinical repairs should be tracked daily and monthly. Ideally, the report should include what type of repair and how many repairs each assistant had for the month. For example:

  • A 3% bond failure rate is excellent.
  • A 5% rate is average.
  • A 10% bond failure rate is a marketing problem!

Additional tips

  • Wear headsets at the front desk so those staff members can communicate with at least one person in the clinic. As changes happen, they can be communicated immediately.
  • Engage staff in writing three notes a week to patients. For example: “Good luck on the soccer match!”
  • Also, set up a system for asking for Google reviews.
  • Put the time planned for the patient to leave the chair on the tray cover. This keeps the clinical team focused on getting the patient out as scheduled. Running behind schedule is one of the top reasons patients do not refer to an office.
  • Everyone on the team needs to have an end-of-day to-do list. This list should be turned in to the clinical coordinator or office manager—employees don’t leave until they check off their lists and turn it in. (Read The Checklist Manifesto: How to Get Things Right by Atul Gawande. An excellent book!)
  • Streamline your letter system. The letters posted in the clinic should be clinic-related. The doctor should give the instruction immediately; the letter should be posted and sent to the Q. The doctor should sign off on their letters before the end of day.
  • If you look at the staff as a whole, credible financial advisers recommend taking your total income for the year and dividing it by $200,000. So, if you are projecting to collect $1.4 million, that’s seven full-time staff members (both administrative and clinical, but does not include a lab technician).
  • One way I calculate the suggested number of administrative staff (including treatment coordinator, financial coordinator and front desk staff): For every $35,000 you collect per month, you’ll need one administrative staff member. In our example, $1.4 million per year works out to just under $117,000 per month; dividing that by $35,000 determines that the practice would need 3½ administrative staff positions.
  • In today’s market, it’s important to offer prime time appointments. You also need to be able to schedule production appointments within 10 days. Same-days starts are continuing to gain popularity. Many patients are ready to start right away!

Focus on clinical efficiency—on the number of months and visits needed to get a beautiful smile. Everyone wants to look great in the selfie! The most progressive orthodontists are focused on fewer visits, fewer months, collections per visit, and beautiful outcomes. This is a great way to build patient referrals.

Efficient orthodontists understand that they can actually spend fewer minutes at the chair or in the exam if they compliment their treatment coordinator or assistant as they depart the patient.

I recommend five to seven minutes at the exam, two minutes with the recall patient, and two minutes at a regular adjustment. It does not always go as planned, but we can improve our efficiency by staying focused and having a plan.

Author Bio
Author Charlene White is an internationally renowned orthodontic practice management consultant. White received a bachelor’s degree in dental hygiene from Old Dominion University in 1975 and launched her company, Progressive Concepts, in 1983. Her lectures, consultations, workshops, articles, training products and software module have benefited thousands of orthodontic practices. Information: 757-456-0555 charlenewhite.com
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