PRODUCTIVITY – Creatively Scheduling Observation Patients to Smooth Out the Peaks and Valleys in Your Practice

COVID-19 has disrupted all of our practices. There were weeks (or possibly months) in which New Patients, Observation patients and Starts were curtailed.  And now we’re trying to establish a new practice equilibrium by rethinking “how we’ve always done things”.

This year, we’ve played catch up, rescheduling Observation and New Patients in an effort to provide a needed infusion to our production.  But unless we were careful, we may have created an Observation bubble 6-12 months from now as they return for reevaluation. As a result, that steady flow of Observation patients leading to Starts may cause high demand and low demand months next year.

For some us in the past, the fall months came as a blessed relief from the summer rush of patients dying to start treatment.  For others, it was depressing time.  New patients seem to dry up and we began to worry that it was OUR practice that was dying.

For many years, I rode this roller coaster too.

To make matters worse, nearly half of our starts at the time were coming from the observation pool.  And since we weren’t managing that well, they too peaked in the summer, doubling the pressure on the summer schedule.

I wondered; wouldn’t it be nice if we could have a steady stream of Starts all year long?  If we could figure this out, gone would be the summers with too many patients and other months with too few.  There had to be a better way!

After dealing with this problem for several years, I had had enough!  So, my Treatment Coordinator and I met and decided on two objectives for this new “system”.

We wanted:

1. To even out her schedule by having the same number of Observation patients each month, and
2. To even out our Starts by filling our “down” months with observation patients who were ready for treatment.

The New Observation System

Here’s what we came up with:

In general, we scheduled observations patient out anywhere from 6 - 12 months depending on their dental development

6 months – for those with special concerns (ectopic canines, delayed loss of a primary, etc.) or for patients who were close to being ready.

9 months – for those on routine recall – not too long that they lost touch with the office and not so short as to appear as if we were “watching the grass grow”.

12 months – for the quiescent period in the middle-mixed dentition (1.5-2.0 years duration) in which no primary teeth were exfoliating.

1. We created two types of observation appointments. We called them “OBS” and “OBS-READY”. Any observation patient who looked as if they’d be ready for treatment at the next visit would be scheduled for an “OBS-READY” and would appear on the day sheet as such.  That way we could be prepared to take records that day after discussing them in the morning huddle.

2. Looking at our past practice history, we identified those months in which Starts were “down”. Depending on the stage of your practice, that may be September, December and April/May.  (A little tip – bring the late spring OBS-READY patients back in April not May.  Otherwise, the parents will say, “Let’s just wait till summer”.)

3. At the beginning of each month, the Treatment Coordinator would print the number of Observations due or scheduled for the coming 12 months. We then identified which of the “normal” months had too many or too few Observation patients.  (At the time, we were managing 85-90 recall patients per month and they were bunching up on some months.  Parents were complaining that we didn’t have any appointment slots available when “Dr. Steedle wanted to see her”.)

4. During the month, we would:

• Intentionally recall our “OBS-READY” patients one month prior to our pre-determined “down” Starts months. That would sometimes mean that I would suggest an “odd” recall schedule like, “He’ll be ready in about 7 months, so let’s bring him back in April.”

• Schedule the “OBS” patients to even out the number of patients for the “normal” and summer months. 

It took about one year for the system to “kick in”, but it worked.  As things smoothed out, we were able to maintain a fairly stable flow of patient Starts throughout the year and a consistent monthly schedule for the Treatment Coordinator. 

A Way to Implement the System

This fall and winter, you can apply the same system to 2021. 

1. Start by printing the number of Observations due or scheduled for the coming 12 months.

2. Create two types of recall appointments: OBS & OBS-READY (If you schedule Observations in the bay, you may wish to consider scheduling OBS-READY in the TC room)

3. Change your “routine” way of scheduling Observation appointments to even out the schedule by assigning them to months to eliminate any Observation bubble next year.

4. On the first day of each month, ask the TC to repeat the process.

5. This fall & winter concentrate the OBS-READY to March or April to increase the Starts prior to the summer rush.

Once I implemented this system, I discovered that I could finally sleep a whole lot better during EVERY month of the year, knowing that I had smoothed out the peaks and valleys in my practice.  Hopefully, you can do the same and avoid some of the “unintended consequences” of the COVID-19 disruption.