If you’re running a dental office and you don’t believe you need to have morning huddles, then you’re an idiot!
If your office is not huddling then please do this for me. Take out your wallet, pull out all your Ben Franklins or John Monashs, hold firmly in both hands, then proceed to tear them up and throw them in the bin.
Failure to huddle is failure to plan. It’s failure to work with efficiency, in the first instance, and there are many advantages and no disadvantages.
A well-prepared team can huddle in five to ten minutes flat! Easy! And the amount of time it can save, by adequately forward planning, well that’s a no-brainer!!
Here’s how we morning huddle at Active Dental.
The huddle looks at
Each patient being seen this day, by both dentists and hygienists
Who are they?
When were they last in to see us?
How long have they been a patient of the practice?
What treatment they are having done?
Any special comforts/styles that they like/prefer during treatment?
Any flags, medical or otherwise, that we need to share?
Any specialists/referring doctors letters?
Is any lab/equipment needed and has it arrived?
What follow on is required for this patient
Is there any Secret Service we can share about this patient?
Any F.O.R.D. that may be useful information to know in advance?
Family
Occupation
Recreation
Desires/Dreams
Does the appointment book look balanced and well structured for a comfortable day for all patients and team members?
If yes, then congratulate and admire
Ask, has the template been followed?
Do we see any clashes with patients or procedures being put into less than optimal positioning?
If so, how can we handle the situation?
What are the likely scenarios that will occur as a result of this?
How can they be best managed?
How can we improve on this for next time?
Where are our opportunities to schedule patients that may call requiring same day appointments?
How does tomorrow’s appointment book look? And the rest of the week and next week?
Will anyone we see today be requiring/be suitable for an appointment tomorrow or in the next couple of weeks?
Are there any financial matters that need attention?
The purpose of the huddle is for each team member to know and understand fully how their day will pan out, who is in, and what needs to be done.
The huddle prevents that “Now who’s next and what are we doing for them today?” look.
A well-huddled dental office works more efficiently. Period.
This then reflects with
Happier patients who feel wanted, and respected. Patients will appreciate that you are prepared for them. Similarly, patients will also recognize when you are unprepared for them.
Happier team that knows in advance what’s going on.
A smoother day creating less stress for doctors and team
A more productive day, [meaning happier doctor]
Morning huddles are easy to do. They are also easy *NOT* to do. The difference, to a dental office, in terms of profitability and efficiency and harmony, is staggering.
I urge you, you *MUST* huddle! Daily morning huddle! Just DO IT!
“How to Structure and Organise the Best Morning Huddles” is just one of the many straight forward protocols and procedures that make up The Ultimate Patient Experience, a simple easy to implement system I developed that allowed me to build an extraordinary dental office in an ordinary Sydney suburb. If you’d like to know more, ask me about my free special report. Email me at david@theupe.com
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How your office let’s you know or announces the arrival of the next patient for doctors and hygienists creates a huge opportunity for you to positively “advertise” your dental practice’s culture.
Similarly, the protocol you use now, or lack of protocol, may be a severe *service defect* in your office armamentarium that is turning off your patients….and you may not even be aware that you’re doing it…
Confused?
Let me tell you how simple it is to turn this situation around and to make it *work* for you in your dental practice, and immediately add “coin” to your dental practice’s image.
You see, this present day and age of computers and networked treatment room workstations has allowed us very easily to become “over-automated” and to lose the personal touch. And heaven knows…we know that as consumers we are all screaming out for that “personal” attention, aren’t we?
We’ve seen that in the grocery store. You race in; you just want to buy a newspaper for say $2.00. You have the cash in one hand, the newspaper in the other hand…but no…. they need to scan it, or they need to key in several or many keystrokes and buttons before you are permitted to exchange your cash for the paper.
Similarly in dentistry the personal touch can easily be diminished because of something that our whiz-bang computer system allows us to do….to the detriment of common courtesy. Let me explain.
I’ve been visiting a few dental offices where their dental software, networked to all treatment rooms, allows front desk, via the software, to alert the treatment room that a patient has arrived for their appointment. Wonderful tool! Or is it?
I’ve got to say I am not a big fan of this facility. Where did it come from? Who invented it? The post office?
I find the use of this feature, and I use the word “feature” in the loosest possible terms, to be one of the most impersonal modalities available to the dental office. Let me explain.
I’ve been visiting one dental office where the treatment room is set up very, how would you say, un-ergonomically. The P.C. for that room sits directly behind the doc, at 12:00 o’clock [to the patient]. The doc, sitting at 11:00 o’clock, has his back to the monitor. The dental assistant, sitting at 3:00 or 4:00 o’clock, has full view of the screen. Now in this office, when the next patient arrives, the front office staff enters it into their terminal and a small icon appears throughout the network to herald that arrival.
Down in the treatment room, the dental assistant, sitting with one eye on the patient and one eye on the monitor, announces proudly to the doc, “your next one’s here”….
And there lies the *epic fail*..
Ask yourself this, having reviewed this scenario; ask yourself, how is this scenario a win for the office?
Let’s run through it step by step, starting in the treatment room.
Firstly, having the DA watching the monitor for the updates distracts her from her primary and what should be her singular purpose at that time which is to be 100% present for the doctor and for the patient. Nothing else. Her primary purpose at this time is to make the doctor’s life easier, and the patient’s visit more comfortable. To me, a clock watching DA is just marking time….
Secondly, her choice of words, in this case, “your next one’s here”? Who chose those? What sort of message does this send to the patient in the chair? Is the patient in the chair feeling like a person, or a number? After all, this terminology implies that the patient being treated was previously heralded as just another “next one”…
Thirdly, the message received by the doctor is taken by him as “you better hurry up….” , in its politest version. Funnily, in this particular office, the announcement by the DA never informs the doc as to how early the “next one” has arrived…
To me this announcement also serves as an alarming distraction to the doctor. It doesn’t tell him who the next patient is, nor does it give him a hint of what he is doing for that next patient. The poor old doc, who has been diligently concentrating on securing that distal proximal box isolation with his matrix band, now has his mind physically torn from that concentration. He asks himself, “who is my *next* one? What am I doing for her? And how long have we got here? Are they early? Will it matter if I run a little over here? Can I alert my *next one* that I am running slightly behind?”…. And so it goes…
So how would you improve on this?
Here’s the procedure we developed over time during my many years at Active Dental Parramatta.
Firstly, we don’t use the computer network for this function. We probably could, but we don’t. We do it manually, and the whole procedure usually takes only 60-90 seconds, and that’s because we have a long corridor or hallway between some treatment rooms and the front office reception area.
Secondly, our treatment rooms are set up with the P.C.s on the doctor’s side, away from the DA. The doc can see the monitor at a sideways glance, for checking charts, radiographs, etc. easily.
Thirdly, the process of someone from the front walking to the back office to announce the patient arrival is far more personable for both the arriving patient as well as the treatment team in the dental office. Here’s why.
The arriving patient is made to feel important by the front office person saying something like “I’ll go and let Dr Moffet know that you’ve arrived”. Nothing more. This is far more pleasant to the arriving patient than seeing someone press a button on a computer, or worse, ring or ding a bell so someone comes running.
The process of going and announcing also allows the front office person to return from the back with information for the arriving patient. They can say things like:
“Dr Moffet said to say hi and to ask you how your trip was…”
“Dr Moffet said hello and also thank you for coming in early/bringing your appointment forward a couple of days…..”
“Dr Moffet said he’s running a little bit behind due to an earlier emergency. He was wondering whether that’s OK with you? Can I get you a tea?”
“Dr Moffet said to say hello and welcome to Active Dental Mr. New Patient. He’s looking forward to meeting you shortly…”
The opportunity to return to the arriving patient with feedback from the back is a great *winner* for the dental office.
Down in the treatment room the arrival of the next patient is announced in the following way:
The front office person enters the treatment room, gauging firstly, when it is OK to speak. Usually, most of the time, they are entering in a non-verbal moment while actual treatment is being performed. However, if there is a conversation or instruction going on between the Doctor and the patient being treated, then the front office person waits for the doc to “invite” them to speak.
The front office person then speaks in a very carefully crafted script. No deviations.
They say, “Excuse me Dr Moffet…[followed by a short pause of one or two seconds only]…just to let you know that Mrs. Betty Smith has arrived for her 9:30 appointment with you”.
Or “Excuse me Dr Moffet…[followed by a short pause of one or two seconds only]..just to let you know that Mr. John Brown has arrived for his 10:00am hygiene appointment with Stacey”.
The pause is very important. It allows the doctor to disengage his visual concentration from what he is doing for the patient and switch his mind to auditory to receive the arrival information. The pause is not for a reply from the doc. He does not need to speak.
The words “Excuse me Dr Moffet” soften the interruption for the treating patient. They promote politeness and an atmosphere of courtesy within the dental office to the patient being treated.
The word “just” and I am not a big fan of the word “just” because it is a redundant word, does have a softening application here, and is very important in softening the interruption to the patient being treated.
The next appointment is clearly identified. The Doc has already huddled for the day, so he knows what he’s going to be doing. Down here we use both the first and last name for the patient, so as there is no confusion as to which patient is here…you see we once had two patents called Russell have sequential hygiene appointments. [I know there may be some privacy issues about this where you work? However, we found that the advantages and benefits of using both names far outweighs the inconvenience and confusion that results from not using both names.]
The patients appointment is then yellow highlighted on a paper copy of the day’s appointment book which is attached discretely to a wall or cupboard behind and beside the treating patient. [More on the benefit of this in a future blog…]
Following this announcement, the Doctor then speaks with a “thank you Jayne” or something courteous. Again, promoting that atmosphere of politeness within the office, sending that message to the patient being treated. If appropriate, the doc can also add a personal comment to Jayne, like “Oh great, can you ask her please how her daughter’s wedding was?” Again, to the patient being treated, this creates an air or atmosphere of friendliness and engagement. More importantly, compared to the earlier scenario, the treated patient at no time feels that they are a “next one”, or a number.
It takes time and practice to develop these sorts of protocols and procedures that subliminally and indirectly send messages of goodwill to your patients. But the time taken is worth it. It builds credibility and notoriety that your dental office cares, and is different.
This is just one of the many straight forward protocols and procedures that make up The Ultimate Patient Experience, a simple easy to implement system I developed that allowed me to build an extraordinary dental office in an ordinary Sydney suburb. If you’d like to know more, ask me about my free special report.
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I am constantly surprised when I visit dental offices at how much inappropriate use of time I see.
Some dentists either don’t know, don’t see or just don’t care about the amount of time, usually their time, being wasted because of poor decisions made in the office and poor explanations and poor instructions given.
Consider this list of tasks in the dental treatment room and what hourly rate you are paying for these to be performed. Remember, if a DA can do it, and perform it prior to the patient entering the room, it is far more economical than having it done by the dentist while the patient is in the treatment room.
Filling out forms
Getting boxes
Putting matrix bands together
Assembling and getting out impression materials
Unassembled discs and mandrels
Things being kept in drawers that should be out. E.g. Cotton rolls, pads, etc
Restricted access to things that should be at fingertips.
Items needed during treatment being kept in non-treatment areas, like a storage cupboard or a steri area…
DAs not doing DA stuff, e.g. docs doing stuff DAs can do, and should be doing, while the DA sits doing nothing. E.g., like loading trays with alginate, or mixing alginate….
Etc. etc.
Lets look at the numbers.
A dentist can work on anything from $400.00 to over $1000.00 per hour. For this equation/example lets use $600.00 as a base. From that let’s say that 60% is going to pay the expenses of the practice…$360.00 per hour [see previous blog http://wp.me/p2c8zv-G ]
So, expanding on from this point, when the dentist is performing procedures that only he can do in the office, like drilling teeth, etc….he is earning $360.00 per hour for the office.
And every time he stops doing this, the income to run the office stops as well.
So in my travels, I often see dental offices where the dentist stops or ceases production and waits for a DA to get something that she should have had ready in advance.
Or he waits while the DA does something that she could be doing after the patient has departed.
Or worse still, the dentist performs a duty that the DA could have, or should have performed prior to the patient arriving, or worse still, performed after the departure of the patient.
In all three situations, the dentist stops working for $600.00 per hour and watches someone on $20.00-25.00 per hour interrupt the cash flow of the dental practice…this is a huge *NO! NO! *
The easiest way to fix this anomaly is to analyse all parts of each and every dental procedure process. Work out if each and every step or stage in each and every procedure is doctor time, nurse time or patient time.
Make sure you know the difference! Anything that is nurse time that is not being done is robbing the practice of vital income dollars. It also is robbing the patient of their valuable time, because it makes the appointments take longer to do. This is really a waste of patient time. It is an insult to your patients. They are paying for you to be ready to treat them, and to do it in an efficient systemized manner. If you don’t look efficient, you look inefficient, slapstick, and uncoordinated.
How do you think your office procedures stack up in terms of time efficiency? Do you think your patients see you as efficient?
If you believe you have room for improvement, it will improve your efficiency and improve your business cash flow. There will also be a flow on effect of patients accepting and booking more treatment, and referring more patients, because you look and feel [to them] more professional and efficient.
This is easy to do and implement.
Just remember, remember this…the doctor’s time is sacrosanct!
It should be well-structured, high priority, and always preserved. It should never be interrupted!
Anything that is not exclusive to the doctor should be performed by other team members. And not at the expense or interruption of doctor time.
Following these principles will have significant positive flow on effects for your dental office!
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The thing about common courtesy, like common sense, is that it’s just NOT that common.
What you and I see as good manners and courtesy, others see as an effort, and often see as too much effort.
Remember that in previous blogs I have said all people, be they patients, customers or employees, and even ourselves, we all wear an invisible sign on our heads that reads “Make Me Feel Important!”
I also mentioned in another previous blog that two dental team members should never pass in a dental office corridor without a smile and verbal acknowledgement of each other. For a patient or customer to see “stony silence” happen is a kiss of death for your practice. When a customer experiences and witnesses a positive exchange, well that is uplifting and it adds “coin” to your practice. It raises the value that your customer sees within your office.
In a similar manner, I think all offices need to have a strict policy on morning greetings and afternoon farewells.
At my dental practice in Parramatta, we created specific policy to cover clearly the behaviours of team members who worked shorter time frames than the extended office hours.
We did this firstly, to cover morning situations, where a team member starts later than the opening time of the office. It was invented to overcome the awkward moment when the treated patient goes out to check out of the practice and encounters a different face that was not present an hour before when they arrived. We did it to eliminate the “Well who are you?” look from the patient and that “well you weren’t here when I arrived” comments.
So we asked all team members who enjoyed the later starting hours to do this: Upon arrival, the first thing they need to do is to visit all operatories and offices and say good morning. This involves a greeting to the doctor, the dental assistant and also, the patient in the chair.
And guess what? We found that this created many additional immediate benefits for our office.
Firstly, it raised the “friendly tone” of the office. It raised the friendly tone for all of us who worked there, but also, it raised the friendly tone in the eyes of the patients receiving treatment during the greetings. How nice is it to hear people pleasantly greeting each other?
It was important that the later starting team member also entered the treatment room rather than call from the door, or worse still call from a drive-by as they hurried down the hallway. Patients loved being recognized, too.
Secondly, it gave opportunity for the dentist to introduce the team member, if needed, to the treating patient, after they had left the room. This again created an added friendliness within the office, allowing the doc to say something like “that’s Betty, Mrs. Smith. She’s just joined our office from such and such, and she’s worked in dental for six years. She’s a great addition to our team.”
It also allows the doc to pass on any thoughts to the later starting person, that he may need to share, but is busy doing treatment…for example he might say “Good morning Betty, how are you? Can I ask you to do something for me please/ can I ask you to get Andrea for me please?….”
The counter to this is when a treatment room, with patient and staff and doctor, hears a number of other team members late arriving and walking and chatting down the hall. This image to me presents a missed opportunity to build rapport and brand..
We also implemented the same principles of friendly greeting when some team members leave before others. Having team members farewell other team members, and patients still in treatment, was another great opportunity to build rapport, build brand, and create an environment of friendly.
Again, it also gave an opportunity to spread nice stories about that team member. Doctor could say to the patient in treatment, something like “ Oh that’s Dr Smith our new assistant dentist. He’s great with children and the other patients of the practice really like him…..etc.”
[We also developed a protocol for passing on information in treatment rooms on when the doctor was required for hygiene checks, and also for letting the doctor know when patients arrive for their appointments…more on those in future blogs.]
The thing about the announced arrival and departure of team members in the practice is that it’s easy to do, and builds instant results…it is so nice for patients and team members to hear friendliness as opposed to hearing nothing, or even apathy…it does wonders for morale and it does wonders for your office image!
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Most dental offices out there are one dentist shows. So if you don’t employ an associate dentist you may not be interested in this blog. If so, you have my permission to skip it…
You see, the Assistant Dentist role,
[or known as the Associate Dentist]
as I see it, is an interesting position in a Dental Office. It offers the following question?
Where in the Practice/Office hierarchy does the Assistant Dentist get positioned?
This question could take months of intense debate to answer and there are multi-factorial contributions into the equation.
The reason for this posting is simply: “I don’t know the answer”, and “It depends…”. So I’m seeking your advice, dear readers…
You see, there are some dentists I know well who have moved on from Dental Office Ownership, and are now enjoying the change of life role of being a dentist in a dental office owned by someone else. However, this role of “mature-age associate dentist” is completely different to the role of “recent graduate assistant dentist” which many of us have experienced, both as young doctors and as dental practice owners. One of my buddies is doing locums. Sometimes as the replacement dentist, sometimes as an assistant dentist…that’s an interesting caper. Another friend of mine is working as an assistant dentist in a “partnership of sorts” for a deceased estate. And a third dentist I know has joined a multi-dental office as the fifth dentist.
Now most dental offices out there are one man shows. That’s a fact! Or one doctor shows [political correctness]. Those that are more, are often, what I would loosely call “partnerships”, where the various dentists through some contractual arrangement have a share in some expenses, such as rent, utilities, office staff etc.…
And then there’s those with the associate dentist, and with that, comes the question of relationship, and is it master-servant? Or what is it?
This is a really tough question, and I guess it really does boil down to the ages, and experiences, of the owner dentist and the non-owner dentist, as well as the future expectations of both….
You see the relationship of an “old-bull young-bull” mentorship type position for a recently graduated dentist coming in to an established practice is very different to another old-bull being hired into an established practice, or an established practice employing an associate dentist for a long employment term….
But I digress…
Anyway, recently a mature age dentist that I know well took on a position of assistant dentist in an office, and here’s his question. Sadly, I kind of don’t quite have an answer for him, but I’m sure with time, an answer will arise…
His question to me is: Where in the office does he stand when it comes to:
1. Other team members, i.e. other younger dentists, younger dental assistants and office staff that have been there some time, and hygienists, long term and short term… and
2. Dental supplies and materials. Those he needs and those he sees being used, let’s say uneconomically, and
3. Working out times working and time off from his position. Asking for holidays, seminar breaks etc.…
Tough questions and tough answers, from both sides of the fence..
I guess we’ve all been recently graduated docs, “young-bulls” so to speak,….where we’ve had to fit in into old established practices, often with older, established D.A.s. But what about the long-term assistant dentist? Where would he fit in. Also, what about the newly liberated former practice owner…like my friend, what would be your recommendation for him?
You see, my friend had a situation recently where his dental chairside assistant had to duck out of the office mid afternoon to go to do something important. Trouble was, my friend the associate dentist was the last in the office to know this, or the last to find out, and had to work out who in the practice he needed to speak to ensure that if this situation arose again, that the process would be seamless next time instead of “awkward”. You see, back in his previous life as a practice owner, my friend would have found out in advance, and made contingency plans. If he had had it sprung on him in his old practice, then simply, he would have then dealt with it directly after the fact.
Now as an associate dentist, he had a small dilemma. Where does he go/who does he go to to correct this behavior/report this occurrence so that it gets dealt with appropriately and doesn’t happen again?
Have you been in this situation, or seen this situation in your office? It’s interesting, because there are times as a dental office owner, when the assistant/associate dentist ducks out/has a day off/week off without asking telling the owner as well….
What would you do? Where is the court, or the hearing, and who is the judge? Does he go to the principal dentist/owner? Does he go to the senior practice manager? Does he address the concern himself?
It’s a tough one…. I welcome your thoughts…
Anyway, as an aside, in conclusion, I’d like to say this….my friend says that he’s thoroughly enjoying his change of life situation of being an associate dentist rather than a dental office owner. He’s absolutely loving it! Enjoying the separation of roles. I guess part of that is that as an experienced dentist, he feels he’s been able to add value, and immediate value, to the production of the practice. And he’s loving the change of life, in that at the end of the day he can just hang up his drill and not have to do all the admin, H.R., bill paying…he loves that….and that, is a topic for future blogs…that’s for sure!!
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