The Art of the Appointment
Posted Apr 28, 2011 in Management
Imagine your dentist-clients worked without appointments. Starting at 8am and continuing throughout the day, patients would show up at their offices wanting everything from a crown repair to a full mouth reconstruction. At 5pm - when your clients normally go home - there are still 25 patients in the waiting room that need to be seen. Your clients work feverishly into the evening to finish their caseloads.
Sound like your workday? Appointments are standard in virtually every other industry. Unless a business advertises "walk-ins welcome," we know that if we want a haircut, oil change or need to see a doctor we have to make an appointment - so why isn't this standard practice in our own industry?
"Most people would say that the dentist is to blame, but really, scheduling is the laboratory's responsibility. If we don't take control of our businesses and our workloads, our clients will take control for us," says Tom Moore, CDT. Moore used a pre-scheduling system for six years in his small C&B laboratory which recently merged with Centex Dental Laboratory in Waco, Texas.
The conventional practice of accepting "walk-ins" leads to one of the most chronic production problems in the laboratory - fluctuating workflow. To minimize this dilemma, laboratory owners and managers are using pre-scheduling policies that put them - not the dentist - in the driver's seat.
Here's how it works: The laboratory decides how many units it will fabricate per day and asks the dentist to make an appointment for each case. The client either calls the lab to ask when it can accommodate the case or he sends the case and waits to hear from the laboratory. Based on its pre-determined capacity and current workload, the lab tells the client when the case will be finished.
There is no guaranteed turnaround time, although some laboratories do give their dentist-clients guidelines as to how long it will take to fabricate various types of cases. Once the lab's day is booked, it doesn't accept any more appointments. "I want to work a nine-hour day and produce seven units so that's the maximum I'll schedule each day," says Fred Godwin, owner of three-person Godwin Dental Laboratory in Tallahassee, Florida.
Ideal for smaller laboratories, pre-scheduling is an excellent time management tool. For instance, six- or seven-day workweeks used to be the norm for Maggie and John Harris, owners of Harris Orthodontic Laboratory in Sacramento, California. Now that it pre-schedules its work, the lab fabricates cases Monday through Thursday and saves Fridays for administrative tasks.
Pre-scheduling gives owners and managers like the Harris's more control over their businesses as well as their personal lives. In addition to a more predictable workflow, the list of benefits is long: higher quality, ability to set your own hours and vacations, less overtime, reduced remakes and a greater on-time delivery percentage.
"If you're serious about creating a business you can enjoy for years and that also allows for a personal life, booking cases is a tool for achieving that goal," says Maggie Harris. "It's one of the best things we've done for our lab in 25 years."
How to Pre-Schedule
If you want to implement a pre-scheduling system, the first step is to determine the maximum number of units you can fabricate daily. To find your production comfort zone, Godwin suggests asking yourself the following questions:
- How many units can your laboratory fabricate per day and do well?
- How many units do you have to fabricate to meet overhead?
- Are you charging enough per unit?
Pre-scheduling doesn't eliminate inevitable problems such as cancellations, late cases or remakes that can wreak havoc with your production cycle. So you still may need to juggle your schedule or implement strategies to maintain flexibility.
For instance, Moore opted to schedule his days at 70% capacity to allow for breathing room and maintain the level of customer service he wanted to offer. "If there was a problem or a rush case, we could still service that client without staying up half the night or charging a rush fee," he explains. "Also, you can't ask yourself or your employees to consistently operate at 100% because your quality will ultimately suffer and your employees will burn out."
Godwin uses another strategy to avoid scheduling conflicts. He gives his clients a projected finish date when they call, but doesn't actually schedule his cases until he receives them at the laboratory. This way, cancellations and late cases aren't an issue. He then e-mails his clients with the finish date and asks for a confirmation.
Since some clients prefer to schedule cases months in advance, it's important to implement an efficient tracking system. Harris uses a daily calendar to enter the patient's name, type of appliance and pick up and delivery dates. She also color-codes each case: pick-up dates are highlighted in pink and outgoing dates are indicated in yellow. "All we have to do is look in our book and we can see how many appliances we will be getting on any given day and know the status of each case," she explains. She also sends out a form so the offices can book several cases at once and fax it to the office.
You may also need to encourage your clients to have two laboratories, as do Barbara and Glenn Paul, owners of two-person Palm Beach Prosthetics, Jupiter, Florida. "We're the primary lab and our clients' overflow work needs to go somewhere else. I don't like to give work away, but I also want to see my husband at night," says Barbara Paul. Her unconventional approach isn't hurting her caseload. For example, at the beginning of October, Paul was booked through Thanksgiving.
Get Clients on Board
Skeptics may wonder how dentists will react to the pre-scheduling concept. Laboratory owners who've made the switch admit they experienced some initial resistance. However, once clients understand how pre-scheduling works and why it can simplify their lives, most are happier. Since more cases are delivered on time, it makes their appointment system more efficient. And, since laboratories have more time to spend on each case, quality increases and chairside adjustments and other problems decrease.
Your main objective is to get your clients to try the system. "We explained in a letter that we'd like to try booking our cases and that if it didn't work we'd change back," says Harris. "We also stressed that we may have to make changes along the way to improve the system."
When Moore announced his pre-scheduling system, one of his clients was hesitant because he no longer had a guaranteed turnaround time. To address his concern, Moore attended a staff meeting and detailed the benefits of the system - more cases delivered on time, less re-appointments and higher quality - and how it would work. Once the office began pre-scheduling, says Moore, it never asked about going back.
In fact, once Moore began pre-scheduling, his turnaround time varied from two to five weeks, but he found that his schedule actually became synchronized with the dentist's. "When I was busy and couldn't get a crown back for a few weeks, it wasn't a problem because the dentist couldn't see the patient until then anyway," says Moore.
The key is stick to your guns. If a client flatly refuses to try pre-scheduling and you feel it's vital to your business, you must decide if the client is worth keeping. For instance, though Paul lost a very large account once she announced her new system, she didn't waiver from her decision. "We worked with him for 10 years, but he decided that he didn't like it because we couldn't always accommodate his due date," says Paul. "He said 'no, I want to have it when I want it' and, since he wasn't willing to cooperate, we said goodbye."
Just because your dentist-client is on board, doesn't mean his office staff - who will actually do the work - will be. In the beginning, be prepared to constantly remind office staff about your system, especially if the client works with other labs that don't offer pre-scheduling. "In order for pre-scheduling to work, you have to have people in the office who understand what they're scheduling. Turnover in our clients' offices is high, so we're constantly retraining on how to pre-schedule," says Chris Cozzolino, client relations manager at Functional Esthetics in Lewisville, Texas.
Cozzolino recommends encouraging one person in the client's office to be in charge of pre-scheduling. This simplifies the training process and also minimizes the chances of booking the same patient twice. The lab trains that person on what information it needs to know when pre-scheduling the case, like the patient's name, type of restoration, number of units, whether there will be a custom shade or try-in, etc. It also provides a case pre-scheduling sheet asking for all of the pertinent details so the person can compile the information before calling it in.
Pre-scheduling is a two-way street that requires a commitment from both the laboratory and its clients. If you expect your clients to get their cases in on time, be prepared to get it out by the due date. "If any complications arise, you're stuck to that date," says Mike Fortuna, owner of 22-employee Hershberger Dental Laboratory in Glendale, Arizona. "You have to do whatever it takes to finish the case and get it out on schedule."
For Godwin, the dual commitment has resulted in an increased feeling of mutual respect and teamwork between his laboratory and his clients. "Now, our clients work with us instead of throwing work at us."
Spotlight on laboratory workflow
There are a number of ways to track and monitor workflow and production. Following are basic strategies you can implement in your lab:
Color-coded case pans are perhaps the most common way to track cases. At a glance, case pans--color-coded by type of restoration—tell you when something is not in the right department and helps you locate a particular case more quickly.
Pinpointing bottlenecks. To meet its goal of shaving two to three days off its production schedule, CQC Prosthodontics in Rochester, New York is reevaluating its entire manufacturing process. One discovery: work was backing up in its porcelain department. The problem: cases were worked on in the order they came in, not in order they needed to go out. "Now cases are worked on according to due dates and it has sped things up tremendously," says Ernest Schmidt, CDT, who heads the lab's ceramics department and training.
Implementing strategies to predict caseload fluctuations. CQC also knows when to gear up for busy times based on year-to-date and year-to-year tracking reports generated by its accounting software. If the laboratory is headed toward a historically busy time of year, it knows that employees must be careful about taking time off. In addition, the lab can give its staff prior notice that overtime may be necessary.
Computerized tracking and scheduling software. To manage large caseloads, your laboratory may need a computerized production scheduling system—as well as an employee or staff solely dedicated to managing it. For example, at Galsky Dental Lab in Boynton Beach, Florida, each case is entered into a computer. The required fabrication time for each type of restoration has been preprogrammed, so as the receipt and due dates are entered, the software automatically schedules each production step.
Bar coding. This electronic case tracking system follows a case as it travels throughout the laboratory. For example, as each technician completes his work on a case, he uses a hand-held wand to scan a work ticket with a bar code, indicating that his step is complete. "Our bar-coding system allows us to look at any case at any given time in the lab, know where it is and whether or not it's on schedule," says Bob Edmonds, owner, Edmonds Dental Prosthetics, Springfield, Missouri.
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