The Schedule Is the Practice
Today's episode revolves around a critical yet often overlooked metric for dental practice owners: the cost of an open chair. This expense, although invisible in conventional financial statements, can significantly impact the overall profitability of a practice.
In this episode, we look at:
- The cost of an open chair in a dental practice can lead to significant lost revenue.
- Practices must calculate their daily production goals to effectively manage scheduling and productivity.
- Block scheduling is essential for optimizing a dental practice's operational efficiency and maximizing production.
- Effective appointment scheduling requires a proactive approach, ensuring patients leave with their next appointment booked.
- Managing broken appointments is critical, as they directly impact a practice's profitability and resource utilization.
- The hygiene department plays a crucial role in driving overall practice production through effective patient engagement.
Looking to learn more about our coaching program or just about KLAS Solutions? Learn more at:
- klassolutions.com -or-
- klasdentalcoaching.com
Transcript
There's a number that most practice owners never calculate, and it is quietly costing them more than anything else in the building.
Speaker A:It's the cost of an open chair.
Speaker A:Here's the math in its simplest form.
Speaker A:Say a chair should produce $400 an hour, and that's bare minimum.
Speaker A:You lose one hour a day.
Speaker A:You work four days a week, 46 weeks a year.
Speaker A:That is 184 lost hours and $73,600 that will never come in the door.
Speaker A:It's not from bad dentistry, it's not from bad luck, not from a soft economy or a tough insurance market that we hear all the time from an empty schedule.
Speaker A:The reason almost nobody sees that number is that it never appears anywhere.
Speaker A:There's no line on your profit and loss statement called money we did not take or make.
Speaker A:The chair sits empty.
Speaker A:Somebody takes an early lunch, the day ends and nothing gets written down.
Speaker A:The loss is real, it's repeatable, and it is invisible.
Speaker A:Today we're going to make it visible, and then we're going to talk about how to build a schedule that stops or stops producing it.
Speaker A:This is the Dental Business Podcast.
Speaker A:I am Phil Cole.
Speaker A:Last episode, if you remember, we talked through the eight numbers that run your practice.
Speaker A:Today, we go deep on the one that touches almost all of them at once.
Speaker A:And that's your schedule.
Speaker A:This is an operations episode.
Speaker A:No theory, no philosophy about culture and vision.
Speaker A:We're going to talk about how a day gets built, how much an empty chair actually costs you, how block scheduling works when it is done correctly, why appointments break and what to do about it, and which numbers tell you whether any of this is working.
Speaker A:So grab something to write with, because there are going to be four or five places where you're going to want to write down your own numbers.
Speaker A:The Dental Business podcast is brought to you by Class Solutions One team.
Speaker A:Five divisions aligned around your practice.
Speaker A:You can learn more@classsolutions.com so let's go with part one.
Speaker A:And that, to me, is the schedule is a production plan.
Speaker A:Most practices treat the schedule like a calendar.
Speaker A:Just fill in the slots, take what comes, hope it all adds up at the end of the month.
Speaker A:And that, to me, is just backwards.
Speaker A:And it is the root of almost every scheduling problem I see.
Speaker A:The schedule is not a calendar.
Speaker A:It's a production plan.
Speaker A:You start with the number you need to produce that day, and then you build that day to hit it.
Speaker A:So let's start where the plan starts, with the daily production goal.
Speaker A:And if I want to be specific about how that Number gets set because most practices either guess at it or they copy a number that they've heard at the local study club dental society.
Speaker A:Work backward from the year.
Speaker A:Take your annual production target, not last year plus a hopeful percentages you're going to throw on there, but the number that actually you need built from the overhead from your debt services, your own compensation and whatever growth you are funding.
Speaker A:This we always call is it should be based off your break even point.
Speaker A:Divide that by the number of clinical days you will genuinely work.
Speaker A:Not 260 will take out the holidays, but continuing education vacation and the days that you already know that you're going to be closed.
Speaker A:Most general practices land somewhere between 160 and 190 real clinical days.
Speaker A: our daily production goal is $: Speaker A: So let's just call it: Speaker A:That is your number.
Speaker A:Now split that by column.
Speaker A:Because if hygiene should be carrying somewhere around a quarter to a third of the total production in a healthy general practice, then roughly 2,000 of that 6,700 belongs to the hygiene column and the rest belongs to the doctor column.
Speaker A:Now you have two goals and each column knows what it owes that day.
Speaker A:That number is not hope.
Speaker A:As we always say at class, strategy is not a hope.
Speaker A:Or I'm sorry, hope is not a strategy.
Speaker A:It is the target.
Speaker A:The entire day is designed around every block on that schedule.
Speaker A:Either moves you towards it or it doesn't.
Speaker A:And if it does not, well, there needs to be a reason it is sitting there.
Speaker A:Here's what changes when a front desk understands they are scheduling to a goal instead of filling holes, they stop saying we have an opening Tuesday at 2.
Speaker A:Instead they start saying the doctor has time Tuesday and we want to get that crown seated.
Speaker A:So does two o' clock work for you?
Speaker A:Same slot on the same day, but completely different practices.
Speaker A:One is passive.
Speaker A:It presents a hole and waits to see if the patient wants it.
Speaker A:The other is directed.
Speaker A:It presents a piece of care and offers a time to get it done.
Speaker A:Patients respond to the second one because the second one sounds like a plan for their health instead of a gap that you're just trying to fill.
Speaker A:The second part is open chair and what it actually costs.
Speaker A:Before we talk about protecting the schedule, you need to know what you are protecting.
Speaker A:So let's put a real dollar figure on open chair time in your practice.
Speaker A:This takes about four minutes and you can do it today.
Speaker A:First figure out what an hour in each chair should produce.
Speaker A:Take your daily production goal for a column and divide it by the number of clinical hours in that column.
Speaker A:If the doctor column owes $4,700 and the doctor works eight clinical hours, that is roughly $585 an hour.
Speaker A:If the hygiene owes 2,000 across eight hours in one hygiene chair, that is 250 an hour.
Speaker A:Those are your hourly values.
Speaker A:So now write them down.
Speaker A:Second, count your open hours.
Speaker A:Not the hours that you felt busy.
Speaker A:The actual unit unfilled, I'm sorry and unproductive.
Speaker A:Chair time.
Speaker A:Pull last month and count the holes.
Speaker A:Cancellations that never got filled, no shows.
Speaker A:Blocks that opened up at 10 in the morning and stayed open the Friday afternoon that never got booked.
Speaker A:Add them up by column now.
Speaker A:Third, multiply open hour times hourly value.
Speaker A:That is your number.
Speaker A:Then multiply it by 12.
Speaker A:When practices run this exercise for the first time, the number is Almost somewhere between 50,000 and a quarter million dollars a year.
Speaker A:And it's not a soft number.
Speaker A:That is capacity you already paid for.
Speaker A:You paid the rent on that room, you paid the team member standing next to the chair, and you paid the loan for that equipment that's inside of it.
Speaker A:The overhead ran whether the chair was full or not.
Speaker A:That is why open chair time is the most expensive problem in a practice.
Speaker A:Almost every other fix costs you something.
Speaker A:Adding a new service costs training and equipment.
Speaker A:Adding new patients, well, it's going to cost you marketing dollars.
Speaker A:Filling an empty chair you already are paying for, well, that costs you nothing but just better systems.
Speaker A:The margin on the recovered chair time to close is pure.
Speaker A:And I want you to keep that per hour number in your head for the rest of this episode.
Speaker A:Because every decision that follows should be measured against it.
Speaker A:When somebody on your team makes a scheduling choice, they are moving $500 increments around.
Speaker A:They usually don't know that though.
Speaker A:Once they do well, they start making different choices.
Speaker A:Let's look at the third part three.
Speaker A:And that's block scheduling and doing it correctly.
Speaker A:And that tool that makes that plan work, as I said, is block scheduling.
Speaker A:The concept is simple.
Speaker A:You decide in advance how much of each day is reserved for high production procedures and how much is reserved for everything else.
Speaker A:And then you hold to these blocks.
Speaker A:Here is the mistake I see constantly.
Speaker A:A patient calls Monday morning wanting cleaning for hygiene.
Speaker A:Or let's just say, you know, a denture readjustment.
Speaker A:The front desk drops them into two o' clock slot where you're holding that for a crown seat.
Speaker A:Because the slot was open and the patient was on the phone and it felt like you were giving them good service.
Speaker A:Then the crown comes in.
Speaker A:A crown case comes in and there's nowhere to put it.
Speaker A:So it goes out three weeks.
Speaker A:And a meaningful share of cases that go out three weeks, well, we know never happen at all because life gets in the way.
Speaker A:Maybe the tooth stops hurting and now the patient has the opportunity to reconsider.
Speaker A:You traded $585 block for a $250 block or less even, and you never felt it because both slots got filled and well, the day looked busy.
Speaker A:But busy is not the same as productive.
Speaker A:That is the whole lesson.
Speaker A:Block scheduling protects you from that.
Speaker A:Let me walk you through how to build it.
Speaker A:Start with how many high production blocks a day need to hit the goal.
Speaker A:If the Dr.
Speaker A:Column owes $4,700 and your average major case produce, let's say around 1,400, you need roughly three of those blocks a day, not two and not six.
Speaker A:Three.
Speaker A:That's the answer to how many blocks you build.
Speaker A:Then place them where they belong.
Speaker A:In most practices you should anchor the largest cases early, first thing in the morning and the first slot after lunch.
Speaker A:That is when the doctor is usually the sharpest, when the room is all set and when running late problems has the least amount of ripple effect.
Speaker A:Long cases at four in the afternoon are basically how teams end up staying until 6:30 and start quietly resenting the schedule.
Speaker A:Then fill the rest of the day around them.
Speaker A:Shorter procedures, emergencies, new patient exams and the work that is valuable.
Speaker A:But it doesn't need that anchor slot.
Speaker A:Then set a release time and this is the part practices skip.
Speaker A:A block is not held forever.
Speaker A:You decide in advance if a Tuesday major block that is not filled by the end of, let's say the day Friday.
Speaker A:Well, it's then releases and becomes available for anything 48 to 72 hours out.
Speaker A:It's usually the common rule that release valve is what keeps block scheduling from turning into empty chairs.
Speaker A:And it is what makes the team comfortable a block in the first place because they know it will not sit there and just rot.
Speaker A:Notice what block scheduling does and does not do.
Speaker A:You're not turning the cleaning or the denture adjustment away, but you're giving that cleaning or denture adjustment the right slot and keeping your high value time for the high value work.
Speaker A:Nobody loses.
Speaker A:The patient still gets seen.
Speaker A:The the day still fills.
Speaker A:It just fills in the order that produces.
Speaker A:Now there are two failure modes to watch for.
Speaker A:The first is building blocks and then not holding them, which is worse than not building them at all, because now you have a plan that the team ignores and everybody learns the system is, well, more or less decorative.
Speaker A:The second is holding blocks too rigidly with no release time, which stands, which I guess would say strands capacity and makes the whole team hate the idea.
Speaker A:Blocks with a release valve held consistently applied by everybody the same way.
Speaker A:Well, that is the working version.
Speaker A:The fourth part of this is where the schedule actually gets filled.
Speaker A:Here is something that surprises owners.
Speaker A:The schedule is not primarily filled at the front desk.
Speaker A:It's filled in the operatory before the patient ever stands up.
Speaker A:The single highest leverage habit in scheduling, I should say, is that no patient leaves without a next appointment.
Speaker A:Hygiene reappointments at the chair six months out before the patient walks to the front.
Speaker A:Restorative treatment gets scheduled while the patient is still sitting in the room, where you just explain what they needed, not just handed a card and not told to go up to the front.
Speaker A:And they'll get you scheduled.
Speaker A:Track that as a number.
Speaker A:What percentage of hygiene patients leave with their next visit already on the books?
Speaker A:A well run practice, I should say runs above 90%.
Speaker A:Should be closer to 95% or more if yours is 60 or 70, which we see a lot of times.
Speaker A:Well, that gap is not a patient problem.
Speaker A:It is a workflow workflow problem.
Speaker A:And it's the cheapest thing on this entire list to fix.
Speaker A:It costs you a change in habit and about 90 seconds per patient.
Speaker A:The reason it works is momentum.
Speaker A:The patient is sitting in that chair, still hearing the explanation, still holding possibly the mirror, still connected to the reason.
Speaker A:And they say yes, that same patient standing at the front desk with their keys out, thinking about their afternoon, maybe seeing they're running a little late, says can I just check my calendar and can I get back to you?
Speaker A:And that call, it never comes.
Speaker A:The second habit is the verbal handoff.
Speaker A:The clinical team member walks the patient to the front and says out loud in front of the patient what needs to happen next and when.
Speaker A:Dr. Miller wants to see her back in three weeks for the crown seat.
Speaker A:Now, the front desk is not starting cold and the patient has heard the plan twice from two people who agree.
Speaker A:Agreement builds urgency.
Speaker A:Silence, well, it dissolves it.
Speaker A:And a word about language at the front.
Speaker A:Small changes matter more than they should.
Speaker A:You have an opening or when we have opening invites, maybes the doctor has time.
Speaker A:Tuesday at 2 or Thursday at 9, which works better for you?
Speaker A:Well, that invites a decision.
Speaker A:But give two options, not an open calendar.
Speaker A:Well, that open Calendar creates hesitation, but two choices creates appointments.
Speaker A:The fifth part of this is the hygiene column.
Speaker A:This is where the doctor to hygiene ratio matters.
Speaker A:In a healthy general practice, hygiene should be driving a real share of production.
Speaker A:Genuinely generally sorry, somewhere in the range of a quarter to a third.
Speaker A:And it should be feeding the doctor column through exams and diagnosis.
Speaker A:The second part is what practices miss.
Speaker A:Hygiene is not a revenue center that happens to sit next to the doctor.
Speaker A:It is the front door to the doctor's column.
Speaker A:When hygiene is just cleaning with no handoffs, no periodontal assessments, no photos, no conversation about the cracked filling on two, three, you have a schedule full of activity that is not producing and it is not feeding anything downstream.
Speaker A:A few things separate a producing hygiene column from a busy one.
Speaker A:Periodontal disease gets diagnosed and treated instead of getting a prophy by default.
Speaker A:Existing conditions get documented and shown to the patient.
Speaker A:The doctor exam happens inside the hygiene appointment and is treated as a real exam, not a 15 second wave.
Speaker A:On the way to I got to get to my other room and the next visit gets booked before the patient leaves the room.
Speaker A:Well, that we'll go deeper on the hygiene department in its own episode of this series, but it starts here and how the day is built.
Speaker A:If hygiene has no protected time for periodontal therapy, that therapy does not happen.
Speaker A:If the doctor has no gap between restorative cases to walk in for exams, those exams get rushed or they get skipped.
Speaker A:The blocks determine the behavior.
Speaker A:Always.
Speaker A:The sixth part of this is broken appointments.
Speaker A:These are the things that wreck even a well built schedule.
Speaker A:Cancellations and no shows.
Speaker A:Every one of them is an open chair you did not plan for and most practices simply absorb it and move on.
Speaker A:Start by measuring it, because almost nobody does.
Speaker A:Broken appointment percentage is the number of appointments that cancel or fail to show divided by the total appointments scheduled over the same period.
Speaker A:Run it monthly.
Speaker A:Run it separately by hygiene and for the doctor column because the causes are usually different and you don't pay attention to that when you first pull it.
Speaker A:Do not be surprised if it's going to be high.
Speaker A:What matters is the direction it moves and if more than a handful of your appointments are falling off, you do not have a patient problem.
Speaker A:Again, you have a systems problem.
Speaker A:Patients break appointments.
Speaker A:They do not value appointments that were maybe not confirmed well or appointments that they never felt any real ownership of.
Speaker A:Also track it in hours, not just percentages, because hours translate into dollars.
Speaker A:Three broken hygiene appointments and one broken crown seat are not the same event, even though they're four broken appointments either way, the fix has three parts and all three must run together.
Speaker A:First, the confirmation process.
Speaker A:That to me is human, not just an automated text that nobody reads.
Speaker A:Automation is fine.
Speaker A:As a first touch, it is not a confirmation.
Speaker A:A confirmation is a person or at minimum a message back that requires a response and it references what the appointment is for.
Speaker A:You have a crown seat Thursday at 2.
Speaker A:Please reply yes, so that we can hold that time for you.
Speaker A:That's a confirmation, a reminder that you have an appointment.
Speaker A:All that is is just notifying or a notification.
Speaker A:Second, a short notice list.
Speaker A:Patients who want in sooner, organized by what they need and how much time they take.
Speaker A: he morning, it gets filled by: Speaker A:Well, most practices technically have this list somewhere.
Speaker A:Very few have it built by procedure and appointment length, which is what makes it usable under pressure.
Speaker A:When a 90 minute block opens, you do not want to scroll the list.
Speaker A:You want to know who fits that 90 minute and call them.
Speaker A:Third is the clear policy that the whole team applies, and applies the same way.
Speaker A:It's got to be written down.
Speaker A:What happens on the first break, what happens on the second break, what happens on the third, whether there's a fee and when it applies, who has the authority to waive it.
Speaker A:A broken appointment should have a cost and a next step, not a shrug.
Speaker A:And the point is not to punish patient patience.
Speaker A:The point has got to be consistency.
Speaker A:When a policy is applied unevenly, patients learn that the appointment is soft and the whole schedule loosens.
Speaker A:One more thing on the same day, recovery.
Speaker A:Because this is where practices lose the most ground.
Speaker A:The moment a cancellation comes in, somebody owns things, filling it, not the team collectively, which means nobody but one person by name.
Speaker A:Otherwise, the 10 o' clock cancels at the 10 o' clock cancels@ 8:45.
Speaker A:Everybody assumes somebody is handling it and the chair sits there all day, producing nothing.
Speaker A:Get those three systems running and your broken appointment percentage drops.
Speaker A:Your open chair time drops, Your production per day climbs without adding a single patient.
Speaker A:This is what we call leverage.
Speaker A:You're not working more days or longer hours.
Speaker A:You're just protecting what you already have.
Speaker A:And part seven, I guess the numbers that tell you that it's working.
Speaker A:So how do you know if any of this is landing six numbers?
Speaker A:Look at them monthly and look at the trend.
Speaker A:Rather than any single month production per day against goal, not monthly total, which hides everything per day.
Speaker A:A month can look fine on the surface, while a third of the individual days missed badly and a Few huge cases covered the difference.
Speaker A:Schedule utilization.
Speaker A:What percentage of your available chair hours were actually filled with productive care?
Speaker A:This is the direct measure of whether the schedule is working.
Speaker A:Broken appointment percentage split by Hygiene and Dr. Key.
Speaker A:Four open chair hours converted into dollars using the per hour numbers you calculated earlier.
Speaker A:This is the one that changes behavior fastest because it is the only one that makes an empty slot feel like it actually is money on the floor.
Speaker A:And 5.
Speaker A:Hygiene reappointment rate.
Speaker A:What percentage of hygiene patients leave with their next visit booked?
Speaker A:6.
Speaker A:Unscheduled treatment.
Speaker A:The dollar value of diagnosed and accepted treatment that is sitting on the software with no appointment attached to it.
Speaker A:That number is often it's just startling the first time someone pulls it.
Speaker A:And it matters here because it is the answer to the question what do I put in the block I just opened up?
Speaker A:You are not looking for new patients to fill those blocks.
Speaker A:You are looking for treatment.
Speaker A:Your existing patients already said yes to.
Speaker A:Post those six numbers somewhere and the team can see them.
Speaker A:Talk about them in the morning huddles.
Speaker A:Note a report the owner reads alone in the office.
Speaker A:Numbers that stay private do not change behavior.
Speaker A:Numbers that a team can see.
Speaker A:Understand the influence and the influence does as well.
Speaker A:Let me give you an order of operation.
Speaker A:Because trying to change all of this in one week, well, it's just not going to work.
Speaker A:Teams will reject it.
Speaker A:And by month two, you're back to the same old schedule.
Speaker A:First 30 days.
Speaker A:Measure only.
Speaker A:Calculate your daily production goals by column.
Speaker A:Calculate your per hour chair value.
Speaker A:Count open chair hours for last month and convert them into dollars.
Speaker A:And then pull your broken appointment percentage.
Speaker A:Pull your unscheduled treatment.
Speaker A:Total change.
Speaker A:Nothing yet.
Speaker A:Just get the baseline and share it with the team.
Speaker A:Most of the time the baseline alone starts changing behavior because people genuinely.
Speaker A:Well, they just didn't know.
Speaker A:Second 30 days.
Speaker A:Build the blocks.
Speaker A:Decide how many high production blocks each day needs.
Speaker A:Place them there the day.
Speaker A:Place them where the day can support them.
Speaker A:Set your release time and write it down.
Speaker A:Then hold them for a month with no expectations so that the team learns the system is real.
Speaker A:Expect friction.
Speaker A:Of course, always in week one and week two.
Speaker A:That is normal.
Speaker A:Third 30 days.
Speaker A:Close the leaks.
Speaker A:Rebuild the confirmation process so it is human and the reference actual procedure.
Speaker A:Build the short notice list by procedure and appointment length.
Speaker A:Write the broken appointment policy and train everyone on it.
Speaker A:Assign one person to own the same day fills.
Speaker A:Then keep measuring the same six numbers every month on the same day of the month.
Speaker A:And set the expectations correctly with your team.
Speaker A:This is not a project with an end date.
Speaker A:The schedule is the practice.
Speaker A:Every dollar you produce comes through it, and every dollar you fail to produce is a slot that was empty, misused, or filled with something worth less than what could have been there.
Speaker A:Here's the part I want to leave with you.
Speaker A:Nothing in this episode requires a new patient.
Speaker A:Nothing requires new equipment.
Speaker A:Nothing.
Speaker A:No new service line, not a bigger building or any bigger marketing budget.
Speaker A:Every dollar we talked about today is already inside your practice.
Speaker A:It is sitting in your existing patient base, in the treatment they have already accepted and in the hours you already are paying for.
Speaker A:Whether somebody is in that chair or not.
Speaker A:The schedule has always.
Speaker A:I should say the schedule is always your lever.
Speaker A:Most owners just never hand that over to it and put their hand on it and pull the Dental Business Podcast is brought to you by by Class Solutions One team.
Speaker A:Five divisions aligned around your practice.
Speaker A:Learn more about our class dashboard at classdentalcoaching.com if you take one action from this episode, make it the four minute calculation.
Speaker A:Your per hour chair value times, Your open hours times 12.
Speaker A:Run it before the end of the week.
Speaker A:Whatever that number turns out to be, it is the size of the opportunity.
Speaker A:Sitting inside a practice that you already own.
Speaker A:Next episode we do go inside the hygiene department, where a lot of this either pays off or it falls apart.
Speaker A:If this one helped, will you do me a favor?
Speaker A:Share it with any other owners that you know.
Speaker A:I'm Phil Cole.
Speaker A:Thanks for listening.
Speaker A:And remember, your practice is a business worth building.
Speaker A:Well, we'll see you next time.
