Business of Dentistry

A Cunning Little Plan

Fans of Blackadder will recognise the character Baldrick who always had a cunning little plan. In this article I will explore how, with planning aforethought, you can save precious clinical time and increase efficiency.

There are two main planning subdivisions:

Strategic Planning

This is the broad brush type of planning and often includes capital expenditure. Examples of strategic planning include, decisions about re-equipping your practice, should you build a new surgery or take on more staff, change opening hours or start to sell oral hygiene aids. Conversely it could involve decisions to downsize. In many of these cases the final decisions can only be made with external professional help from you accountant, architect or lawyer, and are inevitably of a long term nature.

Operational Planning

This is the planning involved in everyday daily professional life and the area to look at for potential process re-engineering and rapid solutions to problems and complaints.

You may be surprised that I regard your most important operational plan. It is that given by your appointment book. Who controls your appointments? Is this the reception staff who try to fit patients in at any time they choose? A classic example of this is fitting patients in at the end of the working day for a long appointment when everyone is getting tired and, unless you have superhuman stamina and concentration, performance may start to flag and clinical outcomes could be prejudiced.

The first question to ask is ‘are you always running late at the lunch break or the end of the day’? If you are then consider why? What effect is this having on you staff and their own lives? Are you losing good staff because you never keep to time? Always remember that you will continue to earn fees from these extra periods. If the answer to any of the above questions is ‘yes’, then the following ideas may help, especially when laboratory services are required.

Do you have in place an overtime payment scheme, days off in lieu of overtime or an annual bonus to say thank you to your loyal team members for their extra efforts?

The next question to consider is when, during the day, you should carry our certain procedures? Is your practice mixed private and NHS? If so, do you have NHS followed by private patients or vice versa all mixed in together. It is very difficult to switch mentally from the standards required for private care from those you are providing for the NHS where you are working down to a price, rather than always up to a standard. Some years ago, during an audit training course, I suggested to a sceptical colleague that he should have specific times set aside for his private patients, who, after all, were buying his professional time. He monitored the results and agreed. Whether this is just some time during the day or whole sessions will depend on the proportion of your time division between the two methods of payment.

It is common practice to carry out crown preparations and send off the resulting impressions to your laboratory technician expecting the crowns to be returned in two weeks’ time for fitting. Have you ever considered what might happen if the lab is inundated with work and just does not have time to return your crowns at the time you have demanded? Murphy’s Law will dictate that the patient you let down has an important family occasion or is going on holiday, and it always seems that the temporaries you have fitted for this case are less retentive than normal.

At the beginning of my clinical career in general practice in 1969, a very wise technician taught me that, just as I as a dentist had an appointment book, so did he, and that if we were to work together successfully I needed to book in with his laboratory every single case. I have always followed this advice except for my time in one NHS training post where the hospital arrangements for laboratory work could only be described as shambolic.

For example, you would like to make, say 4 crowns and you have sufficient time in your diary in about 3 weeks’ time for the preparations, impressions, shades and temporisation and fit 2 weeks later. At this stage, before you finalise the appointments with your patient, call your technician and book in the case. If your technician cannot meet your fit date, for whatever reason, then move your preparation dates forward until you both have the times agreed, and then make the appointments. It creates a poor image in the patient’s mind if, having made long appointments, you then have to change them.

This method means that you have asked your technician to prioritise this time for your case, so that other colleagues who dump their work on the lab are the ones who may have to wait or receive a lower standard of work because of time constraints.

You also need to consider at what time of day you will make the appointment. My preferred time for the above case would be 2.00pm. You have had the lunch break to catch up if required and have had a rest, your nurse can have everything ready, you can start on time, and more importantly, if you are posting work to the laboratory there will be time to write the laboratory instructions, parcel up the impressions and get them in the post to the laboratory the same day. Always use guaranteed next day delivery. Yes, it is more expensive, but how expensive is your time if those impressions are lost? Additionally, the packages are insured against loss, and you can increase the cover for a modest additional premium. If your laboratory has a collection service, then store your impressions in the fridge overnight. Finally, try to complete your day with easier cases, for example review appointments.

There will always be one awkward customer who insists on a 4.30pm appointment, after their working day, for the preparations above, which you know might require a two hour appointment. My explanation for refusal was quite simple. ‘I have to get the impressions in the post to my technician on the day they are taken. If I don’t then there is a real risk they could distort, your crowns might not fit, and we would have to start all over again. What would you like to do?’

Similarly, do not trust the regular parcel post with your returned crowns. If your technician does not have a delivery or courier service, then ask for all work to be returned by guaranteed next day delivery and be prepared to pay extra for this service. Deliveries are made before 9.00am (at additional cost) or before 1.00pm. I found that the former deliveries could be attempted before the practice opened and that the latter was the better option. The service rarely failed, and then only when the country was snowed up to a standstill.

Your fit appointment can them be during the afternoon when you know the work will be back.

Finally, during my career I have used the services of several different technicians. Without exception, all found the courtesy of booking work in with them to be mutually beneficial. Over to you Baldrick!