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AAO TOPICS
Scheduling for Success
Golden Pearls of Wisdom
Do You Need an Office Manager?
This is a big question facing many orthodontists today and, unfortunately, there is no easy "yes" or "no" for anyone. Your need for an office manager is dependent on many criteria, and the manager's role in the practice varies among offices. Some practice management firms advocate "self-management" and are totally against having a person on the staff with the title "Office Manager" or "Office Administrator." I do not agree with this because every practice is unique, and let's face reality, not every office is staffed with a group of self-motivated people. If you eliminate management in this situation, chaos results.
I agree with having an appointed office manager, although I have consulted with offices that were running beautifully without one. These offices were either very small or staffed with a group of self-motivated people that practice excellent teamwork.
If you are unsure about whether or not to appoint an office manager, there are several questions you should consider.
1. Do you feel a need for someone to help you with the administrative aspects of your practice?
2. Are you experiencing stress due to lack of staff motivation?
3. Is there a lack of organization in your practice?
4. Does the teamwork need improvement?
5. Do you feel the need to check up on your staff to make sure their duties are complete?
6. Are you troubled by inner office conflicts?
7. Do you feel there is a lack of communication between you and your staff?
8. Do you have cliques in your office?
9. Do you feel stress due to lack of office policies being carried through?
10. Do you ever feel like it's you against the staff?
11. Do you want a person to help you lead your team? Are you a multi-doctor practice?
If the answer to most of these questions is YES, it indicates a need for an office manager in your practice.
Many of my clients have experienced a tremendous decrease in their amount of stress and an increase in their professional enjoyment after appointing a qualified person to help them lead their team.
WHAT IS THE ROLE OF AN OFFICE MANAGER?
This is an area that I know many doctors are uncertain about because many of the managers I meet are in the role of "sort-of office manager." This type of situation creates frustration for the doctor, the manager and the staff. The office management needs the title and the authority to be effective, and only the doctor can make that a reality. Let's look at some of the situations that create the "sort-of office manager" role:
- If something goes wrong, the doctor gets frightened and takes some authority away from the "sort-of office manager." On the other hand, if the doctor is feeling stressed, it becomes convenient to re-delegate to this person. The doctor/office manager relationship must be cultivated over a period of time. The doctor must place his/her trust and confidence in the manager to prevent diminished morale.
- Many doctors are unwilling to make a commitment by announcing a staff member's appointment to the position of office manager. Often one person has taken the responsibilities of office manager on their shoulders to fulfill the doctor's requests and to meet the leadership needs of the practice. However, the doctor may be reluctant to announce the appointment, fearing the other staff members will object. This creates a frustrating situation for all especially for the person in the "sort-of office manager" role. The doctor must make a decision based on what is best for the practice.
- Many doctors have been reluctant to give their "sort-of office manager" authority because the person has risen up through the ranks in the practice but does not possess the necessary skills to manage people. There is a tremendous need for advanced management training for the person who is going to be leading the orthodontic staff of the future. Continuing management education and self-study are essential to developing the management and people skills necessary to effectively lead an orthodontic team.
To prevent the "sort-of office manager" role from holding back your practice, I recommend the following:
- Find the right person that you respect and trust.
- Outline this person's job description and distribute it to the team.
- Make an announcement to the staff regarding the appointment and the manager's role in the practice.
- Make a commitment to support this person 100%. For example, if a staff member comes to you (the doctor) and complains about the manager or asks you a question concerning a department that is a responsibility of the manager, you should say, "Sally, I understand what you are saying, but you will have to talk with Jean about that."
Many managers undermine their authority by being message carriers for the doctor. For example: "Dr. Smith wants all of you to clean the sinks better starting Monday." This is not the role of a good office manager. An effective manager would say, "We all have a responsibility to keep our office clean for our patients. The sinks were not cleaned yesterday. Let's talk about what is preventing this job from getting done."
The staff needs to be fully aware of the responsibilities of the office manager. The following is a sample job description of an office manager. Each practice must design their own to meet the needs of their office.
OFFICE MANAGER SAMPLE JOB DESCRIPTION
- Responsible for all personnel issues in the practice. To include the following:
- Recruiting, hiring and training of all staff (clinical and administrative)
- Management of all staff compensation (i.e., insurance, retirement, etc.)
- Daily staff management
- Annual performance and salary reviews of all staff
- Any necessary probation or dismissal action against staff
- Coordinate all staff meetings (i.e., daily morning huddles, weekly staff meetings, and retreats)
- Coordinate any staff functions (i.e., staff picnics, holiday parties, etc.)
- Act as a liaison for the staff on issues that demand the doctor's attention.
- Maintain all personnel records.
- Maintain the annual staff empowerment calendar and make sure that all birthdays, anniversary dates, etc., are recognized.
- Act as a liaison between the financial coordinator and the accountant to verify that the financial systems are working properly.
- Frequently review the scheduling coordinator's template to be sure that the appointments being scheduled adhere to office requirements.
- Oversee staff schedules.
- Stay abreast of new developments in training (i.e., home study courses, seminars, etc.) that may be of value to the staff and doctor(s).
- Supervise all marketing strategies of the practice.
- Be properly trained to act in the role of New Patient Coordinator, Appointment Coordinator, or Financial Coordinator when necessary.
- Handle any customer service concerns of parents or patients.
- Organize all travel requirements of the doctor(s) or patients.
- Must constantly look for ways to streamline office systems.
- Responsible for keeping the practice's policy and procedure manual updated and making sure these policies are followed.
- Insure that the office facilities are well maintained.
- Oversee any major projects for the practice (i.e., computer purchases, facility renovation, etc.)
QUALITIES OF AN EFFECTIVE OFFICE MANAGER
The following qualities are highly desirable in this position:
- Energetic person who works the hours needed to get the job done.
- Understands the big picture of the practice and shares the same values of the doctor.
- Honest and direct with their communication. Can tell people the truth in a caring yet direct way.
- Unwavering support of the office manual protocol.
- Keeps confidence of the doctor and staff. The staff learns they can trust the manager.
- Sees both sides and works to find win/win solutions.
- Does not show favoritism.
- Motivates and empowers the staff with their actions and communication.
- Frequently solicits feedback from the staff regarding their thoughts and feelings.
- Develops healthy communication lines with the doctor and is not afraid to be assertive when needed.
- Is viewed by the staff as a hard worker and totally committed to the purpose of the practice.
- Is professional in their look and their actions.
- Proactively takes action and gets things done.
- Knows how to have fun with the staff and still remain effective as a manager.
- Creates a zero fear level. The staff members feel safe in discussing their feelings with the manager.
EVALUATIONS OF THE MANAGER
Once every 6-12 months, the staff should have an opportunity to evaluate the manager. Confidential forms should be given to the staff. The forms should be returned to the doctor to review. The doctor should discuss the positives and any constructive feedback gleaned from the evaluations with the manager. A synopsis of the evaluations from the leader is more effective than reading them individually. A good manager desires feedback on how they can better serve the team.
PERCENTAGE SPENT ON STAFF SALARIES
I have reported in many previous publications that the total of staff salaries (not including lab technicians) range from 18%-23% with the average being 20%. This is the total amount of the W-2 forms. If a doctor decides to add an office manager who does not also function as a financial coordinator, new patient coordinator or appointment coordinator, it will increase the percentage by approximately 2%.
Many doctors tell me that the additional investment in the budget is well worth it because of their reduced stress level. They gladly give up the extra percentage. An effective office manger also helps keep the production moving up, therefore balancing out the addition to the salary percentage.
Have each staff member make a list of 10 things they think the orthodontist holds them accountable for in their job. The orthodontist should make a list of 10 things they hold each individual staff member accountable for in their job. Compare the lists. Discuss the similarities and differences. The goal is to clear up miscommunications. Efficiency experts claim that at least 40% of the average worker's time is spent doing tasks that are either unnecessary or have to be done over because they were not done according to instructions.
Increase profitability by using budget amounts to empower your team:
| 3.5% Lab Costs | 6.0% Clinical Supplies |
| 2-3% Marketing | 1.5% Business Supplies |
| 18-22% Staff Salaries |
Once these overhead goals are reached, reward the team!
Even a 2% reduction in your current budget could save you thousands of dollars!
Encourage Adult Referrals
Separators are one of the most uncomfortable elements of orthodontic treatment for adult patients. Consider using larger padded molar brackets (that you can get from most suppliers) to bond all molars on adult patients. Be sure to let the adult patient know in the new patient process that you have made this transition with them in mind. Tell them that your goal is to make treatment as comfortable as possible for them. Then be sure to ask them to tell their adult friends considering orthodontic treatment about your practice!
Bonus for you: no more separator appointments.
Things To Do During "Lag Time"
- Pull and file charts and phone logs
- Stock paper towels and cup holders
- Roll wax
- Take out trash
- Fill Scope bottles
- Sweep lab
- Make sure island and sterilization is not cluttered
- Make new patient packs
- Check Sterilization area
- Help with confirmation calls
- Vacuum and sweep floor
- Clean lab boxes
- Alcohol units off
- Windex windows and clean marks on walls
- Type ceph cards and fill out cheekwood studio cards
- Make comfort calls
- Look for missing treatment cards
- Check tooth brushing area, restrooms, waiting room, impressions area and staff.
If you finish your work in your area early, please utilize the extra time to help your co-workers stay on schedule. Make a list like this in your practice. Set up a system to note when a duty was performed and then the doctor could surprise the staff periodically by giving a bonus to the person who made an effort to be productive during lag time.
Let the Staff Vent
Staff members (especially females) love to "vent." Start the day off right. At the end of your morning huddle, have each staff member report out loud how they feel on a scale from 1-10 with 10 being "great." This lets everyone on the staff know if someone is having an especially bad day so that a little extra support might be provided for them. It also allows staff the opportunity to share good things that might be happening in their life to make them score a "10." Remember, women love to "vent" so allow that opportunity freely at the start of each day!
Reward Patients Who Pay On Time
Send a thank you note to all new accounts that have paid on time after they have been in treatment for three months. The positive reinforcement will encourage continued on-time performance. Here is a sample letter that you could send:
"We truly appreciate you paying your account in such a timely manner. Your promptness did not go unnoticed.
Thank you for choosing Dr. _____________for_____'s orthodontic needs. We are very pleased to have your family in our practice."
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Appoint now for later for 85% effectiveness or better!
Here is how the most effective recall system in the country today works:
Appoint the patient before they leave the office. "Mrs. Jones, Dr. Smith will need to see Susy again in 6 months for her next pre-orthodontic check. By scheduling today, you will have the best choice of days and times that we have available. Six months will be February. I have February 8th at 3:00 p.m. Would that work for you?" Never ask, "Would you like to schedule for February?"
Send a card (or use Housecalls) one to two weeks in advance of the appointment to confirm. Also, call (or use Housecalls) the day before the appointment for one last reminder.
To calculate your recall system effectiveness, take the number of observation recall patients in the practice, multiply by the frequency of the average visit (i.e. once a year 1, twice a year 2). This equals the ideal number of total observation appointments for the year. Divide your actual number by this ideal number to get your recall effectiveness.
Have You Examined Your Image Lately?
One of the greatest marketing tools for your practice is your image. "Image brings them to the door and quality keeps them there." If you are concerned about bringing more people to the door, take a few moments at your next staff meeting to give your office an "Image Check." Have each staff member on your team walk around the office and rate the following areas on a scale of 1-10. Average the scores. Make a list of any areas that rate less than 8 and set target dates and proactive steps to take action to make needed improvements to your image right away!
| ___ Parking Lot
| ___ Front Landscaping |
| ___ Front Door
| ___ Reception Area |
| ___ Staff Attire
| ___ Front Desk Area Uncluttered |
| ___ Stationery
| ___ Appearance of Consultation Room |
| ___ Magazines
| ___ Finished Photographs of Patients |
| ___ Condition of Plants
| ___ Certificates of Doctor and Staff |
| ___ Cleanliness of Office
| ___ Coffee and Juice Area |
| ___ Sterilization Methods
| ___ Color Scheme in the Office |
| ___ Doctor Attire
| ___ Music |
| ___ Lighting
| ___ Cleanliness of Brushing Area |
| ___ Patient Bathroom
| ___ Visual Aids for Case Presentations |
Do You Have A Problem With Emergencies?
Ideally, you should have no more than 3% band and bond failures in your practice. To determine if you are possibly above that criteria, do the following:
Bond Failure Test
| # of starts last year | _____ (A) |
| avg. # of brackets per case | _____ (B) |
| A (multiplied by) B | _____ (C) |
| C (multiplied by) .03 | _____ (D) |
| D (divided by) 12 | _____ (E)* |
Band Failure Test
| # of starts last year | _____ (A) |
| avg. # of bands per case | _____ (B) |
| A (multiplied by) B | _____ (C) |
| C (multiplied by) .03 | _____ (D) |
| D(divided by) 12 | _____ (E)* |
*E = the ideal approximate number of bonds or bands that should fail each month. If your number is too high, you need to work on your in-office procedures.
Solution: Call Paul Gange at Reliance (8O0-323-4348) and order their video on reducing band and bond failures, or have a consultant come in to observe. Then track your emergencies in the future to determine your improvement.
Enhance Your New Patient Consultation with an Excellent Office Tour!
The office tour is your info-commercial. It is very important to the new patient experience. Do not leave out this step! Listed below are some important areas to cover in your tour and some sample benefits to point out:
Appointments
"We always run on schedule." "We offer flexible appointment times." "Our patients love our computer check-in."
Brushing Area
"Dr. Smith keeps your dentist informed of your progress." "We offer incentives to patients who have excellent brushing."
Clinical Area
"Dr. Smith has invested in the best and latest equipment to enhance your comfort and results."
Sterilization Area
"We have state-of-the-art equipment that is monitored by an outside service."
Doctor's Background
"Dr. Smith graduated first in his class and also is the past president of our state dental association."
Staff Background
"All of our assistants are certified." "Dr. Smith takes the entire team on at least one continuing education trip each year."
Other Tips:
*Show them results (new faces in braces). *Use the doctor's name often. * Use the patient's name often. *SMILE!
Staff Meeting Tips
- Create a "Commitment Board" in your office.
- Have each person share a personal thought with the team on the "benefits of commitment."
- Give everyone a 3 x 5" card to record one thing that they are willing to commit 100% to and how that would benefit themselves and the team.
- Take a few minutes to visualize how it would change your office if everyone stuck to their commitment for the next 30 days.
- Post the cards on a bulletin board in the lounge.
- Vote at your next staff meeting on the "#1 Commitment Player."
- Discuss the results at your next meeting.
Clinical Tip
This clinical tip involves an initial placement of an archwire for a mixed dentition case where you typically have a 2 x 4 appliance in place (brackets on the four incisors and 2 molars - either upper or lower). Since there is a long, flexible span of archwire in the area of the deciduous molars and cuspids that are not bracketed, sometimes it is difficult to place a light enough archwire that will align crowded or malposed incisors that is not easily dislodged by the patient. A simple way to remedy this difficult problem is to take a .016 nitinol wire and cut it extra long so the archwire will be 8 - 10 mm longer than the distal end of the buccal tube. The archwire is dead softened (with a flame) from the distal molar tube to the end of the archwire. Then the archwire is inserted into the regular archwire slot. Next, simply take your finger and wipe the dead softened end of the archwire occlusally as you insert the archwire so that you do not poke the patient. Do this on both sides! Then, hold the distal end of the archwire by utility pliers or Weingart and feed it through a secondary tube such as a headgear tube on the maxillary molar or auxiliary tube on the lower molar back to the mesial. This forms a little loop at the distal which will stick out a little bit and can be tucked lingually towards the gingival tissue to avoid protruding into the cheek. The archwire end that is now looped around back through the mesial is turned up at the mesial portion of the molar tube. This gives you a very flexible archwire to place for initial alignment and rotational control but still very flexible and very gentle for the teeth. The decided advantage of this archwire is that it very seldom will be pulled out of the molar tube or broken like most of the other initial placement archwires that we have attempted.
Evaluating Collections vs. Production for Budgeting
In projecting what you will collect for the new year, you must look at last year's production (all charges). This indicates what you will probably collect in the new year and that is what you must base your new budget on. You need to plan your spending for the new year based on what you expect to have coming into the practice. For example:
| Office #1 | This practice is in the decline. Production is lagging behind collections. The budget should be based on the production of the previous year. Figures for 12 months (end of year): |
| Collections | $564,908 |
| Production | $499,507 |
| Office #2 | This practice has experienced significant growth. The budget amounts for the next year should be based on the production from the previous year. Figures for 12 months (end of year): | | Collections | $498,402 |
| Production | $579,305 |
| Office #3 |
This practice has maintained this year. There was no growth or loss. The budget should be based on production from the previous year. Figures for 12 months (end of year): | | Collections | $498,402 | | Production | $499,550 |
Record your goals on a "goal board" in the lab or lounge area. Track where you are in relation to your goals monthly. Your goals may include tangible and intangible items. For example:
GOAL BOARD
| 500 | New patients |
| 300 | Starts |
| 5% | No show ratio |
| 10% | Overrun ratio |
| 7% | Clinical supply budget |
| 3% | Office supply budget |
| To enjoy our work everyday. |
| To make every patient feel important. |
| To provide a stimulating environment for our team. |
| To ask for referrals. |
Reviewing your goals daily at your morning huddle keeps the team on track. If you are lagging behind in an area, discuss proactive ideas you can implement to facilitate reaching the goal. Remember effort = results.
Valuable Tips for the Leader
Recognition is the key to staff motivation. In general, I see a lack of recognition for the staff in many offices. It is important for the doctor to set up a system to support this in the office. A staff member can confidentially be in charge of prompting the doctor of various occasions. The doctor may want to keep a calendar of staff occasions at home. Some of the things to note are:
- Staff birthdays
- Birthdays of their children
- Staff employment anniversaries
- Certification achievements
- Recognition for taking on new duties
- End of the year recognition for reaching goals as a team
- Monthly staff meeting reports - recognition for achievements in their job
- Recognition for reaching milestones in the practice as a team
A hand written note is a powerful tool and rarely used. Staff members appreciate bonuses and surprises, but the best reward is the vote of confidence from their boss.
"Change the leader - change the organization. Everything rises and falls on leadership. However, I have found that it's not easy to change leaders. In fact, I've discovered that leaders resist change as much as followers do. The result? Unchanged leaders equals unchanged organizations. People do what people see. Leadership is all about influence - a skill that can be developed." John C. Maxwell
John C. Maxwell wrote the book Developing the Leader Within You. This is an excellent book for the orthodontist who wants to take their practice to a new level.
If a doctor holds onto the thought, "I am not a good manager," it will result in poor performance of the team. The orthodontist has a responsibility to manage their entire practice. That includes the patients and the staff.
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