My husband and I were watching The Voice a few days ago, catching up on the episodes we had missed over the past several weeks.  We both agreed that the incredible talent of the contestants surpassed that of previous seasons.  Rather than questioning if the artist should move forward, the decision often instead is which coach would be best suited to guide them through the journey to achieve their dreams. Each one of The Voice coaches offers a unique mentoring approach with the goal to help the contestant reach far beyond their wildest dreams and expectations.

Often I see the most veteran team member put in charge of leading and training- the Blake in the office.  Consistent and reliable with years of experience they understand the ultimate goal, bringing priceless wisdom and pearls to the training table.  Put them in charge of Stage 1 training, the first 90 days. If you do not have a formal systems and procedures manual, develop it the next time you hire a new employee.  As information is delivered, the new team member writes everything down to create the foundation for a written training program with systems and protocols.  Unfortunately, as with computers, no one has yet discovered how to transfer information telepathically from one person to another. Do not expect trainees to tap “Blake’s” knowledge and experience through osmosis.

The Adam (singer, song writer and multi-instrumentalist) in the practice can be compared to an employee who has either worked in more than one orthodontic office or has had experience in multiple areas of the practice. Rather than blindly accepting a system because it has always been done the same way using the same products, Adam would be the team member who is continually trying to find enhanced, streamlined systems that would better serve the orthodontic community. As well as seeing the big picture, they understand the intricate puzzle pieces needed to make your systems work. They can fill a vital role in your training and management program delivering Stage 2 of the coaching process – after the first 90 days.

The human resource aspect of owning your own business often causes the majority of your headaches.  Between monitoring employee performance to establishing pay and benefits, it can significantly increase the number of hours you spend working each month.  Having an Alicia on your payroll; calm, cool and unflappable, can enable you to share some of the HR responsibilities, freeing up time for you to see patients. Develop detailed job descriptions outlining duties and expectations as well provide a measure of performance.  The HR Manager is also responsible for fielding employee conflict and enforcing the 24-hour rule. Under the 24-hour rule if an employee has a complaint or concern with any member of the team, they are to go directly to that person and only to that person.  If they are not able to resolve the problem between the two of them, only then do they take it to a third party for input. If the concern is not addressed within 24-hours life is too short, just let it go. Your “Alicia” can be your human resource gatekeeper, from record keeping to performance auditing to making recommendations for changes in salaries and benefit plans. Update the manuals and job descriptions on annual business to ensure that the documentation is accurate and up-to-date.

Miley, Miley, Miley!  She will definitely bring the excitement into the practice. They challenge you to explain the why and not just the how. They have endless supply of energy and can be counted on to create fun and laughter.  Give her the responsibility of coordinating internal marketing and team activities. Toss her the ball and then let her run with it under your guidance.

The Voice coaches encourage contestants who do not successfully move forward on their first attempt; they highlight the positive and point out specific measures needed for improvement.  The key is to remember that that if you are not successful the first time, it does not mean failure.  Instead look at it as:

F          First

A         Attempt

I           In

L         Learning

Just as Blake, Adam, Alicia and Miley are not the perfect mentor for every contestant, it takes more than one trainer/leader to develop a gifted orthodontic team. Your “dream team” is obtainable with The Voice of the doctor partnered with a solid coaching and management program.




“The game of life is a game of boomerangs.  Our thoughts, deeds and words return to us sooner or later with astounding accuracy.”  Florence Scovel Shinn

My family loves to give me a bad time because every time I see someone with braces I feel compelled to ask them who their orthodontist is and what has been their experience. Other than the time a teenager told me that she loved her doctor because he was “drop dead gorgeous”, the responses I get remind me of Yelp reviews.  The response is enthusiastic if their experience was extremely positive (or exceptionally negative),   lukewarm or non-existent if the experience has been nothing more or less than what they expected.  Looking at this from a mathematical perspective, 20% of patients fall into the two extremes (hopefully more in the positive group), with the remaining 80% in the take it or leave it group.  They have not been inducted into the Raving Fan Club, nor are they badmouthing the doctor and/or team. The nonchalance of 80% of your patients is quasi – they can take it or leave it. Let’s look at some simple steps you can take to change the individuals you are treating into patient ambassadors for your orthodontic practice.

The mood of an interaction is established with the first word or facial expression.  Orthodontic team members are not fully dressed for work until they put on their smile – the most important part of their uniform.  A genuine smile must never cease to shine from the moment they walk through the door in the morning up until the last patient is dismissed.  Turn up the corners of your mouth and remember that your smile is a tool that is free, easy and always available.  Smiling is a catalyst for joy, from an improved mood to better relationships.

Every time you smile you are offering a gift to your patient, a beautiful thing.  Seeing another person smile stimulates the heart and brain even more than eating chocolates or receiving money.  Statistics have proven that it is actually hard to frown when someone is smiling at you.  Just think how handy this information will be when you are trying to schedule a difficult appointment.  People who smile more are generally found to be more trustworthy, sincere, sociable and competent. In Mother Teresa’s words “Every time you smile at someone, it is a gift to that person, a beautiful thing.”  If you want to bring joy to someone’s day smiling is an effective strategy for achieving a multiple of goals. A smile is just a frown turned upside down.  Stand on your head if you need to.  SMILE!

ALWAYS refer to your patients and parents by name; use their name often in your conversation.  Do not call your patient’s parents “mom” or “dad”, they are not your parents! I will never forget the time one of my clients addressed an adult as mom and proceeded to update the parent about the wrong child.  Using their name ensures that you are speaking to the right person.

Don’t be afraid to step out from behind the front desk to greet patients face to face, introduce yourself and shake their hand (this is especially important if this is their initial visit).  Guide them through the computer check-in process and offer them a beverage to drink.  Use the Nordstrom’s touch when patients leave the office, walk around the desk to hand the patient appointment slip and school excuse.  An added benefit is that it gives you the opportunity to ensure that everyone seated in the reception area has checked in (especially when you have seats that are not visible from the desk.)

Have the doctor personally confirm the new patient appointment two days prior to initial consultation. This gives the patient the message that the doctor is personally looking forward to meeting them and will provide the best care available for him/her. It is the most valuable 5 minutes the doctor will spend.

Educate your patients; take away the question and fear of the unknown.  In addition to explaining clearly what is involved before you start the procedure, update the patient and parent at the completion of the visit:

  • What was done today
  • What the patient should expect (closing of space, tenderness, etc.)
  • How is the patient doing overall (progress of treatment, oral hygiene, cooperation)
  • When does the doctor want to see the patient again
  • What will the next appointment involve

Finish off by asking the patient and parent about their experience when you hand them their appointment slip.  If there is a problem solve it quickly and turn complainers into advocates.

Utilize the back side of patient forms (fee estimate, truth-in-lending, patient handouts) to promote your practice.  As well as promoting patient contests and events, it is a great opportunity to promote your Kid’s Club and advocate adult treatment (clear brackets, Invisalign, lingual treatment, etc.)

Some patients feel that it is the end of the world when they are told to avoid hard and sticky food. Create a cookbook with brace friendly recipes along with alternatives for “brace contraband”.  Place several copies of each recipe in a plastic sleeve so patients can take a copy of their favorite recipes home with them.  Encourage patients to share recipes, giving them credit for their contribution (From the Kitchen of Madison).  Add at least one new recipe each month.

Develop your patient schedule based on school hours- take advantage of late starts, early dismissal, teacher in-service days, school closed and lunch hours.  Before school hours have gained popularity over after school and evening appointments. Take a survey of your patients to see if your current hours suit their needs; if not, look at alternative hours. When scheduling appointments, tell patients what you have available, not what is not available.

Identify and anticipate your patient’s and parent’s needs. Patients don’t buy braces; they buy good feelings and solutions to problems. Most patient needs are emotional rather than logical. The more you know your patients, the better you become at anticipating their needs. What can you give your patients that they cannot get elsewhere?  Listen carefully to what they say and check back regularly to see how things are going.

“Making one person smile can change the world, maybe not the whole world, but their world.”  – Author Unknown

Fun in the Sun

January 28 - 30, 2016

January 28 – 30, 2016

Piloting a successful orthodontic practice, between building and maintaining a quality “crew”, monitoring systems and protocols and consistently delivering excellent service to your first class passengers is a full time job. With the right training, practice and dedication, one pilot can fly a small plane. Just as when you transition to a larger aircraft it takes more than one person to keep the plane in the air, it can be difficult for orthodontists to treat patients and manage all of the details needed to keep the growing practice above ground.

Whether you use a co-pilot to assist you or a crew, armed with a comprehensive checklist and well versed in your practice philosophy, it is critical to create a support system to help you with management responsibilities allowing you to concentrate more fully on the overall well-being and treatment of your patients. Just like the co-pilot and crew of the airlines, each person must go through a detailed check list before the plane is ever moved.

During my consulting career I have been asked several times to develop and “name that position”, putting into place either an Office Manager or team committees to assist the doctor in leading the practice. The decision to either have one person in the leadership position or utilize multiple team members depends on how much and in what areas you are willing to relinquish personal, hands-on supervision to someone else. It all starts with hiring right and setting the foundation before you go to the next level.

Start by determining what responsibilities you are willing to turn over to someone else. What can you take off your plate to lighten your load? How much information are you willing to share with an employee or employees? Make sure you understand your emotional commitment to your vision and clarify your expectations to this “right-hand” person you will rely on.

Let’s look at some of the leadership options that can be used to develop your practice. Commonly, in the average to large size practices, a combination of scheduling coordinator, financial coordinator, treatment coordinator, clinical coordinator, lab, clinical assistants, records assistant and a sterilization coordinator is used to cover practice responsibilities. Each position has its own systems, protocols, checks and balances as well as a detailed job description to set the team up for success. Additional responsibilities can be assigned to team members depending on their expertise and your level of comfort. The added responsibilities might be combined with their current job description (Financial/Human Resource, Treatment Coordinator/Marketing, Clinical Assistant/Ordering, Clinical Coordinator/CE Opportunities, etc.) or delegated to a committee who is made up of 2 – 3 team members.

When using the team committee concept determine in what areas of the practice you require assistance. Do you want to turn over some of the responsibilities in one area of the practice or implement changes in several areas over a period of time? Utilizing team committees can give you the opportunity to empower multiple team members instilling the attitude that the practice is everyone’s “baby”.

Following are examples of team committees:

• Human Resource Committee- monitor vacation, sick days, holidays, personal time off – paid and unpaid, making arrangements if we will be down a team member. The Human Resource Committee will be involved with performance reviews and making recommendations regarding future hiring or expanding the employment opportunities for those employees who are not making the cut.

• Marketing Committee- The fun Squad. This is your fun group of team members, someone who can find laughter in difficult situations. The jar is half full, not half empty. Their marketing responsibilities encompass external marketing (DDS deliveries, School programs, community events, school sports, school lunch and learn presentations, etc.) and well as internal contests and programs for new and existing patients. Please feel free to call me if you would like to get some ideas for fun and creative external and internal marketing. They network with your referral sources to create your “Doctor Bible”, a compilation of information regarding their practice (personal information, office hours, services, insurance plans accepted, etc.) enhancing your partnership with referral doctors. Additionally this committee is responsible for decorating the office for holidays and special occasion.

STOP- before you give your team a green light; establish your monthly budget. Typically 3% – 4% of your overhead is the average marketing expenditure in orthodontic practices; 1% for internal and 2% – 4% for external. Have your marketing committee put together your marketing plan (along with projected costs) for the next months.

• The Facility Committee is responsible for monitoring the building from the parking lot to every area in the office. Evaluate the appearance from the perspective of new and current patients (including the little guys who see everything from a different level.) They are responsible for bringing facility concerns to the doctor, including the cost and time required to get work done. It is their responsibility to coordinate work with the repairing company, fielding telephone calls and scheduling work around patient hours so it can be done with minimal interruption to patients.

• The IT/Computer/Software Committee is responsible for computer software updates, computer trouble-shooting and maintaining all equipment. They are also in charge of scheduling training sessions to keep the team abreast of changes.

• The dreaded Uniform Committee! No matter what way you look at it, it is next to impossible to get several women to agree on uniforms they all like. From the color is wrong, the style makes them look fat to I would not be caught dead wearing that; uniforms are a headache that can best be dealt with by someone other than the doctor. Save your energy for decisions regarding your patient’s clinical treatment.

• The CE Committee compiles all continuing education opportunities for the team. From a two hour lunch and learn to a 3 day interactive workshop “Fun in the Sun” January 28 – 30, 2016 in Puerto Vallarta with myself, Rosemary Bray and Carol Eaton, they make recommendations for courses that would benefit the patients and practice. They are responsible for putting together a budget of estimated costs along with the desired outcome of the course.

Another option is to hire or promote someone from within the practice to act as your voice and right arm in the practice. The title of Office Manager often brings with it a negative connotation, especially when it is a new position in the practice. Consider using the title of Office Administrator or Office Coordinator. Be aware of the high probability that it will upset some of your team members, especially those who are threatened by change. Treat them with the respect; avoid keeping them in the dark. Let them know what is happening and why and make sure you are empowering this person in their new position. Emphasize to the entire team that you are still “calling the shots” and ultimately are the determining factor in all decisions. This individual must have the ability to balance friendship/team relationships while leading and managing the practice.

Working with your new leaders and the team requires patience and tolerance as you start to delegate; change does not happen in 24 hours. Create achievable short-term goals in bite size pieces and celebrate as you accomplish each of these goals. Finish one project before you go on to another.

Establish communicating methods to enable evaluation of your current status, progress to-date and as well your ultimate goal. Promote honest input and suggestions, encourage team members to come to the table with a solution rather than a problem. Partner yourself with an individual or individuals with the appropriate mix of experience and skills in place to help you guide the practice to the next level of excellence. Develop capable team members –empower them to make decisions, delegate responsibility thereby allowing you to focus your time and attention to your “passengers” on their flight to a beautiful smile.

Debbie Best, practice management consultant and lecturer has over 35 years of experience in the orthodontic field. Debbie evaluates staffing needs and systems to develop a strategic plan for practice productivity. She designs customized schedules, personalized job descriptions, and a team member handbook to fit each practice’s needs. As a part of her consulting program, Debbie also focuses on the role of the front desk team, financial controls, anti-embezzlement protocol and practice building.
To Contact Debbie: Phone- (925) 447-6993
Website: E-Mail:



When a goose flaps its wings it creates uplift for the birds that follow.  By flying in a “V” formation the flock has 71% greater flying range than if each bird flew alone.  When the lead goose tires it moves back and another goose flies to the point position.  The geese flying in formation honk to encourage the birds in front of them to keep up their speed. Geese instinctively know how to fly together to blend strength, skills and capabilities.  When a goose becomes sick or leaves the formation the remaining geese immediately take over without interruption to their flight.


What can we learn from the lessons of the geese? What happens when a key employee is out of the office, expectedly or unexpectedly?  Does your team fall apart? Do employees appear to be scattered and disjointed or does it cause an interruption in your patient’s care?  Do your team members “honk” politely to give positive encouragement to employees who night be falling behind or need additional assistance?


With the change in the economy we are seeing more practices transition to a trimmer and leaner philosophy.  The value of cross training has increased as we find ways to become more efficient, yet continue to deliver ongoing exceptional patient care.


Where do you start?  Introduce the concept of cross training into your orientation for new employees. Create a detailed job description for each position in the practice including procedure documentation, timeline for daily, weekly and monthly duties and written materials and training tools that are available to use as a reference (software company manual, front office or clinical training manuals, appliance diagrams, etc.)


Utilize morning huddles and team meetings to strategize what responsibilities will be cross trained, evaluating what will have the greatest immediate and long term positive impact to the practice and the team member.  Set up a 12 month schedule outlining the topics that will be cross trained on a monthly basis.  Set aside a two hour lunch or a block of non-doctor time monthly to conduct your OrthoCrossTrainingUniversity (OCTU.)

Assign a team member as the OCTU Instructor for the training session, depending on their area of expertise (camera technique ~ records coordinator, sterilization ~ sterilization assistant, scheduling ~ scheduling coordinator, etc.)


Let’s look at some areas of the practice that cross training can be utilized, allowing all team members to pitch in when someone is out of the office or additional assistance is needed.


Train every employee to sterilize instruments.  Not only can they step in to help as needed, it also gives all team members the confidence to educate patients and parents regarding your sterilization process.   Encourage team members to be current with a Hepatitis vaccination, even if their primary position in the practice is administrative.  Develop a manual outlining the sterilization process, complete with pictures of all of the instruments used and safety guidelines.  If the sterilization process includes putting together tray set-ups, take a photograph of each completed tray along with a list of instruments needed for each set-up and keep it handy.  


Cross train all team members how to clean up the chair after a patient is dismissed.  Create a check list outlining the necessary steps needed to clean a chair and prepare for the next patient:

√     How can you tell if a chair is clean?

√     How do you spray, wipe and cover the unit?

√     What disposables are replaced?

√     Where are the disposables stored?

√     What do you do with sensitive items (burs, hand pieces, etc?)

This will add an immediate positive impact to your patient flow, especially during before and after school congestion.


Establish your protocol for seating a patient.  Develop a checklist covering information that is discussed before the clinical assistant and/or doctor comes to the chair:

√     Do they need to brush their teeth before their appointment?

√     How are they doing with their appliances?

√     Do they need any supplies (toothbrush, floss, wax, etc.)?

√     Do they have any questions regarding today’s appointment? 

The team member who seats the patient will stay with the patient until the clinical assistant is available to start the scheduled procedure.


Train all employees on how to give hygiene and appliance instructions. The administrative team is often asked questions by a patient or parent regarding appliances, elastic wear or oral hygiene.  Having all team members well versed on the parts of appliances, how they work, common concerns, patient cooperation required and given the answers to frequently asked questions will help ensure that patients are receiving correct information at all times.  Checklists are particularly helpful so all important information is covered. When the administrative team is comfortable answering questions it reduces or eliminates the need to interrupt the clinic when a patient or parent calls regarding an appliance.  It also takes away the “mom/dad tug –of war’; if the patient does not like the answer they received from the doctor or a clinical team member, they often will ask an administrative employee to see if they get an answer more to their liking.  Having all team members trained to give accurate instructions keeps everyone on the same page.


With the wave of technology and computers at every chair we are seeing more scheduling done by the clinical team.  Even if you are scheduling appointments at the front desk, all team members should be cross trained to schedule patient appointments.  Not only can the clinical team help out by answering the telephone and scheduling appointments, it also allows for the flexibility of having a clinical team member work on non-patient days to schedule appointments. Having the clinical team schedule appointments also gives them a little more control over their daily schedule.  They can make adjustments to the schedule dependent on special circumstances or ’prize patients” (patients you want to give away.)


Cross train all employees how to post a payment and generate a computerized receipt.  Set up a solid protocol outlining the specific steps used to post payments along with the checks and balances to ensure that it is done correctly.   Should employees run into problems, having a list of common questions and answers is helpful.  Employees must be signed into the system under their name and password before they post any transaction.  This maintains the integrity of the daily financial audit.


Generating computerized reports assists us in tracking patients, from the initial examination through the end of the retention phase of treatment.  Cross training all employees to navigate through your computer software program to generate reports allows team members to actively track patients through treatment.  Educate all employees on the purpose and value of each report and document the required steps needed to generate the information.  Having all employees monitor patient reports reduces the possibility of patients falling through the cracks. 


Cross training does not happen through osmosis.  Create your vision of cross training as a team exercise. Where do you want to start that would generate an immediate and valuable outcome? Set aside non-patient time and develop lesson plans for structured training and role playing, including a test or quiz at the completion of each session.  Review the effectiveness of the cross training, remembering that the team members require on-going practice to stay current with their new skill.


Take the lesson that the geese have taught us and implement cross training to ensure high quality, uninterrupted care to your patients.  As with geese, employees have greater potential working as a team than by flying individually on their own.  Next time you look up in the sky and see geese flying in formation, ask yourself “do our employees work together as an uninterrupted team, confident that your team has been trained to assist or take over if there is a break or change in your formation?”  If your team is flying out of formation, take the first step to cross training today, confident that in 6 months

your team can be flying in a V formation, as strong as the geese used as their role model.

Reliability, responsiveness, feeling valued, empathy and competency – they shape the first and lasting impressions about your office. Having the determination to always do what is in the best interest of the patient is the backbone for creating systems that allow the seamless delivery of excellent, consistent patient care. Patients are looking for the “silver bullet” in orthodontics- the enthusiasm, the WOW factor, countless other spoken and unspoken moments, and then some. It is the culmination of several little things that all add up to the patient’s perception of your office, from the initial referral through the completion of the retention phase.

Just as a precise combination of numbers is required to solve a Sudoku puzzle, orthodontic practices must have detailed systems in place that are closely integrated throughout all areas of the office to meet and exceed patient’s expectations. When one number is out of place, when one system is weak, the patient’s perception of your practice suffers. Just as a solid foundation is needed to ensure the stability of a building, a network of closely monitored protocols and systems is critical to the success of today’s orthodontic practice.

1. Walk the Talk with a Mission Statement You Embrace
One of the first questions I ask new clients is what made them decide to pursue a career in orthodontics. Was it something they were interested in as a child or was there a role model or mentor that encouraged them to venture down the path to orthodontics?

One of my favorite clients (and I am proud to also call her a friend), Dr. Teodora Bonney, told me the story about her introduction to dentistry and orthodontics, starting when she was a young girl in Romania. Her favorite game was pretending that she was a dentist. Her handpiece was the handle of a jump rope nailed to the casing above a doorway. She used colored straight pins pushed into the jump rope handles for burs (each color was a different bur, inverted, cone, etc.) and she used small candy to fill the cavities in her cousin’s teeth. Her interest and passion in dentistry followed her throughout her childhood years, leading to her graduation from dental school in Romania. After moving to the United States she went back to school to get her U.S. dental degree and then completed her residency in orthodontics, allowing her to fulfill her dream of becoming a phenomenal orthodontist.

Talk about the foundation for a powerful mission statement! A little girl in Romania with a dream to make a difference in patient’s lives through dentistry becomes reality in Pennsylvania, USA. Patients reading her story will get swept up in her passion for the lifelong benefits of orthodontic treatment. Her mission statement is currently under construction, however there is no doubt that some of the key words she will use will be compassionate, caring, gentle, family, highest quality, fun (how can it not be fun after using candy as amalgam), and committed to creating perfect smiles for life. She has given a lifetime of dedication to the dental field that has spanned two countries and touched countless lives. That is what orthodontics is all about – making a difference in our patient’s lives.

2. Initial Impression
Joseph Cornell once said “Look at everything as though you are seeing it for the first time, with the eyes of a child, fresh with wonder.” We only have one chance to make a first impression, whether it happens when the patient is handed your business card, the initial call is made to your office or when someone visits your website for the first time. Evaluate every aspect of your patient’s pre-exam experience, from the appearance of your business card through the scheduling of the initial appointment.

Business card or referral form: Have a logo that stands out and reflects the personality of your practice. Use an easy to read font in an appropriate size and color. Remember, not everyone has 20/20 vision! Make sure that your website address is printed on all forms that you use.
Website: Keep your website updated with current information, team member photos and office/patient activities. Consider including video testimonials of patients who have completed orthodontic treatment. With today’s population being so computer savvy, 85% of potential patients will check out your website before they make the initial telephone call. Constantly monitor your website to see your page position if someone “Bings” for an orthodontist in your area.

New patient telephone call: Make sure the administrative team is trained to take the new patient call correctly; both asking questions and giving promotional information to prepare for the initial evaluation. Role-play and practice ways to improve your customer service and “WOW” factor.

3. Flexible Financial Arrangements
With the hit the economy has taken over the past few years, people are more cautious than ever about deciding if, when and where to spend their discretionary dollars. In many households the decision to proceed with orthodontic treatment could cut into their monthly budget for food, shelter and clothing. To encourage patients to start treatment it is important to be “wisely” flexible and creative. This means that we can expand the possibilities for financing, however it is not to the patient’s benefit nor to the practice’s benefit to start treatment on a patient who cannot comfortably commit to the payment arrangements offered. We do not want patients walking away with braces on and then have buyer’s remorse, nor do we want to set up a patient for failure by stretching them financially beyond their capability.

Utilize credit reports to allow you to explore all options available for each patient. Promote in-office financing with no interest or service fee, ideally using automatic debit or credit card payments for their monthly installments. OrthoBanc is a fantastic company to work with to set up the automatic system for your office. This service reduces the time and energy spent on collections and offers patients a selection of dates to make their monthly payments. Enlisting the services of outside financing (Springstone or Care Credit) allows patients to spread their payments over up to 60 months. (No financial interest with the companies mentioned above.)
Take the time at the end of the month to compute the financial impact of losing patients. How many patients did not start because our financial arrangements were too rigid? Did we start any patients that in hindsight we should have waited until they were financially ready? Look at the numbers and use the information to help establish financial options that work for your patients and for you.

4. Value Your Patient’s Time with Effective Scheduling
The clock continues to tick, there is no way to stop it or to recapture lost moments. Often in orthodontic practices we see the hurry up and wait syndrome – everyone wants to come in before or after school. Mid-morning to early afternoon hours are often slow and sometimes unproductive. Just as wasted time is not financially profitable for the practice, waiting time sitting in your office can be a loss of income and source of frustration for patients and parents. The number one concern I see on patient questionnaires pertains to scheduling, whether patients feel that the office runs behind or they are not able to schedule an appointment at the desired time. It is important that we put as much, if not more, value on patient’s time as we do on our own.

Be proactive and design a schedule that fits the needs of your patients and the practice. Consider implementing a customized, doctor time schedule to maximize the hours you have with patients, reducing wasted time and doctor overload. Take the time to do procedure timings and counts to give you the necessary information to create templates that will allow the seamless flow of patients throughout the day.

Think outside of the box and implement programs to encourage patients to come in during your slower, school time hours. A couple of examples of this would be:

*The Brunch Club – offer patients a 5% courtesy off of their total fee if they commit to scheduling all of their appointments during our “non-prime” time hours (typically from 10:00 – 2:00). At the completion of their treatment, if they have followed the Brunch Club guidelines and kept their account current, they receive the courtesy.

* If you use an incentive program, such as the Reward Hub, offer the patient additional points if they schedule and keep their appointment during “non-prime” time hours. It is surprising how flexible a patient and parent will be about missing school or work if there is an extra benefit for them.

5. Keep the Communication Flowing
Don’t stop the communication with parents once treatment is started. We cannot assume that patients will keep their parents updated after their orthodontic appointment. The saying “Nothing, Nothing, I Don’t Know” has been the universal language of children and teenagers for decades.

Parent: What did the doctor do today? Child: Nothing
Parent: What did the doctor say? Child: Nothing
Parent: When do they want to see you again? Child: I don’t know

Take the time after every appointment to do a brief 1 minute update with the parent or guardian. Quickly review the following five points:
1. What we did today along with any specific instructions
2. What you should expect as a result of today’s visit
3. How soon do we want to see the patient again
4. What will the next appointment involve
5. How is the patient doing overall (OH, compliance, progress of treatment, etc.)

This one minute will keep the parent in the loop, increasing overall patient compliance.

6. Keep your Referral Source in the Loop
A common complaint from referring dentists is that they feel as though they lose patients into an abyss for two years when they refer a patient to an orthodontist. They hear nothing about the progress of treatment and unfortunately at times the patient neglects to see the general dentist for their semi-annual cleaning and check-up. In their minds, why do they need to see another dentist, they are already seeing the orthodontist every 4 – 8 weeks?

Strengthen the partnership between you and your referral offices by implementing an oral hygiene program to encourage patients to see their general dentist every 4 – 6 months. Send a letter to your referring doctors explaining the program along with the benefits to the patient and referral office. Following is an example of the oral hygiene form that is given to the patient. The bottom of the form has a place for the dentist to sign along with room for them to add comments.

Dr. __________________ and your general dentist work together closely during your orthodontic treatment to ensure you maintain excellent dental health.

It is essential that patients maintain their regular examinations with their family dentist every six months (or sooner if recommended) during the course of orthodontic treatment.
Since Dr. _________ recognizes the critical importance of maintaining excellent dental health, our office has designed an incentive program to encourage patients to maintain their regular appointments with their family dentist. Just have your dentist or hygienist sign and date the bottom part of this letter when you have your regular cleaning and check-up. Return the form to our office and your name will be entered in our monthly drawing for a gift certificate (or add additional points on their reward card).

Please feel free to contact me if you would like to have a copy of the entire oral hygiene program.

7. Have All Team Members on the Same Page
When a goose flaps its wings it creates uplift for the birds that follow. By flying in a “V” formation the flock has 71% greater flying range than if each bird flew alone. When the lead goose tires, it moves back and another goose flies to the point position. The geese flying in formation honk to encourage the birds in front of them to keep up their speed. Geese instinctively know how to fly together to blend strength, skills and capabilities. If a goose becomes sick or leaves the formation, the remaining geese immediately take over without interruption to their flight.

What can we learn from the lessons of the geese? If one goose is out of sync it weakens the progress of the entire flock. As with geese, team members need to work together, to provide the best possible orthodontic experience for the patient. Cross train all employees to ensure that someone is always available to step in without interruption if another team member is unable to work. Establish clearly defined job descriptions so all team members know what they are supposed to do, when they are supposed to do it and the time frame. Informed, cross trained team members results in a happy team, happy doctor and raving patient fans.

8. Measure Your Performance
Continue to perform on-going evaluations of your patient’s perception of the practice, remembering that their perception is your reality. It is too easy to become complacent when things are going well, when you think you are operating on all cylinders. Measure the patient experience by using mystery shoppers, questionnaires and follow-up telephone calls. Use this information to determine whether there is a disappointment gap – the difference between the patient’s expectations and reality. Map the gap to institute changes that will improve patient care from the inside out, utilizing the information for an opportunity to learn and improve your systems and communication skills.

Make a list of everything that might be contributing towards a negative perception of the office by patients, parents, referral sources and the community. For each “learning opportunity” list one action you will take to make an improvement. Challenging patients and parents often do not respond to logic with logic, they react with emotions. The solution is to deal with the emotions first (theirs and yours). The brain will not deal with logic until the anger and frustration have been put aside.

Keep tuned in to your patient’s needs remembering that your impression of what they want might be very different from what you thought.

9. Stay Ahead of the Technology Curve
New technology is emerging on a daily basis. What was new yesterday is outdated technology today. Although it is fun to get all of the newest bells and whistles, new “toys” are expensive and must be purchased wisely. Evaluate your current systems to determine what technology changes can be made to improve your patient experience on a daily basis. Prioritize your wish list, making note of the technology that is changing the quickest and financially feasible. Although it is fun to have the latest gadgets, it is best to wait until they have been out for a while to ensure that all of the kinks have been worked out.

Management software is one of the first major purchases a practice makes and is often under-utilized due to lack of training. Spend the extra money to get a solid software system that offers excellent support and stays ahead of the technology curve. Do not become complacent with the program once you have it. Invest the time and money to send your team to the annual user’s meeting to ensure that you are maximizing all aspects of the program.

Save a tree and make the jump to paperless. From computerized charting to the signing of forms on a tablet, everything is available with a couple of key strokes. Just think – no more searching for lost charts or paperwork.

Lessons we learn throughout childhood, from our elders and through life experience are often more valuable than what we glean from books and the internet. Growing up I remember my grandfather Bubba stressing the importance of reliability. On his knee I learned rules that would follow me every step of my life:
1. Do what you say you are going to do
2. Do it when you say you are going to do it
3. Do it right the first time

Just as in life, patients will walk away if they do not feel valued as an individual. 68% of the time when we lose a patient it is due to poor care or a rude/indifferent attitude. Let this be your wake up call. Give patients and parents your utmost attention and respect, making sure that you are tuned in to their needs. Surprise them by surpassing their expectations. Following these simple rules will help ensure that you successfully complete your Sudoku puzzle and will have the systems in place to ensure consistent ESP- exceptional patient care.

Debbie Best, practice management consultant and lecturer for Consulting Network has over 35 years of experience in the dental and orthodontic field. Debbie evaluates staffing needs and systems to develop a strategic plan to enhance patient care and practice productivity. She designs customized schedules, personalized job descriptions, and a team member handbook to fit each practice’s needs. As a part of her consulting program, Debbie also focuses on the role of the administrative team, financial controls, anti-embezzlement protocol and practice building.

To Contact Debbie: Phone- (925) 447-6993, Fax- (925) 447-6994
Website: E-Mail:

Patient surveys conducted in practices over the past few years have opened our eyes to the criteria patients and parents often use to measure their satisfaction with their overall orthodontic experience. Although we would like to “fool” ourselves into thinking that our patients are excited and more than pleased with the excellent orthodontic results that we achieve, the overall experience can be negative in their eyes if the practice does not have solid protocols and systems in place.  Did we exceed their expectations, not only in the treatment results, but also during the journey from the initial appointment to the removal of the appliances?

One area of the practice that continually seems to be a bone of contention, not only with the patients but also with the team and doctor, is the schedule.  Do you sometimes feel as though the schedule is your most difficult employee?  If an employee had the following inadequacies, would you expand their employment opportunities?

  • Typically does not start the day on time
  • Runs over often at lunch and at the end of the day
  • Does not have time available when the patients or doctor need it
  • Is inflexible and not open to change
  • Is often running late
  • Presents roadblocks to offering excellent care to patients
  • Is inconsiderate of the doctor’s time
  • Causes conflict between team members
  • Does not allow you to reach your production and collection goals
  • Does not allow room for growth

If you would not allow an employee to get away with the above behavior, why would you continue to use an inadequate schedule?  Remember that one of the most common complaints patients have about orthodontic practices is the schedule.  If your schedule does not suit the needs of your patients and parents, it definitely can be a detriment to the health of your practice.

The same schedule does not work for every doctor.  Just as your treatment protocols are unique, your schedule should be a reflection of your treatment style and philosophy. It should be flexible enough to offer patients a variety of appointment times and dates; however, it should be conformed to fit the needs of the doctor and team. What are the goals of a “perfect schedule”?

  • Run on time
  • Have an adequate number of appointments to see all patients
  • Allow time for non-patient duties
  • Flexible
  • Allow for target production and collections
  • Steady pace throughout the day
  • Patient satisfaction
  • Allow room for growth
  • Allow opportunity for training
  • Minimum of 6 non-patient weeks per year

In my 35+ years of experience in the dental and orthodontic fields, I have found that the best option for most orthodontists is a customized schedule that is based on doctor time.  Decisions that need to be made before you design a new schedule are:

  1. What is your practice philosophy?
  2. What are the goals for your practice?
  3. What are your production and collections goals?
  4. How many starts per month will it take to meet your goals?
  5. How many clinical chairs do you have available to see patients?
  6. What hours would you like to see patients?
  7. How many hours or days per month can you commit to non-patient time?
  8. What will your patient rotation be?
  9. What is your new patient to treatment protocol?
  10. Do you want to implement the patient manager program?

Create a schedule that reflects your practice philosophy and goals.  Every orthodontic practice is unique; your goal is to implement a schedule that will build on what has made you successful and stand apart from your competition.

Most orthodontists will bring in an expert in the area to facilitate the creation of a customized schedule.  When I work with offices to set up a doctor time schedule, we go through the following steps.

Gathering the data:

  1. Develop a detailed procedure list.
  2. Time all procedures a minimum of three times for each clinical assistant.
  3. Count the number of times you schedule each procedure (in the future, not what was done today.)

Evaluating the data:

  1. Design an appointment type for each procedure, using the average time for assistants and doctor.
  2. Add time to each procedure to allow time for clean up and set up.
  3. Try to combine appointment types to keep the maximum number to under 25.
  4. Determine from your counts how often you need each appointment type on a daily, weekly and monthly basis.
  5. Run the numbers to determine the number of clinical assistants you require to see the desired number of patients.
  6. Determine the number of days you need to work per month to accommodate all needed appointments.
  7. Determine the number of new starts (production) you require on a monthly basis to meet your production and collection goals.
  8. Allow room for growth.

Designing new schedules:

  1. Develop your appointing rules (what time of the day do you want to do production appointments, what type of appointments do you want to have available before and after school, when do you want to see new patients, etc.)
  2. Assign a clinical chair to each assistant to allow your clinical team to stay with the patient during the entire procedure.
  3. Build multiple schedule templates to allow greater flexibility of appointment times for patients.
  4. Consider building a production or start day to use when you experience an increased demand (before school starts, school vacations, when flex plans go into effect, etc.)
  5. Evenly distribute the appointment types between the clinical assistants to offer a variety of procedures during the day.  

Utilize your software program to accurately track your doctor time.  The program will indicate how much doctor time you have used and how much time is still available.  You will be alerted if you try to use more doctor time than what is available.  By keeping a close watch on this valuable scheduling tool you will maintain control of your schedule.

Although it takes considerable time and energy to design a customized schedule for your office, remember that it can be one of your most valuable marketing tools.  It is up to you whether it becomes a positive practice builder or a negative “employee” that everyone hopes will just disappear.  Be proactive, embrace the schedule; allow it to reduce stress and let your practice soar.