Don’t Get Fooled by Numbers

We recently attended a dental meeting where a presenter made a “big deal” over their office generating 70 new patients per month for the past several years.  My back of the napkin calculations would indicate that this means they are generating 840 new clients per year.  On the surface this might seem like really good news.  We all know our attrition rate is about 10% per year so we need to have new clients just to stay even.  But how many do we really need to be productive.   Let’s step back and do some more in depth analysis to see how this would work out in an office that is practicing what we would term comprehensive care.  That term means: through initial exam including necessary radiographs, photographs and periodontal charting, comprehensive diagnosis and treatment plan, personal consultation and financial plan before treatment.  We will use information from out office as we do not have data from the presenter’s office. 

In our office we are working 4 ½ days a week.  That equates to 36 hours of available chair time per doctor.  For an initial examination we allocate 30 minutes of doctor time and 90 minutes of chair time. We allocate diagnosis and treatment planning doctor time at 30 minutes.    We try to use non-productive time during the day to treatment plan.  Many cases will be very simple but some will require extensive time outside normal hours to consult with other colleagues, so this is an average.  We allocate 30 minutes of doctor time for a consultation and case discussion during productive time.  Our staff handles financial arrangements outside of that time.   We allocate an average of 90 minutes of doctor time before we begin to be productive with a new client.  Our presenter’s office had three doctors.  So let’s run some numbers and see what all those new patients do to a schedule.

Our numbers say that the three doctor practice has 432 hours available per month to produce.  If they use as much time as we do with new clients that eats up 105 hours leaving only 327 hours per month of production time.  If we allocate 90 minutes per day for hygiene checks that is another 81 hours of production time gone leaving only 246 hours per month to produce.  This assumes multiple hygienists with about 15 – 18 hygiene checks per day of only five minutes or about 9 checks per day at 10 minutes.  By the way – your hygiene department is where clients are educated on self care, reminded of the next steps for their long-term restorative plan and where relationship development takes place.  If your clients feel that the doctor is ‘rushed” in hygiene do you not think this is likely the perception of how the doctor is when doing restorative care? 

So what are we trying to say?  First, too many new clients in a mature restorative practice is not ideal.  What is the proper number?  You will have to do much more comprehensive analysis to determine what is right for you.  The ideal mix is driven by your desire and ability to deliver comprehensive, behaviorally adept care and your personal understanding of work-life balance and desire for financial reward.  Here are some questions to ask.  What is your active patient base?  Are you growing?  What is your hygiene retention rate?  You should have 85% or more of your patients actively appointed in hygiene with about 25% of that population in some sort of periodontal program.  This is the pool of folks that will drive your restorative practice.  What are you trying to produce per hour and per year.  Doctor should produce 65% and hygiene should produce 35%.  There is no one magic number but more is not always better.  Do the numbers for yourself.

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Accountability – You cannot ask for what you don’t deliver

We recently had the pleasure of attending a presentation facilitated by Mike Scott[1] where we discussed what is involved in being accountable, and how to improve accountability in our practice.  Mike emphasized a definition of accountability – “doing what you said you would do, as you said you would do it, when you said you would do it – with no surprises.”    This seems so simple until we step back and realize the level of tolerance we all exhibit for “non-accountable” people in our everyday lives.  In encounter after encounter we deal with people who do not feel that they need to be accountable or do not understand accountability.  This leads to a spiral of negativity and higher stress for everyone involved.  These are the folks who answer a question with “whatever”, don’t show up on time and leave jobs unfinished or poorly done. They leave us unsatisfied and wondering if they can be trusted.

Mike used an example of two boxes, one inside the other.  The outside box is the amount of time and effort we expend on tolerance of less than ideal behavior and the inner box is the level of accountability in your life or your practice.  The larger the inner box is the less time and stress is wasted in your life. 

How do we create an “accountable environment”?  It starts with assessing our own behavior.  What is our tolerance level?  How do we express ourselves when others exhibit less than ideal behavior?  Do we have the emotional intelligence to see the cause of the behavior and our response to it?   What is the tolerance we expect of others?  When our desk is piled high with journals and correspondence and staff is looking for an answer to a case question somewhere on the desk, are we exhibiting accountable behavior? 

Accountability starts with the leader of the practice.  It has nothing to do with being ”tough” or demanding.  It starts with modeling the behavior you expect from others.  Start in small ways to live the definition of being accountable.  If you cannot deliver on your commitment be the first to talk to those involved and offer solutions to get to the goal.  When others miss a deadline DO NOT ASK WHY. Asking why allows the person to have an excuse.  Instead ask what is their next step to get the job done?  When will that be?  And can I count on you?  Empower your staff to take creative action and let them know that you “have their back”.

Some steps to move toward higher levels of accountability are:

Model the behavior you expect from others.  When you discover you have been tolerating non-performers help them find another career.  There is far less stress in training a motivated performer than in dealing with the daily “surprises” and excuses of a non-performer.

Grow the level of accountability by making time to train yourself and your staff.  Celebrate success and communicate openly and clearly about being accountable.  Use agendas and checklists for meetings and create action items and accountability lists – these are all available on the web.

You set the “culture” of your practice.   Be accountable and raise the standard of care for all. 



[1] www.totallyaccountable.com