Practice Management

Increasing Focus On Effective Operational Protocols


Ron Weintraub


April 15, 2015

April 15, 2015

As practitioners, our major focus has us so engrossed in providing successful clinical outcomes from our hands-on treatment that we may neglect our attention to evaluate and manage our office team. Many aspects of a successful practice, however, depend on various components of the team being fully effective. Therefore, becoming cognizant of reasonable expectations and establishing effective criteria to apply to our team’s performance gives us a baseline from which to evaluate them, particularly, the performances of the Hygiene Department and the Front Line Administration Staff.


Notwithstanding the excellent clinical and motivational skills many of our hygienists bring to bear, it is our continuing responsibility to direct the patient recare interface. We should set the appropriate treatment choices with which patients are presented. This determination should be a collaborative process with hygiene providers to develop appropriate protocols. Dentists/owners should be aware of what is actually delivered in the hygiene department as many of our patients are most often seen in the recare mode, only by a dentist who performs an examination and interprets radiographic information at appropriate intervals.

We often leave the delivery of scaling, prophylactic irrigation, and preventive procedures solely to the discretion of hygienists partially because of our trust in their expertise and partially to allow us to attend to tasks in the treatment room. Often we leave the prescribing of necessary preventive periodontal treatment to the discretion of the hygienist. The patient perceives little of our active role in this crucial aspect of patient care.

This amounts to perhaps a degree of abdication of our responsibility to manage our patients’ care. In our practice enhancement role, we often question the dentist as to what their hygienist typically offers the patient required in a value-added manner in the 45-60 minute time slots typically requested for a recare/preventive care visit. We are often confronted with a blankstare, and sometimes the answer is what-ever the hygienist thinks appropriate. In offices with more than one hygienist, the protocol will probably vary significantly in the absence of a set policy. In addition, when patients are offered necessary enhanced hygiene services, are they instructed on the value to their oral health that this represents and are the patients being billed accordingly?


The Front Line Administration Staff include• Receptionist• Schedule Coordinator• Treatment Coordinator and• Office Manager.

This group is tasked with optimizing the success of the clinical environment by ensuring successful core support functions. Among the vital tasks they need to perform are the following:1. Greeting patients by name as they arrive and ensuring they are apprised of any delay to being admitted to the clinical area. In the exiting mode, are they effectively discharging and recording the patient’s next appointment after enquiring if everything went well during their current appointment?2. Answering telephone inquiries in an upbeat, welcoming manner, quickly attempting to identify the patient, and finding a solution to resolve positively the patient’s reason for calling. We need some checks and balances to assure the team has the proper training to deal with telephone inquiries and the inevitable short-term cancellations. Moreover, the team needs to be capable of converting a cancellation to fill any available schedule openings appropriately on the same day.3. Projecting a positive vibe instead of behaving as if the caller were bothering the receptionist keeping him/her from some other more important tasks. One can only picture the often-occurring interchange with a busy medical office.


Task assignments need to be specific. Questions to ask regarding these assignments include the following:1. Is there a designated Schedule Coordinator? One member of the administration team should be delegated to be responsible to keep the schedule intact and viable. In smaller offices, this can be a shared role.2. Is there a Chart Auditor? Is it anyone’s job description to conduct periodic chart audits to uncover patients who have “fallen through the cracks”? Those who are either not on a regular recare protocol or have outstanding treatment previously diagnosed but have not followed up with a scheduled appointment need to be addressed.3. Who is responsible to cross-reference any family members who might have had to change an appointment and have not as yet been rescheduled?4. Who has the responsibility to provide “New Patient Intake” so that this “Evermore Scarce and Valuable” resource is introduced properly to the office and encouraged to refer other connected individuals to our care?5. Who on the administration team is responsible for building and maintaining relations with new and existing patients? Building a relationship with patients encourages loyalty.Once identified, how do we go about realizing our expectations? One way is for the practitioner to step back to examine objectively the existing operation to see how the office procedures rank with a proven optimal set of protocols. If outside help is necessary to provide what we call a Complete Opportunities Analysis, there are a number of practice management organizations that could be called in to provide an unbiased assessment and recommendations for improvement and implementation of the results of these and other crucial areas for practice enhancement.