Ep. 118: The Office Manager’s Daily Routine, Part 1
We’ve discussed the importance of having a well-trained Office Manager and their general job description—but what should they actually be doing all day? In this two-part series, we cover the Office Manager’s daily duties and routine to keep their practice running efficiently and productively.
Links:
Running the Day Checklist - https://www.mgeonline.com/running-the-day-checklist
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QUESTIONS FROM THIS EPISODE
What is an office manager actually supposed to be in a dental practice?
In MGE's view, the office manager is the practice's executive, the equivalent of a CEO in corporate America. They're responsible for running the business, plus its expansion and profitability. In smaller practices they may be "double-hatted" (also working as a treatment coordinator, for example), but the executive role is the job, not answering phones or filing insurance.
Who should attend the morning meeting, and how long should it take?
Everyone involved in delivering or diagnosing dentistry: doctors, hygienists, key assistants, the scheduler, treatment coordinators, and the financial coordinator when needed, with the office manager chairing. If the first patient is at 9:00, everyone arrives by 8:30, and the meeting itself should take about 10 to 15 minutes. Very large teams break into smaller team meetings that the office manager coordinates.
What does a good morning meeting actually cover?
Two things. First, statistics: where the practice stands for the day, week, and month against its targets, reported by the person who owns each number. Second, a patient-by-patient plan for the day, called the lineup: who presents which treatment to which patient, when the doctor pops into hygiene for exams, and who handles financing. Clinical topics belong in a separate clinical meeting.
Why should each statistic "belong" to a specific team member?
Because reporting a number is not the same as being responsible for it. The scheduler owns production, so instead of just announcing "we only have $3,000 scheduled today," they walk into the meeting with a plan to close the gap. Staff have to be trained into that level of ownership, and giving them that responsibility is how they grow.
My hygiene schedule has no outstanding treatment, but my incomplete-treatment list is huge. Why?
That's poor hygiene utilization. Limited hygiene slots fill up with your most compliant patients, who have already completed their treatment, while the middle 60% of your patient base (where the unfinished treatment lives) never gets reactivated. The fix is growing recall capacity, not leaning harder on unpredictable new patients.
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Jeff: Do you have an office manager? And if so, how would you rate their job performance? While having a team member with the title "office manager" is fairly common in dentistry, what this title means and the responsibilities it includes tends to vary. For some, it's the senior-most front office person. For others, it might be an administrative assistant who pays bills. And for some doctors, in the best-case scenario, what's expected is a fully functioning and productive executive managing every aspect of a dental practice.
Now, we've spent a couple of prior episodes discussing the general nature of the OM position, at least from our perspective, including how to find a good one and the broad strokes as to responsibilities and duties and so on. What we haven't had a chance to do yet, until now, is a deep dive into what an office manager's job looks like on a day-to-day basis. How the day should start, where they should place their focus, critical day-to-day management actions, as well as how to rate their performance.
So that's what we're going to discuss on this week's and next week's episode: the office manager's day-to-day functions. And we're taking two episodes on this to make sure we really do it justice, so you can use this against a checklist, which we're also going to be covering, to ensure you have a full understanding of it and can use it in your practice.
My name is Jeff Blumberg, I'm your host, and I'm joined this week by Sabri Blumberg, our Deputy COO. If you've listened to the podcast, you definitely know Sabri. Sabri, I think we have you all set up over there?
Sabri: I'm ready now.
Jeff: If you haven't heard Sabri before, just to tell you a little bit about her: Sabri is in charge of all technical delivery here at MGE. She's our senior-most technical executive. Sabri's worked with thousands of MGE clients, from small practices to large practices, and if you're an MGE client or have been around MGE, you definitely know Sabri. So I'm really happy to have you on again this week.
Sabri: Thank you. This is going to be fun. We've been looking forward to doing an episode like this for a while.
Jeff: Absolutely. Okay, so I think the best place to start would be, let's say this is someone's first episode. What is our viewpoint on an office manager? What is an office manager for a dental practice, in broad strokes? What are they responsible for?
Sabri: MGE's viewpoint always has been: treat a dental practice like a business. Obviously, the business itself makes healthy patients, it's healthcare. But the structure has always been patterned after traditional business systems. And there is no title "office manager" in regular business, per se. It's more of a healthcare title. The equivalent title in corporate America would be CEO. So they are responsible not just for the running of the business, they are responsible for the expansion and profitability of that business, and everything that entails. They are not necessarily a worker. They don't necessarily answer the phone or file insurances. The CEO wouldn't do that.
Jeff: Unless it's a smaller business.
Sabri: Unless it's a small business. And you see that in every business, and you see it in dentistry a lot. It might apply to the people listening right now. If you have a smaller practice, obviously the office manager isn't just going to sit in an office and run the practice. They might be what we call double-hatted, meaning they have more than one hat or position. They might be a treatment coordinator, or filing insurances themselves, while also being the office manager and actually running the business, because the practice isn't big enough to justify hiring someone for that job alone.
Jeff: Got it. So that's what we're talking about when we say office manager: an executive. And the points we've made on prior episodes: sometimes the doctor has this viewpoint of "well, I'm the owner, so I should manage the business." But 90-plus percent of the time, the doctor is most valuable to the business chairside, if they're the doctor-owner. And there's just no way you're going to pay what you would pay a doctor to manage your business either. So it makes sense to have somebody who's actually running the business while you're focused on patients.
Sabri: Correct. Who coordinates and meets with the owner and works off the owner's policy.
Jeff: That makes sense. Okay, good. So now we really get into it. I know you have your office manager checklist there.
Sabri: Yes. There's a lot of writing on it.
Jeff: There is a lot of writing on it. And we're going to go through it from the perspective of: what are they doing in the morning, what are they doing in the afternoon, how does the day end, what are they doing every week. Folks, we'll have this checklist as a download. This is something you can work with your office manager on, or if you are an office manager, it's something you can start using in the practice you're in. Alright, so let's just start. How would the office manager's day start?
Sabri: Running day to day, the first thing they should focus on is preparing for the morning meeting. A lot of practices do morning meetings, but, just like "office manager" could mean just about anything in healthcare, so could a morning meeting. I've seen morning meetings that are clinical meetings. I've seen morning meetings that are motivational meetings. I've seen all kinds of morning meetings. This is a morning meeting that coordinates the sales of the practice and the actual production of the practice. We're focused on what's going to happen in this practice today that could be represented statistically.
Jeff: Now, how would that differ from, let's say, the dental assistants and the doctors and maybe even the hygienist wanting to coordinate how they're going to handle Mr. Smith at 11 who's really scared of coming to the dentist, or what cement they're using for these inlays? That would not be covered in the morning production meeting, correct?
Sabri: No, because that's more of a clinical meeting. And if you have a larger clinical team, they should have a meeting like that as well, just to make sure everybody's on the same page.
Jeff: Okay.
Sabri: Now, there are a lot of things on this checklist that assume you understand, or are knowledgeable in, business itself, and not just the systems of dentistry. So I'm going to run through it and then explain a little bit: this is the system, this relates to business knowledge, and this is why we do these things.
Jeff: Got it. Alright, so let's start with the morning meeting.
Sabri: Morning meetings can become really annoying for everybody when they're not run well and people aren't prepared. So the first thing you need to do is make sure everybody's prepared for the morning meeting, and I'll get more into that later. And you need to make sure the information being brought to the meeting is still up to date, because usually that preparation happens the night before. So the first thing that should happen is we make sure our schedule is correct.
Jeff: And this is just something I know is a thing for you. Because we're talking about a morning meeting where we're going to get statistics for the practice: where are we so far for the day, the week, the month. And then we're going to take a look at who's coming in today and what we're going to do with them. But this pet peeve I know you've had is where these morning meetings devolve into the office manager running it, which is better than having no morning meeting, and the office manager just talks the entire time. Nobody says anything else. It's a morning lecture.
Sabri: Right. And the thing you want to do as a manager is make sure people are taking responsibility for their individual areas. You don't want to operate like you're always giving the orders and everybody's just following orders. You want people to think with: this is my job, and this is my participation in getting the patient healthy. And you are bringing your own data to the meeting.
Jeff: That's the reason I ask. Because obviously schedules change. So the first thing that has to be checked before people walk into the meeting is what's changed about the schedule. If you have a schedule coordinator, I'm assuming that's their job. They walk into the meeting with: okay folks, here's what's going on with the schedule. Any changes, any cancellations, anything we need to know about, an emergency just called and wants to come in.
Sabri: Correct. And we want that data before we start the meeting, so the plan we work out for today is as accurate as possible.
Jeff: Okay. And since we're doing a deep dive, we may as well just talk. Let's say the first patient is at nine. When would this morning meeting start?
Sabri: I would say everybody be there at 8:30. Make sure everybody's prepared, that we've had a chance to get the messages off the schedule and make any last-minute changes we need to make in order to make the day right. And then give yourself about 15 minutes for the meeting. It's a little dependent on the size of the practice.
Jeff: That's true. If it's a larger practice, you need more time.
Sabri: If I have one doctor with no hygienist, and it's just a front desk and a doctor coordinating, it'll take 10 minutes, and that's including sitting down. If I have five doctors, three hygienists, and multiple front desk people involved in the sales to the patients, now we have a longer meeting, where we might even want to break the meeting down into different teams.
Jeff: Right. And I guess that's part of the issue, why some people find meetings to be just terrible: people drone on and don't get to the point. Maybe I'm just talking about myself.
Sabri: No, you're not talking about yourself.
Jeff: You know me. I am a fan of meetings and what they should accomplish, but I'm not a fan of taking longer than I need to, because meetings aren't production. They're organizing for production.
Sabri: That's right. We're just coordinating production. What do I need from you in order to do my job, and what do you need from me? It's like if we're having a meeting here to go over what's happening with our clients: I'm doing that for the clients, not for myself. To make sure everybody knows what they're supposed to be doing. I don't need to unnecessarily drag it out or add a bunch of stuff people don't need to know. Let's get down to business and get it done. Meetings should be very boom, boom, boom. And it's not just a pet peeve of yours and mine, meetings that run long, or where one person lectures and gives all the orders with no participation. I run all the meetings, so that doesn't happen to me.
Jeff: You are pretty quick with your meetings.
Sabri: But it's actually the number one reason I run into, besides not knowing how to run the meeting, why a practice decides "we should have morning meetings" and then the meetings disappear after a few weeks. They're so unstructured and so unproductive that even the doctor gets sick of them.
Jeff: Well, if someone's saying "I have to go to work, so I can't go to the meeting," that's usually a red flag.
Sabri: Very red flag.
Jeff: You and I have both heard that. Even if you're just thinking it, like "can this meeting please be over so I can get some work done," there's something wrong with your meetings if that's what's happening. Alright, I've sidetracked this a little, but I wanted to really explore it. We're doing our morning meeting. The scheduler makes sure the schedule is all good and reports any changes. So then, who's at my morning meeting? Because we can have an office with four people in it, or 40. Minimally, give me small practice to larger practice.
Sabri: Ordinarily you would have anybody involved in the delivery of the dentistry or the diagnosis of the dentistry. So we're talking about hygienists, key assistants, doctors, in the back and in the front. Obviously your office manager, treatment coordinators if you have them, your scheduler, and then if necessary, your financial coordinator. That's pretty much the irreducible minimum that needs to attend. And as I said, if you have a team of 60 staff and all these providers, you break this down into separate teams. You might have one treatment coordinator that works with these two doctors and one that works with these two, and they're having their own meetings that way. The office manager coordinates everything from those teams and gets the information afterwards. You obviously can't attend five meetings at the same time.
Jeff: I've also seen it where you might have a junior office manager type running each meeting, and the office manager bops between them, makes sure they're happening correctly, and stays on top of it. But that's a big office.
Sabri: That's a big office, not a smaller office.
Jeff: Okay. So we've got who's there: our financial coordinator, scheduler, treatment coordinator or coordinators, our docs, our hygienists, any key assistants who are integral to the sales and delivery process. And we're starting our meeting. The office manager is chairing it. What are we covering?
Sabri: The first thing we cover is we take a look at where the statistics are, month to date.
Jeff: Okay, practice statistics. Now, I know we teach our clients to manage on a week-to-week basis, which we're obviously not going to get into in a podcast. We cover that in the MGE Power Program. In a nutshell, the reason we say week to week, and you can tell me if I'm wrong about this, Sabri, because this is the example I've always used: the common time interval used in dentistry for management is a month. How'd you do this month, what did we collect this month, or a year. You don't hear "quarter" a lot, funnily enough. The problem with managing on a month-to-month basis is, if you set a target of "let's do a hundred this month" and you're not monitoring it on a shorter-term basis, daily or weekly... I mean, you probably saw this with new clients. You'll get a call from a new client who's supposed to do a hundred, and they're at 30, and it's the 23rd. Nobody was looking at what's going on, and now they're panicking: how am I going to handle this month?
Sabri: That's right.
Jeff: So you break it down into shorter time periods. If you're doing it week to week, which is good, and we get into the why in the Power Program, you have a little more control. That office that was only at 30 by the 23rd would have known they had a problem by the fifth or sixth, and they would have adjusted. So we're looking at where we're at for the week and how that relates to our monthly target.
Sabri: That's exactly right.
Jeff: And since we have the time to discuss it: these statistics belong to somebody. They don't belong to all of us, or to just the owner or the office manager. And this is interesting, because we've been in a lot of offices and we've seen this. Obviously, keeping a statistic is better than no statistic. But what I've seen is someone will be the scheduler, and the scheduler's statistic would be production. I've seen other ones used that I'm not a fan of, like percentage of appointments kept.
Sabri: For a hygiene coordinator that would be okay. But not for a scheduler.
Jeff: Right, because for a hygiene coordinator, the appointment value is similar each time. Whereas if I'm a doctor's scheduler, one appointment could be worth $12,000 and another is a free reline. That doesn't work. So the scheduler's stat is production, and they sit in the meeting, and the office manager says, okay, where are we at for production? What did we produce yesterday? "So far this week we've produced $10,000. We did 5,000 yesterday. We're at 46,000 for the month." They're reporting the statistic, which is great, but there's no ownership associated with it. Like you just said, it belongs to someone. I think you talked to somebody's staff member once, I remember you telling me this, and they thought their job was just to give that number to the office manager. To keep track of the number. They didn't associate that they're responsible for it, that the number belongs to them and is a reflection of their productivity.
Sabri: That's right. They had no idea.
Jeff: It's almost like me looking out the window going, "oh, hey Sabri, there's a bird."
Sabri: Exactly. "I found a bird for you."
Jeff: "There's a hummingbird." As opposed to: no, I'm responsible for this. This is my number. This tells you whether I'm doing a good or bad job.
Sabri: That's right. All the actions of this person's job should culminate in production. Therefore they are responsible for it. They're the ones who control it in the office. Now, obviously there are weekly and monthly quotas, and these quotas are set based upon what's viable for the office and expansion. There are different ways you set quotas.
Jeff: I'll interject that we use the word quotas, meaning an amount you're supposed to produce. Other people might use the term goals, or targets. It's basically the amount you're setting that you want to hit for the month.
Sabri: Yeah, it's a goal. So let's say it's Wednesday, and the quota for the week is 25,000 in production. If I'm the scheduler, what I'm supposed to say is: alright, month to date we're at this much. Week to date, let's say we're at 10,000. It's Wednesday, so we're on track. Today we have enough production scheduled to stay on track. Give a little report on what's going on, and that we're on track for the day. Or, if we're not on track, what needs to happen to get back on track.
Jeff: And here's something, I know we're doing this checklist, but this is gold, because this is the thing that you've noticed and I've noticed goes really missing. Not only should I be associating that statistic with myself... okay, I'm supposed to do 25,000 in production this week, and obviously I'm dependent on the doctor to a degree, but that's why we're having a meeting, we're coordinating all of this. I'm supposed to take ownership. This belongs to me. I'm production. So it's Wednesday morning, we're supposed to do 25, we're open five days, and I report: we have 5,000 on the schedule today, or whatever we're supposed to have to be on target. Tomorrow we've got six. The following day looks good. We're on track for 25, no problem. That's good. But now let's take the other side. We needed five or six today to stay on track, but we're only at three. So I go: okay, we're supposed to do 25, but we're only at three today. Here's a problem.
Sabri: There you go. Ideally, this person walks into the meeting with: okay, we only have three lined up. Here's what I'd like to do to resolve that. Here are the ideas I have to get back on track, and that's why I'm meeting with everybody, to figure out how we can all work together to do this. But I'm not just giving you my problem.
Jeff: Because the scheduler in this instance might want to coordinate: we have Susie Smith coming into hygiene today, and she has outstanding treatment. Doc, would you be willing to slide in there to get the production back on track? We have an opening here, Susie needs those crowns done, maybe you could talk to her.
Sabri: And I would let everybody know: here are the openings I have. So everybody's on the hunt, knowing what we're looking for.
Jeff: The idea is, at least I'm looking at how to solve this problem, because I'm really taking ownership. It's my problem. I'm not just deciding: well, I've reported the number, and we're not going to make it, and that's that. But that is pretty common.
Sabri: It's not just very common. It's actually the exception when somebody does it right.
Jeff: Well, here's all I'll say as an executive, because I've trained a lot of people. I think if you handle your staff that way, you're doing them a huge disservice, because most people would like to be more in control of their jobs. They'd like more control, more power, more capability, because that's where advancement comes from, and growth. So if you basically turn somebody into a person just reporting a number, and you keep all the responsibility for yourself, you're doing them a disservice.
Sabri: You're not just doing them a disservice, you're doing the entire organization a disservice, because you cannot expand that way. One person can't be responsible for everything.
Jeff: But I'm doing them a disservice too, because if I have somebody who really does want to grow, and I'm putting that demand on them: look, I need you, this is your thing, you need to handle this. I think that's how people grow.
Sabri: That is how they grow. But that brings up another point, which is the training component of the office manager hat. People don't ordinarily walk into a job with this mentality, or the ability to control, in our example, the production statistic. So the office manager is expected to have a training protocol in place to train the staff to be responsible for their statistic and to know how to resolve issues. You can't just yell at people, "why aren't you coming up with a solution," if you haven't trained them on how to do that. Getting to the point where you can run a meeting this way does involve the office manager actually training the staff properly, so they can be responsible for their position and statistics.
Jeff: Just out of curiosity, how often do you see this viewpoint out there? This no-control, no-causation viewpoint: I report the number, the numbers are bad, there's nothing we can do, it is what it is. Is that pretty common?
Sabri: Well, yeah, it is. But it's also created internally, by the executives. Because we're not even telling people, when we hire them, what we're expecting from them. When you hire somebody, how often do you say: your functions include keeping the schedule full, answering the phone, if you have an opening work the overdue list or your short-call list. You're just giving them all this stuff to do. You never told this person what all those actions, all that doing, is supposed to lead towards. You never told them: quite frankly, there are a bunch of things that need to happen that are part of the responsibilities of your position, but ultimately I'm hiring you for a productive schedule. That's what you're supposed to make. And the way I measure that is not by how many people are on the schedule, but by how much production actually comes off that schedule today.
Jeff: The reason I asked how often you see this: if it is a prevalent viewpoint, and maybe if you're listening you might have this viewpoint, that people just won't be responsible and really own their jobs and look at how to solve those problems. But I don't think that's true.
Sabri: No, we know it's not true. But if they haven't trained their staff properly and have stacked up enough failures... you fail at something too many times, then you start thinking that's just the way it is, it's not possible. Instead of solving the actual problem, which is that your training procedures aren't in place to create a person like that.
Jeff: And that also helps you detect if someone's a dud and you can't train them. There are obviously people out there who are not suited for that type of position, not suited for responsibility. But if you have somebody like that, you just wouldn't keep them on a position where you need somebody who can do that. So folks, they do exist, is my only point. Actually, the majority of people are like that.
Sabri: You're trying to give people hope, Jeff.
Jeff: I'm trying to give them hope. Alright, so, morning meeting. The first thing we're doing is getting statistics. We have a form for that, the statistics to keep, and I'll put it as a download. These are the stats you're asking for on a regular basis, by position. Okay, good. So once we've gotten the statistics and we know what's going on, what are we doing next?
Sabri: We're done with all of that, and now we're moving into the morning production section of the meeting. We have our stats, we know where we're at month to date, week to date, and all that kind of jazz.
Jeff: Same people are in the room?
Sabri: Same people are in the room. And let's first take a look at what we're trying to do in this section. In this section of the meeting, we're trying to coordinate the sales for the day. That's really all we're trying to do. And the reason is that nothing else happens in this practice unless patients are accepting their treatment plans. We can't get people healthy, we can't get any production, we can't get any referrals from happy patients, because they're not happy, because they didn't get their work done. Usually the biggest barrier to patients getting their work done is that they need to buy their work. So this is where we coordinate: who's going to educate the patient on what they need? Which provider is going to diagnose it, if there are multiple providers? If the treatment's already diagnosed, and that patient's in hygiene and it hasn't been presented, what part is the hygienist going to play? This is where we coordinate everything.
Jeff: It might even be re-presenting a case for a patient who was there three to six months ago, or a reactivated patient.
Sabri: Exactly.
Jeff: And we do have a handout for this, so I'll put it as a download: the morning production meeting handout. We've distributed a version of this handout for a while, and we've always seen things that could be tightened up when we go on site. So give your viewpoint on how this meeting should roll.
Sabri: Okay. This is the part where people have to come prepared. What do I mean by prepared? They have to know which patients they're seeing. If they're a hygienist, they have to have gone through the patients they're seeing that day.
Jeff: So I would have gone through: this is Joe Schmo at four o'clock, he needs four inlays.
Sabri: That's exactly right. And there are different sequences of treatment planning in dentistry. Not everything has the same importance. Somebody needing a root canal is not the same as somebody wanting a veneer. So treatment is usually broken down, as we discuss it here at MGE, into things that relate to health, things that would upgrade the function of what they have in their mouth, and things that are purely aesthetic, such as veneers, or sometimes Invisalign. So the hygienist, going through the patients coming in that day, takes a look at: who is this patient? Is there outstanding treatment already diagnosed? They look at the X-rays, because they might see, oh, there's a missing tooth here, yet there's nothing in the treatment plan about it. They make sure the existing treatment plan is complete. And they look at whether there's anything they'd suggest the doctor examine to upgrade function or aesthetics. They have these notes, and they come to the meeting having already done this, so we're not doing it as the meeting goes, because that just extends the meeting unnecessarily.
Jeff: Very much so. Plus, that opens the door to everybody talking about a patient and offering their opinion. "I don't think they can afford it."
Sabri: No, none of that. And quite frankly, when the providers, whether that's a hygienist or a doctor, are looking at these patients for today, they are not diagnosing based on the patient's pocketbook, known or unknown. They're purely doing their job as a healthcare provider. They're not the patient's accountant, they're not their insurance benefit coordinator, none of those things. They're just being their healthcare provider, as they're supposed to be.
Jeff: So let's go over the sequence a bit, because this is where we've seen these things get a bit wonky. The office manager is chairing the meeting. Docs are there, the hygienist is there, the scheduler's there, the financial coordinator's there. And I think the financial coordinator is obviously going to be more integral with patients of record, because they don't know much about the new patients. And our treatment coordinator is there. So the office manager goes patient by patient by patient, and we discuss each one to get an idea of what we're trying to accomplish with that patient that day. Let's say we start with you. I'm the manager and you're the hygienist. Your first patient of the day is Joe Smith.
Sabri: Right. So I would say: Joe Smith is coming in for a cleaning. Last time Joe was here, there were two crowns the doctor had diagnosed that Joe did not accept. On top of that, there's a missing tooth over here, and I'd like the doctor to take a look at that, to see if there's anything the doc wants to do with it.
Jeff: And this is interesting. What if this is one of those recalls that doesn't require an exam?
Sabri: Well, then we'd better get an exam scheduled. The doc has to get over there and take a look.
Jeff: So we might be creating an encounter that wouldn't have naturally, organically occurred on the schedule. And then, as the hygienist, let's say the doctor's doing a root canal at the same time. How's that going to work if I need him or her for an exam? That's the kind of thing that gets figured out in this meeting. We look at it and go: alright, doc, you need to get into that room at some point. Actually, it's your first patient, so between eight and nine. We take a look at the doc's schedule, and the assistant goes: this part here, let's say it's not a root canal, this is where the temp is being made. The doc can pop out for 10 minutes around 8:40.
Sabri: That's right. And it doesn't always have to be that the exam is done at the end of the hygiene appointment. Sometimes, to make this work, the doc comes in at the beginning. It depends. But that's the coordination that's necessary.
Jeff: So as the hygienist, I know the doc's coming in, and I might even talk a few things up. "Hey, it looks like we talked to you about a couple of crowns last time you were here. What happened with that?" "Oh, I don't know, I was in a rush." "We should definitely talk to the doc about it, because it looks like things aren't getting any better back there. And have you ever thought about having this tooth replaced?"
Sabri: That's right. The hygienist starts that conversation, especially when the hygienist is aware the doctor has limited time. They know they have to do a little more of the work, and they can help it along.
Jeff: And you've got the assistant on the other side, making sure the doctor gets out of their room and into that room, and making sure the patient the doc is currently seeing is comfortable while that's happening. And we have the treatment coordinator standing by, maybe even going into the room with the doctor. And if any insurance information is necessary, the financial coordinator knows right then and there to get it ready. So we're not scrambling to do this on the fly. We've already planned it. Would the financial coordinator walk into the meeting already knowing how much insurance Joe has left for the year?
Sabri: Ideally, yes. But what if the doc wants to replace a crown, or it's a missing tooth and we don't know how long the patient has had the insurance? We may have to get that data on the fly throughout the day. If there's a missing tooth clause in their policy, things that are very specific with regard to insurance, the financial coordinator is going to have to find out.
Jeff: Alright. So, the way it's supposed to work: you know your patients' treatment plans, at least the ones already diagnosed. Doc knows doc has to get over there. The assistant knows doc has to get over there. The treatment coordinator is on standby for when the doctor goes over there. And the office manager knows all of this is happening. Then we go through patient after patient after patient on your schedule. Let's say the next one is a 17-year-old kid and there's nothing going on.
Sabri: In which case: this is Joe, he's doing great, he's going to graduate high school this year. We'll see him next time. Fantastic. And the next one, and the next one. We pick up on all the ones with outstanding treatment.
Jeff: And the treatment coordinator, at this point, what are they doing? Noting down all these outstanding treatment plans they're hopefully presenting that day?
Sabri: Absolutely. Everything that gets decided in this meeting should be notated, almost in a target format. There's an action list that gets made as a result of this meeting. We know exactly what we're going to be doing today and who's going to be doing it. It's not in people's heads, and we're prepared, so we know it's going to happen before it happens, and the left hand knows what the right hand's doing.
Jeff: Okay. So we've done that with the hygiene schedule. And what's funny: I've seen a lot of offices hoping all of their revenue is going to come from new patients. But new patients are completely unpredictable. This is much more interesting to do with existing patients. The only thing we know about a new patient is whatever they told us.
Sabri: That's right.
Jeff: And obviously, if it was multiple doctors, we might be picking which doctor is going to see this patient. Because certain offices do "whichever doctor's available."
Sabri: Well, in the morning meeting, we can see which doctor's available and who's going to do it. If there are any kinks in the schedule, we work them out then. We figure it all out.
Jeff: So now we've gone through hygiene. Let's say there are new patients on the schedule. The scheduler can fill in any blanks: "they called, they said they broke a tooth," which may or may not mean anything. Or if they're new patients on the doctor's schedule, same thing. But we don't really know much about them. Maybe they called wanting to find out all about an All-on-X case. But you don't know. They might just be shopping. "Can you do it for 15,000?" Nope. So a new patient is completely unpredictable, and we're not counting on that. If we get something from it, great. What we're really looking at, unless it's a new patient we've already seen, in which case they're not new, we brought them back for a presentation and have some predictability, is this: if we have a certain amount we're supposed to produce and collect today, how are we going to do that with our existing patient base? And what's everybody's involvement?
Sabri: And at the end of it, what we've figured out we can sell today, that action list, who's going to see whom and what's going to happen, we call that a lineup. So at the end, we should have a lineup. An action target that figures out how the daily goal is going to be met.
Jeff: Alright, so let's say our daily goal today is $15,000, and we have a lineup showing we could technically present around 45,000 today, and we're pretty confident we can close a third to half of it. Then we're in good shape. Now let's take the other side of that. We need 15,000, and we only have 5,000 in potential. That's a problem. What do we do now?
Sabri: There are different things we can do at that point. We figure out: what do we have outstanding from yesterday, or last week? People who were going to talk to their spouses, think about it, whatever, that the treatment coordinator has to follow up on. Maybe we can move a patient forward, or get a patient in tomorrow or the day after who needs a consultation, so we can beef up the amount we have to present. Ultimately, when that happens, when we don't have enough lined up for the day, it comes back down to the office manager.
Jeff: That's what's interesting with all of this. This is all the office manager.
Sabri: It means the office manager didn't really look ahead. And that's later in the checklist, how to not have these things happen to you. Obviously there are going to be days like that. But if you have a day like that, the manager should realize the failure was yesterday, or the day before, or even last week. Had they been doing what they needed to do every day, looking ahead at the schedule to make sure we don't end up in this position, we wouldn't be sitting here scrambling.
Jeff: And just for those listening, because I know there will be people who go: well, I look at my hygiene schedule and there's hardly anything on it. But what confounds them is that they look at their incomplete treatment list and it's humongous. Why is that?
Sabri: I actually see that a lot. What that is, is poor hygiene utilization. So few patients are in their hygiene. Meaning: if I run a list of their active patients, the existing patients I could reactivate, against the available hygiene slots, there aren't nearly enough slots to service all their patients.
Jeff: So this is an office with one hygienist that really should have three, is what you're saying.
Sabri: Right. I only have slots for a certain number of patients. The first people who take those slots are my quote-unquote good patients. They're the easiest to get in, and they'll clamor to get in. And then I'm out of slots. So I'm not going to do heavy reactivation as a front desk person; I have nowhere to put these people.
Jeff: Got it. So all your good patients are in hygiene, but they've already done all their work. That's why they're good patients. So now I become new-patient dependent. See, I think people don't see this. I know you've been talking this up for a while, but this is critical. Those patients where you say "you need treatment X, Y, and Z" and they go, "of course, let me just do that, how much is it?" Those are the ones who are super compliant on hygiene.
Sabri: Absolutely. That's your top tier of compliant patients.
Jeff: So if you only have slots for those patients, you run into a problem where you no longer have treatment to sell in hygiene. Because the huge bulk of the patient base, the regular people, not the super compliant, wonderful dental patients, and they're not bad, it's the majority of your patients, just the ones who need to be chased a little, followed up with. They're busy. Life's coming at them. It's normal people. It's not your top 20%, it's not your bottom 20%, it's that middle 60 where all your treatment is. But then you've had that one hygienist for years, your hygiene's not growing, so hygiene stays clean. I look at my hygiene schedule and there's nothing there to sell. Then I look at my incomplete treatment list, which is humongous, but I've got to keep producing, so I'm dependent on new patients. But again, that's an office manager failure, right? Because we've often said it: the growth statistic for the practice is the number of recall days in a week. That should always be growing. Otherwise you're bringing people in and dumping them out the back door.
Sabri: Correct. And unfortunately, that's how most dental practices do it. And then they go: I need more new patients, we need more new patients. Which they do, you always need to replenish, but you shouldn't be dependent on them.
Jeff: Because then you're starting your practice from scratch every month. It's just a bad way to operate. No business would operate like that, but somehow dental practices do.
Sabri: True. And then they also wonder why their overhead's out of control. Because it's a lot more expensive to get a new patient than to keep somebody.
Jeff: Exactly. You should be getting new patients, but you've got to keep the ones you have. And if you look at the way Sabri is describing this morning meeting, really the only thing you can count on is: patient Jones, patient Smith, whoever, has X, Y, Z treatment from the last time they were there. You know they at least need that, and maybe more once you look at them. That's predictable. Whereas a new patient is completely unpredictable. They could be a really nice, great-sounding person who wants to do all this treatment, but they have a 520 credit score and can't get a cosigner. Not saying that's bad, but you can't base your whole practice revenue on it. You do your best for every patient, but you can only predict the ones you know. So, alright, we've done this meeting. We've got new patients at this time, our recall patients at this time, we've figured out where the doctor's going to be and where the treatment coordinator's going to be, and we've made an action list.
Sabri: Correct. And we also do that for the doctor's schedule. Because the doctor might be seeing patients who have committed to only partial treatment. So he or she should come out of that appointment saying, hey...
Jeff: Exactly. And what I find is, if a doctor really is convicted and certain in the way they communicate with the patient: "Listen, I'm doing this side, and I really want to tell you, we need to do the other side as well. And the reason is that right now I'm only comfortable with you eating on this side of your mouth."
Sabri: Right. Or we've seen it where you do the upper arch, and the patient was reluctant to do both at the same time. Then they see the result on the upper arch and they're like: heck, let's do the lower one too.
Jeff: Exactly. So the doctor can say: I don't want to wait on this anymore. I want to do this. I need you to do this, because you need to take care of yourself. But again, if we're going over all those names in the meeting, it might be: okay, doc's first patient of the day, we're doing treatment X and Y, and we already know they're doing a refi right now, so they can't apply for credit, so we're pushing that for a month. I'm saying this so people won't think, "well, I presented it to them last week and they said no, should I do it again this week?" No. You want to be intelligent about this.
Sabri: Don't be dumb.
Jeff: But then, who's supposed to keep track of that? The treatment coordinator, to make sure that patient actually ends up back on the schedule. Okay. So now we've got our action item list. We've made this big old list of what has to happen and who's going to see whom and when. And we've done this quickly. I think we've spent more time talking about it than it'll actually take you.
Sabri: In a busy practice, it usually takes no more than 15 minutes. As long as everybody's prepared, and as long as we're not telling stories about every patient. We stick to the topic.
Jeff: Alright. So we've done our morning meeting, we have our targets, we go: okay, good, let's get to work. What happens next?
Sabri: The next thing the office manager does: in that first section of the meeting, the office manager was going over where production was, where collections were, new patients, all the other statistics. There might be some things that are not where they should be, and the office manager should have noted them. So as soon as the meeting is done, they get with those staff members individually and go over: okay, you're this much short of your goal. Show me exactly how you were planning to figure that out. And they work with the staff member to make sure they have a good grip on what they're doing that day to get back on track. If we have catastrophic numbers of new patients or something like that, they're jumping into the PR area. The OM is almost like triage at that point. They jump into the areas that are problematic and get them back on track with that staff member.
Jeff: Got it.
Sabri: And then they work with that staff member throughout the day, without in any way doing that staff member's job for them.
Jeff: Well, yes. If you have to do their job, then what was the point of the staff member?
Sabri: Correct. But some office managers do that. They just jump in and get things back on track themselves. And that's wrong.
Jeff: Now, to that point, and I know this is not a black-and-white answer, it's shades of gray. Let's say you're the OM and your scheduler is having a rough time. They're doing a poor job. They show up in the morning meeting and most of the doctor's primary procedures have blown out that morning. Would you not, as the manager, ramp through the meeting real quick, figure out what we're doing today, and then get right into scheduling? And if your scheduler is somewhat broken, you might have to do some of the work yourself.
Sabri: Well, yeah. It's a judgment call, because if it's catastrophic, you have to get it back on track yourself, and then work with the staff member. And it may be that this person isn't going to correct and I have to replace them. Or maybe they just needed a little bit of me in there showing them: this isn't going to fly. Ultimately, you hope every staff member is going to make it, but that's not always the reality, and you have to be able to differentiate who you can train and who you can't. So taking over the person's position and doing it yourself is something you reserve for the catastrophic only.
Jeff: The last resort.
Sabri: Otherwise, no. Let the staff member do it. Get them doing it, get them winning again, get them back on track. Nobody's perfect all the time. People have bad days, and sometimes somebody gets caught off guard and their area goes like a bad souffle, and someone needs to get it going again and give them the courage. "You can do this. What do you want to do here?" "I want to do this, this, and this." "Good, go do it. I'll check back with you." Or, "why don't you try this instead, and I'll check back up on you."
Jeff: So let's say I've done the morning meeting, I've run it, I'm the manager. I've gone to the various, hopefully not that many, team members who are underperforming and gotten that back on track. What am I doing next?
Sabri: Next: if your staff have checklists, I would make sure they're all doing what they're supposed to be doing that day.
Jeff: So, daily checklists by position. Which, and this is my shameless plug, on our online platform DDS Success, we do have: financial coordinator, treatment coordinator, every position.
Sabri: We have them for the different positions, yes.
Jeff: Alright. So I go check on everybody's checklists. And then what do I do?
Sabri: Once everything's under control: remember, we laid out that action list, that lineup. How are we going to make things go today? It's almost like we choreographed an entire dance. This person is here, that person is there, then this person does that, and routes the patient to this person, who does that with the patient. We put this whole dance together. Well, the office manager needs to go make sure it's actually happening.
Jeff: And that's critical. Because you could have it where things are rolling: doc saw that patient, now they're with the treatment coordinator. You've got two docs and one treatment coordinator. The next doc is about to route another patient who needs the treatment coordinator, and the treatment coordinator is still with the first patient. Who's watching that?
Sabri: That's right. And it's more than being a traffic cop. The office manager is getting that flow figured out. "I'll grab that patient," or "I'll have the patient see the financial coordinator, who can treatment coordinate once in a while." Moving things along and keeping the place moving so the targets are met. Keeping everything on track and adjusting as necessary. They do that throughout the day. They're the eyes watching all this activity, making sure it pulls off correctly.
Jeff: So just to be clear, the OM job, actually any executive job, is not just sitting at a desk.
Sabri: No. You're moving all the time.
Jeff: While I'm doing other things, in between, I'm making sure: wait a minute, that patient was supposed to go see so-and-so, let me go see what happened. Checking this, checking that, debugging, throughout the day.
Sabri: That's correct.
Jeff: Okay, good. And I know we have a bunch more on this. Just looking at the time, I've destroyed the "30 minutes or less." I think we came in at 29 minutes last time.
Sabri: That was pretty good.
Jeff: So I think this is a good point, this is about where we planned to cut it off for part one. When we come back for part two, we get into the rest of the office manager's daily duties, as well as some of the office manager's weekly duties. So folks, that's all we have for you this week. I do have the office manager checklist that Sabri is referencing available for download on the episode webpage. We also have the morning production meeting handout available for download on the episode webpage. Sabri, anything you'd want to tell them about what to expect next episode?
Sabri: Well, there are a lot of duties the office manager has besides just running sales, or figuring out sales. Those are the things I was alluding to earlier: if you do these things well, you never run into a situation where things are a disaster.
Jeff: Good point. It's future planning. Making sure the future is good. Alright, folks, that's all we have for you this week. Sabri, thank you so much for joining me.
Sabri: You're welcome.
Jeff: We'll continue with this on the next episode. And if you have any questions about MGE, you can always find us online at mgeonline.com or call us at 800-640-1140. Folks, have a great week. We'll see you at the next episode.