How is your practice really doing from a performance perspective? How “healthy” is your business? Just looking at revenues or going by gut feeling aren’t a good way to measure the true health and performance of your practice! There are five key areas to analyze to get a proper picture of your office, which Jeff covers in this week’s episode.
Topics:
:11 – Growth rate
9:10 – Hygiene and patient retention
19:35 – Case acceptance and collections
23:36 – Staff efficiency
33:35 – Overhead and profitability
Links:
Full Practice Evaluation - https://mgeonline.com/practice-health-analysis
The MGE Communication & Sales Seminars - https://www.mgeonline.com/abc
Hygiene Formula Spreadsheet - https://www.mgeonline.com/hygieneformula
Overhead Guidelines & Calculator - https://www.mgeonline.com/overhead-materials
Fees & Plans Analysis - https://www.mgeonline.com/fees-and-plans
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Questions From This Episode
Why does Jeff say calling everyone at the front desk a "front desk person" is a problem?
Unlike a hygienist, "front desk person" isn't an actual job description, so when something goes wrong, like a three-hour opening on the schedule, there's no single person accountable for fixing it. Jeff recommends splitting the role into clearly defined jobs, like receptionist, schedule coordinator, and financial coordinator, each with its own expected outcome and statistic.
What does Jeff mean by "no targets assigned," and how does it cause a practice to miss its goals?
A team can come up with good ideas in a morning meeting, like moving a patient up a day to fill an opening, but if no specific person is assigned to actually execute that action step, it tends to fall through the cracks. Jeff recommends assigning each target to whoever already owns that type of work in the practice, a scheduling target to the scheduler, a financial target to the financial coordinator, and so on.
Why does Jeff say a practice needs someone actively "driving" its targets throughout the day, even with a good staff?
Even competent teams run into problems mid-day, an idea to salvage the schedule falls through, a treatment coordinator gets backed up, and nothing guarantees those issues get resolved without someone assigned to actively manage it. Jeff says that's the office manager's role: not just running the front desk, but actively making sure the day's targets still get hit even when things go wrong.
What does Jeff say happens when there's no accountability for missed targets?
If nothing happens when someone doesn't follow through, like a scheduler failing to make calls to fill openings, that behavior tends to continue, and Jeff says it spreads to other team members over time, since seeing one person get away with it makes it feel acceptable for everyone else too.
How does Jeff say a doctor should figure out whether a struggling policy is the problem, or whether it's the person?
He recommends asking whether what's being asked is something the doctor could reasonably picture doing themselves, if it is, and it's still not happening, the problem is the person, not the policy. If a doctor gives up on a reasonable policy instead of addressing performance, Jeff says that apathy shows through to the rest of the team and undermines the practice's ability to hit its goals.
Episode Transcript
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Let me give you a scenario. Your dental practice has a daily production goal of $5,000. It's Monday morning, you start the day with your morning huddle, and find out there's only $3,000 on the schedule. So your team looks at the schedule and suggests a few scenarios to make up that $2,000 difference and hit your goal.
For example, maybe you call Mr. Smith to come in today instead of tomorrow to start those two crowns. Or maybe you talk with Mrs. Jones, who's in seeing the hygienist for a cleaning, about those three inlays you diagnosed last time she was in, and see if she can start them today, since you happen to have some open time around the same slot as her hygiene appointment.
So after discussing a few possible scenarios that could save the day, satisfied you have a plan, you and your team jump into the schedule and get to work. At the morning huddle the next day, Tuesday, you ask how the office ended up for Monday, and find out nothing really changed. You produced the $3,000 that was already on the schedule and nothing more. Disappointed, but not sure what else to do, you begin the Tuesday huddle and go through the same motions. You still have that same $5,000 daily goal, maybe it's already scheduled, maybe it isn't. You and the team brainstorm how to fix it, the day goes on, and you may or may not hit your goal, just like the day before.
Does any of this sound familiar? If you're anything like the hundreds of new clients we onboard every year, you're either not meeting your daily goals regularly, not sure what to do when you don't, or worse, you're not regularly setting goals in the first place, daily, weekly, monthly, quarterly, however you'd lay them out. If you're not setting goals for things like production, collections, or new patients, maybe it's time to start, you can't make a goal you never set. But if you are setting goals for your practice and you're just not hitting them consistently, this episode is for you.
We're going to identify six reasons you might not be meeting your daily goals, and more importantly, what to do about it. My name is Jeff Blumberg, and I'm your host.
Let's jump right into the first reason, and you may have heard versions of this before if you're a regular listener. I keep coming back to it because it's important, and not enough people actually do it: no defined areas of responsibility in the practice.
If you're a traditional dental practice, you probably have one or more people at the front. What do we usually call them? Let's say you have three people up front, we call them "front desk people." That's not really a job description. If you have a hygienist, that's a job description, they're the dental hygienist. But a "front desk person" is basically named after furniture, they don't really have a defined role, they're just working up front.
The problem with having three people at the front desk and no clear division of responsibility is that when something goes wrong, who do you actually talk to? You have three openings on the schedule, you go ask what happened, and everybody just sort of shakes their head. They might be very willing to help, but who's ultimately accountable? It's like putting a baseball team on the field with nobody assigned a position, everyone's just sort of out there. That wouldn't work. Everybody needs a defined area of responsibility.
Now, I've heard the counterargument, that everybody should know how to do everything in case someone's out sick. I'm fine with that idea of cross-training, having a financial coordinator or treatment coordinator able to answer the phone if the receptionist isn't there, that's great. But it still needs to be clearly the receptionist's job first.
So if you have three people at the front, you might have one person as the receptionist, one as the schedule coordinator, and one as the financial coordinator, who might also be your office manager. Or you might have a scheduler slash receptionist in a smaller office. Why do I separate these out? Normally people think of a scheduler and receptionist as the same person, which is really the same problem as calling everyone a "front desk person." Technically, the receptionist should be the one answering the phone, routing communication, making sure it flows in and out of the practice, greeting patients, getting them to the back on time, and taking care of anyone in the reception area. In a smaller office, that's not a full-time job. In a large office getting hundreds of calls a day and seeing 40, 50, 60 patients, it probably is.
Scheduling is a completely different function. The schedule coordinator owns the scheduling book and is responsible for overall office production. That could be the same person as the receptionist in a smaller practice, sure, but as the practice grows, those jobs have to split at some point, or the person doing the schedule gets overwhelmed answering the phone with no time left to actually fill a last-minute opening. The same goes in reverse: say you start with one doctor, two hygienists, and one person tracking the schedule. Add an associate, another hygienist, and eventually three associates and five or six hygienists, and one person isn't going to be able to keep all those providers effectively busy anymore. At that point you might add a hygiene coordinator who handles the hygiene schedule and reports to the scheduler, while the scheduler still owns overall office production. That's the basic idea: clear divisions of responsibility.
Each of these jobs should have an expected outcome. If I have a scheduler, I'd want my schedule built correctly, especially if I've structured certain blocks for certain things, larger, higher-dollar procedures, what we call primary procedures, in the morning, deliveries in the afternoon, consults at certain times. I'd want my scheduler making sure the schedule reflects that structure, is scheduled efficiently, and is scheduled productively. How would I measure that? With a statistic, and for a scheduler, that's usually production. Same idea with a financial coordinator, I'd expect they wouldn't let accounts receivable pile up, and that they're securing good financial arrangements in line with office policy. These are expected outcomes, a division of labor paired with an expected outcome and a statistic that belongs to that person. They have to own it.
If a schedule coordinator's statistic is production, it's not like they're just reporting a number to me as some kind of spectator, "oh yeah, we produced $5,000 yesterday, here it is," as if they had nothing to do with it. They have everything to do with it, because they're the one creating that statistic. If it's up, great. If it's down, not great. Funny thing about keeping statistics once you start, and I think this actually says something good about people, if the stat's up, you'll definitely hear about it. If it's down, people have a harder time owning up to it, that's just human nature. You'll see people who can point to how they contributed when a number's up, but when it's down, there are suddenly a lot of other factors, there was a storm, patients said they were coming and didn't show. But they have to own the good and the bad.
If someone isn't hitting their expected outcome, the solutions might be training, working with them, apprenticing them, especially if you're a manager handing that job off to someone new. But if it's a continuous, long-term pattern of non-performance, you may need to start looking at replacing that person. That's the real guide here, it's not based on opinion or how you feel that day, it's based on hard numbers. Are they performing or aren't they?
Assuming you have people who are actually responsible for something, what's the next reason you might not be meeting your goals? Irregular, or no, coordination. Coordination just means organizing people so they work together as a group, harmoniously. How would you normally coordinate in an office? I'm up front as the financial coordinator, the assistant's in the back, and the schedule coordinator, even sitting right next to me, and we're not necessarily talking regularly about what I'm doing versus what they're doing. That's what meetings are for. That's what your morning huddle should actually be used for, looking at the day as a group, each with our own individual jobs and expected outcomes, while staying aware of what everyone else in the office needs to get done, and staying coordinated about it.
For example, say I'm the schedule coordinator, and during the meeting I find out from the financial coordinator that a patient coming in on recall has a large outstanding balance. As the scheduler, I make sure that before that patient leaves, they've stopped by to see the financial coordinator about it. Little things like that, there's obviously more to it, but that's the basic idea, we're all on the same page, approaching the day in a coordinated way so things don't just slide or fall through the cracks. I've offered this before as a download, we don't call it a morning huddle here at MGE, we call it a morning production meeting, and I have a handout on exactly how to run one. I'll put it on the episode webpage if you want to download it, it's a guide for how that morning meeting should run to get the most out of coordination.
So now, say you have a plan, people who are responsible, and everyone knows who's doing what. What's the next reason you might not be meeting your goals? No targets assigned. Go back to the example I opened with. You've had your morning meeting, the team worked out ideas to turn that $3,000 day into a $5,000 day, someone's supposed to talk to Mrs. Jones about the three inlays you already diagnosed. That may or may not work, she might say yes, she might say no, she might say yes but can't do them today, in which case fine, you do them tomorrow. But who's actually responsible for that target, meaning, something that has to get done?
You've got several people on the hook here. The hygienist might need to do some education with the patient, "hey, Mrs. Jones, we never got those inlays done, let me show you what's going on." The assistant needs to know the doctor has to pop in and talk to Mrs. Jones, even if she's not due for an exam that visit. Then the treatment coordinator needs to know Mrs. Jones might be coming to them afterward to talk financial arrangements. Dissect it and you've got the hygienist, doctor, assistant, and treatment coordinator, all needing to be on the same page to make that target happen. Or take the idea of moving a patient up a day to fill an opening, who's responsible for that? Probably your schedule coordinator, but if literally everyone at the front desk is "responsible" for it, then no one actually is. We all know how that goes.
So you come up with ideas, targets, things that need to get done to fix the day, action steps, and nobody's actually assigned as accountable for getting them done. That's where it tends to fall apart. Ideally, you assign each step to whoever owns that type of activity in the practice, a scheduling target goes to the scheduler, a financial target goes to the financial coordinator, a sales target goes to the treatment coordinator. You're giving it to the person whose job it already is.
And backing up to that earlier point about coordination for a second: meetings have to happen routinely. Your team needs to be so used to having that meeting that it feels odd when you skip one, not the other way around, where meetings happen irregularly, maybe there's an ice storm and nobody's in until 10, fine, cancel it that once, but it needs to become second nature, not the exception.
Now say you've got all three of those things in place, defined jobs, regular meetings, and assigned targets. What's the next reason you might not hit a daily, weekly, or monthly goal? As an aside, I wouldn't just set a daily goal in isolation, I'd want a daily goal that rolls up into a monthly goal, maybe even a quarterly one, because you need to attach it to something bigger. Going back to that $5,000-a-day practice, if you're working 17 days that month, that's an $85,000 monthly goal, maybe more if hygiene's not included separately. So if you only do $3,000 today, you're behind, and you want to start making that up sooner rather than later. You don't want to be two days from month's end sitting at $40,000 with no hope of catching up. I'd attach the goal to more than just the day, monthly at minimum, maybe quarterly too, and you can break it down from there.
So, fourth reason: you've got your people, they have defined jobs, you're holding meetings, and you've assigned targets, but no one is actually driving, pushing, or following up on those targets. Nobody's making sure whatever got assigned in the morning meeting actually happened. You might think, why would I need someone to make sure things get done, my staff is great and very competent? I don't care how competent your team is, if no one is acting as the executive making sure things are actually happening, some things just won't get done. What if something goes wrong? What if someone doesn't follow through? What if your three ideas to salvage the day all fall through by mid-morning and you need new ones? What if your treatment coordinator is stuck with one patient's financial arrangements running long while the next patient is waiting? Things back up, the schedule falls behind, who's making sure all of that gets ironed out?
Ultimately, that's the office manager. In a smaller office, the office manager might wear other hats too, that's fine, and as the practice grows, they'll eventually be able to hand some of that off. Throughout the day, on top of whatever else is on their plate, the office manager is making sure whatever targets or action items came out of the morning meeting, or even the week's targets, actually get done, and when they're not, they're actively sorting it out so the objective still gets hit. If our three ideas to salvage the day aren't panning out, the office manager is finding other ways to salvage it, pushing it, making sure it's handled, maybe stepping in to grab the next patient themselves if the treatment coordinator's backed up, or covering if someone had to leave sick. They make things work throughout the day so targets actually get met.
Maybe you do or don't currently have an office manager, I did an entire episode on that role early on, probably somewhere in the first 20 or 30 episodes, there's a lot of confusion about what an office manager actually is and does. But in short, the office manager is the senior executive running the practice day to day. They're not just the front desk manager, though that's part of it, they're responsible for overall practice productivity, because the owner doctor physically cannot manage the practice while chairside. You can't run the business while you're doing a root canal, you're focused on one square inch for the next hour. Someone needs to be actively running the practice throughout the day and making sure things are actually happening.
So say you've got all of that, defined jobs, regular meetings, assigned targets, and an office manager driving them. What else could stop you from meeting your goals consistently? No accountability or consequences. Say the scheduler was supposed to call five patients to rearrange the day and salvage production, and they just didn't do it. What happens? Nothing, maybe a mild talking-to they can shrug off. Or maybe their performance just isn't there generally, the schedule's full of openings, hygiene keeps emptying out, and you can't figure out why you don't have the patients you need in there to keep the office productive. I'm using scheduling as the example here, but this applies to any position in the office. If there's no accountability or consequence for that, the behavior just continues, and worse, over time it starts to spread to other team members. If I'm the financial coordinator and I notice the receptionist is chronically late with nothing ever happening about it, that sort of gives me license to be late too. I might not take it, but I might, even if I'm otherwise a great employee. Then the schedule coordinator notices both of us getting away with it and decides being sulky or disrespectful toward the office manager is fine too, since the assistant does it and nothing happens. I jokingly call it a staph infection, it spreads through the practice. If there's no consequence for not doing your job, whatever that consequence needs to be, more training, a disciplinary conversation, or eventually replacing the person, you're going to end up with a non-productive team.
Which brings us to the sixth reason, and this one's about you, the doctor. Do you actually care, or have you become apathetic about it? Maybe you've had enough days that fell short of your goal that you've started to believe it just can't be done. Let me give an example, not exactly a daily-goal issue, but a policy implementation one. Say you decide you only want to do your higher-dollar, primary procedures in the morning, since that's when the office is calmest and you're in the best position to do them well, afternoons get busy. Completely reasonable decision, so you make it office policy. But your scheduler can't get anyone to actually book into those morning slots, and now your schedule's empty. You ask why, and you're told, "people just can't come in the morning, they're working."
At that point you have two choices. First, evaluate whether what you asked the scheduler to do was actually reasonable. I would never ask someone to do something I couldn't picture myself doing, that would be strange. I can picture people coming in in the morning, I go to my own doctor's appointments in the morning. So if it's reasonable and it's just not happening, the problem isn't the policy, it's the person, I'll say that again, the problem isn't the policy, it's the person. Now, if you set a genuinely unreasonable policy, say, requiring patients to pay in full two weeks in advance for a routine cleaning, and patients push back because no other dentist does that, well, that actually is a bad policy. But assuming what you're asking is reasonable and it's still not happening, it's not the policy, it's the person, and that's the first thing to evaluate.
Most people don't do that evaluation. Instead they conclude, "I guess we just can't get patients in in the morning, that's not something that can be done," and become apathetic about it, why even bother trying. So you end up scheduling all your primary procedures in the evening instead. This happens with PPOs too, doctors convince themselves patients only want in-network care, patients won't go to an out-of-network doctor, they buy into that belief, never drop the plans, and end up working for half of what they should be earning.
As the owner doctor, you have to set the example and be the inspiration for the rest of the team. If you're apathetic about getting things done and you've lost that drive, it's going to show, and it'll spread to everyone around you. What kind of example does that set for your staff, or for your office manager, who's supposed to be your partner in growing the practice? That's not something you can let stand, it's something you need to handle. My honest suggestion is to get trained as an executive, because just like the doctor role has a specific expected outcome, a healthy patient, and the sales role has an expected outcome, a closed case, being an owner also makes you an executive whether you like it or not, and an executive's expected outcome is an expanding, profitable organization. If you're not getting that, the problem is your executive skill set, and that doesn't mean you're deficient as an executive, it might just mean you've never actually trained for it.
Those are the six main reasons I see, especially with newer clients, for not hitting their goals consistently. You've spent a lot of time and effort becoming a doctor, make it worth it, your career has an expiration date on it, love what you do, and to make that work the way you want it to, there may be a few more things worth learning along the way.
I hope this helps. If you have any questions about MGE, want to know more, or want help, you can find us online at mgeonline.com, or call us at (800) 640-1140. I've got that download for the morning production meeting on the episode webpage if you'd like it. I'll see you at the next episode, have a great week.