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Dental Operatory Chair-side Case Presentation and Checkout
In LEAN there is a concept called “one-piece-flow” - the assertion that every time an item is handed off or moved creates an opportunity for error through miscommunication or mishandling; the more moves, the more opportunities for error. The “item” in this case
is your patient, which brings an additional element of stress. People don’t like be to shuffled around, especially in unfamiliar environments. Reducing “moves” improves efficiency, reduces the potential for error and results in much higher patient comfort levels - which means that everybody wins.
Two major moves that occur in a typical dental practice are presenting treatment to the patient, and collecting payment. While you can’t eliminate these steps, you can control where and how they occur by creating a functional space that allows you to do both in the same exact location that the treatment is provided.
So what, exactly, are we talking about doing in the operatory? For a lot of your patients, it will be pretty much everything that happens after they enter the treatment area: gathering data, diagnosing and educating your patients about their needs, documenting completed treatment, scheduling future appointments, and collecting payments - in short, one-piece-flow!
The Process
Here’s a step-by-step example covering both clinical and administrative functions. We’ll go into greater detail about the tools you’ll need to accomplish this in a bit.
1) Gather Data
Have your clinical team start the case presentation by gathering the data via X-rays and intraoral photos. They are not diagnosing, they are simply illustrating to your patients potential problem areas as they are physically taking the needed X-rays/photos for a full diagnosis. A picture is worth a thousand words; educating a patient about their periodontal disease is done more effectively through images of their lower lingual calculus, bone loss, and blood oozing out of an inflamed sulcus - than by explaining it to them.
2) Receive Pertinent Patient Information from Staff
Doctors shouldn’t go to the treatment room unprepared! Before you arrive for the examination, your staff needs to provide you with the following information: the type of patient (new, emergency, or periodic exam), apprehension level, preliminary treatment plan, the patient’s primary concerns (time, budget, aesthetics, fear, function), and some personal information about the patient themselves. At present, we still find this is most easily done on paper.
3) Perform the Examination with Key Staff Present
In the case of new patients, it is critical that your Tx Coordinator/Patient Advocate be present during the examination. This will save you the time of explaining treatment twice; once to the patient, and again to the coordinator. More importantly, this allows you to introduce your Tx Coordinator to the patient and establish their authority to carry out the plan.
With proper preparation and the ability to see the X-rays and photos alongside the patient you can complete 90% of your examinations within 3-5 minutes, and move on to your next patient. Please note that a significant number of patients will require more evaluation and work-up.
4) Get Acceptance and Schedule Treatment
Now it’s time for your Tx Coordinator to shine! They will answer any unanswered questions about treatment or payment (remember you just gave your them the authority to do so.) They will need a full understanding of dental treatment, appointment sequences, and financials for this to be successful. A reference sheet for quick estimates involving insurance companies is helpful here. Once your patient agrees to the financial aspect and has signed any necessary consent forms, you have received case acceptance! The Coordinator books treatment in your dental software (same-day, if possible) and checkout is now 50% complete.
5) Checkout
Once this happens, the only thing left to do is enter completed treatment in your software system and collect payment for services rendered (or for future services). To do the latter, your staff needs the ability to collect payments and print receipts in the operatory. This means having a credit card slide in room for debit/credit card payment, an internet connection for payments made through loans, and a printer to print receipts. The only time your patient will need to stop at the front desk is if they are paying with cash or check (pretty rare, nowadays).
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