Orthodontic Care: Learn How to Better Align Employee Schedules with the Patient Needs

Blu Nordgren (BN): My name is Blu Nordgren and I’m the marketing communications manager for Cloud 9 Software. Cloud 9 is a browser-based practice management system for orthodontics, pediatric dentistry group practices and DSOs. This year Cloud 9 Software is celebrating its 10th anniversary. Currently we support over 13,000 users across 1,500 locations.

For today’s presentation, all participant lines have been muted. You may submit questions via the Q and A button on the left-hand side of the screen. Questions will be addressed at the end of the webinar as time permits.

And with that, I would like to introduce Wade Walters, VP of Professional Services at ProviderScience.

Wade Walters (WW): Thank you, Blu. Thank you to the team at Cloud 9 for the opportunity to present to you today, and thank you to all of you as well for taking a little bit of your time today in this week to spend with us. It really is a privilege to have the opportunity to speak with you. Certainly, this webinar was planned well in prior to the COVID-19, and obviously, it was a kind of only a merging thread at the time. And the impact that it’s had on all of our lives, everyday life has been dramatic, obviously. And it certainly doesn’t take me to tell all of you that it’s had quite a substantial impact on orthodontic practices like yours. I want to acknowledge that talking about staffing and aligning schedules and things of that, may not feel like the most urgent of topics right now, particularly as practices are oftentimes faced right now with idle staff and in some case furloughed staff. But I would certainly say that it’s our belief that there is no better time than this, because certainly it’s a relevant topic because of, A, there will be a time I firmly believe that very soon that we resume to normal lives and your practices will rebound, and you’ll see surges in care, and having a strategy in place to accommodate that and continue to deliver the high standards of care that you do today are important. So it really is kind of my belief that this is an important topic. Even in light of things that are taking place. And in staff, your staff is certainly probably the most important asset that you and your practices have. And I’m not specifically talking about the orthodontist. I’m equally referring to the entire team, because all of them form relationships with your patients. They care for your patients, and they allow your orthodontists to practice at the top of their profession, and they deliver outstanding care themselves. And so ensuring that they are all allocated and scheduled appropriately is critical to the success of your practice. And today multi location or orthodontic practices and DSOs, they’re a complex puzzle, because it’s what days do I open? What are the number of chairs that I need to be running or columns that I need to have? What type of appointments should I expect and how many of those? And really making sense of all that is really key to ensuring that your practice is meeting the needs of your patients at the right time. And your staff has the resources available to provide the highest standards of care that you expect. But it also is important to ensure that your staff is working productively, because that really does ensure the financial success of your practice.

So one of the things we’re going to be talking a lot about is data. And I once worked for a leader who said, “In God we trust, all others bring data.” And I really firmly believe that, because data is really key to truly and fully understanding the needs of your unique patients, your unique practice, your unique sites, and those things together, really, there are no two practices that are identical. And data is really the way in which you can help understand the uniqueness. And you’ll probably hear me say unique countless times today. But it really is important to understand that, because creating and managing staff schedules that are truly unique to your unique practice needs, is one of the keys. And certainly data is the way in which you can help achieve that. So scheduling of staff has typically been a function of the appointment schedules follow the staff schedule. In other words, you create a staff schedule and then you backfill, you start filling in the patients against that. And really, the questions around that are, that we hear is, well, is it the right schedule for my patients? Is it right for my business? Does this strategy create too much downtime because we’re scheduling the staff first? Or on the flip side of that, does it create a situation in which there aren’t the right appointments available at the right times? So that’s what I mean when we say we create a staff schedule and the patient’s schedule follows. What we really are looking at is to take the data and turn that around so that we say, well, what are the actual patient needs? And let’s then create the right staff schedule to align with that. And certainly in the absence of data, schedules tend to get done the way they’ve always been done and really without the lack of challenging certain assumptions that led to that schedule in the first place. So with that I’m going to, hopefully, advance my slide. Sure. So as we look at it and we say, well, when we talk about leveraging data, what are we talking about? Data is what’s going to guide you. And, certainly, your data is unique. There are no two data sets that are going to be identical for any two practices. Your practice is unique. Your mix of patients are unique. The mix of procedures, the mix of treatment plans that you’re using, those are unique. And that varies by site. Even within one organization with multiple sites, that mix will vary from every single site. Likewise, your technology platform may vary. Certainly, obviously, there’s a large number of Cloud 9 folks here. So that’s certainly a one set of data that’s the same. But the list goes on and on. So all of the unique data, it’s important to make sense of that and the mixes that’s creating that data. And that data is being captured all the time. As I said, it’s your Cloud 9 application or your practice management application is a rich source of that data. The treatment plans that are contained with it, whether they’re elaborate treatment plans or whether they’re reoccurring us frequent of appointments, the appointment data that you have, both the appointments that have happened historically, but also all of your future scheduled appointments, those are a rich source. Things like billing claims. That’s a very rich source of understanding exactly what are the differences between appointments. And then secondary technology platforms or systems that you’re routinely using, they have data as well. So the data is all around you. And one thing that I know that people get nervous about when we start talking about data as well, are we going to get into ePHI or PII information? And I’m here to tell you that you can do so much without ever introducing any ePHI or PII into this. So it’s kind of a nice thing because you can get the insights from your data without all of the constraints that sometimes that those types of regulatory restrictions place on it. So using data is really critical to creating that optimized or aligned schedule. And as we know, your work, it’s never the same. If you look from month-to-month, you know intuitively which months are busier, week-to-week within a month it changes, and heck, even within a day the type of things you’re doing are different based on the day or even by hour. And that really is where the data can help guide you to make informed decisions about what to do and when to do it and how to schedule that. And again, aligning staff to meet with patient trends, understanding and predicting the differences, that’s the key of what we’re talking about. And doing so allows you to create a picture of what the work will look like in the future. And if you have a highly accurate picture of what that work looks like in the future, that’s where you can create a very efficient schedule that meets the needs of your patients and ensures that your staff is working productively.

So what type of data are we talking about? So again, I kind of already talked about the treatment plan data to understand what’s the next appointment and the next, next appointment. What’s the interval between those on the treatment plan? What type of chair is necessary for that? What type of appointment is the appointment that’s four visits from now? Is it a de-bonding appointment versus just a more routine wire adjustment type thing. Understanding the differences between the different types of orthodontic care. Is it more of an Invisalign solution versus a bracket solution? All of that data can help you create that forward look. And treatment plans, as I mentioned, some folks are using elaborate treatment plans and others are simple reoccurring plans. That’s another really great source of data, as I mentioned, because you can really predict out four, eight, even 12 months into the future, what does the picture of my work look like? And I’m here to tell you, you don’t need highly elaborate treatment plans to get that resolved. Now the details do matter. What I mean by that is oftentimes we understand that an appointment occurred, but understanding in the data what was that, and looking for the attributes of an appointment are really help to differentiate the different levels of work associated. So in other words, not all appointments require the same amount of time, not all appointments require the same staff. So understanding and getting the nuances and the differences between that when you extract the data really helps you to understand, okay, well, what takes place? Was there additional imaging that was required? Or a different diagnostic test that was required at this particular appointment? As you extract that, that uniqueness starts to capture some of those differences between patients, between sites and the different level of effort associated with those patients and appointments. And certainly, I recognize that not everything you do will have data that backs that up. For example, comfort care appointments, for someone who says I had a layer that popped out of a bracket, for example. Those are the types of things where you can build in data-backed assumptions around how much additional effort do I need to accommodate those types of appointments. And you can plan for those. So growth guidance type appointments, or initial consults for someone coming in and running chairs to do sort of thing. Again, that can be created and be part of your model that you’re going to create using data-backed assumptions associated with those. And I fully recognize that appointments are not the only work that you do. There’s maintenance activities, things that we call fixed activities to get things done. It can be the cleaning of equipment. It can be the billing and administrative activities that you do, compliance and regulatory type activities as well. All of those things can be kind of incorporated into your model and should be, otherwise it really doesn’t reflect the entire app work that you’re doing.

So what type of labor model are we talking about? Again, we really want to take a very data-driven approach to this planning, and there’s really two business as usual type situation, two types of planning that we like to suggest. One is a strategic planning, and this is kind of using historical data appointment data to actually start to forecast forward, well, how much chair time will I need three months, four months from now? How many days does each site need to be open to meet the projected demand that far in advance? And historical appointments are really great for that. It’s possible to use that data and create a rolling 12-month forecast of how much time is necessary for each site. And so now once you understand how much time of each individual role is necessary, that’ll guide you to how many days need to be open, how many chairs should you have open or how calm should you be running for that particular day and what staff members are needed for that. And really creating that strategic plan, and you can layer in growth trends, those comfort care appointments, the consult history as well. And you can create this forward-looking model of here’s what my staffing requirements are. It allows you to build a ground up schedule for your staff based on projected patient need and demand versus writing a schedule and then back-filling patients into that. This is a very helpful strategy using the strategic historical appointment data for budgeting purposes too as you do that. And again, treatment plans can be another rich source and start to drill down into much more accurate, because you know when those patients are coming and you can aggregate that data into a rolling 12-month plan. The second strategy is what we call tactical decision-making. And this is actually pivoting from historical data to actually starting to leverage your scheduled appointments. And so a common strategy for this is to say, I’m going to take all of my scheduled appointments by site, and I’m going to start looking at the next four weeks. So maybe on Friday I get a rolling four weeks of appointment data mapped out into a daily format. Then layering the employee schedule on top of that, it becomes very easy for you to understand what does my workload versus my schedule that I wrote based on the projection look like. And now this allows you to start making tactical decisions about I have a site that is next week. It is very underutilized, and maybe I can reduce the chairs at the site, maybe I can realign to a different day that needs more help on a different day or a different site. And you can make those adjustments according to that. And I’ll talk a little bit more about that in the moment. This is also a really important strategy as orthodontic care moves to just-in-time appointments. As we see the emerging trend of those appointments being based on guidance tools that you want to wait to schedule the appointment until they’re ready for that appointment based on some sort of solution that you’re utilizing. This is really important because you want to know that if I have a site that is, for the next four weeks, at a 100% utilization, but yet I know that some of my appointments are going to be just-in-time appointments. I can’t accommodate them.

So as you move to a model of just-in-time scheduling, it’s important to understand, well, what capacity do I have left? And do I need to move resources if you’re working from across days or multiple sites to accommodate that at another site from a site that’s less utilized? And those two strategies of strategic and tactical projection and forecasting, they’re used in combination, because you certainly want to look forward and look long range and have an understanding and build that schedule up from the ground up based on patient projected need, but then marry that with what’s actually unfolds with scheduled appointments. And that’s a very powerful strategy of combining those two strategies.

Now, the third one that we’ve included here is something that’s obviously, we see an emerging need for right now, and that’s the post-crisis. And obviously I’m speaking of COVID-19 here, but really to make data-driven contingency planning so that as we begin to resume our normal lives, there have been a whole host of appointments that have not taken place. Well, contained in the data is all the information you need to know is to, well, which appointments are the most pressing that you get scheduled? But again, you’re going to be trying to schedule those make-up appointments, I’ll call them, on top of the appointments that are normally scheduled for June and July and August. So really using kind of a data-driven approach, you can understand, well, what does that surge look like? Where is that surge going to hit? Because guess what? I think we’ve all come to the realization that no two communities are going to restart at the same time. So as you’re planning across multiple communities maybe, it’s important to understand, well, what does this site’s picture look like in surge? And it’s important to understand that for the next round of appointments, because that surge or that bubble of appointments has the potential to reoccur. And again, using a data-driven approach, it’s the opportunity to smooth that out so that you can accommodate all of your patients in the most appropriate strategy in order to meet their needs.

So, let’s talk a little bit about pragmatic labor forecasting. So how does this get done, right? Because it’s one thing to pull the data out of the system, but then to create it, to use it to create a meaningful picture, that’s really the devil in the detail, right? So really what we’re talking about is as you look at those predictive historical appointments, that’s what we’re talking about, and pulling out that data, it’s possible to take those appointments and understand, well, what’s the standard amount of time that, that appointment takes by role? So understanding that a de-bonding versus a bracket adjustment, those are two different types of appointments. So as you pull that data out and you understand, well, when is that next appointment going to occur? Next month, four months, eight months from now, you’re able to actually start to create this picture of how much time is necessary and what type of appointments are necessary. So the standard really is working with each practice to set those standards for those types of appointments, to say this much of the orthodontist time, this much of the assistance time and so on. You can create a picture of, well, how much time do I need based on the history of appointments as well? So that’s what we mean by the standards. And when you pull the data out, coupling that data of appointments with those standards for the appointments, you’re able to create a visual picture of how much help is necessary. So how many? What days, what hour are the appointments looking like? And you can create this forecast that is a year-over-year pattern merged with the emerging trends in the data so that you can create this very specific picture of what the work will look like in the future. That’s using the historical data. And certainly the appointments, as I mentioned, aren’t the only thing that needs to be incorporated. There’s those fixed activities for maintenance and cleaning and those types of things. But also, we typically like to say there should be allowances for human factors. So things like how much turnaround time between appointments is necessary? Making sure that you’d never schedule a certain type of appointment within an hour of the lunch hour. Things of that sort. Those are the types of rules that you can build in to create a realistic tailored picture of what that workload should be for your site. And doing that ensures that you have the right number of days, right number of chairs, you have the right staff working on those days. And it can help guide you in creating that model of, well, what days am I going to be open at this particular site? And when does this type of employee need to go to that site as part of the team as well? Now, as I mentioned, as we’d switched to that tactical or using scheduled appointment data, this is where you’re starting to say, okay, I planned for my appointments to fill in, in a certain way, but now let’s look to see how they’re actually filling in. And you can do this, you can pivot the data from that historical forecast to build your employee schedule and then pivot to, okay, now let’s use actual scheduled data. And now you’re starting to be able to see what does that look like in you’re comparing the employee schedule to what the actual scheduled appointments look like. This is really optimizing begins to create that visual picture of the work of, okay, where am I in terms of that work versus schedule? This is the opportunity to begin fine-tuning and optimizing your schedule that was already written. And these are some of those things like if you see a site that’s underutilized and you have a site that’s a neighboring site that maybe is at capacity, maybe it’s switched days of between the sites and add another day at the other site or add another chair. And those are the types of things that the data can help guide you in terms of actual scheduled appointments. And this is certainly in that traditional model where as I, as a patient, leave my appointment today and I’m given my next appointment. That works very well because you’re able to visually see that. But it also works in that just-in-time model that we were speaking of. And as you’re starting to say, well, we’ll schedule you when you’re ready, you’re able to actually see, well, boy, I know this patient’s going to come due in this approximate timeframe, but I don’t have the capacity to actually take on that patient. So that’s where pivoting to that scheduled appointment data becomes very relevant because it’s ensuring you’ve got the right folks at the right time. And in doing this, it can be done in a very visual way that shows you at a very quick glance what days, what sites are at capacity and which of those are under their capacity as well. And it’s all about then realigning your staff to meet where the demand of your patients is effective. So the data driven optimization, really, this is where one of the nice things is being able to have a position where you’re not having to go through books and appointments schedules and manually look at this. It’s possible to set up the automated data feed from solutions such as Cloud 9, in which you’re able to actually have all of that data, both the historical, but also the scheduled appointments, at your fingertips and have a dashboard that allows you to quickly and easily look at what days, what sites, what weeks do I need to make adjustments? And that data can always be there for when you need it and not having to go look at that and not have someone to go through manually to look at those appointments and things of that sort. And again, as I mentioned, it can be represented in a SAS or a software as a solution scheduling tool that visually guides pretty much anyone can see visually understand where the opportunity lies. And again, that’s the power of integrating that into that solution. The other thing is it really helps ensure that your staff is working to the top of their skillset. And by mapping all of the activities and the appointments to the right employees, that ensures that you have them working at the top of their skillset, which is obviously from an efficiency and a productivity perspective, a really important element of any staffing plan. And as we mentioned, the reallocating of underutilization, that’s productivity, and that is maximizing your cost effectiveness of your solution. The last thing you want is to have an employee with a chair that’s not working, or that you’ve got gaps in your schedule as well. So having a line of sight to that is really, in a very visual and simple way, is key for you to be able to do that.

And lastly, the scheduling metrics. This is, again, part of that snapshot, easy to read, understanding of what days, what chairs, what sites are either at their capacity and not able to take in new patients, which obviously is a missed opportunity, as well as reallocating those folks to other sites for utilization. And obviously that multi-site coordination, that’s part of the jigsaw puzzle that I mentioned at the top of the presentation. It’s oftentimes we’re seeing shared resources and the coordination of that can be challenging. And it’s oftentimes, we see a lot of Excel-based solutions or paper-based solution. And really that becomes, well, what’s the record of truth and who has the most updated information? And how do you communicate back and forth with staff? Are you communicating needs and changes by email or by text message where using this data-driven approach wrapped around it with a scheduling solution really brings out the true value of that projection, because now you can make decisions and make adjustments against that projection with the scheduling application, and immediately communicate to all the parties that need to be told about that. It streamlines that. And again, the scheduling metrics are right then in there for frontline managers to view and understand, and it really eliminates all of the headaches associated with scheduling as well. So that’s the value of that service as a software solution, where you’re integrating both a projection model together with the schedule itself. So that’s really at a high level what we wanted to talk about and be able to share with you.

And my name is Wade Walters at ProviderScience and Elizabeth Hansen is part of our team. She’s our customer success coordinator. And we’d love to hear from you. And by all means, we’re able to take some questions now. And if you’d like to learn more, by all means, you can contact myself or Elizabeth, and we’d love to share more of what we’ve done with others in your industry and with Cloud 9 and have that conversation.

BN: Thank you so much, Wade. We are open for some Q and A. And as a reminder, you may submit questions via the Q and A button on the left-hand side of the screen. Now, at this time it doesn’t actually look like we have any questions from the audience. So if any of our viewers think of something after digesting all of this content, do please email elizabeth@prociderscience.com or wade@providerscience.com, or you can also reach out to Cloud 9 Software’s integrations team. That would be integrations@cloud9.software. Additionally, if you’re interested in learning more about Cloud 9’s practice management system, please contact us at sales@cloud9.software. So thank you all so much for attending, and we hope to see you for our next webinar on April 29th. It will be hosted by Jill Allen of Jill Allen & Associates. And the topic is “Who Are You? Using Your Brand to Your Advantage.”

So thank you again, Wade Walters and ProviderScience. This has been extremely informative and thank you to everyone who’s been here in attendance today.

WW: Thank you, everyone.