Black Holes in the Schedule: A Production Killer – Fixing the Problem – Part 2

To know that candles are expensive is of no value to the blind man. – Russian Proverb


In the last Tracker Tips Blog/E-Newsletter, Holes in the Schedule: A Major Production Killer – Part 1, we discussed the importance of tracking holes in your schedule and the impact that those holes could have on a practice. We talked about:

  • The importance of monitoring, measuring, and analyzing the holes.
  • How holes in the schedule typically came from the following three sources:
    • Broken appointments
    • Last minute cancellations
    • Time slots that were never filled
  • Background information including:
    • Potential sources of production
    • How to determine each producer’s typical production per time unit
    • Examples of the monetary impact of holes in schedules
  • Understanding the results and importance of the holes
  • Preliminary recommendations to help you in analyzing the holes in your schedules(see Initial Recommendations below for a review of the discussion).

If you feel you have a problem with holes, review my last Blog/e-Newsletter, Holes in the Schedule: A Major Production Killer – Part 1. You can find this article on this website in the Blog section or by looking me up on my LinkedIn account at Dr. Paul J. Pavlik. Click on Profile. Scroll down through the Profile to the Publications section and click on Holes in the Schedule: A Major Production Killer – Part 1. This should open the article. You can also send me an email at and indicate that you have given me permission to email you the link to the article in my Drop Box account.

Initial Recommendations

Start by taking a look at your daily schedule over the past several months; it is usually easiest to go back to January of the year you are monitoring; for example, start by reviewing the holes from January through October of this year.

You need to be able to address the following questions:

  1. How should you prepare for the three sources of holes that can develop?
  2. How can creative scripting by you and your staff get patients to be more reliable?
  3. How can you prepare your staff to utilize the nuances of creative scheduling?

How to Prepare for the Holes That Can Develop

You need to be able to determine the impact of the holes in your schedule. This is done by monitoring the holes. The easiest way we have found to do this is to count the number of units of holes. For example, if your schedule is in 10-minute blocks or in 15-minute blocks, you would count the number of units lost each day for each producer (e.g., each doctor, each hygienist, etc.) for each reason for the holes (e.g., broken appointments, last minute cancellations, time never filled), then add them up for each provider, and then total the holes for each month for each provider. Then total the number of holes and the reasons for the holes. You then can further break down the monetary impact by assigning the average (not goal) of each provider per hour. For example:

The following example shows holes in minutes translated into hours. You could use this format, or you can start with holes in units (10-minute or 15-minute units). Use the format that is easiest for you and your staff to document.

Using Creative Scripting to Decrease Holes 

The way you and your staff talk to patients is crucial to the patients’ understanding of how important their appointments are to themselves, to other patients, and to your office.

Here are some examples of holes, what not to say, and what to say to patient questions:

Example 1: Hole created from an unfilled appointment time.

Situation: This scenario is for a patient is trying to schedule her next appointment. (Let’s assume a scenario such as the following.) You already have a 9:00 a.m. appointment next week with another patient scheduled for 6 units (i.e., six 10-minute units) ending at 10:00 a.m. You have an opening in the schedule from 10:00 a.m. to 12:00 p.m. If you schedule the next appointment (e.g., another 6-unit appointment) at 10:00 a.m., you will have another 6-unit appointment available for another patient at 11:00 a.m., assuming your lunch break is at noon. If, however, you incorrectly schedule the patient at 10:30 a.m., you have built in a 30-minute hole at 10:00 a.m. and possibly another 30-minute hole on the backside of that appointment at 11:30 a.m. Now, you have lost an hour of production.

  • Incorrect responses from the scheduling coordinator might include:
    • What time would you prefer?
    • Would you like the morning or afternoon?
    • Is there a time or day that works better for you?
  • Correct responses include:
    • “We have time available at 10:00 a.m. next Wednesday.
    • ”If patient says she can’t make it at 10:00 but can make it at 10:30 a.m., you could say, “I’m sorry, but the next available 10:30 appointment is 4 weeks from now. Since it is important that you be seen, do you think you could arrange your schedule to be here next Wednesday at 10:00?”  
    • In a great majority of instances, the patient will rearrange her schedule.
    • If she cannot rearrange her schedule, schedule her at a future appointment that does not build potential holes into your schedule. Then say, “If we have a change in our schedule to better accommodate you, we’ll give you a call.” (Now, you’ve set the patient up for a call to fill a change in your schedule. If they don’t respond with a No, you can use them for your quick call list.)

Example 2: Hole created from a last minute cancellation.

Situation: The sound of a patient attempting to cancel: “I had an appointment today at 10:00. Well, I’m going to have to cancel.”

  • Incorrect responses from the scheduling coordinator might include:
    • “Call me when you are ready to reschedule?”  (If the patient doesn’t reschedule, you have to track them down later.)
    • “Would you like the morning or afternoon?”
    • “Is there a time or day that works better for you?”  
  • Correct responses include:
    • Ask patient to hold while you pull the chart. Then, give a reason for the importance of the appointment: “I’m looking at your chart. The hygienist made a note at your last visit that you had some infected areas that she treated, and that she and the doctor discussed the importance of this 12-week follow-up to see how those areas were doing. Unfortunately, I don’t have a reserved time for you for another 8 weeks. I know that the doctor and the hygienist aren’t going to want you to wait that long.”  
    • If the patient has been well informed and understands the concern, a reminder is often all that is necessary to get her to come in.
    • If this still doesn’t deter the cancellation, give her an appointment at least 3 weeks out. This demonstrates the popularity of your office.
    • Then ask her, “If we have an opportunity to see you sooner, how can you be reached?”
    • Document the discussion in the chart, remind her of your office policy, and encourage her to keep future appointments as scheduled.  
    • This takes time, but it takes more time to fill an opening – REMEMBER, once the time is lost, you never get it back.
    • What if your patient calls and is ill?  Coordinator: “I’m sorry to hear that you’re not feeling well. Let’s re-schedule your appointment.”  Keep a stack of signed (by all staff members & the doctor) get-well cards at the front desk and mail the card, immediately, to the patient. If the patient is really sick, it’s a great practice builder. If the patient is faking it, she will feel terrible.

Example 3: Hole created from a broken appointment.

Situation: (1st Time Failure Patient.) The scheduling coordinator calls patient to let her know she missed her appointment: “We had reserved an appointment at 10:00 this morning for you. Did you forget the appointment, or was there a family emergency?” The patient might say: “Yes, I completely forgot that appointment. I’m sorry.”

  • Incorrect response from your scheduling coordinator might include:
    • That’s OK. Don’t worry about it.
    • “Would you like to reschedule your appointment?”
    • “Is there a time or day that works better for you?”
  • Correct responses include:
    • “I will reserve another appointment, but please make a note of it. Failures make it very difficult on our schedule. If we had known that you weren’t coming, I might have been able to fill your time slot with an emergency patient, but without prior notice, it’s impossible.”  
    • If you charge for failed appointments, “There is normally a charge for failed appointments; however, since this is the first time that this has happened to you, I won’t charge you.”
    • To alleviate some of these problems, all patients should be reminded about your policy at the first appointment and at the time they schedule for new appointments. For example: “Mrs. Jones, should you need to reschedule your appointment, we would appreciate plenty of notice. We do require 2 business days notice for scheduling changes.” 
    • For patients who fail two or more times: Do NOT give them another scheduled appointment. Coordinator: “It appears that it is very difficult for you to keep a scheduled appointment with us. What we will do is call you when we have a last minute change in our schedule. You can also call us on a day you know you can come in and, if we have an opening, we will be happy to schedule you.” If you have patients who continually cancel or fail, you should FIRE those patients. Remember, they need to be notified in writing and be sure to use a “return receipt requested”. 

Other Examples:

What do you do when the patient says … (For a complete discussion on the best ways for you and your staff to properly administer scripting responses, please contact Dr. Pavlik regarding information for his presentation on “Scripting) something similar to any of the following examples?

  • “I understand that I need to schedule for the treatments, but I’ll have to think about it first.”
  • “It’s no big deal, it’s just a cleaning.”
  • “How much will this cost?”
  • “Why didn’t my company’s insurance plan cover the charges for my treatment?”
  • “Why did this happen all of a sudden when I’ve been coming in every 6 months?”
  • “I don’t feel I need all this deep cleaning stuff. Can’t you just do a regular cleaning?”
  • “Can I just come in every 3 or 4 months for a cleaning instead of having the non-surgical periodontal treatment you recommend?” 
  • “My insurance always paid for cleanings in the past. Why do I have to pay something this time?”
  • “Will this hurt and will I need to take time off from work for recovery?”
  • “If I promise to brush and use my dental floss faithfully, can’t we wait another 6 months?”                                                                                                                              

Additional Tips on Filling Holes That Develop in Your Schedule

Always confirm appointments 2 to 3 days in advance. This will give the extra time needed to fill changed appointments. Last minute changes can be difficult to fill. The following is a list of ideas to help:

  • Tell patients that your standard policy is to confirm and leave other messages via text messaging (be certain to get their cell phone numbers, emails, and phone) reminders. Let them know this is standard procedure for your office as a courtesy to your busy patients.
  • Check patients already in the office, e.g., hygiene & doctor patients, parents waiting for children, spouses, and any visiting patients (those discussing treatment plans or insurance, etc.)
  • Check patients for the next day, day after, next week, etc.
  • Just because patients were just scheduled, or said that they were going to be out of town, doesn’t mean that you shouldn’t try – plans change, and if you don’t ask, you’ll never know.

If you feel you have a problem with holes in your schedule or if you have other questions that concern you regarding the management of your practice, contact Dr. Pavlik at his e-mail address at

The information contained in this article is general in nature and is not legal, tax or financial advice. For information regarding your particular situation, contact an attorney or a tax or financial advisor. The information in this newsletter is provided with the understanding that it does not render legal, accounting, tax or financial advice. In specific cases, clients should consult their legal, accounting, tax or financial advisor. This article is not intended to give advice or to represent our firm as being qualified to give advice in all areas of professional services. To the extent that our firm does not have the expertise required on a particular matter, we will always work closely with you to help you gain access to the resources and professional advice that you need.

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