COO

Fractional Chief Operations Officer

Executive operations leadership from someone who has run the floor and the front office. Vanessa Buchheit steps into your practice as the operations leader you have not hired yet, fixes the systems, holds the team accountable, and stays in the work until performance improves.

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Most Practices Do Not Have a Growth Problem. They Have an Operations Problem.

You have a full schedule most days and empty chairs on others. You have a treatment coordinator doing their best and a front desk that is one system away from constant catch-up. Production numbers move, but nobody can say why with confidence.

What you do not have is one person who owns the answer to a simple question: where exactly is this practice losing production, and what do we fix first?

That is the gap a Fractional COO fills. Not another manager doing another task. An operations executive sitting inside your practice, accountable for the whole system, at a fraction of the cost and commitment of a full-time hire.

An Office Manager Runs Your Day. A Fractional COO Runs Your Operation.

Here is something most consultants will not say out loud.

Most practices already have someone holding the day together. A strong office manager, a treatment coordinator, maybe a consultant who comes in twice a year with a binder of recommendations. For a lot of practices, that is enough.

But an office manager operates inside the systems you already have. They keep the day moving inside whatever structure exists, broken or not. A consultant hands you a report and leaves before anyone has to execute it.

A Fractional COO operates above the day. Vanessa sits in your practice, not just in a review meeting twice a year.

Your Office Manager or Consultant

Your Fractional COO

Keeps today's schedule moving

Redesigns the systems that create today's schedule problems

Reports on production and daily numbers

Ties production, case acceptance, and capacity together into one picture

Manages the team's daily tasks

Builds the accountability structure and hiring plan behind the team

Hands you a report of recommendations

Implements the recommendations and stays until they stick

Follows the process that already exists

Decides which processes should exist and rebuilds the rest

Works within the current structure

Tells you which parts of the structure to keep, cut, or rebuild, and defends the answer

One keeps the day running. The other builds the practice that runs itself. Most practices scaling past their current systems need both.

You Are Not Buying a Title. You Are Buying Nearly Twenty Years Inside Dental Operations.

Anyone can claim a Fractional COO title. The question you should ask is what that person has actually run.

Vanessa Buchheit has spent nearly two decades in the dental industry, starting at the front desk and working her way to the executive suite. Over that time, she has:

Spent five years at Henry Schein, coaching more than 70 dental practices through operational and performance improvement
Served as Director of Education and Client Services at Unified Smiles
Led operations, strategy, and team alignment as Chief Operating Officer at Smalltown Dental, a multi-location DSO, for more than three years
Served as General Manager at HR for Health, where she currently works
Published and lectured on leadership and sustainable practice growth for over a decade
Operated as a Fractional COO for practices growing faster than their systems could support

That is the difference. When Vanessa tells you your schedule template is bleeding production, it is because she has fixed that exact problem in dozens of practices. When she tells you a role needs to be restructured or a bonus plan needs to change, it is because she has built those structures before, watched them fail, and corrected them.

Her core belief drives every engagement: most practices do not need more. They need to better use what they already have.

You are hiring judgment. Judgment is expensive to build and cheap to rent.

What Vanessa Does Inside Your Practice

This is not a quarterly binder and a slide deck. A Fractional COO engagement is hands-on work.

Leadership and strategy

Assesses your current workflows, team structure, and key performance metrics
Sets the KPIs that matter to your practice and kills the vanity metrics that do not
Sits with ownership and leadership to represent operations at the executive level
Builds the accountability structure and performance review process around the team

Team development

Meets with your team on a recurring cadence
Trains your staff, coaches them, and raises their ceiling whether or not the engagement continues
Helps you hire correctly, or tells you the hire you are about to make is the wrong one
Aligns front desk, clinical, and treatment coordination so patients do not fall through the cracks between them

Systems and process oversight

Builds and refines systems across scheduling, patient flow, communication, and case acceptance
Reviews the software and tools already in place and identifies what is unused, redundant, or working against the team
Audits the workflows your team runs on and asks the questions nobody else is asking
Runs the transition when a process, tool, or role needs to be replaced

Operational depth

Digs into the numbers behind the numbers: case acceptance rate, schedule utilization, production per patient, patient retention
Separates the signal from the fluff, then fixes the process causing the gap
Builds the reporting rhythm so you always know where you stand without chasing it
Works alongside your existing team, whatever software or systems they are already using

This role sits at the intersection of process and people. That is on purpose. Systems without accountability produce a binder nobody follows. Accountability without systems produces a team working hard in the wrong direction. The job is to run both sides of that equation.

We Do Not Have to Be Your Software Vendor

Most operations consultants sell you their own system, their own software, or their own process framework. Vanessa does not. She works inside whatever systems your practice already runs on and tells you honestly what is working and what is not.
If the right answer is to keep your current software or process, that is the answer you will get. The value of an executive is only real if the advice is unbiased.

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Man wearing a headset working at a computer with a dashboard, under a Dream Team sign

Nearly Two Decades in the Industry

Vanessa has not split her career across a dozen verticals. She has spent almost twenty years inside dental, from the front desk to the executive suite of a multi-location DSO. She has seen the same breakdowns repeat at nearly every stage of growth: solo practice to multi-location, single doctor to DSO.
What changes at each stage is the complexity. What does not change is the discipline required to fix it.

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Structured Around Hours, Not Vague Promises

Every engagement is built on a defined number of hours per week or per month, so you know exactly what level of involvement you are getting and exactly what it costs. No open-ended retainer, no mystery scope.

Tier 1: Advisory

Strategic oversight, monthly leadership session, KPI and performance review, systems accountability. Best for practices with a functioning team that needs direction and a check on the work.

Tier 2: Embedded

Everything in Advisory, plus weekly involvement with your team, active process rebuilding, hiring support, and alignment across front desk, clinical, and treatment coordination. Best for practices scaling past their current systems.

Tier 3: Executive

Full fractional executive presence. Leadership meetings, team management, hiring and training, full systems oversight, and direct involvement in day-to-day execution. Best for practices in a growth or transition phase that need an operations executive now and are not ready to hire one full time.

Not sure which tier fits?

That is what the first conversation is for. We will scope it based on what your practice actually needs, not what we would prefer to sell.

Book a Fit Conversation

Frequently Asked Questions

What is a Fractional COO and how is it different from hiring a full-time COO?

A full-time COO is a permanent executive hire with a salary, benefits, and a long ramp. A Fractional COO gives you the same operational leadership and decision-making on a defined number of hours per month, with no long ramp and no long-term commitment. Most practices do not need a COO 40 hours a week. They need the right decisions made consistently, every month.

How is this different from the office manager or consultant we already have?

Your office manager or consultant works inside the day you already have, keeping tasks moving or handing you a report to execute yourself. A Fractional COO works a level above that: rebuilding the systems, holding the team accountable, and staying until the changes actually stick. Many practices keep their office manager and add a Fractional COO, and the two roles reinforce each other.

How involved will Vanessa be with our team and operations?

Directly involved. Depending on your tier, that means recurring meetings with your team, participation in leadership discussions, coaching your staff, reviewing your systems firsthand, and being reachable between meetings when something needs a decision. This is not a quarterly check-in.

Do we have to change our current systems or software?

No. Vanessa works inside whatever scheduling software, practice management system, or process your practice already runs on. If a tool is not working, she will tell you, but the engagement does not require replacing what you have on day one.

What types of practices benefit most from this service?

Practices experiencing growth but struggling with inefficiency, inconsistent performance, or missed revenue opportunities. This is especially valuable for multi-location groups, DSOs, and single practices that have outgrown the systems they started with.

How quickly will we see results?

You will see the assessment and the plan within the first 30 days, but real operational change takes longer than a report. Most practices notice movement in scheduling, case acceptance, or team accountability within 60 to 90 days. Vanessa stays until the changes are running on their own, not just until the plan is written.

How do you measure success and impact?

Success is measured against the metrics your practice runs on: case acceptance rate, schedule utilization, production per patient, patient retention, and overall efficiency. You get a consistent reporting rhythm so performance is never a mystery.

What happens in the first 30 days?

A full assessment of your current workflows, team structure, systems, and key performance metrics. A clear read on what is working, what is causing bottlenecks, and what is missing. Then a plan with priorities, owners, and timelines. You will know exactly where you stand before committing to anything long term.

Ready to Put a Real Operations Executive in the Room?

If you are serious about scaling, the next step is not doing more with the same systems. It is having someone accountable for whether your operations actually work. Let's have a conversation about where your practice stands and whether this is the right move.

Speak To Vanessa