Article from RMI DentalSuccess Letter

Defining Terms

As we travel around the United States, North America and the world, no topic has excited more conversation, more feedback and more immediate results than stopping cancellations in your dental practice. That is why we have been asked to write this special report. It is one of the areas for increased practice success that is right at your fingertips.

Let's define terms. It is our belief that the purpose of a dental practice is to create a happy, paying patient who:

-pays more than it costs to service him or her;
-repeats the use of the service;
-and refers other patients to the practice.

We know that the dentist could not be more highly regarded among professionals in the community. In survey after survey, the public perceives the dentist as having a level of integrity, which outranks physicians, politicians, clergy and teachers. The only profession to challenge the dentist in this regard is the pharmacist.

However, this does not mean that patients automatically know how to conduct themselves in relation to the dentist and dental team. We think it wise that people know "up with which you will not put." In other words, patients need to be educated as to what is acceptable behavior in regard to lateness, absenteeism and cancellation. We believe this education is necessary, painless and easy to communicate.

Like proper dentistry, we hold that prevention is a better policy than remediation. Once these ground rules are set in proper working order, expect cancellations to reduce by 80%. As for the remaining problem cases, we have some great first aid ideas. But let's begin at the beginning.

Instituting a New Policy

Determine the cash value of your dental chair per hour. How much is it worth? Two hundred and fifty to five hundred dollars an hour or more is our estimate. At the next staff meeting, sit down with the dental team and calculate it out loud.

The dental team needs to know how much money that empty chair is losing! When everyone understands the potential worth of that chair, attitudes shift. That's the first order of business: to adjust the attitude the team has to cancellations and missed appointments. Everybody loses when that chair sits empty! The company that insures your practice will not call to deduct an hour because your patient did not show. The property management office will not drop in and say, "I see you had a cancellation. We're so sorry that we won't charge you rent for that hour." The practice's overhead does not disappear along with the patient who fails to appear.

When the patient doesn't show, who pays for it? Everyone else does: the dental team, the dentist and the other patients. Rule One in human relations is that we teach people how to treat us. Therefore, if folks are canceling, it is incumbent upon the entire dental team to realize it's time to retrain the patient.

Before we go any further, it's necessary to point out that we're not trying to make the patient wrong. On the other side of town, perhaps the gynecologist or the chiropractor doesn't mind cancellations. Maybe they are so used to rescheduling appointments that your patients presume your attitude is similar. If you think about it, only the best in town - the most expensive or prestigious of services, whether it be a fancy restaurant, hair salon, attorney's office or surgeon - are the places with whom you already know you ought not to cancel your appointment.

Being the best begins with being perceived as the best. The objective is to help patients stick to the original commitment they made to their dental health. We believe the finest thing human beings can do is the thing they have committed to do.

When To Speak

The ideal scenario for getting the patient to commit to no cancellations involves the entire team, but it begins with the dentist. The patient is already seated in the chair. You and your dental team have done your homework. You know the personal profile of the patient, and you've used that information to discover the patient's dominant buying motive (let's say in this case it's economy of time). In addition, you've followed the step-by-step formula outlined at our Boot Kamp. You have gotten the patient to commit to the total treatment plan you have prescribed. Now, add this one thing:

"So, Mr. Busy, we're excited that you're going ahead with this treatment plan and that we're going to get you back to total dental health. I know the obligations on your time and I'm going to make a commitment to you. Every time we schedule an appointment, you can be sure that my team and I will do everything possible to take care of your needs in a timely manner.

Now I'd like to ask for the same commitment in return."

"Sure, Dr. Clarity."

"I know how valuable time is in your profession and so I'd like some help in scheduling you. When are you least likely to have anything interfere with keeping your appointment with us?"

"Early Friday morning is the least hectic."

"Thank you. Let's commit to that schedule. By sticking with the plan we can have you totally healthy as quickly as possible."
Now for the next step. Recognize that you have not yet achieved total closure. Get a two-on-one commitment from the patient. Walk Mr. Busy to the front desk

"Mrs. Appointment Coordinator, you know Mr. Busy, don't you? I have just made a commitment to schedule him so that he won't have any interruptions in his treatment. He knows how important this work is and he wants to get completely healthy again. He has suggested that early Friday morning is the best time for him to come in. Can we get him in the first chair at 7:30?"

"Would 7:30 be good for you, Mr. Busy?"

"Fine."

"We promise to do everything we can to get you in and out of the office in the most timely manner possible, Mr. Busy."

"Thank you, Mrs. Appointment Coordinator. I'll do the same. That's a promise. And thanks again, Doctor Clarity."

Doctor Clarity and his team came prepared. Let's analyze their approach.

First, he spoke the language of the patient. In this case the source of concern was time, rather than, say, fear of pain or lack of money. Everything was benefit, benefit, benefit to the patient. Notice that neither the doctor nor the appointment coordinator ever said, "We're too busy around here and cannot abide rescheduling your cancellation."

Second, Doctor Clarity knew exactly what he was going to say. He was practiced enough about his end of the conversation so that he came across calmly, sincerely and directly. This allowed him to continue to pay attention to the cues and signals that Mr. Busy was revealing, both verbally and non-verbally.

Third, the doctor valued the treatment plan so much that its importance was understood by the patient. In addition to the treatment, Mr. Busy caught on that the dentist also values time as much as he does.

Fourth, everything the dentist said was reinforced by the words and behavior of his team! The patient received a consistent message which underlined the importance of the treatment and of not canceling. Furthermore, a successful transfer of power from the dentist to team member took place. She now has the authority of the dentist as well as the perceived power to take care of the situation.

Should Mr. Busy call to cancel, he will most likely speak with Mrs. Appointment Coordinator, the last person with whom he made the commitment to be timely.

Finally, note that nothing harsh happened. On the contrary, the same message was delivered throughout the interaction. The patient was not made to feel uncomfortable. The situation was simply controlled expertly. Remember that it's harder to disappoint two people than one person. That's why the buddy system works so well with overcoming problem or addictive behaviors. Do you think Mr. Busy will think twice about canceling? You bet he will.

The necessity of the team's acting in harmony with the dentist cannot be overstated. Imagine the same scenario with the chair side assistant or the hygienist present in the treatment room and either one of them walking the patient to the front desk. By being in concert with the dentist, the team enhances Dr. Clarity's level of credibility.

Dentistry is a relation-ship of trust between the doctor and the patient. Nothing could influence the patient to accept the prescribed total treatment plan more than the team's expressed confidence in their leader. Nothing could help convince the patient that cancellation is not the policy more than to see the way in which that leadership moves from dentist to team member. It helps create an atmosphere not only of trust and reassurence but of health as well.

When All Else Fails

These final sections are for those patients who are chronic offenders. Let's say you've walked them through all of the above. They see the Promised Land, but they still call up trying to cancel. Since they prefer to phone when they know no one is in the office to take the call (why is that?), our first recommendation is that you change your answering machine or advise your answering service of a new policy.

"Thank you for calling Dr. No Cancellation's office. Regular hours are Monday through Thursday, 8:00 a.m. to 4:00 p.m. If you are calling with a dental emergency or with a scheduling conflict, please call REACH-ME. This machine does not accept scheduling changes."

How many patients will call you at home to tell you that they are canceling an appointment? Not many. What is fundamentally wrong with saying that your answering machine does not accept cancellations? In actual fact, it cannot reschedule an appointment or advise the patient as to the seriousness of his or her dental health. It is important that patients realize this. If the cancellation is crucial, they will reach you. Imagine a Monday morning without having to begin the day playing back all those messages!

As for the answering service, we believe they don't provide much in the way of service. Understaffed, overworked and under trained, they are no more able to represent your interests than if you were to grab someone off the street and make them your appointment coordinator for the day. Here's the acid test: call your answering service and tell them that you are a patient. See how you're treated, how long you are put on hold, how satisfied you are with the results. Then you will know what your patients go through when they call.

Our second recommendation is that the dentist and team not carry these chronic offenders around in their heads. It is possible to be too accommodating to certain patients who do not keep their word. Upon the third or fourth cancellation, a simple letter or telephone call can be issued which, without offending the patient, makes it clear that such disregard for office policy is unacceptable. Since their behavior has now put their status as a patient in question, the letter might end encouraging them to respond and remediate. Now the monkey is off your back

Considerations to Remember

To prevent cancellations, three critical areas of implementation must be put into effect:

• The entire dental team has got to believe in the treatment as well as know the value of the time in that dental chair;

• The entire dental team must communicate with conviction the importance of the treatment and of time in that chair. Your responsibility as a health care professional depends upon the patient's being restored to total health;

• Confirm the patient's commitment in a two-on-one transfer of power. Walking out of the office, the patient should be thinking about the commitment he or she has just made to at least two people at the front desk.

Consistent practice in these three areas can make a dramatic difference.

We have also discovered that many dental teams have gone three more steps:

• Assign someone to be responsible to remind the entire team about
the importance of the aforementioned in reducing cancellations;

• Make sure that the person makes a list of all the incidents of cancellation over a certain period of time. Discuss these as a team. Talk about what went right, what went wrong, what can be done in the future to prevent the wrong things from happening again;

• Track the lost production that occurred because of those cancellations. You will find that one canceled appointment a day can make a tremendous impact on the bottom line of a practice.

We don't think it unseemly to phone the patient within the first five or ten minutes of the appointment they are missing. Most people can be reached. If they do not answer the phone at home or at work, there is usually some type of device to record a message. And the message is simple.

"Mrs. No Show, this is Mrs. Appointment Coordinator. It's Friday afternoon at 2:00 p.m. and we've been waiting for you for the last ten minutes. We're really concerned about you and just wanted to make sure you're okay."

When these patients call back, have a conversation about what happened, mention how important the treatment is and what you can do in the future to help make sure they arrive on time for the next appointment. Rather than scold, the wise appointment coordinator makes a personal commitment to help those patients get what they came for, their total dental health.

Handling the Cancellation Call

As we demonstrated earlier in the treatment room scenario, knowing the procedure before the event takes place is an excellent idea.

The phone rings.

"Dr. Do It Right's office. This is Paula Prepared."

"This is Gone Fishing."

"Hi, Mr. Fishing, how are you? We are certainly looking forward to seeing you on Tuesday."

"That's why I'm calling. Something important has just come up. I'm not going to be able to make it."

"Oh (pause). Mr. Fishing, could you hold just for a moment while I get your chart?"

Paula returns with the chart and says, "Mr. Fishing, thank you for holding. I wanted to make sure that I have all the information in front of me. I understand that you and Dr. Right had a conversation about your dental health. Just from his notes here, he seems very concerned about the blood and pus in your mouth. That's a serious gum disease that needs to be taken care of as soon as possible. I know he's going to be very concerned about a cancellation."

"All right, I'll be there."

Why This Works

Let's examine why Paula Prepared handled Gone Fishing in this manner. First, she let the patient talk (read sweat) it out instead of jumping in. The excuse often contains a good deal of information that the wise appointment coordinator can use in response. Silence can often be mighty powerful in this regard. Second, Paula paused, allowing the guilt factor to settle in before she went and got his records. Third, she took the condition back to its source. This was the most skillful thing she did, using language that Mr. Fishing could understand. Blood and pus is more compelling than periodontal disease and twelve millimeter pockets. So the decision to commit to the appointment was actually Mr. Fishing's Idea.

This is not to say that every cancellation call will be this easy, but being prepared is the name of the game. In many instances, the motive for canceling remains hidden. Often, the patient needs to be taken back to the person who sold the treatment plan in the first place.

"The doctor is in the treatment room right now, but is there a phone number he can reach you at within the hour?"
Some patients will not want the doctor bothered, but those with real concerns-memories of pain, fear of the drill, questions about expense, worries about dentures—will be grateful for the chance to be reassured.

We have used these techniques all over North America, in small towns as well as big cities. What we have found is that by working with these methods, a denial practice can get better and better at eliminating cancellations. Furthermore, dentist and team often come to discover a more satisfying way of working together. Harmony is a direct result along with a deeper appreciation of what everyone on the team has to offer. Many dentists have told us that they never truly understood how varied - and how crucial - are the skills of the appointment coordinator.

Learning to educate the patient about how to deal with the dental office is part of the job of being a health professional. We are convinced that, by implementing some of the ideas in this special report, you can effectively stop cancellations from crippling your practice.

We wish you continued success in dentistry.

Walter Hailey and Steve Anderson

Call DentalSuccess Today

Ask us about:

• Dental Tele-Pro, our audio tape cassette series designed to train the entire dental team on how to take incoming calls;

• Your Key to the Practice, 12 Easy Steps to Great Emotional and Financial Security, our "owner's manual" for the dental team member, written in collaboration with industry specialist Linda Miles;

• ESP: The Everybody Search Plan, 40 Common Sense and Easy- to-implement Ideas to Get Every one in Your Company Focused on Creating More happy Paying Customers, Clients, patients. Buyers or Whatever You Call the People Who Do Business with You, our survival handbook for the Nineties, written by Walter Hailey and Steve Anderson;

•Speak and the Money Will Follow, The No Fear Guide to Promoting Your Business and Yourself Through the Power of Public Speaking, our audio cassette program in collaboration with Bill Gove, Founder of the National Speakers Association;

•How to Form a MasterMind Alliance, Coordinate Knowledge & Effort in a Spirit of Harmony to Multiply Your Effectiveness Produce Richer Results, written by Steve Anderson;

•Breaking the No Barrier, The Billion Dollar Battle Plan for Getting Everyone You Want to Say Yes to Your Proposition, written by Walter Hailey.

Our Other Special Reports in This Series:

Greg Sneyd, Director of DentalSuccess Financial, talks about ...

In your dental practice you handle significant amounts of cash everyday. And as you strive to move your practice towards being insurance-free, you will probably handle even more amounts of cash. As such, you must make sure that you have the proper procedures in place to eliminate the possibility or the temptation of your team members to decide that your cash is better suited for their personal needs rather than yours.

While I was at Dental Boot Kamp in Nashville I ran into Crown Council member, Gary Griffin who related a story to me about a situation in his practice that resulted in a major learning experience. Gary thought he had a top-notch team. He thought that everyone on his team was honest, trustworthy and respected everyone else on the team. They were all part of the family.

One afternoon, Gary just happened to be looking through the production and accounting records and he noticed that there were two deposit slips for the previous day’s deposit. One deposit slip reflected cash collections as part of the deposit. The other deposit slip did not. Immediately, Gary knew something was fishy.

At the team huddle the next morning Gary asked his team member who had responsibility for the accounting if she knew anything about this. She was speechless, surprised and said she would look into it. As Gary later learned she had been keeping the cash for herself. One deposit slip, which was kept with the accounting records, reflected the total receipts for the day including the cash receipts. The second deposit slip reflected the actual deposit that she deposited in the bank that day. Normally she would hold on to the actual receipt, but that particular day she accidentally placed both deposit slips in the accounting records. A big mistake and fortunately for Gary he had just happened to look at the accounting records that day.

As it turned out she had embezzled $36,000 over an 8-month period. Gary went to the police the next day but had an uphill battle trying to get anyone to take interest in prosecution of the case. Apparently, they all had better things to do with their time than prosecute a case like this. Eventually with a little bit of luck and help from a friend Gary was able to find someone to prosecute.

To make a long story short, she was convicted of 62 felony accounts of theft, had to pay back the $36,000, had to turn custody of her children over to her ex-husband, and was subject to home incarceration for 6 months during which she had to where an electronic locator bracelet. We hope she has learned her lesson and won’t do this again to any other dentists.

It was not an easy or enjoyable process but Gary felt that he had to go all the way to ensure that she did not do this to anyone else. Let’s face it, many dentists are probably the perfect target for this type of criminal behavior. Many dentists trust their team members and rely on them to be honest and trustworthy.

In fact many of you may have had a similar experience. Last week I was talking to Dr. Scott Kiser in Salt Lake City about Gary’s experience and he said that he had a similar experience a few years ago, although not to the same magnitude as Gary. Maybe this situation sounds all too familiar to you, too?

So what do you do to prevent this from happening to you? Well, don’t think that you are exempt from this kind of criminal behavior. Even your most trusted team members might be tempted if the opportunity presents itself. Gary’s team member was considered to be part of the family and this type of behavior from his trusted team member didn’t even enter his mind.

Here are a few procedures that Gary and Scott recommend. One of your team members should record all of the daily receipts in your accounting records. A different team member should prepare the daily bank deposit slip. Then someone different from the team member who prepared the deposit should make the actual deposit at the bank. You, personally, may even want to compare the accounting record of production to the actual bank deposit everyday, or at least on a random basis.

Scott also has a daily record sheet for any patient account adjustments or credits issued. Once every quarter his external accountant runs a report, that is included with their practice management software, which shows all adjustments and credits issued. This enables Scott to monitor whom and how much is being written off or adjusted on all patient accounts.

These are some very simple procedures that help to keep everyone honest. If you’re not doing this every day, start today. And don’t think that you don’t need to do this because you trust your team member as you would trust any member of your family. Don’t let trust be the only element in the equation where cash is involved.

For more information on Dental Boot Kamp or the Crown Council send an email to gregs@dentalsuccess.net or call Greg Sneyd at 800-460-3838 x106.

Art Anderson, your DentalSuccess Tipster, lets you know:

What's on the Menu?

One key to gaining case acceptance is to have patients understand their problems before you provide solutions. This reminder comes from Dr. John C. Kois who has a private practice limited to Prosthodontics in Tacoma, Washington. That seems rather obvious but many times when patients come to the dental office for non-emergency reasons they don’t really know what they want in terms of solutions to their problems. In some ways patients may be like restaurant customers. They know they want a solution to their hunger but aren’t sure whether they want solve it with a steak, seafood, or a plate of spaghetti and meatballs.

It isn’t customary to hand patients a menu, because it is only after a complete examination that total needs are in evidence. Then the dentist sometimes has difficulty helping the patient to understand what the options are–what’s on the menu.

When explaining the dental menu, Professor Alan M. Dershowitz of the Harvard Law School, suggests avoiding three E’s. They are (1) ego – the desire to be right at any cost; (2) eloquence - using esoteric language containing words that are not in the patient’s vocabulary; (3) emotional involvement that puts making the “sale” more important than what’s best for the patient.

To gain acceptance it is important to make patients aware that the philosophy of the practice is to look at long-term dental health. Sensitivity to the patient’s financial capabilities is also important.

The proper strategy is to ask permission to tell the patient about all of the problems that are discovered and the cost of remedying them. The patient needs to know the nature of the ailment, if there is one, or the potential change in appearance or health that will result from the treatment. It is also important for the patient to know the long-term cost of not having it done. When all of these factors are known, it is then time to invite the patient to take part in the solution.