How to Eliminate No Shows and Short Notice Cancellations Forever

When a patient cancels an appointment, everyone loses. The doctor and team lose valuable chair-time and productivity, and most importantly, the patient loses because he/she doesn’t receive the treatment they need. Just two cancellations per day can cost a practice as much as $50,000.00 per year in lost revenue.

We assume that if we educate a patient about their health that they will make the right choices, follow through with treatment recommendations and show up for scheduled appointments. If this were true, then educated people would not smoke or be overweight. It takes more than education, it takes commitment to action.

If and when a patient calls to cancel, make a big deal out of it. Hear them out and then say “oh” and pause for a moment. Do not say “o.k.” and then reschedule for the next available time. Ask the patient, “Will you hold for a moment please while I get your chart?” or say “I need to need to speak with the doctor, will you hold for a moment please while I get your chart?”
Look at three things on the chart:

1. The patient’s condition
2. What is the treatment?
3. Why they are having it done?

Now you are armed with important and powerful information when you return to the telephone call. In the meantime, the patient has had time to understand how important the appointment is.
If the patient thinks that you have discussed this with the doctor, now it has become a big deal, and keeping the appointment will become much more important. No one wants to make the doctor mad.

“Tom, you are scheduled at 8:00 for a crown preparation. We have your crown back from the lab and we know how important this is to you – isn’t there any way you can make it?”

Make it hard for people to do what you don’t want them to do and easy to do what you want them to do. Don’t quote your office policy to patients because they don’t care. It’s all about “what’s in it for me?”

No Shows

What if the patient does not show up? The assistant should call the patient within first 5 minutes. Let the patient know that “we are all waiting for you.” This sends a strong message to the patient and it tells the patient that “you are important to us and we are on top of it.” Don’t ask the patient coordinator to call because if the patient is not in the chair, the assistant has time to call. If you simply send a letter, it won’t arrive until 3-4 days later, so how important was that appointment?

Confirmation Calls

Confirming appointments may sometimes present an opportunity for the patient to cancel. The word “confirm” implies that the appointment wasn’t firm in the first place and allows the patient an out. The same is true with reminder calls. If you are calling to remind the patient, it means that you are not expecting them to remember and it allows an escape route “Oops, I forgot.” Patients may develop a selective or elective memory.

Instead of a “confirmation” call try this:

I’m calling about your appointment with Dr. Smith tomorrow at 10:00 a.m. and just want you to know that we will have everything ready for you. We’re looking forward to seeing you. Will you call us if there is anything that we can do to make your appointment more comfortable?”

If you must leave a message on an answering machine, do not ask your patient to call you back to confirm. That adds another condition and opening for the patient to back out of the appointment.

Late Patients

Late patients will be seen only if the circumstances are such that it could not be avoided and it does not interfere with the next appointment. If a patient arrives too late, they should be re-appointed. Tell the patient that if half the appointment has been missed, you are not prepared to only do half of the job.
If a patient does not provide sufficient notice for a cancellation do not “reward” the patient by giving him/her a prime time appointment – re-schedule the appointment during your usual downtime or at a time that is less convenient for your patient. Otherwise, you are letting your patient know that it’s o.k. to cancel at short notice and there will be no consequence for their action. Your patients need to know that you will work with their schedule but you control yours

New Patients

Have you every wondered why new patients cancel? They are anonymous! You don’t know who they are and they don’t know you. To prevent new patients from canceling, the doctor should take 5 to 10 minutes each evening to call the new patients the night before the appointment to make an introduction and welcome the patient to the practice.
“Mrs. Jones, I’m Dr. Smith. I’m looking forward to meeting you tomorrow. Thank you for choosing my office. Is there anything that I can do, or my staff, to make your visit more comfortable?”

When the call is made, there is no more anonymity and it is the first step in building the relationship with the new patient. This not only surprises and delights the patient, but it sends a clear message that “you are important to me and I am committed to your care.”

If the patient shares information with the doctor, that information needs to be communicated back to the team so the team can follow through on the patient’s requests.

Dramatic changes can occur with just some minor changes in how you communicate with your patients. Try changing the way you handle cancellations for the next few weeks and monitor the results to see for yourself. Remember that the process involves more than just educating the patient, you must prompt your patient to take action and to be as fully committed to his or her own wellness as you are.

The Leadership Secrets of Santa Claus for Dentists

        BELIEVING IS SEEING
              

It’s not easy being Santa Claus.  You may not know this, but Santa has two roles that people rarely associate with him; Santa the Manager and Santa the Leader.  After all, he is running a business and he is the boss. There are workers to lead, letters to read, processes to manage, stuff to buy, stuff to make, standards to maintain, new technologies to adopt, skills to develop, elf problems to solve and so on. Every busy dentist can empathize with Santa.

Here are some Santa quotes, or you can call them Santa Clauses 

·         “You can’t possibly focus on your mission without also focusing on the folks that make your mission happen.”

·         “…getting big things done isn’t about magic...It’s about leadership. AND…leadership is about Walking the Talk

·         “Our success is the result of clearly defined goals combined with well thought out plans…such as our plans to develop our elves and reindeer.”

·         “We might be out of business if we don’t take the time to develop the talents of our elves and reindeer.”

·         “Perceptions are realities for those that hold them…and I must deal with those realities in order to lead effectively.”

·         “The more employees understand about how the business works, the more likely they are to accept and support change.”

·         “Nothing motivates employees more than knowing they’re making a difference.”

·         “…your elves and reindeer are depending on you – just as you depend on them.  Don’t let them down.”

·         “Being good means being good all the time.  There are no time-outs…no crossing your fingers behind your back.  Everything counts.”

·         “Regardless of what’s said or written elsewhere in the workshop, my actions – whether good or bad – are the performance standards that they will follow.”

·         “I must model the behaviors that I expect from others.  I must take the LEAD.  I must be the first to ‘walk the talk’…”

·         “…it’s not how a workshop stands but what it stands for that makes it special.”

·         “Helping everyone turn those good beliefs into everyday behaviors is how leaders create a great place to work.”

It’s not easy being a leader.  Your job comes with many challenges and responsibilities, as you well know.  But it is an important and necessary job.  And it can be a rewarding one – if you do it right.  Helping you do that is what the Leadership Secrets of Santa Claus is all about

There’s no question that employees are depending on you, just as you depend on them. Don’t let them down. Those are the greatest gifts that you can give to your people, your organization and yourself.  Most importantly, never forget that getting big things done all year long isn’t about magic, it’s about leadership.

Happy Holidays and Happy All Days.

Confirmation Overload - How Much is Too Much?

Is your office actually creating no shows and short notice cancellations by confirmation overload?  Many offices pre-confirm appointments  two weeks ahead, then confirm again one week ahead, then call two days before, just to make absolutely sure that the patient is going to show up.  Some appointment coordinators will continue calling the patient until they speak to someone because some doctor does not consider it not to be a confirmed appointment  unless they received an actual reply from the patient.  The patient is asked to call the office to "confirm" that they have received the "confirmation" call.  Too much confirming can turn your patient off and leave them with a poor impression of your office.

When are dental professionals going to start treating their patients like mature adults who take responsibility for showing up for  appointments ?  Are the appointments being made with children?  Confirmation overload is actually creating an opportunity for your patients to cancel, so it is having the reverse effect.  Think about it, you are really telling your patient  that you don't trust them to keep their appointment and you are certain that they are going to cancel.  Then it becomes a self-fulfilling prophecy.  Do medical offices pre-confirm appointments, confirm and re-confirm to make really, really sure the patients show up?  The answer is no!  They expect their patients to value the appointment and show up at the right time. 

I have even heard  of offices that will move the patient out of the schedule if they don't hear back from the patient. That is the worst thing that you can do. Please do not do this regardless of how many consultants might have told you differently.   If your pre-scheduled patient shows up for the appointment and they have been moved out of the schedule because they haven 't called you back and lose the appointment  time, that patient will be extremely angry with your office.  You will definitely  lose that patient, including any future referral sources to your office.  

I know that you may be thinking, "but what if the patient doesn't show up?"  It is the fear of no shows and short notice cancellations that can drive you crazy, but you should not drive your patients crazy, just because you don't trust them to keep their appointments.  You create the habits and expectations of your patients, so start treating them like adults and expect them to attend their scheduled appointments.  This will even work for appointments that are scheduled six months in advance, if it is done correctly. 

 You can avoid no shows and short notice cancellations by how the appointment was made in the first place.  Here is how; at the time of booking , ask the patient "what day of the week are you least likely to be interrupted?"  and  "do you prefer mornings or afternoons?".  Then guide and direct your patient to the most appropriate time slot that you have open on the day that they prefer.  A key point to remember is that you guide and direct your patient to the time that YOU have available, for example, 10:20 on Thursday, Nov. 5.   Your job, as an appointment coordinator, is to guide and direct the patient to the most appropriate time slot and to maintain control of the appointment schedule.  Appointments need to be scheduled back to back  to avoid holes in the schedule. It is much more difficult to fill those small appointments than it is to fill a larger time slot.  If the holes remain unfilled, it represents lost time and lost production.    

The next thing that the appointment coordinator should say is "would you like me to call you as a courtesy?"  If the patient questions what a courtesy call is, the appointment coordinator can inform them that, at the patient's request, she will be happy to call two days in advance, as a courtesy - not a confirmation.  Let the patient know that the time has been reserved exclusively for them.  Then say to the patient;  "Will you do something for me - if you need to reschedule that appointment, would you please call me at least two business days in advance?  This will help you to avoid any unnecessary rescheduling fees"  This process educates the patient to let them know that if they miss the appointment, there may be a rescheduling fee.  Do not call it a "cancellation fee" because that is punitive.  Calling it a rescheduling fee, helps the patient to understand that there is an administrative cost involved in reserving this appointment time.

If the patient requests a courtesy call, then two business days prior to the appointment, call the patient and say, "This is Sandie calling from Dr. Smith's office.  This is your courtesy call that you requested.  Dr. Smith is looking forward to seeing on Thursday, Nov. 5 at 10:20. See you then."  You may wish to add, "If there is something that we can do to make your appointment more comfortable, feel free to call us back at 555-555-5555.  Have a great day."

Do not say "I'm JUST calling to confirm or remind you about your scheduled appointment."  As soon as you say the word "just" you have minimized the importance of anything else that you are going to say.  It's not important for the patient to listen.  Also, if you say the word "confirm" you are indicating that the appointment was not "firm" in the first place.  If you "remind" the patient about their appointment, isn't that expecting them to forget? 

Many patients now have some type of personal organizers, Blackberry's , i-phones, etc.  If the patient has one of these devices, say to the patient, "will you do something for me, will you reserve the time for this appointment, just like I am reserving this time for you?"  The patient can even set their own reminder on their  electronic schedule if they require that reminder.  

Ask the patient if they will give you their email address and permit you to contact them by email or text messaging.  Most dental software providers have a system of sending emails and text messages to patients to confirm appointments electronically and patients respond very well to electronic messages.

The average office wastes a minimum of $12,000.00 per year in administrative human resources costs simply by making confirmation calls.  One of your biggest challenges will be to help the  doctor and  fellow team members understand that this system will work.  Many dental professionals are conditioned to think that patients need to be treated as people who are irresponsible and that there is no intention of keeping scheduled appointments. .  Start treating your patients as responsible, mature adults who intend to keep their commitments.  Empower  your patients to value their oral health by educating them about the linkage to systemic wellness.  Create the expectation that your patients will take personal responsibility for their own health.  Trust your patients to show up for appointments and don't expose them to confirmation overload. 

The Truth About Staff Bonuses and Why They Don't Work

STAFF BONUSES VS. BENEFITS

Hiring “the right people” can be tough and tedious work but it is arguably the most important function you will ever perform. You must have a top performing team in place to give you the peace of mind that your patients are being well taken care of and that you are able to do what you do best - practice dentistry. To attract and retain high quality staff, employee compensation must include fair practices and reward employees based on the merit of each individual's performance.

What happens if your practice has top performers who are at the peak of their salary range? Cutting hours and salaries is not the answer and bonus systems don't work.  Here are five reasons why:

1.     This comment is not popular with employees, but it is worth considering,  why should you give your staff a bonus for doing the job that they were hired to do? It seems to me that this is a redundancy that doesn't make much sense and many practices cannot afford.

2.     Incentive bonus plans are labour intensive to administer.  They require monitoring, analyzing and tracking.  This requires that time and attention of your manager is focused on production only instead of being committed to excellence in the quality of services provided.

3.     Bonuses become an expectation.  If financial targets are not achieved, employees may feel that they are still entitled to receive a bonus. What if your production is down and your practice is losing money and you cannot afford to provide a bonus?.   If employees do not receive bonuses that they were expecting,  they may view it as punitive and morale is affected in a negative way. 

4.     If bonus plans are not administered well they create a sense of unfairness in your office and result in employee unrest.  The dynamics change from being patient focused to looking at the monetary rewards which leads to internal competition.  This is not good for your practice.  Even if you create a bonus system where everyone at your practice receives a bonus, then you are ostensibly rewarding poor performance as well.  If you have to discipline or terminate an employee, then you may run into difficulties with employment labour laws because you have rewarded the employee even though he/she was not meeting performance expectations.  

5.     Some offices will choose to only provide bonuses to the hygienists based on production goals. This type of system is not patient centered and it may encourage hygienists to rush through patient care to meet their production goals.  It does not reward the hygienist who creates value for the patient by taking the time to educate them about oral health thus creating patient loyalty and trust.  It also neglects the other supporting team members who have worked hard to make the appointments, to prevent cancellations and process the payments.

So how do you continue to motivate and retain those star team members while staying within your budget?   Here is a win-win solution - provide your employees with a Health Benefits Spending Account as part of your employee benefits package.  Traditional group benefits programs have been too cost prohibitive for many dentists and eligibility requirements and group size often made the idea of offering health benefits not feasible or practical. 

Health Spending Accounts provide your employees with the flexibility of obtaining services that suit the individual needs of each of your employees while providing the dentist with a tax benefit.  Your employees will be able to choose what is right for them and not be restricted by plan designs that don't address the individual needs of your employees.  

Health care spending accounts allow their employees to make their own personal decisions about their health care spending and actually save the employers money.  Now dentists can provide the same type of benefit programs for your employees and enjoy a tax benefit.  It is a win-win solution that helps dentists retain high quality staff members .  Adding a health spending account to your personnel policies is a great way to keep the good employees and provide them with a meaningful reward for their dedication to your success.

For more information about  how you can benefit by implementing a  Health Spending Account  for your employees contact, Jeff Meir  or Raj Lakhani at ITCC Estate and Insurance Services.  (905) 277-7915. They are the experts who will help you customize a plan that best suits your needs.

Dental Staff Bonuses vs. Benefits

Hiring “the right people” can be tough and tedious work but it is arguably the most important function you will ever perform. You must have a top performing team in place to give you the peace of mind that your patients are being well taken care of and that you are able to do what you do best - practice dentistry. To attract and retain high quality staff, employee compensation must include fair practices and reward employees based on the merit of each individual's performance.


What happens if your practice has top performers who are at the peak of their salary range? Cutting hours and salaries is not the answer and bonus systems don't work. Here are five reasons why:

1. This comment is not popular with employees, but it is worth considering, why should you give your staff a bonus for doing the job that they were hired to do? It seems to me that this is a redundancy that doesn't make much sense and many practices cannot afford.



2. Incentive bonus plans are labour intensive to administer. They require monitoring, analyzing and tracking. This requires that time and attention of your manager is focused on production only instead of being committed to excellence in the quality of services provided.



3. Bonuses become an expectation. If financial targets are not achieved, employees may feel that they are still entitled to receive a bonus. What if your production is down and your practice is losing money and you cannot afford to provide a bonus?. If employees do not receive bonuses that they were expecting, they may view it as punitive and morale is affected in a negative way.



4. If bonus plans are not administered well they create a sense of unfairness in your office and result in employee unrest. The dynamics change from being patient focused to looking at the monetary rewards which leads to internal competition. This is not good for your practice. Even if you create a bonus system where everyone at your practice receives a bonus, then you are ostensibly rewarding poor performance as well. If you have to discipline or terminate an employee, then you may run into difficulties with employment labour laws because you have rewarded the employee even though he/she was not meeting performance expectations.



5. Some offices will choose to only provide bonuses to the hygienists based on production goals. This type of system is not patient centered and it may encourage hygienists to rush through patient care to meet their production goals. It does not reward the hygienist who creates value for the patient by taking the time to educate them about oral health thus creating patient loyalty and trust. It also neglects the other supporting team members who have worked hard to make the appointments, to prevent cancellations and process the payments.



So how do you continue to motivate and retain those star team members while staying within your budget? Here is a win-win solution - provide your employees with a Health Benefits Spending Account as part of your employee benefits package. Traditional group benefits programs have been too cost prohibitive for many dentists and eligibility requirements and group size often made the idea of offering health benefits not feasible or practical.



Health Spending Accounts provide your employees with the flexibility of obtaining services that suit the individual needs of each of your employees while providing the dentist with a tax benefit. Your employees will be able to choose what is right for them and not be restricted by plan designs that don't address the individual needs of your employees.



Health care spending accounts allow their employees to make their own personal decisions about their health care spending and actually save the employers money. Now dentists can provide the same type of benefit programs for your employees and enjoy a tax benefit. It is a win-win solution that helps dentists retain high quality staff members . Adding a health spending account to your personnel policies is a great way to keep the good employees and provide them with a meaningful reward for their dedication to your success.



For more information about how you can benefit by implementing a Health Spending Account for your employees contact, Jeff Meir or Raj Lakhani at ITCC Estate and Insurance Services. (905) 277-7915 or visit www.ddsbenefits.ca. They are the experts who will help you customize a plan that best suits your needs.