By:   Rhonda Savage, DDS

Is it common place for your dental office to have openings in your hygiene schedule?

Do you have patients that fail their appointments or cancel last minute?

Unfortunately, these problems occur regularly in our offices.  Does it seem to you that this is happening even more with today’s economic times?  Why do so many patients fail or cancel last minute?  There are six basic reasons that I would like to talk to you about in this article.  These six reasons actually begin within our own practices and quite frankly, they boil down to lack of communication.

I’ve been in dentistry for over 30 years and know broken appointments are the number one concern of most offices.  I started back in 1976 as a dental assistant, trained “on the job”, then moved to the front desk and worked in the practice for 10 years as I went through college and dental school. Right after dental school, I was active duty in the U.S. Navy during Desert Shield/Desert Storm.  Interestingly, the military also has problems with failed appointments!

During my last year in active duty, I was stationed with the Marines at Camp Pendleton, CA.  When the war started, so many marines were not “dental ready,” which meant they were deployed with dental problems.  Dental emergencies were rampant and the dental facilities overseas  were either nonexistent or lacked the necessary supplies and equipment. Upon the troops return, the base commandant required that all troops become 80% dental ready, which meant that 80% of the men could not have pressing dental issues. As the dental officer for 1400 marines, I went to the colonel in charge and let him know the dental requirements that were coming down from the base commandant.

He looked at me with his steel blue eyes and said “I want your clinic open on Saturdays to get my men ready.”  I replied, “Sir, I could do that, but your men fail 32% of their appointments! Why should I ask my people to work extra days for you when your men fail so many appointments?  I can have a “stand down” for your troops, where we just work on your men and get them where they need to be.  But Sir, it has to come from you as their colonel.  Frankly, Sir, if you don’t care…..I’m not going to care!”  When I left 8 months later, I received an award in front of the troops for getting them to 92% dental ready. His men did not fail their dental appointments!

To affect the kind of change that I’m going to recommend, the changes must start with the leader.  All of you that are reading this article right now ARE leaders in your office and I commend you for having the initiative to further your knowledge!  The changes I’ll be discussing need to begin at the very top and must be threaded throughout the entire office, which means you’ll need regular team meetings to address these recommendations.  Change isn’t easy!  If you’re not having regular, productive team meetings, talk about this as a team.  How can you fit 4 hours of meeting time into your monthly schedule?  It used to be, years ago, that we could get by with one hour a month, but with all the new technology, materials and techniques, we need to focus on training and communication.  This begins with team meetings.  OK…the six reasons are:

1. The dental team is not creating value for the next appointment.  We  need to stress the importance of the upcoming appointment.  Look the patient in the eyes during the last 30 seconds of the appointment and let them know the reason why they need to return.  Get rid of the word:  Just. There is no more “Just” in your vocabulary.  She needs to come back, “just” for a filling”.  Or,  “it’s just a cleaning”.  Every appointment is valuable!  If you want the patient to return for a follow up endodontic x-ray, let them know it’s “complimentary” (nothing is free) but it’s very important they make the appointment so you can be certain the infection is “gone from the bone”.

   Be basic in your language with patients.  They know the word “infection” and “x-ray”.  They do not know what a “periapical” is.  With your hygiene appointments, find a reason for the patient to return.  Let them know “how well they’re doing” HOWEVER….during the next hygiene appointment, you’re going to focus on this area and it’s “very important they make their next appointment on time.”   Even if they have a clean, healthy mouth…find a reason and document it! If the last thing the patient hears is:  “it was great seeing you, have fun on your trip!” this is what they will remember.  If you’ve just prepped a tooth for a crown, let them know that everything went wonderfully; however, it’s very important they make their next appointment in a timely fashion or the temporary could come loose, causing sensitivity.  Also, the prepared tooth could shift and the new crown wouldn’t fit as well.

2. Too much social “chit chat” at the chair:  We have a window of time to educate our patients about the value and importance of dentistry.  So often, as a consultant, I hear a lot of social talk.  Most offices have 75% social talking and only perhaps as little as 25% be about dentistry. We like to reverse these numbers.  We do want you to connect with your patient and make them feel important.  But try to talk more about dentistry.  Your patient will only be as excited about dentistry as you are! As you’re working over your patients, talk about upcoming courses you’re attending, or one you just attended.  Talk about the new materials or techniques that you’re excited about.  At the hygiene chair, talk about the links between periodontal disease, smoking, diabetes, heart disease, low birth weight babies etc.
3. Misguided communication:
   1. Friendly disappointment:  when the patient calls to reschedule last minute, we should be able to keep about 65% of the patients on the schedule by not making it easy for them to reschedule.  I know this is difficult to do, but do not give them your next opening.  Let them know that you’re all so busy that you cannot possibly get them in soon.  Give them an appointment three weeks out, even if you have an opening tomorrow!

      People go “where it’s busy.”  People like to be associated with successful, busy people.  The same is true in the restaurant business.  You’ll go to a restaurant that has a lot of cars outside because the food MUST be good!  When the patient calls to cancel or reschedule at the last minute, be friendly and nice, but very disappointed.  Let them know the VALUE of the appointment. Recognize that whatever has come up is important, but this appointment is also very important because….the hygienist is going to focus on this area; the tooth could shift and move if the temporary comes loose etc.  (The reason has been documented in the chart and the front desk knows what to say!)

   2. Hygiene should be pre-appointing the upcoming recall visit.  When the patient says “Oh, I don’t know what I’m doing in six minutes much less six months!” Let them know that you understand how they feel, however, you do preappoint 95% of your upcoming appointments and if we don’t schedule now, they will not get the time of day and day of week they enjoy.  DO NOT then say “and if you want to change it when the time comes, it’s OK!”  It’s not OK!  We need to reduce the number of changed appointments that happen at the front desk.
   3. Check your recall cards and upcoming appointment cards. If they say, anywhere, that “kindly give us 24-48 hours notice to change the appointment” re-do your cards.  Instead, say:  “We trust this card to be a confirmation of your upcoming appointment and look forward to seeing you soon.”  Make it positive, but do not give them a reason to think it’s ok to reschedule.  We have trained our patients that “it’s ok if I call ahead”.
4. Patients owe you money:  Look at your accounts receivable balance.  The 60 and over column should not be more than 4-6% of the money owed to you.  The 90 and over column should not be more than 2-4%.  Be careful of credit balances.  If you’re carrying credit balances on your accounts receivable, run a credit balance report and then run an AR report “de-selecting” credit balances.  Have a clean AR report with NO credit balances and see what your true numbers are.  Patients that owe you money will fail more than others.  Have a clear financial policy in place. For a complimentary copy of our “Collecting Your Due” form, please feel free to e-mail me at rsavage@harbornet.com.
5. An “Unmotivated Staff”:  I do NOT believe that our team members intentionally get up and go to work in the morning “unmotivated”.  They do become “un-motivated” when they are continuously worked into lunch and/or late after the closing hour.  If you are continuously working into lunch or after hours, this is a scheduling issue. Our team members need time to grab a bite to eat and go to the bathroom!  They have obligations, commitments and chores to attend to after work also!  I don’t mean that an occasional issue is unacceptable.  We are in the health care industry and emergencies or unforeseen changes do happen.  But…however….if these issues are consistently happening:  it’s a scheduling problem.  If we are not respectful of our staff’s time, they will not be respectful of yours. They will pray for cancellations and broken appointments!
6. I leave you with this final important thought:

   If you keep patients waiting, they will fail and cancel last minute. I was guilty of this myself at times.  It’s an easy trap to fall into.  But, if you do not respect your patient’s time, they will not respect yours.  As a consultant, I travel all over the U.S. The last time I flew, a fellow seat mate asked me, when she found out I’m a dental consultant, said: “Tell me….why do dentists even bother making the upcoming appointment for me?  90% of the time, they call and change my appointment.  I make the appointment to fit my schedule!  Why do they even bother?”   That is the frustration of the patient.  Do not move your patient’s appointments to fit your schedule.  It is much better to have a pending appointment list (a VIP list) of patients who would like to be seen sooner. We (somewhat) jokingly say:

   There are only three reasons to change a patient’s appointment:

   1. Death of the doctor
   2. Death of the hygienist
   3. The patient insists and we cannot dissuade them with friendly disappointment.

   If you are desperate and absolutely need to move a patient up, let them know that you “rarely have changes in the dentist’s or hygienist’s schedule, but there has been a change and you’re the first person I thought of…”  We always need to look busy, not needy!

   Other patients will be annoyed if they’re kept waiting in the reception room or in the chair.  Have a team meeting and discuss this issue.  Do you keep your patients waiting?  In hygiene, the doctor should go in at any point and do the exam.  Do not keep your hygiene patients waiting!  Remember these final words:  People count up the faults of those who keep them waiting. If you do not respect your patient’s time….they will not respect yours.  Do not be “Doctor Add On” and keep your regularly scheduled patients waiting.

   We spend so much time, money and energy attracting patients, yet you may be losing them out the back door.  I want you to be successful and thrive!  From a consultant’s viewpoint, I know that if you focus on making these changes, your office will experience fewer broken appointments. The statistics are there! The offices that Linda Miles and Associates have consulted in this year have increased by 30% or more, even in these recessionary times. With a focus on systems, teamwork and communication, you can continue growing.  I’ve listed six reasons why patients fail or break appointments; all of the reasons have to do with failed communication!  Do a top to bottom review of your office:  verbal skills, financial policies and scheduling… and do it now!  You can’t afford to wait!