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2.01.08 Issue #308 Forward This Newsletter To A Colleague
Telephone Communication
Team Development
Informed Consent

Bungled Telephone Talk Costing You a Fortune?
by Sally McKenzie CEO
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Well, uh, no. We can’t do that. The office policy says that you MUST pay at the time of service or within 30 days, NO exceptions.”
“We’re really busy right now. Could you just call back in an hour, please, and we’ll get your new patient exam scheduled right away.”
“I have no idea how to change your appointment. We’ve got this new computer system; no one really knows how to use it, and besides I’m just filling in for the receptionist while she runs an errand.”

As the cliché goes, if I had a nickel for every time a dental office employee alienated, irritated, or frustrated a current or prospective patient over the phone, yes, I would be a very rich woman.

You may think talk is cheap but it’s costing some practices a fortune. Dental offices severely underestimate the importance of this essential business tool. Too often employees forget that the phone is the number one link to the patients. Instead it’s often viewed as a necessary nuisance, a perpetual interruption from the “really important” work. That sense of irritation and frustration comes through loud and clear to the person on the other end of that phone line.

The business assistant, the receptionist, the practice “helper” - whoever answers the phone is the first point of contact between the practice and the patient. Make sure it’s not the last.

Typically, employees who bungle telephone talk simply don’t know the appropriate way to handle this mission critical line of communication.  There is no system in place to ensure that the office’s phone procedures are not only effective but also convey the right message and tone to patients. In almost every case, weak phone skills are the result of three things: lack of training, lack of planning, lack of standard operating procedures.

Telephone duty requires skill, professionalism, confidence, and finesse but not necessarily a dental background. Make sure that those whose jobs require extensive phone communication with patients possess the necessary qualities and are trained to handle the pressures. While you’re at it, take steps to ensure that other team members who “cover the phones” don’t have you wishing you could run for cover. Prepare them to represent your practice well.

For those on the “front lines” daily, candidates with a clear voice, enthusiasm, and a positive demeanor will be more likely to succeed in this position. But, personality is not everything; the position also demands training and preparation.

Remember, on the telephone, you have only your voice. Patients cannot hear facial expressions; they cannot see non-verbal queues. They form a picture of the person answering the phone and an opinion of the professionalism of the practice based exclusively on the quality and tone of the voice and how that person comes across verbally. Telephone salespeople keep a mirror at their desks. They understand that the expression on their face is conveyed in their voice. Are you smiling and happy or stressed out and tense? Answer the phone as if you were greeting the patient face-to-face.

Once you’ve thought about your tone, consider your message. In other words, prepare before you pick up the phone. Prepared presentations ensure that the business assistant – or anyone else on phone duty - is ready to handle questions, cancellations, concerns, and many other patient matters that arise during routine phone contact. It enables the staff member to spell out the facts for the patient clearly and concisely.

The Scheduling/Business Coordinator should know the prepared presentation so well that it comes across naturally. She/he’s not speaking off the top of her head, so there is no chance for error or omission. In addition, everyone is on the same page, so to speak, as others helping out at the front desk also can rely on the scripts to convey consistent messages to patients in each phone interaction.

Next week, preparing telephone scripts, step-by-step.

Interested in speaking to Sally about your practice concerns? Email her at sallymck@mckenziemgmt.com.
Interested in having Sally speak to your dental society or study club? Click Here.

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Dr. Nancy Haller
Dentist Coach
McKenzie Management
coach@ mckenziemgmt.com
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Could Your Team Make The Super Bowl?

With a victory in Arizona this Sunday, the New England Patriots will become the first team to go 19-0 and claim a fourth NFL title in seven years. What contributed to such remarkable success? Here are some lessons that you can take from this winning team to improve the way you run your practice.

Know your purpose. The Patriots have a mission - to win football games. What’s yours? You might dismiss this question, believing it to be trite. Or you may think that it’s a colossal waste of time and energy to go beyond, “I’m a dentist”. Nothing is farther from the truth. Your mission statement is the heart of your business planning because it articulates your purpose.

By defining the core elements of your practice, you align your team. Employees gain clarity. This enables them to make accurate decisions because actions can be compared against the mission statement to assure they are furthering practice interests, or hindering them.

Do employees know the purpose of your practice? Ask each one individually. If you have communicated your vision clearly, their answers should be very consistent. If not, schedule time for your team to write a mission statement collectively.

Pick the best people. The NFL draft is the selection process for each franchise. Sizable sums of time and money are spent on assessing players. Many teams use psychologists and personality testing to make the most informed decisions. McKenzie’s Employee Assessment Test enables you to identify peak performers so you can hire wisely. Our test is the only one that has been specifically normed for the dental industry.

Be an effective communicator. Effective communication is essential for winning plays. This starts before game day. Coaches formulate plays for different scenarios. They also meet with their players frequently for alignment with those plans. Then they review films and make adjustments.

Being an effective communicator requires good listening and observing skills. This information helps you to understand your employees and what they need from you to execute well. Morning ‘huddles’ are important and so are monthly staff meetings. It also is wise to hold individual performance reviews with each team member. These should happen quarterly, or more often if employees are learning new ‘plays’.

Clarify job responsibilities.The Patriots' level of efficiency is the envy of every team in the world because each man does his job with precision, craftsmanship and attention to detail. If your staff is performing well, follow-up with feedback. Let them know they are ‘on track’. Be sure to illuminate what’s working…the good ‘plays’. Show each team member the value of their contributions to practice successes.

Just like a winning coach, let your employees know when they miss a ‘play’. Fairly and respectfully, identify the gaps between expected and actual performance. Listen openly to what they tell you. Involve them in finding solutions. Establish clear performance standards, goals or objectives. Help them to improve in areas that need attention. By teaching and training your employees, you enable them to align with your expectations. When each person understands and executes his/her role, it leads to a winning team.

Develop team synergy. The Patriots have synergy - a phenomenon that occurs when a group achieves greater results together than they could not accomplish individually. Creating team synergy starts with clarity of direction. As the dental team leader, your responsibility is to establish a common purpose.

Team chemistry comes from intense training and time together. It doesn’t mean that everyone is each other’s best friend. But if there is competition between team members it’s healthy, not destructive. The competition pushes each to do better.

In addition to staff meetings, schedule time for your team to be together outside the office. Conduct a retreat that encompasses training with fun activities that unify employees. It will keep your team fresh and motivated to perform.

Be determined and tough-minded. Mental toughness is a prerequisite to Super Bowl team success. Intercept doom-and-gloom thinking when you’ve had a hard day. Exceptional people don't shrink from set backs. They're willing to sacrifice for themselves, and for others. Challenge negative beliefs and pessimistic forecasting.

To build a winning team keep your employees focused on getting their work done, even in times of chaos and uncertainty. Your team will reflect your actions. Be resilient. Super Bowl performance is about inspiring your team to give their best effort. It’s tough work unifying individuals into a cohesive group. It takes time, coordination, and the right mix of personnel. It takes planning and preparation. Add to the equation, personalities and conflicting goals or ideals and it becomes even more problematic to find a team of people that works well together – let alone on the fly at a moment’s notice. But ask the Patriots if it’s worth it. Ask them if it’s rewarding. You know the answer.

Dr. Nancy Haller is available to coach you and your team to higher levels of performance. She can be reached at coach@mckenziemgmt.com

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Carol Tekavec
CDA RDH
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Obtaining Informed Consent- Why Should We Bother?

Good clinical practice and informed consent are inseparable.  Patients need to understand their treatment in order to appreciate the services they are receiving.  Dentists need to be able to present their recommendations in a coherent fashion to encourage treatment comprehension and acceptance.

 Patients who do not understand their dental services are the same patients who end up complaining about treatment outcomes and fees. All of us know of cases where a patient who is not paying his/her bill decides to sue a dentist for malpractice.  While the issues surrounding malpractice are different than those involving informed consent, there is a common thread.

If a lawsuit claims malpractice and lack of consent, the dentist faces a “double jeopardy” situation.  Without written consent, the patient may be able to successfully assert that he did not understand his treatment and did not give his permission to receive the services in the first place.  Proceeding with treatment may be broadly construed by the court as “battery” or more likely “negligence”.  Individuals have the right to decide what will be done to their bodies.

Conversely, patients who have signed a treatment specific informed consent form will likely be required to explain in court why they signed a form that they did not understand.  If the consent form is laid out in easy-to-understand terms with a simple format, the patient will even have a more difficult time in backing up that assertion.  So, obtaining a written consent is important, both for treatment acceptance and risk management.

What is Informed Consent? Informed consent is a process, not just a form. However, an actual treatment-specific, written form or at the very least, detailed notations in a patient’s progress notes (with the patient’s signature next to the consent entries); can verify that consent has taken place. Many offices prefer forms, because, it is more likely that all aspects of a procedure will be discussed. 

As for a legal definition of consent, there are many. One definition is, “An agreement to do something or to allow something to happen, made with complete knowledge of all relevant facts, such as the risks involved or any available alternatives.  For example, a patient may give informed consent to medical treatment only after the healthcare professional has disclosed all possible risks involved in accepting or rejecting the treatment.  A healthcare provider may be held responsible for an injury caused by an undisclosed risk”.

Do we have to have a form signed for everything? According to many legal advisors, written consent should be obtained for any service that is not commonly done or easily understood.   In light of this advice, the Informed Consent Booklet of 31 treatment specific consent forms was developed.   The forms are single page, easy to understand, and follow the accepted  “consent format” of treatment recommendations, risks of that treatment, alternative treatments, risks of the alternatives, consequences of doing nothing, and the fact that fees have been discussed. A section on each form is provided for the patient and a witness to sign. Separate forms are included for such varied procedures as Implants, Periodontal Scaling, and Tooth ColoredFillings". 

Why should we bother providing a consent form for a tooth colored “filling” or perio scaling?  We do these services all the time and everyone understands what they are. Are you sure? Have you ever had a patient complain that a tooth colored “filling” is sensitive, seems a little darker over time, or shows some staining at the margins? Many patients do not understand the possible limitations of tooth colored fillings.  If they are not happy, they may not pay their bills. 

Have you ever had a patient complain that she is tired of paying so much for her “cleanings”?  (In fact, complaints to State Dental Boards concerning “cleanings” are on the rise.) Obviously, many of these complaining patients are not receiving “cleanings”, but periodontal scaling and subsequent periodontal maintenance.  

The issue probably lies in the fact that the patient does not really understand his/her treatment. The informed consent process can be the key to unlocking this lapse in communication.  While it is true that tooth colored fillings and periodontal scaling are procedures that are frequently performed, it is not true that they are always understood.  Educational brochures designed to answer frequent questions help the patient understand these dental procedures.

If we tell our patients about all of the “bad” possibilities that may occur with a treatment, they may not come back. It is not better to keep possible complications or problems a secret because of worries that a patient may not return for treatment.  If a patient receives treatment that results in a poor outcome due to an undisclosed, although not uncommon complication, the dentist will face a tough road should that patient decide to file a lawsuit.  The situation is very different when a patient has signed an informed consent form for treatment that results in a previously disclosed possible poor outcome.  In that case it is the patient who faces a tough road to prove that he/she did not understand the treatment. 

With 34 years in the dental field, Ms. Tekavec is the president and owner of Stepping Stones to Success.  She is a well known author and lecturer.  She has appeared at all of the nation’s top dental meetings, as well as providing programs for dental societies and study clubs.  Still practicing as a hygienist clinically, she is a consultant with the ADA Council on Dental Practice, and was the columnist on insurance for Dental Economics magazine for 11 years.  She is the author of the Dental Insurance Coding Handbook, and a best selling patient brochure series.

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