What Really Happens when Patients Complain?
Just a few short weeks ago, the magnificent winter Olympics were in full swing. Here in the U.S. we tuned in to watch our favorites soar to amazing heights and race at incredible speeds. Several of the U.S. athletes were expected to medal in the games. One was Shani Davis who was favored to win the men’s 1,000 meter speed skating event, until he didn’t. In fact, he didn’t make it to the podium, landing a disappointing 8th place.
Athletes great and small have good days and bad days. But Davis wasn’t alone, others on the U.S. skating team weren’t delivering the times they wanted or that we, the spectators, expected. It wasn’t long before the fingers were pointing. The culprit, some asserted, was that high-tech racing suit they were wearing. The pundits pontificated, the news media salivated, and social media was all atwitter with the news that Under Armour’s “fastest speedskating suit in the world,” well, wasn’t.
Eventually, Under Armour was vindicated when the team switched suits and didn’t realize any better results, but for several days the company took it on the chin. After all, they hadn’t just let the team down, they’d let their country down – or so it was perceived. There they stood on the world stage. How did they handle it? Company officials never blamed the athletes. They didn’t gloat when the skaters didn’t race any better in the old suits. They never wallowed in the muck; they just took the heat. It was a lesson in leadership and grace under pressure. How many of us could do the same?
You’re fortunate that you don’t deliver care on the world stage, and the eyes watching when things don’t go exactly as planned are few. But when patients complain or are dissatisfied in some way with your practice, how often are the comments dismissed with a wave of the hand, a roll of the eyes, with misplaced blame, or a halfhearted apology?
When we don’t like what we hear or we are criticized, it’s easy to get defensive, point fingers, or disregard the message because we don’t like the messenger or we believe they are wrong or just don’t understand. It’s a lot tougher to stand there and take it graciously. It’s even harder to acknowledge that maybe this flame being thrown represents a much bigger fire, one that could seriously burn your profitability.
But you are the dentist. You are a perfectionist. You know that the care you deliver is excellent and you have a topnotch education, years of experience, and hundreds of hours of CE under your belt to prove it. Yet, therein lies the problem. Oftentimes doctors and their employees view the patient experience exclusively – as in it’s what they are delivering in the dental chair.
But when was the last time you considered that your “stage” goes well beyond the operatory, and your performance is judged when the patient tries to make an appointment but can’t get in for several weeks or months. How well you execute is measured when the patient is dodging potholes in your dimly-lit parking lot, or dealing with your financial coordinator’s condescending attitude, or calling in late to work because you’re running behind, again.
From the patient’s standpoint, your performance is measured in every interaction with your practice, and the repercussions can be staggering. Still don’t believe me? Consider a few statistics:
• 70% of buying experiences are based on how the customer feels they are being treated – McKinsey
Next week: Damage control 101.
For more information on this topic, visit my blog: The Lighter Side
Interested in speaking to me about your practice concerns? Email firstname.lastname@example.org
Are You Missing 75% of Your Patients?
I have a little story problem for you. “Dr. Jones” runs a typical dental practice. His staff includes him, two treatment coordinators, two business administrators, and one hygienist. He estimates that hygiene production represents about 25-35% of total practice production and periodontal scaling and root planing represents, oh, roughly 30-35% of total hygiene production. And he is proud to say that the practice brings in some 20 new patients every month. That’s one number he is certain of.
As this story about a problem goes, the full-time hygienist works four days a week, sees eight patients per day, and 128 patients per month. But here’s where things get a little fuzzy. If the practice is retaining patients through a solid recall system, the hygienist should be seeing 148 patients per month on average. That means a single hygienist would have to work 9.25 hours per day to provide hygiene care for 148 patients per month. So what’s really happening in Dr. Jones’s practice?
In actuality, the practice isn’t gaining patients. It might be maintaining. While it may see 20 new patients per month, an equal or greater number of existing patients aren’t returning. If they were, Dr. Jones would have had to hire another hygienist, at least part time, a long time ago. Typically, one hygienist working four days per week can accommodate a practice with an active patient base of roughly 800.
Time and again practice owners are so blinded by the dazzle of new patients that they neglect to consider how expensive it is to lose even a fraction of the patients already in the practice. And, frankly, many of you don’t believe that you’re losing patients. But when was the last time you ran the past-due recall report or tracked the number of no-shows and recalls (which should be no more than 30 minutes per day)? And therein lies another part of the problem in this story.
Patients are drifting away from Dr. Jones’s practice, in part because they don’t fully appreciate the value of hygiene care. Yet it’s the hygiene department that is a primary production feeder for the doctor. The hygienist is the chief educator and trusted advisor. She/he is charged with helping patients to understand the value of lifelong oral care. The hygienist is the head cheerleader for the doctor, reiterating the importance of pursuing the doctor’s recommended care. Whether Dr. Jones realizes it or not, his hygienist is his production partner.
But it doesn’t stop there. The hygiene department is responsible for ensuring the periodontal health of the patients. Yet while some 75% of American adults have periodontal disease, the vast majority don’t know it and are not being treated for it. Amazingly, it is estimated that as few as 3% of all dental patients had claims submitted to insurance for payment on periodontal procedures. How can that be if some 75% of adults have periodontal disease? Plain and simple, practices are not conducting periodontal probing on their patients. In Dr. Jones’s practice, he’s a little ahead of the curve as they are submitting roughly 5% for periodontal care – a far cry from the 30-35% that he guesstimated.
One third of hygiene production in every dental practice should be in interceptive periodontal therapy. That is the industry standard. Dr. Jones’s practice (as well as many others) has not only an opportunity but a responsibility to integrate interceptive periodontal therapy into the hygiene protocols. But Dr. Jones is worried. How will patients react? Certainly, this is a valid concern. After all, any time a practice changes its protocols, it’s likely to generate questions and even concern from existing patients. But when it comes to periodontal disease, the evidence is clear.
Study after study has linked oral health to overall health. The case is so compelling that one would have to ask, are you really fulfilling your responsibilities as a healthcare provider if you are not routinely providing periodontal assessments? Only you can answer that.
But back to the patients, how should Dr. Jones or any other dentist/dental hygienist handle it when the patient gets that quizzical look on her face and asks, “Why hasn’t this procedure been done before?” My advice: Seize this opportunity to write a new and far more compelling story for the patient on the powerful evidence linking the impact of oral health on overall health and the value your practice provides in protecting him or her from disease.
Interested in speaking to Gene about your practice concerns? Email email@example.com
Broken System or Broken Staff?
“Define your business goals clearly so that others can see them as you do” - George F. Burns. Time and time again I hear the same lament, “We had to let her/him go, it just wasn’t working for us.” For Doctors Do and Dun it was clear that their Business Coordinator was failing at everything after having her at the desk for a year. Everyone complained about the schedule being chaotic but not profitable, and bottlenecks at the desk with people checking in and out were causing complaints from patients who had to wait for their turn to check out. On top of everything, Dr. Dun noticed a cash flow problem that she hadn’t noticed in the past and treatment diagnosed wasn’t getting scheduled.
“Our only solution was to let her go and hire someone else.” It seemed obvious that the Business Coordinator was not doing her job, even though she said she was experienced at the front desk when hired.
The doctors questioned who to hire so that the mistakes wouldn’t continue to happen. As they pondered the profile of the right person they were asked if the position had a job description that described the job duties and areas of accountability, such as scheduling for production goals and keeping accounts receivables under 10% at 90 days aging. They answered “no” because they felt that might insult the applicant. After all, “an experienced front office employee should know what their duties are.” The assumption here is that the person who was let go did not know what she was doing.
Upon an analysis of the practice systems (or lack of systems) the following was noted:
1. No hiring system with job descriptions or written hiring protocols that required Employee Assessment Testing or temperament testing was in place.
2. No production/collection goals in place. “Keep the schedule full” was the directive.
3. No scheduling instructions or templates to guide the correct placement of the patient in the schedule based on a scheduling goal were in place.
4. No regular or systematic performance reviews to help identify areas of improvement in place.
5. The doctors did not understand the relationship between the scheduling system and collections and treatment acceptance, leaving the Business Coordinator scrambling for moments to present treatment and also collect for daily charges.
7. The aging accounts receivable system was in delinquent status with 44% of the monies owed in 90 days past due. Contributing to this problem was outstanding insurance claims over 30 days that had not been followed up to clear for payment.
8. The recall system was not being worked with outbound calls to patients who were overdue for appointments. The Business Coordinator did not have the time management skills to prioritize her day nor did she have the authority to delegate tasks to other team members. There was no recall system in place with a guide to making these calls.
9. The treatment acceptance system was broken, as the entire process was the responsibility of the Business Coordinator - who clearly did not have the time to spend with patients because she was the only one checking patients in and out and fielding phone calls.
10. There was a lack of team approach to the systems in the practice because the doctors did not have a knowledgeable understanding of the critical responsibilities of the Business Coordinator position.
The doctors would need to understand that the new hire will have to do “clean-up” of the accounts receivables and the aging insurance report, plus keep the practice moving forward. This is a prescription for failure if the lack of systems that created the problem is not addressed.
Professional Dentist CEO or Office Manager Training is the prescription for success to create systems of scheduling, collecting, insurance billing and follow-up, recall, treatment acceptance and days free of stress associated with broken systems. Fix the systems so your practice can reach its true potential.
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