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  Sally McKenzie's
 Weekly Management e-Motivator
  5.07.04 Issue #113

Patient Retention
Internal “Redecorating” May Be In Order

Sally Mckenzie, CMC
McKenzie Management

      When it comes to patient retention, dentists and their teams commonly blame external factors. In reality, it’s the internal practice policies that are most likely to send patients packing. Consider how often you hear these questions, “Do you offer evening or Saturday appointments?” “Can I make payments for the treatment?” “Wouldn’t a filling work just as well as a crown?” “Will my insurance cover all that?” Patients, either directly or indirectly, are telling you what they want and need in order to stay with your practice. Unfortunately, few doctors and their staffs actually

tune in until the problem is screaming at them from the schedule.

Take the example of “Mary” a business employee who recently contacted McKenzie Management in search of the patient retention solution. She had long been following up with inactive patients to better understand why they left the practice. Specific reasons emerged again and again. The practice hours were inconvenient. The doctor’s fees were too high. The practice was too far away. Insurance doesn’t cover enough, etc – all of those reflect the most common reasons why patients leave practices.

Mary was searching for just the right words, the perfect phrase to convince patients to return. But patients aren’t interested in her prepared script. They don’t want to be passified. They want action. If that dental team’s focus were truly on addressing the needs and expectations of the patients, Mary wouldn’t have to spend her days searching for eloquent phrases and catchy lines in an effort to keep active patients from becoming inactive charts.

In Mary’s situation, the information she has gathered, which essentially are customer complaints, must be shared with the doctor. If the doctor and the team sincerely want to improve patient retention they need to implement an immediate plan of action.

  1. Look objectively at patient retention numbers and take responsibility for improving retention. Listen to what patients are saying, and stop blaming external factors.
  2. Consider adjusting practice hours for 60 days, promote the change to patients, monitor patient reaction, and measure retention carefully. If the response is positive consider making the change permanent. If the doctor refuses to adjust practice hours, then he/she needs to take responsibility for the loss of patients.
  3. Evaluate fees to determine if they are appropriate for the patient population. If the fees are within an appropriate range yet patients perceive that the fees are too high the entire team must take responsibility for educating patients at every opportunity on the excellence of the care provided and the value of receiving dental care in terms of overall health and wellbeing.
  4. If the fees charged are, in fact, too high and the doctor will not adjust then he/she should offer patient financing options. In addition, the team as a whole must continuously emphasize to patients what sets the practice apart, why the dental care provided here is worth the extra investment. Superior service is a must. If the doctor and team are not proactive in addressing this patient concern they must take responsibility for practice erosion.
  5. Make affordable payment options available to patients. If patients indicate that their insurance will not cover their dental needs and wants, provide a treatment financing option such as CareCredit. Patient financing companies provide several affordable plans that benefit both the patient and the practice. In addition, they encourage patients to pursue higher dollar treatments.
  6. Understand and clearly articulate payment options to patient. It is the responsibility of the financial coordinator to understand the financing options that are available to the patients as well as assist the patient in making those arrangements with either the practice or the patient financing company.

The bottom-line: If you don’t like the sheets on your bed, you can change them… but you may have to be willing to consider a different pattern.

If you have any questions or comments, please email Sally McKenzie at

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How To Give Feedback

Dr. Nancy Haller
Executive Coach
McKenzie Management

Dear Dr. Hallar,

Six months ago I came back from a weekend management meeting and on Monday expressed to Carol how I wanted the recall system run. I didn’t want to schedule patients six months in advance any more. I just found out that she never did this. I am very upset. How should I handle this?
Dr. Tucson, Arizona

Dear Doctor,

Clearly you and Carol need to talk. However, the biggest challenge in communication comes when we are under stress, when we have an expectation that is not met. Frequently we have a sense of loss that we convert to hurt and often anger. If we try to talk in the heat of the moment, we can say things that we later regret. Therefore, I applaud your wise decision to wait and think this through.

At the core of your question is a timeless management debate…
Do employees want to do a good job and be productive, or do they want to get by with as little work as possible?

My experience and research indicate that the former is more likely to be true, most of the time. People are inherently good and want to succeed, even if it is not obvious to others. And studies also have shown that the number one factor affecting an employee’s performance is his/her relationship with their supervisor or boss. Before you do or say anything to Carol, be careful that you are not misjudging her actions. Remember that she is more likely operating from a positive intention despite falling short of meeting your needs and expectations. She needs feedback.

Feedback is communication regarding the effect that a person’s behavior has on another individual and/or group. The term ‘feedback’ was originally borrowed from electrical engineering. In the field of rocket science, for example, each rocket has a built-in apparatus that sends messages to a steering mechanism on the ground. When the rocket is off target, these messages come back to the steering mechanism that in turn makes adjustments and puts the rocket back on target again.

Feedback then tells us whether we are ‘on course’ – keep doing what you’re doing, it’s working – or provides us with information to put us back ‘on course’. The problem is most people associate the term ‘feedback’ to mean criticism rather than information. As such, it is met with reluctance or anxiety, or simply avoided. Yet, the process of giving and receiving feedback is one of the most important communication tools you have to keep your office efficient and profitable.

Here are some steps for feedback.

  1. THINK through the main idea you want to express. Organize supporting thoughts or facts so that they lead to your main point. By being concise and clear you increase the likelihood that you have a positive impact and your message will be heard.
  2. BE POSITIVE AND CALM. Make good eye contact. Start the conversation by identifying something (s) you sincerely appreciate about the person. Then define the current issue in concrete terms. Address behaviors, not personalities. Be direct in a non-aggressive manner. Stick to the issue at hand. Avoid bringing in other business or old problems.
  3. NEGOTIATE. Ask the person for their feedback. By requesting their input, you build a “win-win” atmosphere. Remain non-judgmental. Show concern and avoid interrupting. Listen for main thoughts or ideas, particularly with people who include a lot of detail or tend to ramble. Paraphrase what they have said if you need clarification, or simply to confirm understanding.

Here’s a dialogue script for talking with Carol.

  1. Carol, do you have a few minutes to talk? (Always ask permission to talk. Be sensitive that the other person may not be available to give you full attention at that time.)
  2. First, I want to thank you for being so diligent in scheduling patients. I really appreciate how attentive you are to keeping the appointments in order.
  3. Do you remember when we discussed the new recall system? (Pause, clarify as needed.)
  4. I was surprised when I realized that you were still scheduling patients six months out. Can you give me some idea about why you aren’t using the new recall system? (Stop and listen. Ask open-ended questions to draw out thoughts and feelings).
  5. Was there anything I could have done differently/better to help you? (Try to understand it from Carol’s point of view).
  6. Let’s talk again in a week and see how you are doing with this. Thanks Carol.

By communicating in this way with employees, you are on the road to increasing quality results!


The Reluctant Office Manager

Belle M. DuCharme, RDA, CDPMA
Director/ The Center for
Dental Career Development

         An office manager, Jane, came to me for advanced business administrator training from a mid sized town in Colorado. She confided to me that she doubted whether she was right for the job because she did not have the respect of the clinical staff. “I don’t have a background in dentistry so they don’t respect me.” After questioning Jane about the operating systems in the office, I explained to her that the clinical staff was not taking her seriously because she had made some faulty decisions that were costing the practice patients and revenues. She continued to pre-book hygiene appointments

solidly for six to eight weeks out without blocking time for new patients and perio procedures (root planing). The majority of the patients in the practice were between thirty and fifty years of age, yet the percentage of patients in perio was only 6%. This is indicative of a hygiene department in distress and need for reevaluation. New patients had to wait six to eight weeks for an appointment. The practice was averaging 20 new patients a month but was unable to schedule them on a timely basis. This is poor customer service. When they finally came in for their appointment, they would complain loudly to the hygienist or the doctor. The computer system in the office is Dentrix . Jane had not been formally trained on the system and did not know about the unscheduled treatment list and the ASAP list. The ASAP list allows you to immediately access patients who are available to come in for an appointment on short notice. The unscheduled treatment allows you to view patients who have treatment plans but have not scheduled appointments or had to cancel and have not rescheduled. Whenever there was a cancellation or no-show it went unfilled because she was not prepared to call anyone. Posting was not being done from the treatment plan. She had cancelled e-claims in favor of printing paper claims because she was having a problem with errors. She wasn’t aware that she could get help from Dentrix Support. This slowed the cash flow and created a mountain of paper work. Posting of charges to accounts and filing of insurance claims was backed up for a week at a time because the doctor insisted on doing his own charting and determining the fees. I explained that the patient must have a written treatment plan in advance of treatment so that they can make an informed decision about the costs and the treatment options. Accounts receivables were 40% at 90 days where they should not be over 15%. As you can see, the challenges were great.

I customized Jane’s training to include understanding the Dentrix system and agreeing to get a trainer in to show Jane the practice management systems and to get e-claims back on track. I gave her a list of reports that needed to be run on a monthly basis and how to read the reports. We analyzed the recall system and made the necessary changes to accommodate new patients and perio patients. I recommended that McKenzie Management’s, Hygiene Consultant evaluate the practice. Jane was taught to enter a treatment plan and to post from it to the ledger. We discussed changing the system to include clinical notes made by the dental assistant and the use of routing slips to make sure charges were accurately presented to the patient at check-out so we could improve the over the counter collection statistics. If a patient encounters a smooth and efficient front office staff they are more apt to trust that their dental care will be delivered in the same fashion.

The “sink or swim” syndrome is prevalent in many dental offices. Throwing a new employee into the daily working environment of a busy dental practice without proper training is costly to the practice and stressful to all concerned, including the patients.

At The Center For Dental Career Development, our mission is to teach you how to manage systems that create productive and efficient team dentistry.

Keep smiling.

Belle M. DuCharme, RDA, CDPMA, Director

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Sally's Mail Bag

Hello Sally,
My name is Monique and I love your newsletter. I am the treatment coordinator, financial coordinator, office manager and jack of all trades for a dental office. I get to work with my best friend (the doctor). We've been friends for quite some time and we've been through some good times and bad. I love the doctor dearly and I work extra hard to keep the office running as smooth as possible. However, I haven't had a raise in almost 4 years. Since we're so close I am having trouble approaching him for a raise. I've done some research and found that other offices are paying their treatment coordinators MUUUCCCHHH more than I'm getting (and these ladies aren't half as committed as I am to this practice). The doctor is a very generous person with all the other staff. I know I need to bite the bullet, sit down with the doctor and just ask for the raise, and yet I don't want this issue to cause a rift in our relationship. I just can't see myself surviving on less than twice what I make now. I am the only one in the office that owns a home and a single parent. I don't want his pity, but times are tough and money is scarcer every pay check. I was even going to ask for 3 times as much in case there was any negotiating he'd settle for twice my salary. I truly am not a greedy person. How can I express to him that I REALLY need the extra cash to survive? I don't want to leave this office - I don't even want to be less committed to it. What should I do?
Anxiously awaiting some advice.

Hi Monique,
It’s apparent to me that you have not had a performance review in that 4 years for if you had the issue of salary increase would have come to light. Therefore I would recommend that you simply approach him and say: “Dr. X, as you are aware it’s been 4 years since I last had a performance and salary review done. What is a good time for you and I to sit down and discuss this?”
If he says he is not going to give you a review, which I can’t imagine, then you have a choice which is to stay and continue to work as you are or to give him notice and leave the practice. I am positive there are MANY doctors out there that would be happy to give you a raise every 2 years! This is not about friendship outside the office....this is your relationship with him as employee and employer. He doesn’t know how you feel so, it is only fair that you communicate your desire to have a review. Don’t communicate to him that you need extra money. He doesn’t want to hear about your financial situation and you don’t need to justify to him why you are asking for a performance/salary review. No employee will remain motivated or remain employed without seeing advancement. Remember if you don’t ask…you don’t get.
Hope this helps,

Office Managers
Financial Coordinators
Scheduling Coordinators
Treatment Coordinators
Hygiene Coordinators

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This issue is sponsored
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Spring & Summer Schedule
 Date Seminar Instructor(s)  
 May. 28
 9:00 - 4:00
The Top ADVANCED Management skills for a Successful Practice Belle DuCharme, RDA, CDPMA  
 June 4
 9:00 - 4:00
How to Become an EXCEPTIONAL Front Office Dental Employee Belle DuCharme, RDA, CDPMA  

The Center for Dental Career Development has been approved under the Academy of General Dentistry Program Approval for Continuing Education (PACE) program. Starting 10/19/03 through 10/18/07 members of the Academy of General Dentistry can receive AGD credits for all seminars and workshops sponsored by the Center for Dental Career Development.

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