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  01.27.05 Issue #151

Get Patients Over the Excuses and Into the Chair

Sally Mckenzie, CEO
McKenzie Management

You'll be glad to know that there may well be a documented, physiological explanation for those last minute holes that suddenly appear in your schedule. It's not necessarily what you've long suspected - that no show patients are inconsiderate, rude, and otherwise irresponsible. Rather, it's their PKCs that are out of whack.

Let me explain, researchers at a prominent East Coast medical school recently reported that forgetfulness - a disorder often claimed by no shows in particular - is triggered by an enzyme in the brain referred to as Protein Kinase C, aka PKC, which impairs the short-term memory and other functions in the executive-decision part of the brain. The enzyme is evidently triggered by stressful situations. And who in 2005 isn't dealing with stressful situations? So there you have it, a scientifically documented excuse for the forgetful, no-show patients.

Flat tires, sick kids, last minute projects, PKCs, whatever the reason, holes in the schedule have to be filled PDQ before the stress enzymes in your prefrontal cortex fry your cranial nerves and you forget what it's like to turn a profit.

Without question, last minute cancellations and no shows mirror our overextended society. When something's gotta give in your patient's busy lives, frequently it's that cleaning or that filling. Oftentimes, patients have no comprehension of the turbulence that their little cancellation or no show can cause you and your team, largely because dental teams don't do enough to educate them on the importance of keeping their appointments.

In fact, it's been estimated that more than a quarter of your patients, about 28%, are likely routine appointment cancellation offenders. But you don't have to tolerate percentages like that. Develop a policy, educate your patients, and live by the cancellation rules you establish. Here's how:

  • First designate a specific individual to serve as your scheduling coordinator. This person will be accountable for ensuring that holes are filled, appointments are confirmed, and daily production goals are met.
  • Next, provide every patient a copy of your newly developed policy regarding cancellations and broken appointments and inform every new patient of that policy when they schedule their first visit.
  • Take 30 seconds to reiterate the policy to patients each time an appointment is scheduled and when confirmation calls are made to patients, which brings me to my next point.
  • All appointments are to be confirmed 48 hours in advance of the appointment. If necessary, adjust the scheduling coordinator's work hours so that she can make the required calls during times that patients are most likely to be reached.

Keep in mind there is far more to confirming appointments than leaving a message on someone's machine or with another household member. If you are sincerely committed to zeroing out the number of holes in your schedule, you need to identify what is prime time for reaching patients directly. For example, if your practice is located in what is considered a "bedroom community" where patients live but commute to work during the day, evening is the time in which you will experience the greatest success with your confirmation calls.

When patients schedule their appointments tell them that you will be calling two days in advance to confirm the appointment. Request the number where they can be reached directly. Use a positive and pleasant tone when confirming appointments and emphasize the importance of the appointment by noting a particular area of concern. Stress the specific amount of time that has been reserved specifically for that patient.

But don't stop there, next week tackle the cancellations long before they clobber your schedule.

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

Interested in having Sally speak to your dental society or study club?
Click here.

Is Your Team Flying?

Dr. Nancy Haller
Executive Coach
McKenzie Management

I recently flew on an airline I prefer to avoid. I find their open seating process to be disorderly, competitive and inefficient. This particular flight back to San Diego, however, was completely different. Passengers lined up cooperatively. People selected seats without hesitation. They stowed their luggage quickly and stepped out of the aisle. We pulled away from the gate in what seemed like record time.

The credit for this successful course of action goes to the operations agent who demonstrated very effective leadership for team development.

Passengers on an aircraft are not typically a "team" you may be thinking, and you are right. The mere commonality of flying to the same city certainly does not make a "team." Disparate and disconnected people with varied skills, experiences and style do come together to bear the challenge of taking flight but not much else.

What became apparent to me as I took my position in line was how this airline opts agent was defining a mission. Due to the need to share the same gate with another plane, our flight needed to board and depart rapidly. In so doing, we were insuring a prompt return to San Diego...something everyone valued and wanted.

The second step in forming a team is to provide clear direction and purpose. The operations agent communicated what we needed to do and why we needed to do it, and...most importantly...what was "in it" for us. Furthermore, he told us specific ways we could accomplish our mission. He gave organized and explicit instructions on all aspects of how to board the plane swiftly and smoothly.

  • Does your practice have a mission statement?
  • Do your employees know what they need to do and why?
  • Have you taken the time to learn what's "in it" for each one to be working diligently for you?

Although far more simplistic than the roles and responsibilities in your practice, there was no confusion about how my fellow passengers and I needed to function effectively. I normally find this phase of flying to be quite unpleasant, even on airlines with designated seat assignments - passengers bumping into one another and jockeying for overhead luggage short, each man (or woman) out for himself.

But what was truly amazing in this situation was the degree of helpfulness among strangers. More so, in the midst of the time pressure we were under, people were pleasant to each other. Everyone knew what was expected. By understanding our individual responsibilities, there was more cooperation and less friction.

  • How clearly have you communicated with your team? Do they all understand the team's purpose? Are their goals aligned?

One of the most common challenges facing teams relates to decision making. Most teams don't discuss "how" decisions are made. Consequently, conflicts often erupt between team members, or worse, no one feels responsible for decisions and so no decision is made. This group of passengers accepted that the operations agent was our leader, and we approved of him being the sole decision maker. Granted, this situation was much more rudimentary than the complexity of running a dental practice. However, without a clear strategy for making decisions, you run the risk of a low-performing team.

  • Have you established norms for how your team will make decisions? Are the rules of behavior agreed upon in advance and accepted by all members? Is there good camaraderie with your team?

You may believe that your employees are a "team," but perhaps they are just a workgroup. To find out, conduct a simple survey in your office. Individually ask each employee to tell you: 1) the practice's mission, 2) what they are trying to accomplish, 3) the priority of their specific tasks, and 4) the degree of collaboration between staff members. You may be surprised how differently they interpret the team's goals, and how much they are functioning as individuals rather than a unified team.

A well-planned and orchestrated team launch is crucial to keep your team flying toward success. As the team's leader - its captain - you are in a powerful position to influence whether your team realizes its potential. Call me - I can help you to get off the ground! Email Nancy at

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Does Your Hygiene Department Represent a Third of The Total Practice Income?

Dr. Allan Monack
Hygiene Clinical Director
McKenzie Management

Hygiene is the key to success in a general practice. In a well managed office, 33% or more of practice revenue should be generated in hygiene. Most practices do not reach this goal. If your hygiene department is designed to be a prophy based department and not a diagnostic based department, there will be many barriers to successful practice. These include low production, poor treatment acceptance, and higher than acceptable overhead including the hygienist's salaries.

What are the advantages of a diagnostic based hygiene department? The first thing that happens is you focus on the patient's needs instead of reacting to problems. Before you decide on the treatment necessary, all the proper records are taken. This includes radiographs, diagnostic casts if necessary, restorative evaluation, and periodontal charting. Basically, you have performed a comprehensive examination. Now you can decide what are the patient's dental needs.

If you allow the patient to co-discover their problems they will be more accepting of the treatment necessary to fix the problem. Co-discovery is giving the patient the ability to see what problems exist at the same time as the examiner. Once they identify with the need they will be more accepting of the necessary treatment.

If a practice has the hygienists perform eight to ten prophys per day which are "cleaning and check up" visits, the hygienist cannot maximize value for the patient and is underutilizing their abilities and training. A program of services including interceptive periodontal therapy, tooth whitening, root desensitization, sealants, halitosis therapy, snore guards, and other ancillary therapies will enhance patient care and give value to your hygiene department.

Why do practices fail to provide these valuable services? They lack the protocol for identifying and treating the needs and desires of their patients. In many instances, attempts are made to perform some of these procedures at the "cleaning" appointment but then the services are given away. The patient places no value on what was done and the practice does not understand why the patients remain unhealthy and do not follow through with therapy, home care, and monitoring. This in turn causes the practice to remain economically unhealthy.

Ineffective patient retention is the result of the patient not valuing the treatment they receive. When you have many overdue and inactive patients treatment is delayed or neglected and results in unnecessary emergencies and incomplete treatment. Dentists spend significant time and money to obtain new patients while neglecting the patients already in their practices. Spending more effort in reactivating patients of record than in recruiting new ones should be considered.

Appointment no shows, cancellations, and down time cost the average practice more than 20% in lost revenues (both hygiene and restorative procedures) each year. The typical practice averages two openings each day in hygiene. Some practices are much worse. Openings in hygiene must be reduced to less than one opening per day!

Creating a successful dental hygiene program is not an accident. It takes commitment and an ongoing effort to continually implement new skills, materials, and treatment protocol. There needs to be a protocol for assessing and treating periodontal disease that is right for your practice. The implementation of "INTERCEPTIVE PERIODONTAL THERAPY" into your practice will allow you to provide a level of care that enables your patients to obtain optimum dental health. By learning how to involve your patients in co-discovery and co-therapy, you will have a better educated patient with a commitment to complete their treatment.

Don't be afraid to give all your patients a thorough examination with all complete diagnostic records from the first office visit and whenever necessary. Treat every patient in your office as if they have seen you for the very first time at each recall appointment. You will have healthier patients and a healthier practice.

Interested in having Dr. Allan Monack speak to your dental society or study club? Click here.


Missed Past Issues of Our e-Management Newsletter?

Sally's Mail Bag

Dear Sally,

I just bought a practice 6 months ago from a dentist who had the practice 35 years. I have found out that many patients didn't care for the previous owner. I had to let the hygienist go, who worked for him 10 years, due to very unprofessional behavior. I am really concerned that many people didn't like this hygienist and aren't coming back for recalls. I got on Eaglesoft and ran a list of people who were due in all of '03. It gave me 483 names! I really want to know how to get these people back in! Many of them have work that needs to be done from their last recall. We send out reminder cards, but they don't call. Should my front office just start calling each of them or should I send out a letter saying "Come meet our new hyginenist..."? Any suggestions would be appreciated. Townie

Dear Townie,

You need to delegate to a front office employee, who has uninterrupted time to start "dialing for dollars." This effort is similar to telemarketing sales. For the telephone effort to be successful, her effort should be diversified as far as calling times. Early evening's 4-7 might be the best but probably calling 8-5 is not the best thing that can be done. I have written a book, "Building A Successful Recall System" that you can find on my website. You will find many scripts and letters in the book but to help you get started, you will call all of the 400+ patients. Do not send out cards. There are 4 types of communication, face to face is best, phone is second, personal handwritten message is the third best and a form message (you are using) is least effective.

Here is a sample script: "This is Carol from Dr. Thompson's office. Is this Mrs. Richmond?" "Yes, it is." "Mrs. Richmond, as a courtesy of our office, your records indicate that Dr. Thompson wanted to see you back for your professional cleaning and examination in October. Is there a day or time of day that would be convenient for you to come in?"

Hope this helps.


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