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  02.03.05 Issue #152

10 Seconds to Make or Break the Schedule

Sally Mckenzie, CEO
The McKenzie Company

Every dentist in every practice has heard words like these: "Doctor, Mrs. Jones just cancelled her two hour crown and bridge appointment for tomorrow." And every dentist in every practice has experienced the enormous frustration and expense that result from broken appointments. The annual cost estimates range from $40,000-$60,000 in revenues lost. Broken appointments cost both hygiene revenues as well as operative and restorative dentistry that the doctor never has the opportunity to provide.

Certainly the scheduling coordinator is responsible for keeping the schedule to goal and patients in the chairs. But before you point fingers at the scheduler, consider this: Many broken appointments are the result of what is not said chairside.

Clinical teams are responsible for making it abundantly clear to patients that appointments must be kept. If your practice is not stressing the importance of the next visit to the patient while they are sitting in the chair, you probably have many more broken appointments and cancellations than you should.

Ironically dentists often fuel the cancellation fires. The hygienist spends time explaining to the patient that they are now showing signs of periodontal disease, and oral hygiene appointments may need to be increased. But all of that concern sounds like the hygienist is just blowing smoke when the doctor walks in, greets the patient, and in 10 seconds or less marvels at the great job she is doing with her oral healthcare. Talk about mixed messages.

Instead, take 10 seconds to head that disaster off at the pass. The hygienist needs to tell the doctor what she/he has found and subsequently discussed with that patient. Everyone must be singing from the same songbook, otherwise you undermine your practice's scheduling efforts. And even worse, if you can imagine something worse than habitual cancellations, your diagnostic credibility is questioned.

In addition to clearly communicating the importance of keeping appointments chairside take a few more practical steps to reduce the number of no-shows and last-minute cancellations:

  • When making appointments state the day, date, time, and length of the appointment. For example, "Mrs. Smith, your one-hour appointment is on Wednesday, April 28 at 9:50 a.m., if you are unable to keep this appointment, please call us at least 48 hours in advance to allow another patient the opportunity to see the doctor at that time."
  • Maintain a list of those patients interested in coming in sooner for their appointments.
  • Follow-up with every patient who cancels, doesn't show, or doesn't reschedule.
  • Contact "no shows" within 10 minutes of their appointment time.
  • Show concern for their absence. "Mr. Clemmons, this is Ellen from Dr. Denny's office. We were expecting you for a 3 p.m. appointment today and were concerned when you didn't arrive. Is everything okay?"
  • After two "no shows" the patient should be tagged as unreliable. Politely tell the patient you will contact them when an opening is available. For example, "Mr. Clemmons, we are obviously having trouble coordinating a time that is convenient for your schedule and ours. I don't have any appointments available at this time, however, I do have all of your appointment information, and I will contact you when there is an opening to check if you would be available."
  • If patients are canceling frequently because of daytime work and family responsibilities, consider offering some appointments in the evening and/or on weekends.

It is essential that practices schedule on the computer. When a patient cancels, the computer retains the appointment information and scans the available patient data base to fill unexpected openings. With a couple of keystrokes the scheduling coordinator tells the computer to scan the patient data to find a patient that would fit into an open slot. A phone call or two later the scheduling coordinator successfully fills the available units.

In addition to quickly accessing patient data, the computer can keep track of every failed or cancelled appointment as well as any unscheduled treatment, and, best of all, it's not up to the scheduler to try to keep track of all those details either in her head or on some scrap piece of paper that is likely to be misplaced.

Unfortunately, there is no way to totally eliminate broken appointments and no-shows. However, they can be reduced. Take steps to curb them, and watch your stress go down and your practice efficiency, productivity, and profitability go up.

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

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

"How are you today, Mrs. Brown?" Mary the Scheduling Coordinator asks in a cheery voice. "Oh, I'm here, aren't I?" barks back Mrs. Brown, with slight sarcasm.

Unfortunately, many people still view dentistry as a negative experience. Our challenge working with patients is to create trust and an atmosphere that fosters open communication and cooperation. Reassuring the patient that they still have a measure of control over what happens to them in the dental chair is important to keeping that trust.

As with anticipating what instrument the doctor needs in a procedure, the staff needs to anticipate what the patient may want during treatment. Many desires of patients are not verbalized. For instance, one patient asked me if the doctor would stop during the procedure if she felt pain. "Of course," I replied. "We want you to be comfortable and to feel very little or nothing during your procedure. Just raise your right hand and he will stop."

After the doctor has given his diagnosis, the treatment coordinator or financial coordinator takes over to further explain the procedures, answer questions, secure financing and set up appointments. In this process it is important to remember some key points:

  • Empower the patient to participate in deciding upon their course of treatment. Using the intra-oral camera to explore the patient's mouth and take photos of the areas you wish to discuss gets the patient involved.
  • Explain in simple language the reasons the procedures are necessary. Choose language that fits the patient's educational level of understanding and speak slowly using pictures to illustrate.
  • Explain the steps of the procedures, how many appointments and how long each appointment will take and reassure the patient that they will be comfortable during each appointment. Explain to the patient how you will make them comfortable during treatment and what options they have as to anesthetic.
  • Create a comfortable, non-rushed environment when explaining treatment. Don't have the schedule booked so tight that you are perceived as being in a rush. Patients need to feel that they are important and worthy of your time.
  • Ask the patient questions to determine if the patient has any false ideas about treatment (many patients still think that root canal therapy involves removing the roots) use educational, video or other visual aids. When using video or other educational aids, summarize what the patient has viewed and ask if there are any areas that need further explanation.
  • Be empathetic to the patients concerns about the condition of their teeth. Don't make them feel that their mouth is a "mess." Patients who have postponed dental care are often embarrassed and don't want to be perceived as neglectful or hopeless. Encouragement coupled with kind words can build trust and respect.
  • Explain alternatives to the treatment. Make sure they understand the benefits and the possible risks to the procedures. Informed consent in writing is necessary when there are risks and when the outcome could be less than favorable.
  • Look the patient in the eye when discussing treatment. Sit at the same level as the patient and lean slightly forward showing interest and care. You will be able to listen to and observe the patients response more readily.
  • Smile and nod your head in understanding as the patient responds to the presentation. This is proof to the patient that you are truly listening to each word that they say.
  • Never turn away from the patient while speaking. Not only is this rude but also shows that you are not listening to what the patient is telling you.
  • Never be rushed to "close the sale." The patient will feel it and not appoint. Don't say to the patient, "I need to take care of a patient in the other room." The patient may feel that he or she is less important than the patient in the other room.

Presenting treatment to patients requires skill and understanding of patients needs. Many people learn these skills by trial and error. At The Center for Dental Career Development we teach courses to take the "error" out of communications with patients.

For more information on advanced dental business training for your front office employees, email us at

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Increase Your Hygiene Days!

Building A Successful
Recall System


This step-by-step guide to the systems used by today's most progressive practices includes:  telephone scripts, letters that get responses, telephone monitoring techniques to ensure patient retention, tools to monitor your success, and scheduling tips for a productive hygiene department.


Missed Past Issues of Our e-Management Newsletter?

Sally's Mail Bag

Dear Sally,

I am having a difficult time developing an Employee Performance Review Form. I currently have one for admin staff and another for clinical (assistants and hygiene) but they are very generic and not really geared for dental office staff. I only use them because it's all I have.  Do you have staff review forms you could share with me?

Dear Doctor,

I have a downloadable form on my website ( that is a performance review form. In addition to the form I have a book Performance Measurements for the Dental Team. In this book I have developed the areas of measurement for business employees depending on the systems they are accountable for. In other words, if I am your financial coordinator, my performance would be measured on my ability to have 98% collection ratio, no more than 1 x monthly production in accounts receivable, no more than 12% of the total A/R over 90 days and 45% over the counter collections. I also would be measured on the performance of my skills based on the expectations of my job description. For example, I confirm all patient's appointments the day before and speak to a patient. I schedule to daily production goals. These skill statements ideally are customized for the job description.

Let me know if I can be of more help.


Want to Know More About McKenzie Management?

This issue is sponsored
in part by:

The McKenzie Company Upcoming Events
Date Location Sponsor Speaker
Feb. 22 Chicago, IL Bisco International Sally McKenzie
Feb. 24-27 Chicago, IL Chicago Mid-Winter Meeting Sally McKenzie & Exhibit
Mar. 3 Rochester, NY Monroe County Dental Society Sally McKenzie
Mar. 10 La Jolla, CA Southern CA Orthodontic Symposium Sally McKenzie & Exhibit
Mar. 14 Santa Rosa, CA Redwood Empire Dental Society Sally McKenzie
Mar. 17-19 Atlanta, GA Hinman Dental Society Sally McKenzie & Exhibit

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