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7.07.06 Issue #226

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Patient Loyalty vs. Patient Satisfaction

Sally McKenzie, CEO
The McKenzie Company

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Do you have loyal patients or do you have satisfied patients? Or do you have patients who are both satisfied and also loyal? What’s the difference? Loyal patients are keeping your practice afloat. Satisfied patients are there until they find a reason to leave or you convert them to loyal patients. Don’t believe me? Consider this: A few years ago the Harvard Business Review reported that between 65-85% of people who leave one business for another do so even though they are satisfied.

But Sally, my patients wouldn’t just leave my practice.” True. They usually have a reason, and dental teams are often more than a little surprised by what some of those reasons are: The practice hours are not convenient. There’s no place to park, The doctor hurts me. I don’t understand the bills. They don’t accept my insurance. They changed a practice policy. They don’t answer the phone. I can’t leave a message. They charged me for a missed appointment. They are always trying to sell me something. The fees are too high. They can’t keep staff. They told me I have to go to a specialist. They don’t listen to me. What dental teams might consider to be insignificant issues or minor patient problems, are costing practices a fortune in lost loyalty. Obviously, it doesn’t take much to motivate patients to take their dental needs and wants elsewhere.

In other cases, the dentist may want to address patient concerns, but the staff digs in at the mere suggestion that they do things differently. “Our hours have been 8 a.m. to 5 p.m. four days a week for the last ten years, why should we change it now?” Because they no longer serve the needs of the patients, for starters. If staff balk at necessary changes in operations and/or key systems that’s a good indication of poor hiring practices, lack of training, and fledgling leadership. All of which undermine patient loyalty (translation – patient retention).

 In some practices the doctor and team find it much easier to use convenient excuses to justify the shrinking patient base rather than face the reality that it could be practice systems and staff procedures that are driving patients out. “You know that Carolyn Murphy is just like that nasty Mr. Peters who always seems to have a problem with something. Whatever happened to him anyway?” Ah yes, it’s so much easier to blame the patient than to consider that when they raise an issue or a concern or, heaven forbid, a problem they are cluing you into a crack in your system through which you are likely losing patients. But doctor and team often have little interest in being responsive. It’s much easier to see the complaints as isolated incidents.

Or the team’s idea of efficiency is the patient’s idea of inaccessible “Our automated phone system helps us to virtually eliminate interruptions during the day. The patient’s just leave a message and we call them back as soon as we can.” Patients want to talk to a real person right now. If you can’t handle the demand, something is wrong with the system. 

All the while doctor and team justify their rigid inflexibility by convincing themselves that all those patient records indicate a loyal and satisfied patient base. But just how many loyal patients do you really have?  Find out.

Count the number of inactive patient records taking up space in your files or tucked away firmly out of sight in the computer, out of mind, and out of reach. Active patients are those who have been in for a periodic exam within the last 12 months. Inactive patients have not and cannot be counted. Next, have you increased the number of hygiene days per week in the last year? Is your hygienist’s salary more than 33% of what she/he produces? Finally, have you converted 85% of your emergency patients to comprehensive exams?

If the number of inactive records is enough to open a second practice, you have patient retention problems. If you have not increased hygiene days, you have patient retention concerns. If your hygienist’s salary is more than a third of what she produces and if you haven’t converted 85% of your emergency patients to loyal patients, you have more patients leaving your practice than you have new patients coming in.

Next week, building and keeping a loyal patient base.

Interested in speaking to Sally about your practice concerns?  Email her at

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

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Owning Your Own Business…What a Headache!
A McKenzie Management Case Study

Nancy Caudill
Senior Consultant
McKenzie Management

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This case study is an illustration of a family dental practice maybe similar to yours. The names have been change to protect the guilty!

Dr. Kevin Carter’s Story:
I was responding to e-mails one day from clients and the phone rang.  It was Dr. Carter, a four month active client of McKenzie Management.  I want to share with you the history of this practice before I surprise you with the question that he asked…

Office Facts:
  • 10-year old specialty practice
  • Dr. Carter works 4 days a week
  • 1 hygienist working 2 days a week
  • Practice overhead at 62%

Dr. Carter sought McKenzie Management’s help because he felt that he should be more profitable and his production should be more than it was after 10 years of practicing in a “high end” area.  He found himself stressed out and had just fired his practice manager when he discovered that she wasn’t posting checks on a daily basis and missed too much work.  I guess you could say that he had “had it” with running a business and realized that what he was doing wasn’t working and needed to look for a different direction. 

Here is the truth about running a business.  Yes….your practice is a business and you are a business owner, whether you like it or not.  If you don’t want to be a business owner, then you should be an associate somewhere.  I work with dentists all the time that consider that option every day.  However, when I ask a client why he/she chose dentistry as a profession, they all share these two reasons:

  • “I want to own my own business and work when I want to”
  • “I want to help people”

These seem like reasonable and easily accomplished goals; however, we all know that owning your own business is NOT easy.
Just in case you are one of the lucky ones that have managed to conquer all your business frustrations, allow me to remind you what I see in practices every day:

  • Staff turnover
  • Salary negotiations
  • Not enough income to pay yourself a decent salary
  • Not busy enough
  • Too busy
  • No one to delegate the daily business tasks to
  • Stressed out because of all the above
  • No family time
  • Just plain tired of the daily routine

Sometimes you can imagine how simple life would be if you just had to come to work, do dentistry, get your paycheck and go home!  Gee..what fun would that be?


If you are struggling with some or all of these business frustrations, you can seek relief from a reputable dental consulting firm like McKenzie Management.  By the way, we don’t have magic wands to make all the headaches disappear.  Headaches are part of the responsibility that comes with the package but we can sure offer you many prescriptions for you to take to diminish your pain and suffering…sometimes it even goes away permanently!

Here is some good news:  We have been known to turn a “pumpkin” into a “beautiful carriage” when the staff and doctor are willing to do the work that it takes to change the course of their practice.  Funny thing about change…..if there isn’t some outside force that is applied to your daily practice routine, nothing will change and you will continue to get the same results.

Okay…..back to my story.  Dr. Carter took his medicine like a good patient and also administered it to his staff, who also took theirs.  He applied different forces that I recommended to him after we spent several days together discussing his challenges.  The practice changed!  His pumpkin DID turn into a carriage…right before his eyes!

Now to share with you his question:
“Nancy, thanks to you and our hard work as a team, we have been applying your business methods for four months now.  It is the middle of the month and I have met my monthly goal with almost two weeks to spare….can I take the rest of the month off?

What do you think I told him? :-)

Change your prescription and seek some relief.  Call McKenzie Management to discover how we can relieve your headaches.

If you would like more information on how McKenzie’s Practice Enrichment Programs can help you….. email

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The Patient That Demands A Cleaning

Jean Gallienne RDH BS
Hygiene Consultant McKenzie Management

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You come to work on Monday morning and look at your schedule and charts. Oh great!  Mr. Jones is coming in or, you have a new patient in your schedule that demanded to the Scheduling Coordinator, “I just want a cleaning.” In many states it is illegal for the hygienist to see a new patient before the doctor has seen him. Now what do we do?

I recommend you do what the patient wants initially. The Scheduling Coordinator will tell the patient, “I will go ahead and schedule you with the hygienist.” Don’t say what for. You want to get that patient in your office.
Now the patient is in your chair and you have the doctor come in the hygiene room and look at the health history, do a visual exam, and inform the patient, “We will need to have more comprehensive information in order to provide you with quality of care. Hanna, my hygienist, will be doing an examination of your gum tissue and taking pictures of your teeth and gums. This will be a starting point in determining what type of professional cleaning you need. We have five different types of professional cleanings with different names and until we know which one is best for you we cannot proceed. This would be like me giving you a medication just to give you something without really knowing what the problem is.”

Now you have a captive audience. However, you will need to use your people skills to determine the best time to start educating your patient. I would not recommend beginning until you have built some rapport with your patient. I am not talking about asking about their hygiene habits or grilling them about when they had their last professional cleaning. I am talking about developing trust and a friendship with your patient. That way, you’re not just another dental professional out to take all of their hard earned money by selling them dentistry they don’t need. This is what a lot of these patients think and is why they don’t come to the dentist regularly. They know better than you what they need to have done when it comes to their mouth.  Remember the main reasons people do not accept or seek treatment is because of money, fear, or perceived need.

Individuals will make the best decisions for their healthcare when they are safe to express their thoughts and feelings, experience themselves as heard, understood, liked, and there is empathy.

Once you feel they have established this with you as their hygienist, you can talk to the patient about what future treatment may be needed based on what you are seeing in their mouth. Make sure you don’t overwhelm them all at once. This is one approach.

  1. Now that I have had time to explore your mouth and look at the x-rays, I am observing a lot of infection in your gums.
  2. There is a disease called periodontal disease that does not always show signs or symptoms that it is present. Many times a person can have it and not even know because they are not experiencing any pain.
  3. However, based on what I am seeing today, you have periodontal disease and will need further treatment. The doctor will more then likely recommend you have gum therapy because of the amount of bacteria you have in your mouth and under your gums. I will be the one performing this treatment and it is virtually painless to most people.

The hygienist will want to retrieve the doctor and treatment plan the root planing today. This allows the patient to appoint for a comprehensive exam and root planing. Of course make sure today’s schedule is full for all of the hygienists and the doctor before dismissing the patient.

This is a great way to approach a returning patient like Mr. Jones too. He has not been in since 2001 and at that time he had 5 and 6 mm. pocketing. However, he “just wants a cleaning today.” The advantage you have with a returning patient is that you already know quite a bit about his/her personality, how and when to approach. Remember, sometimes silence will encourage questions from the patient. A patient that is asking questions is entering into the self-interest stage of the learning ladder. Educating your patients and developing trust are the two keys to patient acceptance. You just need to know how and when to turn those keys.

For more information on McKenzie’s Hygiene Practice Enrichment Program email

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  July 20 Del Mar, CA - Ortho Symposium * Sally McKenzie  
  July 26 San Diego, CA - San Diego Womens Dental Society Nancy Haller  
  Aug. 2-6 Denver, CO - Academy of General Dentistry * Sally McKenzie  
  Sept. 15-17 San Francisco, CA - California Dental Association * Sally McKenzie  
  Sept. 29-30 Oviedo, Spain - Clinica Sicilia Sally McKenzie  
  Oct. 7-8 Krakow, Poland - UNO Dental Sally McKenzie  
  Nov. 2-3 Santa Barbara - The Art of Endodontics Sally McKenzie  
  Nov. 8 San Diego, CA - San Diego Womens Dental Society Sally McKenzie  
  Nov. 17 Concord, NH - New Hampshire Dental Society Sally McKenzie  
  Dec. 7-8 Santa Barbara, CA - The Art of Endodontics Sally McKenzie  
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