Sally McKenzies e-Management newsletter
Consulting Products Past Issues Library Seminars Training
8.01.08 Issue #334 Forward This Newsletter To A Colleague
Handling "No-Shows"
Dentist Coach
Hygienist's Role New Patients

Another "No-Show"! Now What?
by Sally McKenzie CEO
Printer Friendly Version

It is commonly cited as the number one practice frustration, the number one production killer, and the number one source of stress in dental offices around the country. Dental teams ask themselves daily what they can do to fix the problem. I suspect you know exactly what I’m referring to: cancellations and no-shows. Like Japanese beetles on a rosebush, these daily disturbances can chew through an otherwise perfectly manicured schedule in minutes.California Cruzin'

Patient failures cost individual practices tens of thousands of dollars annually. Just two cancellations/no-shows a day, of an average value of $100–$125 each, can cost $40,000+ a year. That is at least one employee salary! Sadly, attempts to address the problem are typically met with either mixed or poor results.

Consequently, dental teams find themselves regularly working at the mercy of an unpredictable and ineffective schedule driven by the whims of unreliable patients who are either insensitive or unaware of the problems their short-notice cancellations and no-shows cause. Worse yet, oftentimes it’s a problem fueled by the team itself.

The fact is, most dental offices pave the way for patients to short-notice cancel or fail to show for their appointments. When a patient says he/she can’t make an appointment, the typical response is, “Oh, you can’t come in? Well, let’s get you rescheduled.” Cheap recall postcards routinely sent to patients state the time and date of the appointment and tell them what to do if they need to cancel, thereby planting the seeds for the patient to do just that.

Instead of coaching patients on how to avoid their appointments, teach them to value them instead. Reinforce that message in every interaction in the office, on the telephone, in every mailing and email, etc. Provide educational materials in the waiting room, at the appointment desk, in statements and in the hygiene and treatment rooms. Use informational on-hold programs to educate patients about oral health care each time they call your office. Every piece of mail sent to a patient should include some piece of information, such as a pamphlet on oral cancer or tooth whitening, or a copy of an article about a recent oral health study.

Next, pay attention to what you say when patients are in the chair. Comments that the doctor, hygienist and assistants make to patients today will have a huge impact on whether they keep their appointments in six months.

Create a sense of urgency. Doctors often leave patients with the impression that there is no hurry to pursue the recommended treatment. The doctor’s final words to the patient should stress the importance of proceeding with her/his recommendations.

The same holds true for routine oral hygiene visits. This is the opportunity for the hygienist to educate the patient and enhance patient perception by talking about the importance of systemic health, periodontal health and oral cancer. All of that increases the patient’s perceived value of routine care. If a periodontal co-examination is performed and the hygienist talks about the results and educates the patient—even a healthy one—he/she will have far greater appreciation and understanding when you must recommend another visit in four months rather than six.

In addition, consider providing a brief written summary of a patient’s visit. Rather than just sending patients away with nothing more than a yellow credit card receipt, include a hygiene appointment summary. This might provide a list of all of the procedures performed, such as a periodontal exam or an oral cancer exam, a brief review of the hygiene evaluation, home care instructions, a reminder about specific areas the patient may want to pay special attention to between now and the next visit, the doctor’s recommendation for follow-up treatment and a list of free products given to the patient along with their estimated value.

In many cases, this can be a standard template set up on the computer that allows the hygienist to fill in a couple of lines and click “print.” These documents can be waiting for patients at the desk when they pay their bills, or sent to them later via email. Patients will respond well to the summary because they typically don’t realize that the $100 appointment is much more than just a cleaning and exam.

Educated patients are far less likely to cancel and fail than patients who are not. They understand the need for and value their dental appointments and are far more likely to be in the chair at the designated time.

Next week, curb cancellations up front.

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.

Forward this article to a friend.

Dr. Nancy Haller
Dentist Coach
McKenzie Management
Printer Friendly Version

Conquer Procrastination

You’ve bought the book An Idiot’s Guide to Eliminating Procrastination but you only read the first chapter. You want to wait until you have the time to really sink your teeth into the information.

Your desk is covered with stacks of journals and paperwork. You say you need to come in some weekend and file everything.

You have a 4:00 PM patient appointment to review a large treatment case but you haven’t had the time to prepare for the presentation. You flip through the chart at 3:55 PM and wing it.

If these examples describe your behavior it’s likely that you are a procrastinator. You’re not alone. Studies suggest that about 40–45% of the population is made up of go-with-the-flow people. These are folks who want to live a spontaneous life with flexibility. They prefer to stay open to new information and possibilities. Casual and open-ended, they appreciate the process of exploration and discovery. They adapt to change easily and they enjoy the variety that accompanies the lack of planning. They value the process as much as achieving the goal.

Procrastination usually happens when we don’t have enough information about what we are trying to do. On the positive side, your style enables you to juggle many balls simultaneously. You aren’t easily rattled. You adjust easily to unexpected events. You take the time to see all sides of an issue. You really may do your best work in the 11th hour.

On the other hand, you start too many projects and finish very few. You may have trouble making decisions. You do things at the last minute; it stresses out people who work with you, and sometimes backs you into a corner.

If procrastination is holding you back from a more productive and profitable dental practice, read on. The goal is not to change who you are. After all, you are successful and you have many admirable skills.

The goal is to improve implementation. In my experience, procrastinators tend to delay action until they “havetime.” However, it is far better to spend a few minutes every day on something than to postpone action until you have a couple of free hours and do nothing until then. It's too difficult to carve out such a big chunk of time. Remember, the journey of a thousand miles starts with one step. Here are some tips to conquer procrastination:

  • Make a list every morning on a 3” x 5” index card. Identify 3–5 priority actions that can be accomplished easily and quickly. Carry the card with you throughout the day and look at it frequently (at least once every couple of hours).

  • Do only one task at a time and fully focus on what you are doing. Consider a 10-minute plan. Set a timer and work on something for just 10 minutes. At the end of 10 minutes, switch to something else if you want. (Chances are you may get so involved you will keep going.) Reset your timer for the next 10 minutes.

  • Keep track of your accomplishments and celebrate your success at the end of the day. (Track your completed tasks on a weekly basis.)

  • Pay attention to the language of your thought processes. Be encouraging rather than self-defeating. Telling yourself, “I’ve got to get more organized so I don’t feel overloaded,” can be restated as, “By being more organized, I will have more free time for golfing and sailing” (or whatever your recreational passion might be).

  • Schedule planning time and write it in your calendar. Keep these time segments small. Start with 10 minutes of uninterrupted thinking time. Use the timer mentioned above.

  • Accept that there is no perfection. Establish deadlines for your “data gathering” time. Most of life’s daily decisions are not matters of life and death. Give yourself a deadline and stick to it. And remember, even if you make a less-than-perfect choice, you are masterful at adapting.

  • Expect some setbacks. If you don’t complete your five priorities for the day, commit to doing better tomorrow.

  • Remember that everything will take longer than you thought. Be realistic and patient.

If you still find yourself getting stuck, it may be time to modify your environment. Enlist the support of your staff to hold you accountable or hire a personal assistant who can organize your files. Strive for progress, not perfection.

Dr. Haller is available to coach you to higher levels of performance in your practice.
Contact her at

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

Forward this article to a friend.

Angie Stone RDH, BS
Printer Friendly Version

The Hygienist’s Role In The New Patient Visit

New patients come through the door with great expectations, looking for a new dental home—a place where they feel welcome, well cared for and comfortable. Are your new patients feeling this way after a professional cleaning visit with your hygienist?

Your business office team has done a great job with the phone call from the new patient because he/she scheduled and showed up for the initial appointment with the doctor.

Now the patient is coming in for the second appointment to meet the hygienist. Upon arrival, the patient will be greeted with a friendly welcome from the Scheduling Coordinator. The business team understands the value of every new patient and the potential of more referrals if the patient is satisfied with treatment.

Although the interaction with the business team is important, the interaction between the hygienist and patient is critical for patient retention. The hygienist is the person the patient is going to be spending the most amount of time with in the treatment room. The hygienist needs to make a connection with the patient that will make him/her want to return at the recall interval. This visit, in your office, needs to be exceptional compared to any other professional cleaning appointments they have ever had. What should the hygienist do to establish this rapport?

First and foremost, the hygienist needs to be focused on the patient during that appointment time. Patients should never feel as if the hygienist is concentrating on anything other than their appointment. Patients need to be listened to as they discuss their dental concerns with the hygienist. Patients should also be addressed by name, as in, “Hi John! It is so nice to meet you.” Giving undivided attention and using names will let patients know they are valued.

Hygienists have formal education and are licensed to ensure adequate basic clinical skills. Patients typically are not able to see big differences in the performances of clinicians; however, they can—and do—realize when a person is going above and beyond to deliver excellent service. It is the above and beyond that will set your hygienist and your hygiene department apart from the others in your area. Some suggestions for accomplishing this goal are:

  • Dim any bright overhead lights while patients are reclined. This prevents them from staring into the lights for the duration of the appointment.

  • Use accent lamps on corner tables to aid in lighting the room. The use of indirect lighting in combination with the absence of bright lights makes the operatory atmosphere more relaxing for the patient and the operator.

  • Place a small pillow under the neck of the patient and a roll pillow under the knees. This placement supports the neck and bending the knees allows the lower back to adapt to the chair so it does not remain arched for the entire appointment.

  • Purchase a back massager for added patient comfort, like the inexpensive kinds that are used on the seat of a car. Patients usually appreciate the lower back mode the most. Do not get one with rollers; they typically are too much for the patient to tolerate during the cleaning. Place the massager on the dental chair. The controller can be attached to the side of the chair with Velcro and turned on and off by the clinician, or just handed to patients so they can decide what feels best.

  • Provide a blanket to those patients who are chilled in the cool treatment room. This allows them to relax rather than shiver.

  • Apply lip balm to patients’ lips at the conclusion of the appointment. A patient’s lips get very dry from the pulling, rinsing and wiping during the appointment. A thin coat of lip balm replaces moisture and makes the lips feel hydrated again.

  • Escort the patient to the front office. Say a sincere goodbye and, “Thank you for coming in today. It was a pleasure to meet you. I look forward to seeing you again in June.”

The implementation of extraordinary services and techniques will distinguish your hygiene experience from others and will certainly have your new and existing patients telling their friends and family about their wonderful hygiene visit!

Interested in knowing more about how to improve your hygiene department?

Forward this article to a friend.

McKenzie Newsletter Information:
To unsubscribe:
To discontinue receiving the Sally McKenzie management newsletter,
click on the link at the very bottom of this page for instant removal,
To report technical problems with this newsletter or to request technical help,
please send a descriptive email to:
To request services, products or general inquires about The McKenzie Company activities
please send a descriptive email to:
If you would like to have any of your dental practice concerns answered personally by Sally McKenzie,
please send a descriptive email to her at:
Copyrights 1980-Present The McKenzie Company - All Rights Reserved.