7.1.11 Issue #486 info@mckenziemgmt.com 1-877-777-6151 Forward This Newsletter

Are New Patients One-Visit Wonders?
by Sally McKenzie CEO

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When it comes to new patients, practices can be puzzled as to why some will come once or twice and seem very interested in pursuing treatment, but don’t keep their follow-up appointments. They become the “one-visit wonders.”

There are several reasons why new patients either don’t show or fail subsequent appointments. The practice hours are not convenient. There’s no place to park. Treatment hurts. They don’t understand the fees. The office doesn’t accept their insurance. The staff keep bringing up office policies. The phone is rarely answered by a person. The practice charges for a missed appointment. They can’t get their questions answered clearly.The employees are rude, unfriendly, stressed, or rushed. The doctor and staff don’t listen to them.

mailto:info@mckenziemgmt.comAt the root of all of the reasons listed above is the fact that the patients do not feel valued by the practice. They are merely records in the file and it shows. Demonstrating that you value your patients takes place in every interaction and begins the moment your phone rings.

Develop a script so that anyone who takes a prospective new patient phone call conveys consistent, positive messages and gathers necessary information. Above all else, new patients should immediately feel welcome. Staff should express a sense of confidence and encouragement. For example:

Mrs. Jones, I would be delighted to schedule a new patient appointment for you. Would 8 a.m. next Thursday, July 28th work best for you, or would you prefer 4 p.m. on August 1st? We also have a 2 p.m. on Monday if that would work for you.Giving the patient options helps both the practice and the patient to maintain some level of control of their own schedules. Additionally, set aside time to accommodate new patients. These should be during times of greatest patient demand.

From the start, patients should feel that they have made the best choice in calling your office. It doesn’t hurt to tell them what they want to hear. “You are going to really like Dr. Watts, she is the gentlest dentist, and she does some of the most beautiful work in town. I am going to send you our new patient information packet. This will have some forms for you to complete and bring with you the day of your appointment. It also provides additional information about the doctor, her team, and some things to help ensure that your visit is as beneficial as it can be for you.”

Take care in developing the new patient packet. It is here that the foundation for treatment acceptance or rejection is laid. Educate the patient on services available. Certainly, practice policies can be explained, but the tone of these should not be negative or punitive. You can gently explain why policies are necessary, without making patients feel like they are on the defensive before they ever step in the door. In many cases, patients look for reasons not to go to the dentist. The new patient packet should give them many reasons to keep the appointment.

When the patient arrives, warmly welcome them by name. The patient coordinator should escort them into a consultation room to review various forms and materials. The assistant then escorts the patient into the treatment room. Once the new patient is in the chair, follow these steps to set the tone for an excellent new patient experience.

  • Create a comfortable, non-rushed environment when explaining treatment. Patients need to feel that they are important and worthy of your time.
  • Explain to the patient how you will make her/him comfortable during treatment and what options are available, such as anesthetic.
  • Explain in simple language the reasons the procedures are necessary.
  • Use educational tools, like video or other visual aids.
  • Ask the patient questions to determine if they have any false ideas about treatment. (For example, many patients still think that root canal therapy involves removing the roots.)
  • Be empathetic to the patient’s concerns about the condition of their teeth. Patients who have postponed dental care are often embarrassed by their oral health.
  • Make sure the benefits and the possible risks of the procedures are understood.
  • Look the patient in the eye when discussing treatment. Sit at the same level as the patient and lean slightly forward to show interest and care. You will be able to listen to and observe the patient’s response more readily.

Handled correctly, new patients will look forward to returning to your office for many years to come.

Want more of me? Click here to visit my blog, The Lighter Side, for more Dental Practice Management info.

Interested in speaking to Sally about your practice concerns? Email her at sallymck@mckenziemgmt.com. Interested in having Sally speak to your dental society or study club? Click here.

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Nancy Haller, P.h. D.
Leadership Coach
McKenzie Management
coach@ mckenziemgmt.com
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Stop Attitude Problems in Their Tracks
Nancy Haller, Ph.D., Leadership Coach McKenzie Management

A “bad attitude” is one of the most common and destructive issues in a dental office. Employees with “attitude” can poison the work environment. They hurt productivity and alienate patients. After all, attitude is everything when it comes to customer service. Rolled eyeballs, audible sighs and antagonistic nonverbal gestures - when you ignore those behaviors you grant permission for the negativity to continue.

Unfortunately, many dental leaders throw their hands in the air and believe they can’t do anything to eliminate attitude problems. This is a cop out. If you rationalize doing nothing, you’re just leaving your team to deal with the negativity. Then there are dental leaders with good intentions who confront employees by saying, “You’ve got a BAAAAAD attitude and you better change it fast.” It might feel good to say that, but it’s one thing you should never do. Employees with bad attitudes have probably heard that line from authority figures all their lives. Some are proud of their defiance.

You have no control over employees’ personality traits or beliefs, so don’t ask employees to change who they are or what they think. The solution to eradicating bad attitudes is to talk about specific unacceptable behaviors. Because bad-attitude employees are predictably defiant, it won’t take you long to build a list of specific negative behaviors. Document those observable actions in an objective list that includes the what, when and where of the incident. Follow up by connecting those behaviors to the resulting negative consequences.

For example, you really don’t know for sure what kind of “attitude” Front Office Suzie took with Mr. Smith, who has a large account balance. All you truly know is that Mr. Smith complained that he was treated rudely. And even if you witnessed the interaction and agree that Suzie was rude, stick with the actual behavior. What did you actually see her do or hear her say? Perhaps it was her loud tone of voice or negative head shakes. Maybe it was the fact that she continued to interrupt and talk over him. You’ll increase accountability and improve employees’ performance by sticking to observable actions. In fact, take the word “attitude” out of your vocabulary. It’s futile to use the term. Next, narrow the issue to the exact behavior that reduces patient service or efficient practice productivity. Then describe the impact of the behavior on you.

Here is a revised “change-your-attitude” conversation you could have with your tardy Assistant.

  1. Describe the situation: “Our office policy is that employees need to arrive 15 minutes before the first appointment of the day and attend the morning huddle.”
  2. Describe the behavior: “Over the last week you have been at least 10 minutes late on three occasions. This meant you missed much of what was discussed in the huddle and you didn’t have time to set up your trays.”
  3. Describe the impact on you: “I felt stressed because it meant I had to wait for you before I could start procedures with several patients. As a result I fell behind in the schedule.”

Instead of telling your hygienist that she has a bad attitude because she reads People magazine in the staff lounge when she could be helping other staff:

  1. Situation: “There are times when patients don’t show up or there’s a hole in the schedule.”
  2. Behavior: “I noticed when that happened yesterday at 2 o’clock, you sat in the staff lounge and read a magazine.”
  3. Impact: “I felt disappointed because there are many things that need to be done in the office. I would like it if you would help out and find other work when you have an open hour.”

Rehearse your delivery so it is brief, clear and respectful. Being prepared will boost your confidence when you do sit down with the employee. Conduct the conversation in private. Discuss the situation and explain that her/his behavior - not attitude - is causing a problem. Of course it is always wise to listen to the employee’s response, and to ask how you can help to resolve the issue together.

If you have any hope of modifying a bad attitude, the key is to focus on objective facts. Will the behavior change? Only time will tell - provided that you adjust your attitude about addressing problematic behavior promptly, constructively and consistently.

Challenged by “bad attitude” employees? Contact Dr. Haller at coach@mckenziemgmt.com.

Dr. Haller provides training for leadership effectiveness, interpersonal communication, conflict management, and team building. If you would like to learn more contact her at coach@mckenziemgmt.com

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

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Frustrated with HIRING the WRONG people? Remove the guesswork. Employee Testing On-Line

Carol Tekavec, CDA RDH
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Topical Fluorides - Preventive Tool, Revenue Enhancer
By Carol Tekavec RDH

The delivery of topical fluorides can be an important service for dental practices to offer their patients. The use of fluorides has evolved over the years from their original introduction in the late 1940s. Originally, fluorides were believed to provide only a reduction in enamel solubility. Now it is known that fluorides can also affect both tooth remineralization and oral bacterial metabolism.

While fluorides are recognized as having helpful caries prevention benefits, a “one-size-fits-all” approach to office delivery is no longer considered appropriate. Instead, topical fluorides should be provided based on a patient’s individual needs, risk factors, and conditions. Low caries risk individuals may not need in-office fluoride application, while high risk patients may benefit from regular professionally provided topicals. In addition, fluorides are no longer considered appropriate only for children.

Based on this information, how might an office go about developing their topical fluoride application protocol?  We can look to the ADA risk levels and recommendations outlined in their publication, Evidence Based Clinical Recommendations: Professionally Applied Topical Fluoride.  According to their guidelines, patients under the age of 6 who have had no incipient or cavitated carious lesions for the last three years, but at least one risk factor for caries are considered at Moderate Risk; while those under age 6 who have had such lesions during the past three years, and have multiple risk factors are considered High Risk. Individuals over age 6 with one or two incipient or cavitated lesions in the past three years and one risk factor are Moderate Risk; while those with 3 or more such lesions in the past three years along with multiple risk factors are High Risk. (The ADA also stresses that the judgment of the dentist must be a deciding factor in the decision to provide fluorides to any patient under any circumstance.)

Example of risk factors for caries under these guidelines include:

  • Poor oral hygiene
  • Familial high caries rate
  • Enamel defects
  • Exposed roots
  • Xerostomia
  • High bacterial load
  • High frequency sugar or other carbohydrate consumption
  • Defective restorations
  • Orthodontic or other appliances
  • Inability to perform adequate oral hygiene

ADA guidelines for moderate risk patients include professionally applied topical fluoride twice per year, with frequencies of two to four times annually for high-risk individuals. The use of over-the-counter fluoride mouth rinses may also be recommended to both categories of patients.

Based on these recommendations, here is a sample office fluoride protocol:

All new patients are evaluated to establish their caries risk category during their first exam at the office. All “recall” patients also receive an evaluation at least once a year. This may be accomplished by an assessment of the dentist, or the dentist and hygienist as a team. The risk category of the patient may then be noted in the patient’s computer record, to be updated at the appropriate intervals. Detailed information concerning the patient’s condition, and education concerning what is being recommended, is offered to the patient or parents. Financial considerations are discussed, to include the likelihood of insurance covering the recommended professional application of fluoride based on age and condition. 

Many (but by no means all) carriers will cover fluorides twice annually if under age 14. Some will cover fluoride application for adults if cervical caries are identified. More frequent application for persons under age 14 or for adults under any circumstance may be denied and will therefore be the patient’s responsibility. Patients need to know in advance why they need the service, accept the office explanations and commit to payment, or problems will arise after the fact. Common fees for topical fluoride may range from $15 to $40. A “check-list” of conditions may be used to facilitate assessment and patient education. An example using layman’s terms is shown:

Conditions that Create a Moderate Risk for Future Decay

  1. Teeth with exposed roots
  2. Deep pits or fissures in the teeth where bacteria can “hide”
  3. Dark spots between the teeth visible on an x-ray
  4. White spots, brown spots, or other discolorations on the teeth

Recommended Treatment

  1. Fluoride varnish professionally applied twice per year
  2. Over-the-counter fluoride mouth rinse once a day
  3. Over-the-counter fluoride toothpaste twice a day

Conditions that Create a High Risk for Future Decay

  1. Visible cavitations (holes) or decay found today
  2. Decayed areas that have been restored during the past three years
  3. Heavy plaque on the teeth
  4. Frequent sugary snacks or drinks
  5. Low saliva flow, caused from medications or other conditions
  6. Any fixed or removable appliance such as braces, “bridges” or teeth replacement

Recommended Treatment

  1. Fluoride varnish professionally applied four times annually
  2. Over-the-counter fluoride mouth rinse once a day
  3. Over-the-counter fluoride toothpaste twice a day

While the use of in-office fluorides is very much at the discretion of each dentist, these evidence-based recommendations can provide a basis for developing a protocol.  Topical fluoride application can be a preventive tool with benefits for patients of all ages, and can provide practice revenue that may not have been previously explored. For example: If an office identifies 200 adults at Moderate Risk and provides two fluoride applications per year at $20, $8000 would be generated. Identifying an additional 100 adults at High Risk and providing four applications of fluoride annually at this fee would generate an additional $8000; adding $16,000 income to the office that year.

Carol Tekavec RDH is the director of Hygiene for McKenzie Management.  Carol can improve your hygiene department in just one day of training “in your office”.  Interested in knowing more about how to improve your hygiene department?  Email hygiene@mckenziemgmt.com.

Carol is also a speaker on hygiene efficiency and profitability for McKenzie Management. Interested in having Carol speak to your dental society or study club?  Click here

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