8.22.14 Issue #650 info@mckenziemgmt.com 1-877-777-6151 Forward This Newsletter

Do You Take Your ‘Good’ Patients for Granted?
By Sally McKenzie, CEO

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It’s a funny thing about “good” patients. They don’t require a lot. They show up for their appointments. They pay their bills. They are pleasant to have in the practice. Then one day, some of them just disappear without a word. What happened?

Consider the situation that “Dr. Strawman” encountered. He long believed that he had some of the  most loyal and dedicated patients a dentist could ask for - many had been with him for over 20 years. But something was off. Initially, he dismissed it as a couple of isolated incidents, until it became clear that he was watching a pattern unfold. As he shared the story with me, he was incredulous. “How does a patient come to the same dentist for two decades and not know that I can and regularly do perform virtually every type of cosmetic dentistry there is?” he said.

He explained that he had “a handful” of patients just in the last 12 months who had returned to the practice for their hygiene appointments. Upon examining them, it was clear that extensive dental work had been done elsewhere - crowns, veneers, implants, etc. Finally, after the situation presented itself a couple of times, he started asking the patients a few questions about why they had the work done elsewhere. The answers were variations of the same theme: “Well, I didn’t know you did this, Dr. Strawman. And you are always so busy when I come in for my hygiene appointments, I didn’t want to bother you with questions.”

We see it repeatedly among the dental teams that participate in our Treatment Acceptance Training Program; offices assume that their “regular” patients know what they have to offer. The dental team thinks they know what their patients want, but they never get past the small talk to have a real conversation about the concerns and life situations that influence patients’ treatment desires and decisions. Many dental teams are so focused on the fundamentals of treatment presentation, they forget that patients base their acceptance of those recommendations on multiple factors. And those factors change through the years.

 Overall, dental teams tend to be very good about asking questions and learning more about new patients, but they never raise the questions again. Patient priorities and objectives change over time, based on what is happening in their lives. At least every 18-24 months, treat your existing patients like new patients. Sit down and have a real conversation with them that goes well beyond “Have you had any changes to your medical history?”

Do this for what I call the “Mrs. Wilsons” in your practice. These are the “good” patients who have quietly thought about making changes to their smiles for many years - fixing crooked teeth, whitening, veneers, composite fillings, etc. Their children are grown, so they can focus on themselves. They may be newly divorced or widowed. They may finally be ready to change something in their appearance that they don’t like. Their lives have changed and so have their priorities. But they are hesitant to raise the issue unless their dentist does.

Make these conversations deliberate - in other words, make them part of a regularly scheduled appointment at least every two years. Yes, it may require a few more minutes of your time. But doing so enables you to plant seeds that get patients thinking about options, educating them about what your practice has to offer and helping them to make truly informed decisions based on their needs, wants, and priorities.

For example, a patient with large MOD silver fillings may indicate that she wants a “movie star” smile and is interested in veneers for her front teeth. But she might not have ever noticed the blackness that appears on the sides of her teeth and in between when she smiles. Based on the patient’s expressed desire to have a beautiful smile, she may be far more interested in considering additional procedures over time.

Ultimately, it’s up to the doctor and dental team to better educate their “good” patients about how they can achieve their oral health desires and priorities. Don’t assume patients know what you have to offer. If the practice doesn’t initiate these conversations with patients, too many opportunities will never be realized.

For more information on this topic and more, visit my blog: The Lighter Side

Interested in speaking to me about your practice concerns? Email sallymck@mckenziemgmt.com
Interested in having McKenzie Management Seminars speak to your dental society or study club? Click here.
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Carol Tekavec, RDH
Hygiene Consultant
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As Heard on the Radio
By Carol Tekavec RDH

On a recent drive to another city, I was listening to a call-in radio program featuring questions and concerns about money. The caller was describing her visit with what she described as a “coupon dentist”. She explained that she already had a dentist she liked, however the coupon was good for a “cleaning” and exam and she knew she was due to have her teeth cleaned. She described the coupon as being $39 for both the cleaning and exam.

She was satisfied with her cleaning, but said that when she saw the dentist he insisted she have x-rays taken (and charged her $150 for these) and then he identified four teeth that needed fillings. He said it would be $700 for the fillings. The radio host expressed shock at this price and then asked her what happened next. She told him that she declined the fillings and then went back to her regular dentist for his opinion. Her regular dentist told her that she had no need for any restorations.

The caller wanted to know what she should do about this “fraudulent” dentist. The host told her she should call the State Board of Dental Examiners and report him, as well as calling the State Insurance Commissioner. He said that “crooked dentists should be stopped” and this would be the way to do it. He also suggested that she go on social media and write a poor review so others would be alerted.

So many matters are highlighted by this conversation.

The caller bypassed her regular dentist to get a “bargain”.  She fully intended to take advantage of the cheaper fee, even though she liked her current dental office. When faced with what she perceived as a high fee for dental treatment that she didn’t think she needed, she sought out her regular dentist for his opinion. She obviously trusted her regular dentist, even though she went elsewhere to save money. This shows two things: A patient will leave a trusted dentist to save money, and a patient will come back to a trusted dentist if there is uncertainty about what the new dentist advises.

Coupon fees may attract a patient temporarily. However, many patients who take advantage of a one-time offer may return to a regular dentist after using the discounted service. Discounts are not a consistent way to attract new patients.

The general public has no understanding of the cost of dental treatment, or how it is determined. The fee quoted to the patient in our discussion would have amounted to less than $200 per tooth. This is not unusual, and even inexpensive, depending on how many surfaces were involved. Patients do not understand the idea of surfaces unless it is explained in detail. They think that a “filling is a filling”.

In general, people think that dental treatment costs too much, regardless of what is charged. While the patient making the call thought that $39 was a bargain for a cleaning and exam, her reaction to the fee for proposed dentistry was shock. The radio host also was shocked. How many people are shocked by the cost of new tires, clothing, window cleaning, or a tank of gasoline? All of these things can be quite expensive, but people are accustomed to these costs, even though they may complain about them. Dental treatment is not understood in the same way other expenses are perceived. This may be because people are not faced with dental treatment on a daily basis, or because they understand dental “fillings” or “crowns” as products, rather than custom designed restorations. This is one reason that fears of raising fees may be overblown by dentists. Your patients probably already think your fees are high - a dollar or two higher will not affect this perception.

Patients will respond to a discount offer, but may secretly believe that there is something “less than honest” about the proposition. The radio host suggested turning the dentist in to “authorities” as an immediate reaction, rather than some other less drastic action, such as peer review or simply talking to the dentist to get clarification on the fees. Mistrust of the dentist in this example was very high, perhaps amplified by the perception that the dentist was a “coupon” dentist.
Patients may leave your office for a variety of reasons, such as a “cheaper” practice in your area, extensive advertising by a corporate dental chain, or the fact that you are no longer on their PPO list. This does not necessarily mean they don’t like the office, or you, or don’t trust you. If you respond to their leaving with a sincere message that they will always be welcome to come back, you will find that many will return. If they are treated rudely or if there are issues with transferring their records, they may not come back, even if they realize that they made a mistake.

A poor review can be very harmful to a practice because social media is such a part of our daily lives. The radio host suggested leaving a poor review concerning the “coupon” dentist. Be sure that you are monitoring social websites so you can respond to any poor entries that might be left about you.

Your patients are susceptible to various offers and enticements, but this does not mean they are going to leave you for good. Using discounts to attract new patients does not always result in turning those people into patients of record of the practice. More important is your patient’s trust, and that is something that is developed over time.

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.

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Nancy Haller, Ph.D.
Leadership Coach
McKenzie Management
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Tackle the Elephant in Your Office
By Nancy Haller, Ph.D.

The elephant in the room - an idiom for an issue or problem that is very obvious, but is ignored by those involved for their own convenience or comfort. Today’s elephant is passive aggressive behavior. It is the heaviest form of conflict and the most difficult to eradicate. In relationships, passive aggressive behaviors are often used to avoid short-term conflict. But in the long-term, these dynamics can be even more destructive than outright aggression.

As the label ‘passive-aggressive’ suggests, this is where someone expresses his or her anger indirectly. A person with a passive-aggressive behavior pattern may appear to comply or act appropriately, but actually behaves negatively and passively resists. There's a disconnect between what a passive-aggressive person says and what he or she does. The behavior can be difficult to identify, and even tougher to change. Left unaddressed, passive-aggressive actions will spread to other employees and create a culture of heel dragging and mute rebellion.

We all have passive behaviors that come up when we don't want to deal with conflict directly or do a task. We all hedge, fudge and remain noncommittal on issues some of the time. That's normal. It's only when repeated passivity creates continual tension and anger in the office that it becomes a serious issue that must be addressed.

Passive-aggressive behavior erodes relationships and workplace morale. Unfortunately, it’s one of the most common ways anger is displayed in the workplace. Because people fear retaliation for speaking up, or even fear for their jobs, anger goes deep and oozes out in unhealthy ways. In many cases, the problem is a lack of skill - employees do not have the tools to know how to handle disagreements and their anger goes ‘underground’.

The most common form of passive aggressive behavior is the silent treatment. “I’m not angry, I just don’t want to talk” or “What’s the matter? Can’t I just be quiet?” It might appear as sugar-coated hostility and snarky comments followed by “I was just joking…can’t you take a joke?!” The passive aggressive person may appear to be in agreement but then undermines you once you have left the room.This is extremely frustrating for both parties involved, and also incredibly unproductive. Consider the time wasted talking behind others’ backs or being less than open and honest. If you're struggling with passive-aggressive behavior in your practice, here are some strategies to tackle that elephant.

Call It Out
Passive aggressive people spend their lives avoiding direct emotional expression and guarding against open acknowledgment of their anger. One of the most powerful ways to change the behavior in the long-term is to point out anger directly, when it is present in a situation.

Identify the Specific Behaviors and the Impact
Behaviors are actions you can see or hear. Stick to the facts. Our adult mindset is that we jump to interpretations of behaviors and from that we make assumptions and judgments. This generally creates defensiveness because the passive aggressive individual will A) deflect, B) deny, and/or C) exacerbate the emotionality (visually but probably covertly). It’s important to have a neutral, assertive tone and to speak diplomatically. Some examples are:

"When you joke like that I feel offended, and I notice that others leave the room” (instead of saying: “You are offensive”)

“You avoided eye contact with me all day but you were friendly with everyone else” (instead of saying: “You snubbed me”)

“Your words are inconsistent with your actions. You say you want to be a good team player yet you talk negatively about your co-workers when they aren’t around” (instead of saying: “You have a bad attitude”)

Allow Conversation
Some passive-aggressive individuals behave as they do because they don’t believe they have a voice, or think that they’re not being listened to. When appropriate, include the passive-aggressive person in discussions on challenges and solutions. Solicit their input.

Set Clear Expectations and Follow Through
Establish guidelines for behavior in your office. Expectations need to be concrete and in writing. Be firm but brief and calm. Get employees to agree that they will abide by the standards you set. Avoid analyzing or lengthy discussion. You aren’t a therapist and this isn’t counseling. Just set things straight and get on with your day. If the person violates the agreement, this is the beginning of disciplinary action. Document the action and have them sign a written warning.

Teach Your Team How to Deal with Conflict
Healthy communication means being assertive, nonreactive, and respectful. There’s a sense of collaboration, an interest in resolving the problem. It’s win-win, without blame or accusations. Confronting fear of conflict can go a long way in minimizing passive aggression.

McKenzie Management’s Conflict Competence Training is a practical skill-building program that improves team dynamics and creates a conflict-healthy practice. Although passive-aggressive behavior is not pleasant to deal with, there are ways to minimize the damage. Speaking up about unspoken conflict is one of the most important tasks of successful leadership. The bottom line is that passive-aggressive employees aren't honest, and the best way to counter that is to be honest yourself. If there’s an elephant in your office, don’t try to sweep it under the rug! Contact me today so we can discuss how to deal with conflict in your practice.

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

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

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