Practice Management Toolkit Promise a Little-Deliver a Lot Steven Schwartz, DDS The key to success is giving people more than they expect. This is especially true today because consumers are accustomed to mediocrity. In my experience, consumers accept disappointing service, they are happy if they receive satisfactory service, and they are ecstatic when they get more than expected. If you want your practice to stand out from others, you and your staff must look for ways to provide more to your patients than they expect. By giving your patients something unexpected, you change their perception of your practice. Patients see you as someone who appreciates their business and will go beyond the call of duty to serve them. There are four rules for giving patients more than they expect:
Present the Worst Case Scenario Most people are familiar with a situation where presenting the worst-case scenario up front would have been preferable. The following example might seem all too familiar. Mr. Smith takes his car to a mechanic after he notices a grinding sound when he accelerates. He is suspicious that he might need a new transmission. After inspecting the car, the mechanic tells Smith that replacing the transmission fluid will solve the problem and the cost will be about $50. When Smith comes back to pick up his car at the scheduled time, he is surprised to see his car on the lift and the mechanic looking grim. The mechanic tells Smith that the whole transmission is shot and a major overhaul is needed to the tune of $1200. You can be sure that Mr. Smith would not be happy about the situation described above. In the following example the mechanic presents the worst-case scenario. Mr. Smith takes his car to a mechanic after he notices a grinding sound when he accelerates. He is suspicious that he might need a new transmission. After inspecting the car, the mechanic tells Smith that the transmission needs a major overhaul and the cost will be about $1200. When Smith comes back to pick up his car at the scheduled time, the mechanic explains that he fixed the problem with a gasket and new transmission fluid—total cost $89. It is very likely that Mr. Smith would be happy with the situation described above. Even if a new transmission had been required, Smith would not have been surprised because the mechanic presented the worst-case scenario. Based on the above examples you can see how outlining the worst-case scenario might work to your advantage when presenting a treatment plan to a patient. The following examples illustrate how you can apply this rule to treating a patient. While preparing a treatment plan for Ms. Davis
you notice radiographic evidence of a carious lesion progressing close to the
pulp. Your notes indicate that the patient complained of sensitivity to sweets
and cold. You are not sure if the decay is into the pulp or just close to it. Ms. Davis would very likely be pleased with the situation described above. However if the pulp had been exposed and the treatment had included root canal therapy and a crown, Ms. Davis would not have been surprised because you presented the worst-case scenario. If you are hesitant about presenting the worst-case scenario, here is an example of what can happen when you soft sell a situation. In the following example you do not present the worst-case scenario. Because you do not want to scare off Ms. Davis
with the possibility of pain or a high fee, you tell her that the decay is deep
but you do not think it is into the nerve. You tell her that you plan to do
a filling. You mention that you can always do root canal therapy and then cap
the tooth if it turns out that the nerve is exposed. It is very likely that Ms. Davis would not be happy with the situation described above. Even though you mentioned the possibility of more extensive treatment, the patient might not remember anything you said about root canal therapy and capping the tooth. You presented a minimal treatment plan—the more extensive treatment is not included in the written treatment plan. Don't Increase Costs Mid-Treatment No one wants to be hit with unexpected fees. Dental patients are no exception; they expect to pay the fees that are presented in the treatment plan. If you present the worst-case scenario you reduce the chance of unexpected fees. However, on occasion something unforeseen may happen that requires you to perform a service that is not included in the treatment plan. When this happens you must decide how you are going to explain the situation to the patient and whether you are going to charge a fee for the additional service. Consider the following situation: You are preparing the first molar for a filling and you notice a small lesion on the second premolar that will require a minimal restoration. The additional time to prepare and fill the small lesion is no more than two minutes. Your decision about whether or not to charge the patient for the additional restoration depends on the situation. If the patient waited four months to return for treatment and you honestly feel that the lesion was not there when you originally developed the treatment plan, you are justified in charging the fee. If, however, the patient returns for treatment the week following the treatment planning session, it is probably best not to charge for the restoration of the premolar. Consider saying, “I just noticed a small lesion on the tooth in front of the one I’m treating. It’s pretty small and I have time to take care of it today at no additional charge.” Some situations cannot be resolved as easily. Consider another scenario: You are preparing a first molar for a two-surface restoration. When you remove the interproximal wall you discover a moderate-size lesion on the distal wall of the premolar that you missed because the contacts are overlapped on the patient’s radiograph. In this case, treatment of the premolar likely will require additional time or an additional appointment. An additional fee is appropriate and will be accepted by most patients. However, most patients will balk if the same kind of thing happens a second time. Even if you do not charge the patient, the patient might begin to question your diagnostic skills. If this is a common occurrence in your practice, you should think about upgrading your diagnostic skills and examination techniques. No dentist ever became financially independent giving away treatment. Throw In Unexpected Extras You probably remember receiving unexpected extras—free shipping, a hotel-room upgrade or a complimentary dessert. You probably also remember how you felt. In most cases, an unexpected gesture influences a customer’s likelihood of return business. The same is true in a dental practice. Patients like receiving unexpected extras and you should look for situations where you can offer longtime patients something unexpected. It could be an extra toothbrush, or it could be not charging for a situation involving minimal time or materials. I have an unwritten rule in my practice. If a longtime patient comes to me with a problem that I could treat or resolve in my kitchen, there is no charge. Don't Make Them Wait Consumers value their time and service industries are taking notice. You can get new glasses “in about an hour” and your pizza will arrive “in 30 minutes or less.” Fast-food restaurants use seconds to count the time between taking your order and handing you the food at the drive-thru window. If your refrigerator breaks you still might have to wait all day for a repair person; but you have the option of buying a new one and getting “same-day delivery.” As consumers of dental services, your patients also value their time, and they do not want to waste it sitting in your waiting room. Most patients expect to wait a few minutes, but after 20 minutes they become annoyed. If you respect your patients’ time by starting their treatment as scheduled, they will respect your time by keeping appointments and arriving on time. Surveys have found that practices that stay on schedule have fewer cancellations than practices that constantly run behind. Here are three strategies you can use to help stay on schedule:
Arrive Before Patients In my practice it takes about 30 minutes for everyone to get up to speed. Besides booting up the computer, opening the treatment rooms and reviewing the charts, it takes at least ten minutes to get the coffee brewing and another ten minutes for it to kick in. It is important for the dentist and some staff members to arrive before the first patient—work schedules do not necessarily coincide with the schedule for treating patients. A delay in seating the day’s first patient backs up the schedule for the rest of the day. Work hours must be arranged so that the first patient of the day is in the chair exactly on schedule. Don’t Take Personal Calls Whether the caller is a spouse, friend, stockbroker or tennis partner, you should not divert your attention away from the patient. It is rude, disrespectful and unprofessional. The patient is paying for your clinical skills and your full attention. You know how it feels when you are talking to someone and that person is distracted by another conversation. Your patients feel the same way. Instruct your staff to take messages rather than interrupt you for telephone calls while you are treating patients. Setting an office policy for dealing with telephone calls, including a plan for emergencies, will benefit you and your patients. Your callers also will appreciate your undivided attention when you return calls. Don’t Overtreat Every dental practice experiences days when the schedule falls apart. No shows and cancellations one after another make production goals unattainable. Dentists sometimes try to make up for lost production by overtreating patients who keep their appointments. The following example illustrates this point. After a morning of broken and cancelled appointments a patient finally shows up. The dentist completes the scheduled quadrant of dentistry ten minutes ahead of schedule and decides to make up lost production by going on to a second quadrant. Big mistake. It takes longer than expected for the second quadrant to get numb and then the handpiece freezes—all other handpieces are in the sterilizer. Instead of making up for lost production, the dentist is now running behind schedule. The lesson here is do not overtreat. One bad day will not destroy your monthly production goals. If you have time left over during a scheduled appointment, use it to give something to the patient that is unexpected—your attention. Enjoy a conversation with the patient. Let the patient know that you care about them personally and professionally. Do It Right or Don't Do It Goldstein’s Truism states, “Success means only doing what you do well, letting someone else do the rest.” For dentists this means providing the best treatment—do it right or don’t do it. During slow periods it is very tempting for a dentist to avoid referring patients with complex treatment to a specialist even when the required treatment is beyond the dentist’s ability. This approach to keeping busy when things are slow results in the dentist providing the patient with less-than-ideal treatment. The consequences range from having to redo treatment at no charge, to losing dissatisfied patients, to becoming a defendant in a malpractice suit. There are many strategies for providing the best treatment for your patients. Consider these three:
Refer the Patient to the Person Who Can Provide the Best Treatment Put yourself at the other end of the mirror and explorer—put yourself in your patient’s position. Ask yourself, “Would I want a dentist with my skills and knowledge of this procedure treat me?” If the answer is no, send the patient to someone who can provide the best treatment. By doing so you will avoid experiencing unnecessary frustration, loss of time and a possible malpractice suit. Get Additional Training Make good use of downtime during slow periods. While your staff is going through charts contacting patients who have slipped through the cracks, enroll in a high-quality continuing education course. By high quality I mean a course that, once completed, provides you with the skills and knowledge to render quality treatment to your patients. Avoid courses that emphasize how little you know and are nothing more than commercials for the presenter. Attend courses that provide hands-on or clinical experience. Watching a three-hour video produced by an implant manufacturer does not make you qualified to perform implants. Explore opportunities to practice newly learned techniques on patients other than your own. The ideal situation is to have an experienced clinician at your side for your first attempt at treatment. Spending time as an instructor at a dental school or hospital residency program allows you to share your knowledge and learn about new procedures and techniques. Look into training programs that provide mini-residencies that allow you to treat clinic patients. In lieu of paying a course fee, some programs will barter for your services as an instructor in your area of expertise. Hire a Specialist Hiring a specialist to work in your office might allow you to limit the number of procedures you do not enjoy or are outside your comfort zone. Consider the following questions:
If you answered yes to these questions, the solution might be to bring in a specialist. There are many dentists, general and specialists, who do not want the responsibility and hassles of managing a private practice. They prefer to work for someone else and just concentrate on performing clinical dentistry. They also prefer not being tied down to one location. These dentists will work in two or three practices in different communities one or two days a week. Hiring a specialist on a part-time basis provides you with passive income and provides your patients with superior treatment in familiar surroundings. Action Steps
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