“Confirmation” Calls and Cancellations

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I’ve been thinking about some of the systems many dental practices create and considering the high cost of these mostly remedial efforts. We believe that in many cases, the systems we create in our practices are designed to fix problems we created ourselves! If this hypothesis is true for you, you are likely paying huge costs to address situations which might have been avoided in the first place.

The confirmation call is a classic example of this syndrome. When we institutionalize the confirmation call, we create a very expensive remedial system. In many cases, the  confirmation call is like the sign on a blue highway:

LAST EXIT BEFORE TOLL

First, let’s examine the word “confirmation”. I wonder how many patients think about an appointment as “tentative” or “penciled in” until it is “confirmed” by a phone call a day or two in advance?  If you, indeed, consider the appointment confirmed when made, any call after that is simply a reminder. When you call a patient to “confirm their appointment” on a particular date and time, it equates to giving them the option NOT to come because it implies the appointment was tentative. I wonder whether, upon receiving such a call, a patient might quickly assess her schedule and bank account balance to determine whether she still finds it convenient and affordable to come for her appointment?

So why do you make confirmation calls? My clients tell me it is primarily to insure that patients remember to come for their appointments because open time on the schedule is costly and frustrating. If that’s the case, it seems like the best place to address this issue is at the time the appointment is made and insure you do everything to identify your expectations and ask your patients to honor their agreements with you.

When you make an appointment with (not for) a patient, you have negotiated a contract which must include agreement on the following issues:

1.The procedure to be performed
2.An understanding of why the procedure was recommended and why the patient has asked you to perform it
3.The fee for the procedure and how you and the patient have agreed the fee will be paid
4.The date and time as well as approximate duration of each of the appointments in the sequence
5.That these arrangements are confirmed at the time they are made – you agree to be on time and fully prepared to deliver on your promise and simultaneously the patient agrees to show up on time and fully prepared to deliver on his promise.

When the appointment-making process has been done well, confirmations become unnecessary and far fewer appointments will be changed or canceled for reasons that have to do with unexpressed expectations you have from one another.

So, what is the true cost of confirmations? Certainly more than the high cost of administrative time and energy to make phone calls and handle changes. The cost is in underdeveloped and unclear relationships. These relationships tend to be as unclear about what concerns or problems the patient is asking you to solve, how the practice recommends solving them, and the costs you both will pay to get there.

I hear some of you thinking; “But what if they are forgetful or WANT a reminder?”

Certainly some patients may request a reminder because their lives are hectic and their organizational skills are not great. But only those who specifically request this reminder should be called. Those patients who have control of their lives and keep a personal appointment calendar don’t need a reminder.  So, how will you know the difference and how will you change what you are currently doing? You ask.

Let’s examine this a step further.

We’re not suggesting that you drop “reminder” calls if your patients have been trained by you to expect them. You must honor all agreements, implied or explicit. On the other hand, If you choose to make a shift to eliminate the burden and volume of “reminder” calls, you must let every patient know that there will be a change in the way you handle them in the future.  There must be a deliberate discussion about what will be different and why you are making the change. Then you must come to an agreement or, in a few cases, agree to honor their special request to handle their situation differently.

You can begin saying something as simple as,

“Rene, I know you have become accustomed to our calling (the evening, two days…whatever) before your appointment, but since we consider this appointment confirmed when made, I’m wondering if there’s any reason you have for wanting us to call and bother you with a reminder. You can be assured that we will be prepared to see you at this time.”

You could go one step further;

“Rene, you are probably used to getting a card in the mail and a reminder call several days before your next hygiene appointment. Well…”

“… we’ve found that sometimes we don’t connect with our patients and then they aren’t sure whether they still have an appointment…”
or
“…we have found that making the calls requires a full time person and we simply don’t want to have to raise our fees when it’s not necessary…”
or
“…we have found that a lot of our patients don’t want to be bothered with a reminder call that interrupts their day…”

“…so, we have chosen to handle our confirmed appointments a little differently in the future. Unless there is some reason why you would need a reminder (email/text/call), I won’t bother you with one. I want to assure you that we are completely committed to this time and we will be prepared and ready for you when you arrive. Will that work for you?”

That doesn’t mean that the tentative or reluctant patient will keep an appointment just because you’ve delivered that message, however. You must come to know your patients more thoroughly and understand all of their expectations, fears, preferences, wants and concerns. Only then will we be able to make appropriate appointments.

Next, how to handle the patient who calls to cancel their appointment…

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