We Need More Help at the Front Desk!
Why is it that team members in the non-clinical roles, often referred to as the “front desk staff”, complain about the amount of work they have to do and always seem to be stressed out? Here are a few of the comments we hear all the time:
“The people in the back don’t understand all the stuff we have to do”.
“How can I do the insurance when I keep having to answer the phone?”
“We never get caught up.”
“I’m constantly having to stop what I’m doing to take care of a patient. Then when I come back to it, I forget where I am.”
We have a couple of theories about the traditional front desk configuration and why it sets most teams up for failure.
THEORY 1: The front desk isn’t the area in which the dentist works. He or she doesn’t fully understand the challenges the staff is faced with and is less likely to know how the systems work against them, not to mention the outdated equipment and software challenges. For instance, many practices have only made a partial transition to paperless charts, making the practice dependent on two systems (paper and computer), which makes locating information more difficult, causing duplication and increasing the chance of error. The dentist rarely understands the challenges this poses for the team. (This is a subject in itself!)
THEORY 2: People who work in this arena often develop tunnel vision and have difficulty
seeing new ways to structure their work. The result is that the front desk staff keeps doing the same old things in the same old ways, and not doing any of them at optimal level.
THEORY 3: When the non-clinical staff complains long enough, the dentist usually breaks down and adds another person to the team to do the same things the other team members are doing, creating more confusion, more errors and even less efficiency and effectiveness – not to mention more overhead!
So, what’s the answer? Consider separating the tasks into two areas of specialty and assign the responsibilities to the individual who has the right skill sets. Let’s look at the responsibilities of the non-clinical staff and how those duties break down.
There are three distinct areas of focus in every practice – what we call the A-B-Cs :
Responsibilities that support the business of the business. They are related to paper and tasks – not patients. They can occur “behind the scenes” and in most cases, are not ones that must be addressed in the moment.
The key in this role: to be EFFICIENT with THINGS.
Just some of the responsibilities that might fall under this heading are:
– review chart entries at dayʼs end to balance against deposits
-insurance pre-authorization, submissions, review and followup
-opening and sorting mail with distribution to appropriate person
-entering payments from mail and over the counter
-printing receipts for patients
-monthly and annual closing and archiving
-organizing invoices and packing slips before matching to statements for payment
-payables entry in accounting system
-preparation of a/p report for dentist review and approval
-preparation of checks for dentistʼs signature
-mailing signed checks
-inventory of office supplies
-purchase of ofﬁce supplies and patient amenities
-errands as assigned
-maintenance of ofﬁce equipment and machinery
-computer system oversight and IT
-maintaining patient amenities (ie: coffee station, water, etc)
-hourly upkeep of patient washroom and reception area
-implementation of marketing, promotion
-communication and follow up with the lab
-communication and follow up with vendors
-planning continuing education
These responsibilities require focus, attention, detail, someone with self-direction and organizational skills -an analytical thinker. This same concept can also be applied in the clinical area of the practice – responsibilities associated with sterilization, operatory preparation, inventory and lab duties. They are all essential to providing patient care but occur independently of patient care.
B – Behavioral:
This arena has to do solely with the business of our patient’s business and is often the most overlooked area. These responsibilities often occur with patients and are focused on patient care, connection and communication. While some of the duties require planning and preparation, events often occur in the moment, can not be predicted and must be responded to in real time. This job requires an individual with big picture thinking. The best people are those with sensibility, grace, maturity, empathy, curiosity, good listening skills, confidence, good command of language, and the ability to think on their feet.
The key in this role: to be effective with PEOPLE.
The responsibilities that most often fall under this heading are:
-working with new patients from initial telephone call through treatment planning
-supporting patients in the moment whether on the telephone or in person
-urgency triage and establishing clear expectations with urgency patients
-maintaining oversight of patients in process – those for whom treatment has been
recommended but not yet completed
-organizing and managing the “lost souls” project – those for whom treatment has been
recommended and have dropped out of sight
-handling fees and ﬁnancial arrangement discussions that are not properly handled
-addressing patient complaints and issues in a timely manner
-ensuring that patient interests and concerns are clearly understood by all
-supporting patients by helping them price-test their treatment options
-ensuring that all patient-contact staff are prepared behaviorally for patients before they
-identifying patterns and trends with patients as they occur
-maintaining oversight of the schedule and making appointments as necessary
-managing patient correspondence and followup
-coordinating non-clinical aspects of care with specialists and referrals
-internal training on communications and patient relations
-connecting with referral sources, public relations, networking
C – Clinical:
Events related to the delivery of care. Commands most of the focus of the practice and is often the most up-to-date area. Requires the attention and oversight of the dentist/business owner. Removes the dentist/owner from constant oversight of the two other areas, making it even more important that self-directed, well-matched, highly-effective people are placed in the non-clinical roles.
As you can see, the non-clinical staff is responsible for two of the three critical areas of the practice. These staff members are often asked to perform both Administrative and Behavioral roles simultaneously while the responsibilities are very different from one another and require different skill sets. It becomes clear that when we ask them to assume both roles, they are split between two very different responsibilities, making them choose in the moment which is more important. This usually creates more problems, and sets them up for failure, making them less effective or efficient in either of these areas.
It is our opinion that when you separate the Administrative from Behavioral roles and hire/assign responsibilities based upon strength in one of these two areas, you encourage deep competency, similar to your competency in the area of dentistry. Each person performs at a higher level when they are focused on only one arena and they become more successful than if they were asked to do everything with less effectiveness.
This is not to say that a person who is assigned administrative responsibilities can’t support the one who is responsible for patient connection by answering the phone, welcoming patients or checking patients out when necessary. There are always exceptions. Some practices opt for a third person to act as a greeter or to handle phone triage and appointment scheduling. Remember, the goal is to encourage deep competency in their skill set and prevent team members from performing in areas where they are not as skilled.
This concept may require you to think differently about the individuals, skill sets and responsibilities in your practice. A good exercise for each of your non-clinical team members is to have them make a list of their duties and determine whether it is administrative or behavioral (we hope you aren’t asking them to also perform clinical roles too!). Ask them to assess how much of their work load is in each of these arenas and discuss how roles might be shifted to better serve this new model.
Take home message: You most likely don’t need more people serving in a non-clinical role – you just need the right people, with the right skill sets, in the right positions, which creates a better, more efficient and effective systems.
A caveat here – you may discover that you have team members who share similar skill sets leaving you with no one to serve an administrative or behavioral role. This may be the eureka moment that explains why certain problems keep occurring in your practice. This process may also cause you to consider restructuring your non-clinical staff altogether. We can help you consider your options and sort through the implications of making changes to better serve the practice and your patients.
Laying Down the Law With Patients
While it’s clear that our patients have expectations – sometimes valid, sometimes unrealistic – we have expectations too! And how often is it that our patients disappoint us because they don’t do what we expect of them? While this blog article could turn into a full-on gripe session about those darn patients and how they constantly let us down, I believe how we think and what we do or don’t do, have a great impact on how our patients act and if we want them to change, we have to change first.
Here’s the deal; First, there are some things that we don’t get a vote on and there are other things we do. Second, how can we hold our patients to accountable to any expectations if we don’t come right out and have an honest conversation about them? Expectations are reasonable only when they are clearly conveyed, discussed and agreed-to by both parties.
So, what are the valid expectations? In our opinion, we believe there are only four things you can ask of your patients. I think you will strongly agree;
1) SHOW UP – and on time
I could devote a book to this subject. How often does a patient let you down by no-showing, or arriving late (and thinking it’s OK, I might add)? How dare they? First, this is a professional business arrangement. It can’t be treated casually. Having your patient sign a form with your “office policy” is not good enough. (How many people read it anyway?) You must look your patient in the eye and tell her you have reserved this time with “fill-in-the-blank” just for her, you will be fully prepared when she arrives, and ready to get started. “Can I get your commitment to that?” THAT will get their attention.
What doesn’t work? A recall system or any other communication that conveys the message that you “request the courtesy of — hours notice in the event of cancellation”. You’ve, in essence, given them a ticket to reschedule. And putting them in the penalty box by “fining” them for not showing will just put a strain on the relationship without addressing the problem. Instead, speak to the obvious;
“Bob, we were expecting you this morning for your appointment with Dr. Norris and honestly, we are disappointed you didn’t make it. We had that time set aside just for you.”
How can you assure this won’t happen in the future?:
“ I can arrange your next visit in one of two ways; a deposit of $fill-in-the-blank will reserve your time or, I can call you on a day when an opening avails itself to see if that will work with your schedule.”
Same thing with people who habitually show up late. Speak to the obvious;
“Lisa, I’m glad you finally made it. I only have 35 minutes of time left before my next patient arrives so, I promise I will get as much accomplished as I can. It might mean we will need to schedule another time to have you come back to finish what we can’t take care of today.”
Message: you’re late, I run on time. I will not inconvenience my next patient, you will still pay for your full appointment, and you might have to come back again. Reasonable? I think so.
2) PAY AS AGREED
Aside from insurance claims, there should be no reason for you to have any outstanding accounts with patients. Period. How is it that practices get into the accounts receivable business with patients in the first place? Unspoken or unclear understandings about 1) the fee and 2) the terms for paying the fee.
No dentistry should be performed without an actual discussion about the cost associated with the treatment recommendation, what the patient will be expected to pay, how that fee can be made, and a mutual agreement with the patient on the terms. Something as simple as:
“Gentry, the fee for the treatment you have chosen is $fill-in-the-blank and our first preference is that be paid (in full at the first appointment or a % to reserve the appointment and remainder on the first appointment, etc.). Will that arrangement work for you?” If it does, great. You are done. If it doesn’t, you find an alternative that works for both of you.
Remember, it is better to NOT do the dentistry than to do the dentistry and NOT get paid.
3) BE HONEST
What would we want our patients to be honest about?
#1 on the list: Let us know how you are feeling and what you are thinking.
You can’t read your patient’s mind. You need to know if he is apprehensive, if he isn’t sure the treatment you’ve recommended is right, or if finances are an issue. That is why having a dedicated and gifted facilitator on your team can help you connect with patients at a deeper level and help them voice what might otherwise be left unsaid.
#2 Lifestyle, health issues or recreational/prescription meds. These have a huge impact on what your recommendations might be and the outcome.
#3 Don’t make an appointment if you don’t intend to show up, or agree to treatment if you aren’t sure, etc.
These could be uncomfortable conversations. Coming right out and asking your patient to be honest may imply that you think they are lying. So, how do you convey this very important value? You can suggest the ways in which you hope they will tell you the truth. If you use context to frame the idea, it will make the conversation go more smoothly;
“Some people are reluctant to share personal lifestyle information with us such as their recreational drug use or the state of their health but these issues have tremendous impact on how we might treat someone or the outcome of treatment. I want you to encourage you to be as open as you can with us and know that we will respect your honesty and never make judgments based on what you tell us. In exchange, we will never mislead you or withhold information that we believe is in your best interest.”
Or encourage honestly by speaking to the obvious…
“Something tells me you aren’t fully committed to the treatment we have recommended. Before we go any further, please share with me what you are thinking and what concerns you still have.”
4) BE GOOD NATURED
We’ve all had them. The patients who show up on your schedule and you break out in a sweat. You plan a strategy to be in the lab when she arrives. You avoid engaging her in conversation and ignore the terse comments. In my opinion, that is NOT OK. If there are patients in your practice who are bullies, they need to be called on it.
When my kids were little and one of them would come to me complaining, “Mom, Casey’s chasing me”, my reply would always be, “Then stop running”. The same is true with nasty-tempered patients.
Yes, it is uncomfortable to address someone when they are behaving badly but it can be done with grace and one of two things will happen: it will either defuse the situation and she will recognize, apologize or explain herself OR she won’t get it and the relationship will end. Either way, you win.
Here’s the grace part:
“Hilda, I get the sense that you aren’t very happy about something, and if it’s something we’ve done to make you that way, we would want to know about it. What’s going on?”
You will know very soon by her response where to take the conversation next.
“ Goodness, I had no idea. Thank you for being honest with me. Let’s see what we can do to make it right.”
“You know, Hilda, it is becoming clear that despite our best efforts, we may not be able to make you happy. I am more than willing to transfer your records to another provider if you like.”
Conveying your expectations makes such good sense because it prevents a myriad of problems before they occur. And you will find that there are many remedial systems that can be eliminated when you front-end your relationships with a conversation about expectations.
Having direct conversations with patients about these expectations requires team members with courage, confidence and finesse. It requires level thinking, maturity and most important, time. That is a big investment but pays off quickly by eliminating many of the issues that cause us stress.
It’s prom season! If you or your children have gone through the prom experience, you know there are a lot of expectations about this life event – your date, the friends you will go with, what you will wear, the transportation to get you there, where you will have dinner beforehand and what afterparty you will attend. If you were like me, my expectations for this magical night were not the same as my reality.
What does this have to do with dentistry? While as teens, we gave a lot of thought to prom and we discussed it at length with our friends and our parents, the expectations our patients have may not be as thought-out or clear. BUT THEY DO HAVE EXPECTATIONS.
These expectations aren’t tattooed on their forehead – they are internal. And they are formed over a period of time based on previous experiences. Patients rarely leave a practice and move on if they are happy with their dentist. Consider that most people who call your practice are recycled patients who, with the exception of having just moved to the area or their dentist has retired, have likely not had their needs or expectations met.
In a recent Facilitator Study Club teleconference, we discussed this topic and gathered a list of some expectations patients might typically have:
Time: How much time do they think it will take? Do they want an appointment quickly? Do they want to get in and get out quickly or do they want the dentist to spend a lot of time explaining or answering questions?
Conditions and treatment: What do they believe the dentist will find? What do they hope the dentist will find? What do they believe the solution will be?
Pain or discomfort: Do they think it will hurt? Do they expect it not to hurt? Are they hoping to have sedation?
The practice: Do they expect simply the basics or do they anticipate amenities like refreshments, entertainment options, warm blankets and the like? What about clinical standards?
Communication: How do they expect to be treated? Do they have a certain way they wish to be addressed? Are they accustomed to getting a reminder call, or text, or email about their next appointment? Do they like to interact socially or prefer you cut to the chase? Would they prefer more specifics and detail or just the bottom line?
Fees: How much do they believe it will cost? What are they prepared to pay? What role are they thinking insurance will play in their decision-making? How do they expect to pay for their treatment?
I’m sure you can come up with your own extensive list.
If you don’t know what your patient’s expectations are, how will you ever be able to meet, or better yet, exceed them? You would hate to find out what those expectations are by disappointing them. And more important, if your patient’s expectations are unrealistic, you would want to know sooner rather than later so you can prevent misunderstandings before they occur.
Your patients will tell you their expectations if they believe you:
1) are genuinely interested
2) will do your best to meet or exceed those expectations
How do you find out? The natural answer is YOU ASK. But as simple as this sounds, it is often overlooked and not practiced consistently. We see this play itself out in practices all the time. Team members guess, make things up, base it on assumptions, which are based on previous experiences with patients. Our own personal expectations or preferences may also play into our assumptions.
And because some patients may not be good at expressing their expectations without prompting, it is essential for you to create a curious culture and a framework for finding out. Make time at the onset of the relationship to have a conversation with your patient about what they expect and come to an understanding about what you can and, in some cases, cannot do. Don’t hand them a form to fill out. Instead, you might use a questionnaire as a guide to help you in this process. (If you would like a sample questionnaire, email me). Allocate time in the schedule for these conversations and assign the responsibility to the most behaviorally gifted person on your team. Provide this team member with additional support and training as well as the private space in which to have these conversations with patients.
The fact that you work at understanding your patients in this way sets you apart from most other practices. Through this information-gathering conversation, patients become clearer about what is important to them, you become clearer about how to serve them better and you establish the foundation of a strong relationship with more successful outcomes. Less patients will move on to be recycled again somewhere else.
NEXT TIME: Conveying practice expectations to patients.
Contact me for a copy of our sample questionnaire or to learn more about the Facilitator Study Club,