Mercury Aligns With Mars

Do you promote yourself as a holistic or a mercury-free dentist? If you do, then you know that working with this special group of patients brings a unique set of challenges. Recently, I conducted a Team Teleconference with a group who was struggling with how to best serve these patients.

Their goal:  To better understand these patients and learn how to connect with them more successfully. In other words, how can we align with what they want?

Here’s the email they sent me to establish the agenda for our session:

Holistic calls seem to always be the challenging call in our office. The patients are always very detail oriented  and can really throw us off with some of the questions asked. Another problem we face is they take so much time on the phone. I immediately guide them to our holistic website and walk them through our holistic approach when removing Amalgam.
 
There seems to always be a lack of understanding by the patient about what is involved. What I constantly hear from these patients is that they don’t want to have an exam, (don’t want) x rays and just (want to) have their amalgam removed.
 
How can we efficiently handle these calls? How can we handle these conversations to help the patient better understand why the exam and digital X rays are important? How do I get these patients to understand our process without coming off “rude” or “condescending”?

Keep in mind we do offer the consult as a last resort to help convert the call to a future appointment.

Our session brought about some clarity by breaking down the knowns and unknowns.
To start, the team identified some common themes that emerge when working with these patients:

1) They do a lot of personal research on the Internet.
We know that there is an equal amount of incorrect information as there is accurate information out there and each patient will struggle to discern what is fact and what is fiction. When they call your practice, they already have a set of beliefs which may or may not be correct. If what you tell them goes against what they have begun to believe, they will experience some internal conflict.

2) They self-diagnose or have been told by a trusted authority that the mercury in their mouth is;

1) toxic and 2) may be making them sick.
This may or may not be true in their case but you will not change their belief system in a short phone call. It is what it is. Gaining clarity about what they believe is essential and you must use this as the CONTEXT for which you will begin your relationship with them.

3) They are apprehensive and slow to trust.
They may believe you want to perform other procedures that aren’t necessary or will also be harmful. Some individuals may have had negative experiences with health professionals in the past, which leads to their distrust. They have a story and you must take the time to learn what that is.

4) They are health-focused.
Some of these patients place high importance on their diet and their exercise regimen – sometimes to the point of obsession. On the other hand, they may have a multitude of health issues and their life revolves around illness and doctor appointments. This is a part of the story you will uncover and must understand in order to determine IF you can help them, and if so, HOW you will offer to help them.

Because of these issues, they will consume more time than your typical patient, asking questions  and discussing their unique circumstances. There is no way you will change this. If you are going to serve this special group, you MUST be prepared to take the time required to fully understand them.

Also, there is a BIG difference between being efficient, and being effective. Efficiency relates to paper and processes while effectiveness relates to working with people. And effectiveness can’t be measured by whether or not you convert the phone call to an appointment. Not all callers are ones you will want to invite to become your patients. You must know when to cut your losses.

During our session, we broke it down into bite-size pieces to come up with a more effective way to work with these patients when they call.

What do they want?
In quality of life terms, what are these patients hoping you will help them with?

-They want to feel better
-They want peace of mind in knowing the possible toxins are gone

Above anything else, this is what you are providing. The procedure of removing the amalgam fillings will simply be the means by which you will help them get there.

How do they want you to accomplish this?
-They want it done in the least amount of steps necessary
-They want the safest procedure possible
-They want it done for the least amount of money

What don’t they understand?
-They’ve been told or read something they have come to believe that is different from what we tell them.
-Why xrays are necessary.
-Why a thorough exam is both clinically necessary and required by law.

How can you help them get what they want?

Because you don’t know what might be necessary just by talking with them on the phone and the approach requires a thoughtful process considering their unique situation, you will need to provide the context for why this is important in their case. Experiment with the following process and refine it as you get more successful:

1) Find out more about their unique situation – learn their story
When a caller begins the conversation by asking about mercury-free dentistry or removing amalgam, find out why they have an interest. It’s as simple as saying;

“That’s a great question. You’ve called the right place. Tell me a little more about your situation and let’s see how I can help you.”

2) Be quiet, listen, and take notes.
The patient will choose to tell you those things that are most important and can provide you with the foundation for how you will relate what they want with what you offer.

(Sidenote: if the caller begins by telling you every little detail that happened years ago, there are several ways in which to determine whether you must 1) disengage because of red flags, 2)  focus the caller, or 3) offer to refer them to a source of reliable information (like your web site), and call them back at a later time. More on this in a separate article.)

3) Use what you have discovered to provide context to the solutions you recommend.
It doesn’t matter that the protocol you use for each person is the same. You must make what you recommend unique to their particular situation. Remember to:

-refer to them by name
-acknowledge what you have heard
-explain what you recommend based on what you have heard
-get their approval

Here’s an example:

“Barbara, because you mentioned you suspect the mercury in your mouth may be causing some of your health issues, Dr. Holistic will want to learn all about those concerns. She will also want to evaluate what other things might be occurring in your mouth that you would want to be aware of and whether they may be contributing to your problem. I would like to suggest we arrange a time for you to come in to discuss your concerns with Dr. Holistic and she can to determine what diagnostic tests may be appropriate to discover the best way to help you. These may likely include xrays to see what the human eye can’t see going on under the surface. How does that sound?”

(Another sidenote: the subject of xrays and some patient’s reluctance to allow them is another layer of the story. You must peel back this layer in order to understand why this is a problem for them. Don’t assume you know what it’s about. Stay curious and relate to what they are telling you. If you would like to know more about how to address this issue, contact me for a primer on the subject.)

The TAKE HOME MESSAGEs:

Stop telling and start listening.

Use what you learn to create the framework for how you will help them.

Make it personal and unique to their situation.

You can use this same approach with ANY patient. It will help you connect more personally to each caller, begin to develop trust and help you establish a strong relationship from the very beginning.

Top 5 professional habits you should commit to in 2014

With every new year, comes an overwhelming amount of commentary on new year resolutions and goals. A lot of them are common sense no brainers mixed with an equal amount of recommendations we know are unattainable. Reflecting upon 2013, I would like to shift the conversation to some things I believe have become overlooked.

I have discovered that many people have forgotten the basics. It annoys me when the professionals I work with don’t afford me these common courtesies. If you want to gain respect from your colleagues, patients, customers and employees and you want them to offer you the same respect in return, it is absolutely essential that you follow these very basic rules of business etiquette in 2014.

Here are my TOP 5 No-Brainers every business professional should commit to in the new year:

Number 5: Don’t interrupt.
Of course, there are some exceptions to this rule and if you made it through high school, you can surely figure out what those are. I’m talking about people who cut you off in mid-sentence because they believe what they have to say is more important than what you are expressing. It indicates they are not listening. It comes off as rude, disrespectful and confrontational. If you are guilty of this, listen more, talk less. If someone else violates this rule, let them know you weren’t finished with your thought.

Number 4: Do what you say and say what you do.
If you tell someone you are going to do something, don’t just talk about it. Do it! If you aren’t sure you will follow through, don’t commit to it. How many times have you been disappointed by someone who has said they were going to do something then dropped the ball? And it adds additional insult when they don’t give you the courtesy of letting you know, which leads me to 4a:

4a) If you commit to something then discover it was unrealistic or you can’t follow through, own it.   It’s as simple as saying you’ve discovered you’ve bitten off more than you can chew or your time commitments have gotten the best of you. You will continue to earn respect from your peers, co-workers, and employees when you are honest with them about your shortcomings.

Number 3: If you change your mind, say so.
Everyone has that right. But changing your mind and not telling us is not OK. People will have different expectations and you will inevitably disappoint them – possibly make them angry – if you don’t tell them your thinking has changed. We will continue to think you have your original mindset unless you tell us otherwise.

Number 2: If you are in a meeting or conversation, DO NOT LOOK AT YOUR CELL PHONE!
We’ve all been on the receiving side of someone who shifts their attention from us to their “next-best friend”. Why would anyone think this is appropriate? This is rude and disrespectful. Period. But it is occurring at epic proportions these days. Just because others engage in this behavior doesn’t mean it’s OK. It says they could care less about what’s happening outside the edges of their smartphone screen – so why should we? Business owners and CEOs can often be the biggest violators of this. Regardless of how important someone is, your time is equally important. If someone does this to you, stop talking until they look up and tell them you’d be happy to continue when they aren’t pre-occupied. Let’s shut this behavior down in 2014.

Number 1: Reply to emails. And do it in a timely manner.
Just like the sign in the public bathroom stall that says; “please flush after use”, this is so basic that I shouldn’t have to mention it. That being said, a large percentage of the emails I send out go unanswered. If email isn’t your thing, tell people up front or simply don’t give out your email address. Otherwise, people expect an acknowledgement or reply – THAT’S WHY WE SEND EMAILS! If you don’t reply, it’s the same as saying you don’t care or the sender isn’t worth your time. Your lack of response indicates your lack of interest which erodes your credibility, regardless of your position or role in any business.

Are you starting to see a pattern here? Every one of these has to do with professional courtesy and respect. And if we want people to respect us and behave in a certain way, we have to commit to that behavior ourselves. That is the hallmark of a leader. And yes, these are basic. That’s where we have to begin to build a solid foundation of professionalism, gain respect from others and to further develop our effective communication skills.

Do you have something you would like to add to this list? Let’s start a dialog and spread the word in 2014.

Smile Gallery No-Nos

What’s a dental web site without good Before and After photos?

But honestly folks, most Smile Galleries, or Results pages or Before and After sections – whatever you call it – they seem to fall short. Most of these pages look like a hot mess and I’ll tell you why.

Most dentists don’t understand why people visit that area of their web site and what those future patients hope to find. I believe it is because most dentists are looking at something entirely different. They are looking at their artistry. Their patients, not so much.  Please understand that what is appealing to you is not necessarily appealing to your patients. Frankly, while the intricate, artistic work you are trying to showcase may impress you and your colleagues, it is lost on most patients. Yes. I said it.

I believe that people look at these pages to imagine what might be possible for them. They want to “dream” and envision how they might look and how their life might be different. They might attract someone and develop a relationship, they may get that promotion, they might develop new-found confidence, maybe begin a whole new career path, or it could be as simple as feeling comfortable enough to smile again, or chew steak, or bite down on an apple. Anything you can do to help them connect with that feeling can encourage them to take that first step.

Here are my Top 3 Before and After No-Nos

No-No #1: Close-ups of just mouths

Detached mouths without faces are not compelling to patients. Besides the teeth, there are other subtle nuances that aren’t so attractive – namely male facial hair. Ugh. It really detracts from the beauty of the dental work. And while the work you’ve performed may be impressive, what they see does little to help patients connect with the benefits. I encourage you to display full faces instead of just mouths. It actually makes the difference even more dramatic and helps bring the humanity to what you do.

No-No #2: Scary Before Images

Clicking on a page and seeing scary Before images may do more to discourage than encourage potential patients – especially those who are fearful. I would prefer seeing beautiful After faces and smiles when I arrive on a Smile Gallery page.

How might they see the Before images to appreciate your work? How cool would it be to “roll over” the beautiful After image to reveal the Before image? I have seen this technique used in the past and it is SO much more impressive! Sadly, I searched my bookmarks and can’t find a single site that features after photos with a before rollover. Why not be the first? If you’ve fashioned your Gallery like this, please, please PLEASE send me a link. I would love to share it with your colleagues.

No-No #3: Anonymous Smiles

Who are these Before and After faces and what are their stories? Think about the impact it would make to include a brief story about their struggles, how they decided to make a change and how, with your help, it has made a difference in their life. This is where the magic can happen for people. Patients are more likely to connect with the quality of life benefits they are hoping to receive with your help. They will read something that makes them think “That’s me!”.  It can give them courage and motivate them to action.

With these three No-Nos in mind, you’ve got roughly a month before the season of self-improvement rolls around: January. Take inventory of your own Smile Gallery and consider if making some changes might better serve your practice and encourage more potential patients to take the next step.

And if you need help coordinating the effort or telling your patient’s stories, give me a call. I can help you make over your smile gallery for greater impact.

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 :

A – Administrative:

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 statements
-daily deposit
-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
-correspondence
-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
-planning meetings

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
discussion
-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
elsewhere
-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
arrive
-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.”

Or

“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. 

Great Expectations

      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,

My Prediction for 2013

Good news!  U. S. News and World Report has announced their list of the top jobs (those in greatest demand) for 2013 and topping the list at number one is dentist!  Following in the number ten position is dental hygienist! At the risk of angering some of you, I’m going to say it. No more whining! You can position your practice and seize the market. But you must decide to take a good hard look at your practice and make some improvements.  Look at these FIVE ELEMENTS and ask whether you are making the most of each opportunity:

1) Your Physical plant

Patients have very little in which to judge your expertise or competence and some will assess you by the appearance of your practice. From the exterior and signage to the decor, wall art and clutter, look at your practice with new eyes or ask a third party or professional to give you their honest opinion. And while you must like and be comfortable in your surroundings, the more important issue is who you are targeting and what will appeal to them.

2) How are patients welcomed?

The best investment you can make is to train the team members entrusted with answering the phone and welcoming new AND existing patients. NO AMOUNT OF ADVERTISING OR EXTERNAL MARKETING WILL BENEFIT YOU until your team members learn how to connect with people in the most effective way. The challenge is that you rarely know how your team members are engaging people because you are focused on doing dentistry. Enlist the help of a professional to both assess and train your team appropriately.

3) Work on building relationships

This may sound like a no-brainer but there is more to building a relationship than learning where your patients work, their children’s names or where they went on their last vacation. Everyone who works in the practice must be capable and willing to learn communication skills that will carry your relationships beyond the superficial. This requires learning why patients come to you, what they are asking and expecting of you, and how you can connect with them in ways that help them get what they want. The end result is more patients authorizing more dentistry sooner!

4) Fostering referrals

It stands to reason that if you manage expectations and give patients what they want, they will be happy and continue to come to your practice. Far too often, we don’t ask our best, most satisfied patients for referrals. Do you and your team know the art of asking for referrals in a genuine way? Do you have a referral program that encourages people to voluntarily share their experience in direct and viral ways? Enlist the help of a professional to AMP UP this highly overlooked goldmine.

5) Marketing

For you old-school guys and gals, WAKE UP!  It’s 2013 and if you aren’t getting your business out into the community, you will be left behind. For those of you who have marketing plans in place, now is the time to re-assess their effectiveness.  Keep these three essential elements in mind as you craft your campaigns:

Reach – who you are targeting

Frequency  –  how often you are sending messages out

Top of the Mind Awareness/Familiarity  –  being in the consumer’s mind when they are in the market or have a need

I encourage you to consider more non-traditional means of promoting your practice with a heavy emphasis on education and good-will marketing. Think creatively and out of the box. Don’t rely on a team member to try to implement your marketing when they “have time”. Instead, hire someone who can focus on it.

I predict that if you tackle all five of these goals this year, your practice will SOAR. I would love to help you with each of these areas to make 2013 your greatest year ever and be poised for success for years to come.

“Confirmation” Calls and Cancellations

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…

The three most annoying things patients say about dental insurance …and how to respond.

Dental insurance will play a factor in how you will pay for what you want. Dental insurance should never dictate what you want.

Recently, I took a pole among our clients and asked what were some of the most challenging and annoying things patients say about dental insurance.  I compiled the responses and among the answers I read a lot of frustration. I chose the top three and hope to provide some constructive ways to handle these statements in the future.

Let’s get something out of the way right up front. Most patients don’t know what their dental benefits cover. They don’t understand how dental insurance works. For the most part, patients aren’t informed and let’s face it, who wants to take time to read the benefits manual? Just thinking about it makes me want to stick forks in my eyes.  So what do they do? They look to us.  Why is it that they think we would know? We’ve taught them this behavior.

Because we allocate our precious manpower and resources to make calls on their behalf. Because we investigate their benefits. Because we communicate with the insurance provider for pre-authorization. Because WE read the terms of their policy, we have, in essence, assumed responsibility for their insurance so they don’t have to! We, and I’m talking dentists as a whole, have created our own nightmare.

On the other hand, the insurance companies work very hard to create the perception in the patients’ mind that they are a vigilant benefactor who stands beside them and protects them from you, the greedy dentist. Because patients don’t understand the nature of dental insurance and the fact that the goal of the insurance provider is to NOT pay, we become the casualty.  And as a result, when insurance benefits pay for only a small amount of the procedure or deny the claim, or refuse to cover any costs, the practice becomes the bad guy. The patient takes it out on the messenger. We must learn to remove ourselves from being the “middleman”.

So how do you reverse this destructive trend?
You sit down with your patients and you have a dutch uncle talk with them about insurance realities. You have an opinion, knowledge, experience, and insight they don’t have. You can influence the way they think about their benefits. You can expose the insurance game for what it is. You can begin the process of getting them to own the responsibility of understanding what their coverage does, and does not provide. Part of your discussion should include these two non-negotiable philosophies:

1)  The insurance company’s goal is to make money and KEEP that money.  Our goal is to have the health of our patients influence our recommendations and that is not one the insurance companies share. We have never heard this as part of the insurance company’s mission.

2) Dental insurance will play a factor in how you will pay for what you want. Dental insurance should never dictate what you want.

Now, on to those annoying questions/responses:

#1  I have XYZ – Do you take my insurance?
There should be nothing annoying about this question but when you get this call, chances are you automatically form an opinion and label the caller. They are just trying to take advantage of their benefits. Insurance is like a coupon and they are trying to find out if you take their coupon.

If you do, the next thing you need to find out is if they understand the limitations of that coupon.
“Yes we do. Tell me, what is it you have been led to believe about your coverage?”, would be a great way to find out how much they know. Then you are able to start increasing their involvement from the very first call.

If you do not “take” their insurance, find a way to answer the question without saying NO. Avoid don’t, can’t, and use affirmative language.  Tell them what you CAN offer. Here are some examples of how you might approach it:

“If your plan is one that allows you to choose the dentist you think is right for you, you can come to our practice. We would love to welcome you here.”

“Here is what we can promise you. We will make make sure you get every reimbursement you are entitled to. Most importantly, we won’t allow insurance to dictate our standard of care and we will be honest with you about what we recommend based on what’s important to you.”

“Mrs. Jones, XYZ insurance has some interesting rules. They will allow anyone to come to our practice. This is how it works…”

#2  Oh, my insurance will pay for everything.
If they think their insurance will cover everything, we will have a problem. It is a given that no plan covers 100% with no “out of pocket” expenses, in any circumstance. There will always be some limitations. So it is a given that every dental client in this country with some kind of coverage will likely be disappointed.  Shift the focus away from us to some place else where it rightfully belongs. Try a response that will begin to shift their expectations from the very beginning:

“Well, isn’t that wonderful.  Almost all of our patients find that’s not the case and are very disappointed. Bring in your benefits book and I will highlight those things you will want to be aware of before we begin so you won’t be disappointed with us when they (not us) let you down. We will help you in every way to get the benefits you are entitled.”

#3  I don’t want it if my insurance won’t pay for it.
Where do they get the restrictive mindset?  The insurance company.  When they emphasize “preferred providers” or  “standard and customary”  they send messages that they know what’s best for the patient when that couldn’t be farther from the truth.  We haven’t done our job to turn that thinking on it’s head. Patients don’t understand that their employer negotiates with the insurance company and they are the ones who decide what benefits their employees will receive. They don’t understand that insurance was never meant to provide full coverage for procedures. One way to present it to patients is;

“Dental benefits are designed to keep healthy people healthy.  And sadly, unlike medical insurance, dental insurance has an annual cap of around $1000. Plus, there are lots of restrictions designed to discourage you from getting the care you have chosen. Your insurance will help with some of the expense but unfortunately, the coverage your employer provided you is not comprehensive enough to do much more. I hope that will not prevent you from choosing what’s in your best interest.”

So, the question should be:  “Are you prepared to pay (fill in the blank) to get what you want and have (fill in the blank) help with a small portion of that?”

I hope this has made you think about how you might be contributing to the insurance mindset and how to change it.  Use these tools to shift the influence of power and get your patients thinking differently about their benefits.

What annoying comments or questions about insurance are you hearing? The following statements were among some of the other top contenders. Knowing what you know now, how might you address these comments in the future?  Use this as a team discussion and send me your responses.

Are you a preferred provider?

Just submit my insurance and I’ll pay the difference when it comes back.

I’ll decide after you do the pre-determination.

My insurance company says your too expensive.

I have to see another dentist because you aren’t in network.

Dental Speed Dating: The Four DOs and DON’Ts of New Patient Calls

Your first point of contact with a new patient is likely to be by phone. Those few minutes are the most valuable commodity you have to attract someone to your practice and establish a new relationship. Think of it a dentistry’s form of speed dating. If you handle the call appropriately, you can lay the foundation for a meaningful relationship. While people who triage these crucial calls understand this, they often struggle with how to handle them properly.  At some point in the call, things go south and the potential is lost. This has become more obvious lately since I have been helping a number of practices hone their phone skills.  With the assistance of recorded inbound calling, we have had the advantage of listening to some of these calls, analyzing what went well and where the team could improve. It is a valuable coaching tool that I encourage every practice to consider. (Personal Note to Staff: this tool is not designed to “spy” on you – it should be used to help you become better at what you already do.)

Let’s deconstruct the initial phone call and I will introduce you to some ideas that will help you become more successful with those patients looking for a new dental home.

First, it’s important to remember that every call has money attached to it.  People usually find your practice because of some kind of marketing. Be it from a billboard, web site, search engine, the newspaper, a patient referral or some other advertising source, the dentist has invested money in attracting these new patients. Whatever they saw, heard, or read was enough to encourage them to pick up the phone and call you. Keep in mind that when someone calls your practice, she is predisposed to liking you. She wants you to be the right place and she is hoping that you can help her with whatever the reason was that she called. If she has called the right place and you do the right thing, she will easily become your patient. If the call ends without an appointment, the practice has lost money.

There are four things you will want to focus on during each call.

1. Thank them for choosing to call your practice
I’m not talking about your standard salutation; “Thank you for calling Smile Valley, this is Jennie, how may I help you?” That is not a true “Thank you” – it is merely the way in which you choose to identify the practice. I’m talking about the point at which the caller has had an opportunity to share why they called and you respond to that initial information. This may seem obvious but I rarely hear a genuine “thank you” at this stage in the call.  Just remember that they have a choice of who they call and you were that choice. Let them know how much you appreciate it. Believe me, this is rare.

2. Be intentional
Avoid being mediocre or ordinary by devoting 100% of your focus and attention on the caller. When the phone rings and you are available to focus on the call, pick up a pen when you pick up the phone. Listen intently. Take notes verbatim (to transfer to their record later). Find out the caller’s name and address him by his name.  Acknowledge and empathize if you hear emotion (anxiety, frustration, pain, concern). This extra effort quickly becomes obvious to the caller and he will recognize your commitment and desire to help.

3. Find out WHY they are calling now
Why would someone call a dental practice in the first place? When people are well cared-for and everything is fine, they will not have a reason to call or make an appointment to see you. Something happens to shift someone from not wanting to see a dentist to wanting to see a dentist. What might that be? A problem develops that is compelling enough that they have been motivated to contact a dentist. That problem could be many things and sometimes it is not as obvious as we might think. It is your job to suss that out.

For example, if someone calls with a broken tooth and wants to see the dentist, you may assume that the problem is clear: you immediately consider them an urgency patient because you assume there is pain associated with it. However, that condition could create a variety of other problems as well: it might cause pain, but it might also make chewing difficult, or it may be visible and look bad, or the person might not have any of these problems but has a concern that the rest of the tooth might break or it will begin to be painful.

Let that drive where you take the conversation. This is the foundation of triaging a call so you can best determine if you can provide the service they require and you can find the appropriate time in the schedule to help them.

Speak to the obvious – only that which has been said. For instance, if the caller says “I broke a tooth! I need to see the dentist right away!”,  don’t guess about what is happening.   Instead of responding with “Are you having some discomfort?”, try “It sounds like you are concerned…Let me see if I can help. What’s going on? ”

Let them tell you their story then ask appropriate questions to fill in the blanks. If their issue is not so obvious, ask them to “Tell me what’s going on today” or “Tell me what concerns you have and what you will want the doctor to pay attention to”  instead of “What is your chief dental complaint?”.

4. Find out why they called YOUR practice
How did they choose your practice to call? What do they know about you?  Chances are that whatever they learned about you from advertising or a personal referral will be useful information about what they value. For instance, if the reason is because they work in the same office building, proximity and convenience may be important to them. If they heard from a friend that the dentist was gentle, it is likely that is high on their list of priorities. If they aren’t quite sure about another dentist’s diagnosis and recommendation and they learned you provide second opinions, trust is likely an issue. Ask them to clarify or confirm what you have heard. For example, “It sounds like location and convenience is important to you, Hank. Is that the case? Aside from that, are there other things of importance that you would want us to know?”.

What you must NOT do:

1.Don’t make the patient jump through hoops.
Try your best to make it as easy as possible for the caller. Convey to the patient how you can help instead of telling them about the obstacles they must overcome to become your patient.
For example, if you don’t have an appointment on a certain time or date, you might phrase your response by saying “I CAN find you something comparable on a different day – how does Tuesday sound?”

2. Don’t use negative phrases or words. Steer clear of “You have to…” “You need to…” or “Our policy is…” kind of statements. Instead of “No, we don’t take that insurance”, you might say, “Let me tell you what we CAN do for you”.

3. Don’t answer the phone if you are not prepared to devote your full attention. I know. Many dentists get annoyed when they hear the phone ring more than two times but it is sometimes better to go to a carefully-crafted voicemail message than being answered by someone whose focus is on something else. If you would like some suggestions on effective voicemail triage and messages, contact me and request our white paper; VOICEMAIL GUIDELINES

4. Don’t put the caller on hold for long periods of time. While your “voice on hold” recording may be very compelling, no one wants to be on hold for more than 30 seconds. Simply offer to call them back in a timely manner.

There is an art to establishing a relationship with a new caller. It requires your full attention, a curious nature, and a helping spirit. If you devote yourself to taking these steps, you will naturally experience a higher rate of success with new callers. You will also discover that you are more aware of the patient’s needs and more prepared to help address their problems when you meet them for the first time.