NETMA: Nobody Ever Tells Me Anything
Always Look For The WHY
One of our consultants called me yesterday to get my take on what was happening in a practice on the west coast. The office has two young dentists who in just a couple of years have a huge thriving practice. They currently have four hygienists and are experiencing some growing pains. They have worked hard to get the front desk filled with competent staff and feel like they have finally achieved this. A problem has occurred with one of the hygienists and her interaction with the front desk staff while trying to manipulate her schedule for productivity. This hygienist is one of the most productive in the office and could probably run the entire office. The hygienists in the practice are paid on a modified commission basis and this particular hygienist tries to “engineer” her schedule every day for maximum productivity. The problem has occurred because she is constantly moving or asking the front desk to move the patients around to fill cancellations and no-shows. There is some frustration with the front desk because they are spending all of their time trying to accommodate her requests, while at the same time trying not to upset the patients by making them change the time of their appointments. Enter the doctors. The doctors call us and say: “We have a problem with xxxxx constantly wanting to move patients around, and now yyyyy at the front desk is upset because the patients are upset about constantly changing their appointments”.
You get the idea. The doctor’s say: We have a problem with the hygienist and the front desk. The hygienist says we have a problem with too many cancellations or no-shows. The front desk says we have a problem with the hygienist making last minute requests to change the schedule. The patients have a problem because they arranged their day to come in at a particular time and now the office wants them to alter it. Bottom line is that there is a “PROBLEM” but none of them are correct in identifying what the problem is. This happens all the time. Someone identifies what they perceive is a “problem” while in fact it is really a “SYMPTOM of a PROBLEM”. Just today I had the wife of a dentist tell me that their office had a problem with creating a system for making collections calls. Are you kidding me? If they had great financial systems in place, there would be no need for collection calls. So the problem is lack of financial arrangements, not collection calls. The poor accounts receivable and their lack of follow through stems from the first moment they encountered the new patient without sufficient financial arrangements.
Back to the hygienist, front desk staff, and the doctors. As Steven Covey in The Seven Habits of Highly Effective People has stated: Always begin with the end in mind. Look at the result you want and then work back from there. Never start down a path without understanding what you want for a result. Ask yourself: Why do I want this? In this case we have an office with too many cancellations and no-shows. Why? There is no systematic strategy for recall, scheduling, and follow up. If there were, the problem with openings in the schedule would have been minimized. We have a system for this. Just write and I will send you a 28 page article about how to set up a system for cancellations and no-shows. Start there.
Ideally, we want to keep the hygienist busy every minute of the day and insure that she meets or exceeds her production goal every day. It takes at least one to two new patients per day plus having 60% of the day filled with substantial cases to make this work. A substantial case would be scaling and root planning, quadrants of sealants, impressions for night guards and sleep apnea appliances. There is no way to have a productive day of hygiene without enough new patients to create the possibility of more substantial cases. And there is no way to be productive doing only recall appointments all day long.
Every office needs to consider more TLC (Thinking Like the Customer). We need to fully embrace consumerism and how we would want to be treated in this situation. I agree with having someone come in a few minutes earlier or later, but not as a re-occurring strategy to mitigate poor recall and cancellation strategies. Constantly changing appointment times makes you look less competent and caring. It’s as if you have decided only to worry out yourself and not the person that really pays the bills: The Patient.
Every office needs to have a hygiene coordinator that, in addition to their other duties, makes sure to work the hygiene schedule and recall system. In addition the hygienists need to remember that they are just staff members that need to pull their own weight. The hygienist should take the time to confirm appointments, check their schedule, and do whatever it takes to make the day productive without creating animosity with the patient. If you have a cancellation, go to the doctor’s schedule to pick up patients that have not already scheduled a cleaning. Read and reread our Cancellation and No-Show information and start incorporating every detail in your daily schedule.
Bottom line: Take the time to determine the REAL problem and work on it. You need to stop thinking that every upset in your practice is a problem. They are most likely symptoms or ripple effects of a poor system. You will never take your practice to the next level just putting Band-Aids on symptoms. As long as the problem exists, other symptoms will pop up and create more chaos. You should always look for the WHY.
Michael Abernathy, DDS