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How to Deliver Total Patient Service AND keep your schedule under control.

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CrownCouncil.info800-276-9658

Copyright 2013

Stop Cancellations!

and

A Special Report by

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Building the FoundationWhy the Problem is Not the Problem…

Why the Problem is Not the Problem…

Like so many things in life and in dentistry, cancellations are not a problem! They are just a symptom. For example: there is no such thing as a collections problem. It is just a symptom of a bigger problem with financial arrangements. If there is a good financial arrangements system in place then there are few collections problems. Or how about this: there is no such thing as a seat problem with lab work that consistently does not fit. But there may be an impression problem in the office or casting problem at the lab. A crown that does not fit is just a symptom of a bigger problem.

So quit thinking of cancellations as the problem. It’s not! The problem lies with the over all system you have in place to help patients accept and stay committed to treatment. If you have a lot of cancellations, don’t try fixing the symptom, try going back and taking a look at the cause - the case acceptance system you have in place. (If you have one!)

If you are going to solve a problem, you have to go back to its very roots – its origin. The foundation of a solid case acceptance system, which helps patients commit and stay committed to treatment, starts with every team member having a clear understanding of the purpose of the practice. If you don’t know why you are there in the first place, it is not likely you’ll do a very good job of it. So start asking your team the tough questions. The next time you have a team meeting, ask them what the purpose of the practice is and then just shut up and listen! At first, the silence may be deafening! The answers may be as varied as the team members you have in the practice. But until everyone is “on purpose,” your practice results may be just as varied.

In short, everyone’s purpose should be to create happy, paying patients who pay more that it cost to serve him or her and repeats and refers. Imagine the difference it would make to focus on patient commitment not just “appointment book control” at the front desk. Or how about every clinical assistant focusing on long-term patient relationships with the practice, not just organizing instruments and taking x-rays. How you view your job, causes behavior that creates results with patients. So don’t just start working on the surface problem by trying to fix a symptom without first checking to make sure the foundation is in place.

3CrownCouncil.info ~ 800-276-9658

A Fundamental Philosophy

What’s your system?

Once everyone on the team understands their purpose, then you better wake up to the next fact: your patients don’t come trained when they show up to your office! Most patients have experienced so much abuse of their time in medicine and have been treated so much like a number or health insurance policy instead of as a person that they have subconsciously come to expect something similar everywhere they go in healthcare. Because of that, everyone on the team needs to understand that you have to teach your patients how to treat you. They don’t come trained. It starts by treating them with respect and courtesy and asking for and expecting the same in return. You communicate those expectations every moment you interact with them from the first conversation on the phone to the last good-bye as they walk out the door. It is a funny thing in life, we often get what we expect because our expectations influence our behavior and our behavior creates results.

Creating a committed patient who follows through and doesn’t cancel is more than just a grab bag of miscellaneous tactics. It is about having a comprehensive system that you and your team use every day to get consistent, predictable results with your patients. So what’s your system? If cancellations flair up, do you just look at your administrative team and “tell” them to pull it together. Or do you look at the entire system you have created with your team to keep patients committed to treatment and see where the breakdown is? If you don’t have a system, then you are totally dependant on the people in your practice to make it up as they go along every day and do the best they can. That’s not good for your practice. It’s not fair to your team. And it is only frustrating to everyone involved.

What’s your system?1. Discuss and define the purpose your practice with your team. Until everyone on the team is saying the same thing, you won’t have any hope of seeing them doing what it takes to get and keep committed patients.

2. What do you need to do to “teach your patients how to treat you?” How are you training them today? What are your real expectations and how do you communicate with them verbally and non-verbally?

3. What’s your system? Start working together with your team today to define and fine-tune the system everyone will use to gain and retain happy, healthy, committed patients.


Who’s most at risk?

Hygiene Patients:They may think: “It’s just a cleaning.”

New Patients:They may feel anonymous and say to themselves:“No one knows me.”

“Financial Flu” Patients:Patients who get “sick” the day of treatment becauseof payments due.

Team Commitment:

Patients place as muchimportance on theirappointment time as

YOU do.

Stop Cancellations Rule:We teach patients how to treat us. That is accomplished in a positive way, not a negative way. Reward good be-havior and set positive expectations of your patients in advance.


80% of the solution comes from preventing the problem in the first place. Set your patients up to succeed in your practice.

Note: This does not replace the “Appointment Commitment Call” (see #5 below) that is placed by the administrative team two days before the scheduled appointment.

1. New Patient Welcome Call:Appointment coordinator prints out a list of all newpatients scheduled for the following day and gives it tothe doctor at the morning meeting. The doctor calls each one the day before their appointment.

Doctor:

Prevention:

“Mrs. Jones, this is Doctor ___________ at (Office Name). I am looking forward to meeting you during your appointment tomorrow at 3:00 PM in our office. I wanted you know that we will have everything set up and ready to go for you at that time tomorrow. If there is anything that I should know about before you come in that would make your visit more comfortable, please give me a call at _________. Otherwise, we look forward to seeing you tomorrow at 3:00 PM. See you then.”


(Recommit every patient at every appointment to his or her continuing care.)

2. In the Treatment Room:Doctor conversation with new patients or patients who will be coming back for several appointments:

Hygienist conversation with patients of record(at every appointment):

“I’m committed to helping you get the outcome you want in a timely and comfortable way. In order to do that, I need your help. We need to make sure that your appointments are set at times when you have the least likelihood of any type of delay or in-terruption in your schedule so nothing stands in the way of doing what we talked about today. Does that make sense? So if you will work with _______, ourappointment coordinator, we will be committed to the schedule that the two of you put together to make sure everything happens as planned. Fair enough?”

“Congratulations” or “Here’s what we found today that needs some work.” “The best insurance policy you have to stay on track is to do your home care each day without fail AND make sure that nothing stands in the way of our regularly scheduled appointments. I want you to know that when we do have an appointment scheduled together, I have that time reserved especially for you. I work very hard to make sure nothing gets in the way of that. So if I could make a suggestion that you do for yourself what we are doing for you here in the of-fice? Make sure to write down the appointment time on your calendar. That way if a potential conflict comes up, you can say that you have a prior commitment. Does that make sense?”


(Give them a choice of the days you are available.)

Hand the blank appointment card or postcard to the patient and let them fill it out. It has more power if it is in his/her own handwriting.

3. Keep “The Chain” Connected with a Strong “Relationship Link.”

Connect the clinical relationship to the administrative relationship.

Communicate:• Planned and agreed upon treatment.• Patient’s “P.I.” (Primary Interest). • Any patient concerns or potential obstacles.• Ask the patient: “Is there anything I missed?”

Dental Assistant talking to the administrative team member, while standing next to the patient:

Administrative Team Member to ask:

“(Administrative Team Member Name), we have had a great visit with (Patient Name) and he/she is ready to get started with the treatment we have outlined here. (Patient Name) is very excited to get started because he/she is looking forward to his/her upcoming reunion.”

“Which day of the week do you have the most control over, where you would have the leastlikelihood of any type of interruption in your schedule?”

(Primary Interest) “It is very important to (Patient Name) that this be completed within the next month.”(Concern) Is there anything I have missed (Patient Name) that we need to discuss before you and(Administrative Team Member Name) work on the schedule and the financial arrangements?”

Appointment

card suggestion

s:


Appointment card suggestions:Eliminate all language that has penalties or guidelines for cancelling an appointment. Instead, the card might say:

“Please mark this important appointment on yourcalendar today. We look forward to seeing you atthis time that has been reserved especially for you.”

4. Get a Verbal Commitmentfrom the Patient for theScheduled Appointment:

The two most powerful words whenscheduling an appointment:

Example:

“So your appointment with Dr. Jones is scheduled for Thursday at 10:00 AM to get started on yourbeautiful class reunion smile. Will you be here?”

Will you?

Missed Appointment andCancellation PolicyIf you are unable to keep a scheduled appointment,

please give 24 hours advance notice, to ensure that you

will not be charged for the appointment.If less than 24 hours notice is given and we are unable

to fill your time slot, you will be expected to pay for the appointment,

Thank you.


5. Appointment Commitment Call:

Give your patients the option of which method of com-munication they prefer when receiving messages from you regarding their upcoming appointment: phone call, text message or e-mail message. Have the appropriate tech-nology in your practice to accommodate their preference.

When calling, e-mailing, or texting to assure the patient’s commitment to their upcoming appointment, eliminate these two words from your vocabulary:

This call should be made two days in advance for new patient so the doctor can make the welcome call the day before the appointment. If the new patient is coming in sooner, coordinate the calls in the morning meeting.

Suggested dialogue or message:

For hygiene appointments:

“Mrs. Jones, this is (your name) from (office name) and I’m calling about yourappointment with Dr. ________ on Tuesday at 3:00 PM. I wanted you to know that we will all be ready for your appointment and we are looking forward toseeing you at 3:00 PM on Tuesday. We’ll see you then.”

“(Patient Name), this is (Your Name), at the (Office Name). I wanted to let you know that we have everything ready for your appointment tomorrow at 3:00 PM with (hygienist name) your hygienist. We look forward to seeing you then.”

Confirm & Remind


First Aid:

Pre-requisite:

Follow this verbal skills outline:

What to do with the “exceptions” or those who call to cancel or change their appointment.

Quit saying “Oh, that’s okay.” when the patient makes a plea for your sympathy by saying “I’m really sorrybut I need to cancel my appointment.” Instead, be firm and friendly.

1. Listen and don’t react. Take a deep breath and just say “Oh.”

2. Ask them to hold while you get their records. (Go get the chart or look it up.)

3. Ask for a re-commitment: “Thanks for holding Mrs. Jones. I have your chart here. We have you scheduled on Tuesday at 3:00 PM with Dr. _______ for the prep work on the veneers (scheduled treatment) we talked about you wanting to have done before your next high school reunion. (Her Primary Interest) I know how important this is to you and you are very important to us. Is there any possible way you can keep this appointment as origi-nally scheduled? Anyway at all?”

4. If not: “Mrs. Jones, let me see what I can do to find something that will work for all of us. Which day and time do you have the most control over, when you would have the least likelihood of any kind of interruption in your schedule, so we can prevent this from happening again?”

5. Last resort: (If they won’t reschedule and they won’t tell you why.) “Mrs. Jones, I know how important this is to you and how important this is to the doctor. If you would hold for just a moment, I know Dr. _______ would love to talk with you.”

6. Frequent offenders: “Mrs. Jones, I need your help. For some reason we have not been able to make these appointments work like we need to. I just looked back and we have rescheduled this appointment at least 5 times. What would you suggest we do to get this back on track?”

For patients with hectic schedules that change frequently, consider putting them on your “Same Day Appointment List” and get their approval to call them with short notice on the day when you have time available.


Voice Mail Message:

Which day of the week is the most dreaded day in the dental office? MONDAY, because patients call for two or three days over the weekend to cancel their appointments. Make it easy for them to do what you want them to do and hard to do what you don’t want them to do:

Suggested answering machine message:

“Thanks for calling (office name). Our office hours are ________. If you have reached this messageduring office hours, we are assisting another patient and will return your message as soon as possible, so please leave your name and phone number. If you are calling after hours and would like to schedule anappointment, please leave your name and phonenumber and we will return your call as soon as wereturn. If you have a dental emergency or if you have a conflict with your scheduled appointment, please page the doctor by calling _________________________. Our voice mail system is not monitored for scheduling changes. Thanks for calling.”


Q - Should we charge for missed appointments or have a cancellation policy?

A - Yes and no! A poorly written cancellation policy can send the message: “We don’t have very many patients that respect our time so we really have to sock it to you if you cancel because we have so many that do!”

Our preference is to train your patients how to treat you. Most of us will rise to the expectation given.

There are some target markets that need a firm but friendly cancellation policy. You might print it on the appointment card you give them when they schedule that says:

“Your time is important to us. We appreciate your commitment to the above scheduled appointment date and time. In the unlikely event that a serious, un-avoidable conflict arises, we appreciate your calling our office at least 48 hours in advance in order to avoid a missed appointment charge.” You decide what policy makes the most sense for you.

Frequently Asked Questions About Cancellations and No Shows:


Q - Should we send appointment reminder cards?

A - If your patients are in the habit of receiving an appointment reminder card from you then don’t quit until you have them trained to expect something different. Look carefully at the message that is on the card. Many preprinted cards have a note that has a cancellation “invitation” on it like, “Appointment changes within 48 hours of the scheduled time will be charged at the regular fee.” All this does is say that it is OK to change or cancel your appointment as long as you give enough notice. It is your decision, but it is easier in the long term if you teach your patients that you expect them to keep their appointments as originally set.

If you do use reminder cards, have the patient fill out the card themselves when the appointment is set so they will recognize their own hand writing when it shows up in the mail. The language should say:

Q - Should we call to confirm appointments?

A - Have you been doing it to this point? Don’t stop doing something if your patients have come to expect it. Unless you have trained them to expect something different, you have to be consistent. Here are some verbal skills suggestions when you do call. Eliminate the word “confirm” from your vocabulary. It just gives the patient an opportunity to get out of the commitment. Confirm implies that it was not firm to begin with.

Q - What about digital reminders?

A - Set up a system to give your patients a choice of how you communicate with them. Do they prefer a post card, call, text, or e-mail? There are so many ways to communicate today that individuals have preferences. Find out how they operate the best and accommodate accordingly.

“You have an appointment with (Doctor’s Name) at 9:00 AM on Tuesday, February 2013. We look forward to seeing you at that time.”


Q - What should we do when someone doesn’t show up?A - Call them within 5 minutes of their scheduled appointment. If you can’t find them, leave a message that says something like this:

Be sensitive to potential extenuating circumstances. Don’t automatically assume that they have not shown up for frivolous reasons.

Q - What should we do with repeat offenders or those who always want to change their appointments?A - In most cases, they do what they do because you have allowed it. Remember, you teach people how to treat you. If the problem is recurring, you might want to say,

In very bad cases, here is a suggestion:

At a certain point, it does not make sense to keep spending time on someone who is not going to change. You may be afraid of offending the patient; however, in most cases the patients who give you the most hassle are the ones who are not profitable for your practice anyway. Furthermore, they associate with people just like themselves who would not necessarily be good patients either. Be firm but friendly and remember whose practice it is!

“Mrs. Jones, this is Stephanie calling from Dr. Rich’s office. It is 8:35 AM on Tuesday and we are here waiting for you for your 8:30 AM appointment. We haven’t seen you yet and are very concerned about you. Would you please give us a call at 777-7777 as soon as you get this message so that we’ll know you are okay?”

“Mrs. Jones, it sounds like you have some other very important, pressing priorities in your life right now. Am I right? Here’s what I would like to suggest to make things a little easier on you. I have a very special list of patients who I call on relatively short notice when we do have an opening in our schedule. I’d be happy to put you on that list and call you within an hour or two of an opening. That way you can be sure to be here and we can accommodate you the best. Does that make sense?”

“Mrs. Jones, it sounds like you have some other very important, pressing priorities in your life right now. Am I right? I don’t want to keep bothering you about this and I know that when the other things in your life calm down, then maybe it will be easier for you to make a commitment to an appointment. So I am going to make a note in your chart that you will call us when you are able to schedule an appointment that you are sure will work for you. Does that make sense?”


1. Are you canceling or moving your own patients as the rule versus the exception?

2. Are you running late, more than on occasion, and disrespecting patients’ time?

3. Are you seeing patients who show up to their appointments late without

addressing their lateness?

4. Do you have unclear case presentations with no real commitment made by the patient?

5. Do you ever schedule a patient without firm financial arrangements?

6. Are you allowing patients to cancel and reschedule with no consequences?

7. Do you typically have 1 or more no shows per 8 patients in hygiene?

8. Do you typically have one or more last minute schedule changes in a day of hygiene?

9. Do you have one or more no shows in the Doctor’s schedule per day?

10. Do you have one or more last minute schedule changes in the Doctor’s schedule per day?

11. Do you double book your patients in case they don’t show?

12. Do you have new patients who cancel or no show as a rule?

13. Do you leave messages on patient’s answering machines to “confirm their appointment?”

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

No

No

No

No

No

No

No

No

No

No

No

No

No

Checklists:What is Your Cancellation (Symptoms) Score?

Now add up how many times you checked “Yes”

4 Or under Great Job!!!5-8 Work to be done.9-13 It’s time to get busy NOW implementing the systems in this report!


1. Do you always quote the fee and have a clear financial arrangement made?

2. Do you ask for commitment from the patient and deal with patient objections before scheduling the patient?

3. Do you maximize the patient’s condition when presenting treatment?

4. Do you always do a great Relationship Link, being sure to include the patient in the conversation?

5. Do you state the benefit/concern to the patient when scheduling their next re-care visit?

6. When placing a confirmation call do you either speak directly to the patient or leave a message asking them to contact you regarding their appointment?

7. Do you have a clear cancellation protocol that both the patients and the team are aware of and do you follow that protocol?

8. Do you track all last minute cancellations and no shows either in the computer or in the patient’s chart?

9. Do you call the late patient within the first 10 minutes of their appointment and do you show concern that they have not yet come in?

10. Have you or any of your team members had a conversation with a chronic canceller asking them for their commitment?

11. Do you show concern if a patient comes in late and do you ask them to wait while you see if you can accommodate them?

12. Do you always pull the patient’s chart before rescheduling an appointment so that you can discuss the treatment?

13. Have you released patients from your practice because of 3 or more same day cancellations or no shows?

14. Do you ask the patient, “What time of day could we schedule you so that you would be least likely to have any conflict?”

15. When confirming an appointment, do you use words like “Dr. Great looks forward to seeing you on Tuesday at 3:00 PM. Will you be here?”

Checklists: What is Your Prevention Score?Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Now add up how manytimes you checked “Yes”

4 Or under Good Job!!!5-8 Work to be done. 8-16 It is time for an overhaul!


Stop the Insanity - Controlling the Schedule Before it Controls You!Webinar available for download at www.CrownCouncil.org

Stop Cancellations - Reduce cancellations, no shows and appointment changes.Webinar available for download at www.CrownCouncil.org

Total Immersion - www.TotalPatientService.comIncorporating a Team Motivation strategy into your practice.

Total Practice Support - www.TotalPatientService.comImplementing the Strategy, a customized approach. Learn how a ToPS PracticeAdvisor can take your practice to the next level.

Morning Opportunity Meeting Action Thoughts - Subscribe HEREDaily wisdoms and action ideas to start your morning heading in aproductive direction.

Additional Resources forControlling Your Schedule:

1

2

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5

3


Total Patient Service Institute: The Total Patient Ser-vice Institute aligns your practice with the ideas, tech-niques and systems based on The Natural Laws of To-tal Patient Service, practice achievement, and personal success. From its:

- Detailed practice analysis, - Action-packed seminars, - Interactive workshops,- Idea-filled roundtables, and - Performance driven Total Practice Support program lead by ToPS Practice Advisors, the ToPS Institutedelivers exactly what its name says —results that will make your practice ToPS!

877-399-TOPS, [email protected]

TotalPatientService.com

The Crown Council is an international association of practices dedicated to creating “A Culture of Success” through continual improvement of the professional, the practice, and the community. The Crown Council provides exclusive resources for the ongoing effort in your practice to create a Culture of Success every day, with every team member and every patient.

800-276-9658, [email protected]

CrownCouncil.info

TotalPatientService.com ~ 877-399-ToPS

For over 3 decades, Steve Anderson has studied, ap-plied, proven and pro-claimed: All human action is grounded in Natural Law. Know the law and better results can be predictably designed. Ignorance of the law, however, does not free one from it. As a Behavioral Physicist, he identifies the applicable Natural Laws, ed-ucates, and designs systems to accomplish predictable, consistent results.

Presenter For over twenty years he has spoken at major industry meetings and conventions in North America, Australia and the United Kingdom, conducted hundreds of seminars, and worked with thousands of businesses and organizations to in-crease their productivity and profits through the ap-plication of over 101 Natural Laws. His combination of

behavioral physics, high en-ergy, humor and every-day application makes him one of the highest rated speak-ers at every venue where he appears.

AuthorHe has written over 100 ar-ticles for industry publica-tions, authored 5 books, and produced dozens of audio and video learning programs. He hosts two monthly programs viewed by thousands around the world interested in boosting productivity and profits.

EntrepreneurAs the founder of over a dozen businesses, he has propelled organizations and individuals to the high-est levels of performance and productivity. In 1995, he co-founded the Crown Council (www.CrownCoun-cil.info), an international industry association that

now spans three continents. Through the Crown Council, he co-founded the Smiles for Life Foundation, (www.SmilesForLife.org) which has raised over $32 million dollars in the last 12 years for children’s charities world-wide. He has been named the “Businessman of the Year” and is an Ernst and Young Entrepreneur of the Year finalist. Steve is also the founder of Eagle U (www.EagleUniversity.org), a non-profit foundation that pro-vides success education for high school and college stu-dents, giving them a 7-year head start in their career and their life.

Steve and his wife Cheryl live in the Dallas – Ft. Worth area with their seven children.

Steven J.AndersonBehavioral Physicist

StevenJAnderson.com

TotalPatientService.com877-399-ToPS

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StevenJAnderson.com877-399-8677

and

A Special Report by

September 2012

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