Exceptional Dental Practice Management

Decisions, Decisions

 

The phone rings.  It's a patient with an emergency.  Or is it?  How does the practice you work in define an emergency.  It does have clear guidelines for classifying emergencies, right?  No?  Well, it's easy to do and will make a big difference in scheduling.  My sometimes asks me, "How many days do we actually work the schedule we discussed at the morning huddle?"  Not too often.  Emergencies happen and we are here to help those people, but not everything is an emergency that has to be seen that day.
    When you put every person who calls with a problem on the schedule the day they call, you create an emergency situation for the practice.  The emergency patients end up stuck in the middle of the scheduled patients and the doctor and staff are in a race with the clock. How much of what they are now thinking is focused on the patient they're with.  Probably not much.  They are looking at the schedule, dreading the next addition and formulating a battle plan in their minds.  Because what started out being care, just became self-defense.
    You can make it so much better.  First, be sure you have designated buffer time for emergencies.  We set aside an hour before lunch and 30 minutes at the end of the day.  We really urge the staff not to fill that time before the day it's scheduled for.  If we end up not needing it, there's always plenty of other things to do right before lunch and the end of the day, resulting in a less stressed staff and doctor.
    Have an emergency call decision tree.  It looks like this:

                                          Phone Call Decision Tree

                                                 Identify Patient

       New Patient with Problem

Get personal info(phone #, etc) 

              Get info about problem

                   What area hurts?

                     When did it start?

                   Does it keep you awake or wake you up?

                   What makes it hurt?

                   Have you taken anything for pain? What?  Did it help?

                     If something is broken is it in the front of the mouth?

                     Is it sharp and cutting your tongue or cheek?

If patient is having constant pain, is kept awake, has sharp edges  or broken tooth in front of mouth, schedule in the emergency time for the same day.  Let the patient know that the team will do what they can to make them comfortable, but that depending on the severity of their condition, they may need to return for definitive treatment.

If the problem has been going on for more than a few days, is not keeping the patient awake, and is not causing issues with appearance or function, schedule the for a comprehensive exam at the first available time, which should be within the week.

    Patient of Record with Problem
        Pull up patient's chart, try to identify tooth from chart notes

            Get info about problem

                   What area hurts?

                     When did it start?

                   Does it keep you awake or wake you up?

                   What makes it hurt?

                   Have you taken anything for pain? What?  Did it help?

                     If something is broken is it in the front of the mouth?

                     Is it sharp and cutting your tongue or cheek?

If patient is having constant pain, is kept awake, has sharp edges   or broken tooth in front of mouth, schedule in the emergency time for the same day. Let the patient know that the team will do what they can to make them comfortable, but that depending on the severity of their condition, they may need to return for definitive treatment.

 

If the problem has been going on for more than a few days, is not keeping the patient awake, and is not causing issues with appearance or function, schedule the for the first available limited exam appointment.  If you have a patient care coordinator, schedule the appointment with her on the same day. You can have her take an x-ray if you feel it's needed and re-appoint the patient for the type of operative appointment needed.  She can then inform the patient of the fee and schedule them to return.

     This is meant to be a guide, not the definitive answer.  The front desk assistant must use her judgment as well.  If the patient calls at 10:00 and the emergency time is still available, she should go ahead and schedule the patient there, regardless of whether he falls into a same day emergency definition or not.  A patient who is in pain, has a broken front tooth or a sharp cutting edge should be seen the same day, regardless of whether the emergency time has been filled or not.  People make mistakes.  Be patient and redirect the assistant to the guidelines to help her understand how to handle emergencies. 

    When you can take some measure of control about the way you work, you will be more relaxed and that will be reflected in the way you relate to your patients and team members.  A busy office is not necessarily a productive office.  A team that runs around all day just keeping up, runs out of gas and becomes tense and short-tempered.  We'll all have crazy days, but when it becomes a crazy practice, something's got to change.  Don't wait until the pressure makes everyone explode.  Make some easy changes and you'll see a big difference.

 

 

 

Dilemma At the Desk

    Many times dentists and managers tend to forget about the front desk, until something goes wrong.  As long as broken appointments are filled and collection is at a decent ratio to production, we are pretty content to allow the front desk assistant to survive on her island alone.  When things are going smoothly we take it for granted and don't really pay much attention to what's happening "up there."  It is only when something goes wrong that we realize how great an impact the activities at the front desk have on the entire practice.
    You can imagine the stress the front desk assistant must feel when a patient cancels, creating a hole in the schedule.  She knows that everyone is noticing that empty, glaring void and wondering what she is going to do about it.  If the practice has their hygienists on commission, it can make them feel resentful.  That hole has a price tag on it for more than the dentist, the hygienist may be losing money, as well.  Some hygienists feel that the front desk must assume the responsibility for keeping their schedule filled and when a cancellation occurs, she may feel like she's let them down.  In reality, she may have personally confirmed the appointment only to have the patient call and cancel at the last minute anyway.  What they both have to do is make sure the patient understands the value of the appointment.  It is helpful if the hygienist calls the patient and lets them know that she is disappointed that they didn't make their appointment and reminds them of conditions that may be present that make regular appointments imperative or remind them that in order to remain in great dental health it is important to stay on a good schedule of preventative care.
    Another very sticky problem at the front desk can be quoting fees and asking for payment.  Some people may be great at greeting patients warmly, scheduling appointments, dealing with insurance and building relationships with patients and team members.  They may have difficulty talking about fees and payment though.  The dentist or manager must decide if their good traits outweigh their weakness and if they do, they must help them find a way to work around their weak points.  In this situation, clear, concise guidelines are necessary and scripted responses can be invaluable.  Get other team members involved as well.  When the dentists suggests treatment and the patient agrees, the assistant or hygienist should enter the treatment onto the patient's chart and print out two copies of the treatment plan.  The staff member can then give the patient a copy of the treatment plan and explain the treatment sequence and fees to the patient.  If the patient has questions about payment, the staff member can then inform the office manager or financial coordinator and allow them to explain payment policies and options to the patient.  Once this is agreed upon, notes should be placed in the guarantor notes section of the ledger and a payment agreement printed out for the patient.  Copies should be placed or scanned into the patient chart.  The receptionist can then access the guarantor note before the patient ever reaches the front desk so that she knows what the patient expects to pay.  When there is no need for a payment agreement, I suggest that the receptionist inform the patient of today's fee along with any outstanding balance and ask, "Will you be paying with a check or credit card?"  She must then have the self-discipline to wait patiently.  If the patient says that they were not aware of the policy and are not prepared to pay, the receptionist should print out a bill and give it to the patient and ask them to drop their payment in the mail when they get home.  She should then note the fact that she explained the policy in the guarantor notes.  She will  know that the patient is aware of the policy at their next appointment.
    The front desk assistant has to think ahead and also be able to make quick decisions.  She must consider what works with the schedule while trying to accommodate the patients in a timely manner.  A phone call decision tree can be helpful.  A few well thought out questions can let the receptionist know whether the patient needs to be seen that day or whether they can wait a day or two.  Next I'll talk about what questions can help the front desk assistant make that decision and how they can schedule so that they can satisfy the dentist, the staff and the patients.

Schedule From Hell

    I think scheduling is one of the most difficult, yet one of the most important jobs in the practice.  A great schedule keeps things moving, keeps production on target and keeps the clinical staff happy.  If the schedule is a mess, though, you end up with patients who get grumpy because they're kept waiting, possibly a very busy day with nothing to show for it on the day sheet, and a group of mutinous employees. 
    If you really think about it, the scheduler almost serves two masters.  She needs to schedule the way the dentist wants her to so that production goals are met and he works the way he wants to.  On the other hand, patients can really be insistent about getting that first or last appointment of the day.  Then there are the people who call and say their tooth is killing them and they can't wait another minute.  Of course she wants to bring them in, they're suffering.  What she doesn't know is that the tooth started bothering them two weeks ago, they had other things to do then besides go to the dentist.  How can you make it easier for her to maintain a good schedule?
    Setting aside blocks of time for certain procedures helps, but only if she sticks to it.  We set aside a crown prep in the morning and one in the afternoon.  We also set aside two crown deliveries each day.  That usually evens things out.  The rest of the day is to be filled in with other operative and exams.  When that pattern is adhered to, we're fine.  When it's not, we have to scramble to meet our goals, it's as simple as that.
    What can you do if you set it up and the receptionist overrides the blocks and fills them with non-productive procedures?  I find it best to hold her feet to the fire.  I'm not mean, but I'm serious about it.  I pull up a chair, which immediately sets her antenna on end since I never try to micro-manage.  Then we go through the schedule and talk about how it should have been done.  It's effective and we get back on track.
    I think the manager or dentist have to keep an eye out and check ahead so that they can give the receptionist feedback and backup.  It's not easy to put people off when they are demanding to be seen at a certain time.  Just keep letting her know that she can't allow the patients to run the schedule.  Make sure you don't take more new patients than your practice can handle.  If you are scheduling operative out more than a month, you may want to start a call list of people who would like to be new patients.  When you have room for them, you can call them.  Most of the time, they're still there.  You do a disservice to all your patients when you can't serve their needs in a reasonable time.  Your practice won't collapse if you don't take every new patient that calls.

Don't Let Treatment Fall Through The Cracks

    If you treatment plan a crown and the patient never schedules an appointment, you wasted the time you spent looking at the tooth, diagnosing the problem and talking to the patient about treatment.  While you can't perform assault and battery on your patients to make them accept and begin treatment, you can improve the likelihood that they will end up in your chair with their mouth open.  Having an administrative staff that is well prepared and ready to follow up on treatment is key to keeping production flowing. 
    It's a great time to be in dentistry because there are so many innovations that make life easier...if you know how to use them.  Computerized systems are a great advancement, but they can take some time and effort to learn; and you probably never know everything.  We are on Dentrix and I love it, but it takes some effort to learn to use it's systems to your best advantage. I've been really trying to install good methods for preventing patients and treatment from falling through the cracks and into oblivion.  I began by clicking on continuing care and let it run the view for all.  Wow!  All the way  back to 2003.  At first I thought I'd just go in and delete all that old continuing care, but then I decided to kill a few birds with one stone.  I used it as a mini audit as well.  Some patients were archived, most were called and offered a recall appointment to reactivate them and some were placed in our inactive file.  We even discovered that a few had passed on and were able to change their head of household so that we didn't continue sending correspondence in their name.  We've reactivated a surprising number of patients this way and cleaned up continuing care as well.
    I also added a treatment plan follow up to our continuing care reason list.  I set it for one month and if a patient doesn't schedule an appointment it pops up in a month to remind us to call and see if they're ready to begin.  The phone call and their response is recorded in their office journal which is easily accessed from the continuing care list.  Another method is to send the first procedure on the treatment plan to the unscheduled list by scheduling it and  clicking wait/will call.  Finally we use the notes section of the schedule to place one more reminder to check back with the patient.
    You can keep a finger on the pulse of your practice.  All it takes is planning, dedication and persistence.  It also takes staff members that are dedicated to learning and using it.  Once you get started you'll be gratified to see everyone working together to get your patients appointed and the treatment that you planned under way.   

The Rules Of Engagement

 It's been a while since I posted one, but Ed Horrell's newsletter seems to really reinforce the post I wrote yesterday about making patients feel welcome in the practice.  So, here it is:

Your customers want to be engaged.  They want to be addressed, recognized, and made to feel important.  This is the essence of world-class customer service.

Make sure that whatever you do in service, make sure your service is engaging.  When you or your employee comes near a customer, make sure you acknowledge that person.  Whether it is in a retail environment or simply walking down the hall, make sure your employees are taught to make eye contact and greet people when they encounter them.

This is "engagement"....and it is a secret to help you own your customer.

    That is what our front desk person, Janis excels at;  making our patients feel important. That's because she realizes that they are important to her and our practice.  There are times when I'm really  working hard on a report in my office,and I'm tempted to act like I don't see the person who Janis is checking out.  I know that the patient likes me and would love to come in my office to chat and hear all about how the plans for my daughter's wedding are coming.  On the other hand, my boss wants this report and I have had lots of interruptions.  Service wins out and I get up and greet the patient.  The few minutes of delay in completing my paperwork is outweighed by the benefit derived from the time spent making a patient feel special.  It also gives me a break and I can return to the routine of what I was doing with fresh energy.  Most of the time patients won't let you away with ignoring them anyway.  I've heard patients ask an employee who is lost in thought, "Aren't you going to say hello to me?"  Thankfully our staff truly is just "in the zone" about something and not actually ignoring our patients.  Once they tune back in they are effusive in their pleasure at seeing the patient. 
    It's the same with staff too, don't forget.  They need to be engaged, recognized and made to feel important.  This is one area in which giving a little returns a lot on the investment.  It's like putting gas in your car.  It's the fuel that takes you where you want to go.  Want to deliver great patient service?  Fuel up your staff and you'll get there. 

Who Opens The Show For You?

    I can't say it enough.  The person at your front desk is the opening act of your show. They set the stage for success.  That's why concert headliners have warm up acts, and Johnny Carson had Ed McMahon.  This is the person who sets the mood and she is the first impression that patients get of your office.
    I was trying to set up an appointment for a 23 year old patient of ours the other day.  She lives out of town now, but needed an intentional root canal for a central incisor.  I called an endodontist in the town she lives in.  I was responded to (I won't call it greeted) with coldness and disinterest.  There was absolutely no connection.  After about two minutes I decided that this office wouldn't do for our patient.  At another office the person who answered the phone when I called sounded more caring, but when the patient called to set up her appointment she got someone else who sounded more like the person from my previous experience.  The patient called our office crying from frustration and fear.  She said she would come back to town rather than have her work done in an office that sounded so unfriendly. 
    The point that I don't want you to miss is that neither of us ever had any idea of what the dentist was like.  We don't know if he does great work or if he's the kindest human being on the face of the earth.  We can only assume that it wouldn't have been a good experience because he's allowing an unfriendly, disinterested person to be the first contact that patients and other professionals have with him.  That's right, not just with his practice, but with him.  The front desk person feels like an extension of the dentist's attitudes and personality.  We all figure that he knows her, he must know how she treats people on the phone and he must be ok with it.  So I won't send my patient to him and if I tried to, she wouldn't go. 
    So, the front desk person has an enormous responsibility to the practice to be personable and caring.  The dentist has a responsibility to himself to choose wisely for this position and to monitor that person. 
    We have a new front desk person who is fantastic.  She's been with us for almost six months and she really is a welcoming gateway into our practice.  As manager I do the pre-clinical interview with our new patients and always thought that I was their first experience with our practice.  I realize now that Janis is the true opening act.  Her voice is incredibly welcoming and I think patients can't wait to get here to see the person behind the voice.  Nothing knocks her off balance and she has the presence of mind to use the hold button if things get too intense and she needs advice or just to regain balance.  When patients arrive, she stands to greet them and introduces herself.  The other day I heard her say, "We couldn't wait to meet you!"  She meant it.  I believed her and so did the patient. So, now the patient has that nice warm, fuzzy feeling. This is who you want for your opening act. You can't have her, she's ours, but now that you know who you need you can either find someone like her or develop your current front desk to be personable and warm.  Sometimes it's just a matter of becoming aware of what phrases and words work.  Just a few changes or additions can send a warm and fuzzy patient your way.

Her Stress Is Your Stress

 Receptionists, this one's for you.  One of the hardest jobs in the dental practice is the receptionist position.  Lot's of people don't realize it, but it is.  First of all, they are responsible for getting the schedule filled and keeping it that way.  Of course, they can't control the fact that patients cancel.  What are they supposed to do, threaten them?  "What do you mean you want to cancel?  I don't care if your temperatures 110, get your lazy rear out of that bed and get over here!  Don't you realize what your thoughtlessness will do to our schedule?  Do I have to send someone over there to explain it to you?"  Maybe that sounds like a fantasy, but you know you can't do it.  So you send that appointment to the garbage can and start scanning your call lists for possible replacements.  At this time of year, don't forget your college students who are home for the summer.  I try to keep them on a June and December recall.  Start looking at some of them for possibilities.  Look at your unscheduled treatment plan list as well.  Don't forget to document the contacts you make and their responses so you don't keep calling the same person.  If they've told you they want to wait, they'll get annoyed if you keep calling.
    The other really tough thing for receptionists is deciding which emergencies truly need to be seen that day and which patients can wait another day. Try getting together with the dentist and make up a decision tree.  Find out what he considers a same day emergency and make up some questions to ask patients to determine whether they need immediate attention or not.  New patients in our office are generally seen for a comprehensive exam before beginning treatment.  There are exceptions to every rule, however, and if they have a problem we will attend to that and then proceed with an appointment for the full exam.  Broken front teeth, pain and broken teeth that are sharp are all same day emergencies for us.  We set aside an hour in the morning and a half hour in the afternoon for emergencies.  They can be filled the same day with other things if no emergencies arise.

    One of the things I think receptionists have to deal with that must be exhausting is keeping everyone happy.  The patients want appointments when they want them.  The  clinical staff doesn't want a jammed schedule or one full of holes.  The dentist wants a productive schedule with a variety of procedures.  It's enough to make your head spin, but she must keep her composure and a pleasant demeanor.  There are so many other things she is responsible for that no one thinks much about.  Insurance, billing, asking for payments (never fun), answering the phone, greeting arriving patients, it never ends. 

    If you are a receptionist and you're reading this, congratulations.  You've got a tough job and if you're doing it right you keep the practice running well and productive.  If you are a dentist or team member, tell your receptionist how much you appreciate what they do.  Remember, their stress would be your stress if they weren't there.

WOW! Them At The Front Desk

    What is the difference between a competent front desk person and a fantastic front desk person?  The difference is the WOW!  The first W stands for Wonderful.  When patients arrive it is wonderful to see that person.  She stands to greet them in a relaxed, sincere manner.  She offers them a refreshment and smiles pleasantly and makes eye contact while talking.  She remembers things they told her last time they were in and brings it into the conversation.  She cares and they feel it.  No request is an imposition.  Truly, it isn't.  She's not just saying that, she means it.  She really gets a kick out of getting the patient what they need.  She realizes that without the patients, she wouldn't have a reason to come to work. 
    O represents her great Organizational skills.  She knows when that insurance form was sent, where she needs to fill in the schedule, who can come in on short notice and who to call to fix the leaky faucet.  She matrix's the schedule so that production is high and there are a variety of procedures each day. She understands that the way she organizes the schedule impacts the team and the patients and she plans each day wisely and carefully.   She listens to instructions and learns quickly because she pays attention. 
    Finally, there's that Work ethic.  She's not above helping out with sterilization, cleaning rooms, seating patients...anything that will improve service to the patients and to her coworkers.  She understands that there will be times she'll work a little late and takes it in stride.  She looks for ways to make everything go from good to great.  She is the face of the practice and she takes the responsibility seriously. 
    When you think of how much satisfaction there is in doing a great job, you'll want some WOW! for yourself.  If you're a boss or a manager that's already got someone like this, go to work tomorrow and say "WOW!, I'm glad you're here.

How To Be A Greased Pig

    In the South we have a day called Farm/City day.  There are all kinds of fun events, but the funniest one is the greased pig catching contest.  A bunch of good ole boys and gals chase a greased pig but it's just about impossible to get a grip on it.  The pig usually wins.
    Every dental practice needs at least one greased pig.  Not the kind the Board of Health will object to...one that mans the front desk.  We need someone up there that everything slides right off of.  Everybody in the practice has a story to tell about how a patient was rude or mean but, the front desk person deals with every single person that calls or comes in.  So the opportunities for insults or crankiness tip the scale against her.  She has to be a slippery little one.  She can't let anything stick and she can't take it personally.  Because...it really isn't personal.  She has to be able to deal with whatever is said to her, shake it off and move on, leaving it behind her.  There are two reasons that this is important: 1- the next patient needs her to be her best and 2 - she needs to be happy in her job.  It's that simple. 
    Letting patient's moods or comments get under your skin is an exercise in futility.  They get over it or don't even register it at all within moments.  If you sit and stew too long you'll be a soggy mess.  If you share the experience with the rest of the staff you leave behind your purpose of serving each patient the best you can.  All you can do is call upon your own integrity and inner brilliance.  You know that in the long run, this really doesn't matter.  See it for the momentary irritation it is and brush it off.  Better yet, be a greased pig and never let it get stuck to you to begin with.  Remember, the greased pig usually wins.

She Rocks!

   

    I have to brag about our front desk superstar today.  She's great!  She has lots of wonderful traits and what she doesn't have yet, she's working on getting.  When she started a year ago, she couldn't work the computer mouse.  Now, she's a whiz.  How'd she do it?  Heart.  Perseverance.  Dedication.  Commitment.  Desire.  Integrity.
    Cindy didn't know anything about dentistry when she came to us. Now she works the front desk by herself and keeps a sunny disposition and all the balls in the air.  She keeps the reception area in order, the bathroom picked up regularly and offers the patients refreshments and pleasant conversation.  She stays relaxed even though she may have a patient checking in, another checking out and the phone ringing.  Ask her for something and she'll get it to you in no time.
    She's everybody's go to person.  Need a shoulder to cry on, a listening ear, help with a patient?  She's your woman.  Today we had an elderly patient who didn't have transportation to the office.  I picked her up, but then I couldn't get away to bring her home.  Cindy to the rescue.  She not only brought her home, she brought her to the drug store on the way home.  All done with a smile and not a second thought. 
    She's someone I can count on.  All the time, every time.  She's consistently kind, sweet and caring.  If you asked her, she'd say she's nobody special.  That's another one of her good traits.  She's humble.  She's a rare find and we're happy that she's ours.  Happy Anniversary a little early Cindy.  Rock on superstar!

Phone Tag

    The phone is the lifeline to your office.  It's the thing that sets everything in motion.  It tells your patients what you think of them.  If I call your office and I am immediately put on hold, you're telling me that you're too busy for me.  If I hear a smiling voice thanking me for calling, I'm being told you want me there and will treat me well.  It's that simple.  Some of what happens depends on the person handling the phone, some of it depends on what's happening to her.  Is she over-loaded and stressed?  Things at the front desk tend to happen in spurts.  If everyone is scheduled on the same time slots, everyone is probably dismissing patients at the same time.  Try staggering starting times by 10 minutes in hygiene.  Then one hygienist isn't standing waiting while the doctor checks the other's patient.  Establish better flow. 
    Does she need help?  One person at the front desk can have many things happening at once, often too many things.  I like the idea of a floating office assistant that can help out wherever she is needed.  This person can be invaluable.  It is very important for the person at the front not to sound or look frazzled.  She is handling payments, making appointments, answering the phone and at times refereeing children in the reception area.  It's hard to remain calm under all that pressure.  The floating assistant can help. 
    When answering the phone have a check sheet available and pay attention to what the patient is telling you.  Ask questions that pertain to the problem they are having and make notes on the schedule.  It is frustrating for patients to have to repeat the same information to numerous staff members.  It looks much more professional and organized to have the information passed on to the rest of the staff before the patient arrives.  The staff can than ask questions based on the information they already have.  This makes the patient feel that their problem has a high priority. 
    It is important to be able to answer questions knowingly and if you don't know the answer, admit it and go ask someone who does have the answer.  Never lose patience.  You don't get that luxury.  Pride yourself on your self-discipline.  Giving in to a moment of frustration will never be worth the position you will be in because of it.  Always call patients back before leaving for the day.  It is frustrating for patients to expect a phone call and not get one.  It sends the message that they are not important to you.
    Be happy to accommodate patients as much as you can without inconveniencing other patients.  Never make it seem like a chore but like something you are happy to do for them.  Be their ally and they will work with you when you need them to.  You are the gateway to the practice and the phone is the tool of your trade.  Make every contact successful and you will excel.