Coach Barrow

Dear coach

I’m thinking about our patient cancellations at the moment – the cost financially and emotionally on the practice – and also the cost when we try to explain to patients our policy and they get irritated and complain. Nobody likes this aspect of our work very much – it seems a perennial problem. Do you have any examples of systems that work?

Dear dentist

This whole area is a classic example of some fundamental rules of business, so as well as offering some solutions, I hope you won’t mind me pontificating a bit on management as well.

Rule 1 – Blame a system not a person

I don’t believe that many patients set out over their cornflakes in the morning with the intention of defrauding a dental practice by not arriving for an appointment.

Neither do I believe that your staff are undercover agents for your competition, bent on damaging customer relationships.

However, both groups will “do their best in the absence of a system” – and sometimes that means they will do what suits them, rather than you. I don’t blame them for this.

So when things do go badly wrong, it’s appropriate to take a leaf out of the book of Dr Paddi Lund and look at the system (or lack of it) that created the situation. It will never be a good time for the trial, conviction and execution of a patient or team member!

Rule 2 – Create systems and communicate them

Whatever your systems for cancellations are (and we will look at that in a minute) – make sure that the patients are all aware of them by publishing them:

1. in your Welcome Pack for new patients;
2. in your patient newsletter
3. in the recall letter.

Then make sure that ALL of your team members are aware of them by publishing them in your procedures manual.

Rule 3 – Make the language of rules do part of the work

If I join a dental practice and they tell me that there is a “cancellation policy”, the first thing I think is “they have cancellations!” You have educated me to believe that cancellations are expected, are a natural occurrence. So I’ll probably have to come up with a few to be a normal patient?

However, if I join a dental practice and they tell me that there is an “emergency cancellation policy” – I have been educated to believe that cancellations usually take place in the event of emergencies – not just because I’m busy or not bothered on the day.

One little word can make a big difference.

If you tell me that your emergency cancellation policy is to make a charge – it sounds a little inflexible and harsh. So my son falls off a ladder and it costs me?

If you tell me that “in the event of a genuine emergency cancellation there will be no charge, however, in the event of other cancellations, we will endeavour to fill the time allocated to you with another patient, however, we reserve the right to make a charge for the time lost” – I am hearing that you will listen to the circumstances and do the fair thing.

If I cancel three times and each time Johnny has fell off a ladder, it’s going to sound a bit unrealistic, so as a patient, I am being educated to behave reasonably.

Now - about the 24 hour notice thing. I always struggle with this:

1. you cannot give 24 hours notice of a genuine emergency;
2. imagine the conversation – “so when did Johnny fall off the ladder?” “Oh – about 4.00 pm yesterday.” “Oh – I’m sorry, that was 23 hours ago – if he had fallen off at 2.00pm you would be OK.” Sound a bit daft?

So why not just do away with the “time thing” and just revert to emergencies and non-emergencies plus a big dose of common sense, correct language and discretion?

Rule 4 – Build the “buggeration” factor into your prices

You can measure the rate of failed appointments (many dental practices report 5-10%) and make an adjustment to your hourly rate to compensate for this. Technically you could then waive cancellation fees for emergencies as discussed and still feel no loss. You would have to make sure that patients did not take advantage of this by having great systems for non-emergencies.

Rule 5 – Have a realistic, modern and effective recall system

Realistic means that a reasonably well-organised patient could be expected to “play the game”. Here, the system may depend upon the average profile of your patients. When I go to see my dentist or hygienist, we book the next routine appointment there and then. I have my trusty PocketPC ready and they have their practice management software. I see no reason why, in this age, you cannot expect patients to book 3 or 6 months in advance:

1. using a diary/personal planner;
2. using a PDA;
3. using your practice management software;
4. issuing a reminder, maybe 2 weeks beforehand, by text message to their mobile phone, by email, by post or by telephone call (in that order of preference).

Rule 6 – expect to be paid

Have you considered taking a credit card booking for appointments? Many restaurants ask for credit card information, hotels ask over the phone and offer cancellation before 4.00pm on the day of arrival – then charge your card if you do not turn up. Why not the dentist?

Rule 7 – expect to be appreciated for having a firm policy

My dentist clients tell me that their best patients (the A’s) never quibble about a firmly communicated and applied policy. It’s the C’s and D’s who cause the fuss – and I have spoken to some dentists who apply a financial penalty to encourage them to leave the practice!

Rule 8 – Have a word-perfect and compassionate team

Take the time out to explain, discuss, agree and role-play your cancellation policy and the conversations that are most likely to happen. If your team are confident in what they are saying – and they know that the principal will back them up if the case is referred up the line of command – then this will “show” and inspire confidence. Simultaneously, expect your team to listen well and show discretion in circumstances of genuine hardship. Firm, confident and compassionate – qualities of leadership and excellent customer service.

I suppose, in conclusion, what I’m saying is that the solution to your problem is 20% about having clearly stated rules (no matter what those rules are) and 80% about working with great team members and great patients who appreciate fairness in business. If they don’t – why have them around?