I recently completed an assessment of a really good practice. This practice is ideally located, effectively managed, and consistently performs very well! By performing well, I mean its schedule utilization is consistently above 90%, very strong monthly production, collection performance is >95%, expenses are under control (practice overhead <53%), and the staff is well trained & very committed to the practice. I found myself wondering … How can this practice get any better? Why would the doctor pay a consultant to assess a practice that functions this well? I really admire doctors who recognize the importance of continuous improvement — not being satisfied with “really good” performance and striving for excellence! I told the staff that I thought they were fortunate to work for a doctor who really cared about the overall “health” of the practice — this concern helps protect the doctor’s investment and helps ensure viable long-term employment for the staff. While observing the practice in action during my assessment, it struck me just how hard the staff was working & how effectively they worked together to get the job done! It made me wonder …
What would happen if someone didn’t show up for work one day?
How vulnerable would the practice be if a staff member couldn’t show up for work? We don’t often think about the consequences if a staff member were to become sick or there was an accident that prevented them from coming to work for an extended period of time. Most practices can “get by” if a staff member is away for a day or two, but what if a staff member was not available for weeks or months?
In my assessment report, I recommended the doctor make provisions for such an occurrence because of the impact this would have on the practice. I recommended they establish written roles & responsibilities for each function within the practice (hygiene, assistants, front desk), and prepare reference material that provided essential information about how the practice operates. Such a resource will not only serve as a “life line” in the event that someone is unable to report for work, it also serves as a valuable tool for training a new employee.
The week following my meeting with the doctor to review my assessment recommendations, a member of the front desk staff became very ill and missed several days of work. The doctor discovered first hand just how vulnerable his practice was!
The ability to anticipate problems and take actions to minimize their impact is often what separates good practices from great practices. How prepared is your practice?
Managing “Lates” – More Art Than Science!
Have you ever arrived for an appointment a few minutes early, only to be forced to sit in a crowded waiting room, well beyond the scheduled appointment time? To make matters worse, while waiting for your appointment, have you ever seen someone else arrive late for their appointment … yet be taken before you! If this has happened to you, I’m sure you remember how it made you feel. If this hasn’t happened to you, I’m sure you can imagine how you would feel! Handling the late arriving patient is a critical aspect of every practice. On-time appointments are a key driver of patient satisfaction, and patient satisfaction is the life-blood of a successful practice. You know how this works — the late arriving patient has a “sob story” about why they were late and the staff, feeling sorry for them, “shoe-horns” them into the schedule causing a “ripple-effect” lasting the rest of the day! (or significantly shortens your lunch)
How does the practice handle lates? Every practice needs to be fully prepared for handling the inevitable late-arriving patient. The reception staff should be trained on how to respond, and responses should even be scripted and practiced to ensure proper delivery. The practice’s response to the late arriving patient depends on a lot of factors — How legitimate is the excuse? (snow storm) Does the patient have a history of arriving late for appointments? How full is the schedule on that day (can the disruption to other patients be minimized)?
As a minimum, the late arriving patient should never be seen immediately upon arrival. This type of “rewarded” behavior is guaranteed to be repeated in the future. If the late-arriving patient has a history of showing up late and/or by seeing this patient, it will negatively impact other patients, the appointment should be rescheduled for another time. If, on the other hand, the late-arriving patient has a good history with the practice and can reasonably be accommodated that day, then that is what you do. In either case, it is imperative, that the patient be told why a course of action is being taken. The rescheduled patient needs to be told that their appointment time was reserved specifically for them and by “squeezing them in”, it would have a negative affect on other patients, the doctor, the staff, and the quality of care being delivered. The accommodated patient needs to be told that they will be seen, however, there will be somewhat of a delay in order to not have a negative affect on other patients, the doctor, the staff, and the quality of care being delivered. As you can see, managing the late-arriving patient is more “art” than “science” — it is never “black and white”. The staff must consider the circumstances, then make the best decision for the entire practice.
Getting Great Patient Referrals
Today’s post comes from Rick Spence from PROFITguide.com (modified slightly to be more relevant to dental practices).
Do you know how to get great referrals from satisfied patients?
Here’s a clue; they rarely come unbidden. Smart dental professionals manage their practice so they are always asking for referrals, and making it easy for patients to refer others to them.
Business writer Daniel Kehrer of Business.com, in a recent article on sales-training site Rain Today, points out that professionals such as doctors, dentists and real estate agents are masters of referral marketing. But most other entrepreneurs are not, he writes, “because it’s harder than it looks.”
Kehrer offers seven keys to getting more and better referrals. Here’s Mr. Spence’s take on his top four points:
Implement a referral-generation plan. You must create a system for soliciting referrals. You need to make sure that you and your staff consistently ask for referrals in a systematic way.
Provide some ammunition. Give your patients the tools they need to provide effective referrals. Supply them with brochures or cards, to give to other prospective patients, to give prospects a starting point to learn more about you. Or create a special page on your website for referral-driven prospects. It could provide upgraded resources for new customers, or offer discounts or service packages that will help prospects make speedier decisions about becoming a patient.
Get the right information. When asking patients for referrals, make sure you obtain the details you need. Use a form, checklist, or database program that helps you capture additional information, such as the prospect’s company, job title, industry, or responsibilities. “A simple name and number isn’t really a referral,” says Kehrer. “It’s just a lead.”
Target your most influential patients. Is your resources are limited, seek referrals mainly from the clients whom you believe will be most influential in your target market. Leveraging your resources, so as not to spread yourself too thin, is a key success tactic for any entrepreneur.
Practice Held Hostage
Is your practice being held hostage by a staff member? Do you have a staff member who is such an integral part of the practice (and they know it) that they call the shots & hold you hostage in making demands? Demands for time off, demands for better pay, demands for special privileges, etc If so, you’re not alone. Many practices are held hostage and doctors end up “paying the ransom” rather than confront the staff member and correct the behavior.
A big part of effectively managing your practice, is to establish the ground rules by which the practice operates, make the rules crystal clear to all staff members (especially new staff members), and hold the staff accountable for adhering to the rules. Stop paying the ransom! Paying the ransom rewards the behavior, and rewarded behavior will be repeated … guaranteed! (just ask any parent of small children!)
One simple tool practices can employ to help avoid the “hostage taking” is a Staff Policy Manual that clearly specifies practice policies to all employees, and provides an answer to many staff requests before they’re even asked. Staff members probably won’t ask the questions if they already know the answers.
The policy manual specifies how the practice will operate in terms of such topics as: working hours, pay periods, recording time worked, overtime, performance & wage reviews, loyalty incentives, breaks, tardiness / attendance, dress codes, time off (vacation, leaves of absence, maternity leaves, bereavement leaves, funeral leaves), holidays, cell phone useage, personal phone calls, using office equipment, office emergencies, and staff meetings. A well written policy manual can neutralize the “hostage” situation because your response to such requests is dictated by the office policy in effect.
In the absence of a policy manual, the practice’s expectations of the staff must be clearly communicated and the staff must be held accountable for performing in such a manner. Don’t try to avoid confrontation with difficult staff members by sending them “signals” of your displeasure and hoping they will get the message. This rarely works. Doctors must talk to these staff members about their performance and clarify what is expected of them. Staff members must be given every opportunity to perform as expected, and if they are unwilling or unable to do so, action must be taken to improve the level of performance (ie/additional training).
Remember, continuously giving in to the hostage taker’s demands, will not make the problem go away … it will likely guarantee a repeat performance sometime in the future. Performance that is rewarded, will continue!
A Sign of the Times
Yesterday while stopped at a traffic light near my dentist’s office, I began looking for the sign for his practice. His practice is located along one of the busiest roads in town in a shopping plaza set back from the road. Since his practice is not visible from the road, the sign out front is the only mechanism for alerting passing motorists to his existence there. Knowing this, I continued to strain my eyes looking for his sign among the couple dozen other signs in this particular plaza. Finally! I spotted it! Buried amongst the congestion of the other plaza signs. I couldn’t actually read the sign (yes, my eye sight is starting to go!), but I knew it was his because I’ve been going there for years. I thought, what a waste of money putting a tiny sign in this location — nobody can safely read it while driving past this location, and the sign is virtually invisible to motorists waiting at the nearby traffic lights!
Over the years, I have helped many practices with their marketing efforts. One of the fundamental marketing principles is creating an awareness of your practice to the community at large — to the people passing the practice on the way to work, to the people out walking the dog in the evening, etc. Do the people who live in your community even know you exist? I’ve spoken to people who have lived for years in a community and were totally unaware of a dental practice’s existence! What a shame!
I believe its important for practices to consider their location and take full advantage of the traffic volume passing the practice every day. Make people take notice of your practice. Give people a reason to remember you. One of my clients, whose practice is situated on a busy road, utilizes a portable sign out front and changes the message every month to make people take notice. Another client of mine is installing a digital sign to make people take notice of his practice and to convey catchy messages to the thousands of potential patients who pass the office every day. I think these are good examples of smart practices using their location as an advantage to create awareness and enhancing their marketing efforts.
What are you doing to make people notice your practice? Are you taking advantage of a high traffic location?
Keeping Your Finger on the Pulse
While visiting an automotive assembly plant a few years ago, I was intrigued with how such a large facility with hundreds of employees assembling thousands of parts could be managed effectively. I wondered … How does the management team keep tabs on the plant’s performance? How do they know when improvement action is needed within the plant? How do they know when to leave things alone? Part of the answer came when I observed their daily morning ritual of meeting together for 20-30 minutes reviewing ‘key performance metrics’. The ‘key performance metrics’ were critical pieces of information, graphically displayed, showing exactly how the plant is performing. The graphs showed performance of such things as: Safety, Quality, Delivery, Cost, and Employee Morale. A simple glance at the graphs showed even the casual observer exactly what was happening within the plant. After their quick morning meeting, the managers went their separate ways doing the work that needed to be done.
I think many dentists could benefit from this approach to practice management. Begin tracking practice performance by graphically displaying key performance metrics in the office. Such performance graphs would be compiled and updated by the staff and displayed in a location visible to the staff but not visible to patients. These simple graphs, along with a corresponding red / yellow / green status indicator would give the doctor a complete picture of how the practice is performing. With a periodic glance at the graphs (less than 2 minutes), the doctor could ascertain whether everything is operating as expected or whether something was wrong and needed his/her attention.
In the dental practice, these performance metrics might include:
- Daily / weekly production (How much billable work has been completed?)
- Daily / weekly collections (How much should we be collecting?)
- Number of new patients (How many new patients are we attracting?)
- New patient referral sources (Where are the new patients coming from?)
- Accounts receivable (How well are we collecting the money owed the practice?)
- Practice expenses (How much money is the practice spending?)
- Patient feedback (What are patients saying about the practice — good & bad?)
Taking the time to gather and analyze practice performance information is not a priority for most doctors. However, being proactive and taking steps to make this information readily available on a regular basis (weekly, monthly, quarterly) enables the doctor to keep his/her “finger on the pulse” and know instantly whether everything is operating as expected or if something requires immediate attention. Like the managers of the automotive assembly plant, having this information “at your fingertips” is vital to the success of the practice.
Welcome to CI Perspective
Welcome to “CI Perspective”, our new blog dedicated to the continuous improvement (CI) of dental health care practices. In the coming weeks, we will be using this blog to share insights and observations on relevant topics impacting practices in today’s business environment. We hope that you will subscribe to this blog, check out our posts, and participate in the discussion!
