Dental News - Mistakes were made: When to let them go or when to clean them up

Sally McKenzie, USA

Tue. 3 July 2012

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If you read my articles regularly, you might have noticed that I dedicate a fair amount of space to telling you how you should be addressing shortfalls in your practice systems. In this column, I’m taking a little different approach. I want you to plan a party. Now, this isn’t just any party. This is a “screw-up party.”

I have to give author Bill Bartman credit for the term, and I really like the concept.

The idea is that you embrace the mistakes, you acknowledge the weaknesses, and you celebrate the fact that you have “screwed up.” I can virtually guarantee that you and everyone on your team have made at least one major mistake in the past six to 12 months.

Mr. Bartman refers to an employee who made a $10 million contract error. The company managed to whittle it down to $1 million, which most of us would still consider a huge blunder. But the point Bartman makes is that if he were to have crushed the employee, who is otherwise very good, he would have shut down the flow of creative problem solving and new ideas, not just from that employee but from others as well.

The “chilling effect” as we know it happens when speech or conduct is suppressed because of fear of penalization.

Frequently we find employees are too paralyzed to take action. They are afraid of making mistakes. They are afraid of being reprimanded. They are afraid of disappointing or angering the dentist. They have to secure approval on everything from the way they answer the phones to the way they punctuate a sentence. Consequently, the practice is virtually immobilized because no one has permission to think, to improve systems or, as the case may be, occasionally screw up.

Celebrate the blunders

Dentists, being notorious perfectionists (a quality that patients dearly appreciate), are keenly focused on doing everything right. Understandably, you are mortified when you or members of your team make mistakes, even though you fully understand that to err is human. Like everyone else, some days you and your team are simply more “human” than others.

Yet, it’s through mistakes that you and your practice have grown, and perhaps once a year, throwing a party to celebrate the blunders rather than stuffing them in the closet, hoping they go away and never embarrass you again is something to consider.

It’s easy to celebrate how great you and your team are and the successes. But what about the tough challenges, the hurdles and the many things that went wrong that you and your team had to face?

The fact is that, while the experiences were likely not enjoyable, yours is a better team today because of them. Giving yourself and your employees permission to be human and make mistakes, at least occasionally, may actually help to avoid bigger blunders in the future.

Case in point, I recently had a conversation with a dentist whose collections coordinator accidentally charged a patient $1,120 for a $120 procedure. The patient called the office furious. The matter would have been resolved at the end of the day, but at the time the patient was checking out, things were chaotic at the front desk.

The dentist, unfortunately, got an ear full from the patient. During these stressful economic times, it’s easy to get upset and fly off the handle with employees when things go wrong. After taking it from the patient, he promptly ripped into the employee, which he later deeply regretted.

In this case, both the dentist and the employee made significant errors; one was an accidental mistake, and the other was poor judgment. Nonetheless, it was an opportunity for both to grow personally and professionally from the experience.

Fortunately, in the scenario above, the dentist did offer a sincere apology to the employee. They also looked at the patient check-in/check-out system to determine how bottlenecks could be addressed and pressure eased during hectic times.

None of us enjoys making mistakes. Nonetheless, they are a fact of life and work. A “screw-up” party gives everyone a chance to acknowledge blunders, talk about them openly, offer creative solutions to help prevent them in the future and, most importantly, move on.

Don't make this mistake

Now let’s consider a more serious problem in your practice that, unfortunately, doesn’t happen just once in a while. In fact, it may be occurring daily, and it would be a grave mistake not to address it. What is it? Thousands of lost patients. Let me explain.

Living in a fantasy

I recently had a conversation with Dr. John. Like many dentists during the last couple of years, he’s experienced some challenging times. But one thing that Dr. John firmly believes is that his practice is not losing patients. He is living in a fantasy. But Dr. John, a sole practitioner, is not alone in his delusions; he is like 78 percent of the 128,000 general dentists in the United States.

The vast majority of solo-practitioner practices are losing more patients than they are bringing in, and many of them scoff at such a notion. Holes in the schedule? “It’s the weather.” Lower production? “It’s the economy.” Fewer hygiene days needed? “It’s the hygienist.” And the excuses go on; seldom will these dentists acknowledge that they are losing patients.

We work with these” Dr. Johns” and “Dr. Janes” every day. Typically, they have been in practice for 15 to 30 years yet can’t quite explain why they are still solo practitioners. Some have had 2,000 to 3,000 people come through their offices and never return. The harsh reality is that such practices are losing more patients than they are gaining.

Dentists commonly believe that patient records in the computer or in the files constitute active patients. In actuality, only those patients that have been in the practice for a hygiene recall appointment in the past 12 months can be counted as active patients. The recall system, or lack thereof, is a huge factor in patient attrition.

Yes, patient retention will vary from practice to practice, but it’s essential that you understand where yours falls. To measure patient retention, determine the number of recall patients that are “due” for the month, with and without appointments on the first of the month. Put that number in a secure place. On the last day of the month, run a production/provider report for hygiene and add the number of periodic exams and periodontal maintenance procedures performed for the month. This total equals the number of recall patients “treated.” Divide the number of patients “treated” by the number of patients that were “due” and that percentage gives you your patient retention for the month.

Next, take a good hard look at recall. It is the most important system in the practice for ensuring patient retention; it’s also the most ignored system in the practice.

How do you know if your recall system is weak? Look at the number of hygiene days. If they haven’t increased in the past 12 months, the practice is losing patients. In addition, the schedule has open timeslots; however, the schedule looks full because the practice schedules patients six months out. Moreover, no one on the business team is responsible for ensuring that the hygiene schedule isn’t riddled with holes or following-up with past-due patients.

Effective recall system critical

It is essential that if you pre-schedule patients six months in advance you educate the patients, and the business staff must follow-up with patients on the phone. Too often it’s the follow-up that falls down.

In addition, when the patient is in the chair, communication between dentist and hygienist and with the patient must reinforce the need for ongoing care. Most patients don’t think they need to go to the dentist every six months, and many dental teams are not particularly effective in convincing patients otherwise. It’s not uncommon for the dental team to trivialize the importance of care delivered and confirm the patient’s misperceptions.

An effective recall system includes other key components as well: The practice is actively educating the patients. Professional recall notices are used as well as e-mail and text messaging. The patient is involved in the recall process by personally addressing the envelope that they will receive in the mail with their recall information and informational brochures.

A business employee follows up with patients to ensure they will keep their recall appointments. In addition, the hygienist is scheduled to meet specific production goals and there are never more than a firmly set number of openings in the schedule on any given day.

Certainly, every dental team makes mistakes; however, there are some that are costing your practice far more than others.

Note: This article appeared in Dental Tribune U.S. Edition, Vol. 7 No. 3, March 2012.

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