Written by Gary Kadi and Michael Massotto Wednesday, 30 April 2003 19:00
Is your hygiene recall system a waste of time? It is unless your current system is at least 80% effective in having patients return to your office at least twice annually to maintain their dental health. If you are not getting this level of compliance, it is probably time for a change.
However, before we share with you our suggestions and recommendations to assist you in developing and implementing a powerful system that ensures patient compliance and acceptance with a virtual 100% rate of pre-appointment, we need to address some basics. In our 7 years of coaching and consulting dentists, we are consistently amazed that such a vital aspect of successful practice and patient care is so frequently viewed as frustrating by the staff, not valued by the doctor, and poorly complied with by the patients. What we often discover is that there are several key misunderstandings on the subject of hygiene recall. Once these are handled, however, the willingness to give hygiene recall its rightful importance as a foundational must for quality patient care and practice growth can be achieved.
To begin with, the word recall is a misnomer. Recall implies loss. It actually means to summon back, cause to return, or cause to exist again. In essence, it means "we blew it, he's gone, and now we somehow have to convince him to come back." At best, this is a scathing indictment of bad service and poor patient education. We prefer using the term recare, which implies successful results. In other words, "we did it right, he's happy, and he'll be back on his own because we have good control and he truly understands the value of maintaining the health of his teeth and gums." We have found that using the term recare helps increase the value of hygiene in the mind of the staff and the doctor, and consequently the patient. Calling essential maintenance care recall lessens its value and relative importance, especially to the patient, and promotes the "it's just a cleaning" mentality.
The second key area of misunderstanding regarding hygiene recare is actually marketing, or specifically, how you choose to position yourself in the market based upon your practice philosophy. We often lecture on a triangle that has quality, service, and price as its 3 points. You must decide which 2 of these points (more on this in a moment) you are going to choose to develop in your practice and have at the forefront of your marketing and promotion. Your choice will also dictate how you will handle your recare system. Why not offer all 3? You can if you want to go broke. Let us digress to explain and then bring it full circle.
SOME CORPORATE ANALOGIES
It is a common theme in dentistry, and in most other businesses for that matter, to try to be all things to all people in order to capture as much of the market as possible—in this case, new patients. It is agreed that what patients want is high quality and great service at low prices. However, there is no way to offer this combination without driving your overhead through the roof and sending your profitability out the window. So trying to be all 3 will not work, but which 2 should you choose? The following are examples of 3 different, successful corporate models. Each is tremendously profitable, yet each has chosen to niche itself differently to market and sell its products.
As one example, there is McDonald's. McDonald's offers quick, efficient service (your food in 7 minutes or less) at low prices (ie, "the Dollar Meal"). However, the quality is not exactly filet mignon, to say the least, nor could it be. No one is going to pay 6 bucks for a McDonald's hamburger. That is fine with McDonald's because it has mastered the other 2 points of the triangle (service and price), and that is what attracts its customers.
Next, there is the example of B.J.'s Wholesale Club, or its equivalents Costco and Sam's Club. The mass appeal of these companies is name-brand quality products in bulk quantities at low prices. They sacrifice the service point of the triangle in exchange for owning the other 2 categories of quality and price. Customers who shop at B.J.'s, Costco, or Sam's do not expect a glitzy department store environment with helpful sales people and fast service. The niche these stores own is quality and price, so they can get away with a warehouse environment with very little customer support staff, long lines, and self-serve cardboard boxes for shopping bags.
Finally, there is the quality and service model of excellence that is the Ritz Carlton Hotel. Customers are treated like royalty in a pristine environment of luxury and superior service that is the industry standard. No one who stays at the Ritz Carlton, however, expects a $79-a-night AAA discount and a free continental buffet-style breakfast. It is simply a given, based on its niche of quality and service, that the prices must be high. The Ritz Carlton has mastered these 2 points of the triangle so well that there is never any question as to what it charges for its services.
So, how does this relate to your practice and hygiene recare system, given the Q/S/P triangle? You must decide to gear your practice development strategy and philosophy toward 2 points of the triangle and own them in the minds of your existing patients and potential new patients. Will you be the McDonald's, Costco, or Ritz Carlton of dental practices? In other words, do you want to be a clinic, family, or high-end cosmetic and restorative practice? All 3 can work, and we have seen each type done to perfection, but whatever model you choose will dictate how you will pursue hygiene recare.
The majority of our clients aspire to the Ritz Carlton model and hire us to assist in creating this experience for their patients and staff. Therefore, the hygiene recare system we institute focuses on serving patient needs and wants beyond expectation by taking the time up front to do thorough education on dental health and the policies of the practice. The "Ritz Carlton" practice places value on hygiene recare because it recognizes hygiene as not only an essential component of providing the highest quality dentistry, but also as a critical marketing and sales element of practice development. This leads us to a third key area of misunderstanding regarding hygiene recare, which relates to the 3 basic ways to grow and expand a practice.
GROWING THE PRACTICE
Quite simply, there are only 3 ways to build a practice, and 2 of them are intimately connected to hygiene. The first way is building a practice through acquisition of new patients, which most doctors are fixated on as primary. As a result, they invest the majority of their resources in developing this area. However, marketing for new patients, though important, is the most costly and difficult way to build a practice because it seeks to attract and enroll patients into your office who are "cold"—there is no relationship or trust built through an ad or marketing piece. A great deal of money must be spent, particularly if you are looking to attract a specific type of patient to your practice, in order to bring in a sufficient number of new patients to sustain steady growth and profitability.
The other 2 methods deal directly with hygiene and are dependent upon having strong systems and a well-trained staff in place to support their success. Both utilize the strong trust and personal relationships the hygienists and doctors have created with the existing patients in the practice over the years. Through this rapport and understanding of the importance of regular hygiene visits, the need or desire to pursue various recommendations for treatment can be generated.
However, rapport and trust alone are not enough to have patients stay committed to care or reach for additional treatment (cosmetic or otherwise). It takes a practice dedicated to making patient education primary and requires a paradigm shift on the part of the doctors, from external marketing to internal marketing, and sales that are centered around a strong hygiene department. Doctors always complain to us about the salaries they pay their hygienists. To them it is an expense. To us it is an investment—a very wise and lucrative one if you have the right person with the right training and the right bonus program in place.
Many of the hygienists we work with generate restorative and cosmetic recommendations upward of $50,000 or more in monthly production outside of hygiene. Do the math. If the average hygienists make, for example, $35 an hour on the high side, and with a good bonus program they can make a total of about $40 an hour, figuring a 35-hour work week, they would pull in $1,400. Multiply $1,400 times 50 weeks of production for the year, which is also on the high side, and they would be making $70,000 a year in salary, which of course, most doctors would view as extremely high. But as a low-side estimate, if they are averaging $40,000 per month in doctor production, that is nearly a half-million dollars a year they have contributed to the gross of the practice, and this does not even include their hygiene production! Do you think their salary plus bonus, which amounts to only about 15% of that half million they are bringing in, is worth it? If so, it is best that your hygienists are free to do what they do best. This should include educating patients on proper dental healthcare with extensive use of the intraoral cameras, indicating need for treatment, and discussing recommendations on various treatment options based upon the patient's dental health and aesthetic goals.
If you did not notice, we neglected to include making patient phone calls to track down the MIAs and the inactives. This brings us to a fourth key point of misunderstanding on the subject of hygiene recare.
THE HYGIENE RECARE COORDINATOR
One of the most unfortunate situations we encounter in practices is the lack of a hygiene recare coordinator. This is a part-time position for a person with good phone skills, an outgoing personality, and no fear of confronting people. This person's sole responsibility is to make calls utilizing a chart-audited list of inactive patients who have not been to the practice for care in more than 6 months, but less than 24 months. The objective is to keep the hygiene schedule full, while at the same time providing a valuable quality assurance service for the practice. Additionally, this job encompasses making 2-week reminder calls and sending reminder postcards. With training and the right script, hygiene will maintain a full schedule. Good public relations is also generated by ensuring that patients are cared for properly by having them keep to a regular maintenance schedule and that the quality of the service being delivered is ensured through the survey and discovery of the reasons why patients dropped out or did not commit to care, so these can be handled and prevented in the future.
Regrettably, however, the duties of a recare coordinator are usually expected of hygienists, to be performed in their down-time, since the need for a position in the office dedicated exclusively to recare is not known or understood. It is illogical to assume or demand that your hygienists be responsible for what a recare coordinator should be handling. Hygienists are not natural telemarketers, nor should they be. It is not their skill set, and requiring them to be on the phone, from our experience, creates more upset and lost production than it saves in the long run. True, you may have hygienists with a stellar phone presence and phenomenal social skills, but it is simply not cost-effective or fair to have them handle the administrative side of recare. Furthermore, hygienists of this caliber are maybe one in a thousand, so they are better off being coached and trained to generate more dentistry while chairside.
The final key point of misunderstanding on hygiene recare is that it should be a pre-appointment system with a 100% compliance rate as a goal. It is also a crucial control system to manage patient care effectiveness and ensure a long-term relationship as your patients' dentist of choice. Since only 50% of the population has a dedicated dentist, it definitely is in your best interest to have a recare system that is understood, valued, and accepted as essential by your patients, or they too will soon end up being a statistic.
Therefore, patient education and tracking are the keys here. You need to have strict policies concerning scheduling, missed or broken appointments, and hygiene recare visits of which all patients must be aware and agree to (with a logical reason provided as to why these policies are in place). Many of our clients have a lifetime guarantee on their dental care tied to recare compliance, and all utilize a tracking system with a 1-month card, with 2-week and 48-hour reminder calls on hygiene appointments. A daily missed appointment log is also kept to prevent patients from falling through the cracks, and the log is reviewed daily for follow-up. In essence, a patient should either be in the computer or in the book as an appointment, on a short call list if they were unable to pre-appoint with good reason, or in the missed appointment log for follow-up and rescheduling.
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