Practice Marketing and the “Chain of Success”

Dentistry Today


Proper marketing techniques for the dental practice are critical to its long-term success. Dental practice marketing consists of two distinct components: internal and external. Internal marketing, by definition, is every action taken within the practice to stimulate referrals, keep the existing patient base happy and coming back for re-care, and making “missionaries” of everyone who walks in the door, patient or not. External marketing is promotion, advertisement, or public relations activity that is conducted outside the practice to attract new patients. Whether a project is internal marketing, external marketing, or both may depend on how it is used. One example of this may be your practice brochure (itself a marketing tool). It is handed out to existing patients in the office and mailed to people in the community or handed out at various community functions.

Marketing is as varied as the people conducting it. Before beginning a marketing campaign, you should develop a marketing strategy (an integral part of any marketing plan) with which you are comfortable and which accomplishes your goals and objectives. External marketing strategies that are gaudy, ill conceived (ie, TV, radio, newspaper, etc), can be both obnoxious and, to the “desired” patient, unprofessional. That does not mean all television advertising, for example, is bad. Just remember to keep it in “good taste” and you will attract the kind of long-term care patients you want for your practice. Remember, TV is a big net and you catch all kinds of fish! Having a marketing strategy with the emphasis on quality care, and not just price, will ensure you meet your objective.

Marketing means different things to different people. Most envision glitzy TV ads, fast-talking announcers, and flashy commercials. This specific activity is advertising, and it represents only one phase of marketing. Marketing is actually a multifaceted field that includes public relations, advertising, and promotional activities. Marketing as it pertains to dentistry is typically whatever action you take to promote your practice for the purpose of attracting new patients. Because it is so essential to the dental practice’s success and very survival, internal marketing is the focus of this article.



When business people contemplate marketing, they do not usually consider their employees’ everyday demeanor and interaction with their customers as “marketing.” It’s business as usual, and often the people/customers they deal with receive less than top treatment from them or their employees. Curtness on the phone, slow or poor service, a detached attitude, indifference, or downright belligerence are often attitudes to which both the potential new and old customers are subjected at the interpersonal level. No amount of money spent on external marketing can offset the damage done by a disgruntled or uncaring employee. I have extended the use of the term “internal marketing” to include all contact with the dental customer/patient. Its effect on practice growth and income is far more important than all the external marketing a dental office can buy.

The fact is, we must be accomplished internal marketers because we are not only selling a healthy beautiful smile, we are also “selling pain” as a dentist friend once told me 35 years ago. If you asked each of your patients if there was anywhere else they would rather be than in your office today (regardless of the procedure), fully 90% would say “yes.” This means that we not only have to be aware of internal marketing techniques, we must be masters of them!

Over the years our consulting group has observed that virtually every step the patient takes in the practice is an opportunity to implement internal marketing techniques. Because each step is interrelated or linked, years ago we dubbed this flow of the patient the “Chain of Success,” with each link interdependent—one weak link and the chain is broken.

If a dental practice is a business, then it must produce a product. Our “product” is a healthy, happy patient who ideally refers other similar patients to us. We are helping people look better, feel better and, with what we know now of the systemic implications of periodontal disease, we are probably adding years to their lives. As this person moves through the practice, each staff member contributes to producing this “product,” the happy, healthy patient. Herein lies what we call the “Chain of Success,” which is only as strong as its weakest link. Consider this analogy seriously and you will understand why it is essential to have kind, understanding, and skilled people on your team.


Link No. 1: Productive Scheduling—The Telephone

The primary objective for the person answering the telephone is to schedule the patient. A pleasant phone voice is a must. This contact is usually the very first impression the patient has of the practice. You want to make a good one! When talking on the phone, smile into the phone. You want the person at the other end to feel welcome. If you have a negative tone, the patient might schedule, but may think again about the appointment and not show up at all.

When scheduling a new patient, first determine the status and desires of this patient. Be directive with patients to help them overcome barriers to needed treatment. Courteous but directive statements, such as “I’ll put you down at 2 o’clock tomorrow,” help the patient make a decision. If this is not okay with the patient, they will tell you so. Do not ask if they want an appointment, or “What time would be convenient for you?” Instead, suggest a time and date for them.

The person who answers the telephone and does the scheduling is one of the most important people in the practice, and will determine to a large extent how productive a practice is (not just “busy”).


Link No. 2: Reception
It is important that you extend every effort to make the patient feel comfortable and at ease in the reception area. Here are three important points:

(1) The reception area is your second chance to make a good first impression: it must be neat, clean, and inviting.

(2) Furnishings must be nice, but not necessarily expensive or overly ornate. Try to make it feel like your living room.

(3) Your receptionist should greet the new patient with genial conversation in an open, friendly manner. It should never be a head popping out from behind a sliding glass window saying, “…. help you?” and then sticking a pencil and a pad in the patient’s hand. In effect, this is telling the patient that they are not important, they are interrupting your work, and they are a “bother.” A friendly face and warm greeting are critical, and very likely will set the tone of not only the first appointment, but all the ensuing ones (if there are any more). Make them comfortable. Patients at ease will buy; uncomfortable patients won’t. Which do you want?


Link No. 3: New Patient Exam
Regardless of who orchestrates the new patient exam, his role is that of liaison between the new patient and the doctor. If you use a patient coordinator, he assists the doctor with the new patient exams by gathering all the information needed in order to diagnose by building a rapport with the patient, by promoting the practice and the doctor, and by assisting in selling the dentistry the patient needs. The exam process begins by building rapport with the patient, ie, talking about where they live or work, how they heard about your practice, etc. The next step is reviewing the medical history that the patient has completed. If there are any medical problems, the patient coordinator needs to alert the doctor during the exam.

A lot of time should be devoted to the next step: reviewing the dental history with the patient. Uncover issues such as fear, past experiences, her opinion of her smile, gum problems, TMJ problems, etc. This allows you to tailor your approach to address those things the patient wants, as well as what is needed. The patient will be surprised at your thoroughness, which is always a major concern.

The clinical exam consists of hard tissue charting, periodontal charting (PSR or full probing, whichever is appropriate), oral cancer screening, a TMJ exam, and any necessary radiographs. The intraoral camera and hand mirror should be used when necessary to help the patient “see” the situation concerning her oral health. Again, your thoroughness is a major talking point with the patient.


Link No. 4: Treatment Presentation
When presenting treatment, the doctor should summarize the treatment plan—especially after the “guided tour”—and explain the treatment to the patient. However, the patient coordinator (if used) should explain the details because the doctor can be too technical with explanations concerning needed treatment. This approach allows the doctor to continue producing in other areas in the practice. Visual aids, a hand mirror, and the intraoral camera at this juncture of the appointment are very important. The patient must completely understand the treatment that the doctor proposes. A confused patient will not accept treatment. The patient needs to understand:

  • what the problems are
  • what it is going to take to fix the problems, and
  • what will happen if the problems are not fixed.

This is absolutely critical. The patient needs to be so involved in the process that he feels as if the treatment plan was at least in part his idea. At this point, the doctor or patient coordinator is to be directive, but at the same time let the patient feel in control.

It is imperative to offer only one treatment plan. It should be the most ethical treatment plan that the doctor can provide. It should be the treatment plan that the doctor would provide for a family member, for example. After reviewing the findings with the patient, the doctor can say, “If we can work out the particulars, does this sound like a way you would like to proceed?” This presentation procedure is typically very impressive to the patient, who will again extol how nice and thorough you are.


Link No. 5: Financial Presentation
Financial arrangements should be presented in an area where the patient is most comfortable, either at the chair or in the business office/consultation room. Most people are not comfortable discussing their financial condition where the rest of the office can hear. Always be conscious of the patient’s attitude. Try to make sure the patient is at ease. Watch the patient’s body language, and if the patient is in a negative posture, attempt to eliminate any barriers before proceeding with financial arrangements.

At this juncture of the appointment, the patient is given the total amount for their entire treatment plan. Do not itemize what the fee is for each procedure. Offer the patient a discount for prepayment of the entire treatment plan. The most desirable financial arrangement is payment up front, whether paid by cash, check, credit card, or approval through a dental fee plan, bank, or finance company. The least desirable arrangement is what we call “pay as you go.” With this arrangement, patients tend to cancel appointments or drag their treatment out over an extended period of time. Your objective in making financial arrangements is to get money out of the picture so that the patient keeps his or her appointments and completes treatment. Again, the patient will be impressed by your willingness to help them have the treatment they now want.


Link No. 6: Technical Expertise
Patients deserve quality, efficient, and speedy treatment. Further, the doctor must be certain that he is proficient in delivering most, if not all, the general dentistry procedures needed by the patient. Obviously, the doctor must be able to prepare teeth for veneers in order to be able to treatment plan veneers or any of the plethora of new sophisticated techniques and procedures not taught in dental schools: if you can’t do it, you can’t treatment plan for it. This includes many of the specialty areas, eg, endodontics and orthodontics. Technical training is a must in today’s practice if you are to provide your patients with advanced aesthetic and reconstructive dentistry.

The use of expanded function assistants (EFA), or expanded duty dental auxiliaries (EDDAs) and dental hygienists, makes the practice far more efficient and profitable. Further, it serves as a cost-containment measure for the patient. The doctor should never do a reversible procedure or task that an available assistant can perform. There are few practices that will be successful without the use of intelligent, skilled people. EDDAs and dental hygienists must be thoroughly trained and comply with limitations set up by individual states as to the duties that they can perform. Even if limited, they can still perform many tasks. EDDAs help reduce the cost to the patient because the doctor is not the one performing the reversible procedures. This allows the doctor to focus on the things that only he or she can do (such as irreversible procedures). As a benefit to the practice, if assistants can do half of the reversible procedures during the day that the doctor was previously doing, production can potentially double.

Technical expertise can be a major boon to the practice. Patients want to know that everything is up to date, and that their doctor is “on the cutting edge” and “does beautiful work.”


Link No. 7: Marketing and Producing Missionaries
We made marketing a “link” in the Chain of Success as it is an ongoing, conscious, planned effort to build your practice by providing outstanding services in a comfortable, friendly environment and asking your existing patients to refer others to your practice. Consumers not only want convenience, but also quality in services they receive. You want to make the patient feel good about spending time and money at your office, and having visits that are happy, rewarding experiences. You especially want them to refer other people to your practice. One of the most basic and effective marketing techniques to stimulate practice growth is simply asking your existing patients for referrals. This can be done at any time during the patient’s visits, but it is probably most effective when treatment is completed, the patient is happy with the results, and truly is in a mood to “tell the world.”

Over the years, we have developed and incorporated some very effective internal marketing techniques. Although we have listed over 200 different internal marketing techniques, the top four in our opinion are:

(1) Posttreatment calls—absolutely nothing tells the patient that you truly care more than a phone call from the doctor following extensive treatment.

(2) Always greet your patients in a friendly, happy manner, both on the phone and in person. Keep a smile on your face (or close by). Patients remember “how friendly they are at Dr. Jones’ office,” and tell their neighbors.

(3) Always make sure patients are comfortable during treatment. Adjust the chair, keep lights out of their eyes, etc. Give them a blanket if cold. They will appreciate your kindness and will say so. Anything you do to make the patient more comfortable and less apprehensive will be long remembered.

(4) Perfect your injection techniques for local anesthesia. Use topicals, etc, so the patient feels little or no pain. This allays many patients’ greatest fear, and they will sing your praises about “how easy Dr. Jones is with his injections.”

When a patient has completed treatment and is probably in their best “referring mood,” the patient coordinator may use a posttreatment review form or a quality assurance survey. It only takes 2 to 3 minutes to fill out, or the patient may take it home and mail it back in a postage-paid envelope. Regardless of the form, explain that quality assurance and control are very important to you, and that you do value their opinion. With most patients, this makes a big impression. Most importantly, use this opportunity to also ask patients for referrals. Tell them that you would love to have more patients just like them. Don’t be abashed about asking them to refer their family and friends.

Making missionaries of your patients is a significant aspect of your practice. You want your new patients to feel they have received the most thorough exam ever and the best treatment ever. You also want them to feel as if they are the most important patients you have. You want them to know that you provide the best treatment with the newest technology available. You want them to feel special because you are going to ask them to send their family and friends to you. Again, the best time to do this is immediately following the completion of their treatment plan.


Link No. 8: Retention

Not only do you want your patients to refer others to your practice, but you also want existing patients to remain in the practice. Although a good referral source, those patients who have been a part of the practice for a period of time do not usually refer others to you as readily as someone who has just been introduced to your office. However, most of these patients either have families or will have families, and you want these families to become part of your dental family as well; hence, you want your old “standbys” to always be a loyal part of your practice.

It is important that patients remain in the practice and not become “lost sheep.” To prevent this from happening, they need to be either on the appointment book, in the recall system, or in follow-up binders. The easiest way to keep the patients coming back is to pre-appoint them for their next re-care visit. This is done before the patient leaves the office, following their prophy or their last STM appointment.

It is important for clinical staff to always stress the importance of the patient’s next visit, whether it be the next re-care visit or the appointment to complete restorative, endo, crown and bridge, etc. There are very few patients who do not have some chronic problems that should be observed periodically. This added incentive gives them an additional reason to come back for re-care.


The key to a successful practice is to be absolutely certain that each link in your practice’s Chain of Success is strong. One weak link will undermine all the rest. The fabric weaving those links together is your internal marketing techniques.

All successful businesses, including dental practices, have a common denominator—well-trained, skilled people in all key positions who know and consistently implement their duties and responsibilities and function as a team in accomplishing the practice’s goals. The force that holds the “chain links” together is the knowledgeable staff, led by the knowledgeable doctor.

Success in dentistry today relies mainly on people skills. Statistics show that patients who leave the practice, or are dissatisfied in any way, do so because they do not value the services received. Patients will not know if the margins on their crowns are perfect, but they will know if they have been neglected or feel unimportant while visiting the office. 

It is essential, therefore, to make patients feel good about their experience at your office and make them comfortable while they are there. Educating them about their treatment needs and giving them a beautiful smile, while making them dental missionaries who send other patients to your office, is what it’s all about!


Dr. Havill is part-owner of Dental SolutionsNOW, a company dedicated to providing dentists with timely information to increase practice income. Dr. Havill is a dental practice management consultant in Louisville, Ky, and has been involved in all areas of dentistry, including general practice, consulting, and practice management. In 1989 Dr. Havill and Dr. Jerry Mayes collaborated to develop the Dentistry 2000 Total Operating System, which has been successfully implemented in dental practices nationally. Dr. Havill can be contacted at (502) 245-3991. For additional information about Dental SolutionsNOW, visit www.Dental