By Cathy Jameson, Ph.D.
Broken appointments and no shows seem to be a problem that is plaguing the industry. The reduction of these appointment glitches begins in the treatment area with the clinical team. The clinical team establishes the need for the next phase of treatment and instills in the patient a clear understanding of the benefits of the next appointment.
Scheduling is the responsibility of the whole team - not just the person administering that appointment tool. The engineering of the day lies in the hands of the scheduling coordinator, but that team member is helpless if the clinical
team does not diagnosis carefully, outline a clear and comprehensive treatment plan, and explain treatment needs clearly and motivationally. The word “team” takes on a clear meaning when both the clinical and business team work together to encourage a person to schedule an appointment and to keep that appointment.
It is critical that a patient understand the value and importance of any appointment. Sometimes we “ask for” broken appointments and no shows because be undermine the importance of our own services. We want to soften the blow by not telling a patient how bad something is because we don’t want to look like the bad guy. However, if the appointment doesn’t seem important in the message we send to the patient - we are asking for them to (1) not schedule in the first place, or (2) cancel the appointment if something else comes up, or (3) simply not show up and not think anything of it.
Everyone on the team needs to be aware of the patient’s entire treatment plan and work together to focus on the completion of that treatment. Always be looking toward the next appointment.
Before a patient is excused, the last person to be with the patient needs to give the patient a reason to come back. That person needs to let a patient know the following:
Before the patient is escorted to the business office, sit down, roll your chair around, establish eye contact and give the patient a clear and encouraging reason to come back. Body Language is critical here. Keep the chair at a 45 degree angle, leave the bib on, and - sitting down - position yourself so that the patient will naturally remain seated. This body positioning encourages the patient to be a better listener.
This will only take about 30 seconds of time but will encourage scheduling and will offset broken appointments and no shows.
Approximately 60% of the perception of a message is sent or received via the body language. That is why the body and
chair positioning is so critical. Practice this with each other and you will see the strong impact made by body language.
Tone of voice accounts for 30% of the perception of a message, and so, the way you present your message also has a
strong impact. You have to believe in yourselves and in the dental care you are providing and you have to sincerely feel
By Cathy Jameson, Ph.D. that the patient will benefit from the treatment to be rendered. This confidence will come across loud and clear in your message. Last, but not least, the words you speak account for 10% of the perception of the message. Verbal skills can make all the difference in the world. Paul Harvey says, “It’s not what you say, it’s how you say it.” He should know!!!
Tom Hopkins of Scottsdale, Arizona calls these the four P’s of Professionalism. He believes that is you follow these four
p’s – which are pre-planning, practicing, perfecting, and performing - you can master almost any skill.
Applying these to our “Reason to Come Back” sequence, I encourage you to sit down as a team and write out scripts that apply to most of your procedures - scripts that give a clear and precise reason to schedule a next appointment. Even if you have completed the restorative treatment, give the patient a reason to come back for the next evaluation and hygiene treatment appointment to insure the investment they have made in their mouth and teeth.
Once these scripts are written, practice them with each other. Go to the treatment area to practice so that you can apply the proper body language. Everyone needs to be saying the same thing and must be saying just what the doctor wants.
Perfecting the skill will come with the practice and with the actual performance. As you are performing the “reason to come back”, evaluate from time to time during team meetings. What’s working? What’s not working? How could be more effective? Are people scheduling? Are the broken appointments and no/shows reducing? These are the kinds of questions to ask upon evaluation. If you are not getting the results that you want, don’t give up. Instead, figure out how you can do it better and try again. That’s what Mr. Hopkins means by “perfecting” the skills.
1. Patient who has received an evaluation and hygiene treatment. Clean mouth. No restorative treatment needs. Never,
never again say, “Everything looks great, Mr. Jones. We’ll see you in six months for your next checkup.”
When you say this, you undermine the significance of your own expertise and you establish no importance in the next
appointment. Instead, say something like this,
“Mr. Jones, you are doing a great job with your home care. Keep up the good work. Your teeth are in excellent condition.
It is extremely important that we work together to keep you as healthy as you are now. So, let’s schedule an appointment
for your next evaluation and professional cleaning. We need to see you in 6 months for that appointment.”
Same goal - schedule an appointment in 6 months. Big difference in the message. The second example will get better
results in the scheduling of the appointment and will give people a much stronger desire to keep that appointment.
2. You have prepared a tooth for a crown. Now you need to schedule an appointment for the seating of the crown.
“Mr. Jones, we have finished the first phase of your treatment. We have prepared the tooth for the crown and have taken
the impression. We will be sending this impression to the laboratory where they will be preparing a crown specifically
Watch for understanding from the patient. Pause to give them a chance to respond. And then continue with -
“It is critical that you come in for the next appointment when we schedule it, because we do not want any shifting of
the teeth to occur that might cause the crown not to fit properly. This would mean that we would have to retake the
impression/scan and send it back to the laboratory for another crown to be created. For your own health and for the best
results, we want to make sure you are clear about the importance of the next appointment. It is every bit as important as
Again, watch for the patient’s recognition and understanding of the importance of completing the treatment in a timely manner. Then move on to -
“Do you have any questions?” No. “Then, we will look forward to seeing you in a couple of weeks. Jan will go with you
to the business office where Cathy will schedule your appointment.”
3. Patient has two quadrants of restorative that need to be done. You have completed the upper left quadrant and need to
schedule an appointment for the lower left quadrant.
“Mr. Jones, everything went quite well today. As we outlined during our original consultation appointment, today’s
appointment completed the first phase of your treatment. We removed all of the decay in the upper left part of your mouth
and filled these teeth with a tooth colored material - just as we had discussed.” (During this conversation show the before
and after images/photos to reinforce the need for that completed treatment).
Pause and wait for questions – answer any about that treatment. Then move on to -
“Now for the next appointment, to do the same thing for the lower left part of your mouth. As you remember, four teeth
in the lower left part of your mouth have decay. (We strongly suggest that you have images/photos of this from your initial evaluation and bring these back up on the screen for the patient to review at this time). We are ready to schedule your next appointment to restore these teeth. The teeth are not going to get any better, so let’s go ahead and schedule an appointment as soon as possible so that we do not risk letting the decay get any worse.”
Get an acknowledgement from the patient. Then ask -
“Do you have any questions? If not, Jan will go with you to the business office where Cathy will schedule your next appointment. I look forward to seeing you soon.”
Notice that all four issues were addressed:
Now that the patient has been given a reason to come back, the chair is fully raised, the bib is removed, the arm of the
chair is lifted and the patient is escorted to the business area where they are excused. Approximately 3-5 minutes before
the patient is escorted to the business area, a clinical person needs to give notification so that the business administrator
can prepare for the checkout. With the information at hand, the business administrator can complete the appointment,
have insurance form in batch, be prepared to collect the fee for the day, and have available appointments pre-chosen for
the scheduling of the next appointment.
Most business administrators tell me that getting the information from the clinical team in advance of the patient’s arrival
will save them 3-5 minutes per checkout. This is of tremendous benefit to the patient, because we all know that once they
get out of the treatment room - they want out of the office as quickly as possible!
Once you are at the business desk, compliment the patient for the day’s appointment, tell the business administrator what
the doctor needs to do next, tell how much time needs to be scheduled, and that the doctor would like to see the patient as
soon as possible or at the first available appointment. (Unless a particular time frame is necessary between appointments).
NOTE: Be sure not to ask for a specific day and don’t get too specific about length of time between appointments in front
of the patient. You back your scheduling coordinator into a corner when you do this.
Your scheduling coordinator already knows this. You aren’t doing this for the scheduling coordinator - you are doing it
to reinforce the appointment particulars to the patient and to encourage them to schedule and to keep the appointment.
Stress the importance of the appointment and tell the patient that you and the doctor will look forward to seeing them at
their next appointment.
Build your practice from within. Nurture the practice that is already in your office and in your files. Work together to
enhance your scheduling and to reduce broken appointments and no shows. Teamwork. That’s what it takes. Everyone
focused on a common set of goals and working together to help each patient reach optimum health.
The reason to come back is an enhancement to your scheduling scenario. It is an enhancement that could make a powerful
difference in your days, your months, and in your year. Give it a try.