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Mon 4 Feb 2008 04:00 AM

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Dear diary

No-shows, cancellations and appointment scheduling can play havoc with your dental practice's profit margin.

No-shows, cancellations and appointment scheduling can play havoc with your dental practice's profit margin.

Arranging bookings might seem a straightforward responsibility in the highly technical atmosphere of a modern dental clinic. It is rare that a dentist in the Middle East pays much attention to the matter, leaving phone calls to the front desk.

Yet appointment scheduling can be one of the most important variables to a practice's commercial success or failure.

The least effective way to schedule is to just ask patients when would be most convenient for them and fill the openings.

Clinics with a naïve approach to scheduling are almost certainly losing out on revenue and run the risk of burnout among their clinical staff.

"The least effective way to schedule is to just ask patients when would be most convenient for them and fill the openings on the page in any random way," argues Julie Weir, a US-based dental practice management consultant.

A laissez-faire approach to scheduling leaves a dentist free to concentrate on clinical matters, but a proactive appointment policy should not only increase revenue but actually impact on clinical results. Dentists should set aside an hour and assess for themselves whether their appointment schedule is working for, or against them.

A kick in the teeth

For the majority of new patients, the scheduling process will be their first exposure to a practice and its values. Potential patients are busy people, and if scheduling an appointment feels like a chore there will be a sour taste in their mouth before they are even asked to open it.

"When I call I don't want to be on hold for five minutes or have to press a whole bunch of buttons to get where I want to go," explains Dianne Walizer, senior manager at Beacon Partners, a US and Canada-based management consultancy firm.

The dental environment can be charged enough for patients, and your scheduling techniques should attempt to reduce stress by any means possible. This maxim applies as much to the dentist as to the patients, according to Julie Weir.

"Dentistry is a very stressful profession - it has the highest suicide, divorce or addiction rate of any job," says Weir. "It is very important to structure a day for reduced stress."

Dentists spend around 90% of their working day within 12 inches of another person, and the intensity can take its toll.

While sustained human contact can be wearing, there is nothing more grating for a dentist than dead time. No-shows or late cancellations are all too common in Middle Eastern markets and they can be financially crippling - sometimes without the practice realising why the books aren't balancing.

If an appointment will yield the equivalent of a US$300 procedure, a no-show effectively leaves the books down $300.

If you reschedule and they don't show, then you are down $600. Even if they do, in reality you are still at zero. If you put them on the schedule for a third time and they don't show then you face either being $600 down, or $900 down. Not the best of choices.

With some patients you realise that if you had sent them a $100 cheque after the first missed appointment with a note asking them to go to a different practice then you would be better off," observes Weir

The labour costs of simply chasing up errant patients can be disastrous for practices, according to Zeina Enright, clinic coordinator at Dubai's Villa Fortuny Clinic. "It is very frustrating and time-wasting for a company like us," she complains. "Sometimes we have to call numerous people just to fill a half-hour gap - you can waste up to two hours trying to fill a slot, which is ridiculous.

Appoint to improve

Seeking to minimise these losses, many clinics enforce a cancellation fee on offending patients.
This almost always sends out the wrong message, believes Julie Weir. Cancellation fees are notoriously difficult to collect and, even if you succeed, you are likely to have lost that customer for good. Weir suggests that clinics invest time in training their front desk staff to conduct phone calls in a diplomatic but persuasive manner.

The verbal skill is to give the patient two choices, but to make sure they are both times that work for you and your template.

Emphasise the amount of the dentist's schedule you have reserved, and impress upon the patient how busy they are. If they try and cancel, make it clear how difficult it will be to fill that slot at such short notice.

"Every once and a while you can turn a patient around and they'll try and make the appointment," explains Weir.

If they still can't, say that you understand and ask if they want to reschedule and if there is a time that they can really commit to, because it might not be possible to reserve a third hour if they were to miss the second appointment as well.

Weir also recommends that patients are reminded of appointments two days in advance, as people will often not get the message until after working hours. A voicemail message collected at 8:00am cancelling a 10:00am appointment that day is of little benefit to any clinic.

Dr Hibah Shata runs the Specialized Dental Clinic in Dubai. For Shata, easing patient anxiety can be a big factor in reducing cancellations.

When a patient books an appointment the next thing I do is I call them personally to explain what they will be doing in the clinic, which reassures them," she explains.

If you can make people loyal they obviously will be less likely to go anywhere else, but they will also be more likely to keep the appointments that they make.

It is crucial that everyone on the clinic is on the same page, when it comes to the practice's daily plan. Having a 10-15 minute morning meeting can be invaluable when it comes to ironing out snags in the schedule.

It should be brief but should confirm everyone is familiar with the day's agenda. Has there been any change in the schedule? Is there any way to fill those gaps?

There might be a patient seeing the hygienist who could need a filling - if they do, can they be squeezed in? It is crucial that clinics make the most of every hour, and daily communication is one of the most effective ways of achieving maximum schedule productivity.

Mental block

In the US, many dentists have eschewed traditional scheduling methods and moved to a system referred to as block scheduling.

As dentists (and patients) tend to have more energy in the morning, it is recommended that 70% of clinical productivity should occur before a dentist's lunch break. In an 8:00am to 5:00pm day, dentists should schedule the most intense procedures in the mornings (or the first slot after lunch, if unavoidable).

The structure relies on demanding procedures (such as crowns) being interspersed with less intense appointments (fillings, for example) during the morning, and leaving the afternoon free for simpler tasks.

The practice should draw up an ideal template, allocating patients the times that suit the clinic, rather than offering an open-ended schedule.

"The verbal skill is to give the patient two choices, but to make sure they are both times that work for you and your template," explains Weir.
You need to make it sound like the benefit is for them - explain that tolerance to pain for patients tends to go down during the day, and they will be much more willing to schedule for the morning.

Zeina Enright feels that whatever measures you might take to improve scheduling, in Dubai at least, there will always be "that 20% who okay it the day before and then still not turn up". Yet most clinics in Dubai do not keep any formal statistics about their dead time.

A simple but risky strategy is to overbook your schedule by the percentage that you expect to cancel on the day. If you analyse the data, claims Diane Wilizer, it might not be as random as you think. "You do have to keep your own stats because every area will vary depending economic conditions," she says.

To say that you have to overbook by 50% might get you in trouble - but for other clinics you could overbook by 200% and be fine."

The key to this policy is to keep accurate records to allow an informed decision - and it is probably wise to be conservative with your initial estimates.

If your clinic gets a reputation for gambling with other people's time then it can be very difficult to repair the damage already done to your name.

A time to drill

No matter how established or organised a clinic may be, no schedule will run to plan every day.

If you want to see healthy returns from your practice, it is important to make contingencies for when something goes wrong, just as you establish protocols to ensure things normally go right. Every clinic suffers from cancellations; it is how one deals with them that differentiates the most successful practices

And just because a clinic is busy and has a full schedule does not necessarily mean it does not need to be changed.

If dentists want to be profitable long-term, then they have to consider their own longevity. By careful planning, it is possible to create a template that works for you, works for your patients and works your clinic. Now all you have to do is turn up on time.

Med tips: Making the most of the working dayBlock party

Create your ideal schedule and try your best to make it a reality - remember you control appointments, not the patients.

Making an impression

Your front desk staff must be efficient and courteous when fielding phone calls. It may be the clinic's fifteenth call of the day, but the patient only deals with the practice once.

More than a filling

An introductory call will ease the anxiety many first-time patients are bound to feel and should encourage them to keep to their arranged time.

Afternoon delight

Don't come back from lunch dreading a block-booking of patients - plan for an easy ride to finish the day so you can come back refreshed tomorrow.
Fine by me

Aggressively enforcing cancellation fees should be a last-case scenario. Turn a patient round, and the long-term benefits will be tenfold.

Don't play bookkeeper Over-booking can be a great strategy but get carried away and you'll risk alienating your client base. Remember to gamble in moderation.

Stats all folks

You can't make educated decisions about appointment scheduling if you don't have accurate data. It may be a chore, but keeping track of no-shows can pay dividends in the long-term.

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