Averages vs. Leverage

Why Can’t Everyone Say Yes?

The Law of Averages vs. The Law of Leverage

What is reasonable to expect for a case acceptance ratio? A recent inquiry through the Crown Council e-mail network elicited my following comments:

Before you decide what is a good case acceptance ratio, consider two natural laws: the Law of Averages and the Law of Leverage.

The Law of Averages: The more people you present to, the more people will accept. It is like baseball. The more times you get up to bat, the more chances you have to get a hit. That is marketing for your practice. The more you tweak your marketing, the more you can influence the number and the type of people who respond. If you want your "case acceptance" to be really good, just dump more and more money and time into your marketing to eliminate the people you don't want and have more of the people you do want. It costs a lot of money, but if the whole goal is just to have great case acceptance, then you are going to have to really get your marketing very refined to bring in exactly the kind of patient you want who is ready to accept today.

The Law of Leverage: With the right systems and verbal skills in place, you can increase the amount of dentistry that people accept. Archimedes once said that if you gave him a lever and allowed him to place the fulcrum, he could move the world. Your case acceptance system and verbal skills is that fulcrum. Let me emphasize the SYSTEM part. You have heard me say many times, 94% of success is in the system. You have to have a case acceptance system that works and works for you. That is one of our biggest areas of focus at the Total Patient Service Institute; a case acceptance system that meets the patient where he or she is today and helps them move forward toward life-time care. Once you have that system in place, the next job is to get the team to follow in your footsteps in that system. How do you get them to do it? Training, measurement, and accountability. It takes all three.

Here’s a summary. Averages: You’ll get more hits the more times you get up to bat. Leverage: The more skill and the better system you have, the better chance you’ll get a hit each time you do get up to bat. So what is more important? The Law of Averages or the Law of Leverage? Both laws are important and they work hand-in-hand. Just remember: it is a lot easier to persuade people who have never really considered comprehensive dentistry than it is to find the few who have!

Here’s another natural law that will bring us to the final answer: The Law of Continual Improvement. Dr. W. Edwards Deming, the grand daddy of quality was never a big fan of "bench marking." He was an advocate of continual and never-ending improvement. If you have an "acceptable percentage" then it is easy to stop improving. For example, I used to think that 100% conversion of prospective patient calls to scheduled appointments was "acceptable" until I discovered that much better that 100% is possible. But if we had never been trying to improve, we would have never discovered better than 100%. So keep pushing the envelope. You never know what is possible.

So what is a good case acceptance percentage? If you finally decide on an average that is good enough, then you are probably headed for trouble. Continually engage the Law of Averages combined with the Law of Leverage and if you stick with the Law of Continual Improvement, your results will just keep getting better and better and better.

The Power of Focus

If you are like me, there was a time as a kid when you discovered the power of magnification. For me it happened when Dad took a magnifying glass out of his drawer and we went outside with a small piece of paper. Positioning the magnifying glass in the perfect position in relation to the rays of the sun, he lit the paper on fire. Three seeming unrelated things: a piece of paper, a magnifying glass, and the rays of the sun. But when the three are focused just the right way, they are very powerful. That is the magnifying power of focus.

The same principle applies in the office. That which we focus on with the right ingredients, has the power to ignite a powerful force. What are the ingredients?
1. Focus
2. Skill
3. Measurement

First: Focus. While talking to a long-time dentist acquaintance of mine this week, he commented on how they had doubled their average new patient flow last month. How did it happen? Focus! A new internet tool they are using on their website records the in-bound calls that are generated from their website. In listening to those calls, it was clear that things had gotten off track in this area and it was time for some focused effort for improvement. Their first step of improvement was simply to make a decision to focus on a specific area for improvement and stay after it until things got better.

Second: Skill. Once you have determined your area of focus, there needs to be skills and systems implemented or re-implemented to get better results. In our first example, the team immediately went back to their ToPS New Patient Relationship Form and started using it on every potential new patient call. Next, they reviewed their ToPS verbal skills that they learned at the ToPS “Total Immersion” Course and started using them on each and every call. The best intentions and most positive attitude will only go so far. With the right skills…and the right attitude, results will start happening.

Third: Measurement. We all need feedback. Without measurement we never know if our focused efforts are paying off. In addition to the total number of new patients, this team started measuring the ratio of potential new patient calls to new patients scheduled from those calls as we have discussed before. With daily measurement, the team could see if their efforts were focused properly and if they were getting better results. In the magnifying glass example, there is a difference between creating a bright light and creating a burning flame. Sometimes the difference is a slight twist of the wrist. But without visible feedback, you would never know if you were on fire or not! So how do you know if your practice is “on fire?” You’ll never know unless you measure the areas on which you are focusing.

So where do you need to put your magnification focus in your practice? You can’t focus on everything all the time. But you can focus on some things some of the time. With the proper focus in the right areas, you can move through the practice one area at a time and light them all on fire!”

1. Focus
2. Skill
3. Measurement

Three ingredients of continual, never-ending improvement. Decide right now where you need to put some magnified focus in your practice…and watch things catch fire!

Redirect and Appoint

While speaking this week at the Canadian Dental Association/Pacific Dental Conference in Vancouver, B.C., a point came up worth revisiting from time-to-time in the office. It has to do with doing the right thing for the patient when the patient has not been doing the right thing for him or herself!

Here’s the scenario:

A patient who has not been in for a couple of years or more, who has unscheduled treatment, calls with a “problem.” A tooth that you had discussed in the past, but the patient refused treatment has now broken. The patient is not in pain, but wants to come in to get it treated or “smoothed off.” Before you jump right in and schedule the patient to get the tooth fixed, you might want to rethink your direction. There might be a bigger opportunity here that would be in the patient’s best interest. Is it better for the patient to just keep patching things when they break, or get on a path of lifetime care? So here is how you Redirect and Appoint.

Appointment Coordinator (AC): “Mr. Jones, I am so sorry to hear you are having problems. Could you hold for just a moment while I get your records?”

Hold

AC: “Mr. Jones, I have your records here. Let me guess. Is it the tooth on the lower left?” (Make the best guess you can without asking which tooth.)

Patient: “No, it is on the upper right.”

AC: “Interesting. I would have guessed that the tooth on the lower left would have broken before the one on the upper right. Mr. Jones, it looks like your body is starting to tell you something. I can tell by looking at your chart that this is not going to be an isolated incident. There are other teeth that are much worse off than the one that broke. Let’s go ahead and get you scheduled right away to come in and address the tooth that did break and while you are here, I am going to schedule an exam so you can have an update on your current health and you can discuss with the doctor what to do so this does not happen again or worse in these other areas. Does that make sense?”

Here’s the point:
1. The only way to get a patient on the right track is to have current records and a treatment plan. Doesn’t it make sense to do that in one visit when urgency is compelling them to come in rather than trying to convince them to come back for an exam after the urgency is gone.

2. All of us need a little push from time to time to be reminded of what is really important. When the body gives patients a reminder that it is being neglected, we need to be right there to reinforce that message and get them on the right track instead of supervising the patient’s neglect.

So, watch and listen for these opportunities to “Redirect and Appoint.” It is the right thing for the patient, the right thing for the practice, and the right thing for your professional and clinical integrity.

Better than "Yes"

Among the many things we measure on a daily basis is the ratio of prospective new patient calls to the number of appointments that get scheduled from those calls. It is not cheep to get the phone to ring and we want to make sure we are maximizing the return on that investment.

So what is a reasonable expectation for appointments set to incoming calls? If the marketing is targeted to the right group and the verbal skills are correct, is there any reason why the appointment percentage shouldn’t be 100%. Note that I said the percentage. That does not mean that 100% of the patients who call are going to schedule. For example, what if someone calls to find a dentist who takes Medicaid and you don’t. You can use your best verbal skills to help him or her understand the benefits of coming to you anyway, but there are people who have life conditions important to them that direct them to other offices. That’s OK. You are not going to get them all. In fact, you don’t want them all! You’re not everybody’s dentist. But for every prospective patient who calls that you are not able to schedule, there should be another call behind it where you are able to inquire about other family members who might want to come in as well. Instead of scheduling just one appointment from that call, you could schedule two. That increases your average. When you look at it from that perspective, 100% is achievable. At least that is what I used to think.

Here’s the rest of the story.

Recently, in an office we work with, I started to notice an interesting trend. The call to scheduled appointment ratio was greater than 100% on a regular basis. At the end of each month when we totaled up the numbers, the appointment ratio was 120 to 130%. Was this a mistake or was something going on here? We checked into the numbers and they were correct. What was going on is that the appointment coordinator had a “Better than YES!” attitude. She was not satisfied with just getting one “yes” per call, she wanted two or more. And two or more she got! With good verbal and relationship skills, you can engage each caller in a slightly extended conversation with questions like:

• Who else at home is over-due for their regular dental appointment?
• Tell me about your family. We love families in our practice.
• Since health is a family affair, we like to invite the whole family to be part of our practice.
• Who else is at home that should be coming as well?

Like most situations, when you ASK, people respond. And respond they did. Just by virtue of expecting something “better than Yes,” this office starting getting one of the best percentages on their calls to scheduled appointments that we have ever seen.

This great example has raised my expectations. 100% is no longer good enough! 120%, 130% or more is possible if you just ASK and expect something “Better than Yes!”

So, raise your expectations. Don’t be satisfied with a simple “Yes.” Commit to “Better than Yes” by asking for more than just one scheduled appointment per call.

A Great Recovery

While in Las Vegas this week at our Crown Council Annual Event, I was reminded of a simple principle of Total Patient Service worth reinforcing with your team. It’s the principle of “Recovery.”

After dealing with a long series of mishaps with a hotel that were handled poorly before and after the incidents that occurred, I said to myself, “this is really not that difficult.” You see, no body’s perfect. To execute 100% with every patient to their satisfaction is an impossibility. But how you recover from a mistake may very well be the difference between average and great.

A patient in a practice we work with sent the doctor a very strong letter with complaints of things that had gone wrong during her last visit followed by a demand that her records be transferred to another dentist. How would you handle that situation? Instead of sending a strong letter in return or just rolling over and sending the records, this wise dentist picked up the phone and called the patient. The patient was surprised that the dentist would take the time or even bother with the issue. The dentist apologized followed with the secret of a great recovery: The dentist asked: “What can we do to make it up to you?” The patient did not know what to say. By the time the call was over, the mishap had been taken care of and everything was back on track.

Many times, the secret to a great recovery is a simple question:
“What can we do to make it up to you?”
“What would you like us to do?”
“If you were us, what would be suggest we do in this situation?”

Many times the patient’s solution is much better than anything you might come up with on your own. So, just ASK! It may be the fast track to recovery that will leave the patient smiling and coming back.

Flat or Double?

I had an inspiring experience this week working with a great team who has built the leading and largest dental practice in their town. During an evening break, I was talking on the phone with my 13 year old daughter Ashlin. After telling her about the practice and how great it was, she asked, “Dad, if they are so good, why are you there?” I laughed and then explained to her that the reason the best are the best is because they continue to learn no matter how good they are. That is what keeps them on ToP.

What surprised me about this team was that a well meaning “consultant” had recently planted in their minds that they would be lucky if they “stayed flat” this year “because of the economy.” I just about came unglued when I heard this! If you have read or reviewed our ToPS Special Report “How to Thrive in a Down Economy” recently you know why. So ToPS Practice Advisor, Chris Toconis and I set out to help them see a different vision.

We had a blast as we worked together on ToPS systems in many areas of the practice. The team was engaged, open, and excited. They were ready to learn and absorb it all thanks to the great leadership in the practice that had paved the way.

Then came the true test. After we had worked on the new systems and skills, we all walked back into the practice for a day of seeing patients to see what was really possible. The energy was palpable. The excitement was electric. Several of the team members huddled outside one of the treatment rooms as Chris visited with the first new patient. What everyone had pre-judged as being a walk-in, walk-out patient, ended up accepting extensive treatment and wanted to get started today! With that as the starting point, the team was ready to kick it into gear in their own treatment rooms. We worked together side-by-side answering the phones, presenting treatment, and making financial arrangements. It was an fast-paced day filled with opportunities.

We called it a day about mid afternoon so we could huddle as a team and debrief before the end of the day. When we tallied up the results for the day compared to what was scheduled at the beginning of the day, this team had doubled their scheduled production. They produced twice as much as they had scheduled on the books that morning! And that was just in 3/4ths of a day!

Today, this team has a whole new vision of what is possible this year. “Flat” is no longer in their vocabulary. A steep rise is!

What this team experienced this week is not unusual. It happens every week in ToPS practices all over the country. While the masses have resigned themselves to mediocre performance this year because of what everyone else is saying, we are seeing spectacular improvements in case acceptance and production all over the country. Why? Because when you have the right systems in place and you have the confidence to implement them, your practice will be ToPS.

What Financial Arrangements? A Case Study

As you probably know, in addition to our ToPS clients that we work with around the country, we have a group of dental offices that we manage on a daily basis. Among other benefits, it provides us with an active laboratory in which to test and implement everything we teach. Occasionally we come up with a real head scratcher. Here’s one that happened this week. I will share with you what happened before, during and after treatment. Feel free to comment by clicking on the “comment” icon below with your own ideas.

Before
A 61 year old, male patient came in last week for an initial exam for which he paid in full. After the exam, he was presented with a treatment plan for nearly $4,000 which included a root canal, bridge and some other restorative work. He was also presented with several financial arrangement options including third-party financing which he declined and said that he would find the way to pay for it. He signed the financial agreement and scheduled the next appointment.

During
He came in this week for the treatment which included the majority of the work. At the conclusion of the appointment he said that he had no money and would pay when he could and then left!

After
When the situation was brought to my attention, I called him for clarification. He carried on for several minutes about how he was an honest man, how connected he was in town, everyone including the mayor would vouch for him, etc. With the best verbal skills I know, I thanked him for the background and then ASKed him what he would do if he were in my shoes. He said he would probably ask the customer what he could do. So I asked him what he could do. He said that he had a hundred dollars in his pocket and that he could pay that. I concluded by telling him that objectively speaking, I had a signed financial agreement, services that had been rendered based on that agreement, and no payment. Technically that was theft of services. If he could find his way back to the office to make some type of good faith payment that day, that would be a good idea to prevent the police from becoming involved. He did come in about a half hour later and paid one hundred dollars and said that he would pay us something each month.

Will he pay more? I doubt it. We made some calls around town including the mayor’s office. The mayor had never heard of him.

Questions
I’m sure you have had things like this happen to you before. So here’s the question; if a patient signs a financial agreement, is that sufficient? Or do you choose to always error on the side of caution and ask for payment up front before treatment begins? The bigger question at this point is if when faced with a situation like this, do you choose to treat it as an exception or the rule and change everything you do because someone stiffed you?

The practice of dentistry is filled with interesting choices. What choices would you make in this situation?

I look forward to your comments.

Have a great week.