Reliability, responsiveness, feeling valued, empathy and competency – they shape the first and lasting impressions about your office. Having the determination to always do what is in the best interest of the patient is the backbone for creating systems that allow the seamless delivery of excellent, consistent patient care. Patients are looking for the “silver bullet” in orthodontics- the enthusiasm, the WOW factor, countless other spoken and unspoken moments, and then some. It is the culmination of several little things that all add up to the patient’s perception of your office, from the initial referral through the completion of the retention phase.

Just as a precise combination of numbers is required to solve a Sudoku puzzle, orthodontic practices must have detailed systems in place that are closely integrated throughout all areas of the office to meet and exceed patient’s expectations. When one number is out of place, when one system is weak, the patient’s perception of your practice suffers. Just as a solid foundation is needed to ensure the stability of a building, a network of closely monitored protocols and systems is critical to the success of today’s orthodontic practice.

1. Walk the Talk with a Mission Statement You Embrace
One of the first questions I ask new clients is what made them decide to pursue a career in orthodontics. Was it something they were interested in as a child or was there a role model or mentor that encouraged them to venture down the path to orthodontics?

One of my favorite clients (and I am proud to also call her a friend), Dr. Teodora Bonney, told me the story about her introduction to dentistry and orthodontics, starting when she was a young girl in Romania. Her favorite game was pretending that she was a dentist. Her handpiece was the handle of a jump rope nailed to the casing above a doorway. She used colored straight pins pushed into the jump rope handles for burs (each color was a different bur, inverted, cone, etc.) and she used small candy to fill the cavities in her cousin’s teeth. Her interest and passion in dentistry followed her throughout her childhood years, leading to her graduation from dental school in Romania. After moving to the United States she went back to school to get her U.S. dental degree and then completed her residency in orthodontics, allowing her to fulfill her dream of becoming a phenomenal orthodontist.

Talk about the foundation for a powerful mission statement! A little girl in Romania with a dream to make a difference in patient’s lives through dentistry becomes reality in Pennsylvania, USA. Patients reading her story will get swept up in her passion for the lifelong benefits of orthodontic treatment. Her mission statement is currently under construction, however there is no doubt that some of the key words she will use will be compassionate, caring, gentle, family, highest quality, fun (how can it not be fun after using candy as amalgam), and committed to creating perfect smiles for life. She has given a lifetime of dedication to the dental field that has spanned two countries and touched countless lives. That is what orthodontics is all about – making a difference in our patient’s lives.

2. Initial Impression
Joseph Cornell once said “Look at everything as though you are seeing it for the first time, with the eyes of a child, fresh with wonder.” We only have one chance to make a first impression, whether it happens when the patient is handed your business card, the initial call is made to your office or when someone visits your website for the first time. Evaluate every aspect of your patient’s pre-exam experience, from the appearance of your business card through the scheduling of the initial appointment.

Business card or referral form: Have a logo that stands out and reflects the personality of your practice. Use an easy to read font in an appropriate size and color. Remember, not everyone has 20/20 vision! Make sure that your website address is printed on all forms that you use.
Website: Keep your website updated with current information, team member photos and office/patient activities. Consider including video testimonials of patients who have completed orthodontic treatment. With today’s population being so computer savvy, 85% of potential patients will check out your website before they make the initial telephone call. Constantly monitor your website to see your page position if someone “Bings” for an orthodontist in your area.

New patient telephone call: Make sure the administrative team is trained to take the new patient call correctly; both asking questions and giving promotional information to prepare for the initial evaluation. Role-play and practice ways to improve your customer service and “WOW” factor.

3. Flexible Financial Arrangements
With the hit the economy has taken over the past few years, people are more cautious than ever about deciding if, when and where to spend their discretionary dollars. In many households the decision to proceed with orthodontic treatment could cut into their monthly budget for food, shelter and clothing. To encourage patients to start treatment it is important to be “wisely” flexible and creative. This means that we can expand the possibilities for financing, however it is not to the patient’s benefit nor to the practice’s benefit to start treatment on a patient who cannot comfortably commit to the payment arrangements offered. We do not want patients walking away with braces on and then have buyer’s remorse, nor do we want to set up a patient for failure by stretching them financially beyond their capability.

Utilize credit reports to allow you to explore all options available for each patient. Promote in-office financing with no interest or service fee, ideally using automatic debit or credit card payments for their monthly installments. OrthoBanc is a fantastic company to work with to set up the automatic system for your office. This service reduces the time and energy spent on collections and offers patients a selection of dates to make their monthly payments. Enlisting the services of outside financing (Springstone or Care Credit) allows patients to spread their payments over up to 60 months. (No financial interest with the companies mentioned above.)
Take the time at the end of the month to compute the financial impact of losing patients. How many patients did not start because our financial arrangements were too rigid? Did we start any patients that in hindsight we should have waited until they were financially ready? Look at the numbers and use the information to help establish financial options that work for your patients and for you.

4. Value Your Patient’s Time with Effective Scheduling
The clock continues to tick, there is no way to stop it or to recapture lost moments. Often in orthodontic practices we see the hurry up and wait syndrome – everyone wants to come in before or after school. Mid-morning to early afternoon hours are often slow and sometimes unproductive. Just as wasted time is not financially profitable for the practice, waiting time sitting in your office can be a loss of income and source of frustration for patients and parents. The number one concern I see on patient questionnaires pertains to scheduling, whether patients feel that the office runs behind or they are not able to schedule an appointment at the desired time. It is important that we put as much, if not more, value on patient’s time as we do on our own.

Be proactive and design a schedule that fits the needs of your patients and the practice. Consider implementing a customized, doctor time schedule to maximize the hours you have with patients, reducing wasted time and doctor overload. Take the time to do procedure timings and counts to give you the necessary information to create templates that will allow the seamless flow of patients throughout the day.

Think outside of the box and implement programs to encourage patients to come in during your slower, school time hours. A couple of examples of this would be:

*The Brunch Club – offer patients a 5% courtesy off of their total fee if they commit to scheduling all of their appointments during our “non-prime” time hours (typically from 10:00 – 2:00). At the completion of their treatment, if they have followed the Brunch Club guidelines and kept their account current, they receive the courtesy.

* If you use an incentive program, such as the Reward Hub, offer the patient additional points if they schedule and keep their appointment during “non-prime” time hours. It is surprising how flexible a patient and parent will be about missing school or work if there is an extra benefit for them.

5. Keep the Communication Flowing
Don’t stop the communication with parents once treatment is started. We cannot assume that patients will keep their parents updated after their orthodontic appointment. The saying “Nothing, Nothing, I Don’t Know” has been the universal language of children and teenagers for decades.

Parent: What did the doctor do today? Child: Nothing
Parent: What did the doctor say? Child: Nothing
Parent: When do they want to see you again? Child: I don’t know

Take the time after every appointment to do a brief 1 minute update with the parent or guardian. Quickly review the following five points:
1. What we did today along with any specific instructions
2. What you should expect as a result of today’s visit
3. How soon do we want to see the patient again
4. What will the next appointment involve
5. How is the patient doing overall (OH, compliance, progress of treatment, etc.)

This one minute will keep the parent in the loop, increasing overall patient compliance.

6. Keep your Referral Source in the Loop
A common complaint from referring dentists is that they feel as though they lose patients into an abyss for two years when they refer a patient to an orthodontist. They hear nothing about the progress of treatment and unfortunately at times the patient neglects to see the general dentist for their semi-annual cleaning and check-up. In their minds, why do they need to see another dentist, they are already seeing the orthodontist every 4 – 8 weeks?

Strengthen the partnership between you and your referral offices by implementing an oral hygiene program to encourage patients to see their general dentist every 4 – 6 months. Send a letter to your referring doctors explaining the program along with the benefits to the patient and referral office. Following is an example of the oral hygiene form that is given to the patient. The bottom of the form has a place for the dentist to sign along with room for them to add comments.

Dr. __________________ and your general dentist work together closely during your orthodontic treatment to ensure you maintain excellent dental health.

It is essential that patients maintain their regular examinations with their family dentist every six months (or sooner if recommended) during the course of orthodontic treatment.
Since Dr. _________ recognizes the critical importance of maintaining excellent dental health, our office has designed an incentive program to encourage patients to maintain their regular appointments with their family dentist. Just have your dentist or hygienist sign and date the bottom part of this letter when you have your regular cleaning and check-up. Return the form to our office and your name will be entered in our monthly drawing for a gift certificate (or add additional points on their reward card).

Please feel free to contact me if you would like to have a copy of the entire oral hygiene program.

7. Have All Team Members on the Same Page
When a goose flaps its wings it creates uplift for the birds that follow. By flying in a “V” formation the flock has 71% greater flying range than if each bird flew alone. When the lead goose tires, it moves back and another goose flies to the point position. The geese flying in formation honk to encourage the birds in front of them to keep up their speed. Geese instinctively know how to fly together to blend strength, skills and capabilities. If a goose becomes sick or leaves the formation, the remaining geese immediately take over without interruption to their flight.

What can we learn from the lessons of the geese? If one goose is out of sync it weakens the progress of the entire flock. As with geese, team members need to work together, to provide the best possible orthodontic experience for the patient. Cross train all employees to ensure that someone is always available to step in without interruption if another team member is unable to work. Establish clearly defined job descriptions so all team members know what they are supposed to do, when they are supposed to do it and the time frame. Informed, cross trained team members results in a happy team, happy doctor and raving patient fans.

8. Measure Your Performance
Continue to perform on-going evaluations of your patient’s perception of the practice, remembering that their perception is your reality. It is too easy to become complacent when things are going well, when you think you are operating on all cylinders. Measure the patient experience by using mystery shoppers, questionnaires and follow-up telephone calls. Use this information to determine whether there is a disappointment gap – the difference between the patient’s expectations and reality. Map the gap to institute changes that will improve patient care from the inside out, utilizing the information for an opportunity to learn and improve your systems and communication skills.

Make a list of everything that might be contributing towards a negative perception of the office by patients, parents, referral sources and the community. For each “learning opportunity” list one action you will take to make an improvement. Challenging patients and parents often do not respond to logic with logic, they react with emotions. The solution is to deal with the emotions first (theirs and yours). The brain will not deal with logic until the anger and frustration have been put aside.

Keep tuned in to your patient’s needs remembering that your impression of what they want might be very different from what you thought.

9. Stay Ahead of the Technology Curve
New technology is emerging on a daily basis. What was new yesterday is outdated technology today. Although it is fun to get all of the newest bells and whistles, new “toys” are expensive and must be purchased wisely. Evaluate your current systems to determine what technology changes can be made to improve your patient experience on a daily basis. Prioritize your wish list, making note of the technology that is changing the quickest and financially feasible. Although it is fun to have the latest gadgets, it is best to wait until they have been out for a while to ensure that all of the kinks have been worked out.

Management software is one of the first major purchases a practice makes and is often under-utilized due to lack of training. Spend the extra money to get a solid software system that offers excellent support and stays ahead of the technology curve. Do not become complacent with the program once you have it. Invest the time and money to send your team to the annual user’s meeting to ensure that you are maximizing all aspects of the program.

Save a tree and make the jump to paperless. From computerized charting to the signing of forms on a tablet, everything is available with a couple of key strokes. Just think – no more searching for lost charts or paperwork.

Lessons we learn throughout childhood, from our elders and through life experience are often more valuable than what we glean from books and the internet. Growing up I remember my grandfather Bubba stressing the importance of reliability. On his knee I learned rules that would follow me every step of my life:
1. Do what you say you are going to do
2. Do it when you say you are going to do it
3. Do it right the first time

Just as in life, patients will walk away if they do not feel valued as an individual. 68% of the time when we lose a patient it is due to poor care or a rude/indifferent attitude. Let this be your wake up call. Give patients and parents your utmost attention and respect, making sure that you are tuned in to their needs. Surprise them by surpassing their expectations. Following these simple rules will help ensure that you successfully complete your Sudoku puzzle and will have the systems in place to ensure consistent ESP- exceptional patient care.

Debbie Best, practice management consultant and lecturer for Consulting Network has over 35 years of experience in the dental and orthodontic field. Debbie evaluates staffing needs and systems to develop a strategic plan to enhance patient care and practice productivity. She designs customized schedules, personalized job descriptions, and a team member handbook to fit each practice’s needs. As a part of her consulting program, Debbie also focuses on the role of the administrative team, financial controls, anti-embezzlement protocol and practice building.

To Contact Debbie: Phone- (925) 447-6993, Fax- (925) 447-6994
Website: http://www.consultingnetwork.org E-Mail: debbiebest@aol.com