Practice Management
Your Recall Program: Is It as Productive as It Could Be?
Your Recall Program: Is It as Productive as It Could Be?
Copyright 2002 Journal of the California Dental Association.
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A good recall system can improve the efficiency of any dental office. The majority of patients do not respond to the standard reminder postcard used in the passive recall system. An active prebooking system is far more productive. This article will outline an effective recall program and include discussion of implementation, verbal skills, and patient reactivation.
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One of the many concerns in a dental practice today is having an effective recall system. Many general practices do not utilize a recall system that is as efficient as it should be. Any recall system is only as good as the person responsible for its success, and that person must monitor it constantly and consistently for the repetitive system to be effective. This article will outline an effective recall program and include discussion of implementation, verbal skills, and patient reactivation.
For a patient to attach as much perceived importance to a recall system as possible, those implementing the system should avoid using the term "recall" for two reasons. First, the general perception among patients is that a "recall" appointment is not important: "After all, it= s only for a cleaning," they may think. Second, the dental profession needs to distance itself from the use of the word "recall" when advising patients of their need to return to the hygienist within a specific time because of the term’s negative associations. The dentist is not "recalling" the patient back into the practice to check whether the dentistry is defective and in need of replacement - like a car company "recalls" a tire.
Therefore, the creation of value and importance for that appointment in the minds of patients begins with finding a synonym for "recall." Alternative phrases include "continuing care" (favored by the author), "preventive care," or "recare." Without the perception of value, patients will be more hesitant to schedule an appointment and will, more often than not, cancel or fail to appear. The importance of good verbal skills in helping to make a continuing care system ultimately successful will be more fully discussed later in this article.
The author has found, with few exceptions, that a "prebook" or "preschedule" continuing care system is most successful in the majority of practices. Jennifer de St. Georges, international lecturer and expert in the field of practice management, believes that prebooking hygiene is the most effective system. "Practices that are committed to prebooking hygiene in the correct manner will experience many benefits," she said.1
There can be, of course, drawbacks to prebooking patients. However, the advantages of that approach have been shown to far outweigh the disadvantages. As long as patients are in the schedule, they remain readily accessible. Much greater productivity ensues by maintaining patients in the appointment schedule and reappointing them, should the need arise, than to expend extra time and effort tracking them down later.
Specific inefficiencies are inherent in the passive recall system, i.e., mailing postcards to remind patients to schedule semi-annual prophylaxes. The rate of nonresponse tends to be high, and much valuable staff time may be used attempting to locate patients so that appointments can be scheduled. This practice is often unproductive and wasteful.
While a prescheduling system is superior, two big, though solvable, problems can detract from a successful implementation: poor control of the system and poor verbal skills. The front desk administrative staff is most often responsible for prescheduling. Without good organization and good verbal skills, patients will not respond well. Too often, the appointment coordinator attempts to schedule a patient for a three-month or six-month continuing care visit. If the patient declines, it is usually because the appointment coordinator asked a closed-ended question: "Do you want to schedule your next visit?" A closed-ended question requires nothing more than a yes or no answer. Most frequently, the reaction to this kind of question is, "I don’t know my schedule that far in advance, so send me a postcard and I’ll call you." That brings the patient back into the passive recall postcard system. To maintain control of the conversation and elicit a positive response, the coordinator should inform the patient what is going to be done. For example, "Mrs. Brown, I know that Patti, our hygienist, wants to see you in August. She can see you on Tuesday the 1st or Wednesday the 2nd. Which of these would be the most convenient for you?" Most people will not object to this approach. For those who do object to prebooking, the verbal script should be structured as follows:
Appointment coordinator: "I understand, Mrs. Brown. Don’t be concerned. We will mail a postcard to you three to four weeks prior to your scheduled appointment with the day, date, and time of your appointment. Should you find any problem, I will be happy to re-schedule your appointment for you."
Roger Levin, DDS, MBA and president of the Levin Group, Inc., a national dental practice management consulting firm, agrees that prepared, rehearsed scripts are absolutely necessary when conversing with patients. "Moving a patient into a certain time-frame within the schedule is important. Create an image for the patient that conveys that you are doing him a favor. This requires advanced verbal skills, a pleasant personality, and a sincere desire to make everyone happy," he said.2 Levin suggested that words such as "certainly," "my pleasure" and "no problem" are perceived as courteous and helpful. As has been said before, excellent verbal skills are a must for the best communication. It is an important ability that helps practices grow.
The above script serves to allay any fears about making an appointment so far in advance, with the resultant objection by patients that they are being locked into something uncomfortable or inconvenient. It is also important to note that many appointment coordinators have in their own minds the idea that patients do not want to preschedule appointments. Their speech and actions reflect that thinking, which only helps to confirm the reason the prescheduling system is not working in a particular practice. It is also important as part of this prebooking system to complete a postcard with the day, date, and time of the appointment at the same time the appointment is scheduled. Those postcards should be filed in a "tickler" file by month and mailed out three to four weeks ahead of the scheduled appointments. Most software has the capability to send a personalized letter to the patient reconfirming the importance of visiting the office so the hygienist can check for any special areas of concern and the dentist can proceed with the periodic examination and oral cancer screening. This reminder gives continuing care patients ample time to reschedule their appointments if necessary and gives the appointment coordinator ample time to repair any openings in the schedule.
Along with the reminder cards or letters discussed above, a telephone call 24 hours prior to the appointment is often still necessary. There are additional ways to help ensure a successful prescheduling continuing care system. The dentist and/or hygienists should all be part of the prebooking team. In fact, the system will be most successful if the dentist or hygienist is actively involved in motivating the patient to return for any needed treatment in addition to the prophylaxis. The front desk appointment coordinator can efficiently schedule the hygiene department without knowing the patient’s condition; but one prophylaxis every 40 or 50 minutes, for example, is not necessarily the most efficient use of the hygienist’s time. In many offices, the best way to enhance and control the hygiene schedule is for the hygienist to schedule the next appointment while the patient is still in the chair. The perceived value, as was discussed earlier, can be enhanced dramatically if the dentist and hygienists participate in the program. Therefore, it is strongly suggested that the dentist or hygienist create a "set-up" situation by giving patients reasons to return by telling them that they are expected to return during a specific month.
Further, it is highly recommended that one avoid the statement, "I’ll see you in six months." The patient will be much more apt to remember the name of a specific month (e.g., September) rather than the number of months (i.e., return in six months). After a short time, the patient will likely not recall what the sixth month is unless the name of the month is used in the beginning. "I know I went to the dentist a few months ago, but I can’t remember when"3
The point here is that scheduling the next hygiene visit should not be left up to the appointment coordinator alone. The dentist, dental hygienist and clinical assistant should be discussing the return visit before the continuing care patient arrives at the front desk. To illustrate further, if the patient has been seeing the dentist for a number of dental procedures and has now completed the treatment, the patient is ready to move into maintenance. At the end of the last treatment appointment, it is important for the dentist to give the patient a reason to return to see the hygienist. The reason must be more than simply performing a prophylaxis. Therefore, upon dismissing the patient at the completion of the last treatment, the dentist creates a perception of value and importance in the mind of the patient by saying, for example, "Take care, Mrs. Brown, I’ll see you at your continuing care appointment in August. I want to be sure that the tissue around the crown that I seated today remains healthy." The clinical assistant should reinforce this statement so the patient is not surprised when he or she reaches the front desk and the appointment coordinator schedules the next visit. In this way, perceived value has been created.
With the use of good organization and management and the use of the appropriate verbal skills, more patients will preschedule. Karen Greenhouse of Karen Greenhouse and Associates said prescheduling is vital for any dentist who has an existing preventive program in the practice. "If you understand the psychology of prescheduling patients, you will undoubtedly choose to preschedule. Most of your patients’ lives are busy. Careers, jobs, family and other doctor’s appointments dominate their calendars. If your office helps patients to preschedule, the patients will automatically work the rest of their lives and appointments around the already existing continuing care visit. Yes, sometimes that appointment needs to be changed. However, the name of their dentist remains in front of the patient for months before the visit. By prescheduling, you help the patients keep the priority of their dental care in their minds," she said.4 Remember, keeping control of the conversation with the patient is a must for a successful appointment schedule.
As with any system, there are some drawbacks. One such drawback is that the hygiene schedule is filled far in advance. Hence, it is appropriate to reserve some appointment openings for new patients. If a practice sees an average of 25 new patients per month, one can assume that there will be approximately 25 prophylaxes or other dental therapies that need to be scheduled. Should the entire month be scheduled with patients who have been prebooked three to six months in advance, there will be no way to accommodate new patients. Accordingly, it is wise to reserve five spaces per week for new patients. As a rule of thumb, one should plan on filling the reserved slot (if it hasn’t been filled) within 48 hours of that appointment time.
The second drawback to this program is that the dentist and hygienists must be well-organized so they can be sure that their personal schedules do not interfere with the patient appointment schedule. Therefore, vacations, personal days, continuing education courses and conventions must be planned far in advance. These days should be marked out on a year calendar, with this information being communicated to the appointment coordinator so that the schedule can be blocked out accordingly. If it is the dentist’s philosophy, or the law in the area, that a hygienist cannot treat patients without the direct supervision of the dentist, everyone involved must plan ahead and be in agreement. Should the staff fail to do this, the practice may find a full day of hygiene patients scheduled with either the hygienist or the dentist absent. The front desk will be left with a dilemma.
Finally, it is important to revisit the issue of efficient systems. As mentioned earlier in this article, a system is only as good as the person responsible for it. Therefore, it is vital that the practice have one individual who is responsible for the continuing care system’s effectiveness and efficiency. Too often, this part of the practice is left to chance and/or more than one administrative individual. For any program to be effective, one person should be assigned and the program’s effectiveness reviewed on a quarterly basis. It is also possible to employ an individual outside the staff to purge the current files so as to reactivate those patients who have failed to return, for whatever reason. It is not correct to assume that because a patient has not returned for a continuing care visit that he or she has left the practice for another dentist. There will be a number of patients who have chosen to seek care elsewhere; however, a large number of "inactive" charts are patients who have simply avoided an appointment and, with some coaxing, will return to the practice.
There is a misconception in many practices that the charts have been purged completely. Further investigation usually shows that there has been inadequate organization and preparation for a successful program. As in an effective continuing care program, there must be a plan and the patient must be given a reason (perceived value) to return. To illustrate this idea, if a patient is called and hears, "Mrs. Brown, it has been six months since you were in to have your teeth cleaned. Would you like to make an appointment?" she will probably not schedule a visit. Why? There was no perceived value conveyed nor was there any importance communicated. Why is having one’s teeth cleaned important? Additionally, the question asked by the caller is a closed-ended question, as mentioned earlier. Instead, each patient’s chart should be pulled to find a reason for the patient to return to the practice.
There are two scheduling scripts provided in Figure 1. One is for the patient who has not been into the office for six months or less. The other is for the patient who has not been in for more than 12 months. If the patient has not been into the office for more than a year, scheduling him or her for an oral cancer screening, periodic examination, and a professional prophylaxis is less threatening and more appealing to the patient than trying to schedule a treatment appointment. Figure 1 is included here for dentists to photocopy and use in their offices. The name of the person performing the audit and the date should be noted on the form.3
A recall program cannot be effective without organization, planning, good management, and good verbal skills. The most effective recall system is the prebooking system in which the patients of record are in the schedule, precluding the necessity of tracking them down if they do not respond to a reminder postcard. It is far easier and more effective to reschedule patients, if necessary, than to have to telephone and convince them to schedule hygiene visits. Experience shows that the majority of patients do not respond to the standard reminder card used in the passive recall system. Good verbal skills and the institution of a telephone audit/purge campaign will promote the continued growth of any dental practice.
Author
Jeffrey M. Goldstein, MBA, is an assistant professor and course director of practice management at the University of California at Los Angeles School of Dentistry. He is also a practice management consultant with Barron and Goldstein.
References
1. de St. Georges JM, Editorial. Management: Building the Successful Dental Practice Jan/Feb 1999.
2. Levin R, Customer. Independent Dentistry 4:23, Dec 1999.
3. Goldstein JM, How to improve your recall system. Independent Dentistry UK May 2000.
4. Personal communication.
To request a printed copy of this article, please contact/Jeffrey M. Goldstein, MBA, Barron and Goldstein, 2239 Cheremoya Ave., Los Angeles, CA 90068-3006 or at jgoldst@ucla.edu.
Figure 1. Dentists are free to make photocopies of this form for use in their offices.
