Patient Development and Maintenance Chapter 9 PDF

# Patient Development and Maintenance ## Objectives After completing this chapter, you should be able to do the following: * List and explain guidelines for developing patient loyalty to the dental practice * Explain the purpose of a recare system and name the primary types of recare systems * De...

# Patient Development and Maintenance ## Objectives After completing this chapter, you should be able to do the following: * List and explain guidelines for developing patient loyalty to the dental practice * Explain the purpose of a recare system and name the primary types of recare systems * Demonstrate strategies for encouraging patients to preschedule treatment and hygiene appointments * Describe different patient reminder methods * List both internal and external methods of marketing the dental practice ## Key Terms * patient recare system * reactivation letter * patient retention marketing * new patient marketing Besides being a healthcare facility, the dental office is also a business. A financially successful practice depends on a regular flow of patients. A patient who is disappointed at the treatment and care received may decide to find another dental office to attend. Each time a patient decides to leave the practice, the result is a loss of revenue. Thus, each member of the dental team has a role to play in the development of patient relationships. The role of the dental administrator in maintaining and acquiring new patients in the dental office is an important one. In particular, the dental administrator is expected to develop patient loyalty by making a good first impression, making the patient needs a priority, communicating effectively with patients, and maintaining up-to-date contact information. Furthermore, the dental administrator must effectively manage a recare and reminder system and contribute to the marketing of the dental office. ## Developing Patient Loyalty Developing patient loyalty to the dental office is an ongoing process that takes time and efforts on the part of every team member of the dental office. For instance, a patient who contacts the dental office for the first time may have many questions about his or her specific dental needs, and the office administrator must be able to answer those questions with confidence and clarity. Building positive patient relationships affects all staff members in that patients will begin to trust other staff members once they develop trust with one. The same holds true in situations where a patient loses trust in one staff member; that is, the loss of trust with one team member impacts the relationship with the whole team. The following are guidelines for the dental office administrator for developing trust and long-lasting patient relationships to build and maintain the patient base of the dental office. ### Make a Good First Impression You have only one opportunity to make a good first impression on a patient. The impression the dental administrator makes on patients, or anyone entering the dental office, strongly influences their perception of the dental office. Each person who comes into the dental office should be given immediate attention. If a patient enters the office for a scheduled appointment, consult the schedule and greet the patient by name. If the patient is a child, greet the child by name as well as the parent. Communicate any delays in the schedule immediately and offer the patient some form of comfort or distraction, such as a glass of water or magazines. For children, provide books or coloring materials that are age appropriate. Addressing patients on their arrival is an important part of building the patient relationship since it communicates to patients that they are important to the dental practice and it is a recognition that the patient time is valuable. The goal of the dental administrator is to create a positive perception of the office for the patient, which will facilitate an enjoyable dental experience and lasting relationship. Moreover, a patient who feels a positive relationship with the dental office will be more likely to accept and follow through with treatment prescribed. You can accomplish this goal by applying many of the professional guidelines discussed in earlier chapters, which are summarized below: * Dress professionally. Your outward appearance is an indication of how you feel about yourself, your environment, and the business you work for. As a front office staff member, you are a frontline representative of the whole dental team. A clean, neat outward appearance communicates pride in the work you do and the people you work with. * Smile when speaking with the patient. Being approachable is an essential element for relationship building. Smiling when greeting or speaking with patients portrays an approachable attitude that facilitates communication with others. * Greet the patient promptly. Addressing patients and their reason for attending the office is a professional way to acknowledge patients’ presence and communicate to them that they are important to the dental team. Patients who are left waiting at the front office quickly develop a negative impression of staff members and the quality of service. Furthermore, paying attention to people who enter the dental office avoids situations in which a front desk that is not attended to can become a situation for crime to occur. * Do not carry on personal phone calls while working. A patient who is in the reception area can overhear any telephone or face-to-face conversation you have with others. If you must make or receive a personal phone call, find an area where patients will not overhear your conversation. Personal conversations are unprofessional in an environment where patients are present. * If you are busy with another patient, give the patient who is waiting a verbal or nonverbal cue of acknowledgment. If you are on the telephone, glancing up and nodding your head and smiling is a nonverbal way to give a patient a cue that you are aware they have come into the office, and will be with them as soon as you can. If you are speaking to another patient face to face, interrupt your conversation briefly to acknowledge the other person and inform them that you are currently with a patient and let them know when you will be with them. If you see the patient and you do not acknowledge his or her presence, the patient will perceive this as being ignored. * Keep the front desk and reception area clean and well-organized. Patient charts and other paperwork are considered confidential in the dental office. Leaving information on the front desk where it can be viewed by others violates patient confidentiality. Keep paperwork on the front desk in a neat, organized manner to avoid visual access by other patients. In addition to adopting these practices, be prepared to respond intelligently to any questions a prospective patient may pose to you regarding the dental practice. A list of questions you may have to field is provided in Box 9-1. ### Focus on the Patient First Creating a patient-centered dental practice means that the focus of the practice is on providing services that the patient wants. The patient-centered practice places the needs of the patient first and takes the emphasis off of the patient as someone for the dentist to treat. For example, the patient-centered practice will have appointment hours that are accommodating for patients, such as in the evening or on weekends, an after-hours emergency contact will be available for patients and has systems in place that educate patients on all aspects of their dental treatment. Ultimately, the team of a patient-centered practice listens to the patients and provides solutions for their concerns. Exceptional customer care for each and every patient in the office is the focus and assists in successful relationship building. Treat each patient as if he or she is the most important person in the dental clinic. This means, give patients your full attention when they are in the office, return phone calls in a timely manner as promised, and always thank them when they call or come into the office. When ending a telephone call, say "Thank you for calling" and when a patient is about to leave the office, say "Thank you for coming in today," acknowledging that the patient has chosen to attend the dental office can be a welcome compliment. Remembering details about patients when they are in the office goes a long way toward building relationships and practice loyalty. Mention birthdays, vacations, and other special events that you are aware of regarding the patient. ### Keep Information Up-to-Date Each time the patient comes in to the practice, confirm that there are no changes in address, phone number, work number, or insurance coverage. Patients often forget to let their dentist know that they have a new work number or cellphone number where they can be reached. A quick check by asking, "Have there been any changes to your phone number, address, or insurance information that we have on file?" should elicit the information you need. Keeping the demographic information up-to-date is just as important as keeping a patient's health history current in the chart. Your responsibility is to ensure that the patient chart is current. To contact the patient, you must have the correct mailing address and telephone number. Sending time-sensitive mail such as account statements to incorrect addresses creates frustration for you and the current occupant of the address. In Chapter 8, we discussed the importance of updating patients’ health history on a regular basis. In addition, as children grow older and become adults, maintaining the health history information in the chart is important and can be easily overlooked; therefore, it is important to consider the child the same way you would an adult patient in this regard. ### Follow Up and Follow Through Each patient in the dental practice must be contacted, by a phone call, letter, or postcard, at some point during the 12-month period after his or her last appointment. Always follow up with patients regarding treatment that has been done or needs to be done, and follow through by contacting them in the method and timeframe promised. Not staying in touch with patients could mean a loss of a patient and revenue for the practice. This chapter highlights some of the marketing strategies commonly used in the dental office for patient relationship development. ### Inform Patients of All Treatment Details and Costs Another way to foster goodwill with the patient is to clearly disclose all relevant treatment details, especially related to cost and financial arrangements. Use a detailed treatment outline form and financial responsibility form to outline patient responsibility. Being upfront about the costs and length of treatment avoids unpleasant surprises when treatment is complete. Chapter 15 covers the particular elements involved in treatment planning and how to effectively present a treatment plan to a patient. ## Recall/Recare Systems A patient recare system, also known as a recall system, is a proactive method of scheduling future appointments with patients and reminding the patients of these appointments. Note that in this text, the term recare is preferred, as the term recall can have negative associations and can make the patients feel that their appointment is not important. The dentist is not "recalling" the patient back to check whether the dentistry needs to be replaced, much like how a car company recalls a car for a defective part. Thus, avoid the use of the word recall when informing patients of their need to return to the hygienist. Other terms used to describe this type of appointment include continued care and preventive care. The reminder and recare system can be paper-based (letters, cards), electronic (computer database), or by telephone. The critical component in the recare system is that patients are receiving their notification of a recare appointment and that the office administrator documents all communications with patients. The patient recare and reminder system is an integral part of maintaining patient relationships in the dental office. Regardless of the type of system in place in the dental office, they all have the same goal: maintaining patient flow through relationship maintenance. It is important for the patient to feel the need and the importance of returning to the dental office on a regular basis. Creating the patient's perception of the practice begins with the dental administrator and continues as the staff members place importance on and emphasize the value of the recare appointment. Without the perception of value, patients will be more hesitant to schedule or maintain a recare appointment. Good verbal skills, team communication, and patient education are an important combination for a successful recare system. The main types of recare systems used in dental offices are as follows: * Prescheduled recare appointments * Written correspondence and telephone recare systems One of the many concerns in a dental practice today is having an effective recare system. Any recare system is only as good as the person responsible for its success, and that person must monitor it constantly in order for the system to be effective. The dental office administrator is largely responsible for the success of this system. ### Appointment Prescheduling Avoid this scenario: Administrator. Do you want to schedule your appointment now? Patient: No. I'll have to call you. Use these alternatives: Administrator: Mr. Jones, our hygienist, Jane, would like to see you in 3 months. She has an opening on Monday July 14 or Tuesday July 15. Which day is better for you? Or Administrator: If you schedule your appointment now, I will mail you a reminder card 3 to 4 weeks prior to the appointment, and if you need to reschedule it, there will be no problem at all. These suggested scripts focus on getting around patient concerns regarding scheduling appointments too far in advance. Scheduling an appointment too far in the future may make patients feel locked in. Maintain control of the appointment schedule by reminding patients well advance of their appointment. ### Prescheduling Recare Appointments Prescheduling recare appointments means scheduling a patient's next appointment before he or she exits the practice after a completed appointment. This can be a very effective recare system for several reasons: * Patients have an appointment in the schedule, and the patient has requested to be contacted if an appointment earlier than the one already scheduled becomes available. * The goal of effectively maintaining the daily schedule and the level of production is much more easily achieved since patients do not have to be encouraged to set appointments after they have left the practice. A general rule of thumb when prescheduling recare appointments is never to ask a closed-ended question. A closed-ended question solicits a "yes" or "no" answer, and often the answer is "no." Box 9-2 provides some scripts that can be used for navigating through objections when prescheduling patients. Encouraging the patient to schedule the next appointment before leaving the dental office begins with the clinical team while the patient is in the operatory. For example, a patient who has come in for an annual examination with the dentist is told that she needs to return for an appointment for a filling. The dentist explains to the patient the risks involved in waiting too long before getting the treatment and the advantages to having the tooth treated early. When the patient arrives at the front desk, she informs you that she did not bring her schedule and will have to call you. Your role is to make appointment scheduling for the patient hassle free. In this situation, you can do the following: * Offer the patient an appointment that is at the same time on the same week day in the future; oftentimes, patients will schedule appointments on specific days where free time is more likely, such as the patient who schedules appointments every second Friday because that is a regular day off for him. * Inform the patient that you will call her later on in that day or early the next day. Some people lead very busy lives, and it is often more convenient for the patient to be contacted about scheduling the appointment rather than expecting the patient to contact the office. * Offer to e-mail the patient. Electronic forms of communication such as cellphones and e-mail are common in the workplace. Many people prefer the freedom of answering e-mail letters at a time that is convenient for them, for example, when they are at home in the evening. ### Written Correspondence and Telephone Recare Systems Written correspondence recare systems involve sending letters to patients to remind them of future needed treatment. These letters can also be used to introduce an exciting new method for treatment. Letting patients know what treatment is available to them can encourage them to make an appointment and often serves as a personalized reminder. Such correspondence is a gentle and effective way of maintaining contact with patients, particularly if it has been some time since they have been in to the dental office. Sending a letter to the patient who has not been in the dental practice for quite some time is often referred to as a reactivation letter. Figure 9-1 provides a sample of a letter aimed at reactivating the patient to the dental office. A telephone call is always made approximately 2 weeks to 1 month after the letter is sent out as a way to follow-up on receipt of the letter and attempt to schedule an appointment for the patient. Recare cards are also used to correspond with patients and are mailed out monthly. Each patient in the practice has a particular time frame in which the dentist or hygienist recommends he or she return to the practice, or that the patient requests he or she be notified. Most patients are asked to return for an examination and cleaning every 6 or 12 months. This means that on the 6 or 12 month time period from when the patient was last in the dental office, he or she will get a notification to return to the office for his or her examination and cleaning. ### Patient Reminders Reminding patients of scheduled appointments is a large responsibility of the dental office administrator. Different types of patient reminders used in the dental office and methods of effective scheduling are discussed next. The patient reminder cards are very important marketing materials used in the dental office. #### Telephone Reminders Each patient who has an appointment in the dental office must receive a phone call one business day prior to the appointment. Make the reminder phone call simple and direct. Use terminology that the patient understands. The following are examples of effective telephone reminders: * Use the following if you speak directly to the patient: "Good morning Mrs. Brown. This is Sandy from Saddlelake Dental Clinic calling. How are you this morning? (Wait for response.) I am calling to confirm your appointment with Dr. Jones at 9:00 AM tomorrow morning. (Patient will confirm attendance.) We're looking forward to seeing you then. Have a good day." * Use the following if you get voice mail or an answering machine: "Good morning Mrs. Brown. This is Sandy from Saddlelake Dental Clinic calling to conform your appointment with Dr. Jones at 9:00 AM on Tuesday morning. Could you please call our office to confirm this appointment at (999) 555-1234? Thank you and have a good day." Notice that the word confirm is used in these reminder phone calls instead of remind. Avoid using the word remind when confirming an appointment with a patient, as it can come across as condescending. "Confirming" the appointment sounds much more professional. When a patient informs you that they are unable to make their appointment time, the appointment should be rescheduled immediately. Chapter 10 focuses on rescheduling appointments and effective terminology to use in this task. Having a short-call list, which is a list of patients who wish to come in and see the dentist on short notice, will be helpful in situations in which patients reschedule the day before their appointment, as these newly vacant time slots can then be filled. When all of the patients on the schedule have been called, a notation as to the status of the call-such as "confirmed," "no answer," or "left message"-should be made on the schedule. #### Mailed Reminder Cards Although calling patients is often seen as the most effective way to remind them of appointments, some dental offices may choose to mail a reminder postcard in place of, or in addition to, a phone call. Reminder cards are usually mailed out approximately 1 to 2 weeks prior to the appointment day to patients who have scheduled their appointments weeks or months in advance. The reminder card includes the date and time of the upcoming appointment and may be used for annual dental examinations, oral cancer screenings with the dentist, or scheduled dental cleanings with the hygienist. Figure 9-2 provides some examples of such a card. #### Computerized Dental Recare Systems Computerized dental recare systems can create 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 type of reminder provides patients with a reasonable amount of time to reschedule their appointment if required, or enough time to arrange in order to allow the time for the appointment. Such cards are mailed to patients who schedule their next appointment months in advance before leaving the office. The most effective way to maintain an appointment reminder system is to keep preprinted reminder cards on hand with an area to record the date and time of the appointment and the name and address of the patient. Ask the patient to fill out the information on the card and then place the card in a monthly card catalogue file. When that month comes around, simply put a stamp on the reminder card and mail it to the patient. Patients are always pleasantly surprised to see mail for them that is addressed in their own handwriting! Following up with a phone call to confirm the appointment at least 2 days prior to the appointment. Confirmation of an appointment is important in maintaining a productive daily schedule. Providing patients with enough time to reschedule allows time for you to fill the vacant appointment time. #### Appointment Reminder Cards Patients who schedule an appointment for some time in the upcoming weeks are often given an appointment reminder card before leaving the dental office. An appointment card always includes the name of the patient, the date and time of the appointment, and the name and address of the dentist. Appointment cards with a removable sticker with the date and time are very popular, as patients can easily place the sticker on their calendar as a reminder (bottom of Fig. 9-2A). ## Marketing To be successful in today's economy, businesses, including dental offices, must compete for market share. One way that dental offices compete for market share is by incorporating marketing strategies into business practices. All businesses have a marketing program that is made up of many strategies that complement each other. In the dental office, there are strategies put into place that the office administrator is responsible for integrating into everyday tasks. The reminder calls and cards we discussed earlier are one way of advertising the dental office and maintaining the patient flow in the practice. All team members are responsible for contributing to the marketing of the dental practice. Each staff member should promote the practice by educating patients about the importance of maintaining good oral health and telling their friends and family about the dental clinic they work in. If the staff members in the dental office cannot speak positively about the practice and the philosophy it stands for, the chances are good that many patients will feel the same way and will seek out another dental office. In the dental office, there are two main types of marketing: marketing aimed at retaining patients and marketing aimed at attracting new patients. ### Patient Retention Marketing Patient retention marketing refers to the marketing that is done within the dental practice to retain patients. It starts with the first impression that the dental office administrator gives to patients when they call the office to make an appointment or come into the office. The perception that the patients have of the dental office is partially created through the internal marketing. The biggest influence on successful internal marketing comes from the dental team members. For example, the dental office administrator sets the tone for the patient by being cheerful and professional at all times. The dental assistant shows empathy and competence by ensuring that the patient is comfortable. The dentist provides quality dental treatment for the patient, and the dental hygienist educates the patient on the importance of good oral health. This brief example shows how each staff member contributes to the positive dental experience for the patient with a view to having the patient return to the clinic in the future. The following suggestions are used in dental offices and aimed at patient retention. These suggestions can also double as tactics used to obtain new patients. * Clean and tidy dental office. Keeping the front office area clean and presentable includes dusting, tidying books, straightening chairs in the reception area, and maintaining a neat and organized looking front desk. Incorporating standard precautions into the clinical areas and making patients aware of this fact is also a way to impress upon, and let patients know that the utmost care and attention to detail are valued in the dental office. * Cheerful voice and friendly face at the front desk. Keeping an upbeat attitude encourages patients to come into the office. A friendly and sincere attitude is contagious and the office administrator who reflects this attitude often has a positive influence on the rest of the staff and the tone of the appointment. Patients will enjoy attending the office and an upbeat attitude can often decrease the effects of anxiety on a patient. * Staff enthusiasm. Staff members who are enthusiastic about where they work, the job they do, and the people they work with can create an atmosphere that is enjoyable for patients. An enthusiastic attitude promotes the dental office and reinforces to patients that they have made the right choice in being patients at the practice. * Staff identification tags. Once you have introduced yourself to the patients the first time you meet, you have the advantage of seeing their names on the schedule and reading the chart in preparation for their next appointment. This helps staff to remember patients and makes it easier to learn the patient names. However, patients may not always remember all of the staff members’ names, which is the reason why each staff member should wear a name tag for identification. This allows patients to learn your name as they get to know you a little more at each visit. By getting to know staff members by their names, patients can much more easily develop loyalty to the practice. * Professional appearance. Dressing appropriately for your position and remaining aware of maintaining a professional appearance communicate to patients that you care about the image of the practice and are concerned that patients think positively about the office and the staff members. * Practice newsletter. A newsletter that is printed up and mailed out to all current patients of the dental office is an effective tool for keeping patients informed about the dental clinic. A newsletter usually includes information on topics such as new products, staff announcements, office closures, and education information. Additional methods of patient retention marketing are listed in Box 9-3. ### Marketing the Dental Practice #### Patient Retention * Correspondence such as cards and letters to patients * Relaxed environment * Patient referrals from existing patients * Giveaways such as magnets and pens #### Attracting New Patients * Office sign * Newspaper advertising * Yellow pages advertising * Tours of the office * Presentations at schools on oral hygiene * New patient incentives provided via a neighborhood welcome committee Ultimately, patients are more inclined to return to a dental office where the staff enjoys each other and the patients and where they do not feel as if they are just another number. Being polite and respectful at all times and addressing the patient by name are helpful in achieving the goal of patient retention. When patients trust the healthcare professionals they use, they often encourage friends and family to become patients of the dental clinic. The greatest compliment any patient can pay to a dental team is to refer his or her friends and family! ### Marketing to Attract New Patients Any type of marketing done outside of the dental office has a goal of attracting new patients to the clinic. A sign displayed outside the building indicating where the dental office is located, a practice name and phone number listed in the phone book, and an advertisement in a newspaper are all examples of new patient marketing. The following are some strategies that can be used to attract new patients to the dental office. * Staff business cards. All staff members should have a business card that tells who they are and the position they hold in the dental practice. When you are in a business situation such as a dental conference, you can very easily give out your business card so that your contact information is available to the individual who requires it. Patients also appreciate receiving a business card. As a dental office assistant, you will have many opportunities to provide a business card to patients, family, and friends as you assist in the recruitment and retention of patients to the dental practice. * New patient incentives. New patient incentives are used to attract new patients to the office and are often offered in the form of a service. For example, new patient incentives may include complimentary bite-wing x-rays with a new patient examination or a complimentary whitening product with a new patient examination. Other new patient incentives also include providing the person who refers a new patient with a gift certificate as a way to say thank you. * Web site accessibility. A very effective marketing strategy used by dental offices is the use of a Web site. Every day patients are searching the Internet for a dentist in their area. With the increase of computers in households and the number of people who have access to the Internet, part of the dental office marketing strategy should include attracting online consumers. The first impression of a dental office, for some patients, is made by a great-looking Web site. Additional ideas for new patient marketing for the dental office are provided in Box 9-3. Remember, however, that all the new patient marketing that is done can be undone very quickly if there is no recognition of the barriers that can occur when new patients call the practice to make an appointment. Chapter 10 looks at some of those barriers and how to avoid them. ## Chapter Summary The dental office relies on the office administrator to represent the practice in a professional and positive manner. As the relationship between the patient and dental team builds, the tasks and duties of the office administrator can help maintain and grow the relationship. Effectively using reminder and recare systems develops patient loyalty. Patient reminders and other types of marketing, both internal and external, can create a positive image of the dental practice for the patient. ## Review Questions ### Multiple Choice 1. The critical component in a recall system is * a. that it is computer- or written correspondence-based. * b. that patients receive notification and the office administrator documents it. * c. that patients feel recalled to the practice. * d. that patients are in the schedule and accessible. 2. Sending information to a patient who has not been to the dental office for some time is called a * a. recare card. * b. reactivation letter. * c. newsletter. * d. hygiene update. 3. Effectively using reminder and recard systems * a. develops patient loyalty. * b. guarantees to increase revenue. * c. creates more work. * d. involves all staff members. 4. An effective marketing strategy used in the dental office is * a. the use of a road sign. * b. the use of a Web site. * c. a mascot. * d. monthly telephone calls. 5. One of the many concerns of a dental practice today is * a. staff retention. * b. having an effective recare system. * c. production revenue. * d. patient relationship development. 6. Scheduling a patient’s next appointment before leaving the completed appointment is termed * a. recare scheduling. * b. prescheduling. * c. auto booking. * d. recalling. 7. Acknowledging a patient when he or she enters the dental office is important because * a. it lets the patient know that you are busy and will get to them when you can * b. sends a non-verbal message that the patient is important to the practice * c. is a way of letting the patient know you are aware of their presence * d. makes everyone feel better because you are nice to them 8. It is important to keep patient demographic information up to date in order to * a. maintain accurate contact and financial information about the patient * b. keep an up to date mailing address for time sensitive statements * c. carry out the office administrator responsibilities * d. all of the above 9. Dressing professionally is an example of * a. focusing on the patient first * b. making a good first impression * c. keeping information up to date * d. following up with the patient 10. An example of fostering goodwill with patients is * a. disclose all relevant treatment and costs associated * b. not staying in touch with patients through recall cards * c. keeping the front desk neat and clean * d. not acknowledging patients while you are on the phone ### Hands-On Activity 1. Create a script with a classmate regarding a patient who must preschedule an appointment to see the hygienist in 3 months. How are you going to encourage the patient to schedule the appointment without sounding pushy? 2. Create a Web site home page for the dental office you work in. What will you include on the home page and how will you make it appealing to new patients?