Fall 2000 Practice Management Diary:

According to orthodontic practice consultant Karen Moawad, the 13 most common issues that aggravate orthodontic patients and parents are the following:

1. Being seen late for your appointment without being told why or given the opportunity to reschedule

2. Lack of available appointment time

3. Feeling rushed during the appointment

4. Lip service - printed materials from your office or your staff that say, "We care about our patients," and then no one is available on the weekend to handle a sticking wire

5. Cold, indifferent, or condescending attitudes

6. Inability to listen to a patient's concerns

7. Receiving a bill before one has been informed about it

8. Receiving treatment of any kind without prior information

9. Inadequate information prior to anything

10. Inadequate emergency service

11. Delay or failure to return phone calls or letters

12. No recall system - a real lack of service to working or busy parents

13. Inadequate phone lines

Once the inevitable occurs, and the parent is mad at you or your staff, what happens next? Here is one scenario:

Your practice has a new family. Their examination, diagnostic procedures, consultation, and financial arrangements go along without a hitch. But, when the parent and child arrive for the delivery of a removable appliance, it is not in the office due to a laboratory error. You have systems in place to prevent such mishaps, but a series of glitches isn't caught. Mom and child are disappointed and angry when they hear the news. The appointment coordinator tries to make amends by scheduling a new delivery appointment after school instead of the usual during-school hours. The basic problem may have been solved but both patient and parent have lost confidence in your practice.

A Better Approach

The following scenario shows how this situation could have been handled so that satisfaction and confidence in your practice were actually raised:

Your treatment coordinator calls before the patient and mom leave for your office:

"Mrs. Manes? This is Judy Howard at Dr. Wilson's office, the orthodontist?

"Yes, hello. I'm afraid I have some bad news for you and Betty. There was a mix up at the lab and her retainer will not be ready today. We'll have to reschedule her appointment.

"Oh, I'll bet she will be, and I'm very upset to cause her disappointment. Dr. Wilson asked me to call you to apologize and to see what we can do to make this right. First of all, the retainer will be ready the day after tomorrow, and I want to reschedule at your convenience. What time would be good?

"5pm on Thursday? Fine. Now let me ask: Did you have to take off time from work or engage a babysitter for Betty's little brother? In other words, did we cause you any unnecessary expense? If so we want to be sure that you are reimbursed.

"Yes, I am very serious. Mistakes can happen, but when they do we are determined to correct the situation.

"So the babysitter took Benjamin to a movie? Would you please deduct the cost of the babysitter and the movie from your next payment to our office? I will instruct our bookkeeper about it.

"Mrs. Manes, I'll feel very badly if you won't do that.

"Thank you. We'll look forward to seeing you and Betty on Thursday at 5 pm.

"Bye."

After the phone call Judy wrote a note to the bookkeeper explaining that Mrs. Manes would deduct an unknown amount from her next payment. Then she wrote a note of apology to Betty Manes, and enclosed two free passes to the local cinema.

Clearly the treatment coordinator is doing more than expected in this situation-and that's the idea! If you want your patients and parents to maintain a high level of confidence and satisfaction with the service and professional behavior in your office, you will always have to do more than just fix the problem.

Implementing Service Goals

There are several difficulties in getting your staff to deal with problems in this new way. First, it is not a way people typically behave with their friends or families, and it's not easy finding people who have a natural aptitude for presenting a quality service.Your staff will have to be trained.

Second, you and your staff will have to agree on a service goal. Although most orthodontists and their staff members have operating service goals, they it may not have been discussed within the office. The result is an implicit service goal, where each person operates under his or her own personal view of proper service. If orthodontic teams have discussed aspects of a service goal, some have not made wise choices. Some poor service goals might be:

1. We will strive to provide service as directed by the doctor. Anything the parent or patient wants from us beyond that will have to be discussed.

2. Unhappy patients or parents should be referred to the doctor or the treatment coordinator.

3. Patients or parents are always right. We will strive to make them feel that way regardless of whether we believe, understand, or accept their position.

A better service goal would be to ensure that each patient and parent is satisfied with your service and professional care. When we make a mistake we will take initiative in providing a thoughtful solution and, in addition, we will make an unexpected extra effort to win back the patient's or parent's confidence and satisfaction. Finally, we are committed to examine the problem and see if a change in our systems or behavior is warranted.

You will need a sincere commitment from everyone who works with the patients and parents to understand and embrace the service goal. This will require meeting together and brainstorming the precise wording and the implications of your service goal statement until each person can understand and implement it.

You will also need to delegate authority to settle the problems that arise. When your adult patient complains to your billing secretary that the replacement of a retainer should not have resulted in the bill that was sent, the usual response is, "I will talk to the doctor and get back to you." This may take minutes or days. Meanwhile, the patient continues to fume and discuss the problem with family and friends. If the bookkeeper has authority and training, she might say, "Well, from what you say, Mr. White, I will reverse the charge immediately. You may discard the statement. But, I am much more concerned about the breakdown in communication around this. We try to be very careful to inform our patients properly before billing. I will discuss this with Dr. Wilson and the assistant who saw you at your last appointment. One of them will call you to see what we can do to avoid a situation like this. When is it convenient for you to receive a call?"

She finishes the call and discusses the problem at the morning meeting. The dental assistant who took the impression for the replacement retainer indicated that the retainer was being replaced because of a defect in the acrylic, which allowed plaque to collect. There should not have been a charge, but she had failed to properly indicate this on the bookkeeper’s copy of the lab receipt. Later that day, she called Mr. White to explain what happened, and to say that his feedback helped the staff to improve the existing system. After she hung up, she sent him two movie passes with a thank-you note.

The staff and Dr. Wilson re-viewed the procedure at staff meet- ing and decided that every lab slip must be marked either charge or no charge. Prior to this, lab slips were marked N/C, or no charge. If not marked, a charge was automatic.

A Team Effort

There is no prescribed method for handling service problems in the orthodontic office. It takes creativity on the part of all the staff. But they can't even begin unless you have given them the authority to reverse a charge, send a gift, make an appointment at an unusual time, order a taxi, deliver a bouquet of flowers, or whatever else seems to be just the right thing.

Finally, you will need to pay for all this good will. At first, your staff could end up giving away hundreds of dollars each month, However, as each episode changes and improves your service capabilities, you will find that the need to make amends to disgruntled patients and parents will practically disappear as your reputation for flawless care-taking increases.

Why worry about angry patients and parents? If you depend on referrals, you obviously don't want negative comments flying around. You can also learn from people who have experienced problems with your service. Unfortunately, when people are angry they may not want to give you feedback because they wish to avoid a dispute, or, they may simply not want to help. At some point, they might even wish to hurt you. However, if a prospective patient hears how successfully you handled a problem, that may be the positive recommendation that drives that person to the tele-phone to make an appointment. Successful management of complaints and mistakes can be a powerful practice builder.

 
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