Over the many years that I have been a dentist, the leading lecturers and consultants in the world of dental practice management have focused on what is called the systems approach to improved financial performance. Of course, who would dispute the fact that well-thought-out systems improve performance, both clinical and financial? The editorial focus of articles in Dentistry Today, except for the occasional practice management Focus On or Viewpoint article, is devoted to clinical content, and the information published is but one of the many venues that can assist clinicians in their quest for a higher level of clinical knowledge. In my opinion, what has often been overlooked in much of the conversation is the reality that our team (and let’s not forget that we are also members of our dental teams) and our patients are human beings who thrive in the context of nurturing and supportive relationships.
To Be Human: What Does it Mean?
To define human beings as relationship-seeking entities would not be inaccurate. We form relationships with everything and everyone around us. That is simply a part of what it means to be human. Relationships are required for optimal performance and growth. Sometimes we are self-conscious about this, other times we are not. We are not mechanical in the sense that we cannot plug in formulae and predict outcomes in any consistent way. Think about it! Sure, we become better performers when we develop habits and specific protocols, but that is different than being flexible and nimble—in other words, just being human. There are way too many twists and turns in life to be able to predict everything that will be required of us.
Everyone is Unique
To state the obvious but often overlooked, Alan is different from Rose or Julio or Carol, and each of us needs to feel appreciated in our uniqueness if optimal performance is to be achieved. When I say “uniqueness,” I mean that platitudes are simply not enough. Human beings crave authentic appreciation, gratitude, and respect. What is said to us and about us has to sound real in order for the words to register. We need these things from others, and we also have to feed ourselves since our own level of confidence and self-esteem are essential building blocks. Nothing is more central to successful outcomes than self-esteem. There is a growing body of knowledge that unequivocally leads to the conclusion that practices that nourish the growth of healthy self-esteem of all its team members will experience greater business success.1
Rules for the Front Office Team
First, here are a few universal truths in successful monetary transactions:
- It is easier to collect fees from patients who feel respected and liked.
- It is easier to collect fees for service when we smile and exudeself-confidence.
I now want to introduce a distinction between interactions that are either transactional or transformational, or some mixture of both. This can be a key distinction, and we should be mindful of it. The front desk—the physical location where patients pay for services—is the place where the transaction is consummated. Of course, this is transactional. However, I maintain it is also potentially the place that the relationship with our patients can be enhanced and, therefore, becomes transformational. What does that mean? How can it happen? And what means can we employ to make it transformational?
Recently, I was discussing this distinction with a long-time patient, and he agreed that it was somewhat fuzzy, but then he told me a story that brought some clarity to what we were talking about. In his words:
“Years ago, when I came to the front desk, I was anxious. I was financially strapped at the time, and I had just learned that I needed another root canal. I felt bombarded by life, but Rosie couldn’t have been kinder or more understanding. Her voice and words soothed me. She told me not to worry and that we would work something out. I’ll never forget that interaction!”
There are many ways to characterize this conversation, and one way is to appreciate that it was transformational. Rosie, with her reassuring tone of voice and choice of words, created a conversation/experience that our patient remembered 25 years later. Interactions like this are transformational, and patients remember moments like this because they see and feel them as meaningful and/or special.
Examples in Effective Communication
The examples below help to shine a light on things our front desk team does routinely, thereby making them conscious and bringing intention to each task.
Setting the stage: The patient has just been dismissed from the treatment room and now stands in front of you. The front desk (FD) team member smiles (note: always smile) and says, “How did the visit go? I hope you are comfortable.”
The FD team member then:
- Gives any special instructions (orally/written as needed) that have to be conveyed. Is there a follow-up appointment required?
- Assesses the environment that the patient is entering into. Imagine being him or her and try to imagine what they see, hear, smell, and might feel. This trick is not new, as it was originally suggested that the treatment team members sit in the dental chair so we could see exactly what our patients see. There is no reason that this exercise shouldn’t be used for the patient experience at the front desk; it can be a very good learning tool.
- Considers, from the patient’s perspective, what things might need to be changed to make this interaction more pleasant and welcoming. Remember, happy, satisfied, and respected patients are way more likely to pay their bill in full and even frequently pre-pay for their care.
- Remains totally connected to the patient; this means no multitasking, no phone calls, and no other distractions. The other staff members need to know that they have to deal with everything that goes on so that you can concentrate on the person in front of you.
- Asks the classic customer service question, “How did the visit go for you?”
It is helpful to consider what might be distractions for the patient.
- Attire (uniforms or street clothes) should be clean, neat, and appropriate. Is there a dress code in the office?
- Speech: Is the language clear, well-articulated, and spoken in complete sentences?
- Smell: Is anything weird going on that could be distracting? For example, many foods have lingering smells.
- Do you have flowers? Are they fresh? Are they dead? No dying flowers!
- Auditory considerations are important! Are there any distracting conversations going on in the background? Conversations that other dental team members might be having that shouldn’t be part of the interaction you are having can be quite annoying to a patient. Remember you have to stay focused on and be with the patient who is present in front of you.
- Is there music in the background? Is it appropriate and chosen with the patients in mind or simply distracting background noise for the dental team?
The FD team member is the leader of this area, and we should be able to grade each interaction from 1 to 10 and collectively explore ways to improve. I previously wrote in Dentistry Today about how the team meeting is the setting to discuss all of these things.2
Back to the Notion of Relationships
The question is how do we, as the clinicians and practice owner-leaders, create the conditions that allow our dental teams to learn how to improve patient relationships? The answer is that we can use the experience at the front desk mentioned above as the model. What skills are on display here, and how can we improve them? Using the Team Meeting format, we can practice consciousness-raising and relationship-building skills and then use them not only at the front desk, but throughout the practice. Held regularly, these meetings, using an agreed-upon and well-organized protocol, help us practice and improve the skills needed in every interaction with our patients. The secret sauce in all of this, the thing that binds us to each other and to our patients, is the relationships that we have and nurture. Sometimes we do this self-consciously with intention, and other times it is done effortlessly without having to think about it. In either case, the practice leader and the dental team must dedicate themselves to this activity. Okay, that is simple so far, but what is neither simple nor obvious is how exactly we can teach these essential relationship-building skills.2 Using the essentials in the context of Team Meetings, we commit to the improvement of team relationships.
These meetings need to be properly designed and skillfully facilitated so that the thoughts and emotions of the entire team are given air, heard, and respected so that the issues and good stuff are expressed. The questions that must be asked and answered are “What are we doing well, and what things need improvement?” This is how relationships are deepened. We actually practice talking to one another about the easy and hard stuff. This challenging work pays huge dividends for our lives inside and outside the office.
A sports analogy might be helpful here: Players improve performance by repeating an activity over and over again. Relationships can be seen like that; some team members do it easily, but most of us can get better at it by repetition. At Team Meetings, we practice conversations and relationships, and, over time, our skills improve. As our skills improve, we are able to more effectively relate to our patients. Not surprisingly, our abilities at the front desk will improve, as will our abilities at fee collection.
CLOSING COMMENTS
I stress team meetings because they can be a wonderful learning tool and, over time and with repetition, bring success. The time spent in team meetings can be used to teach the entire team the skills and levels of appreciation/gratitude that create a culture, which results in an office that works and interacts at an incredibly high level. Organized and properly led team meetings can create this work-related culture that is nurturing and positively experienced by all, including the patients being served. High-end businesses have regular staff meetings. The positive results that can be born from these meetings in our dental practices will be seen by our patients, who will begin to view their dental treatment experiences in a positive light.
References
- Branden N. The Six Pillars of Self-Esteem. New York, NY: Bantam Books; 1995.
- Goldstein AJ. The eleven essentials of effective staff meetings, part 2: Getting it together in the name of customer service. Dent Today. 2004;23:146-149.
Dr. Goldstein graduated from the City College of New York before receiving his dental degree from the University of Pennsylvania School of Dental Medicine in 1968. He holds leadership positions in and a Mastership with the Academy of Laser Dentistry. Dr. Goldstein is a founding member of the newly formed Dental Coaches Association, a uniquely qualified group of certified dental coaches. He maintains a general dental practice as well as a coaching practice in New York City. He can be reached via email at llaama1@mindspring.com or via the website coachingpractice.com.
Disclosures: Dr. Goldstein reports no disclosures.
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