Broken appointments

Oct. 2, 2014
Communicate the value of the dental hygiene appointment

Communicate the value of the dental hygiene appointment


Dear Dianne,
We are having a terrible spate of broken appointments, and the problem is stressing the doctor in a major way. We've always had a few, but lately, the problem seems to have grown. If my schedule is full, I will usually see eight or nine people. Every day, I have at least one opening, and sometimes there are several. One day last week, I only saw three people, which really made me feel terrible! Can you give me some tips that I can pass along to our business assistant that will help us with this problem?
Kerrie, RDH

Dear Kerrie,
There are many reasons why patients disappoint or cancel at the last minute, some of which are valid. However, from your brief post, it is clear to me that your office needs to make some wholesale changes in communication with patients. Ineffective communication is at the heart of many downtime problems. Let's begin with the basics.

Have you ever wondered why there are more disappointments in the hygiene department than on the doctor's schedule? The biggest reason is that the hygiene appointment is trivialized by phrases like "just a cleaning," or worse, "cleaning and check-up." Everyone in your office should remove these phrases from their vocabulary. I recommend that the standard hygiene appointment be called "preventive care," "continuing care," or even "professional hygiene care."

Please understand that the "label" we place on the hygiene visit cannot overcome poor quality care. Patients should receive more than a "flick and polish" visit if they are to perceive the care provided as high quality. Patients are not stupid.

Another phrase to eliminate is "deep cleaning." This phrase conjures up all kinds of unpleasant images in the minds of nervous patients, which may lead to cancellations or disappointments. Stanley Steamer deep cleans carpets. Dental professionals provide "definitive periodontal therapy." Further, I recommend that the periodontal maintenance visit be called a "disease control visit."

At the business desk, the process of "confirming" appointments can be counterproductive. "I'm calling to confirm your appointment ..." sends the message that the office is not sure the patient is really coming. So we have to confirm an appointment that the patient gave his/her permission to place in the schedule. So another word to eliminate is the word "confirm." Instead, we provide "courtesy reminders" to patients who desire them. Otherwise, the office should consider the appointment to be confirmed whenever the patient schedules the appointment, although it is appropriate to ask patients if they would like a courtesy reminder. If the patient requests a reminder, find out which number to call, tell the patient when the call will be placed, and ask about the medium for the message:

"Tell me, which phone number is best for me to reach you directly?"

"Do you prefer text messages or email notifications?"

"Will my call be going to voicemail?"

Many offices preappoint all hygiene patients for their next visits. For many patients, this is acceptable. However, if a patient has a history of disappointment or late cancellation, it may be more prudent not to allow such a patient to preappoint. Preappointing is a privilege that should not be extended to everyone. You need to be discriminating about whom you allow to reserve appointment times that are several months away. Here's a model response for patients who preappoint only to disappoint:

"Mrs. Jones, we've had previous issues with coordinating your busy schedule and ours, so I believe it would be best if we were to contact you when it is time for you to return."

If a patient insists on prescheduling, you have to be sure to make your point with grace and tact:

"We know you are busy person, and we are a busy office. If you reserve time, there is a commitment on your part to keep the appointment and a commitment on our part to provide you with the best care. We'll keep our commitment if you will, too."

Any patient with a history of disappointment should be

handled differently from dependable patients. A message on a patient's voicemail is not an acceptable way of reminding them about their appointment. If a patient cannot be reached during regular business hours, someone should take the number home and call after hours. Such patients should be called two days ahead of the appointment:

"Hi, Mrs. Jones. This is Mary at Dr. Smith's office. I'm calling regarding your appointment on Wednesday, May 5, at 10 a.m. It is imperative I speak with you directly. Could you please return this call by tomorrow, Tuesday, May 4, at 10 a.m.? The phone number is . Thank you for your consideration."

Every person who misses an appointment without contacting the office must be notified in some capacity. Here is my three-pronged strategy for addressing missed appointments:

Offense No. 1: Send a letter.

"This letter is to inform you of your broken appointment on . This time could have been used for another patient awaiting an appointment. We understand that circumstances may occur to cause these disappointments. Many dental offices charge a fee for broken appointments. However, we have opted to send you this letter with the hope that this will not happen again."

Offense No. 2: Send another letter.

"There seems to be a problem coordinating your busy schedule and ours. Unfortunately, it has been recorded that you missed your scheduled appointments on

and . A broken appointment affects three people: (1) the doctor or hygienist who prepared for your visit; (2) another patient who was awaiting time to receive needed dentistry; and (3) you, because your dental needs have not been met. If you wish to remain a patient in this practice, your full cooperation is needed to see that this does not happen again."

Offense No. 3: Consider dismissal.

Upon the third offense, the doctor should consider terminating the relationship with the patient.

Some offices charge broken appointment fees as a punitive action against patients who break appointments. My two thoughts are:

• Unless the fee is very high, it will in no way cover the production loss

• Such fees are rarely paid, and they generate ill will.

No dental practice needs negative missionaries in the community. It is preferable to deal one-on-one with people who are unreliable in keeping their appointments.

Scheduling is a business desk function, and someone has to be in charge of the schedule. One of my mantras is: "Nothing, nothing, nothing is more important than the schedule." If we don't have warm bodies in chairs, production stops. Too much open time in the schedule can lead to reduction of hours, a lack of raises, and even job loss. Open time in the schedule should set off flashing red lights and sirens! Unfortunately, what I observe in many offices is that keeping the hygiene schedule full is not a priority but one of those "we-do-it-if-we-have-time" issues.

Business assistants must be aware of the gravity of an incomplete schedule, and they must be focused on keeping downtime to a minimum. Everyone who makes patient calls should be trained in using the proper verbal skills. Most importantly, managing the patient database and keeping patients active in the practice requires diligence, as well as commitment to keeping the schedule as full as possible every single day. Filling the schedule might not be the most "fun" job in the office, but it should occupy the highest priority!

All the best,
Dianne RDH

DIANNE GLASSCOE WATTERSON, RDH, BS, MBA, is a professional speaker, writer, and consultant to dental practices across the United States. Dianne's new book, "The Consummate Dental Hygienist: Solutions for Challenging Workplace Issues," is now available on her website. To contact her for speaking or consulting, call (301) 874-5240 or email [email protected]. Visit her website at