The search for a more productive recall system

'The primary reason recall programs are not as effective as they should be is because of the lack of perceived importance and value on the part of the patient.'

by Jeffrey M. Goldstein, PhD, MBA

A productive and effective recall program is something that many practices have difficulty establishing. The purpose of this article is to discuss the most effective recall program, including implementation and the verbal skills necessary to make it successful.

It is important to note that any system or program is only as good as the person or persons responsible for its success. Also, for a repetitive system (like recall) to be effective, it must be monitored constantly. Along with constant monitoring is the need for consistency.

The primary reason recall programs are not as effective as they should be is because of the lack of perceived importance and value on the part of the patient. To be able to attach perceived importance to your system, my first recommendation is to avoid, at all costs, the word "recall." Too many people believe that a "recall" appointment is not very important — "It's only a cleaning." Recall is a word that adults have used and heard throughout their lives and it is, too often, unimportant in many people's minds.

Also, the word "recall" can have a negative connotation. Substandard or defective products that have a problem are "recalled." So, to begin to establish value and create importance, it is necessary to find a synonym for "recall." My preference is "continuing care." Some like "preventive maintenance" and others prefer "recare." It is important that everyone in the office use the same terminology so that your patients do not get mixed signals as to the type of appointment they are scheduling. That consistency is very important. Remember that "recall" is a negative. Don't make your program sound like you are contacting patients to recall them because the dentistry that you placed is defective.

The word "cleaning" is another term that definitely does not communicate importance or establish value. How important is a "cleaning"? Therefore, like "recall," the word "cleaning" should be eliminated from everyone's vocabulary. There is no ADA code for this procedure. If you are not comfortable referring to an adult prophy, you may choose to refer to the visit simply as the patient's "hygiene appointment" or "hygiene visit."

I have found that pre-booking or pre-scheduling continuing care patients is the most successful recall strategy in the vast majority of practices with which I am familiar. Although there can be some drawbacks to pre-scheduling, the advantages far outweigh the disadvantages. Once you have a patient in the schedule, as opposed to "patient never-neverland," the chances are exponentially greater that they will not "fall out" of your practice. It is much more productive to keep them in your schedule and re-appoint them, if necessary, rather than send them a reminder card, hoping that they take the time or remember to call your office to schedule an appointment. I don't see the advantage of your staff spending their time on the telephone, calling patients that have failed to call you once they have received their "reminder card." Generally, this is wasteful and unproductive. There are too many important matters that they could be attending to. The telephone script for pre-scheduling might sound like this:

Doctor: "Jeff, now that we have completed your treatment, it is important that you return in August for your continuing care and oral cancer screening appointment."

Gladys (appointment coordinator): "Jeff, I know that Dr. Goldstein wants you to return in August for your continuing care and oral cancer screening visit. I'm going to schedule you now."

Roger Levin, DDS, 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. Dr. Levin goes on to say, "Moving a patient into a certain time-frame within the schedule is necessary. Create an image for the patients that conveys that you are doing them a favor." In other words, allow your patients to do what you want them to do.

There are additional ways to help insure the successful pre-scheduling continuing care system. The doctor and/or hygienist should both be part of the pre-booking scenario. In fact, the system will be most successful if the doctor or hygienist is actively involved in motivating the patient to return for more than "just a cleaning."

The perceived value that was discussed earlier can be enhanced dramatically if the doctor and hygienists participate in the program. Therefore, I'm suggesting that the doctor or the hygienists create a "set-up" situation by giving the patients a reason to return and telling them that they are expected to return in a specific month. I recommend that one avoid the statement, "I'll see you in six months." Your patients will be more apt to remember the name of a specific month as opposed to the number of months until their next appointment.

It is important to remember that the next hygiene visit should not be left to the appointment coordinator alone. The doctor, dental hygienist and the clinical assistant should be discussing the return visit before the continuing care patient gets to the front desk. To illustrate further, if the patient has been seeing the doctor for a number of dental procedures and has now completed the treatment, he or she is ready to move into maintenance. Therefore, at the end of the last treatment appointment, it is important that the doctor give the patient a reason to return to see the hygienist, in other words, create importance. The reason must be more than to just have his or her teeth cleaned. When dismissing the patient at the last treatment appointment, the doctor might say, "Goodbye Mrs. Brown, I look forward to seeing you in August for your continuing care appointment. Susan (the clinical assistant), would you please make sure that Gladys (the appointment coordinator) schedules that appointment today! I want to see Mrs. Brown to make sure that her oral condition is as good as it is now and to make sure that she has an oral cancer screening." His request can be reinforced by Susan as she escorts the patient to Gladys. This is an example of creating perceived value.

As with any system, there are a few drawbacks. One problem with pre-scheduling is that the hygiene schedule will "fill up" with no availability for new patients. Therefore, be proactive by saving appointments throughout the week for the new patients. The time saved should reflect time for new patient prophies, full mouth debridements, and a few scaling and root planing blocks.

A second concern is personal schedules. It is appropriate and important that the hygienist's and doctor's schedules not interfere with this program. Therefore, vacations, personal days, continuing education courses, and conventions must be planned far enough in advance to avoid scheduling conflicts. Mark out all of the appropriate days so that patients will not be scheduled during that time. One of the best ways to do that is with a large erasable marker calendar. Then you can see an entire year at a glance, and it is much easier to block the days that will not be scheduled. Make sure that these dates are communicated to your appointment coordinator.

To reiterate, I have found that, in general, more patients will schedule with good organization and management. Keeping control of the conversation with the patients is a must for a successful appointment schedule.

Jeffrey M. Goldstein, PhD, MBA, is an assistant professor and course director of practice management at the UCLA School of Dentistry. He has been a partner in the Los Angeles-based dental management consulting firm of Barron and Goldstein for the past 22 years.He can be contacted at at jgoldst@ucla.edu.

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