Go beyond the open door to win referrals

April 1, 1997
Creating a dental practice that generates its own new-patient flow through referrals is every dentist`s ideal situation. However, turning that ideal into a reality is not as easy as it sounds. It involves changing your attitude and following a philosophy which says patient relationships are a priority. Referrals are born as a natural byproduct.

Referrals are a byproduct of nurtured relationships.

Michael Schuster, DDS

Creating a dental practice that generates its own new-patient flow through referrals is every dentist`s ideal situation. However, turning that ideal into a reality is not as easy as it sounds. It involves changing your attitude and following a philosophy which says patient relationships are a priority. Referrals are born as a natural byproduct.

Once this shift in attitude is adopted, the results-both short term and long term-will be realized. All too often, dental practices are created with the end goal of satisfying the dentist`s needs-financial and otherwise-rather than meeting the health and educational needs of the patient.

Think about how backwards this is. If the dental practice is set up to sell specific products in the name of simply increasing profits, then you`ve forgotten who and what your main focus should be. Referrals- and the profitable practice that follows-are what happens on the way to developing significant relationships.

The more you strive to meet and exceed patients` needs, the less you have to worry about getting the patient to refer his friends and family.

The truth is, our patients are the main reason we are in practice; without them, we are lost.

In my 25 years of practice, I have seen many dentists who lose sight of this patient focus. Inevitably, those practices either fail financially or wind up being swallowed up by managed-care systems. On the other hand, those dentists who provide excellent service to their patients excel at creating a referral-driven practice.

What follows are several key points to remember when working toward establishing a successful, relationship-based practice and, thus, one that generates referrals.

A Win-Win Agreement

Referrals are based on the quality of the relationships that you establish with your patients. The quality, depth, sincerity and concern you demonstrate for another determines whether or not someone will refer a friend or relative to you. The best way to cultivate the kind of relationships that generates referrals is by entering into what I like to call a "win/win agreement."

A win/win agreement in a dental practice begins with understanding what a patient wants, needs, and expects.

Find out what the patient`s chief objective is. Is he afraid of pain? Does she want to be healthy? Does she hate to wait? Does he hate Novocain? What do these people want and hope for from dentistry?

Satisfying the patient`s goals and objectives is absolutely paramount, but that may be impossible to achieve if you are too focused on selling. I see the majority of dentists trying to sell goods, rather than providing good service.

Most people approach others with their own agenda, whereas people who are most effective in building a relationship are the ones who carefully listen to what the other person needs and wants.

Getting to know your patients is impossible, if you`ve delegated that responsibility solely to your administrative staff. Office staffs change. You, however, always will be the single, most important representative of your practice. You, as well as your staff, need to create solid relationships with your patients. Only then will you achieve a true win-win relationship.

Unrealistic Expectations

Even if your patients aren`t sure what they expect or want, this is an excellent chance to help them find out. Lee Iacocca once said that the first job of a salesman is to help the client figure out what he or she wants. So, you may have to work with some patients for a while before they determine what it is they really want.

One way to do this is by conducting a preclinical interview, asking specific questions about a patient`s past history. Highlight past problems, as well as positive dental experiences. What is important to him/her in terms of his/her family and health? What does he/she value in a relationship?

This interview, conducted in a nonthreatening, nonclinical environment, will serve as an invaluable barometer to measure against as your relationship with the patient develops.

Without this key information, it is hard to assess how well you achieve a patient`s specific goals in the end. The important thing is to get those goals out in the open, agree on what those expectations are, and determine whether or not they are realistic for both you and your patient.

Honesty is an important element in the interview. Only after I am certain what it is my patient wants, can I assess whether or not those expectations are realistic, based on my capabilities and what modern dentistry can and cannot do.

For example, I once had a patient in her 70s, who wanted some dental surgery that she believed would make her look 20 years younger. I explained that the treatment could possibly take 10 years off her age, but not 20. Without that conversation, I very likely would have had an unhappy patient and possibly worse.

Another reason for the preclinical interview is that unrealized expectations potentially can turn into lawsuits. I`d rather underpromise and overdeliver than the reverse, for obvious reasons. Once you`ve clarified what to realistically expect in terms of dental services, you`ve reached an understanding and common goal.

Knowing You Care

Ultimately, listening to the patient achieves other goals as well. It proves that you care enough to hear your him/her, and that`s the basis of any good customer service - whether in a department store, hospital or dental office.

I believe there is too much posturing in an attempt to impress patients with our knowledge, when the real concern of patients is whether or not we care about them. To sum their sentiment: "I don`t care how much you know, until I know how much you care." Trust is built when people really understand that you`re not there to sell them something, but that you`re primarily there to help them achieve their desired outcome.

It all boils down to attitude and an unconditional, positive regard for people, regardless of their actions. This attitude is easy to adopt, once you commit to it.

Throughout the preclinical interview, as well as during other patient contact, being open and honest will further deepen your relationships. That trust, combined with a positive experience with your practice, later translates into referrals.

Often, dentists want referrals, but they are not willing to invest their time and emotions into the patient relationships. Then they wonder why they don`t get referrals. Again, I believe referrals are a byproduct of a certain type of practice, where patient relationships truly are nurtured and maintained.

After treatment, it is time to sit down with your patient one-on-one again. This is the time when you can show them the "before-and-after photos." It is a chance to remind them of where they were before treatment, where they are now, and the process that brought them there.

Remind them: "This is what you said you wanted; this is what we did; and this is where you are now." People have a tendency to forget, so show them the progress.

Negotiated treatments-situations in which both parties realistically know what to expect-are the ones in which everyone wins. This is where the "win/win" comes in.

Wouldn`t you like your patients to feel that they got more than they bargained for in terms of service and attention? That`s the theory behind added value . . . and that`s exactly what creates referrals.

If I simply meet someone`s expectations, without giving that person something extra, the relationship probably is over. You have to give your patients more to create an added-value practice; you have to offer a service that has extra value. When you create that relationship and educate the patient, and the patient ends up with more than he/she expected, referrals are imminent.

Journey Most Important

If your ultimate goal is to get referrals, the journey to get there is even more important than the end result. In other words, building a practice that creates referrals includes many steps. These steps are geared to creating an atmosphere of excellent patient relations and developing trust and communication with all your patients. Only then will you receive the referrals that you seek.

So, you see, you can`t aim at referrals themselves; referrals are what happens as a result of creating nurturing and enduring relationships with your patients.

The reason some dentists receive referrals, while others don`t, is because they are not afraid of meeting their patients on a personal level and then following up with a request for a simple, old-fashioned, word-of-mouth endorsement to family and friends.

Even if the idea of sitting down with each patient for an hour-long interview is daunting, striving toward being a referral-driven practice is a worthy goal. It speaks to our need in the profession to respond to the changing culture of health care and dentistry. Focusing on excellent patient service and patient relations is where we need to start.

Dr. Michael Schuster is founder of the Center for Professional Development, a business school for dentists, based in Scottsdale, Ariz. He is a graduate of Marquette University, and is internationally-known for his seminars on technical excellence, practice development, and patient and profitability management, throughout the United States, Canada and Europe. Dr. Schuster is the author of 12 tape programs on professional excellence and practice management. He also is the publisher of a monthly newsletter, The Profit Letter, and his most recent program is titled "The Private Care Practice: The Profitable and Ethical Option to Managed Care."

When You Should Ask For Aunt Ruth`s Business

Much like putting a bucket under a cow and merely expecting it to give milk, referrals will not happen without you taking an extra step. Once you`ve evaluated the service you`ve given to your patient and determined that you have delivered more than he or she expected, then that`s your cue to ask the patient to refer friends and relatives.

That`s the time you`ve confirmed that your patient is happy with the service and that his/her expectations have been met and then some. It is clear that you have both followed through on your commitments to each other. This is the perfect time to ask for referrals.

You might present it something like this: "You know, Mrs. Jones, I really value you as a patient. What my practice needs is more wonderful patients like you. So, if you have a friend or maybe someone you work with who is not getting the quality of dental care that they should be getting, I would appreciate you giving them my name."

Once referrals start coming in, don`t worry about what percentage of patients are coming from people recommending you. Rather, your concern should be more about the growing number of happy clients.

Reward your referring patients whenever possible with personal thank-you notes and telephone calls. When patients begin referring friends to your practice, keep the original patient informed about the status of the patients they referred to the practice. Keep them involved and make them feel as if they are an important factor in the success of your practice.

The days of physicians making house calls seem far behind us, but that`s where we must look to find inspiration for the future. In fact, dental practices that don`t become more patient-service oriented most certainly will fail.

If you don`t start becoming a practice that services its patients, I predict you can say goodbye to your practice in the near future.

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