by James R. Pride, DDS; Amy Morgan: and Mary Lynn Wheaton
Crisis management - i.e., managing the unexpected - is key for practice success. Out of crisis can arise creativity, innovation, and change. Had Dr. Thompson not had a plan or been monitoring her numbers, she might have panicked, deciding not to purchase the second practice. Instead, she went ahead with the plan to achieve her goals. In this month's article, we will examine how she handled the first crisis and, with the aid of her consultant, came out ahead.
By the end of January 2000, four months into the program, Dr. Thompson was struggling. From October through December, before opening the second practice, she could not meet the first-quarter goal of $1,093 in daily doctor production, up from her average of $976. (Although $1,000 per day is generally the bare minimum for doctor production in a start-up practice, and Dr. Thompson's production was lower than normal, the same principles apply regardless of the goal.) Dr. Thompson and her consultant had projected a first-quarter increase of $117 per day in doctor production based on the following action steps:
- Preblocking for production; i.e., reserving (in this case, two) daily appointment slots for needed dentistry of a crown fee or higher
- Scheduling to meet production goals
- Overlapping procedures
Dr. Thompson and her team had audited the charts when developing her plan. They knew that ample dentistry to meet production goals had already been diagnosed for patients of record. However, these procedures were not being preblocked. Dr. Thompson has learned to inspect what she expects. Consequently, she discovered that the appointment coordinator was not using the kind of verbal skills that can build production and minimize cancellations when communicating with patients. The coordinator also was missing the morning huddles. Therefore, the preblocks in the schedule were not being filled consistently.
Dr. Thompson's consultant immediately began training and coaching her on how to confront the appointment coordinator to gain a permanent commitment and change in behavior. Dr. Thompson put the first conversation with her appointment coordinator in writing to ensure that it would be effective. She addressed how she felt about her staff member's behavior in a nonthreatening way. The conversation was not a personal attack, but an account of the behavior and its effect on the practice.
In addition, Dr. Thompson was short a hygienist who had been projected in her annual plan. Without a hygienist, she not only was missing hygiene production, but also the benefit of having her diagnoses reinforced and supported. With Dr. Thompson performing her own hygiene, doctor production per day dipped to $883. Even with this crisis, she felt confident that she could move ahead with her plan to purchase the second practice, using the action steps to handle scheduling and hygiene. She remodeled to consolidate the two offices, then opened the new practice in January 2000.
In her leadership-training sessions, Dr. Thompson carefully planned for the merger by following this plan:
- Establish a philosophy of comprehensive care and quality service and commit to it in writing.
- Hold a pivotal meeting with staff members to acquaint them with expectations and plan for the practice merger.
- Send a letter to patients coming in from the second practice to familiarize them with the new philosophy of care. Dr. Thompson's letter closed with, "Thank you again for your trust and loyalty to me and my team. We enjoy being able to provide your oral-health care and look forward to building strong relationships with each of you in the future."
- Send staff members to training, where they develop "quick cards;" i.e., scripts to introduce patients to the new practice. During this time, Dr. Thompson's consultant continued to coach her on how to hire a hygienist and successfully retrain her resistant staff member.
An influx of new patients from the second practice arrived in January, as expected, raising total office production from the mid-$20,000s per month to $33,624. All new offices have great marketing potential if there is a plan in place to generate excitement and recruit new patients. The steps listed above helped to create this excitement for growth in Dr. Thompson's case.
With one hygienist from the second practice joining the staff to accommodate the increase in patients - and with temporary hygienists hired to help serve the original patients while recruiting continued - daily doctor production rose to $1,079. A feisty doctor and staff worked well into lunchtime and stayed late to handle patient volume, knowing that this was only temporary until the transition was completed.
In the second quarter, the bar was raised again, with daily doctor production projected at $1,210 and monthly production at $39,603. Dr. Thompson's challenge was to make up her production shortfall from the first quarter and reach the new level set in the second quarter, meeting her annual expense forecast.
While continuing to upgrade her scheduling system and search for a second hygienist, another obstacle became apparent. The previous dentist performed more event-oriented, single-tooth dentistry than Dr. Thompson wanted to accommodate. Many patients from the second practice were emergency-based and accustomed to having restorative treatment performed during that visit. The number of emergency cases was wreacking havoc with the schedule and steering the practice away from the goal of comprehensive care with minimal emergencies. Although this created workload issues and contributed to low productivity, once Dr. Thompson began to convert these patients to her philosophy of care, they would provide a treasure chest of potential for her growing practice.
Using a special "Telephone Information Slip," Dr. Thompson's staff conducted the initial phone contact with new patients by screening the callers, recording their motivators and concerns, and then scheduling them appropriately. This display of concern for callers was the first and most important step in converting new patients to Dr. Thompson's philosophy of care.
Both doctor and staff faced their challenges with optimism. They began to convert patients to the practice one by one. With steady commitment during the next few months, they minimized the problems and dramatically reversed direction. The turnaround occurred in the second quarter, with the practice not only catching up to, but surpassing its year-to-date goals.
In the second and third quarters of the management program, total monthly production soared from the mid-$20,000s to new records in the $50,000s to the highest figure ever of $64,577. After eight months in the program, Dr. Thompson was 24 percent over the entire previous year's production of $255,000 and 12 percent over the year-to-date goal of $282,501. Now things were cooking!
The team surprised even themselves with their incredible performance. Of course, the sudden, stellar increase in production created a new series of problems. Collections plunged from 113 percent year-to-date to 87 percent. A short-term lag in collections is not uncommon when production suddenly increases. But was this just a lag or something more serious? Where was the money? We will discuss this next time.
For details on educational materials, seminars, and management programs, call Pride Institute at (800) 925-2600.
This series of articles chronicles the true story of a young dentist whom we're calling Dr. Mary Thompson. In two years, she transformed her $255,000-a-year start-up practice into an $812,099-a-year, high-quality office. Our article in the June issue of Dental Economics described how Dr. Thompson, just three years out of school, began her program of management improvement with the dream of buying the practice next door and doubling her patient base of 1,200. Pride Institute consultants helped her develop an annual plan to purchase the second practice and raise production incrementally - not only to meet the greater overhead, but to substantially improve earnings for both doctor and staff. After the first quarter of the plan, Dr. Thompson bought the second office and consolidated it into her practice. She and her consultant projected an increase in production even before the new practice opened, and they prepared a strategy to meet the goal. However, obstacles immediately cropped up, causing the practice to fall 13 percent below projections.
- If at first you have difficulty achieving new goals, stay the course and do not give up your dreams!
- Do not let performance issues go unchecked. Confront staff members who are falling short of your expectations.
- Continually work with the team to preblock appointment slots, the cornerstone to increasing production.
- Develop and practice proper verbal skills to introduce patients to a new dentist and convert them to a philosophy of comprehensive oral care.