The complaint box: Who said, Read em and weep?

April 1, 1998
No matter how successful your practice, how professional your staff, how well-run your business office or how skilled the dentistry delivered, sooner or later, somebody`s going to find something to complain about. That`s fact number one.

When someone blows the whistle on your practice, listen.

Sally McKenzie, CMC

No matter how successful your practice, how professional your staff, how well-run your business office or how skilled the dentistry delivered, sooner or later, somebody`s going to find something to complain about. That`s fact number one.

Fact number two is that of those who do complain, some will have genuine grounds and some won`t. Some will do it nicely, tactfully and respectfully, while others will be grouchy, arrogant or just plain rude.

Third, and most important, is that the complaint is a free, somewhat impartial appraisal of a certain aspect of your practice that you may not have been keeping an eye on at the moment. With any luck, it will throw a spotlight on a corner that`s been cut, a service that needs attention or an individual who could benefit from more training or from an attitude adjustment.

The bottom line, then, is that you will receive complaints. Such sentiments will not necessarily be issued in palatable form. But they can, nonetheless, be a boon to your business. As soon as you recognize this last point, I predict you`ll find yourself actually soliciting complaints from your patients. You`ll finally relate to the wisdom in the words of former New York City Mayor Ed Koch, when he invited his electorate to "tell me how I`m doing."

The other side of a complaint

Contrary to popular belief among dentists, a complaint usually is not an assault on the integrity of your practice, voiced by a patient who has plans to leave. As a rule, it`s a request for a minor adjustment, voiced by a patient who wants to stay. Being two sides of the same coin, the compliment and the complaint imply trust in - and overall satisfaction with - the practice. The complaint then leaps forward to express disappointment about some specific condition. Again, the patient who takes the time (effort) to complain typically does so because she has a stake in the practice. She wants the problem resolved. If that doesn`t happen, she may have no choice but to go elsewhere, though she`d really rather not.

When I declare that not enough patients complain, you may think I`ve gone off the deep end. But it`s true ... reports from our clients who track patient attrition confirm that for every 10 dissatisfied patients, only one will complain. The other nine "have their say" by walking out the door, never to return. Of patients who do complain, most stay with the practice if the complaint is resolved. Even if it isn`t resolved exactly as patients would have liked, they`ll usually be appeased if:

* Someone in the practice fully listens to the grievance.

* The complaint is handled professionally and in a timely manner.

* The patient is kept abreast of how a complaint is being handled, as well as the final outcome.

* The patient feels `valued` by the practice.

It`s critical to remember that the other nine dissatisfied patients didn`t say a word. They just got up and left. If only you`d had the chance to know what was on their minds, you might have been able to turn their negative feelings into positive ones. And, having that information, you might be able to avert another patient`s discontent. Perhaps asking for complaints isn`t such a bad idea!

It`s criticism we don`t like

Go ahead hit me. Harder now, don`t be shy. Who, in their right mind, would embrace such an idea, Sally? It`s crazy, soliciting complaints from patients! What`s wrong with letting sleeping dogs lie? If patients aren`t complaining on their own, how unhappy could they be?"

If these sentiments echo yours, we need to talk. With regard to complaints, there`s no room for you to take offense. Typically, a complaint about your practice seldom is meant as a slap in the face. When a patient says, "You`ve gotta straighten out that new gal in the front desk - she`s got one doozie of an attitude," it`s not a declaration of war. Nor is the patient striking from an adversarial position. The fact is, the patient`s actually sticking her neck out for your benefit as well as her own. She doesn`t want to deal with some "snooty little twerp," but, just as importantly, she recognizes that this snooty little twerp might really offend other patients who are less tolerant ... and that wouldn`t be good for your business.

And then there are the patients who say:

"You`re going on vacation again? Where am I sending you this time?"


"When do I get to drive your new convertible - after all, I did pay for it!"

What should you do when you hear sarcastic remarks like these? Turn the other cheek and smile! The truth is, such tongue-in-cheek comments often are uttered with more than a touch of pride. Look beneath the surface and you`ll find that the majority of complaints actually are expressed because the patient is on your side.

I know, I know, you want me to get down to the nitty-gritty about the complaint that is, in fact, issued as an assault. Typically, by the time a situation gets to this point, the complaint has been ignored too long or mishandled too many times. The resulting escalation of feelings - from disappointment to frustration and even on to rage - could have been avoided if the initial complaint was taken more seriously or was given more than a haphazard response or quick-fix.

Remember this, once a patient feels wronged, your margin for error begins to diminish until either:

- It appears that you can do nothing right.

- You resolve the situation and thereby restore patient confidence.

Moments of truth

Like it or not, complaints point out glitches and flaws in plans, procedures and personalities. Now, although I am asking you to welcome complaints, you`re still charged with the ultimate responsibility for keeping problems to a minimum. To anticipate and perhaps avert such problems, it`s important to examine the continuum of care and service provided by you and your staff. Exactly what steps must the patient go through to receive treatment, and with whom will she need to interact?

Is the process patient-friendly? Are the individuals? Would you feel comfortable walking in the patient`s shoes? Take some time and visualize, objectively, each situation and every individual that your patient will interface with throughout the process. Start with scheduling an appointment at a convenient time (within a reasonable amount of time), to receiving a confirmation call, to parking at your facility or getting there by public transportation. Visualize being greeted by your front-desk staff, then waiting in the reception area, followed by more waiting in the operatory. Examine the professionalism of your hygienists and dental assistants, the level of patient comfort during procedures and the positive distractions available throughout treatment (music, TV, virtual vision or dynamic conversation by the doctor). Mentally walk through your dismissal and checkout process, front-desk billing and collection, the post-op phone call from you or a staff member to see how the patient is feeling, etc.

As you take this whistle-stop tour, be on the lookout for any barriers to loyalty that might be lurking about. And, when you find them, take corrective action. If you hear of a problem that you have not seen or experienced, don`t assume that it`s the patient`s "problem." Make no mistake, doctor, one way or the other, the problem`s yours as is the solution. In many practices, there exists a conspiracy of silence that covertly denies that complaints have been made or that there are any relevant grounds for those complaints. Watch out for such a conspiracy of silence; it will undermine any attempts to "do the right thing" for the patient.

If you should lose a patient because of something he or she has complained about, you can be pretty sure that the complaint was not handled well or not resolved to the patient`s satisfaction. Brainstorm with your staff to find the key to not losing patients in these circumstances. The goal here is what`s known in corporate America as "zero defections" or "zero migration" in dental circles. This translates into no patients leaving the practice on bad terms and no patients broadcasting negative comments about the practice.

What`s SWAT?

The sad truth is that many a patient has been lost because the wrong staff member said the wrong thing to the wrong patient at the wrong time. In all too many practices, we find entry-level employees - often high school or college students working part time - serving as the primary interface with patients on the phone or at the reception desk. This occurs because it`s assumed that the rookie can`t do much damage if she`s just fielding calls and greeting patients. Give it some thought, doctor: do you want your lowest-paid, least-trained staff member (the one hired as an extra pair of hands) in a position to have so much interaction with your patients? Sooner or later, she`ll be eyeball to eyeball with a dissatisfied patient. From where will she get the professional judgment, initiative, discretion or tact to handle the situation appropriately? Like it or not, you and your staff are critical links to getting off the patient-replacement treadmill and achieving zero defections. Here`s how:

1. Create a patient relations SWAT (Special Weapons and Tactics) team.

2. Focus on problem-solving skills, empowerment and accountability for SWAT-team members.

3. Record and review every complaint received by the SWAT team. Complaints, which represent areas of concern, should be brought to staff meetings and discussed. Repeated complaints must be considered as red flags and should receive immediate attention.

Unlike a one-time, shot-in-the-dark maneuver, this needs to be an ongoing program, requiring a long-term commitment from you, combined with an all-out team effort. Bear in mind that the creation of your SWAT team may impact your organizational structure, hiring objectives, employee incentives and training. As a result, you may need to consider reallocating budget monies.

SWAT team action plan

1. Actively listen to the complaint. First and foremost, clear away any distractions, take out your earplugs and listen, allowing the complainer to "let it all out."

2. Apologize ... sincerely, without admitting fault. Immediately say something like, "I`m sorry you`re upset. Here`s the way I understand the situation ... do I have it right?" Responding in this way eliminates the wall between you and the patient, allowing you both to be "on the same side." Further, this keeps the focus of the encounter on facts instead of emotions.

3. Gauge the patient`s emotional investment in the situation. Understand the course of emotional escalation:

- Disappointment, leads to:

- Frustration, leads to:

- Anger

4. Address only the request in the complaint, not the emotion. The earlier in the process you can step in, explain to the patient that you understand the problem and are ready to act, the greater the opportunity you have of appeasing the patient ... and the less stressful it will be for everyone involved.

5. Take ownership with a "let me see what I can do to help" attitude. This demonstrates that you`re looking at the situation from the patient`s perspective and taking responsibility for trying to fix it.

6. Approach the patient about how she/he would like to see the problem resolved. Listen for cues on what is important to the patient.

7. Resolve the problem, if possible. If not, go out of your way to "make it up to the patient."

8. Wait a few days and check back with the patient to verify that the complaint was resolved satisfactorily. Such consideration reinforces patient loyalty.

Strategic don`ts

Don`t tell too much: "You`re right, Mrs. Jones. We`ve given our billing over to an agency that doesn`t seem to know which end is up." Instead, "Mrs. Jones, I can see why you`re concerned. Give me a little time to check this out and get back to you. In the meantime, don`t give it another thought; you`ve put it in the right hands."

Don`t use the word "why." It puts patients on the defensive. "Why didn`t you call the office when the crown first fell out and why would you try to recement it with super glue?"

Don`t tell a patient what you can`t do: "Sorry, Charlie. Dr. Clarence is completely booked until the end of February. I just can`t get you in before then." Instead, be a hero. "What I can do, Charlie, is ask Dr. Clarence if there`s any way we can fit you into the schedule in the next couple of weeks. If not, let`s tentatively set it up for the end of February - just so you have a definite appointment - and then, I`ll call you if we get a cancellation. What day of the week is best for you?"

Don`t guarantee what you can`t control: You have my word, Mrs. Houndstooth, Dr. Birmingham will call you back this afternoon." Instead say, "If this is an emergency, the doctor would want me to interrupt him. Otherwise, he`ll return your call after he finishes seeing patients."

Scripts for various phone and face-to-face situations provide employees a certain comfort level and eliminate the need for guesswork. Role-playing these situations is another valuable tool that boosts staff confidence and comfort level.

Missing in action

Patient attrition is no surprise. Every practice experiences its share. What is surprising, however, is how few practices perform what I call "defector debriefings." What good is it to keep track of the number of patients your practice loses if you don`t know why you`ve lost them? Of patients who don`t return to a practice, here`s a typical profile:

- 1-5 percent pass away.

- 3-10 percent move away.

- 5-10 percent are driven away because they feel the fees are too high.

- 20 percent are "HMO`d" away thanks to managed-care terms and provisions.

- 55-71 percent are wooed away by the prospect of another dentist or practice that might try harder to keep their business or might really care if they stayed or left.

In view of the fact that most patients do not complain - but have their say by not coming back - it`s critical to measure not only patient retention, but also patient satisfaction. And that`s where a patient survey comes in.

Fishing for the info you need

The problem with the word "survey" is that it scares away all but a handful of die-hard researchers. Don`t worry. I`m not going to give you a crash course right now on surveying ... or fishing for that matter. I just want to say a few words about the verbal survey, something you do all the time without getting hung up on it. "How`re ya doin?" Yes, of course, that`s a verbal survey! Easy enough?

Now try this one: "What one thing could we have done to improve your experience with us today?" maybe try that question with one or two patients. You might want to encourage your staff to ask for patient feedback. To make it really easy for patients to submit their suggestions for improvement, try a 24-hour suggestion line on your voice-mail system or answering machine.

Mindful that unresolved complaints have a life of their own, ask your patient. "Is there any area of our dental practice that you think we need to work on a little harder?" With this simple inquiry, you`re putting your hand out to your patient and acknowledging that you care what he or she thinks. What a great way to encourage an open dialogue! It`s also a great way to neutralize any negative publication the patient might have otherwise considered "broadcasting." The verbal survey is one more way to make your practice patient-friendly - and to transform complaints from something negative into something quite positive.

Complaints policy

This practice has a positive attitude about complaints. In fact, we view any complaint as an opportunity to do better. Complaints, therefore, do not alarm us, but enlighten us. We consider the handling of complaints to be an investment of our time, not an expenditure of it. So please, speak up!

The price of inertia

On hearing a complaint, you or your staff might be inclined to take a "sorry, there`s nothing we can do about it" attitude, or "sorry, but that`s our policy." However, before doing so, remember the nine or 10 times (conservatively) that your patient will not only tell the story of how she was wronged, but how insensitive you were to her complaint.

Expectation gap ... the great divide

Try to examine the difference between what patients expect and what you and your staff assume they expect. This expectation gap happens in the best of practices with the best of intentions. While you and your staff are busily delivering the service you think patients will want, you may be falling short of the performance they actually expect. Typically, this great divide occurs when:

- Communication between you and your frontline personnel is inadequate;

- You are not sold on the relevance of patient feedback;

- There is no system for customer-service accountability.

Closing the gap will mean taking action to bring patient satisfaction up to par with patient expectation.

Say what?

When a patient is complaining, it`s time to tune in - take responsibility - and make him or her feel that you care. Try these complaints/comforts on for size:

"You guys think I have nothing better to do than sit around your waiting room all day! I rushed here from work. I`m going to be late for my son`s Cub Scout meeting, and heaven knows when I`ll get to prepare dinner ..."

"I understand why you`re anxious Kimberly - you`re a busy lady - and I`m truly sorry about the delay. You know how hard we try to honor appointment times, but as the mother of four, you also know that emergencies do happen! In the future, give me a call just before you come in and I`ll let you know how the doctor`s schedule is running. For now, let me see exactly how long he expects to be. Maybe we can get you back on schedule."

"A hundred and sixty-eight dollars! For what?"

Generally speaking, fees shouldn`t come as a surprise. In the event that they have not been discussed with the patient previously, here is a suggested response:

"I didn`t mean to startle you, Mrs. Tightfist. Let me itemize the fees for you. The initial exam with Dr. Jones was $35, and because this was your first dental exam since 1993, we needed to take full-mouth X-rays, which are $65. The prophylaxis, or cleaning, was $48, and, finally, the fluoride treatment was $20. It`s important to us that you also know we use the highest-quality materials available and that our fees are based on the time and expertise required for each procedure. Since you weren`t aware of what the charges would be today, go ahead and pay what you can now and I`ll be happy to put the balance on your credit card. And by the way, I`d like to personally welcome you to our practice and assure you that your dental health is in the best of hands."

"Whaddaya mean no appointments available for five weeks? I`m not asking for an audience with the Pope, ya know. I just want to get the darn veneer made for this tooth so I don`t look like I`ve been in the ring with Mike Tyson."

"You`ve got quite a sense of humor, Mr. Holyfield, but I do understand the problem. Let me talk with the doctor this afternoon and see if he has any ideas about getting you in sooner. If it`s OK with you, I`ll call you about 4 o`clock and let you know what the options are. And don`t worry, we`ll get that smile fixed!"

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