Tips from a fellow traveler

Feb. 1, 2000
Dr. Berman provides tips for the front-office `engineers` who must keep your `power plant` running smoothly.

Part 1

Dr. Berman provides tips for the front-office `engineers` who must keep your `power plant` running smoothly.

Marvin H. Berman, DDS

Arguably, the front-desk operation in every dental office is the power plant of the business. It can make or break a practice. From answering the phone to making appointments, from case presentation to collecting the fees, from greeting patients to dealing with insurance policies, the front-desk staff members are the engineers who keep the office running smoothly.

The roles these people play are even more critical because you, the doctor, are far removed from the front- desk action and its moment to moment happenings. Problems can arise that affect a patient`s relationship with the office ... problems that go unnoticed until it is too late and a patient leaves the practice. You cannot be everywhere or watch everything all the time. So, it is important that you select employees with a good work ethic and who will be dependable, honest, outgoing, and efficient - a tall order! Never forget that good business management always starts from the top. You set the tone! The practice reflects your personality and expresses your philosophy. The employees may suggest policy changes that will make the practice more efficient or successful, but you have the final say so.the buck does stop and start with you.

Yes, there is a boss and everyone is accountable. The word "boss" means supervisor and/or manager. It does not mean tyrant! It is essential that you keep involved with the goings-on at the front desk by asking questions, checking the daily reports, and monitoring the income coming in and the disbursements going out. Your presence should be felt at the front desk. Although it is efficient and necessary to delegate many of the office functions to other people, you should never abdicate responsibility completely. I strongly recommend that you rotate and cross-train every staff member for front-desk duties, including your office manager.

Checks and balances

Nobody should perform the same task all the time. Beware the employee who says, "I`m the only one who knows how to do that!"

Let me remind you that I`m a fellow practitioner who not only talks the game, but plays the game every day. In the not-so-distant past, I had just such an employee who I trusted implicitly. However, she betrayed my trust and embezzled a large sum of money before she was discovered. Not only did I lose money, but because she was my "key" employee, the feeling of betrayal and the hurt at the time were devastating to me personally. So, my advice is that no one person should do the bank deposits. I see all bills to be paid and I write all checks. In other words, I have the pulse of the office and I have ultimate control of the purse strings.

The other advantage to cross-training everyone, including your dental assistants, is more flexibility. Everyone should know how to do everything, so that no segment of your business stops because one certain employee is late, or ill, or on vacation.

The smile

"Start off each day with a smile and get it over with." Good advice! A smile can be an ice-breaker. It conveys an air of friendliness and - even more importantly - it could diffuse a potentially confrontational office situation. For example, if a patient is upset about something, a smile on your face can prevent a small issue from escalating into a major blowup. It`s also very difficult to stay angry or yell at someone when you`re thinking smile. This principle applies to office-staff relationships and to all life encounters.

Computerization

Computerization can streamline the front-desk operations in many ways. In fact, the mainstream use of computers has not only changed the way we conduct business in our offices, but it has forever changed our personal lives as well. As technology advances, computers will continue to change our lives in many ways that we thought impossible just a few short years ago.

We introduced computers into our office operation in 1992. Today, almost every office function - except for the dentistry itself - is either computer-dependent or assisted. Electronic billing to patients and insurance companies, the recall system, birthday cards, production and aging reports, and receipts are all generated on the computer.

Doctor-referral letters, thank-you notes, bank deposits, the payroll, tax deposits, and daily, monthly, and yearly income and disbursement reports are all computer-driven. Even the appointment schedule is a computer function!

A word to the wise

It`s smart to run a daily paper ledger of income generated at the desk and payments received in the mail - especially cash payments. Payments are recorded both in the paper ledger, as well as in the computer. At the end of each day, the paper trail, the computer totals, and the daily patient-production report have to match.

Minor glitches notwithstanding, computerization has been a positive addition in terms of time and efficiency and financial return. But, we must not lose sight of the human factor. The old maxim of "garbage in and garbage out" is absolutely true! Accuracy and reliability are still controlled by humans. Computer keys are important, but they pale in comparison to the human touch. It is the human touch that is the real key to practice success.

The computer cannot convey affection or emotion. It cannot convey care or concern. Life is not about numbers and letters and printouts and codes. When doing the "name, rank, and serial number," maintain eye contact with the patient. Don`t focus on the computer screen.

The office manual

We all have a philosophy which governs the way we practice ... a system of some kind within which we and our employees function. What is your policy on vacations, raises, bonuses, or tardiness? Do you have a dress code? How often do you run the autoclaves? Change the developing solutions? Water the plants?

What is your system for re-ordering supplies and who does it? Checking prices? How do you like your instruments set up or handed to you? What are the daily duties at the front desk (e.g., start up computers, answer messages, straighten the reception room)? What are the weekly duties? The monthly ones? The yearly ones? How do you send insurance claims?

You need an employee manual to cover all the issues - from what to do, how to do it, when to do it, and who does it. The office manual provides a concrete reference for your sometimes elusive employer-employee relationships. The office manual is the map, but we still have to be the navigators of our destiny.

Writing an employee manual is not difficult. You simply ask employees to write down every task they perform every day, the rules they follow, and why. You then edit their input and add your perspective about what you expect from your employees and what they should expect from you.

For instrument setups, make a diagram. If it concerns computers, indicate the menu keys for certain procedures like generating reports, working the appointment scheduler, "troubleshooting," and who to call for support.

Of course, the most difficult problem for all of us is defining and articulating loyalty and dedication. You know when people have it or they don`t. The "haves" go about their business regardless of salary level, because that`s the way they are. These are the people you should value - the people you would really miss if they were not there. Yes, you can motivate by example, give constructive criticism, and perform employee evaluations. But, you can`t teach initiative or instill a good work ethic.

I don`t believe in bonuses for doing the job for which you were hired. I expect everyone to work with the same enthusiasm that I display. Nobody`s perfect, including me, but I`m always trying my best and that`s all that I ask of my employees. Rewards and bonuses are earned for performance beyond the call of duty.

Office-policy statement

Every new patient should receive a copy of your office policy - a short, sweet introduction to what you and your practice are about. As a pediatric dentist, I address such issues as why we save baby teeth, even though they`re going to fall out; who gets the Saturday and after-school appointments; why I don`t believe in putting children to sleep for treatment as a first choice; the important relationship between eating and brushing; and why both fluoride treatments and fluoridated water are needed.

We clearly state in our office policy that we expect payment at the time of service. We spell out that we will bill the insurance company, but the co-payment must be paid upfront. We also note that there is a charge for appointments not cancelled appropriately. If you are a general practitioner, you may want to address such items as why the gums are as important as the teeth and why a bridge should be made when a tooth is missing, even if it doesn`t show. In our policy statement, we emphasize how much we care about our patients. We tell them that we`ll do our best to serve them to the best of our ability.

Developing a written office policy is not a difficult task. Just write what you believe to be in the mutual best interest of your patients and your office.

Reports and printouts

Your computer system can generate cross-referenced reports until the cows come home. These reports and printouts tell you more than you ever need or want to know about your operation. So, generate only the reports that really mean something to the practice. Your daily production and income certainly are numbers you need to know. The number of new patients, the recall list, and the insurance-payment aging report all provide pertinent information. The idea is if you`re going to generate the reports and lists - use them!

If your computer generates the names of the three or four people who missed their appointments that day, call those people that same day. Find out why they missed their appointments and book new ones. If you wait a week to call these people, then you`re dealing with 15 or 20 names.

If you have a listing of the doctors who referred new patients to your practice that day, then generate the thank-you, doctor-referral letters that same day. Other reports are important because they indicate the productivity levels of various dental procedures - i.e., how much time you`re spending doing what!

Inter-office communications

Although the front desk or business area functions separately from the operatory or clinical-treatment area, their separate functions must be synchronized if your practice is to run smoothly. A good illustration is the beginning or the end of a patient appointment. The front- desk employees should know about any concerns that may have been expressed to them by patients, such as a sick relative, money problems, changing insurance, or any confusion about the treatment plan. The doctor should be given this information so he or she will not be caught offguard by the patient.

Similarly, during the treatment visit, any changes from the treatment plan should be conveyed to the front desk, so the charges can be altered accordingly. At the end of the treatment portion of the visit, the front-desk staff should know when you`d like the patient to return and if there are any special instructions to be given.

In our office, one touch of a key - linked to our appointment scheduler - automatically generates a "Care Slip" for every patient. This goes into the operatory with the patient and contains relevant information, including the patient`s name, insurance status, date the last X-rays were taken, payment record, last prophylaxis, treatment performed last visit, treatment remaining to be done, etc.

This Care Slip is updated and sent back to the front desk with the patient record at the end of the visit. The updated Care Slip includes any information that needs to be conveyed to the front desk, so everybody is on the same page. Nothing is more disturbing to a patient or a customer in any service business than the feeling that one hand doesn`t know what the other is doing. Talk to one another.

Intra-office gossip, whispered complaints, and all forms of resentment should not be tolerated. Pitting one employee against another or setting up a competitive atmosphere works to the detriment of the practice.

Don`t let bickerings deteriorate into more serious arguments. It doesn`t matter who`s right and who`s wrong. The issue is the success of the practice. You and your staff should all be working toward the same goal. If you don`t have that feeling, then clear out! No matter what, everyone should speak in a civil, respectful tone. Don`t wash your dirty linen in public!

Staff meetings

Staff meetings are important. They offer a place where issues can be discussed openly, in front of everyone, so that no one can say, "That`s not what you said."

Many experts feel the need to set aside an entire day to talk about a million things. Not me! If an issue arises, it should be dealt with the same day, so when the details are fresh and vivid in everyone`s mind. You don`t want to leave the office and go home harboring anger and resentment. Don`t leave the dirty dishes in the sink over night! They`ll be much harder to wash the next day.

If you focus on one idea or one problem at a time, it`s much easier than dealing with a laundry list of items.

For more information about this or to order his latest videotape course on "Winning Friends and Influencing Patients," contact the author at (773) 764-0007. A biography of the author appears on Page 8.

The phone face

No more than three "ringey-dingeys," please! If you`re busy and the phone rings, simply pick it up and say, "Hello, this is Dr. Berman`s office. Can you hold for a moment, please?" Or, you can say, "How can I help you?" Then, listen to the request and say, "Can you hold on?"or "May I return your call?" The rule of thumb is the person on the phone waits in deference to the person standing in front of you in the middle of a transaction - unless it`s an emergency.

The first contact

Usually, the first contact a patient has with any office is via the telephone. In our personal lives, we often will call some place of business and say to ourselves following the conversation: "Gee, he sounded really nice," "She wasn`t very friendly," "He sounded very rushed," "She was very abrupt," "He sounded like a very warm person," or "She sounded very reassuring."

Even the word, "hello," can set the tone for the rest of the phone conversation. It can convey an attitude. Do you sound harassed? Irritated? Do you give the person at the other end of the line the feeling that they`ve intruded? Do you sound glad that this person has called? The caller can hear a smile on the phone. You can convey an attitude not only with what you say, but by the way you say it.

What not to say!

When you ask for the caller`s name and you don`t understand what he or she said, don`t say "Huh?"

You also should not say "Come again?" or " How`s that?" or "Could you speak a little slower?" Instead, say "I`m so sorry I didn`t understand. Could you spell that for me" or "Could you repeat that please?" This is especially frustrating when speaking with people with foreign accents or with very soft-spoken individuals. However, the reason for the problem doesn`t matter. What does matter is not making a caller feel uncomfortable.

Gathering information

We have a standardized "New Patient Questionnaire" that details all of the information to be obtained during that first phone conversation. After routinely requesting the name, address, and phone number, we ask, "Who referred you?" or "How did you hear about Dr.Berman?"

As a gesture of friendliness, we acknowledge that person with the patient; i.e., "Oh, Janet Wilson! She`s a lovely lady!" or "Dr. Parker. We went to school together!" Don`t say something stupid like, "Who?"

Then it`s on to "How can we help you?" and "Are you in pain or having discomfort?" or "Oh, you need a routine dental examination? When was your last visit to the dentist? Two years ago." Don`t say, "Two years ago???"

This patient finally may have gathered enough courage to call for dental care. Don`t scare the heck out of this caller! The single, most important principle to remember with a phone conversation - when you can`t see the face of the person calling - is that you must listen!

What you can learn

You can pick up little hints about a person`s personality type and where they`re coming from. Is this person nervous or excitable? Does he or she sound demanding? Is the caller "bad-mouthing" dentistry because of all previous bad experiences? Did the caller ask, "How much does a visit cost" or "How much is a filling?" or "Does the doctor accept insurance?" or "Does he give gas?" One of my favorites is, "Do you charge for an examination?"

Listen to all of the caller`s concerns and then relieve apprehensions of the unknown by telling the great story about "our" office. End the phone call with, "We`re so glad you called! We`ll be looking forward to seeing you." This is a positive conclusion to a friendly conversation.

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