by Dr. Paul Homoly, CSP
When patients have a positive experience in your practice, they will not only be more inclined to accept recommended treatment and return for ongoing care, but also refer friends and family. The resulting outcome will help to build your reputation and your practice. So what makes a patient’s experience positive? Is it the décor of your waiting room? Is it the way your team interacts with patients? Is it the clinical excellence you deliver? I have found there are five key distinctions that set the foundation for consistently delivering an ideal patient experience. Distinction means “to refine one’s thinking.” For example, a baseball player must distinguish, as the ball leaves a pitcher’s hand, whether a pitch is going to be a fastball or a curve ball. Then the player must determine how to react. If the batter is unable to make a distinction, or refine his observation, hitting a home run is nearly impossible.
Distinguish between excellence and leadership
The most important distinction, and the one that drives the success of a practice, is to distinguish between excellence and leadership. In dentistry, excellence traditionally has been defined as clinical ability and the clinical outcome, which is important. But there are many aspects of clinical excellence that patients don’t perceive. They cannot perceive a perfect margin or tertiary anatomy. In many ways, excellence is an inner experience known only by the dentist and his or her team. Leadership, on the other hand, is immediately perceptible by patients because leadership results in on-time appointments, nurturing relationships, and great teamwork. The leadership of a doctor encompasses many things. These include providing and implementing vision and direction, setting the tone of the practice, guiding team members through training and feedback, and encouraging and motivating patients to achieve optimal oral health. There is a distinction between excellence and leadership since excellence is not a substitute for leadership.
In fact, leadership needs to be the constant companion of excellence. Leadership is not just for the doctor. During a patient’s experience, it is the staff person with the patient who is the leader. This person can articulate the vision of the practice, proactively provide solutions to problems, and motivate engagement in optimal oral health. If your practice has leadership problems and you treat them with trial-and-error solutions, they become like potholes on a road. Imagine you are driving a car. As long as the car goes slowly, if you hit a pothole now and then, the ride is not too bumpy. But as soon as you accelerate, the potholes become more evident. The same principle applies to your practice. When you try to accelerate your practice and it begins to “shake,” it is not because of the patients. Rather it is because of who is behind the wheel.
Distinguish between educating and understanding
The second distinction that enhances the patient experience is between educating and understanding. Educating patients is to tell them what they do not know about their dental health, what the consequences of those dental conditions are if left untreated, and the ideal treatment recommendations. Typically, patient education conversations are one-way dialogues in which dentists talk and patients listen. Dentists have relied on patient education to help patients make good choices about recommended dental health care. Often, the single greatest issue that impacts a patient’s ability to accept care is not what is going on in his or her mouth, but what is happening in the patient’s life. When you take the time to understand people, the conversation becomes two-sided versus one-sided. As a result, you and the patient have a dialogue that leads to the best solution for the patient.
Unfortunately - in many situations - no matter how much a patient is educated, he or she is still unable or unwilling to move forward because the recommended treatment does not fit the patient’s lifestyle requirements. A team must be understanding if a patient is to accept care. Understanding a patient means gaining awareness of what is happening outside his or her mouth - with the patient’s budget, work schedule, family and time constraints. So, rather than approaching treatment acceptance from the “inside-out” and starting with the mouth, it is often more effective to approach treatment acceptance from the “outside-in” by understanding the patient prior to examination and diagnosis. When you spend more time understanding patients and less time educating them, not only will case acceptance increase, there will be less stress for both patients and the dental team.
Through understanding, you can effectively gauge the patient’s level of readiness. Be sure not to exceed that level of readiness, and only provide services that make the patient comfortable. Once you exceed a patient’s readiness level, he or she initially may comply and say “yes.” But when it comes to keeping an appointment, it might be a completely different story. So, if a patient needs the dentistry, what will make him or her ready? Quite simply, life will. A patient initially may say “no” to complex dentistry or cosmetic care, but that readiness will change if he or she has - for example - a wedding or reunion to attend. By consistently gaining understanding and identifying a patient’s level of readiness, you will build a long-term relationship. So, when the time is right, a patient will happily accept your treatment recommendations.
Distinguish between provider and advocate
The distinction between a provider and advocate is critical. For an ideal patient experience, a dentist must perform both roles. The provider is the clinician, the person who does the dentistry or directs the clinical services. The advocate is the advisor, the one who guides and supports and encourages a patient. The advocate presents treatment in terms of outcomes - what a patient will experience as a result of the dentistry. The language the advocate is going to use revolves around words like “comfort,” “confidence,” and “peace of mind.” Providers present treatment in terms of input - or what we do. They use language that revolves around actions such as “we are going to do a crown or bridge.”
Between the two, your primary role is that of advocate because an advocate helps patients make good health-care decisions regardless of the impact those decisions have on your role as provider. As an advocate, you are reassuring the patient that the treatment recommendation will fit into his or her life. The more you use the advocate role, and the more it is clear to the patient that you have his or her best interests in mind, the more the patient will trust clinical recommendations that benefit the provider role. Trust instills confidence, which is a cornerstone to an ideal patient experience.
Distinguish between fees and budgets
The patient experience typically deteriorates during the fee discussion because it is an uncomfortable subject for many dentists. This is why it is important to understand the distinction between fees and budgets. Fees are the cost of dental care - the dollar amount. The budget is the suitability of the cost of care relative to the patient’s financial resources. Dentists tend to quote fees rather than budgets, yet patients respond better to budgets. So, when you quote a fee, you need to have an idea of what the patient’s budget is.
For example, you could introduce cost early in the treatment and fee dialogue by saying, “John, typically patients would like to know the approximate cost and time required for the treatment I am going to recommend that will help you achieve the oral health goals we have discussed. I would estimate the cost to be approximately $4,500.”
How John responds will give you a good indication of his budget. Then, when you quote a dollar amount, start with the most comfortable payment option. First, use a program like CareCredit patient payment plans to take you from fee to budget. The entire consumer industry, especially for larger purchases, is driven by giving people the ability to pay over time. The reality is, with health insurance coverage benefits remaining at the same level they were 15 years ago, most dentistry is elective and requires investment by the patient. When you quote a fee, patients only hear the total amount and become focused on it. Conversely, if you start by discussing a patient’s estimated monthly payment, a treatment fee of $4,500 seems more manageable in a budget when it is $250 a month. By quoting fees without fitting them comfortably into a patient’s budget, you can create subtle anxiety, frustration, and tension between a patient and team.
Distinguish between condition and disability
The key to enhancing the patient experience, and the last distinction I will mention, is the difference between condition and disability. A condition is a clinical finding that is outside normal or healthy limits. A disability is what the patient is experiencing as a result of a dental condition. Conditions are clinical in nature whereas disabilities are emotional. Patients respond to communication that focuses on relieving their disability, not on the clinical discussion about how the condition is going to be fixed. Patients who have conditions with no associated disabilities are the most difficult and challenging for dentists and their teams. Unfortunately, most dentistry performed is on conditions with no associated disabilities. When diagnosing, dentists need to associate a disability for the patient via a simple four-step process.
First, create awareness of the condition with the patient. For example, a dentist might say, “Adam, were you aware that you had some old and broken fillings in the back of your mouth?” Second, illustrate the condition by comparing it to something with which the patient is familiar. Continuing the dialogue, the dentist might say, “Adam, fillings can break like cracks in a car windshield. They start small but, over time, get worse.” The third step is to provide patients with the consequences of not fixing the condition. So the dentist might say, “Adam, patients in my practice who have cracked fillings like yours often find that the affected teeth can crack or be lost.” Finally, associate a disability and create concern with a patient by saying, “Adam, if left untreated, you could have bigger problems later. Does the idea of having broken or missing teeth bother you?” Now a patient knows he or she has a condition, has associated a disability with the condition, and is concerned about delaying or declining treatment.
Generally, a patient is unable to evaluate your clinical expertise. But a patient easily can base decisions to accept dental care recommendations on his or her experience with your practice. By providing leadership, seeking to understand a patient’s life circumstances, becoming an advocate, helping a patient fit dentistry into his or her budget, and making sure a patient understands the condition of his or her oral health as well as the associated disabilities will demonstrate that you care not only for a patient’s teeth but for the individual as well.
Dr. Paul Homoly, CSP, graduated from the University of Illinois College of Dentistry in 1975. He practiced restorative dentistry for 20 years in Charlotte, N.C. During the last portion of his clinical career, Dr. Homoly expanded his work as a consultant and trainer. He is president of Homoly Communications Institute, a resource for dental industry professionals, that provides seminars, workshops and consultations on case acceptance, practice development, speaking, and practice management. Contact Dr. Homoly at (800) 294-9370, via e-mail at email@example.com, or on the Web at www.paulhomoly.com.