Mastering the art of communication

3M Dental is proud to sponsor the Dental Economics year-long "Mastering the Art of Communication" series.

Part 9

The Art of Maintaining Relationships

3M Dental is proud to sponsor the Dental Economics year-long "Mastering the Art of Communication" series.

Sandy Roth

Thinking about the bottom line has a significant influence on many practices - sometimes to the exclusion of the long-term health of the business. Practice profitability is important, of course. Dentists and team members alike must know about, understand, and pay attention to practice finances. In the pages of this magazine, readers find many different ideas and perspectives about how to improve financial health. But if a focus on finances becomes dominant and overshadows patient care, the nature of the practice is changed in notable ways.

At one level, practice economics are simple. Additional profit can only result from increased production and decreased expenses. The trick is to keep these two strategies in balance. Decrease expenses too much and you strip the practice of assets- human and otherwise - that are needed to provide your unique and distinctive service. Increase production without sound planning or philosophical congruence, and you can become overwhelmed by the frenetic pace. In looking at how to increase production, the conceptual formula that makes the most sense is a simple one: more collaborative patients who choose better dentistry sooner.

Collaborative patients: A highly successful practice is one that attracts a substantial number of patients for whom the practice is most appropriate. What makes a practice "appropriate?" It depends on the practice. Generally, a practice is appropriate when the goals of both patient and practice are in alignment, with each actively working in collaborative partnership. Your practice is not appropriate for patients who ask for something you either can`t or won`t provide. Your obligation is to tell those patients that you cannot serve them the way they wish. Events tailored for new patients will help determine what each patient is asking from you. It is the first opportunity to form a collaborative partnership.

Choose better dentistry: "Better" dentistry is care that either (a) prevents predictable problems, (b) creates long-term solutions, or (c) enhances existing conditions. I have never met a dentist who would rather fix a problem than help a patient avoid it in the first place. Nor have I ever come across a dentist who wouldn`t prefer to provide the most comprehensive, long-lasting, and highest-quality solution he or she could provide. Patchwork dentistry and postponing treatment for non-clinical reasons does not fit the definition of "better dentistry." Better dentistry will be chosen if the relationship is based on mutual respect and understanding, even when patients must struggle with issues like time, money, energy, and courage.

Sooner: Economically, it is better for the practice when a patient chooses to engage your services now rather than later. Earlier intervention and restoration almost always provides a better clinical outcome as well. Most dental problems rarely improve on their own, nor do they get easier to solve with time. Postponing dental treatment also results in more costly and less comfortable treatment. Dentistry performed sooner is better for both the patient and the practice.

What leads to these collaborative partnerships? Among other things, better skills, more highly trained staff members, time, and perhaps even a different practice structure.

A traditional practice structure is comprised of both a clinical and administrative arena - the back and the front. However, it is almost impossible to engage in a meaningful, facilitative conversation at the traditional front desk. Patients awaiting treatment are privy to both incoming and outgoing telephone conversations, as well as discussions between other patients and the receptionist. This arena is too public; the privacy needed to discuss appointments, fees, financial arrangements, and treatment plans is absent.

Moreover, the front-desk staff must judiciously balance both attention to patients and administrative tasks. When the receptionist complains that she "didn`t get a thing done" because of telephone and patient interruptions, it is obvious that the systems and structure must change. We must redefine the practice model to introduce a behavioral dimension, and modify the administrative and clinical dimensions.

This modified structure has the administrative arena responsible for the internal operations of the practice and its business, focusing on paper and instruments instead of patients. Administrative staff would work best in private, separate areas where they can concentrate without interruptions or distractions. Clerical and financial work, which requires great attention to detail, are examples of adminsitrative work. Administrative work isn`t just paperwork; it also includes clinical management tasks such as sterilization, inventory, stocking, and lab case management. It does not involve patient contact, but does require a high level of competence in specific skills.

The administrative staff can undertake many duties traditionally performed by front desk and clinical personnel. Shifting these duties frees front desk and clinical personnel to focus exclusively on patient relationships and high quality care.

The clinical arena is responsible for delivering selected patient services efficiently, with great skill and attention to patient comfort. This patient contact work requires both strong clinical ability and superior interpersonal communication.

The behavioral arena is a new concept for many dental practices. This arena is where facilitators - behaviorally oriented team members who bridge patients to the dentist and team - develop and maintain relationships. Facilitators must have highly developed communication skills, a private area to speak with patients without interruption, and the time to focus on patients and relationships. The behavioral arena must provide the structure and support for patients during the clarification process - when facilitators help them become clear about what they want and why - and likewise when facilitators help them address issues of time, energy, money, courage, and comfort.

In the August issue of this ongoing series, Mastering the Art of Communication, I introduced the process by which facilitators begin forming relationships with new patients. Maintaining ongoing relationships requires facilitators to also focus their attention on existing patients.

Facilitators deal with three distinct groups of patients. Patients in the process of making choices require ongoing contact and encouragement without manipulation. Many patients will not make an immediate decision about their care. Some require time to get their finances in order, while others will struggle with their fears. Still others will be uncertain about pursuing treatment.

As a key player at new-patient appointments, the facilitator must remain connected with the patient by telephone, correspondence, or in person, encouraging and supporting the patient in decision-making without hard-sell tactics or manipulation. It is better for the patient to act sooner rather than later; however, it is too soon if the patient has not yet made the committed decision to begin and follow through with the recommended care. The facilitator is a continuous link until the patient has identified, addressed, and dealt with the barriers to care.

Patients in limbo are those who have accomplished some treatment but have yet to complete it. Facilitators must remain in contact with these patients to review the recommendations and learn how the patients` priorities have shifted. Although some patients embrace the entire treatment plan and act on recommendations immediately, many more choose to accomplish their dentistry over a longer period of time.

These patients may be clear about what they want and simply have to deal with the logistics of time, money, and energy.

Lost souls are those patients who have discontinued their active involvement in your practice. Facilitators must contact them to learn how they intend to pursue their care. In many cases, these are patients you would enjoy having in your practice but who have dropped out of sight for a variety of reasons. The facilitator`s efforts to re-establish a working relationship might encourage them to return for care without fear of judgment or disapproval.

The facilitator`s primary responsibility is to build and maintain relationships. This public relations and marketing role requires special skills and a serious focus; it is not reasonable to ask a facilitator to accept responsibilities and administrative tasks traditionally associated with the front desk.

Facilitators must have a highly developed understanding of the principles of human behavior, communication, and interpersonal dynamics. An effective facilitator can contribute significantly to even the best practice. Expectations will be clearer, and problems can be intercepted before they become relationship-destroyers.

From a behavioral perspective, it is the relationship, rather than financial, bottom line with which dentists must concern themselves. Only within a strong relationship do you have increased opportunities to provide more patients with better dentistry sooner. The relationship bottom line is the return on your investment in building and maintaining patient relationships based on understanding and respect.

How do you increase the relationship bottom line? Through better communication and facilitation skills.

- Your first job is clarification - the process by which we help patients and clients become clear about what they want.

- Your second job is facilitation - the process during which we help patients and clients identify, understand, and address their barriers and limitations.

- Your next job is dentistry.

When you become "relationship bottom liners," every team member who has patient contact becomes a facilitator. Every team member will be responsible for production, collection, scheduling, recall, new patients, marketing, cancellations, and no-shows. No team member who has direct contact with clients can look upon these aspects as "not my job." The implications are clear. Everyone must become a clarification expert and facilitator.

Team members must develop the skills to engage in meaningful discussion with patients and clients. Idle social "chat" is a luxury the team can ill afford until clarification and facilitation issues have been addressed. Team members often rely on lighter conversation to build rapport. There is, however, a huge difference between a true relationship and a social acquaintance. Although patients may enjoy some casual conversation, it is not enough to sustain relationships and keep them coming to your practice.

Some people can`t be treated appropriately in your practice. Perhaps you have tried to be all things to all patients at some point in your career. While there may be individuals with whom you work very well, you may find some individuals so frustrating or difficult that you groan when you see their names on the day sheet. What makes the difference? Two variables to consider in maintaining ongoing relationships are alignment and action.

Alignment is the degree to which a partnership exists between the practice and the patient based on a similarity of perspective and goals. In dentistry, this is determined by whether the patient and practice are both oriented toward short-term vs. long-term goals. We can measure each individual patient`s degree of alignment along a continuum ranging from "very aligned" to "not aligned."

At the extremes, it is easy to determine which relationships will be successful and which ones will not. A patient who is focused on long-term solutions will not feel well-served in an emergency-oriented retail practice. Likewise, a patient who prefers to deal with a problem only when it becomes unbearable would feel out of place in a practice that emphasizes prevention.

Action defines the degree to which a patient is an active partner. Does the patient make plans and follow through? When unexpected problems occur, does the patient engage in problem-solving or delay the inevitable? Is the patient intentional or laissez-faire? Does the patient initiate discussions or wait to be called time after time? Does the patient prefer to be "done with" or "done to?"

Those patients who are very active and very aligned are the people with whom you will have the best relationships and with whom collaborative partnerships will be most successful. Those who are inactive and not aligned are not patients you can likely help.

It is easy to determine how to manage relationships that fall at the extremes, but how will you work with the bulk of your patients - those who fall somewhere between these extremes? Consider the matrix below, which juxtaposes activity against alignment. Resist the temptation to go through your charts and put a blue dot for Priority One, a green dot for Priority Two, etc. The purpose of this overview is to help you understand why some relationships work and others don`t, and what you can do about it.

Many dentists have hundreds or even thousands of shelved charts for inactive patients. Hating to lose a patient, they give their staff the assignment to call and remind the person that he is overdue for a hygiene appointment or ask if he is ready to proceed with recommended treatment. This task is arguably the least gratifying in the practice. Team members often ask how many times they should have to call, leave messages, or listen to "I`ll call when I`m ready" before they can consider the answer a final "No." The model will help you make the decision about where to put your resources and energy.

No Priority - Those relationships that fall across the lower axis "Not Aligned" are not relationships at all. These are patients you cannot help. They do not want what you have to offer and you do not offer what they want. Think of it this way: They are customers who are in the market to have their car inspected and your business is auto detailing. Just because there is a car in common doesn`t mean they should be in your shop. Refer them to more suitable providers and turn your attention elsewhere.

Priority One - Those patient relationships which fall in the upper left sextant of this matrix are those in which you have a clearly articulated and agreed upon goal and plan on which you are acting collaboratively. These relationships have nothing to do with the cost or complexity of the dentistry; rather, they are based on a mutual understanding and collaborative effort. These relationships are low maintenance with high expectations. Because you are on the same page, your efforts are spent providing services exactly as promised and maintaining strong working partnerships. The more patient relationships you develop at this level, the more intentional your practice will be.

These patient relationships must receive your most focused attention and must be your highest priority. Most dentists will never have a practice comprised exclusively of these relationships. The goal is to organize your resources to serve these relationships well and encourage others on the fringes to become either more active or more aligned.

Priority Two - These are the relationships with patients who are very active in attending to their dental care and who make choices that are frequently, yet not always, in alignment with your first recommendations. These are important relationships which require your next highest level of attention.

For example, parents often prioritize their children`s care over their own. Although you may believe the adult requires more sttention, you must honor the choice of the parent.

Your challenge in these relationships is to ensure that patients are aware of the difference between their choices and your recommendations and that they don`t feel judged when they make choices in accordance with their priorities.

Priority Three - These relationships are difficult to maintain without a specific plan, because these patients are only active in spurts or cycles. Sometimes this is because they have lives that take them through cycles (for example, accountants cycle around tax season in the same way teachers do around school calendars.) As the patients` circumstances change, they may allocate the time, money, or energy to act more comprehensively.

Remember, most people can afford almost anything they want; they just can`t afford everything they want. Your job is to stay connected and supportive.

Priority Four - These relationships offer the greatest opportunity for your team`s facilitation skills. They can run the gamut from success or failure depending on the level and quality of nurturing given. Many patients - perhaps even the bulk of those in your practice - are partly aligned and intermittently active. If you have set working with collaborative partners as your first priority, you will always be prepared to serve these patients when they are ready.

What is essential to help these patients? Curiosity, support without judgment, and truth. These patients are always entitled to the clearest recommendation and your opinion about the implications of their choices. With good communication skills and integrity, many of these relationships can become more aligned.

Priority Five - This is a unique group. Many dentists who practice in sunbelt areas have patients who winter in the south and summer in the north. Dentists who serve these patients during the summer may not see them at all during the winter. During the off-season, these patients may be completely inactive in the practice, yet highly congruent with their care. The wise dentist will coordinate care with an alternate provider and strive to maintain a strong, collaborative, patient-focused relationship.

Another example is the patient who is inactive because due to other preliminary treatment - orthodontics or oral surgery in preparation for a reconstruction, for example.

These are strong, healthy, intentional, and collaborative relationships on hold for a specific reason. The dentist and team must be prepared and available when the time is right, because this relationship can quickly move into a Priority One collaborative partnership.

When should you give up? Those who are not asking for your help are not your patients. Store their records; don`t annoy them with incessant calls trying to persuade them otherwise. As long as the relationship is moving toward a greater level of activity and alignment, stay connected and prioritize your efforts.

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