Episde #559: 7 Steps to Reduce Cancellations

One secret to a better practice is better scheduling. When you can reduce your cancellations, you will have better days, a happier team, and become more profitable. You can do exactly that with seven essential steps, and Kirk Behrendt brings back Robyn Theisen, an amazing ACT coach, to share how to incorporate them into your office. With a few changes to your verbal skills and mindset, you can start saving more appointments! To learn how, listen to Episode 559 of The Best Practices Show!

Episode Resources:

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Links Mentioned in This Episode:

Previous Best Practices episodes with Miranda Beeson: https://www.youtube.com/results?search_query=act+dental+miranda+beeson

Dental Intel: https://www.dentalintel.com

ACT’s Capacity Tracker: https://drive.google.com/file/d/1MdN96fVhau8tcP10kW2_cU-Tv91K8r7l/view?_hsmi=241651107&_hsenc=p2ANqtz-98AjmJ7LkC2HvkK9uuY8l577tbOQ_8dHgEv1V_RVjByeE1xTLRFEYlHJVqxNmOsEBjwFPH-Cjr7iCbb4p-dJiLdKWb7A

Main Takeaways:

Remember that all of your cancellations start at the chair.

Value your dentistry and communicate that to patients.

Track your cancellation and no-show percentages.

Appointments are confirmed once they’re made.

Never tell your patients it’s okay to cancel.

Code and track your patients’ behavior.

Get rid of your cancellation fees.

Quotes:

“Cancellations become something that’s acceptable in the practice. And with practices today that are busy, hygiene is overflowing, they tend to become, as soon as someone has cancelled, it’s filled. So, they overlook the problem and how much time is spent on keeping the schedules full. If we could keep more patients in the schedule, there is more time for your business team and your whole team to be spending with patients and creating those relationships.” (2:29—2:58)

“We must value what we do and speak to patients in that way. Patients place as much importance on an appointment as we do. So, when we talk about, ‘It’s just a cleaning,’ or we brush over that appointment when we’re walking a patient out for PIT Stop, or we don't talk to them about how important those appointments are, creating urgency, any of those things, it devalues the appointment, and it becomes very routine to them, and it becomes no big deal.” (3:55—4:19)

“It starts with our belief system. And what you believe is leadership and how you talk about dentistry. So, the clinical team and the dentist himself or herself and how they talk about it, that's really important. It isn't “just” a cleaning. I like to tell people too, when [they] don't want to schedule ahead and they say, ‘I don't know what I'm doing six months from now,’ I'll say, ‘Well, great. Let's get this scheduled, and then you'll know so when something else comes up, you can tell them, I can't do that. I've got to be at my dentist at that time.’” (6:05—6:35)

“Seeing a hygienist twice a year, that’s sometimes the only doctor’s appointment that people have in a year. And the mouth is the gateway to so many things. It’s a really important appointment. It’s not “just” a cleaning.” (7:33—7:45)

“All cancellations start at the chair. I think the business team carries the weight of the cancellations and no-shows. And really, the clinical team has such an impact on this as well with the language and how many times they talk about the cleaning, how many times they talk about returning for the appointment, the urgency the doctor puts on the treatment that they're recommending. All of those things start at the chair.” (8:25—8:51)

“[We want] the patient to hear it over, and over, and over again with the PIT Stops and the handoffs. I know we tire of doing them in dentistry, and it’s really not about us. It’s about the patients, and they can't hear it enough.” (8:54—9:05)

“Know the cancellation and no-show percentages. You cannot impact what you don't know. And most often, I think people believe that their cancellation or no-shows are low, and it’s oftentimes higher than they believe that it is. So, knowing what it is — you can't impact it without knowing where you're starting from.” (10:20—10:38)

“We use, and many of our practices use, Dental Intel. That's a great source. Now, in Dental Intel, it has to be done correctly. For each software, there are nuances to how you break or cancel an appointment so that it falls into the right bucket with cancellations and no-shows. The other ways are capacity trackers. So, having each clinician keep track of how many hours they saw patients for that day, and how many hours they did actually see them. So, that's a manual way to do it as well.” (11:50—12:18)

“I would like for [cancellation and no-show percentages] to be under 10%, combined. I do believe that having some openings in your schedule is good because it allows for growth. It allows for new patients to come in. It allows for us to have scaling and root planing. We need to have some ability to have openings in the schedule — emergencies that call, some of those things. But I want them to be controlled, and I want to be able to refill them. So, having that under 10% is my goal.” (13:36—14:10)

“Consider your appointments confirmed when they are made and use language that supports that. So, telling your patients that you have the time “reserved” for them, ‘It’s on our calendar. Go ahead and put it on yours so that you also have reserved that time.’ Eliminate “confirm” and “remind”. If we continue to call and confirm appointments, it means it wasn't firm in the first place. When we've “reserved” time for them, that's the language that we want to use. And when you're calling those patients as a courtesy reminder between appointments, using it more as an assumptive close of, ‘We’ve got this time reserved. We’re all set to see you tomorrow, and we’re looking forward to it,’ rather than, ‘If you can't make it, call us,’ or giving patients a bunch of outs of ways to not come in, or it’s okay to cancel or no-show for the appointment.” (16:48—17:40)

“Having a 48-hour cancellation notice, you've just told patients when it’s okay to cancel with you. So, eliminate the 48-hour cancellation. The appointment is reserved. Let's go on the assumption that the patient is going to be there.” (19:09—19:22)

“[Instead of “cancellation”, say], ‘We’ve had a change in the schedule.’” (20:18—20:20)

“Start coding patients’ behavior. So, creating codes in your practice management software to track cancellations, changes in schedule, no-shows, and late arrivals so that we can track a patient’s behavior. Someone once told me, ‘When a patient shows you or a person shows you who they are, believe them.’ And so, if there is this trend in how they are treating you, it’s on us to respect our schedule and to train the patients how to respect it as well.” (20:51—21:21)

“I like to create my own [patient behavior] codes so that it’s a way for us to track it and it keeps it separate from any ADA code. It’s another code, and it’s unique to our practice. So, create a code that works for you.” (22:13—22:23)

“At two [cancellations], I'm going to have a conversation about it . . . You recommended having the conversation about putting them on a call list. I would add another option to that. I would allow them to be on a call list, or they could go ahead and prepay to reserve the time with us. So, ‘Either one of those will work. Which is going to be best for you?’” (23:44—24:13)

“I also say to patients, ‘Gosh, it looks like we’re having a hard time getting our schedules to line up. What recommendations do you have, or what suggestions do you have that could make it easy for this to work for the both of us?’ So, putting it back on the patient too, to understand from them like, ‘What can we do with this system that's going to work for you to be here when you need to be?’ So, it’s not just about me. It’s about them too.” (25:15—25:40)

“I hear from teams all the time that it’s customer service to allow patients to behave this way. I push back on that in that this is a relationship business. And in a relationship, there are two sides, and each person is responsible for their behavior. So, it’s having boundaries and teaching them to respect my time, and I will absolutely do the same for yours.” (26:23—26:42)

“I hear a lot of team members, and I used to do it myself too, when patients would call to say that they needed to cancel their appointment, I would tell them that, ‘Oh, that's okay.’ And really, it’s not okay. So, remove that piece of it. I believe when patients call in and they are, ‘I'm so sorry. I can't be there,’ they're expecting for us to make it very easy. They're expecting for us to say, ‘It’s okay. No problem. We’ll take care of it.’ And so, I like to tell them, ‘Let me put you on hold for one minute. Let me take a look at your account, and I'll be right back with you.’ And by putting them on hold, the pausing, collecting yourself — because I know that these can be hard conversations for team members to have. It’s a change for them. It’s different, and confrontation or having a tough conversation can be hard for them. So, putting them on hold, having the patients wait for a moment and collecting your thoughts, and really being able to understand how many times this patient has cancelled, or they have not shown up, or they have been late helps you to frame what you're going to say next.” (28:26—29:28)

“Many of our practices right now, hygiene is overflowing. They're not going to get in for six months. So, how about saying, ‘Gosh. I'm concerned because my next appointment that I have available is six months from now. That is a long time between your hygiene visits, and I'm concerned about your health. Is there any way that you can keep that appointment today?’ Or what are their health goals? Like, ‘I'm really concerned. I can't get you in to see the doctor for another month or so. I'm concerned about the crown that you were needing. Is there any way that you can keep that appointment?’ So, build value into it, and go back to what's important to them rather than scolding them. It’s really about, let's build value into this and see what they can do to make it.” (32:22—33:02)

“Get rid of your cancellation fees. I believe that verbal skills outweigh a cancellation fee, hands down. And cancellation fees are generally a threat. They don't really get used. When they do, they get reversed. And the fee that is charged is never enough to cover the appointment time. So, instead, use the other things we've talked about. Create a bulletproof no-show cancellation policy and get rid of the fee. Keep more patients in your schedule.” (33:47—34:24)

“As the business team, when you put these into place and you save appointments, celebrate it. Let your team know that you saved an appointment. It’s a big deal. So, when you actually put these things into place, celebrate the wins and celebrate the decrease in that no-show cancellation percentage.” (36:19—36:36)

Snippets:

0:00 Introduction.

2:14 Why cancellations are a problem in dental offices.

3:48 Step 1) Value what you do and communicate that to patients.

5:54 How to get the team to think better and create value.

8:22 Step 2) All cancellations start at the chair.

10:16 Step 3) Know your cancellation and no-show percentages.

10:38 Where to get the data for broken appointment percentages.

13:20 Good and bad cancellation and no-show numbers.

14:49 Breaking and dragging appointments.

15:36 The Capacity Tracker.

16:45 Step 4) Consider your appointments confirmed when they are made.

19:06 What to say instead of “cancellation”.

20:47 Step 5) Start coding patients’ behavior.

21:57 Should I use the ADA’s patient behavior codes or create unique codes?

22:50 How many strikes for cancellations?

24:15 Teach patients how to behave in your practice.

28:22 Step 6) Don't say, “That's okay.”

31:31 Advocate for your patients.

33:43 Step 7) Get rid of your cancellation fees.

36:11 Last thoughts on cancellations.

Robyn Theisen Bio:

Robyn Theisen brings an entire life and legacy of dental experience to the team and every team with which she works as the daughter and sister of dentists. With almost 20 years of experience in dentistry, her roles ranged from practice management to operations at Patterson Dental to coaching teams. Robyn’s passion is empowering teams to realize that they can dramatically impact the lives of the people they serve by implementing skills and systems to remove barriers to life-changing dental treatment. She has done it for decades and does it every day with dental teams.

Outside of coaching, she enjoys time with her husband, Rob, and two daughters, Emerson and Ruby. She loves traveling, music, fitness, and cheering on the Michigan State Spartans.