#2 – Broken appointments handled effectively

A five percent no show rate for 20 years equals ONE YEAR of lost production.

If a client can’t make their appointment, we ask that they give us 24 hours notice.  If they show us this courtesy we will re‑schedule them. If they give us less than 24 hours notice, chances are we won’t be able to fill their spot in the schedule.  Since we have lost productive time, we will use them at our convenience to fill future holes in our schedule.  If we reschedule them immediately, it tells them it’s ok to fail appointments with us, and you can bet they will!  Even if there are spaces in the next day or two, wait at least one week before offering them a time.  If they can’t make that time, but want another, politely thank them and let them know this is the only opening you have now, and you’ll call them as soon as something else opens up!

When they break an appointment with us, follow this procedure:

  1. Select the patient
  2. schedule them a new appointment in extra column at same time
  3. choose either cancelled/no show as the treatment
  4. If the patient is new, do not select Cancel or now show – just type it on the appointment line
  5. make appropriate notes – reason, amount of time etc
  6. set this appointment complete
  7. Select their appointment in the appointment book in Dentrix
  8. Click on the Break Appt. icon – this will place them on the unscheduled list.

Broken appointments handled effectively

Cancelled appointments with less than 24 hours notice are one of a secretary’s biggest headaches and result in as much as 30% in lost productivity in some offices.  Cancellations should be treated as a broken appointment.  You might think that the only reason for a cancellation or no show is the client forgot.  Here are a number of real reasons:

  1. Financial arrangement too strict or not done ‑ and client realizes they can’t afford the treatment
  2. Client doesn’t understand what treatment is to be done or its value
  3. Client broke an earlier appointment and was immediately given another appointment, client learned it was ok to break appointments
  4. Client not told how we feel about cancellations
  5. Client had a bad experience with doctor or staff –  a. Client was made to wait a long time or  b. Pain/stress not handled well

Seven minutes past the client’s scheduled appointment time call him/her. Show concern, but don’t reprimand.  If you reach the client on the phone, see how long it would take them to get to us.  There are two situations.

a)  Client is already late ‑ determine how long the appointment is, how long it would take them to get to us, how much time is left and if treatment could be completed in the time remaining.

b)  Client calls to cancel with less than 24 hours notice.  Before accepting the broken appointment, see if you can get the client to come in.  Do they need a ride (Handivan, friend), can they get a baby‑sitter (neighbor or last resort bring them in)?  Re‑emphasize how important the appointment is.

One type of response you will get occasionally is “I’m sick.”  Often the client is actually sick.  They should NOT be in the office spreading germs to everyone else!  However, about 25% of those calls are from people who have the “sniffles” or other minor complaints.  Use your communication skills to separate them out from the really sick and try to get them to come in.  “Gosh, Mrs. Smith, I’m sorry you have a cold.  You don’t have to worry about giving it to us.  Everyone wears mask, gloves, and eye protection.  I know how much Doctor _______ wanted to do your treatment today.  Why don’t you come in and try?  If you’re uncomfortable, we’ll reschedule then.”  If you can’t keep the appointment, put them on the broken list and the back staff will note the cancellation on the client’s treatment sheet.

A well managed practice with clients who appreciate the office should have no more than five cancellations per week per producer.

Clients who break appointments with less than 24 hours notice are never given another appointment immediately (unless they have an excuse that was beyond their control).  A tactful way to say this might be: “I’m sorry, Mrs. Jones, but our schedule is completely filled right now.  I’ll make a note of how much time you will need for the appointment and call you as soon as we get an opening.”

Client who comes in late for an appointment:

Patient comes late ‑ Don’t ever look or sound irritated with the late client.  Always show concern.  After all, all our clients are on time, aren’t they (as far as your delinquent client is concerned)?  Show concern.  “Oh Mrs. Gabel, I’m so glad you’re alright!  I was worried about you!  Please have a seat and I’ll see if we have enough time to provide your care.”

Secretary then checks with the provider; if there is not enough time say “Thank you for coming but Dr.’s next patient is scheduled for   ______ in ______ minutes, and we won’t have time to complete your _________ today.  We appreciate you coming, but we’ll have to reschedule your appointment.”  If there is at least 1/2 hour remaining in this appointment, check with the doctor.  He may be able to do some of the treatment.  Let him decide.  If it is a cleaning appointment and at least 1/2 hour remains, accept the appointment.  Expect to charge a full fee on the cleaning appointment and a generous fee on the doctor’s appointment.

Besides a poor financial arrangement, the client may cancel because they don’t value the appointment. Be sure to share with the staff the next day why the client canceled, but be sure not to blame or point fingers. Make sure the staff is stressing the benefits of the appointment.

Damage Control

Okay, your client has “no showed.”  What do you do now to try to control the damage to your schedule?  Actually, you’ve got a number of possibilities.

1.  Look on the ASAP list in the appointment book. Keep it up to date.  When contacting these clients, never use the word “cancellation.”  Say “Mr. Smith, we’ve had a change in our schedule and I immediately thought of you.  I know you want to get ___________ done.  Would you like to come in at ______?”  Make sure your call list notes where the person lives or works so you will know if they can

a) Come on short notice

b) How quickly they can be here

2.  Warn the provider of the problem.  Have them look at the rest of the clients being treated that day.  Can any of the appointments be lengthened or come in earlier?

3.  Let the other providers (dentists, chairsides, or hygienists) know that there is a hole in the schedule.  Keep them alert to look for fill in procedures.

4.  Try to move up a client scheduled later in the day.  This will buy you more time to fill a hole later in the day.

5.  Emergency clients are often the keys to filling in these holes. They think we’re wonderful for meeting their needs so quickly and we appreciate their help.

What could be better?  Make sure you make a good financial arrangement before the provider begins this unscheduled treatment!  As you can tell, this is a time consuming hassle.  Is there any way to reduce the number of no shows?  Sure.  Try these ideas:

  1. Make sure the staff (and doctors) understand how serious this lost production is.  Some staff may look at this as a welcome break in the office routine.  They may not want to “dump a client” on someone else.  Help them learn to take pride in being highly productive.
    Clients will respect our time in exactly the same degree that we value theirs.  Make sure your producers are on time.  Know when your producers are behind schedule.  If they are going to be more than 15 minutes behind schedule, call and let the client know they won’t need to “rush,” that we are running ____ minutes behind schedule. Always place a client on the call list if they miss an appointment.   Never immediately reappoint them. Stress to your clients that you have reserved this time for them.   Stress how important it will be for them to be on time.
  2. Confirm all appointments
  3. Make sure tomorrow’s schedule is filled before you go home tonight.

***When you are ready, keep track of every broken/missed appointment for one month.  Also note:

  1. Why did the client miss?
  2. How much productivity time was lost?
  3. Did another client fill in this time?
  4. How much time did you “waste” scrambling to fill this hole?
  5. What could have been done to avoid this failure?

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