Dr. Christopher Phelps

	Researchers from the University of Edinburgh recently published an in-depth analysis of 2009’s  Air France Flight 447 Tragedy and what went wrong.

 is worth a read, but in the end the group boiled the problem down to a problem in the interaction between automation and humans. Automated systems are great. They save time. They give us the power to make calls, schedule appointments and communicate with our team and our patients. However, they can also lead to office disasters, especially at the point where a human has to take over from the technology.

	According to the researchers, handoffs from technology to a human are especially perilous when:

	·  When the person dealing with them is startled or inexperienced

	·  When we misread the cues coming from the system

	In these situations, the human part of the equation is likely to make a series of errors that result in a catastrophic failure of all the systems you have in place. Handoffs between technology and people can throw your office into chaos. And, in my experience, once of the biggest danger spots in most dental practices is the hand-off from the phone system to the team.

Related reading: 3 tips for closing more patient phone calls

	Phones are a great technology. They let people communicate over long distances in an instant. With a phone, your patients can find you online and immediately dial your office, respond to your marketing, or make an appointment. You need phones to do business. But, as with any technology, the point where a person takes control leaves a lot of room for error.
	If your phone system is working correctly, when a patient dials the number from your website or an advertisement, they’re connected to your office. The phone begins to ring. It’s time for technology to hand off the caller to a real person. And at this point, in an average practice, a few things can happen:

	1. A team member answers the phone and helps the patient book an appointment.

	2. A team member answers the phone and fails to book an appointment.

	3. A team member answers the phone and puts the caller on hold for some amount of time.

	4. A team member answers the phone and transfers the patient to someone’s voice mail.

	Here’s the thing. If you’re interested in pleasing your patients, growing your practice, and developing your team’s abilities, only option number one counts as a successful handoff. All of the other resolutions represent a “loss of control” issue, where the handoff from technology to human failed. When the phone is ringing, absent appropriate safe guards and training, your team is more likely to miss the handoff than to succeed at it.

	Why your staff fails at phone-to-human handoffs

	Everyone knows how to use a phone, and you train every new team member on the idiosyncrasies of your personal system, so why do they keep failing? Like an airplane pilot who suddenly has to take the controls, the problem has to do with the problem of applying that training in a high stress situation.
	
	Answering the phone is a lot like driving a car. Beginning drivers tend to get into a lot of fender benders because they don’t have the muscle memory to control the machine. In unfamiliar situations, they have to think through every single action, and the more choices they have to make, the more likely they are to mess up.

	Experienced drivers are less likely to get into accidents under normal circumstances, but throw some ice, an illness, sleep deprivation or even just yelling at the kids in the backseat into the mix, and suddenly they can’t function. Stressful situations are hard even on experts. And how many of your team members have spent as much time answering the phone as they have behind the wheel?  All it takes is a perfect storm of noise, busyness and a patient standing in front of them, and the person on the phone gets lost in the shuffle. It’s an expensive problem. If the average value of a new patient is $1,000 in the first year, a busy 15 minutes where three calls get dropped is like losing half to a whole day of production for many general dentists. Talk about catastrophically failed handoffs.

	So, what’s the anatomy of a failure? In general, it begins when a team member is surprised by a call, either because they’re dealing with another patient, or because someone else hasn’t answered yet and so someone unfamiliar with phone calls is answering the call. Because they’re not ready for a handoff, they’re startled. They don’t have a mental plan for the call. They either let the patient steer the conversation off course, or they decide to put the person on hold (resulting in either a dropped call or a hang-up) or send them to voicemail (another hang-up). If the team member is especially unprepared or over-busy, they won’t answer the call at all.

	You won’t know about these failures for a while, if you ever find out. But if you can admit that given enough stress, even an experienced team member can screw up a call, you can put training and feedback processes in place to help minimize future disasters.

Related reading: Top 10 strategies to enhance the power of your practice phone

	When the researchers from Edinburgh analyzed the Air France disaster, they came up with some ideas on how to avoid future crashes. While pilots receive extensive, and continuous training, they don’t get a lot of supervised practice flying planes under the sorts of circumstances where unexpected handoffs from technology are expected to occur. So, pilots need more time spent trying to keep the plane flying at high altitudes, since most of their normal experience involves takeoffs and landings.
	
	Likewise, your staff needs to practice dealing with phone calls at high stress times. One thing you could do is conduct an office-wide simulation. When the practice is open, have team members call into several lines at once while another talks at the desk like a chatty exiting patient. Have your front office team practice answering the phone and booking an appointment under these conditions. Give immediate feedback on how they did. You can do the same during a busy day at the office, by having your office manager observe phone behavior in high pressure situations and give immediate feedback.

	It might also help to track when your busiest times of day are. Then, if you use a service like Call Tracker ROI, when you get your monthly report you can see who is having the most trouble at crunch times, and schedule them for extra practice and observation time. The more someone learns to answer calls and book patients in these high stress times, the more they’ll develop the ‘muscle memory’ they need to navigate difficult phone situations under pressure.

	Phones are essential to our business. We can’t live without them, and an office that can’t answer phone calls and book patients won’t survive for long. Pay attention to the moment of the handoff, where a human takes over from technology. If your team can learn to master handoffs, you’re well on the way to a growing, thriving practice.

Articles






The perils -and power-of the telephone handoff.Researchers from the University of Edinburgh recently published an in-depth analysis of 2009’s  Air France Flight 447 Tragedy and what went wrong.

How phone skills can make or break your practice

	As a Cialdini-certified trainer, I help other dentists learn about Dr. Robert Cialdini’s principles of ethical persuasion and apply them in their dental practices.

	Ethical persuasion is an essential part of being a great clinician. You can’t help your patients unless you can persuade them to accept your diagnosis and treatment plans. Cialdini discovered that ethical persuasion is based in six main principles: liking, social proof, reciprocity, authority, scarcity and consistency. When you keep these principles in mind, you find that your case presentations become more persuasive, that patients are more likely to make and keep appointments, and that you provide the sort of amazing care to patients that helps a practice grow and thrive.
	
	Last fall, Dr. Cialdini published a new book in which he shifted his focus from the art of persuasion to setting the stage for persuasive attempts. In “Pre-suasion,” he talks about how things like a person’s physical environment, emotional state and current thoughts can affect what sorts of messages they’ll find persuasive and how likely they are to be persuaded.

	It’s a great book, and I’d recommended it to anyone who’s interested in creating a really great dental practice. One of the most important takeaways is that small things can have a huge effect on later decisions. If a patient is refusing to get a crown, is it really because he doesn’t care about his teeth? Or is he just aggravated because the bathroom soap dispenser was empty, and so he likes you a little less than he did earlier today?

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	Cialdini focuses on how subtle environmental cues change people, for instance, how the view outside his office window changes his writing style. Little things in your office also change people and their receptivity to treatment. It’s time to put some thought into creating the right pre-suasive atmosphere in every part of your office.

	When a patient walks into your office, what are they thinking about? Unless they’re regular patients with a long history of easy appointments and cavity-free check-ups, they’re probably worrying about one of two things: the possibility of pain or the possibility of expensive dental work. You can use pre-suasive techniques to distract them or to make them feel more at ease.  To create a positive atmosphere in your waiting area, try:

			Hanging photos of people with great smiles. Since frightened people naturally seek out the safety of a group, photos can help them feel more at ease. The smiles will refocus their attention from pain or cost to smiles and teeth.

			Adding a complimentary coffee and hot beverage kiosk. The unexpected gift will help them like you and your office, and the warm drinks will relax and soothe them.

			Utilizing lights and decor that mimic natural light and the outdoors as much as possible. Cialdini cites research about how the weather has a dramatic effect on people’s outlook. Help people feel like it’s a sunny day by paying careful attention to your decorating choices.

			Offering soothing entertainment. Research has shown that tablets with games have a mild sedative effect, so make some available. You may even want to publicly post a “leaderboard” with scores to encourage a sense of fun and togetherness for your patients.

	Make sure your bathroom has a really good mirror. Most people can’t help looking in mirrors, and it will refocus your patients’ attention to their appearances and away from pain. Human nature means that most of us are more willing to take big steps to protect our looks than to protect our health. A patient who has just looked in the mirror may be more willing to accept a necessary root canal or crown than a patient who hasn’t, because now they’re focused on their appearance rather than fear of pain.

	Your hallways are important, even though patients will only experience them for a few moments. Keep the décor cheerful and smile-focused. Use the space for inspiration, not advertisements, so that your patients understand that your main focus is on helping them, not on making money. In general, prominent advertisements for procedures can be very risky for a dentist, since it sends the message that you’re trying to “sell” a treatment or a vendor. Think carefully about each poster, flier or model you add to your practice.

	In a well-run office, your patients are going to spend most of their visit in a patient bay. In many offices, they have a lot of time to look around the bay and take in everything – your décor, your tools, even the brand of sterilizing wipes you use. You need to be especially attentive to the arrangement of the bays. Helpful touches include:

			Personal photos of you or your hygienists. These humanize you and your staff and can make it easier for patients to like you and trust your advice.

			Diplomas or certifications. These convey authority with no effort on your part.

			Photos of past, happy patients. Worried people naturally seek out a crowd. Seeing a crowd of happy patients who succeeded with their treatments will make your new patients want to succeed with their treatments.

			Anything but ads. As I mentioned before, ads make it look like you’ll put profit ahead of patient well-being.  Keep promotional materials for procedures out of site unless you’re actually answering questions about that procedure.

			Reading materials that emphasize aesthetic appeal or health. A copy of a financial magazine will focus patients on the cost of treatment rather than on the health or aesthetic value. There’s a reason that health, beauty and home and garden magazines make great reading material for your patients. They aren’t only interesting and calming, but they also shift attention to areas where you can help them.

			Impeccable maintenance. If your patient bays look dingy, sloppy or poorly maintained, patients will think that you’ll do dingy, sloppy and poor work on their teeth. Walk through each bay with a critical eye at least once a week and resolve any issues immediately.

	The pre-suasive mood in your employee-only areas could be even more important than the mood you set in your public areas. Why? Because, as Cialdini discovered, what we look at effects how we perform in our jobs. He cites the example of an employee engagement consulting group who discovered that they did better work when they could see the employees they were supposed to engage. They started putting poster-sized portraits of their clients’ employees in their workspaces and saw their performance improve dramatically.

More from the author: Do you know why patients aren't coming in? 

	Your employees also need reminders of why they’re there and who they serve. Your reception desk and hygiene teams may get to interact with patients all day, but what about your billing and scheduling teams? Does your IT person understand that patient service is your number one priority? Put pictures of your patients throughout the office so that your staff members remember who they’re serving.
	
	Another interesting sidenote from Cialdini’s research is that inspirational posters actually improve job performance. Don’t be afraid to use them, and swap them out occasionally so that they feel fresh and new all the time.

	Finally, it’s important to send the message that you value your employees. Think about adding little ways of saying “thank you” to your staff-only areas. Maybe a fresh bouquet every week, interesting coffee choices or nicer headphones will help your staff feel appreciated at work. Create an environment where even the back office staff feel appreciated, able to succeed and ready to focus on patient care.

	Without pre-suasion there can be no persuasion

	Cialdini’s work on pre-suasion hammers home an important point. There is no generic “patient” or “employee.” Everyone you talk to is being tugged in different directions by their hopes, their worries, the food they had for breakfast and the last thing they saw before they walked into a meeting. You can’t force your patients to prioritize health or accept treatment. You can’t even persuade everyone to agree with your goals for treatment. You can, however, create an environment where your patients are more likely to prioritize their oral health and your staff members are more likely to prioritize your patients. And creating that effective pre-suasive environment will help you build a thriving dental practice.

	You can find information on Dr. Phelps’ upcoming events and training opportunities at: 

Creating the right atmosphere can help patients feel more at ease.

How to create a ‘pre-suasive’ dental practice

	If you want your dental practice to grow and thrive, you need to find out why potential patients avoid your office.

, only about 62 percent of adults visit the dentist at least once a year, and nearly 30 percent of American adults have untreated caries. These are people who need care, so why aren’t they coming into your office?

	Every patient who avoids dental care has some roadblock preventing them from making an appointment. If you can find out what the roadblocks are in your target demographics, you can take steps to clear them for your potential patients. Once you remove the roadblocks, you’ll see them in your office.

Read more: The importance of patient acquisition in a competitive market

	So, how do you discover what roadblocks your potential patients face? You could pay to survey them, but polls are becoming less reliable as people avoid 

 from strangers. You could ask your current patients about roadblocks for their friends and family, but “people who already visit the dentist” probably won’t give you accurate information on people who don’t visit the dentist. If you want good information on roadblocks to dental care, you’re going to need to get out into your community and talk to your future patients.

	When I did this, I discovered that one group of patients-retirees-avoided seeking dental care because they no longer had dental insurance. They needed a way to make expenses predictable before they would come into the office. Once I
	developed an in-house dental savings plan, as detailed in my book 

 into my office. I listened, understood their problem and developed a targeted response to clear the roadblock. As a result, my practice grew. You can take the same approach in your community by going out and really listening to what people have to say.

Once they come in: 6 ways to ethically persuade a reluctant patient to follow a treatment plan

	Roadblocks will vary by demographic. For people in their 20s, roadblocks might include office hours that don’t fit with work schedules, or a fear of painful dentistry. So, if this is the group you’re trying to reach, you might start by adding evening and weekend hours. Or, you might decide to specialize in gentle dentistry, so you could reach the people who are afraid of the dentist.

	Up next: What to do after you've removed the roadblock

	Once you clear the biggest roadblock for 

, you may notice that your numbers grow for a while and then level off. This is a signal that it’s time to go back out into the community and gather more information. While your last solution helped some patients, it didn’t meet the needs of all your potential patients.
	
	For instance, in my own practice, after I introduced my savings plan, there were still area retirees who weren’t getting dental care. So, I went out into their communities and asked why they weren’t coming in. It turned out that a common concern was transportation to and from appointments. Now, I send an 

 car to pick up and drop off non-driving patients. It’s an inexpensive service that makes their lives easier and helps get them into the office. After I started this service, I discovered that some retirees just don’t want to leave their communities. So, I’m starting mobile dental offices in areas with a high concentration of retirees so that I can reach people who want to stay close to home.

It's time to ask: What is the first impression your new dental patient has of you?

	The key is to avoid complacency. Once you find a clear one roadblock, start looking for the next one. To grow your practice, you need to constantly investigate and 

meet the needs of your current and future patients.

	What groups of patients are you trying to 

? What are their roadblocks, and how can you clear them? Making it easier for patients to come in for treatments is one of the most effective forms of marketing at your disposal, and too many dentists ignore it in favor of billboards and postcards. Make sure that you are listening to the needs of your community, and then act on those specific needs.

Every patient has some roadblock that could be preventing him or her from coming into the office. How do you identify these roadblocks, and what can you do about them?

Do you know why patients aren't coming in?

	What is the state of your dental practice right now? Are you growing? Are you winding down in preparation for retirement? Are you holding steady and happy with stability? Many dentists embrace stability.

	After all, we’ve chosen a profession that is fairly safe, has reasonable hours and pays a good salary. If you’re not losing patients, why should you work to attract new patients? What’s wrong with the status quo?

	There is plenty wrong with a “stable” practice. A dental practice is like an organism. It's got multiple “organs” (or departments), all working towards its overall health. When one department is sick, the whole practice suffers. And, like a living organism, the alternatives aren’t growth or stability. They’re growth, or a slow but certain death.  Why do you need to grow to survive? Consider some of the effects of a stagnant practice.

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A stagnant practice can’t offer new services

	It’s a great time to work in dental medicine. Our field has benefitted from all sorts of technological advances. 3D printing and chairside milling technologies let us give our patients top-of-the-line treatments in a single appointment. We’ve got a better understanding of the oral-systemic health link than ever before. We can prevent disease and decay, treat infections effectively and help our patients improve their smiles through orthodonitcs and other means and manage their chronic conditions.
	
	However, training and technology require pretty large up-front investments. In a growing practice, there’s enough money coming in to train staff, buy new tools and reconfigure spaces to work with new technologies and work flows. In a stagnant practice? Your services remain stagnant too. That means you can’t invest in patient care, and you no longer provide the latest and best treatments.  As other dentists in your area adopt new technologies, you’ll lose patients and go from stagnant to dying.

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	So, a practice without growth means a practice without new services. Well, that’s not a big deal, right? After all, your old services are just fine. You’re happy with them, your patients are happy with them. What’s not to like?

	If your practice isn’t growing, you’re seeing the same patients over and over again. You get to know their teeth very well. You may become an expert at dealing with those particular mouths and those particular patients. You’ll have stability, but not variety.

	They say variety is the spice of life, but it doesn’t just add interest to your practice. Variety also adds challenges. It encourages you and your employees to stretch in new directions, learn new skills and hone difficult techniques. Without the variety provided by a growing practice, you can fall into a rut. And that means that when an existing patient has an odd problem, you and your staff won’t be qualified to address it.

Continue to the next page to see other detrimental effects...

When your practice stagnates, wages stagnate (and benefits decline)

	Your patients are fairly price-sensitive. Either they’re paying out of pocket and counting pennies, or they have insurance and don’t want to pay anything above the official reimbursement rate. However, your staff probably expects annual raises. When you go too long without giving a raise, your best people will feel unappreciated and start looking for an employer who can pay them what they deserve. Meanwhile, you probably also offer some sort of health insurance, and those costs never go anywhere but up. 

	So, how can you keep your employees happy and your patients happy? You can’t, unless you grow. Without growth you’ll either lose patients to keep your employees, or you’ll lose your employees to keep your patients-and then lose your patients anyway, since you’ll no longer have top quality employees.

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	So, what’s the problem with a stagnant practice? You end up with unhappy staff, unhappy patients, and lowered standards.  A stagnant practice is an ailing practice. If you want to care for your patients, your staff, and yourself, you need to grow.

	Look at the growing practices in your area. Why do you think they’re so successful? It’s not necessarily that they do a better job than you do. It’s not because their owners are better looking than you are. It’s not simple luck. Growing practices succeed because someone is taking the time to find underserved groups, develop programs to serve those groups, and make members of those groups aware of the new services. 

	Growing your practice takes planning. But, as with any change, the first step is to understand why you need to change.  If you’ve made up your mind to be a growing practice instead of a stagnant practice, you’ve taken the first step to a better future filled with new patients.

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If you’re not losing patients, why should you work to attract new patients? What’s wrong with the status quo? Many things, says one practitioner.