Here are 6 proven strategies for reducing broken appointments and no-shows:

1. Reason to come back:

At the end of every appointment, the clinical team member who is with the patient--whether that is the clinical assistant or the hygienist--needs to set the patient in an upright position and stress to the patient the significance of the next appointment. You want to plant in the patient's mind the benefits of the next appointment and the possible risks of not appointing or of not showing up for that appointment.

No matter how wonderful the person in the business office may be or how wonderful her verbal skills may be, she will not have as strong an impact on the patient as the person who has been with the patient clinically. The clinical team member has been in that person's mouth. The patient will be more likely to comply with the clinical person's recommendations than with anyone. The clinical assistants and the hygienists will have a strong effect on whether or not the person schedules and whether or not he/she keeps their next appointment.

Verbal Skills:

Hygienist to patient:

Mrs. Jones, you are doing a great job with your home care. However, Dr. Jameson and I are still very concerned about the gum tissue on the upper right around those crowns. I'm making a note in your clinical record to evaluate this area again in 4 weeks. It will be very critical that we can count on seeing you at that time.

Or:
Clinical assistant to patient:

Mr. Crawford, your root canal has been very successful. Dr. Jameson is very pleased with the results. Now, he is recommending that we crown that tooth in order to prevent the tooth from breaking. The last thing either of us want is for you to lost that tooth. So, let's go ahead and schedule your crown appointment now.

Or:
Doctor to emergency patient:

John, we would like to see you again to do a comprehensive evaluation. Once a complete evaluation has been completed, we can sit down and talk about your total treatment needs. We're going to take care of this immediate need, then we need to sit down and discuss a plan of action that will stop this pattern of emergencies. Please know that your best interest is foremost in our minds at all times.

Then, whoever escorts the patient to the business office for the scheduling of the appointment--not so much for the business administrator but for the patient. Remember that repetition is the key to learning. As educators, you must repeat the benefits of the upcoming treatment so that the patient's awareness is enhanced.

2. The verbal skills of scheduling:

The appointment coordinator must stress not only the importance of the next appointment, but she must also indicate the amount of time being blocked for them in the doctor's schedule. The appointment is the responsibility of the patient and you can help the patient accept that responsibility by the way you schedule in the first place.

Verbal Skills:

Appointment coordinator to a patient scheduling a two-hour crown appointment:

"Mr. Bailey, Dr. Jameson will need two hours of his time in order to provide the treatment that you have accepted. In order to reserve this much of your time and of Dr. Jameson's time, we need to make sure that we find a time that is good for both of you. We need to make sure that we can count on you to be here for this very special appointment. Rescheduling this much of the doctor's time on short notice would be an impossibility. So, let's find a time that is good for you and good for the doctor.. Which is better for you, mornings or afternoons? Mornings are better? Dr. Jameson has an available two hour crown appointment on Monday, July 21 at 10:00 or Thursday, July 24 at 9:00. In your schedule, Mr. Bailey, which appointment works best? Thursday, July 24 at 9:00? Great. Since we can count on you to be here, I will reserve this time for you now."

3. Confirming appointments.

Begin confirming appointments in the morning around 9:00 a.m. Confirm in a very positive manner and always stress the importance of the appointment and the patient's responsibility for the appointment. When you are originally scheduling the appointment, try to make notes in the patient's personal record regarding a particular area of concern.

Then, when you are confirming you can reinforce the need for the appointment relative to this area of concern. The patient will be more strongly motivated to come to the appointment if you stress the benefits of the appointment and certain risks that might occur if they do not come. In addition, you will be showing your patients that you go the extra mile in providing patient care. In other words, you aren't just calling off of a list--you are knowledgeable about their particular situation.

In today's "answering device world," you may be frustrated if all you get is a recorder. Be sure to ask for a daytime number for confirmation when you are scheduling the patient in the first place. Otherwise, you are setting yourself up for frustration. Do not leave a message on the recorder and think that you have confirmed. A left message is not a confirmation!

If you have called at 9:00, then again at noon, and you are beginning to panic over the patient you cannot reach, then, leave a message. However, in your message, ask the patient to call you to confirm their appointment. Ask them to call by a certain time. Thank them for their cooperation.

For Example:

Mr. Bailey this is Jan from Dr. Jameson's dental office. I'm sorry that I have been unable to reach you, personally. Mr. Bailey, I am calling regarding your appointment with Dr. Jameson on Thursday, July 24 at 9:00. Please call our office by 12:00 tomorrow--that's Tuesday--about that appointment. I'll appreciate your call. Thank you.

If you are having a great deal of trouble with no-shows and broken appointments, you may want to start confirming your appointments two days in advance. This will give you time should you have unavoidable changes of schedule. You will reduce your stress by doing this. Nothing can make you sicker than to have a change of schedule at 4:00 in the afternoon and have no time to fill that void. Don't put yourself in this type of compromised position. Pre-plan. Preventive management!

If you have been confirming one day in advance and change to two days in advance, be sure to let your patient's know that you are making this change. Otherwise, you will have two day's worth of patient's showing up at the same time!

Example:

Mr. Bailey, in the past we have confirmed our appointments one day in advance. However, today, I am calling two days in advance to give you plenty of advanced notice. I am calling about your appointment the day after tomorrow--that's Thursday, July 24 at 9:00. Do you have your calendar with you? Check to make sure you have that on your schedule.

4. Recording Device:

If you are having a lot of changes of schedule left on your recording device during the night, you may want to consider changing your message. Some people will call you at night and leave that type of message because they do not "want to face the music." This leaves you in a terrible mess because you have no chance to convince them of the need to come to their appointment or no chance to reschedule them.

Consider the following message. You will maintain much better control with this recording.

For Example:

You have reached Dr. Jameson's dental office. Our office is presently closed. Our regular working hours are Monday through Thursday from 8:30 to 5:00. If you are calling regarding a dental emergency you may reach Dr. Jameson at 231-5467.If you need to speak with us regarding your dental appointment, please call during our regular working hours. We ask that you do not leave a message regarding changes of schedule on this machine. However, if you are calling to confirm an upcoming appointment, you may leave the message now. Thank you.

You will find that people will respect your request. You will also find that they will not become perturbed by this message.

You may be saying, "Well, then when we come in the next morning the phone will ring with people needing to change their appointments."

Great! This will give you a chance to speak with the person directly. Thus, you will be able to try to convince them of the benefits of coming to the appointment. If you cannot encourage them to "come in," then at least you have them on the phone and can reschedule the appointment.

5. Rescheduling:

If a person does call to make a change of schedule, obviously, your goal is to reschedule them while you have them on the phone. If you say, "Oh, that's OK. Call us when you think you can make it." Or, you allow a person to "Just call you." -- you just committed "appointment suicide."

Rather, when a person calls to tell you that they can't make an appointment that you carefully scheduled, say to the patient:

Oh, Mrs. Jones, that is very difficult. As you remember, we have scheduled two hours of your time and two hours of Dr. Jameson's time for this appointment. At this late notice, I would not be able to fill the void left by your absence. This, of course, would be very difficult for us. I'm sure you can understand the dilemma. Is there anything we can do to make it possible for you to come in for this appointment?

If the person is ill or has some other unsolvable problem, obviously you would accept that situation. Your responsibility is, then, to reschedule the appointment. If, for any reason you are unable to get that appointment rescheduled, ask the patient for permission to call them back.

For Example:

Mrs. Jones, I can understand your inability to reschedule at this time, and I appreciate your offer to call me at a later date. However, it is our responsibility to make sure that we keep you on a program of regular care, so--may I ask your permission to call you in a few weeks to reschedule this appointment?Thank you. Tell me, Mrs. Jones should I call in two weeks or would you prefer that I call right after the first of the month?

You are staying in control by asking the patient to let you give them a call. In addition, when you do call, you will not seem as though you are intruding.

Notice that you give the patient two choices--either of which you accept. This is called an "alternative of choice." Most people will respond positively to this request--to call them one time or the other. Make sure that you make a note of when you are to call. Then, JUST DO IT! Always do what you have told a person you will do. Use a tickler system--either a manual system or a computerized system. Use it and pay attention to it!

6. No-shows:

There is nothing worse than a "no-show." You know what I am talking about--the person who agrees to the appointment. The one who says she will be there when you call to confirm. Then, the next day--they simply do not show up! What can you possibly do?

There is no question. This is the most challenging of all scheduling "glitches" and the one that is most difficult--if not impossible--to rectify.

Here are a few "tried and true" strategies for handling this type of difficult situation:

Call the patient if he/she is 5 minutes late.

Put the patient data in the tickler file if you are unable to reach them. Don't let them slip away. Do not rely on information placed on the Saturday page of your appointment book. After awhile, you will stop looking back far enough and patients will fall through the cracks.

Continue to try and contact the patient to find out why he/she didn't show. Encourage him/her to reschedule. Let them know you care about him/her.

If you are unable to contact the patient, send them a letter expressing your concern over the missed appointment. Stress your commitment to their health and well-being. Let them know that you have tried on multiple occasions to call and reschedule the appointment. Invite them to call you for that rescheduling.

In Summary

Broken appointments and no-shows are an ongoing challenge for those of us trying to manage productive, profitable dental practices where stress is held under comfortable control. The above outlined 6 strategies are not new--they are just good. If you are already doing many of these things--pat yourself on the back and keep up the good work. If you are having trouble with broken appointments and no-shows, implement all of the strategies. They will work for you to reduce--not eliminate--the number of these scheduling "glitches."

Patients feel comfortable about most anything when communication is clear. When patients know you have their best interest in mind, they normally respond well to your requests. Schedule management time to work with one another on improving your individual communication skills. Role playing can be fun and enlightening. You must practice in order to get good at anything--including communication.

If you can reduce even one broken appointment or no-show per day, think of the difference this will make in the bottom line of the practice--and think how much time it will save. Frustration and stress will be reduced for everyone--clinical and business team alike.