Episode 142: How To Prevent Broken Appointments and No-Shows

Carrie Webber, Owner, The Jameson Group

Our transcript of the podcast with  Jameson Files host Carrie Webber has been lightly edited for flow. To enjoy the audio conversation, you can watch on YouTube or listen to our podcast on iTunes, Google Play, or Spotify

Welcome to the Jameson Files. I’m your host, Carrie Webber, and I’m so happy to be back with you for another episode.

Today I want to talk about a subject that continues to be a pain point in your practices, and that is broken appointments and no-shows, and what we always call that is the hole in the bucket. You do all of this work to fill your bucket, to fill that schedule, and all it takes is a couple of holes in that scheduled bucket before the money starts pouring out of the bottom. And it’s exhausting and frustrating to keep trying to fill those voids that are coming into your schedule. 

11 Keys To Eliminating Broken Appointments

So you may be looking for that magic bullet that’s going to help you reduce those broken appointments and no-shows completely forever. The bad news is, I can’t stand here and tell you that you can eternally remove broken appointments and no-shows. But what you can do is start being more proactive about scheduling processes, patient experience, and communication skills. That always helps to reduce those broken appointments and no-shows. And if you have systems in place to fill the voids (should they unfortunately come your way), you can fill the holes left by canceled appointments. 

So to start things off, I want you to start thinking about your systems that support effective scheduling and the reduction of broken appointments. Then I want you to think about your skill sets: your verbal skills, your confirmation processes, your follow up processes. All of these pieces of the puzzle, when brought together, help to build a strong foundation for effective scheduling. 

One of my favorite books is Atomic Habits by James Clear. I quote it all the time, so I’m sorry if I’m gonna be repetitive here. But what Mr. Clear says is, you do not rise to the level of your goals. You fall to the level of your systems. And so if you feel like the hamster on the hamster wheel day in and day out, constantly having to battle, keeping your schedule filled, then there is a likelihood that we need to take a step back and look at the scheduling systems in your practice. What systems do you have in place in order to be effective and consistent in your scheduling experiences so that those patients you are scheduling see the value of that appointment? 

Step 1. Proactive vs Reactive Scheduling and Planning

So let’s start thinking of our approach to scheduling, reducing broken appointments and no-shows, proactively instead of reactively. When something is an ongoing pain point in your practice, there’s a very high chance you are living in what we call “reactive mode.” You are entering every day prepared to be responsive to broken appointments. You know you’re going to have to fill voids, turn on a dime, and manage the chaos that is going to ensue in your day. 

Our goal is to start thinking proactively about taking the offense so that we are in control of our schedule and working as a team to support the schedule and the patients’ sense of value for being a part of that schedule. And you may say, ”Yeah, yeah, easy for you to say, Carrie, you’re not sitting here trying to fill voids in the schedule!”

This is where we need to look at how you’re scheduling. Are you doing it effectively and in a way that leads to consistency in your daily rhythms? At Jameson we teach what we call the “essentials of scheduling.” I’m going to briefly overview what we consider some of those essentials right here. But if you want a deeper dive into the essentials of scheduling, I encourage you to go to the Grow online learning platform that we have at Jameson. There’s an entire learning pathway there where one of our advisors walks you through the essentials of scheduling and how to start incorporating this into your scheduling systems. (And if you’re a Jameson client listening to this, this will not be foreign to you. But you may be wanting a refresh. If so, reach out to your advisor and request this at one of your upcoming sessions.

1. Production-Goal Scheduling

But for all of us here as a part of the Jameson Files podcast community, let’s review briefly what we call the essentials of scheduling. First, you need to schedule based on your production goal. Why? Because you first have to know what you need to schedule day in and day out to be able to keep the doors open, reward your team, and reward yourself. Understanding this keeps your business flowing. So schedule based on a production goal, and let the entire team know what it is. 

In your daily huddles, you should be reviewing what production is scheduled to be that day. What was scheduled for yesterday? Did you meet or exceed your goal? What is scheduled for tomorrow? Tracking in this way keeps you working as a team toward helping the pursuit of the goals you’ve set for your practice.

2. Schedule doctor vs. assistant time.

And when you schedule for a production goal, schedule doctor time and assistant time. Why? Because an effective schedule has got a doctor dovetailing with the other team members. He or she should never be in a position where they are supposed to be in two places at the same time. Does this make sense? 

So if you know what portion of your procedures and appointments are actual doctor time and what increments are actually assistant time, then you can more effectively stagger the schedule so that your doctor doesn’t have to be superman or superwoman and fly around the practice all day, ultimately leading you to run behind schedule. You know where that leads.

And so what you can do to be more intentional and proactive in scheduling is make room for the attention and the presence that is demanded of your doctors, your assistants, your hygienists, and your entire team with your patients.

If you’re wanting to build value for appointments, those patients need to feel that value, and the way you schedule your doctors and team can help that.

3. Maximize your scheduling software.

You need to be maximizing your scheduling software. You may say, “Oh yes, I am absolutely maximizing Dentrix!” Well, I think Dentrix trainers would beg to differ with you. There’s a likelihood that you are grossly under-utilizing the tools that you have available to you to effectively schedule, stay in communication, fill voids in the schedule, and so on. 

So it may be time for a reality check about how well you’re utilizing the tools, technology, and software you have available to you. If you are like 90% of dental practices, you likely have patient communication software that you are under utilizing in terms of confirming appointments, checking on patients that might be running a little behind, refilling voids in the schedule, and more. So do the work, train on the tools, and maximize the tools you have. They’re going to help you in your time management and in your execution of your systems. 

4. Schedule a variety of procedures. 

We find a lot of times that documentation is subpar in practices. So make sure you’re detailing each appointment so that everyone on the team that’s involved in that appointment knows what they’re preparing for. That helps in time management and in execution of appointments. Schedule a variety of procedures.  

Does anybody ever have that day where it’s a lot of really quick fill it, fill it in, fix it up, kind of appointments, and that by the end of the day you are toast, you’re exhausted, and you have no production, um, to back up the day. Um, it sure felt busy and productive, but it really wasn’t because we’re not scheduling for a variety of procedures. So let’s be more intentional in how we’re filling the schedule every day. 

5. Pre-block. 

We go into detail on this in the Essentials of Scheduling pathway on Grow because this is a really important piece. We need to have primary, secondary, and tertiary appointments so that we can be scheduling a variety of procedures in the day. That way, instead of having these peaks and valleys in your schedule, you have more consistency. That is healthy scheduling. 

We wanna make sure we’re making room for the doctor hygiene evaluations. Remember, when your doctors are scheduled to be in two, three, or four places at once, they’re typically not in at least two or three of the places they’re supposed to be! And you know what? Those evaluations are very important moments in the patient’s interactions with you, and that will build value for future appointments. 

Block time for emergencies, and make sure you discuss that in your daily huddles, especially if you find that you’re seeing too many emergencies. Know ahead of time how many you can see today.

So that is a brief review of some of the essentials that you need to be proactive about in your scheduling processes. It’s the foundation you want to build for a patient’s experience so that you can be more successful in retaining appointments and not having patients fall through through the cracks.

Step 2. Proactive Patient Partnership Building

When it comes to broken appointments and no-shows and reducing them, verbal communication is an area you should continue to refine. And that starts from the time you schedule an appointment. When you confirm an appointment, when the patient goes through an appointment, when they’re checking out of an appointment, and when you schedule them for the next appointment, your communication skills are critical. 

The verbal skills used in these patient interactions are either going to build value for the appointment or diminish the sense of value. Remember, the ADA Health Policy Institute tells us that in their consumer-facing surveys they’ve found that the top 3 reasons patients delay treatment, don’t accept treatment, or don’t show up for treatment are cost, time, and fear.

6. Show that you value your patients by listening.

When you understand this, you can actually be proactive in your conversations. A healthy patient-practice partnership requires that you are comfortable with talking about your patient’s concerns, obstacles, and objections. Your taking the time to hear and understand them builds value. And a patient who feels valued is more likely to stay active in your practice or to complete the treatment they need. 

We don’t want them to be in a fight or flight mode where they feel overwhelmed, where they don’t feel heard, where they’re just giving you a false yes so they can escape the conversation. So we need to continuously work on our verbal skills and partner with our patients in making the right decisions for their ongoing health.

At Jameson we teach that the four pillars of a healthy patient-practice partnership are trust, need, urgency, and value. We want to be building these pillars of trust, a sense of need, a sense of urgency, and that sense of value with every interaction with our patients, including on the telephone. Oh yes, the telephone! So what you have to think about weak words versus power words. Be more aware of what you’re saying on the telephone when you’re scheduling these appointments with the patients and when you’re confirming appointments with the patients. Start developing a heightened sense of awareness as you speak and then reflect on those conversations afterward. 

7. Learn to elevate your conversations.

First, a retail-minded vocabulary needs to be traded in for a service-minded vocabulary. For instance, use the word reserved instead of scheduled. “I’m going to reserve this time with Dr. Jameson for you, Mrs. Jones.” Do you see how that elevates the sense of value just in shifting a very commonly used word? I’m saying scheduling right now about a bazillion times in this podcast, but when we start thinking of reserving this time, it heightens the sense of value for the time that we are discussing. 

Here’s another one. Instead of saying visit or opening or we have a cancellation, start thinking about utilizing the words opportunity or a change in schedule. Instead of cleaning, profi, or recall, say a professional cleaning or your continuous care appointment.

Watch out for minimizing words like just a little, kind of, sorta, maybe—we want to completely eliminate those from the conversation. For instance, don’t say, “Just wanted to call Mrs. Jones, to see if maybe you’d like to come in today.” No, it’s: “Mrs. Jones, I’m reaching out to you because we have an opportunity in our schedule, and we know that we need to reserve some time with Dr. Jameson for you, and we wanted to see if you were available today.” Can you see how that would change the conversation immediately in terms of a sense of value? 

So think about the conversations you have, listen to your interactions with patients, whether you are on the telephone or interacting when they’re at your office. What could you say differently to elevate their sense of value? 

8. Learn how to guide conversations well.

Also learn how to guide a conversation by giving alternatives of choice: “Which would you prefer, Mrs. Jones, mornings or afternoons?” And then when they’ve made that choice, give two or three options that fit your pre-blocks in your scheduling. That gives them a sense of control, but ultimately it’s also giving you the control of seeing patients where it’s most appropriate for your schedule. And beware of those famous last words: I’ll call you. No, no, no, no! We know “I’ll call you” means they are never gonna call. So plan ahead about how to stay in control of that conversation.

Partner with the patient and use elevated words in those conversations. And remember, repetition is the key to learning. Repetition is the key to retention. Repetition is going to be the key to building that sense of value from your patients. 

9. Master the patient checkout.

Let’s move on to the patient checkout. For this, if you feel like a broken record in the patient checkout, you are probably doing it right. Whether you are the doctor, the assistant, the hygienist, etc., repeating this process at the close of the patient appointment is important. 

So, at the end of the appointment, you want to say, “Here’s what we did today. Do you have any questions about what has been provided today?” If not, say, “Now this is what we have reserved for you at the next appointment. Here’s what you can expect at that appointment. Do you have any questions for me about that?” If not, ask, “Do you see any reason why you can’t make it to the time and day that we have committed together for?” And then when all of that is agreed on and understood, you take them to the front business team. You address your team member by name, saying something like, “Carrie, we had a great appointment with Mrs. Jones today. We already have her time reserved for her next continuous care appointment on [whatever date], and we will be continuing on [whatever therapy] she’s doing. Again, Mrs. Jones, do you have any questions for me before I leave you with Carrie?” … No. … “Great! Okay. Here are two business cards. We love having you as a patient. If you know anyone that’s looking for a dental home, we would love to see them here in the practice. We’ll see you next time.”

And then you hear the repetition that we keep saying again and again. Here’s what we did today, here’s what we’re doing next time. Do you have any questions about this? Do we see any reason why we can’t go ahead and reserve this time? And so on. We’re repeating that message again and again to build value.

10. Utilize patient communication software.

Utilize patient communication software in your confirmation process and in your follow up. If you find you’re having a lot of holes, broken appointments, and no shows, maybe you need to review how you’re utilizing this.

If you say, “Oh, we already used text to confirm,” well, are you using just the basic generic text, where you turn it on but don’t even know what it says? Ask yourself: Can I customize that? Do we need to change the timing and try a different timing? Do we need to do it more than once? Do we have patients that need an actual human being calling and making sure the appointment is confirmed? Make sure you look at what’s working in your patient communication software, what’s not, and what can be adjusted in order to get a better result. 

Remember, no change means no change. So take a look, be real with yourself, have a team meeting and review what’s working well and what’s not. All the studies show that consumers in today’s age prefer to communicate via email or text, and even more by text. Now, you have an older generation of patients that do not want that, so know your patient demographic, know the process that works for you, and work the process. 

11. Create a solid safety net.

Let’s move on and talk about having a solid safety net or a “move forward” list. A lot of patient communication software has an ASAP list. If you’re using that, perhaps it’s working well for you. But what we incorporate in Jameson is also having those verbal conversations with patients to ask if they’d like to be placed on a list to be moved forward in the schedule, should an opportunity arise. 

It’s just as important that you’re scheduling appropriately so that you are not conflicting with their insurance. This takes a lot of proactive forethought, but you can do this. And what this does for you is it creates a list where people have verbally said yes. And guess what? I have signed up for just such a list with my dentist because if it works in my schedule and I can just get it done, I am all about that. 

Of course, that doesn’t work for everybody, but it does work for some. And so asking if they would like to be on that list and then making sure you’re making note of when you’ve reached out to people so that you don’t start to abuse the yes is important. So it is a very useful system, but at the least, if you’re not utilizing the ASAP list functions in your practice management software, that could be an awesome place to keep record of patients that you can reach out to when there are voids in your schedule. 

And once again, daily huddles are very powerful when they’re used correctly. And one of the steps in an effective daily huddle is to review voids in the schedule. There may be patients that are in the schedule that have a need, and you could go ahead and move them into the doctor’s schedule that day. So the entire team can be on the lookout to help our scheduling team fill those voids.

So remember, build the foundation of the Essentials of Scheduling, master strong verbal skills, ace patient checkouts, and maintain a solid safety to reduce your broken appointments and no-shows. Also, we have so many resources for you on our Grow online learning platform. And if you have any topics for an upcoming Jameson Files podcast, please reach out to us [email protected]. We want to make sure we’re providing content that is relevant to you.

Leave a Comment

You must be logged in to post a comment.