Lisa Bainham, Practice Manager at The Old Surgery Dental Practice in Crewe and president of the Association of Dental Administrators and Managers (ADAM) shares some suggestions as to how to minimise last minute cancellations and no shows.
Across the dental industry, on average, between five and eight per cent of all appointments are either missed or cancelled. As there is quite a cost to having a surgery empty, minimising missed appointments is something we wrestle with constantly.
To address this, I recommend the practices I work with make courtesy calls. People lead full and sometimes hectic lives and things can get in the way of appointments. Plus, when you’re managing busy work and home lives, it can be easy to forget you’ve booked a dental appointment, so it can be nice to have a gentle reminder.
Courtesy calls simply help the patient and the practice manage their time better. Also, I often find it best to make the call around checking they are still okay to attend, rather than asking if the appointment is still convenient, this can prevent people dropping out last minute.
I appreciate this can sound like something you can’t afford to do time and wages wise but, if you work out the cost of having somebody make these calls for a few hours a day versus surgery downtime for a no-show, it’s worth it.
The cost of missed appointments
In an average practice, you’re looking at probably in the range of about £150-an-hour costs to run the practice. That doesn’t include wages which, again, in an average practice will be anything between £200 to £300-an-hour for salaries for nurses and hygienists if they’re employed. So, an hour’s time wasted could be costing anything up to £300-an-hour for that one surgery, which patients don’t really realise.
The last thing we want to do is upset any patients. But at the end of the day, those costs are still there whether the patients turn up or not. Our nurses will still be paid, the electric, the rent, everything else is still going to be paid. So, it has to come down to a business decision to implement systems to reduce that five to eight per cent as much as possible.
Patient agreements
What can help with this is a patient agreement which will clarify expectations on both sides. Any new patient who comes to us we set out, ‘this is what we’ll do for you and this is what we expect of you.’ But if you choose to have a cancellation policy and charge for missed appointments, you have to let them know that you will do this. And as long as they’ve got that agreement, you stand by it.
I think some practices find it difficult to follow through with a cancellation fee because they don’t want to upset a patient and feel it’s a bit like overcharging. But it’s all about how you word it. Mine is based on having a respectful, good relationship from the very start. You’re setting it on the table and then either they’ll not do it, or if they do get a charge, they will already have been made aware that it was something we reserve the right to impose.
However, we won’t be unreasonable. Sometimes we have to flex a little bit. We won’t necessarily go in all guns blazing the first time someone misses an appointment or if there is a genuine reason for not attending. And also, if we do feel we need to charge for the appointment, we won’t always ask people to pay the full cost of the treatment they missed, sometimes we’ll meet them in the middle.
But at the end of the day, patients who persistently miss appointments may not be the best patients for your practice. I have and will end relationships with patients if they are bad attenders. I just have a frank conversation along the lines of: ’There is a cost to us when people don’t turn up for their appointments so, if you continue to miss appointments, we may have to part company.’
The benefits of cancellation lists
As I mentioned before, courtesy calls help reduce the numbers of missed appointments. Perhaps also sending text reminders as well as a very good ‘short notice’ list. We’re booking so far ahead now and when you start booking anything past six to eight weeks, it goes out of people’s heads. So, you could see your numbers of people who did not attend (DNA) will go up as people can be likely to forget. Having a thorough list with emails, mobile numbers, all the correct contact details to make sure if you have a cancellation you can phone them or email them is a real help.
We have an electronic cancellation short notice list. If there is a cancellation, we ping that cancellation to the first five people on the list that want a 20-minute appointment with the hygienist. We do explain to them that this cancellation goes out to about five people, so, if you want it, ring us as quickly as possible because it is first come, first served. However, if you don’t, just ignore us and wait for the next one. That system works really well.
Taking deposits ahead of appointments
You could also consider taking deposits before appointments as this makes it more likely they will attend. We want to make sure we accommodate everybody that needs to be seen. We found that prepayments help us to do that and keep our prices down. If you have a large percentage of missed appointments, your prices are going to have to go up to reflect that. If patients are intending to come, then why would they object to prepayments?
Patients who pay monthly for a dental membership plan at a practice are more likely to attend regularly
It is a well-known fact that plan patients are really good attenders. They’ve paid for the two exams and two hygiene appointments so they want to make sure they’re going to get those. Patients who aren’t on plan sometimes, are possibly not as respectful of the service and our time, as they don’t appreciate the cost to the business of non-attendance. In my experience, plan patients are a lot better attenders and they let us know if they’re not going to be coming, which we appreciate.
It’s about the communication with reception. Making sure patients know, if they can’t make it, to please give us as much notice as they can because we have patients that we’re not able to see that would really appreciate that time.
And having this system right from the start, giving patients the message that ‘missed appointments aren’t great and we want to make sure that we are reasonable and keep our costs down to a minimum for you. However, we need your co-operation to be able to do that.’
About Lisa
Lisa Bainham still works in practice and is involved in all aspects of running the business, including compliance, accounting and business development. Having won Practice Manager of the year 2016 at the Dental Awards, Best practice UK and Best Patient Care UK, Lisa is now a Judge for the awards. Her knowledge and experience over her last 24 years enables her to support other practice managers in her role as President of The Association of Administrators and Managers, ADAM. Lisa also provides support to practices across the UK & Ireland through her consultancy, Practice Management Matters.
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