Dr. John Meis: Hey everybody, welcome to this session of The Strategic Thinker. I’m Dr. John Meis and I’m here with Dr. Jason Howell, how are you doing Jason?
Dr. Jason Howell: I’m doing great, thanks for having me.
Dr. John Meis: Thanks for being here. So, Dr. Howell has vast experience in group dentistry having worked as a clinician and mentor in 2 very large DSOs, he has a lot of clinical experience working in individual practice, startup practice, multi-doctor practice, and really understands the management-clinician places that are challenging. And, it really can be challenging, can’t it?
Dr. Jason Howell: Absolutely, yeah. What we do on a daily basis is more challenging than I think most of us realize getting into it. So yeah, it’s absolutely a challenge.
Dr. John Meis: So, one of the challenges that we have is that we want to be developing our doctors. We want to help them become better earners for themselves, and more productive which means better earnings for the company. And, one of the discussions that I’ve had maybe 200 times is taking with doctors about this and ways to become more productive and one of the things that I often hear is, “Well I’d be more productive if I had more new patients.” Right? Have you ever hear that?
Dr. Jason Howell: I’ve heard it. I’ve said it! I’ve said it numerous times. (Laughs)
Dr. John Meis: Same. (Laughs)
Dr. Jason Howell: You say 200 times, that’s 200 times in a month depending on how many doctors or practices you talked with. But yes, isn’t that the common theme? “I’d be more productive, we’d have more profits if we just had more new patients.”
Dr. John Meis: “If you as a management team were just doing a better job with marketing and new patient acquisition, everything would be fine in my practice,”
Dr. Jason Howell: That’s right. “If you guys would just allow us to spend some more money to advertise more to get more new patients in the door, we’d be good.”
Dr. John Meis: Right, right. And so, we know that’s a common theme, we know that dentistry as a profession has really bought into this idea that more new patients solves everything. But, when you track profitability and new patients, you’ll see that there’s a certain part of the graph where more new patients does increase profitability, so there are practices that do need more new patients, but not that many. There’s a point at which new patients go up and profitability levels off, and then profitability starts to go down. So, they’re not well correlated, new patients and profitability are not well correlated. But, there is something that is correlated very closely with profitability and that’s patient retention. So, I thought we would talk about that today.
Dr. Jason Howell: Yes, absolutely.
Dr. John Meis: So now, the perception we have as clinicians is often that, “well, my patients love me” right? And so, “my patients always come back, I really don’t lose that many patients.” And I hear this from practices that are on broad ends of the scale. So, one practice that we know very well, a large multi-doctor practice, a single location, but a big location. They’re getting about 400 new patients a month. And so, at 400 new patients a month, they should be adding a hygienist every 6 or 7 days.
Dr. Jason Howell: They’d run out of space, right?
Dr. John Meis: Yep right, but they weren’t hiring a hygienist every 6 or 7 days because they were getting 400 in, but they weren’t retaining them, so they had 400 leaving. So, they were working awfully darn hard, because new patients are more difficult, right? So, they’re working awfully hard.
Dr. Jason Howell: Yeah so, this is such an interesting topic because what we see over the course of time is, especially with our group practices, is we spend a lot of money to market and advertise just to get new patients in the door. But, we as doctors and teams forget about the patients that are already in the practice, that are coming every day to their hygiene visits, that we already have a relationship with, that have already had treatment done. And, there’s still an extensive amount of work to be done, that’s in our practice and these are patients that already trust us and have spent time with us. And, for the management team and the leadership team, this is a constant battle of, “Yes, I understand we do need to attract more patients, it is the life and blood of the practice at times. However, what about all the patients that we have already? How do we keep them from coming in one-and-done visits, and how do we get them to continue to come back and refer their friends and family?”
Dr. John Meis: Yeah. So we think of retention and most people, because our practice management software doesn’t really measure that very well, people don’t have the perspective of whether they’re losing patients or not. But, we know on average practices lose about 30% of their patients a year. So, it’s a big number that’s dropping off, we just don’t have the sense of it. And, when we retain those patients, like you said, we’re able to discuss treatment with them, and in every single practice, there’s a significant amount of treatment that has been recommended to the patient population that you have, that they didn’t move forward with for one reason or another. And sometimes, we don’t go back, we don’t talk to them about that treatment, and in just typical practices, about 70% of restorative, of the doctor’s production, comes out of recall hygiene. So, retention is really so critical.
Dr. Jason Howell: Well, let’s think about it in this way: every new patient that walks in door is a patient that we’re going to have to build a relationship with, build trust with, find out what their wants, needs, and desires are, and these are all important things. But, every patient that comes back for re-care visits is a patient we’ve met, we’ve probably already done some work on, they have developed trust. The front desk and the team leaders and the management up front that does deal with financial arrangements and things like that, already knows how they like to do things. These are golden opportunities for us as doctors and hygienists and team members to re-appraoch and re-establish the relationship and say, “Hey Dr. John, I know you’ve been coming here for many years now, is there anything that I’ve forgotten to ask you about as far as your teeth that you would like to fix, or anything that you’re unhappy with that maybe we could change? I’d just like to make sure that I’m checking in with you.” These are golden opportunities to just take somebody that’s been in your practice and turn that into more treatment, and also turn it into a relationship where they can invite others and refer other friends and family.
Dr. John Meis: So, case acceptance is easier with existing patients, and it’s very, very clear that that’s a great strategy. And, we as managers know that, but sometimes talking to doctors about that is difficult.
Dr. Jason Howell: That’s absolutely right.
Dr. John Meis: And so, we were talking about the different ways that we could improve retention before we started recording, and we came up with a list of 10 or 11 or 12 or something, and if we thought about it more than 2 minutes we would have come up with another 10 or 12. But, we decided to talk today particularly about the patient experience and patient satisfaction.
Dr. Jason Howell: Yeah, so this is a key point, because patient retention to me is something that we can make sure that we’re doing well as long as we as a team are continuing to touch base on some key points in what we do throughout the day with all our patients. We see a new patient on the schedule and all of us get our A-game ready to go, “We’ve got to make a great impression!” And we forget about all the patients that are already in the practice that we should have our A-game ready to go even more so, because these people have already got a relationship. So, how do we have a wow experience? How do we have this patient retention by making sure the patient has a great experience, not just if they’re new, but if they’ve been coming to us for 5, 6, 10 years.
Dr. John Meis: Yeah. I know in your practice you have what you call The Way. So, tell us a little bit about The Way and how you came upon that.
Dr. Jason Howell: Yeah so, The Way for me is... I’ve been in many practices over my career and so whatever the name of my practice is, so if it was Logan Street Dental Care, it would be “The Logan Street Way”. And, I always encourage any of my mentee doctors that come in is, “Let’s develop Your Way, and let’s be very clear on how we as a team are going to take care of patients.” And so, to put together Our Way is anywhere from 20 to 25 things that we want to make sure that we do for every single patient visit. And, the amazing thing is what you’ll see, our office has ebbs and flows and as things are ebbing up, we’re really rocking and rolling, we’re doing all of The Way. As things start to slow down a little bit, it’s always invariable that somebody on our team, usually not me, but probably one of the front desk managers or one of my assistants will say, “You know what, we’re not really doing this that well,” or, “We’re forgetting to do this.” And, that’s when we always go back to our sheet and we go, “Well, what are we doing well? What are we not doing well?” And, it can always correlate to how our patient flow is working.
Dr. John Meis: Yeah. So, the natural state of the universe is chaos, right? So, no matter how well you get it dialed in, over time it has a tendency to drift back to chaos. And, as managers that’s one of the things that we can do to support our offices is really to be able to identify places and times when we’re getting off track, we’re not following The Way. And so, you have a 25-point thing that you review regularly and talk about, “Okay, here’s what we’re doing right now, how can we do this even a little bit better?”
Dr. Jason Howell: Right, we try to get together, so our monthly meeting we’re always going to review Our Way, what do we do that works well, our processes that we’ve put together that we know are tried-and-true. And, we may go over those once a month, but invariably once a week we’re touching on 2 or 3 of those aspects because somebody usually realizes we’re slacking. And so, I encourage everybody to have that, and some of the team leaders can help develop that as well, but something to be reviewed at a team meeting, at least once a month.
Dr. John Meis: So you, a top performer in pretty much every organization you’ve ever been in, you come by this naturally, right? You’re just wired this way. But, not every doctor is wired that way, right? So, as managers how do we help doctors kind of dial into the same, to you it comes naturally, but how do we create a process so that we help our doctors who aren’t naturally inclined to think that way to get involved with this?
Dr. Jason Howell: Yeah, well one thing that worked really well for me is, you know I was not naturally this way in the beginning, and so one of the biggest things for me was reaching out to some other mentors within our dental groups. And I think that’s what’s great about a dental group organization is that we’ve got multiple offices, multiple doctors, multiple team leaders, and everybody has things they’re better at and naturally good at. And by reaching out to those people and saying, “Hey, do you mind if I come spend some time at your office and watch what you’re doing? I’d like to learn more about this. And, I’m not so great at this. Can you help me with that?” And that’s what I did, I picked a lot of people’s brains. And so, a lot of the things that I put together is a whole ball of clay that we’ve just made and turned into something that works great for us. That would be one of the biggest things I would say that is important with our dental groups is to really grab ahold of each other and use what each person does well to put together your own plan.
Dr. John Meis: So, I’ve been physically in about 319 practices, and I keep count because not many people have been physically in that many offices. And in every single office I’ve been in, I always learn something. There’s always something that they’re doing uniquely good, and I often take my camera and I take pictures of anything that’s unique and think about, “Okay, how do we make that thing into a process that then we can recreate in other locations?” And so, there’s always something there. Sometimes it’s something you want to do, sometimes it’s something you don’t want to do, but you always learn something. So, office visits I think are extremely helpful. And, when we talk about the patient experience, most dentists think their patient experience is amazing, whether it is or it isn’t. Because we really don’t have, in most groups, we really don’t have a great feedback mechanism in order to help us have a little more self-awareness, and help our clinicians to have a little more self-awareness. So we don’t really have, in many practices, a great way to measure and compare and contrast, right? And, as a manager, when you have metrics, when you know the numbers, if you’ve measured it, what you can measure, you can manage. So, I thought we would talk a little bit about measurement.
Dr. Jason Howell: Yeah, I think this is a great topic to talk about because we as dentists, well 1 - we think that everybody loves us. We think that every single patient that we’ve taken care of loves us and is going to come back to every visit and do every bit of treatment we recommend. And what our team leaders and management know a lot better than us is that not everybody loves us. And, that’s understandable. Not everybody is going to love the dentist they go to, but more importantly is that the team leaders have a more realistic idea and view than we do. But us as dentists for a long time really all we’ve thought as a metric that we could maybe measure is reviews or feedback. And now, in this day and age with social media and everything else, you can post Google reviews, you can look at a review on every different social media. But we as dentists tend to have... let’s just say we’re very picky on which reviews we believe. A great review sounds fantastic. A bad review I can come up with excuses on why maybe...
Dr. John Meis: Sure.
Dr. Jason Howell: But, this new system that some people have used for a long, long time that you can share with us, is a great way to measure really patient feedback in a simply way.
Dr. John Meis: Yeah, and that measurement is Net Promoter Score, used in many, many industries and the Net Promoter Score is asking patients, it’s a 3-second survey, it’s asking them one question and that is, “How willing are you to refer us to your friends, family, and colleagues?” And at 10, you’re very likely to, and then 9 right... it’s a 1-10 scale. And then, there’s a little calculation that’s done to give you that Net Promoter Score. So, those that are really proponents of your practice and those that are detractors, the ratio between the 2, there’s a little calculation that’s done to give you a score. And so, that score is very, very helpful because it’s a good way to help practices get a little self-awareness. So, most practices think, “Well gosh, I’m going to be a superstar on this.” And the score is from minus 100 to 100. And, the dental industry as a whole on average scores a 1. So, we’re kind of right smack in the middle. And so, if you have 15 locations and you get a Net Promoter Score, and there’s lots of services that do this, they can automate it, they can integrate it with your practice management software, and they can do it all in the background, all you get is a score. So, when you have that score and you’ve got 15 locations, well I promise you, you’re going to have one that’s up here and you’re going to have one that’s down at the bottom, right? And, everything in between. And, if you have enough practices, you’ll end up with a bell curve. The good news about this is when you have a hard metric like this that’s done completely the same for every single practice, you can compare it from practice to practice. And, now we can go to those that have a very high Net Promoter Score and we can identify on the 25 things, or whatever your patient experience Way is, and every group has that a little bit differently. But, you can compare, “Well, what are they doing on this? What are they doing on this?” And, you can identify best practices and you can identify worst practices, right? And so, this is a great tool to get self-awareness and also identify where we should learn from and where we need to help and support those doctors in improving their performance so that their score goes up. And, just think of everything that happens when the Net Promoter Score goes up. Your referrals go up. Your retention goes up. Your productivity goes up. Your profitability goes up. I mean, everything becomes sweeter as we support our teams to drive a better performance on Net Promoter Score.
Dr. Jason Howell: Yeah, and just as you mentioned with the dental group concept and being able to look at multiple offices is one more thing that goes up is communication between those offices on, “I saw that you’re getting a great score, so what are you guys doing differently?” Or, “You know, your Net Promoter Score has gone up 5 months in a row, what did you guys change?” This is just such a good tool, and another thing I love about it is it’s one simple question. It’s quick. It’s easy. It’s very simple to fill out. So, what you tend to see is a lot more surveys be actually completed than some of our 10-point, 80-question surveys. So, this is a great tool.
Dr. John Meis: Yeah, very good. So it’s one thing that you can use to help your practices to improve retention and that’s it for this Strategic Thinker. Thanks for being on with us, we’ll see you next session.
