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Ask The Coach — Missed Appointments

Published on July 7, 2014

Dear Coach:

I’m having a terrible problem with missed appointments and I’d like to “fire” everyone who doesn’t comply with our missed appointment policy. Except then I’d be left with no patients. Even though we impose severe penalties on anyone who misses an appointment, it doesn’t seem to matter. I’m looking for a recommendation that will really work! Got one? C.G.
C.G., I appreciate how frustrating it is to motivate people, whether those people happen to be your staff, your patients, or even your children. But learning how to effectively motivate people is the most rewarding endeavor anyone can undertake, not just because it works, but because it is always — and I mean always — the right thing to do. Since few dental CEOs have degrees in psychology, you’ll have to learn what the behaviorists have known for a long time — that every behavior has consequences. And if getting patients to do what you want them to do is not working, and then you must think about the behaviors you’ve been using and understand why they haven’t been effective.

Behavior depends largely on the consequences of past and present behavior. If the consequences are rewarding, the odds are great that the behavior will be repeated. To put it simply, you get more of the behavior you reward, which may seem paradoxical to you. You may think it makes more sense to punish people when they make “mistakes,” but, as behaviorists know, negative reinforcement is a highly ineffective strategy to use when attempting to change or modify behavior.

The goal of every fee-for-service practice is to develop and maintain relationships with quality patients and this only occurs through consistent, conscious, and caring efforts. Winning and keeping patients depends on rewarding each person for being your patient. The rewarded patient commits to consistent continuing care visits, accepts your treatment plan, agrees to your financial arrangements, reappoints for the next appointment, refers family and friends, values your practice’s philosophy, and, yes, keeps every appointment.

Remember that Newton’s Third Law of Motion says for every action, there is an equal and opposite reaction. It’s hard to turn an uneducated patient into a raving fan if all the education you provide is catching him in the act of misbehaving and imposing punishment at every point of contact. Behaviorists will tell you that the more attention you pay to a behavior, the more it will be repeated. Which means that all the energy you and your staff are putting into punishing your uneducated patients is reinforcing the behavior, not extinguishing it!

Notice that I said “uneducated” patients? I firmly believe that most people will do the right thing, unless, of course, we’re talking about that rare creature with bad values. There is nothing you can do to motivate a person with bad values; the best thing to do is recognize it and end the relationship quickly. But, for the rest of those who keep stepping on toes, I believe the truth of the matter is that you haven’t invested the necessary time to develop a clear policy on missed appointments, communicate the policy consistently to every patient, and reward every patient for following the policy.

Have you ever noticed when you’re life isn’t working, who is it who is always around? I believe that, as much as you would like to believe it’s the patient who is at fault, I believe the opposite — it is you who are responsible for the unclear policies, ineffective communication, and lack of respect for the patient. It is you who must accept the responsibility for the situation.

So where do you begin? We’ll talk about that next time.

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