Dr. Donald J. Rinchuse discusses the many facets of a customer service-oriented practice
Part 2 of this essay discusses the importance of WOW customer service, which is the “secret sauce” in orthodontics. Financial profits are an outcome of incredible patient/customer service, so clinicians must serve the customer to find success. Companies such as the Ritz-Carlton and Disney have realized the importance of customer service: If we don’t serve the customer, someone else will. We are reminded that the golden rule can be elevated to even a higher level and standard — “more than the golden rule”: Not to just treat patients as we would want to be treated, but to treat patients as we would want our children (and grandchildren) to be treated.
In part 1, I discussed the following:
- The history of advertising in dentistry
- The legal challenge to uphold advertising
- The contextual environment of ortho-dontic practice
- The importance of belief in success — a positive attitude
- The beginning of a detailed discussion of the “secret sauce”
The secret sauce is a nebulous concept and is clearly not one factor for all practices. There is no real “secret” to the “secret sauce” for orthodontic success and profitability. Each practice has its peculiar niche in which a marketing plan can be developed. Some of the factors that practices can highlight are a special technique or appliance (e.g., self-ligating brackets, clear aligners, non-extraction treatments, and early treatments), sleep apnea,1 TMD, communications, WOW service, website, internal marketing, tele-dentistry, Adult Smile Center,2 and so on.
This led to the consideration that there are arguably still three general factors that can predict success in orthodontics: price, results, and service. In part 1, I discussed “price” and “results,” and part 2 will consider “service” (Table 1).
Professional codes of ethics
All dentists who care for patients should be cognizant of the principles of ethics established by the various dental/orthodontic professional organizations. The American Dental Association’s (ADA) Code of Professional Conduct has five principles:
- Patient autonomy (“patient self-governance”)
- Veracity (“truthfulness”),
- Non-maleficence (“do no harm”)
- Justice (“fairness”)
- Beneficence (“do good”).
The ADA believes that the dental profession must make a commitment to society that its members will adhere to act in the highest ethical standards because the dental profession holds a special position of trust within society. Other dental professional organizations have similar codes. For instance, the core values of the American College of Dentists are similar to that of the ADA: autonomy, beneficence, compassion, competence, and integrity. The values of the American Association of Orthodontists are patient self-governance (“Autonomy”), do no harm (“Non-maleficence”), treat people fairly (Justice), do good (Beneficence), and truthfulness (Veracity).
Many publications have addressed the ethical and professional considerations of patient management such as that by Rinchuse, et al.3
Business versus profession
It is often discussed whether orthodontics is a business or a profession. In years past, dentistry and orthodontics were considered more of a profession than a business, emphasizing the service aspects(s) of practice over the business and profit side of practice. There were considerably fewer orthodontists with less competition and almost no advertising besides a listing in the Yellow Pages of the telephone book. You could just about set up your practice in any area you wished. The adage was that you just put your “sign up,” and patients would flock to your office.
But nowadays graduates are coming out with significant educational indebtedness, and there are now orthodontists who consider themselves more so entrepreneurs than practitioners. There is much competition not only from other orthodontists, but also from general dentists doing orthodontics (e.g., Invisalign® and Six Month Smiles®). And as mentioned previously, there is the emergence of the tele-orthodontics. For sure, the business part of the profession is very important. Few orthodontists could survive if they choose to operate based on past thinking. Nonetheless, orthodontics has become more of a business than a profession in which the bottom line is the “almighty dollar” rather than service, albeit, only if service can be translated into an internal marketing plan that yields profits.
The old paradigm of patient care was “paternalism.” This is the view that the doctor is all knowing and is in control of all aspects and decisions in the treatment of patients — i.e., the “father knows best” philosophy. In keeping with this paradigm, the doctor looks down on the patient and has little to no interest and tolerance for the patient’s views. On the other hand, patient “autonomy” is the focal point of patient-centered care and stresses the importance of the patient’s views in the context of his/her treatment. The patient has a voice in how he/she will be treated. In this view, the doctor and patient sit face-to-face and jointly discuss the patient’s treatment in relationship to his/her views, concerns, and expectations. Humanism, empathy, and compassion are valued in patient-centered care (Table 2). Aristotle said about the doctor-patient relationship, “They wouldn’t care how much you know, until they know how much you care” (Table 2).
In the patient-centered model, the doctor and staff should refer to the patient for more than their diagnosis and treatment. That is, rather than say, “The Class II, orthognathic, expander, or Invisalign patient is here,” say, for example, “Josh, Mary, Suzy, or Jack is ready for an adjustment in the next room.” Use the patient’s name, and use it often.4 Various aspects of patient management have been discussed in other publications,4-7 including the discussion of various educational-psychological principles5 (Table 3). Parenthetically, it may be important for graduate orthodontic residency programs to consider candidates with proven ethical and service-oriented values rather than attempt to “train” these values into current residents who may lack these values.8
Prearranged dialogues (“scripting”) for staff have merit to effectively communicate (verbal, written, social media) with patients and families. This typically involves the patient’s/family’s first contact with the office. Nonetheless, staff trained in the philosophy and concepts of patient-centered care can deliver high-level UN-scripted conversations with patients and families, which would be more genuine. How do you script humanism, empathy, and compassion?4,5
Importantly, the doctor-patient relationship is being challenged by a “product/consumer-driven” philosophy. As previously mentioned, the age of tele-dentistry and tele-orthodontics is upon us. A patient need not see an orthodontist for treatment, or else see the orthodontist regularly. Clear aligners can be delivered directly to the patient’s door-step with little to no direction from a dentist/orthodontist. The American Association of Orthodontist and several state dental boards are challenging tele-orthodontics (Table 1).
The physical environment of an office is important for excellent patient service. It is essential for creating a brand. The geographical location of an office is the first consideration for an orthodontic office. The old adage that a doctor can just decide where he and his family want to live and then just set up an office is no longer true. A deliberate evaluation and analysis are needed to establish where, and possibly with whom, a new graduate will associate with or open an office on his/her own.
Once a practice location is decided, there are some considerations. Can patients easily get to the office? Is there parking? How about the exterior of the office? What about signage and entrance to the office? Also, if an orthodontist decides to open a new practice, some reflection is needed to determine how big the office will be in square footage, number of operatories, décor, and so forth. The office should be clean, neat, and inviting.
Successful orthodontic practices are “branded” according to the amenities and theme of their physical structure. An attractive office lifts the spirits of the doctor, staff, and patients. The doctor’s and staff’s clothing (uniforms) should reflect the practice brand. The layout of the office is important in regards to space for reception, billing, consultation, treatment, private office(s), lab, sterilization, staff lounge, lunch area, and so on. Special attention is needed to the design of the treatment area because this is where the product is delivered and made and, of course, the money produced. A recent feature of the treatment area is a “perch.”9 This is a discrete location for orthodontists to access their computers, have private conversations with staff, and so on, without going to a private office. It is a satellite to their private office.9
Adults versus children
Orthodontic offices may focus their practice on children or adults. Some do both. A game room for children as well as an isolated, Internet access room for adults could be offered. Also, the physical structure of operatories should offer private adult areas, distant to the treatment of children and adolescences. In addition, there can various child-centered activities features in the office.
Some orthodontists have a special area for adults. For instance, after 31 years in practice, Dr. Herb Hughes decided to “design a new ‘Adult Smile Center’ to be a separate, spa-like area with comfortable leather seating in the waiting area, soft lighting, relaxing music, a coffee and tea bar, and partitioning in the clinic area that makes each station semi-private.”2
A good listener
Oprah Winfrey and Barbara Walters were considered two the best TV talk show/news host interviewers. TV celebrities would want to tell their stories to these two iconic figures. What did they have that the other TV talk show hosts and news celebrities did not have? For one, they empathized with their guests. We saw the pain of the guest written on their faces. Their questions were posed in a delicate and sensitive manner. They maintained eye contact and paced their guests in their speech and mannerisms. They repeated phases that the guests expressed back to them in their communications. They picked up on the guests’ nonverbal cues.5
How often when we have a new patient/family for a first visit consult that we drift off to see what is going on in other aspects of the practice? This is a natural tendency. But we should be cognizant that breaking eye contact and attention to the patient and family is not good listening and communications. As mentioned, repeating back to the parent/family their chief complaints and concerns is requisite of good communications. Using the patient’s and parent’s names often in the conversation reflects the doctor’s concern for the family (Table 3).4,5
Dental financial guru, Dr. Roger Levine said, “In today’s crowded dental marketplace, you want to stand out from the competition. Exceptional service is always a differentiator, especially with new patients … WOW customer service.”10 In regard to orthodontics, Dr. Larry Jerrold stated, “We don’t treat malocclusions; we treat patients who happen to have malocclusions. We must never forget that we are in the personal service business.”11
So how do we orthodontists stand out from the competition and deliver WOW patient service? Dr. Scott and Jessica Law believe that in our orthodontic practices we should strive “to be the best part of our patient’s day.”12,13 There may be many things that go wrong, or will go wrong, in a patient’s day, but it should not be in our practice. In addition, the Law’s add, “A few years out of retention, patients won’t remember my name, or my team members’ names, but they will never forget the way we made them feel when they came in to see us.”12,13 The staff at Law Orthodontics are trained and conditioned to accept this philosophy into their hearts and apply it each day. What a credo for WOW customer service!
If we look outside of dentistry and orthodontics to two of the largest companies that apply the principles of WOW customer service, it would arguably be the Ritz-Carlton and Disney. The Ritz-Carlton credo is, “A place where the genuine care and comfort of our guests is our highest mission; finest personal-service … guests will always enjoy a warm, relaxed, yet refined ambiance.” The Disney principle is, “Serve the customer to find success.” The business models of these companies revolve around exceptional custom service. That is, customer-focused and -driven service. “If we don’t take care of the customer, someone else will.”
The late Dr. Randy Pausch, in his book, The Last Lecture,14 tells a story about an exceptional customer service experience he had while visiting Disneyland and the profound affect it had on him and his family. Dr. Pausch stated that when his family (mom, dad, sister, and he) visited Disney for the first time, he and his sister decided to buy a set of Disney glass salt and pepper shakers for their parents as a thank you for taking them there. He and his sister were preteens. It so happened that during all the fun activities at Disney, the salt and pepper shakers broke. They decided to buy a new set to replace the broken ones. The shakers cost $10. When they went back to the Disney story to tell the store manager that they needed another set of shakers, the manager asked them why, and they told her about how they broke. To their surprise, the manager said that she would replace them for free. Dr. Pausch and his sister politely interjected and said that the salt and pepper shakers broke as a result of their negligence. But the store manager insisted, “Our packaging should have been able to withstand a fall due to a 12-year-old’s excitement.” Dr. Pausch and sister told their parents about their experience with the salt and pepper shakers, and the family was so impressed with the service that over the years they spent over $100,000 patronizing Disney. That is quite a return for Disney for a $10 set of salt and pepper shakers! The story illustrates the positive and lifelong impact that exceptional customer service can have on a business (Table 1).
“More than the golden rule”
The golden rule is, “Treat others as you would want to be treated.” More than the golden rule is, “Treat others as you would want your children/grandchildren to be treated.” This is a higher calling than the golden rule. Certainly, parents want to be treated well in the healthcare environment, but parents love their children more than themselves, and would want and appreciate that their children would be treated better than they would. Can you imagine the impact an orthodontic practice would have by treating patients at this higher standard? Would this be the WOW patient service that we orthodontists are seeking to increase our “bottom line? Is this the “secret sauce,” and that which we can do on a day-to-day and minute-to-minute basis?
So the secret sauce might be right in front of us every day and not some nebulous practice management and marketing gimmick. This may be one of the few things we orthodontists can really control — our love and passion for our patients and families. Do everything in, and with, love. Love patients into our practices. Orthodontists need to respond to patients and families with a kind heart. As the lyrics of one of Tim McGraw’s songs go, “Always stay humble and kind.” If the orthodontist’s personality is not necessarily the caring type, he/she needs to buttress this limitation by having staff that care about people. There are some who opine that only the perception of caring is needed, and the words and actions directed at patients and families can be scripted. There is some truth to this thinking, but this is not the best approach, and eventually staff will not be able to maintain this act and pretend for long.
Can the intense search and achievement of profitability, produce stress and unhappiness? Is the adage, money won’t make you happy, true? We all have seen news reports of the countless celebrities who have fortunes but are not happy. Do ortho-dontists walk the fine line between success and happiness? Is it true that you can’t have it all? Did we not pursue orthodontics to have the greatest careers of all? And, of course, this leads to a happy and fulfilling life. For many orthodontists, this has been true.
There is the belief that true happiness comes from serving and giving to others. Don’t look for happiness (you can never find it), but bring happiness. And, in times of need, plant seeds (help others). Orthodontists need to be generous with their blessings. Orthodontics can be the conduit to serving others and be a means to “pay it forward.” This could range from providing free or discounted fees for the indigent and underserved to supporting non-orthodontic outreach programs. For those (orthodontists) who have been given much, much is required in return. An orthodontist cannot practice and live in a vacuum and forget about the needs of others (Table 2).
What we don’t talk about
One orthodontist’s financial success can be another’s loss. When one practice competes against others, one practice wins, and the other loses, taking dollars away from the other. The dollar “pot” is not endless. And it may not be the smaller practices taking patients away from the very large practices, but the larger practices taking away from the small and average practices. Incidentally, it is not better orthodontics that generally drives patients into orthodontic practices, but better service, price, marketing, and the belief that the results will be superior. Of course, there are dental referrals that are independent of patient referrals, and the above may not necessarily apply.
The secret sauce that we can all do, day-to-day, is incredible service; serve the customer to find success. Excellent patient management is an important component of exceptional practice management. Ortho-dontic offices must be apprised of the proven educational and psychological principles applicable to superior patient care.
We are reminded that the golden rule can be elevated to even a higher level and standard — “more than the golden rule.” This is, not just to treat patient as we would want to be treated, but to treat patients as we would want our children (and grandchildren) to be treated.
- Kulkarni M. Changes lives, one airway at a time — rapid palatal expansion and reducing airway resistance. Orthotown. 2017;10(8):40-45.
- Hughes H. Thirty-one years into practice, Dr. Herb Hughes updates his business model. American Association of Orthodontists. The Practice Management Bulletin. 2017;35(4):2-7.
- Rinchuse DJ, Rinchuse DJ, Deluzio C. Ethical checklist for dental practice. J Am Coll Dent. 1995;62(3):45-48.
- Rinchuse DJ, Rinchuse DL, Sweitzer EM. What is the patient’s name? Am J Orthod Dentofacial Orthop. 2004;126(2):234-236.
- Rinchuse DJ, Rinchuse DJ. The use of educational-psychological principles in orthodontic practice. Am J Orthod Dentofacial Orthop. 2001;119(6): 660-663.
- Rinchuse DJ, Ackerman MB, Rinchuse DJ, Rinchuse DL. Orthodontic treatment and Generation Y: managing “helicopter” parents and their progeny. Orthodontic Products. 2008;15(9):80-82.
- Rinchuse DJ, Kandasamy S, Rinchuse DL, Rinchuse DN. The patient’s chief complaint. Orthodontic Practice US. 2012;3(2):48-52.
- Rinchuse DJ, Rinchuse DJ. Graduate orthodontic programs: who is admitted? Am J Orthod Dentofacial Orthop. 2004;125(6):747-750.
- LaTrace A. Make every square foot count. Orthotown. 2017;10(10):28-31.
- Levine RP. New game, new rules. New playbook … winning strategies for increasing production. Pennsylvania Dental Journal. 2017;84(5):210-222.
- Jerrold L. Bringing skeletons out of the closet. Am J Orthod Dentofacial Orthop. Aug 2011;140:277-79.
- Law S. Orthodontics is in the details. The Progressive Orthodontist. 2010:6-12.
- Law J. The unique eye. The Progressive Orthodontist. 2010:27-28.
- Pausch R, Zaslow J. The Last Lecture. Hyperion: New York; 2008.