Appearing in the July 2002 issues of "Inscriptions", the journal of the Arizona Dental Association:

What has changed in the dental industry since September 11th?

My advantage is that I was able to witness the effect 9/11 and the downturn in the economy had on the 35 practices I have worked with from September 2001 through the end of May 2002. Each experienced some repercussion from the events of last fall. Granted, my world is small in comparison to the total number of dentists in Arizona; but it is large enough to gather some generalities.

What changed was the realization that regardless of how great each dental practice operated, nothing could be taken for granted any longer. Whatever level of patient services a practice strived to achieve prior to September 11th, 2001, those levels are being tested. Practices realized they needed to put forth even more of an effort to secure the trust and confidence patients had in them.

In the practices I worked with, new patient volume dropped a bit. Some patients weren't readily accepting recommended treatment as witnessed by a decline in case acceptance. The occurrence of failed and broken appointments rose a bit. These factors were present in all offices, although some felt the effect more than others.

What was different in the offices that witnessed less of a change than those that experienced more?

I observed that the offices which encountered less of an impact, had previously worked hard on customer service and building relationships with their patients. The trust and confidence of the patients was well established through exceptional service by the doctor and staff. This resulted in steady case acceptance and kept appointment rates. The offices that took their success and patients for granted productivity slip. These consequences forced them to re-focus on what is important in sustaining patient relationships.

What is important in surviving downturns in the economy?

In my experience, it's relationships. And in order to ensure one has loyal patients in a practice, it is vital to have a solid foundation of fundamentals in dental practice management: A well thought out business plan, a fantastic staff, effective marketing, and superior patient services. I've seen predictable and measurable growth and prosperity in dental offices after 9/11 when attention is focused on the details surrounding the entire patient process. Each step of the process must be perfected so that patients comply with treatment recommendations, keep their appointments, pay for services, and are so happy with the office that they refer friends and family to the practice. Walt Disney said, "Do what you do so well so that people cannot resist telling others about you."

These details are difficult to master; it takes hard work. Education is a large part of the process. One has to realize that learning is ongoing. Not only the doctor but also the entire staff must consider the value of reading books on how to deal with people, attend courses on negotiation, sales, and/or interpersonal skills. More importantly, consider talking about these issues as a team and discuss how to handle them in the practice on a day-to-day basis.

Speaking of staff, were there any issues regarding staff that jumped out, and what were they?

During the morning of September 11th, the entire staff of a client of mine was so distracted from the television coverage that patients were being seated late for their appointment, and staff was not focusing on the treatment. He immediately assembled the team in the staff lounge and acknowledged that a catastrophic event was unfolding and as horrible as it was they had an obligation to serve the patient. He encouraged the team to focus on the task at hand: take care of patients! One slip during a procedure because of inattention in the operatory could cause irreparable consequences for the patient and the practice.

Unfortunately, I discovered staff didn't fully comprehend the impact 9/11 had on the dental industry right away. By and large, they didn't perceive that people had changed. The staff realized how serious the impact of 9/11 was when a number of patients called canceling their appointments because they were second-guessing if their jobs were stable, if they would still have dental insurance, and if they would have enough discretionary income for dental care. Initially, some patients kept appointments because they were being laid off and they wanted to complete recommended treatment in time to use up their insurance and while they still had the money. But after that, reality set in and patients no longer were scheduling at dismissal because of all the uncertainty about employment and finances.

Overall, there was not a sense of urgency to raise the standards of how we served the patient.

How does a practice guard against future downturns in their productivity?

The first step is to employ a great staff made up of people who have the following characteristics: honesty, autonomy, integrity, responsibility, self-discipline, enthusiasm, strong work ethic, and accountability. Next, lead them in using principles that are well grounded in ethics and doing what's professionally and morally right. Finally, train them to do the job so well that the patient receives the highest level of patient service and professional dental care. The end result is a strong relationship of trust and confidence that patients have in the doctor, the staff, and the entire practice. There's an old adage that I truly enjoy, "Ideas are a dime a dozen. People who put them into action are priceless."

Due to the downturn in the economy, are people more hesitant to comply with treatment recommendations?

To some degree, my answer goes back to the previous discussion on how well the office built relationships, and how people were faced with a high degree of uncertainty. What I found in the practices I work with is that we saw a slight decline in case acceptance. Once we acknowledged that patient's had changed, we moved quickly into corrective action. We went back to fundamentals and reviewed what we were doing, and more importantly WHY we were doing it. Why were we talking so much about diagnosis, treatment, etc., when we could be asking questions and listening carefully to the patient to learn about their desires, motivations, and possible resistance to treatment recommendations? Why weren't we embracing change and raising the standards on how we take care of people? Sometimes it takes a wake-up call like 9/11 to help us realize that nothing can be taken for granted, and it's up to us to improve ourselves and make even more of a commitment to a higher standard of patient service. Raise the bar on all that you do. Make a contribution. Make a difference.