“Tales from the Troubleshooter #4”

Firstly all congratulations to Dhru Shah & team at Dentinal Tubules www.dentinaltubules.com as they reach their 5,000th subscriber.

Here’s the latest piece of mine they have published in which we reach the half way point of Jimmy’s story. You can find it on-line here

Tales from The Troubleshooter – Case 1. Jimmy’s story.

Part 4. Who are you really serving?

The Seven Pillars of Dental Practice Management© are:

  • Vision
  • Financial Controls
  • Sales
  • Marketing
  • People,
  • Environment
  • Systems

We’re halfway through the case study that is Jimmy’s rescue and it brings us to the vexed subject of marketing. At some point in their evolution most dental practices indulge in what I call “desperation marketing”. This frequently involves throwing sums of money at newspapers, magazines, radio, television or video displays in public areas. The result, because it is done without sufficient research and thought, is rarely worth the effort and certainly does not give a good return on the investment of time and money.

There are many definitions of marketing from the formal yet succinct used by the Chartered Institute of Marketing: “Marketing is the management process that identifies, anticipates and satisfies customer requirements”.

Adcock’s definition is even snappier: “The right product, in the right place, at the right time, at the right price.”

Not forgetting Chris Barrow’s take: “The process of eliminating those people you don’t want to treat”.

We looked at Jimmy’s customers whose requirements needed to be identified and satisfied.

Firstly the patients. They are the individuals that wanted / needed treatment in order for the business to survive. They came in two sub-groups:

A) The under 18’s – the majority of the practice. They were being treated under NHS contract mostly with standard straight-wire techniques.
B) Adults. 100% private contract, the majority referred by their GDPs many out of curiosity.

Second. The parents of group A. Their needs and expectations had to be assessed and managed.

Third. The referring dentists.

Last, but not least, the Primary Care Trust – they are the major source of income.

Patients Group A

The practice takes referrals from a large area including urban, suburban and rural areas with varying patterns of disease, motivations and views on health. The referring dentists were from wholly private and mixed practices with a sizeable proportion from “NHS corporates”.

Main concerns to everyone were:

  • The time wasted by non-attenders.
  • The large number of breakages that were having to be seen.
  • The number of treatments that were not completed.

The situation was turned round by changing one thing only – communication.

Steps were taken to ensure that the team listened to every patient. They sought to discover what the patients wanted and what they thought, sometimes it was apparent that the referring dentist had not told the patient why they were being referred. Frequently they (the patients) knew little of what might be involved and had no interest in interceptive treatment – especially if extractions were involved.

Before treatment was commenced it was made absolutely clear that the patient’s oral hygiene had to be and remain above average. Any patients with active lesions were returned to the referring dentist for treatment and disease control until the oral condition was stable.

Audits were undertaken of breakages, analysed by dentist, tooth, adhesive and cement used, appliance type and number per patient. We were able to say with confidence which patients were having most problems and advise accordingly.

A policy of zero toleration of time wasting was introduced.


The “rules” were laid down in a “what you can expect from us and what we expect from you” contract. This way we empowered the parent to ensure that the patient took good care of their appliances (fixed and removable), by cleaning properly as they were shown and keeping to the correct diet.

They were advised as to what to do in case of “emergency”, reassured as to the fact that a true orthodontic emergency is a rare event and how they should assess the situation if there were any concerns. The result was a reduction in urgent appointments and greater understanding of what the appliances were doing.

Patients Group B

At last what is understood as “conventional” marketing.

  • The website was completely refurbished and made more attractive to both adults and children.
  • The practice owner started writing a regular blog on matters orthodontic.
  • The practice introduced a social media policy utilising Facebook & Twitter.
  • Regular press releases to tie in with any current news items.
  • An online newsletter to current and past patients with details of new treatments, success stories and dentally related items.
  • The exterior of the building was given a “make over”.
  • Self referrals were encouraged.
  • Pricing became more transparent with several options made available.
  • Internal marketing techniques (aka asking for the business) led to increased interest from other potential patients.

Referring Dentists

All referring practices were contacted and asked whether they had any comments (positive or negative) on the service provided – and we listened and acted accordingly.

Open evenings were re-introduced so that new techniques could be explained and our approach reinforced:

  • The indications and limitations of some of the fashionable new techniques using removable aligners.
  • The difference between Damon, straight-wire and other fixed appliance techniques.
  • The use of twin-blocks and the importance of early referral in some cases.
  • The use of IOTN and the availability of alternatives to the NHS for those cases that fall outside the allowed limitations.
  • The use of orthodontics before, during and after restorative and periodontal cases.
  • The approximate costs of treatment.
  • The full range of adult treatments.

Primary Care Trust (PCT)

Since the imposition of the “new” contract in 2006 relations with the PCT had been lukewarm at best and hostile at worst. The need for clawback and the way it had been handled by the PCT representatives had done nothing to improve matters. So, much to the surprise of the PCT, pride was swallowed and we went on a charm offensive. Every letter was acknowledged and response was achieved within days rather than either weeks or not all. At every stage we went to great lengths to stay one step ahead of the bureaucrats with the result that cordial relations have been maintained. CQC compliance was attained.

So how did this benefit the practice?

There was an increase in

  • Private patients via self referral & GDPs
  • NHS referrals
  • Cash-flow
  • Gross turnover
  • Profitability
  • Staff satisfaction
  • Patient feedback
  • Patient compliance.

A reduction in:

  • Wasted time
  • Bad debts
  • Complaints

One year on the course is set fair, the work has been done and is constantly reviewed, new marketing techniques are introduced, evaluated and persevered, changed or rejected depending upon results.

Next month the People.

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