EP52: How Your Team Can Help Case Acceptance Today (Part 1)

In this episode, we’re listening to Dr. John LIVE sharing insights about the opportunities within an office to improve case acceptance numbers.

If your restorative schedule is slowing down, if you’d like to do more big cases, or if you’d like to involve the whole team in the patient appointment in a positive way, this episode is for you.

Listen now:

[music] Welcome to the Double Your Production podcast with the Team Training Institute, the one place designed for dentists and their staff who want to grow their practices by following in the footsteps of those that have done it or in the trenches. We know exactly what you're going through. And now your leaders, the stars of the broadcast, Dr. John Meis and Wendy Briggs. [music]

I am going to start with a story. And it's a story about a plane crash. I'm going to narrate the story. I know it really well. So this is United Flight 232. It is taking off from Denver, Colorado on its way to Chicago, Illinois. This flight was about 18 days after Samantha, my daughter, was born.

The plane was flying, everything was going normally, sailing across. It was about halfway between the two cities. And then something happened. There it goes. So the engine blew apart, which happens in planes. I've been on a plane that's lost an engine. And it's something that-- planes are designed to fly with just one engine, so if you lose an engine, the flight's a little bit slower, but you still end up being okay. In this case, the shrapnel that came out of that engine severed all of the hydraulic lines and all the control things use hydraulics. And so they couldn't control the airplane by rudder, right? And so they were still flying. They still had two engines, they still had airspeed. Everything was good, but they couldn't control the direction or the altitude of the plane. There was two pilots flying this plane. There was an instructor pilot in the back who came into the cockpit. And they began to realize that if they used differential thrust, meaning a little more thrust on the right side, the plane would turn, a little more on the left side, it would turn.

So they started these big circles over the cornfields in between Denver and Chicago and the plane started going down, down, down, down, down, down, right? They found the nearest airport. It had an Air National Guard unit at it and all Air National Guard units have really good fire departments. And because they knew that this was not going to be a pleasant landing, and they knew it with plenty of time, there were tons of emergency crews as this plane came in. So came in but as it slowed down-- every time it slowed down, the right ring would tip. And so they had to slow it down to be able to land on the runway and hopefully, stop on the runway, but just they slowed it down, the wing tip dipped.

Here's the actual footage of what happened. [music] Okay. That's a simulation. Here's the real video. Simulation. Video. Here's the stats. Flight 232. The airport, Sioux Gateway Airport in Sioux City, Iowa, where I was born and lived for 50 years and was a practicing dentist. Plane occupants, 296. Injured, 172. Fatalities, 111. So there's 13 or so people that walked away from that without even being injured. Hard to believe.

So this is what happened happens after airplane crash. So these are air guardsmen who are picking up bodies and putting them in body bags and loading them on a truck. That truck went to a hanger where they had refrigerated trucks brought in. So 111 fatalities. Identification from dental records, 110. 110 people were identified by their dental records. One, a flight attendant that was killed, they had her fingerprints but the rest of them were identified by their dental records. So there was a team of people that identified those bodies, and I was one of them.

So I want to talk about what happens with the FAA and NTSB that really applies to how we can think about our treatment planning and case acceptance. So most dentists really never profit from their mistakes, and there's a lot of reasons for that. And I see people making the same mistakes over and over and over and over and over again. But some do profit from their mistakes. So the question is are you in the right place right now? Are you open to learning? Are you open to be coachable?

And teams, you have a very important role in this, a very important role in this. So I want to tell you just how important the role is. Let me read for you something that I came across on Facebook. This is a Facebook message.

"I've spent the last three working on convincing a long-time anxious patient of 30 years that he needs to replace his amalgams. They're over 30 years old, broking, leaking, surrounding tooth structures fractured, etc. I finally had the patient ready to schedule and when doctor came in for the exam, I explained how I went tooth by tooth with the internal camera to show the patient why they need these replaced, and he look at the patient and says, 'All these amalgams are holding up great. They're just fine.' There were seven teeth that needed fillings and two crowns. The patient turns to me and says, 'See? You don't know what you're talking about.' Now, this is after several meetings about production or replacing old broken down fillings. [inaudible] schedules been practically empty. He has done this in the past. I've taken him aside to let him know how unprofessional and rude it is to do that in front of patients and that I wouldn't put up with it. But when the patients are his friends, he won't do the needed work. I've been a damn good hygienist for 15 years and was a dental assistant before that. I would've replaced those fillings years ago if it was my mouth. And he would have, too. So my front office manager and I put our notice in right after we finished that day. I worked my ass off for him - pardon my French - ass off for him as the only employee in the back, so I was doing 8 hours and hygiene and all the assisting work in the back with only the help of the front desk manager. I cleaned out our toilets, I took out the trash. Now, he has no one. "

Take this as a lesson. If you're a dentist, don't ever make your hygienist look like a fool. Right? So our teams are critically important. Would this dentist who had one front desk person and one hygienist probably not doing real well - if that's his office makeup - would he have been helped by listening to the coaching of his team? So team, you are so important.

I know you can't read this, but I'm going to walk through it. Most of you have seen this before. There's a few new people in the room so I want to walk through this. This is one of the two diagrams for our Blue Diamond Coaching Program. Okay? So I'm going to walk through it. This is calls and really contacts, incoming calls, emails, texts, messages. Now our job is to answer those, right? And if we answer those, our job is then to convert them to an appointment. And if we get them converted to an appointment, our job is to do everything we can to help them arrive for the appointment. Right? Next is diagnosed, needed and wanted treatment, right? Patients are going to accept some or all of it. Great! We're going to make arrangements per payment. These two boxes got-- my diagram got a little mixed up. We're going to arrange for payment. We're going to do the treatment efficiently. We're going to make sure they make another appointment. Right? And then we're going to do everything we can to help them arrive for that appointment. If they don't, they go back into here for outgoing contacts where we're going to use calls, emails, text messages and mail to help them get back on the schedule. Right? That is the practice success loop. Fairly simple, really. What we want to be able to do is to measure all of these things. And now we have technology to do it.

So if you're a Blue Diamond member, you have our analytics software that allows us to measure everything around this loop and using other technologies that we-- [SmartBox?] has a technology that will allow you to measure this. That's what I use in my own practices. So now we can measure it, right? And it's important because there is in every practice a perception performance gap. Right? None of us are as good as we think we are. Right?

So I didn't know about this performance perception gap. I really didn't understand it very well. And where I first learned it was with hygiene reappointment. So somebody smart had told me, "Hey, hygiene reappointment is really, really, really important." And it was very-- it used to be a very, very difficult thing to measure because the [developed?] practice management software doesn't really help you manage your practice very well. So we had no way. We had to manually figure it out. And when you're running 10 columns of hygiene, that's a lot of work to figure out hygiene reappointment.

But our hygienist, so we measured it. And we found that we were only reappointing about 60% of the people. And we went to the hygienist and of course now when I see that, inside I'm going like, "What?" First, I doubted the data. Once I saw that the data was sound, I thought, "What are these people doing?" So I went, rather than with my anger, I went with my curiosity. And I went to them and I said, "Hey, look at this, this data, this is interesting. How is this happening?" And they were like, "No, no, no, no. We're reappointing everybody. We're reappointing everybody. We're reappointing everybody." I said, "Here's the data. You're not. You think you are. There's a perception and performance gap. You didn't know about it."

Another place where we see this is in calls. We've talked about it a little bit. Average practice answers about 60% of their calls. Right? You're not really working on it. You're only capturing 60%. So if we get a hundred calls, and calls are coming in, right? If we take a hundred calls coming in, wanting appointments, only 60 get answered. And the data is also, the average practice that's just doing okay, not a bad one, this kind of average practice gets 36 appointments out of that. Okay? So that's not so great, is it? So if a new patient value in a practice has 2,000 and you heard some of those numbers on Thursday for those of you who were here, some in this room, the new patient lifetime value is more like 5,000 0r 7,000 or 8,000. But if we use just 2,000, you can see we are absolutely shooting ourselves in the foot. We're only capturing 36% of the people who are calling who want to make an appointment, but we don't know it. We don't know it unless we measure it.

Peter Drucker, "What gets measured gets improved." Now, some of you may not know who Peter Drucker is, but he wrote the still the bestselling and best, period, book on being a good executive. And for those who'd like to read, this is the one to get, the 50th-anniversary issue. It is as timely today as when it was written. Those of you who are lazier, you can get on YouTube and you can watch the quick draw that summarizes the main points in that. All right [laughter]? A time hack.

So this is a weekly management review for a group practice. So with this practice, every week, the doctors and the office managers get on the phone with the regional manager, and they go over these numbers. Now, I know you can't see them. I'm going to blow up the piece that I wanted to point out to you. All right? So when we look here, this is call-answer rate and call-schedule rate. These practices are almost identical. They're staffed the same. They have the same phones. They have the same everything. All right? They're about as identical as we can think about it. And this is a new one, and so we don't have the technology hooked up yet. So look at this. Call-answer rate, in this month, 96% for this one - which is very hard to hit - and 68% for this one. Right? So as a manager, what are we going to do? We're going to call up the 68% one and yell at them? I don't suggest that. I suggest that we focus on this one, and paying great attention to that one, and helping them celebrate. When everybody gets to see everybody's numbers, this one already knows they're not doing well. Right? And so now that we have the data, we're going to expect this one to come up. If we're not, we know we don't have the right people. Right? Same systems, same training, same everything. One's at 96 and one's at -what was it? - 68? Okay? Same everything.

So when you see data and when you see a range, we know there's opportunity. Right? Where there's range, there's opportunity. And so what happens when people get celebrated for doing something amazing is absolutely magical. And I'm going to show you one of my favorite, favorite celebration. But I've got to set this up a little bit for you to kind of understand the whole picture here.

So this is a World Cup soccer finals. Now, United States soccer is not as popular a sport as it is in the rest of the world. Right? And so in the rest of the world, this is the thing. This is the sporting event; comes around every four years. It's bigger. It's much bigger than anything else. Right? World Cup soccer is amazing. Now, the United States was playing China. Thank you [laughter]. So the United States was playing China, and it's the final game. The person who wins this is the champion. And it was a really close game. And so what happens in soccer if they come to the end of regulation time and they're tied, they give what's called extra time. All right? And so at the end of that extra time, if they're still tied, they do five penalty kicks. So penalty kicks is one kicker standing and [inaudible] out from the goal, one goalie; and the kicker tries to kick it past the goalie. Right? And each team gets five people. Okay? That's the setup. Let's see what happened. Oh, Mitch, could you just-- there you go. Thank you.

[crosstalk] China [crosstalk]. Kristine Lilly, the heroine, player in [inaudible], header of the line [inaudible] saved that one, that was close call. Saved it. Now, we're coming to the end of extra time. So she missed the penalty kick. Now, there's only one more penalty kick. If the United States gets it, the United States wins the World Cup the first time ever. All she's got to do is kick it in. Listen to it while you watch it.

I don't know if I can describe this well enough in words, but it was like it happened very quickly. But it was in slow motion, but I could see it, like almost see the ball not rotating and just hitting the back of it and then it was like then the explosion of the people behind and you see all the colors and the flashes and everything and next thing you know you're giving your celebration and then the team is on top of you.

The raw emotion of the celebration, listen.

[crosstalk] Mandy Chastain's penalty and celebration was seen all over the world. A captivating nation rejoice and--

All right. That's what happens when you celebrate people that have high performance. It drives everybody up. Be focused on the ones that don't have high performance. It doesn't pump everybody up. All right? So we're going to discuss a few things here today. We're going to talk about to industry. One of these industries kills about 400,000 people per year in the United States. We're going to talk about airline safety and what it can teach us about case acceptance. And then I'm going to tell you a story in my own practice of how I came upon a troubled time and how I use some of the things that I learned from the plane crash that I was involved with, to work my way out of it. So here's what you're going to discover. This is my case, acceptance breakthrough. And what it leads to is better patient care, better team satisfaction, better income, and improved wealth.

So I want you to come up here, I saw your t-shirt this morning, and this is a perfect time for me to point this out. Your t-shirt says what?

We keep people before our profits.

That's the only way it works. Right? without people that you serve and serve with, there are no profits. Right? But we got to remember the order; people first, right? Thank you.

You're welcome. Okay, so I'm going to talk about my breakthrough and I'm going to talk about some principles that apply to finance and enterprise. Okay, who's this guy?

Warren Buffett.

Warren Buffet, one of the richest men in the world. One of the only people on the Forbes 400 list that is an investor, that has only been an investor. That's how he made all of his money as an investor. And he has a principle that he calls the float. So let me describe it for you.

His company, Berkshire Hathaway owns insurance companies, and how the insurance company business model comes, we all write our checks to our insurance company, and it goes in, and they get money coming in, and money coming in, and money coming in, and they're holding that money until something happens, right? So they have the use of this money for a period of time until they have to pay anything out. Warren calls that the float. So he's taken that money and invested it in companies, invested very smartly, very wisely. And through that, over a period of time, he has amassed tremendous wealth, okay?

The float, it's a beautiful concept and almost magical because he's using people's money with no fee, right? In fact, making a profit while he's using their money because all of his insurance companies are profit over the long term. Some of them have had some years where they weren't, but they're all profitable over the long term.

But float unless you own an insurance company, it's not available to us, right? Anybody here own an insurance company? Yeah. Me neither. So it is a financial explosion tool.

I want to describe another one. Most of you have heard me talk about it. I talk about it a lot. I call it the next dollar phenomenon. So I always use the lemonade stand because it's so simple to understand. So we sell a glass for $1. The cup and all the ingredients cost 10 cents, fixed cost, the rent, the labor, all that, $89 a day. So if you sell 100 glasses in a day, how much profit is created? Because I know as dentists we need the math done for us, it's $1. Okay? So I want to make one change to this. Same thing but instead of 100 glasses, we're going to sell 120 glasses. So we're going to increase sales by 20%. Okay? Let's do the math on profit. What? $19? 20% more sales yielded 19 times more profit? Yes. Yes, it did. Okay? Economists call this marginal profit. I call it the next dollar phenomena. The next dollar that you serve people-- the next dollar that you get from serving people is much more profitable than the last.

So let me demonstrate this in dentistry. We decide that we are going to embrace the concept of same-day dentistry. And we are going to fit in an extra filling. Let's say that filling cost $200. I don't know what-- we're in Florida. It's probably 300 here. I don't know. So $200. What's the cost on that extra filling? The rent's already paid. Utilities are already paid. Insurance paid. Team's already paid. They're out there. Everything's paid. There's no lab bill. What's the expense for that one additional procedure? Supplies, right? So supplies, for most of you in the room, should be around 6%. Like it to be around 4 but 6 is a reasonable number. So of that $200 procedure, there's $12 of cost or $188 of profit. Do you see how this applies? Okay. So this is the second most magical financial explosion tool that I know of, right? The next dollar phenomena. It's largely unavailable to people. But luckily, you own dental practices and it is available to you.

So what other magical tools do we have? In our success loop, diagnosis of needed and wanted treatment and patient acceptance. A tremendous lever here. If we master this, we have the same type of leverage that Warren Buffett has with float. Okay? We've got the analytics to measure what that is. Guess what. When we look at diagnostic percentage in restorative and we look it in hygiene, guess what there is when I look from practice to practice to practice. There is a tremendous amount of--


Opportunity. And I know that because there's a tremendous amount of range. Now, if you have one fact is, you don't know what the range is, do you? You just know your number. Is that number good or is that number bad? So that's why we developed the practice success loop. Our business coaches have the metrics. They can tell you where you stack up in our industry, right? So that you have the benchmarks. That way you can identify where the lowest hanging fruit is and go after that. Where you're going to have the biggest impact. And, for most practices, it's this. Improving these two is almost magical. Just like the float. So why I'm sharing this with you today is that I goofed this up for a long time. And then I learned how to do it pretty well. And I've been in 309 practices in the United States and Canada, physically been in it. I used to manage 180 doctors. Watched many of them work. I've learned a lot by watching all those people. And, now, it's even better. So I want to talk about the tale of two industries because it's kind of fascinating. So this is the airline industry. So I've got just a few stats here just to describe what this was like. So bear with me. So at the beginning of airline flight, it was a rather dangerous thing. So in the early 1900s, of the first 14 US Army pilots, that was before there was an airforce. Guess what? Eight of them died in service.

The aviation schools, 25% died during their training. It's hard to imagine something more dangerous. But aviation, today, is very, very different. So in 2009, there was the crash of Concord flight 3407 in Buffalo, New York, all right? Crash right, boom, on a house. In a neighborhood. Just crushed that house. So the pilot, very inexplicably, got a stall warning. And what stall means is that the plane is not moving fast enough through the air to have enough life to be able to keep the plane flying. I'm a pilot so I know that in planes they have, what is called, a stall warning. So the stall warning happens. It's a little indicator and in planes it's goes [inaudible], right? So the closer you are to a stall, the louder and more obnoxious the noise is, all right? And stalls are not a problem. They happen all the time. In fact, right at the end of landing you actually are in a stall. That's what helps you get to the ground, right?

So all you do to get out of a stall is you do two movements. This one and this one, okay? Nose down, power up, right? If you do those two things, you're out of a stall in seconds. In this flight, inexplicably, stall warning went off, pilot went-- plane went up, airspeed lost, pancaked down on a house. It was very close to the airport but pancaked on top of a house. After that flight, for 10 years, not a single plane crash. Not one. Only one fatality and that was the woman that had the engine break apart and she got sucked out the window. So there are, how many millions that's on this slide? So there are-- it's coming up on another slide. The number of people that fly is incredible. And they went 10 years without an accident at all until just recently, right? And what was the recent-- what was the cause of the two recent crashes?

The first one's [inaudible].

No. [inaudible].

[crosstalk] [laughter].

Computer overriding the pilot to prevent a stall. Yup. So let's compare flying. Oh, I got the numbers here. No. The number of people that have flown is just-- it's unbelievable. I fly all the time, and I never worry about it because I know how safe it is. Here's the other industry. The Journal of Patient Safety estimated that more than 400,000 people die in America every year from preventable medical errors. And I bet you that I'm not the only one in this room that knows someone that died from a preventable medical error. Anybody else? Yeah. Look around. So let's compare flying to healthcare because there's something more deeper going on, right? So in airline safety, what happens when they have an accident?


They investigate it, right? And so they have someone that comes in and does a very, very thorough investigation. So it's the National Transportation Safety Board, NTSB, that does these investigations. I've been involved in two of them, right? So this airline crash and then I was the part-owner on a plane that crashed unfortunately and killed two people. So I was involved in that one. So I understand how this works. And why did they do the investigation?


It's how they learn what happened, right? And that's how they learn how they fix it. Do they care which airline it is?


They don't care which airline it is. Do they care whose fault it is? They don't care, right? They just want to know the answers. The critical difference between aviation and medicine is that, okay? In medicine, do they care who does it? Oh, they do. The surgeon that brings in tons and tons of treatment is going to be treated differently than the surgeon who doesn't. It's an entirely different thing. I was on the board of a health system multiple hospitals in Iowa. I was on the board for 12 years, was the chairman of the board for 2. And so there are attempts at safety, but it's not that great. So in healthcare, when there's something that goes awry, we know now there's going to be litigation, right? And so the victim's family or the victim is going to be suing the hospital and going to be suing the doctors. They have different insurance companies so the doctor and the hospital are going to sue each other, right? These suits last for years. Takes forever for these to get done, right? And so, now, everybody's trying to cover their own butt. And that's why 400,000 people die because they're not trying to get to the root cause and figure out how to change it, figure out what's wrong and what we can do to make it better, right? So you're going to ask what does that have to do with your case acceptance?

Listeners. Sorry to have to leave you on a cliffhanger this week. This lecture was incredible by Dr. John at our latest meeting. So if you'd like more information on coming to see us live or on having Dr. John take a look at your practice individually, come and find us at www.theteamtraininginstitute.com/podcast. We can answer a lot of your questions there. Follow some links. Get our book. Get more information about us. Again, this cliffhanger will be resolved. We will have this part two episode coming within the next few weeks. So keep an eye out for that, and thank you so much for listening today. We'll catch you next time. [music]

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