John Meis (00:02.199)
Hey everybody, welcome to the Double Your Production podcast. I'm Dr. John Meis here with my partner, Wendy Briggs. How you doing, Wendy?
Wendy Briggs (00:09.878)
Doing amazing. It's gonna be a great podcast today.
John Meis (00:11.375)
Fantastic. Yeah, so this is episode number two of this topic and the topic is missing pieces in the case acceptance process. So when we have been hitting the road hard here lately and one of the things that we found from audiences really all across the US and Canada is that practices are pretty darn full. Their patient flow is pretty good. And so if we want to improve our performance when we have really a solid patient flow, one of the levers that we have to use to do that is improving case acceptance. When we improve case acceptance, then we have longer treatments. We are eliminating single tooth dentistry appointments. And it all works out better and more efficiently for the patient, works out better and more efficiently for the practice. And so case acceptance is really important. Really, really critical. So Wendy, on episode number one, do you just want to give a quick highlight as to what was on episode number one?
Wendy Briggs (01:17.102)
Sure thing, yeah, we talked a lot about diagnostic and treatment planning standards and how to clarify those and identify those and the importance of doing that. There's a lot of, I guess, fun to be had. If you begin looking on social media posts for examples of when it doesn't go well, there's plenty of those, certainly, because it does cause a lot of frustration. And certainly, in dentistry, we have some unique circumstances. We have hygienists that might temp in certain offices. And when you do that, you often have plenty of great stories to share. Well, this is one of the most common topics that we hear vented about or shared is when doctors are watching everything or when the hygienist sets a patient up that the doctor's gonna recommend X and the doctor comes in and says, nothing needs to happen. Those are situations that become very, very challenging if they're happening day in and day out. So... having those things identified and clarified really helps the practice move forward at an exponential rate really when compared with practices who don't have those things.
John Meis (02:23.811)
Yeah, and when you see some of the rants on social media, it breaks my heart because these are dental professionals that are wanting to do the best for their patient. And because the communication isn't there, the standards aren't set, they're not able to help the patient to the level that they could. And it's very, very frustrating for them. And it's really heartbreaking. So we wanna help stop that. So last time we talked about having those standards. So shall we talk about the communication back and forth between the dental team and doctor when it comes to exams?
Wendy Briggs (03:00.01)
Yeah, I think the second thing, there's so many different missing pieces that we could talk about, but we're trying to talk about the ones that we see causing the most disruption and chaos in the practice. And communication is so critical. We call these trust transfers. Over the years, I believe some of our practices that we worked with might call them two-on-one transfers, or some people will call them the handoff. There's so many different ways you could describe it, but the key is we want all the pertinent information passed from one team member to the next. And too often when a doctor comes in for the exam, if the handoffs are complete and on point, what that means is it's far less time on the doctor to be in the room doing the exam, number one. And number two, the patient feels heard. Um, their confidence in our capabilities rises because they, they realize we were listening. Um, and I think there's so many benefits that can happen when we actually have these. Trust transfer is locked in and nailed down.
John Meis (03:58.743)
Yeah, it allows the patient to hear the information one more time, which helps them, you know, to be able to understand it gives them another opportunity to get questions to ask questions so that they get more clarity. And you know, it reduces the exam time you mentioned, it also reduces the mental energy drain on the doctor. So in dentistry, we run out of mental energy long before we run out of physical energy. And so anything that we can do to save mental energy is helpful because once it once the doctor runs out of mental energy Then they have to take a break. This is when you see them go into their office and they're looking at HG TV or ESPN or something That they're just having to zone out for a little while to rebuild their mental energy So we can help reduce that drain by having the information given the correct information in the correct order, and it's very, very helpful for doctors.
Wendy Briggs (05:00.938)
Right, you know, we talk about, I just mentioned the one transfer that happens when the doctor comes in the room for the hygiene exam, but we have identified 12 different transfers that exist throughout the day when it comes to patient care. And every single one of those transfers can really, I guess, lay the foundation for a successful patient visit, from patient experience to actual acceptance. You know, all of those pieces of communication can become really vitally important.
And I think Dr. John, you did a great job focusing on, you know, what it means to the team and doctors mental energy. But what I love about an amazing trust transfer is the impact it has on the patient themselves, right? I've got a personal experience to share because, you know, when you're looking for some of these things, you notice them out in society. It's not always about a dental practice, but many of you know, my dad suffered a pretty serious stroke a few months ago. And I wanna just take a quick moment and say thank you to all of the kind comments and texts and cards that we've received from our members and colleagues. It was really heartwarming for me and much appreciated. But during this experience, I got to see firsthand what solid communication can look like from the patient's perspective. So professionals that deal with stroke patients in the hospital are at the top of their field, right? Super high level care.
The neurosurgeons, the cardiologists, the entire stroke care floor, especially at the very beginning, were consummate professionals and really, really excellent at their jobs. And every time there was a shift change, morning and night, the care team would gather in the patient's room and do a verbal handoff in front of the patient. Now, my dad wasn't often aware what was happening, but I was and my mother was. And it really helped us to know that this key information was passed from the night nurse to the day shift team and they covered everything that was critical. So I noticed the handoffs happening. I think I even took a few photos because I'm like, this is an amazing thing to witness. And then, after a few weeks in the stroke recovery unit, the hospital, patients are often shifted to a care facility. And the difference in communication between the hospital unit and the care facility unit was night and day. And really, everything took a huge step backwards from the patient's perspective because nobody had a clue what was going on, from one shift to the next. And if they did, we didn't know it, right? So if they did transfer key bits of information, the patient was left out of the loop. And this happens sometimes in dental practices, if we do a pre-handoff in the hall or in the lab or through a post-it note, the patients left out of that vital communication. And the frustration starts to build, you know, because something that was communicated with yesterday's crew didn't get transferred to today's crew. And so my mother came home many, many times, very frustrated at the care he was not receiving because there was a breakdown in communication.
So a great personal experience to see the impact that lack of communication can have on patient experience. It can be really frustrating for them as well and frustrating for us because all of a sudden the patient launches into the same story they've already told the hygiene team or the assistant, you know, super long, very detailed and we're kind of looking at each other and our frustration's mounting because we're like, oh my gosh, I already told the doctor this, but see the patient didn't know. The patient didn't know, we told the doctor. So having these communications in front of the patient really helps the patient have a much more I guess acceptable or positive experience with our team.
John Meis (08:34.903)
Right, yep. So just some of the principles in that story are number one, they had a process. Number two, they consistently, they did it every time, a consistent process. Three, they did it in front of the patient so the patient could, now in your dad's case, part of the time he couldn't, but in dentistry, most of the time when handoffs are happening, the patient is alert and awake. So it gives the patient an opportunity to ask questions, to clarify something that maybe wasn't communicated clearly. So doing it in front of the patient is world-class. I know many doctors and teams prefer to do them in the hallway or somewhere else. I know many doctors and teams prefer to look at the x-rays somewhere else, not in front of the patient, but we're really missing an opportunity to influence the patient, to include them in the care, to help them understand things at a higher level, and to build the trust that's necessary for patients to move forward with care.
Wendy Briggs (09:45.418)
Now, sometimes there are certain elements that need to be privately transferred, right? If we've got someone who's incredibly anxious or someone who's incredibly frustrated or, you know, those things, we're not talking about that. That can be done privately, but then all of the pertinent information to their care, opportunities that were noticed, chief complaint, anything that's causing the patient pain or frustration, you know, those things we need to revisit in front of the patient, especially if we don't want the story again about how they broke the tooth eating soft bread at the restaurant, blah, blah, you know, all of those things that we tend to hear time and time and time again.
John Meis (10:18.315)
Yeah, yeah, for sure. So what does what does a handoff look like? Oh, really good.
Wendy Briggs (10:25.706)
Yeah, it's a really good one. So usually we walk through five or six steps, right? The most common thing, obviously we wanna have a systematic process in place for the introduction. It might seem so simple, but you've talked about how sometimes when you walked into a room, you would greet a patient as if you'd never seen them before, not having realized you had seen them before. Sometimes even new patients, right? They may have come to the practice with other members of the family, but this is their first visit today. So we wanna set our doctors up for success and either introduce them to the patient or welcome back the patient. That's a pretty slick and easy way to clarify.
John Meis (11:03.735)
Yeah, you can imagine what it does to the strength of the relationship when you go and introduce yourself to someone who you already know. And it happens all the time when we're not careful. So that's why it's an important part of the handoff. Awesome.
Wendy Briggs (11:18.494)
It happens outside of the dental practice. It happens in real life, right? Where we meet somebody at a social event and you're like, oh gosh, yeah, I actually did remember meeting them, but now I just made a fool of myself. So that's the whole point is to try and have these things appear seamless and very well orchestrated. So that's the first thing. The next thing is something personal. We want a brief personal update. And as a provider, I'm always looking for something that this patient has in common with their doctor, the doctor that's gonna be seeing them, especially if we know that ahead of time, right? Because what that does is that facilitates the emotional bond between the doctor and this patient. And it helps facilitate trust in that they have something in common. Commonalities help build those connections that are really important if we're talking about long-term patient care.
John Meis (12:06.987)
I love that and if you can imagine how much time that saves because when I see doctors trying to create an emotional connection with their patient. They're often searching for one of these commonalities in their conversation And so if it's handed to them in the handoff, they don't have to take the minute or two. And I know minute or two doesn't sound like a whole lot of time, but a minute or two times 16 per day times 200 days per year. It is a lot of time. And so this is just a real nice shortcut way of managing that. Love that.
Wendy Briggs (12:41.954)
And then we shift our focus to teeth, right? And sometimes, you know, I love our doctors and sometimes a hygienist will say, gosh, you know, the conversation gets away from me at this point. And sometimes the doctor and the patient are talking about some of those personal things and then they're never able to come back to the handoff. So sometimes as a provider, the assistant or the hygienist, I would look at the patient and say, hey, John, if you don't mind right now, I'm gonna fill the doctorate on some of the things that we talked about. So I'm essentially asking permission to finish the handoff in such a way that it's not rude. And also it's helpful because the patient realizes it's my turn to talk for a few minutes. And so I can go ahead and finish the handoff.
John Meis (13:21.259)
Yeah, yeah. And so, you know, go ahead. I was just going to say, this is sometimes hard for doctors to be quiet during this time, to just sit back and listen. Often, just having seen so many exams, a doctor comes in, starts talking with the patient. They get into a rhythm between the two of them, and the information doesn't get transferred. So this is an important part that the doctor just take a moment to listen to all the information that's been gathered. It's gonna save you a bunch of time. So the 30 seconds or so it takes for a good handoff is well worth it.
Wendy Briggs (14:03.466)
I completely agree, completely agree. And that's essentially what I was gonna say is that also enables us time. Some doctors, it's interesting, we watch hours and hours of undercover video and some doctors, it's funny that they don't realize that they do this, but they come in the room and sometimes they don't even look at the patient, they look right to the x-rays. And they're clicking through the radiographs, which needs to be done, but they're doing it, you know, while we're doing the handoff or while we're doing that personal information. And so if you really want to facilitate the emotional bond, take just a few minutes and sit knee to knee, eye to eye with the provider and the patient, be present for the handoff. And then you can go ahead and shift. When I start doing the teeth introduction, then you can go ahead and shift and start looking at the x-rays. And we found that to be very, very impactful with facilitating trust and patient acceptance. So then when we do shift to teeth,
We always encourage the providers to begin with the chief complaint always, right? So the patient came in with a broken tooth or something bothering them, that's where we start. And that way the patient knows we were listening to them, we're paying attention to what's important to them first. Some doctors wanna hear kind of what we did today. I've worked for doctors that wanted to know everything. They wanted to know we did a periodic exam, we did four bite wings, we did a pan, we did a prophy. And I've worked with other doctors that say, I don't need all of that, just tell me if something was different. So for example, if they came in expecting a prophy but we found early signs of periodontal disease so we've done something different today, that's what the doctor wants to know. And this is why it's so important that we have these discussions because no two doctors are gonna want exactly the same information in their trust transfer.
John Meis (15:40.535)
Yeah. Yep.
John Meis (15:50.083)
When one great sign that you have very firm treatment standards is when you can report only the exceptions. Right? You don't have to say the whole thing because of course we did all that. It's our standard. So if you're needing all that information, it may be that your standards aren't clear enough or strong enough or they're not followed as consistently as they need to be.
Wendy Briggs (16:15.618)
Very, very good point. So we talk about that, what was completed. Then we talk about opportunities, what was discussed. So if we notice something, an older feeling that was starting to break down, I'm worried about this tooth on the upper left. My best guess is we're looking at a crown there because of the wear, because of the dark spots, because I'm worried there's a new cavity in that, around that filling. We're using our language, right? So we talk about what was completed, what would the opportunities look like?
And then we finished the handoff with any treatment that was on the record from previous appointments that has yet to be completed. So let's say we had diagnosed a crown last time and we hadn't moved forward on that. Um, it gives the doctor an opportunity to really create urgency, build urgency for that treatment that was recommended previously that is yet to be completed still today.
John Meis (17:05.567)
And if it's a single tooth, for sure, we're setting it up for same day dentistry that we're going to take care of that today. So, yeah, absolutely. So that's what a what a handoff looks like. And there is you may have noticed she went in a very, very specific order. Right. And that's really helpful on mental energy. We get all the information in exactly the same way, in exactly the same order and in a similar way with every exam. And that really helps set the doctor up for success.
It sets the team member up for success. And most importantly, it sets the patient up for success because they're going to understand what's going on in their mouth. They're going to understand, or what's going on in their mouth. They're going to understand the consequences of not treating whatever's there. And they're going to move forward with treatment at a much higher level. Now you may think that, you know, these little things, some of these may seem like little tweaks don't have a big difference, but we have seen practices that go through our case acceptance course. And we've seen doctor productivity do as much as double.
Wendy Briggs (18:08.814)
Right. And it's really powerful how all of these handoffs are critical. You mentioned the case acceptance course. One of the things that we do is we actually separate into groups, and we go in different areas of the conference center. And each group has three handoffs to script out. So they do what I just did, create bullet points for handoffs. So I just did the hygienist to the doctor. But what about from the assistant to the doctor? If we've got an emergency patient, what about after that appointment, after the exam, the provider, myself, the hygienist needs to do a handoff to the financial team, right? What do we need to give them an estimate for? There's so many different handoffs that happen, trust transfers that happen throughout the course of the day, that that's another thing that our post-course surveys, people are always so appreciative of the fact that they've got all the handoffs now, all the trust transfers scripted out for their practice. And it becomes a really tremendous tool to take back and implement, especially as we mentioned, bringing new providers up to speed, bringing new team members up to speed. Those become a lot easier going forward, but certainly the acceptance from the patient also shows a tremendous impact as well. As you mentioned, you know, 50% bump isn't uncommon after this meeting.
John Meis (19:22.871)
Yep. So we've got better patient dental health. We've got better team engagement. We've got less wear and tear on the doctor. So it's a win-win-win all the way around. So we know these things are relatively hard to put in place on your own. We know that because we've taught the principles for years, and very few practices if they didn't go through a structured event like our case acceptance course, they really have a hard time putting it together and putting it in action. And it's so important to be able to do that, obviously, because patient care is better, the patient experience is more consistent, and the dental health of your patient base will be getting better over time. And right now in this environment of worker shortage in dentistry and churn, that people are moving from practice to practice much more quickly than was typical in the past. Having training systems is really important to bring new people up to speed quickly. If a person is going to be there for a couple of years, well, they'll get it on their own. But some of the tenure, the average tenure of dental employees has gone down, which means we have more churn, which means we need better training systems. And when you leave the case acceptance course, you have your training system documented, ready to go for the team members that you have now that weren't at the event, as well as new team members that would join.
Wendy Briggs (20:56.426)
Right. And another thing we love to see is we love to see practices actively growing. Right. So when you grow and you need to bring on new team, it reduces the doctor's blood, sweat and tears. You keep more of your stomach lining. All of those things are really positive features of having some of these things nailed down. You know, these systems, these missing pieces, if you will, can really make an impact.
John Meis (21:18.223)
So if we can have the training system in place, then people aren't learning by trial and error, which is slow, and the patient experience suffers by the errors. So Wendy, fantastic job on episode number two of the Missing Pieces of Case Acceptance. Next topic is going to be technology in case acceptance. And there's been some advances that are really terrific that we're going to be pointing out how useful they are and how to use them and I'm excited about that. So yeah, it will. So that's it for this episode of the Double Your Production podcast. We'll see you next time.
Wendy Briggs (22:00.11)
Thanks everybody.
