Resolving Negativity in the Office

Some time ago, I read this article in the Wall Street Journal – which discussed dealing with feuding employees. There is good information in this article on feuding employees, and anyone having staff-conflict issues should check it out. Since dealing with staff bickering and personality conflicts can be a major source of stress in an office, knowing how to deal with it can be extremely useful.

As the Wall Street Journal article points out, when you let employee situations linger too long, bad things happen, and you can end up losing not only the problem employee but other good employees as well. So, when you encounter two or more employees feuding, our recommendation for you is to find out as quickly as possible who seems to be instigating the problem, as well as determine which of the two employees is the most productive, and to quickly nip it in the bud.

Normally, when a feud is going on, other staff members have either been involved or have observed it in one form or another. It usually bothers them as well, even if they are not directly involved. What we recommended to practice owners is to interview these peripheral staff and get a more neutral opinion of what’s going on and who is really causing the problem. Also, interview the staff involved and get their respective sides of the story. From this you should be able to find out who the real problem employee is.

ACT FAST! The longer you let something like this linger, the greater the odds that you will lose not only the problem employee, but the good employee and possibly other staff members who are sick of being involved in that type of work environment. If you act swiftly on such matters, you will keep your employees happy.

There’s another very important point: the longer this kind of thing is allowed to continue in your office, the more likely it is that other staff members will start to feel that their workplace is not safe. They will also feel that the owner is not in control of the office and that they may want to find a better environment to work in. You could end up losing a really good employee because you didn’t confront the problem and act swiftly and appropriately.

Having the right office policy and job descriptions in place to govern acceptable and unacceptable behavior in the workplace will give you an important foundation to stand on when handling this kind of situation. Lack of such policy can make the workplace less than harmonious. And don’t forget to document, document, document the non-optimum issues in writing and what was done to handle the people involved. Without documentation, you can open yourself up to potential legal issues.

The “staff infection” is a term that I came up with long ago to discuss the effects that a negative employee can have on a team and how fast it can spread. Similar to how the “Staphylococcus Infection” is dangerous to the body.

The “staff infection” starts in various ways, such as with a staff member that often rolls his or her eyes at staff meetings. This staff member engages in rumormongering and can be counted on to “stir the pot” in the office. This can be the idle staff member or the person who always seems to be busy but gets nothing done. You get the idea. This is the employee that you are “just not sure about.”

What would you think of a doctor that did not practice good sepsis control and permitted Staphylococcus germs to fester in or on his or her equipment? It simply does not make sense, does it? Nobody would do that. Preventing any sort of infection in a patient is more than second nature to any doctor. What would your opinion be of a doctor that was aware that his or her patient had an obvious staph infection but did nothing about it? Enough said.

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Looking Toward the Future: 10 Steps You Must Do Before Selling Your Practice

In the course of your career, you might decide to sell your practice. There are ten important aspects of your practice that you should consider NOW, so that when the time arrives, you will have developed a truly marketable practice.

1. MAINTAIN STRONG REFERRAL SOURCES

Professional respect has value. Do you have good relationships with other professionals in your community? You should. If so, are those relationships so strong that you can transfer them to a new owner?

For example, if you have several professionals who continually refer patients/clients to you, you would want to ensure that those referral sources will continue to send patients/clients to the new owner. Otherwise, the buyer might want to discount the practice price by the amount that would be lost from not getting referrals from just those few sources.

Most professionals will continue to refer to the practice after your departure, as long as they are assured that those clients/patients they refer will receive the same good care that you currently provide them. It is also important for your referral sources to know that the new owner will reciprocate with referrals to them (assuming that is the type of relationship you currently have).

Keeping up with and then transferring these relationships will help your patients/clients too. That maintains continuity and quality of care for them, which will help them to always think well of you.

2. MAINTAIN FACILITIES AND EQUIPMENT

Everyone is inclined to pay more for something if it looks attractive. The same principle applies to buying a practice. If your facilities are pleasing to the eye, you might be able to command a higher price. While a clean carpet is only just that, it might demonstrate to the buyer that every aspect of your facility and practice is probably well maintained.

Well-maintained, state-of-the-art equipment also speaks well of you. It says that you have a growing practice that is keeping in step with technology.

3. INCREASE YOUR GROSS SALES

The best indicator of the value of a practice is its cash flow. Your successor will want assurance that he is acquiring a reliable income stream. Now is the time to concentrate on reactivation of old patients/clients, increasing your marketing budget to attract new patients/clients, setting goals for the staff and moving the practice toward maximum productivity.

4. IMPROVE YOUR BOOKKEEPING RECORDS

Part of selling a practice requires that you develop and present an accurate picture of what you have accomplished. You will want to be able to disclose good financial figures. Plan to have at least five years’ worth of good financials because the buyer wants predictability. Have an outside professional prepare “compiled statements.” That adds credibility. The practice buyer will find that well-maintained, accurate accounting records help with forward planning. Additionally, good records can even help you explain a slump period.

5. DEVELOP A TRANSITION PLAN

Very few practice owners supply the buying owner with a transition plan. If you were to do that, you will be far ahead of other owners who want to sell their practices. You should develop a plan because it not only can increase the worth of your practice, it can make life easier for everyone. Put the transition plan in writing, then review and outline all the systems and how they work. The marketing plan, referral sources, management policies and accounting systems should all be put down in narrative form.

Indicate a time frame in which the practice will be transferred to the new owner. That will give him an idea of how long he will have to learn the ropes. Don’t expect to make the deal and run with the money. An adequate time frame to transfer a practice in which you will be working side-by-side with the new owner, will range from 30 to 120 days, depending on the size and complexity of the practice.

Part of an effective, valuable transition plan can involve a good loan package. It shows that you have put together a transition plan that is easily understood by a third party. It indicates that you have a good relationship with the bank. That can enhance the value of your practice, since the banker knows that the systems will remain in place and generate cash flow to repay any loans.

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Did You Hire the Wrong Person?

A recent survey conducted with practice owners across the US revealed that the number-one management problem they have is personnel issues. Among the problems mentioned by hundreds of owners surveyed were:

  • Procuring qualified personnel,
  • Getting employees to perform competently once hired,
  • An inability to hold staff members accountable for their work,
  • Turnover and handling disputes among employees.

Correctly isolating and debugging non-optimum practice situations is a skill that every doctor finds he needs. Oftentimes, a manager who is seeking solutions overlooks some administrative fundamentals which, left undetected, cause a problem to appear larger or more complex than it really is. Moreover, failing to discover the real source of a problem leads to poor decision-making. In the case of managing employees, this type of failure is not only frustrating, it’s expensive.

The real work begins after the hiring process ends, for each employee must be well trained for his/her position in the practice. Lacking thorough training, an employee will not perform to the expected standard. That will inevitably lead to either the employee quitting or the doctor firing him/her.

There is an exact technology for finding and hiring good staff members. Assuming the hiring techniques are sound, the most devastating managerial mistakes are made during the training period. During that time, an unskilled manager might make assumptions that lead to incorrect reasons for poor performance, and those conclusions, in turn, lead to bad decisions regarding personnel. All too often, a suitable person who is both willing and trainable fails to receive the information needed to do the job. As a result, turnover occurs and doctors and office managers spend their time dealing with personnel problems rather than treating or servicing patients.

Written job descriptions are a must for each position in a practice. More importantly, those descriptions need to include fundamental data that are often omitted because the manager assumes that the employee already knows what is needed from him. Common sense, or common knowledge, to one person may not be so to another. Verbal instructions are much less effective than thoroughly written job manuals.

Every job description in an office should include the seven following sections:

  1. The responsibilities that the person holding the job position has to the patients,
  2. A general description of the position, which includes its purpose,
  3. A statistic that quantifies, and thus objectively measures, the production of the position,
  4. A list of specific duties that one in the position is expected to perform,

What are the final three sections that a job description should contain and the four things to examine when employee problems arise? Read the final half of this article by filling out this form.

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A Functioning Office Manager

Your Key to Success

The primary function of the office manager is to accomplish the goals and purposes of the practice as determined by the owner of the practice. The OM should assist the owner in developing policies that forward the purpose of the business as a whole. It is the OM’s job to see to it that all members of the group are fully contributing to the expansion of the practice, and that a high level of communication exists between the group and the owner.

The OM should run the day to day activities of the office and keep the daily distractions off of the owner/doctor’s plate. This would be accomplished by ensuring that the OM, first of all, was trained in the handling of staff and felt comfortable with the hiring, training and correction of all staff members.

The OM should be a person who understands the importance of communication and the power that open communication can generate within any group. The OM should energetically lead the group toward accomplishment of the established goals. The OM should be someone with good communication abilities and someone who can really care for the staff.

The OM would ensure that all internal communication systems are strongly in place and operational, and that the staff is taking responsibility for keeping all unnecessary “traffic” from and within their own posts to a minimum.

To affect the above, the OM should have a strong working understanding of the management tools such as statistical management, the establishment of a communication system that really works for the office, written communications, job descriptions for each position, written policies for the practice, and personnel management.

The OM is in charge of seeing to it that all areas in the practice are running smoothly and producing the desired products of each respective area. This would require her/him to have an understanding of organizational structure and function. They would ensure that all functions in the organization were being firmly held by someone and that they were trained in the skilled handling of their assigned posts.

The OM should have a very strong working knowledge of statistics and their use in strengthening the practice. The OM would be in charge of posting statistics and going over those statistics with the staff in the staff meeting to determine the appropriate steps to take in order to improve, maintain, or increase practice production statistics.

It is the OM’s responsibility to obtain compliance from all staff in regard to the owner/doctor’s wishes and any program or project steps that are being worked on.

The OM would be responsible for the hiring and firing of personnel and for conducting performance evaluations on a regular basis with all staff.

The OM is responsible for the preparing and implementation of programs that would take the group through the needed steps toward the accomplishment of company plans.

Fill out the form to read the rest of this article which includes: 5 key objectives of an OM, the results the OM must obtain for the practice and how to select an OM (highly recommended). Scroll to top

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Optimize Your Marketing

In today’s economic climate a great deal can be said for the benefits of marketing effectively. There are many mediums for marketing a practice – referrals from existing patients/clients are normally the best and most cost effective means of getting new patients/clients. External marketing, such as the Internet, business directories, new resident mailings, bus benches, and even the local newspaper, radio and TV, has worked for some. Some form of one or more of these has proven to be successful in various markets, but not all of them are effective in all markets. Given all this, it is vitally important to know how your new patients/clients are finding out about you, and based on this, you should focus your marketing dollars in the most effective areas.

This brings up the topic of this Hot Tip.

Somewhere on your new patient/client form there should be a little line that says, “How did you find out about our practice?” If you don’t have this line on your new patient/client form, you should institute it right away. Some offices have little check boxes that mention their various marketing activities, and others just offer a blank line to be filled in. However you do it, the purpose of this is for your new patients/clients to tell you which of your marketing tools have been most effective. This is vital information for your promotional and marketing activities, only as long as you do something with it. Unfortunately, many doctors don’t use this information properly.

In fact, the last poll taken in our online journal “The Practice Solutions Magazine”, showed that 54% of those responding said that they “did nothing” with the information that they got from this question on their forms. At the same time, our current poll shows 43% stating that they are increasing the amount of marketing they are doing currently. The poll data seems to support that “marketing for new patients/clients” is important to practice owners but the importance of tracking effectiveness of marketing seems to be missing.

Let’s take up effectiveness of marketing as a running theme and discover how it might be used. A simple starting point would be to actually use the data you have already gathered by doing a quick breakdown of where your new patients/clients came from for the past 6 to 12 months. Assign your front desk person the task of reviewing the files of all your new patients/clients and tabulate their responses to the question concerning what brought them to your office. Once the tabulation is done, have this staff member provide you with a summary of this information – i.e. “45% came from referrals, 20% came from new resident mailings, 10% from Yellow Pages ad, etc.” Use the results from this summary and locate the area(s) that seem to be providing you with the most new patients/clients. Do not be surprised if “referred by a friend or relative” shows up as the number one item – in fact you should be surprised if it doesn’t.

At this point, inspect your marketing budget. How much do you spend to make sure people know how to find your practice? How much are you spending on ads and how many new patients/clients came from that? What kind of materials do you have to stimulate referrals? Examine each area that you are spending your marketing dollars on and what your return is on those dollars. While taking into account the cost effectiveness of each activity, you’ll want to invest more heavily in the area(s) that are giving you the most return. For example, if “referrals” is your number one draw, and the local radio ad is not producing much, how can you shift your advertising dollars into more support activities for referrals? As an example, creating a “Refer a friend or family member” card might be one way to start.

To summarize:

  1. have a means to know where your new patients/clients are coming from;
  2. don’t ignore this data – tabulate and evaluate the information;
  3. invest your marketing budget in the most effective areas based upon the data you gather;
  4. regularly re-assess this information and adjust your marketing plans and investments accordingly.

If you do the above regularly and religiously, you’ll find a steady increase of new patients/clients coming in your door. The first priority is always to strengthen the area that is working best, before looking to add additional avenues.

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Marketing and Promotion Ideas for Your Practice

In my nearly 23 years of delivering practice management training and consulting, I’ve found that of all of the marketing techniques available, properly asking for referrals is easily one of the most useful marketing and promotional ideas for your practice. There are several reasons for this:

  1. It is the least expensive. You don’t have to create and buy ads, make newsletters, send mailings, etc.
  2. It is something that you can directly affect on an ongoing daily basis and see and monitor the results without much time lapse.
  3. It is something that you can train all of your staff to do. You can create reward systems to enhance the staff to do more of it.
  4. You can, more than any other way, attract the type of patient/client that you want. If you analyze the patients/clients in your practice, you can quickly isolate those who are the most cooperative, financially secure and the most fun to have around. These people will, by referral, bring in similar types of new patients.

The whole trick to getting referrals is nothing more complicated than ASK FOR THEM. This can and should be done as a coordinated team effort by all staff. There are many successful actions that you can implement in order to accomplish this.

To get referrals, first, determine which patient/client will be approached. A quick staff meeting at the start of the day can identify patients/clients who’ve had great results and are very happy with their service. Those satisfied people are the ones that you would want to approach. Next, determine who will talk with one of these people. It may likely be the receptionist who will be talking with the person after their appointment. Lastly, work out a simple script that can be used and have a card ready to give out to the person that they can then give to their referral.

Other Marketing Ideas

The following is a list of other successful actions that you can do to promote your practice and get new patients. They are all very inexpensive and easy to do:

  • Ask for referrals!
  • Ask for referrals!
  • Ask for referrals! (ok, point made).
  • Send patients birthday cards.
  • Send out a quarterly newsletter that educates patients.
  • Put up a new patients/clients welcome board in the reception room.
  • Put up a “Thank you for referring” board in reception listing out the patients/clients who referred new patients to the practice.
  • Send thank you letters to every patient/client who referred anyone into the practice.
  • Reward referring patients/clients by sending them to dinner, the movies, etc.
  • Provide a staff reward for generating referrals.
  • The doctor and staff should hand out business cards anywhere and everywhere that is appropriate.
  • Post your practice mission statement in your reception room.
  • Make post-care calls to patients/clients to ensure that they are doing well. This shows you really care.
  • Give tours of the office to school children.
  • Offer family discounts for cash patients.
  • Put up educational posters in all treatment rooms or areas to educate patients about the health care you deliver.
  • Have TV monitors with educational videos that are on a continuous playback loop showing in reception and/or treatment rooms.
  • Have a patient/client appreciation month.
  • Participate in health fairs.
  • Give brisk service with lots of care and affinity.
  • Have all staff who are on the phone always “smile on the phone.”
  • Stay in good communication with any patient or client who is waiting – never let them just sit in silence for any long period.
  • Never make patients/clients wait. Deliver on time.
  • Call your patients/clients by name.
  • Develop a logo and place it in every possible place you can – letterhead, newsletter, business cards, posters, etc.
  • Call patients/clients 2 weeks and then 2 days prior to recall appointments.
  • Confirm appointments the day before.
  • Have simple informational pamphlets. Create your own if you have to.
  • Make follow-up calls after sending a postcard mailer.
  • Use over oversized or odd-sized business cards. People will notice and remember them more than a normal card.
  • Take photos of happy patients and clients and place them on the bulletin board.
  • Have the doctor write a column for a local newspaper or other publication addressing issues within your profession.
  • Share successful results of patient delivery with your staff.
  • Once per year, offer 10% off for payment in full on all old accounts receivables.

All of the above actions will cost you very little up front and will generate the highest quality patients for your practice. Put these into place and you will see your new patient numbers not only increase, but the quality of your patient base will increase.

If you would like no-cost, no-commitment tips on how to effectively implement this information into my practice, fill out the form to the right, and we will be more than happy to assist you.

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Putting New Employees on the Job

Practice owners bring on new employees for a variety of reasons. Often, when practices are undergoing expansion of production and income, they require increased staffing. Or, due to poor past hiring procedures practice owners find that they have to replace some employees who are poor performers. There is a natural attrition rate as well when a staff member moves out of town, gets a higher paying job, etc.

Many past Practice Solution articles have been written on numerous aspects of our successful hiring procedures, including testing, how to conduct proper interviews, how to weed out non-qualified candidates, legally acceptable and unacceptable questions to ask, etc. You’ll find some of those articles in this issue of Hot Tip.This article will go over some of the best actions to implement when putting new employees on the job.

Once you’ve decided to hire a new staff member, the first thing to do is have them complete all appropriate paperwork. This would include signing whatever employment contract you use as well as having them read all of the appropriate office policies and attesting to having read them.

Personnel File

A personnel file is vital for maintaining proper documentation on every employee. You can set yourself up for legal problems in the future if you don’t have this properly in place. Therefore, creating a personnel file for the new employee is one of the first things you should do after hiring the person.

The office manager should create a personnel file for the new employee which contains:

  • The full job application and the resume turned in during the hiring process.
  • Any other forms used in the hiring process.
  • Any tests taken.
  • Any interview notes, write ups, etc.
  • Employment contract.
  • A copy of the policies the new employee read and signed.
  • A checklist of everything the office manager will be doing with the new employee to bring them onto the job. Make sure the checklist is filled out as each item is done.

As the new employee becomes a regular employee, the personnel file should be constantly updated with job reviews, disciplinary warnings, commendations, etc. The personnel file is your key management tool for documenting everything having to do with that employee, from the time they are hired until the time they leave, for whatever reason.

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12 Steps to Collect Past Due Accounts

Collecting on past due accounts is a function that the Accounts Manager will find herself/himself having to do. Any contact with a patient/client, even under these circumstances, should be kept on a friendly, professional and dignified basis. This will promote respect for the office and its business practices.

Always remember the following points with regard to your patients/clients:

  • Most people have good intentions and want to cooperate with agreements that they have made.
  • Although a person’s account may be overdue, most people still have a good intention to take care of it.
  • Most people prioritize their bills and will first pay those that they feel are most pressing.
  • Most people with past due accounts will pay those bills where someone is actively requesting them to pay.

Bearing in mind the above, your role is to arrange to be one of the creditors that your patients/clients will not delay paying. The following points may be helpful in this regard:

  1. Bill promptly every month.
  2. Ensure that your bills are accurate.
  3. Ensure that you have the original signed financial agreement from your patient/client.
  4. Contact the patient/client as soon as you realize the account has become delinquent.
  5. When you speak with the patient/client, let them know that you believe that they are able to make payment.
  6. Let the patient/client know that you expect to be paid, and refresh their memory on the signed agreement.
  7. Allow the patient/client their self-respect; never back them into a corner, insult or badger the patient/client.
  8. Explain to the patient/client that you want to help him/her work it out so that they can maintain the agreement that they made with your office.
  9. Be prepared to offer some options to the patient/client that they may not have considered.
  10. Be willing to really communicate with the patient/client so that a true understanding and agreement can be reached.
  11. If absolutely necessary, utilize the credit reporting associations. Let the patient/client know that you are planning to do so and that this will go on their credit rating.
  12. As a last resort, utilize the services of a collection agency, and let the patient/client know that you plan to do so.

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Building a Successful Practice Through Efficient Hiring

To build the most productive and profitable practice, having stable staff that work together to accomplish the mission of the practice is vital. Knowing how and who to hire is a key skill. Losing employees who may have seemed appropriate for your team, yet were not actually a good fit, is an enormous hidden expense in a practice.

In fact, based on the typical costs of finding, interviewing, testing, training and getting a new employee fully functioning on the job, turnover costs can equal six to nine months of the salary of the position. If a position pays $3000 per month, your costs could be $18,000 to $27,000 every time the position turns over. Therefore, it’s vital to know how to screen applicants properly in order to hire the best possible individuals for your practice and avoid the stress and high cost of frequent turnover.

Checking References

Checking the references that a job applicant provides is an important but often neglected step in the hiring process. The quality of staff can make or break a practice, so investigate carefully and hire only those whose background indicates that they will be good employees.

Checking references is not always an easy process. Many employers have become reluctant to voice opinions about a past employee to protect themselves from legal or privacy issues. However, you should still do reference checks on any candidate that you consider hiring, to gather any data you can get.

It’s best to check references prior to a one-on-one interview with the applicant since you might uncover information that will eliminate that candidate and save you interview time. If that’s not possible, check references after the interview but before hiring.

Here are some questions you might ask references:

  • How long was _______ employed by you or your company?
  • Can you tell me his/her ending wage?
  • Why is he/she no longer employed there?
  • Was he/she a loyal employee?
  • Was he/she dependable?
  • Do you feel he/she is honest?
  • Would you rehire this person?

Again, a past employer may not be willing to answer some of these questions. The key question is the last one, “Would you rehire this person?” This question is important to ask if the reference person is very guarded or hesitant in giving answers.

Keep in mind that checking references is just one of several vital steps in the hiring process.

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How to Set Reminders for Continual Services (Recall)

Whether you are using an automatic reminder system, or it is someone’s job function to send out reminders; or a combination of both. The below information will be highly beneficial to increase your appointments scheduled, reactivating clients/patients and having them show up to their appointments.

In many offices recall can be one of the most overlooked aspects of a practice. Many offices are only utilizing about 30% of their recall poten­tial. This means that patients are not getting the care that they should, and a lot of business is slipping through the cracks of the practice.

One of the biggest problems encountered when you are trying to put in, or straighten out, a non-existent or inefficient recall system is that you may already have “trained” the patient or client that it’s not really all that important to come in for regular exams or other repeatable services. So, the first thing you have to do is let your patients/clients know how important these appointments are.

Patient/client education plays an important part in any successful recall system, whether you simply tell patients/clients or use pictures and other visual aids. The point is that you have to spend the time with your patients/clients. You might think that this is too much trou­ble to go through. But, just realize that the success of your recall system is related to the education of your pa­tients/clients and the use of the system itself.

You will always have people that will not “have the time” or “think it’s unnecessary” and will not participate in your recall program. But, most people, once they have been properly educat­ed and are programmed into the system to keep these appointments, will cooperate.

The System:

The following can be used for any type of follow-up or recall appointment:

  1. Have a supply of postcards made that the patient/client will fill out prior to leaving the office. You should also have appointment cards with spaces for appointment dates and times to be filled in.
  2. Before the person leaves the office, the receptionist should schedule them for their next appointment. They should always be scheduled for their next appointment, no matter how far away it is. (The prior education of the patient on the importance of regular exams is very important to this step going smoothly.)
  3. Put the person’s name in the appointment book and give them an appointment card with the date and time on it.
  4. Give the person a postcard and have them fill in their name and address on the card. Let them know that you’ll send the postcard out ahead of time to remind them of the appointment and that you’ll also give them a call. Having them par­ticipate in the making and scheduling of the appointment is highly effective, it creates a more solid agreement to keep the appointment.
  5. File the postcard in a file box that is divided into each week of the year. File the card in the weekly slot that is two weeks prior to the appointment.
  6. At the beginning of each week, pull out the cards for the appointments scheduled two weeks away and mail them.
  7. Using the recall confirmation dialogue, call the patients two to five days before their appointment to confirm the appointment.

You’ll find that because they filled out the card and received it in the mail, you’ll have a much easier time of confirming and keeping these appointments.

Other Tips on This System:

  1. To really get the person to comply, it is important to stress the importance of “continuing care” rather than the traditional “come and see us in 6 or 12 months” attitude.
  2. Watch the language you use too. Sometimes the word “recall” can have negative connotations. Patients may think of “defective” merchandise being recalled by manufacturers. Use “reexamination,” “reevaluation,” “regular visits,” or “regular appointments.”
  3. It is helpful to note the name of the person that the patient/client should call to make an appointment with (if appropriate) or indicate to the patient who will be calling them and when. This makes their appointment scheduling more personal.
  4. Reminder calls should be made when you are most likely to reach the person. Call after 5:00 p.m. on weekdays or on Saturday morning. Be very diligent about follow-up calls if you can’t reach the person. Make every attempt to reach the person by phone, and send letters if the phone calls are unsuccessful.
  5. Do not let patients fall between the cracks. Every patient should be in two places: in the appointment book with an ap­pointment and in the reminder system to be reminded at some time in the future of their appointment.

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