Internal Marketing: Developing a Patient-based Practice Andrea Cook

Most health-care professionals rush to invest in marketing only when their market changes or when their business is declining or facing slow growth.

A balanced marketing plan must be part of our growth and profit strategy, especially during these challenging times. The mix should include internal and external marketing, advertising, etc. External marketing, such as advertising, alone is an option with no ensured return. Internal marketing is centered on the patient with the goal of ensuring loyalty so that current patients will invite new patients.

The number of GP referrals is decreasing (48 percent in 2007 vs. 41 percent in 2009) while the number of patient referrals has increased (30 percent in 2007 vs. 35 percent in 2009) as reported in the 2009 Orthodontic Practice Study; Journal of Clinical Orthodontics, December 2009. Patients evaluate quality orthodontic care based on different metrics than many orthodontists. Orthodontists often define a successful case as Class I occlusion, financially profitable, etc. Patients define their excellent orthodontic treatment by the manner in which they are treated – whether or not they are seen for their appointments on time, if the office location is convenient, were there few emergencies, was treatment completed on time, etc. They naturally assume that their teeth will be straight and they will have a beautiful smile once treatment is completed. For quality internal marketing to ensure patient referrals you need to make sure you exceed their expectations in the areas that they feel are most important to them. As the orthodontist, you will continue to provide them with the best occlusion and that beautiful smile they expect from you.

Office Evaluation
Now is the time to evaluate your office. It can be very eye opening to have someone who has never visited your office walk through and give you feedback. What is the environment in your office? Does it project the feeling that you want your patients to experience? Every doctor and office should develop the experience they would like to provide their patients when they come to their office. This is different for every orthodontist, office and demographic region. Is this a fun and exciting environment? Or does the office project a more traditional or conservative feeling? The environment and feeling should match the doctor and the physical space you have. Review all of your written and verbal materials. If you have not had a revision and a fresh look in the past five years, it might be time to look at a new brand for your office. There are many very good marketing teams that can give you a new look possibly without a total revision and large expense.

To determine if your office is in need of changes ask yourself and your team some important questions:
  • Are your patients seen on time?
  • Are your procedures completed on time?
  • Is treatment completed on time?
  • Is equipment to perform procedures available?
  • Are clear protocols developed?
  • Is training provided?
Asking these questions will help determine what technology and which products or training is needed to make sure you are providing the best patient care possible.

A good start on defining your patient expectations is to survey your present patient base. What is important to them? How are they judging you and how are you at addressing their needs? Once you define who your patients are (where they work, where they go to school, etc.) and what their needs are, then you can establish a patient plan that will exceed their expectations and allow you to gain patient referrals.

Patient Plans
Your patient plans should include each step in their treatment from the initial phone call through graduation from retention. The plan will define what will happen at each step, who is responsible, who is their backup, full scripting for consistency, the transition into the next step as well as an introduction to the team member that will be working with them at their next visit. Having patient plans in place will ensure that each patient moves through their treatment smoothly and consistently. The same quality care will be provided to each patient and each team member will be able to deliver a message of consistency.

When developing your patient plan, do not let present constraints alter your perfect plan. Disregard present physical space, present team members and any other restrictions to build the plan you would like to work toward. Once you understand what the ultimate goals are, you can determine which will be short-term goals and which will be long-term goals with more financial investment. Including present conditions in your plan will not allow full development of the patient plan. Look at what is needed in each step of the patient plan to provide the patient experience you have defined.

If new technology is needed in your office, use your resources to help determine which will be the best fit for you and your practice. Technology is not a one-size-fits-all concept. There are many excellent options on the market that should be explored prior to making a financial investment. Using your colleagues and study groups is a great avenue for accurate information on how the implementation worked in their practice. In doing this, you can find out what worked well for them and where their challenges were. The use of consultants can offer an independent view that might give you a different insight to the product.

During a patient’s visit to your office, reports show that they will have four contacts during the visit. Developing a consistent message that can be delivered by each team member at each contact will assure your patients that your team is a unified force. There should be guidelines and scripting for:
  • Scheduling
  • Cancelled appointments
  • Missed appointments
  • Emergency Visits
  • Breakage
  • Compliance
  • Oral Hygiene
Clear guidelines in these areas will empower your team to deal with difficult situations and patients. Once patients learn the guidelines for your office, and as long as each team member follows them, the attempts to bypass the system will decrease. It is very important to have your team trained with the proper verbiage skills to deliver the guidelines to the patient in a positive manner.

A job description for every position in your practice is a critical piece in the development of valuable team members. You cannot expect employees to perform to your standard unless you are clear as to what the expectations are. When team members are hired they should be given a clear job description as well as a timeline and training to fulfill this position. Often, when experienced team members are hired, they are simply placed into the position without clear definition of their role in the office and what is expected of them or the training needed to fulfill the position. This presents a system failure – not an employee failure. Make sure they have all the tools and training needed to become a valuable team member.

Employee Development
Now that you have a plan for each patient to move through treatment you can ask some important questions. Do you have the team to deliver this patient experience as it is defined in the patient plan? It is important to evaluate your team to confirm that all team members are able to deliver the quality care you desire and have the necessary training and equipment. A performance-planning session with each team member will evaluate their present role in the office and will determine if this is the best position for them and for the office. Specific goals should be set for the year – both personal and office goals – along with a list of training and equipment that will be needed to reach these goals. If there are existing employees who are unable or unwilling to provide the quality care you want to provide, it might be time to review their place in the practice. If you have team members with the right attitude, training can move them to the level necessary to fit the needs of the office.

In order to retain quality employees you need to understand how to fulfill their needs. I believe a good place to start is beginning to understand what your employees want from a workplace. After all, if you know what your employees desire in a work environment, you simply need to provide it and all will be well. This is a great theory, but research shows that employers are not that successful at identifying what their employees actually want. In fact there is a significant disconnect between the things that employees say are important to them, and how highly employers rank those same things.

The first step in understanding key factors in retaining employees is to allow each team member to prioritize their needs. In this exercise each team member will receive this list. The doctor (or doctors in a multi-doctor practice) will receive the same list.

Team members: Review the list of items below and select the one most important to you. Continue to rank the remaining items in order of most important to least important. Doctors: Review the list of items below and select the one you feel is most important to your team members. Continue to rank the remaining items in order of most important to least important.
  1. Full appreciation for work done
  2. Feeling “part” of things
  3. Sympathetic help on personal issues
  4. Job security
  5. Good wages
  6. Interesting work
  7. Promotion/growth opportunities
  8. Personal loyalty to workers
  9. Good working conditions
  10. Tactful discipline
A one-on-one review of this information will ensure that each team member has the opportunity to express their areas of importance. Once you have this information you can establish communication and goals for the upcoming year. Making sure the employees’ goals match with practice goals can allow the doctor to determine the fit for employees in the team and practice. This can also be a determining factor for retention of employees who cannot meet the practice goals.

Now you have the patient plan in place and the team on board to deliver the highest quality patient care. Each team member has specific personal and office goals (from the performance planning session) for the upcoming year. Specific training time needs to be set aside to allow them to accomplish these goals. Too many times, new technology or products are introduced into an office without any training for the team. We have all experienced the purchase of an item at a meeting, brought back to the office and used without any instruction. Besides not getting the full use out of the technology or product, there is often misuse of products that can cause bond failures and other clinical issues.

On-time Schedule
The most common complaint patients have with an office is being seen late without any explanation. Many times when working with an office I hear, “We have to keep the exam on time.” I agree that each appointment should be kept on schedule but without emphasis placed on any specific appointment. If the exam appointment is kept on time at the expense of the clinical flow, the reputation of the office might become negative. During a patient’ orthodontic treatment approximately 90 percent of their care takes place in the clinic. As patients exit treatment and reflect on the care they received they will place more emphasis on the times they were seen in the clinic over the one time they were seen for their one initial exam appointment. All appointments need to be started on time and finished at their scheduled out time for the procedure.

A good rule to remember is: Promise your performance, perform as promised. Following your schedule template will allow procedures to start on time. Starting on time is important, but finishing each procedure as scheduled is just as important. Many feel that if the patient gets into the chair on time for their appointment, they will be happy. You need to make sure that you can complete the procedure in the appointed time in order to start the next patient on time. This can be a vicious cycle that is the downfall of many schedules. I recommend that the clinicians document their OT (ending time) for their procedure to help keep them on track during an appointment. The template should be built to allow each clinician to complete the prescribed procedure in the allotted time. If a patient arrives late for their appointment the clinician should accomplish all that can be completed in the appointed time.

Remember, the goal for today’s successful orthodontic practice is to “exceed patient expectations.” I challenge you to exceed yours.

Author’s Bio
Andrea Cook’s in-office, hands-on training motivates and energizes orthodontic clinical teams. She bases training systems on practical knowledge gained through 20 years chairside experience. Andrea works as a clinical consultant and trainer for premier orthodontic offices across the country. Since effectively training clinical team members is a critical portion to the advancement of clinical productivity and profitability, Andrea works with teams to increase efficiency, improve communication and guides the office to a new level of excellence. For more information on developing and implementing patient plans, job descriptions, running your clinic on time, or other clinical and sterilization needs, please contact Andrea Cook at 253-332- 3376 or You can also visit her Web site at
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