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Trust and Value: a FieLD gUiDe To ToDay’S DeNTaL paTieNTSThe five types of patients in your practice, how they value dentistry, and what that means to you

JUNe 2012 | BooK oNe

a SpeaR eDUCaTioN e-BooK

iMTiaZ MaNJiCeo, SpeaR eDUCaTioN

TABLE OF CONTENTSFoReWoRD 2

WHy THiS e-BooK iS aN iMpoRTaNT STaRTiNg poiNT 3

We LoVe THeM aLL, BUT SoMe aRe eaSieR To LoVe THaN oTHeRS 3

THe pyRaMiD oF VaLUe 6

THe eVeNT-DRiVeN paTieNT 8

THe ReaCTiVe paTieNT 9

THe pRoaCTiVe paTieNT 10

THe DiSCReTioNaRy paTieNT 11

THe RegeNeRaTiVe paTieNT 12

pLayiNg THe WHoLe pyRaMiD 13

We’Re JUST geTTiNg STaRTeD 14

aBoUT THe aUTHoR 15

© 2012 SpeaR eDUCaTioN

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FOREWORDI believe in the power of “Great Dentistry”. I think the fee-for-service model the profession is based on has done great things for patients and for dentists, and it’s only getting better. I believe dentistry is going places.

Are you ready to come along?

The world around us is changing quickly—we can all see that—and dentistry is no exception. But it’s not just the incredible pace of change in clinical technology, materials, and techniques. It’s the people, too. The patients you serve are changing—they are becoming savvier consumers, with rapidly evolving expectations. Dentistry needs to evolve to meet those expectations.

This is something I’ve learned in my business as well. It wasn’t that long ago that just about the only way I had of reaching dentists was face-to-face, by hosting workshops and seminars. I still love doing that. And now the changing world of communication technology has opened up more possibilities. I started doing webinars, and online video courses. I stay connected through social media and I write a daily blog on the Spear Education website. And now, I’m bringing my message to you in e-book form.

This is the first in a series of e-books where we’re going to explore how to be the best dentist you can be in this exciting new environment. Each one will be a stand-alone book—a quick but informative read—that addresses one important topic, but they’ll all add up to a comprehensive new vision for contemporary dental care.

We’re going to be talking about developing the right framework for excellence in clinical care, value creation, team alignment, community development, and life factors, so you can achieve the ultimate goal: delivering the greatest care to the most people, in a world of special challenges and special opportunities.

The future belongs to Great Dentistry. Let’s explore it together.

Imtiaz Manji June, 2012

WHAT IS GREAT DENTISTRY?

At Spear Education we define it as “the pursuit of clinical excellence that transforms the practices of doctors and the lives of patients”.

And who is doing this “Great Dentistry”? We call this clinician “The Striving Dentist”: “an individual whose pursuit of mastery in the science and art of dentistry is matched only by the unrelenting desire to succeed in all areas of life”.

If that sounds like you—welcome. We have some things to talk about…

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WHY THIS E-BOOK IS AN IMPORTANT STARTING POINTAre great patients born or made? Is it just the luck of the draw—the kind of people who walk in your door—or are there things you can do to influence the way they think about dentistry?

I believe that just about any patient has the capacity to become a great patient.

This e-book series is dedicated to that premise. In future volumes, we’ll look deeper into the mindset of today’s consumer: the difference between their perceived wants and needs, their issues with price and affordability and how to reach them on their terms. We’ll get into detail about how to create an experience for new patients that sets the right expectations from the start. And we’ll explore ongoing strategies for building those relationships and increasing value over time. We’ll talk about how to create great patients who want and appreciate great dentistry.

But you can’t be strategic about how you influence patient value until you recognize their current behaviors and understand their journey through dentistry.

Dentists spend their careers forming a deep understanding of dentistry—mostly from the perspective of a dentist. But patients come with their own preconceptions, their own attitudes, their own value systems. And if you’re going to have any chance of influencing their actions, you have to have a deep understanding of those unique perspectives. That’s what this e-book is about.

So let’s get inside their minds.

WE LOVE THEM ALL, BUT SOME ARE EASIER TO LOVE THAN OTHERSFirst of all, let’s talk about what we mean by a great patient relationship. I know you love and care for all your patients, but let’s admit it, some you love more than others. Why? Lets us count the ways:

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THE TOP TEN THINGS THAT MAKE GREAT PATIENTS GREAT

1 They are happy and see you as helping them

2They have overcome their fears by embracing how dentistry has evolved

3 They want to have a healthy mouth and great smile

4 They trust you and accept your recommendations

5 They come back when appointed

6 They don’t cancel, no-show, or arrive late

7 They don’t show up on your “high-maintenance” lists

8 They value your services and pay promptly

9 They respond promptly when contacted

10 They want friends and family to experience your care

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Let’s break down it down even simpler. Because everything in that list really comes down to four key behaviors.

These are the four things that make an ideal patient ideal, and they are the four fundamentals all great practices focus on.

These behaviors tell a story—a story about their value for you and your practice and about their value for care in general.

This is not an exact science. You can’t know for sure what any person’s values are by tracking a few behaviors, but it can give you a pretty good indication.

So let’s examine this deeper, with the understanding that while patients fall along a continuum of engagement, there are a few types worth identifying more closely.

In fact, there are 5 general types of patient, and they can be perhaps best expressed as fitting into a pyramid of value…

BREAKING IT DOWN: THE FOUR KEY BEHAVIORS

The Behaviour What it means What it does

1 Respects your recommendations

They trust you and ask the right questions

Drives acceptance for great dentistry

2 Respects your timeThey appoint & show up

Drives your schedule

3 Respects your value They pay as arranged Drives your economics

4 Respects the relationship

They tell others about you

Drives your growth

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THE PYRAMID OF VALUEHere is how the patients in your practice fit on the pyramid:

Before we get into examining each type, let’s remember this very important fact: no patient should ever be considered “locked in” to one of these designations. This is a continuum, and by providing the right experiences, both clinical and value-centered, you can move patients upward toward ideal care. It may take a couple of appointments, or it may take 20 years. But it can be done.

The key is trust: the higher the level of trust a patient has in you, the higher their sense of value.

I don’t believe that the “boutique” approach to dentistry—serving only high-end patients—is realistic or even desirable. I believe in the pyramid approach, and the recognition that different people occupy different points on the pyramid at different times in their continuum of care.

It’s a more inclusive way of looking at things—one that recognizes that everyone has the capacity to enjoy great dentistry—one day.

With that said, let’s look at the pyramid and then go through it, level by level.

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REGENERATIVE“it’s worth the investment”

DISCRETIONARY “i want to look/feel better”

PROACTIVE“Help me prioritize”

REACTIVE

“i know i should, but…”

EVENT-DRIVEN“Just fix me”TRUST VALUE

THE PYRAMID OF VALUE

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THE EVENT-DRIVEN PATIENTThese are the people who occupy the bottom of our “pyramid of value.”

I used to refer to these as “emergency” patients, but emergencies can happen to any patients at any level. Event-driven patients are different. They don’t participate in the practice until something significant happens—they’re in pain, they have trauma, something broke or fell out. Often, they have helped create the emergency through neglect.

Maybe it’s fear or outright phobia, maybe it’s severe financial limitations, maybe it’s just because they have not been brought up to value dental care at all—whatever the reasons, these patients are very limited in their outlook and very resistant to hearing anything beyond their immediate perceived need.

These patients tend to make up a small portion of any patient base.

The Event-Driven Profile

• May be overly fearful or phobic

• May be very limited financially

• May never have experienced regular care

• Not interested in a complete treatment plan

• No commitment to hygiene or periodic exams.

• Accepts minimal care

Just fix me“ ”THe eVeNT-DRiVeN MiNDSeT:

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THE REACTIVE PATIENTThese are basically good patients who understand the need for regular hygiene and exams, but who for one reason or another only participate in a limited way.

These patients tend to re-appear on your overdue list. They have a sense in the back of their minds that dental care is important, but they usually engage as a reaction to something. Maybe it’s a small discomfort or concern that reminds them they haven’t seen you in awhile. Maybe they just feel guilty about not having had a “cleaning” in a long time. So they come back. And then, after a couple of hygiene visits, they disappear again—until something prompts them to return.

So what’s driving these cycles? Put simply, understanding the reasons for hygiene care is not the same as valuing it, and these patients—however dentally educated they may be—haven’t prioritized recare enough so it can compete with other demands and distractions life brings.

Reactive patients typically accept essential tooth-based dentistry (crowns, fillings, etc) but they also lead the way in excuses—“I’m too busy.” “I can’t afford it right now”—and they tend to drop out of more complicated treatment plans.

These patients make up a significant “ground floor” of opportunity in the practice. The Reactive Profile

• Understand the reason for hygiene and periodic exams

• Participate in a limited way

• Sometimes return is prompted by concern or guilt

• Accepts essential tooth-based care

• Drops out of accepted treatment plan when fatigued

I know I should, but…

“ ”THe ReaCTiVe MiNDSeT:

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THE PROACTIVE PATIENTThese are the patients who have come to understand the value of hygiene and having a healthy mouth and participate in their dental care—within certain parameters.

They are committed to regular hygiene care and they regularly appoint in advance. When you identify a problem that needs treatment, they tend to follow through on your recommendations. They may have to reschedule from time to time, but for the most part they are good about keeping appointments.

A major concern for these patients is “cost.” Economics is a factor and so insurance support is always important to them. That’s why, when you get into treatment choices that push the limits of their coverage (or aren’t covered at all) you get into a gray area. They trust your diagnosis and they may be interested but they have to balance that against the age-old question: is it worth it?

This is the largest segment—and essential “bread-and-butter” core— of your patient base.

The Proactive Profile

• Understand the value of basic dentistry

• Participate regularly

• Insurance-driven in their decisions

• Typically complete treatment they accept

• Gray area when it comes to more comprehensive care

Today’s Dentistry, Meet Yesterday’s Insurance LimitWhen dental insurance came out in the 60s, the limit was $1000 and the most expensive crown was $90. A lot of things have changed in dentistry, including the cost of care, but insurance limits, and many patient mindsets, are still stuck in 1967. Overcoming that mindset is often the battle with this patient type.

Help me prioritize

“ ”THe pRoaCTiVe MiNDSeT:

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THE DISCRETIONARY PATIENTThis patient is ready now to look beyond tooth-based care and make an investment in esthetic treatment. That doesn’t necessarily mean the “perfect smile” and a veneer solution. It can be any defect that’s now bothering them: a diastema, a dark amalgam, a gummy smile—the concerns can be small or large in reality, but for whatever reason they have become larger than life in their minds.

So where do these patients come from? Sometimes they walk in as new patients knowing exactly what they want. Often they are proactive patients who have been influenced to take action by you or by an external motivator. A TV makeover show, a friend or co-worker who has a great smile, a new higher-profile job, an upcoming wedding—whatever it is, they know what they want they’re ready to pay for it.

No matter how small or large the case, these patients now have a value mindset that has elevated them above and beyond the lower levels of the pyramid. Their desires are not always realistic, because sometimes the foundational oral health just isn’t there, but their ambitions are encouraging, because it gives you a whole new paradigm to talk with them about.

This is a special subsection of the patient base that is primed for great dentistry.

The Discretionary Profile

• Now focused on appearance/correction of defects

• You often wait for them to self-identify

• Often influenced by outside sources (media, friends, new circumstances)

• It’s not about insurance

• Interdependent care with specialists and lab

• Overall dental health may not be there

I want to look/feel better

“”

THe DiSCReTioNaRy MiNDSeT:

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THE REGENERATIVE PATIENTSo now that we have covered everything from the “only-when-they-have-to” patients to the “asking-for-esthetic-treatments” people, what’s left? Who’s at the top of the value pyramid?

The regenerative patient becomes aware of value beyond esthetics and wants their mouth to be “as good as new”—or even better. They want the best that dentistry has to offer: the highest contemporary standards using the best modern materials and techniques. When you think about it, dentistry is probably unique among health care professions in the way that it can not only restore, but often surpass, what Mother Nature originally bestowed. That’s a pretty awesome benefit. And these people at the top of the pyramid are really interested.

Regenerative patients basically break down into two sub-categories: there are the “super discretionary” patients who have chosen to have their mouth restored to the best level possible and chosen to prioritize it in their life. And then there are the “high-need” patients who simply have no choice at all—disease or trauma or long-term neglect has left them facing a complete restoration.

For these patients, their current oral health condition is not really a factor, because everything is going to be looked at anyway, and the whole process is likely to call for an interdisciplinary effort involving specialists and a great lab.

These are the patients who challenge you to be the best you can be.

The Regenerative Profile

• Highest level of care—as good, or better than nature

• Sometimes a “high discretionary” patient (“I want the best”)

• Sometimes a “high need” patient (“Is there any hope for me?”)

• Usually doesn’t matter where their oral health is now

• Interdependent care with specialists and lab

It’s worth the investment

“”

THe RegeNeRaTiVe MiNDSeT:

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PLAYING THE WHOLE PYRAMIDNow that we have a thorough understanding of these five types of patients and what drives them, it becomes about awareness. Look at your patients as they come in and think about where they fit on the pyramid of value.

It’s not about pigeonholing, it’s about being prepared for all of these patient types because each of them is asking something different from you.

All of them should have a place in your practice.

After all, no matter how “evolved” your patient base becomes you will have to deal with proactive, reactive, and event-driven needs.

And you’ve no doubt already had the experience of having a proactive or reactive patient suddenly “wake up” one day and embrace a higher level of care. So you know it can happen. The question is, what can you do to make it happen more often?

That’s where we’re going in our next e-books…

• The event-driven patient is asking you to perform triage.

• The reactive patient is asking you to adapt to their limitations.

• The proactive patient is asking for a road map to keep them healthy over time.

• The discretionary patient is asking you to make them look and feel better.

• The regenerative patient is asking for your very best.

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WE’RE JUST GETTING STARTEDSo, back to the question we started with: are great patients born or made? I think this e-book has shown that patients usually do come to you with a certain set of perspectives and value judgments. It’s your role, now that you can identify those perspectives, to re-shape those judgments.

And we’re going to talk about how.

In the next volume in this series, The Patient as Consumer, we’re going to discuss the nature of needs vs. wants in today’s patients, and what it takes to influence them to move up the pyramid of value. It’s a powerful introduction to what the new model of dental practice should look like.

Then, in The New Patient Experience, we’ll walk through the components of one of the most important value creation opportunities you get: the new patient’s first appointment. That’s where you establish the right expectations and the right habits. That’s were the process of upward mobility on the value pyramid begins.

WATCH FOR IMTIAz’S NExT E-BOOKS IN THIS SERIES:The Patient as Consumer: Mastering the Essentials of Today’s Retail Dentistry The New Patient Experience: 8 Proven Steps to Establishing a High-Value Relationship.

WANT TO LEARN MORE FROM IMTIAz?For more on this and other topics, visit speareducation.com/digital-learning to find Imtiaz’s video lessons for dentists and their teams. Don’t have a membership yet? Take advantage of the free 5-day trial and see what’s waiting for you online.

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ABOUT THE AUTHORIn his current role as CEO of Spear Education and Scottsdale Center for Dentistry, Imtiaz reaches thousands of dentists each year with his speaking engagements, online education, published articles and popular blog, all the while providing the strategic vision and corporate leadership behind the industry’s premier destination education center. In addition, Imtiaz lends his skills and passion to the Open Wide Foundation, whose mission is to bring quality dental care to impoverished communities around the world.

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Spear Education makes it easy to pursue Great Dentistry in a number of ways: in seminars, in hands-on workshops, with Study Clubs and through online Digital Learning. It’s a comprehensive system of “layered learning” designed to maximize productivity, retention and flexibility. Most importantly, it’s designed to be ready when and where you are. Anywhere, anytime, you can access the complete Spear library of learning content.

For more about our courses, tools, or tips visit www.speareducation.comFeedback or questions? Drop us a line at digital@speareducation.com