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 By Neil B. Gailmard, OD, MBA, FAAO, Editor November 11, 2009 - Tip #405 
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No Shows: A Culture Defining Moment

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Additional Information

I love the topic of office policy for no shows. I've been asked how to handle no shows by very successful eye care providers (ECPs) on many occasions and I think my response usually comes as a surprise. To me, the value in the discussion is not so much on how we handle patients who don't show up for appointments, but more than that, it serves as an example about the true philosophy of the practice on customer service. How you handle no shows tells me a great deal about how good your really are at customer service in general.

No shows are a great example

It's easy to be great at customer service when it doesn't impact your practice in a negative way. We can all let the customer win as long as the office also wins, but where we separate the wheat from the chaff and the men from the boys is how your office handles the tough and unfair situations. This is where most ECPs draw the line and tell patients about an office policy and imply that if they don't like the policy they can go elsewhere. Keep in mind that a policy is really just a way to say no or to say you can't do something. If you are going to say yes, you don't need a policy.

Ironically, ECPs and even more so, staff members, feel they are being good business people by stopping people from taking advantage of the practice; by not allowing what is perceived as unfair. But the key word is "perceived." You may perceive a no show situation as unfair to you but I assure you the patient perceives it as not his fault. Whose perception really counts in these situations? From a business perspective, the customer's perception is what matters most. As business owners, we hate to hear that, but take heart; the premise was devised as a tool to make more profit and it really works!

You might think that it takes guts to stand up to patients who abuse the practice in some way and tell them no. Many feel it takes strength to give patients a warning and say such action will not be tolerated in the future. I say it takes more guts to let patients win in those situations! I say it takes a firm conviction that the payoff will actually be better for the practice in the big scheme of things. I say the ECP who lets the patient win when it is not so easy is one who really "gets it." The vast majority of ECPs don't get it. They think they are good at customer service, but once staff members begin to protect the practice from unfair treatment by the public, you go down a slippery slope. The office culture changes and the focus is no longer on showing patients how much you care. You end up perilously close to the same behavior we see in most healthcare offices: horrible customer service!

My policy on no shows

My response to no show patients is to simply be understanding. To realize that from the patient's point of view, something came up that prevented him from coming to my office. To some patients that something may have been a serious illness; to others it might have been an invitation by a friend to go the local mall. Or perhaps the patient honestly just forgot the appointment. I see no good in judging the worthiness of the reason (or the reason cited). What matters is what response will be the best for future business.

I love the topic of office policy for no shows because it is a great learning tool to demonstrate how strongly a practice feels about customer service. When an ECP or office manager tells me they...

  • send a stern letter about the no show policy...
  • advise patients they can't have any more appointments but must call ahead or drop in and see if the office can accommodate them...
  • threaten to charge a fee for a broken appointment...
  • require a credit card deposit or other security in advance...
  • tell patients they may not have any future appointments on Saturdays...
  • advise patients that they will be double-booked in the future (I actually agree with double-booking repeat no show offenders but I would never tell them I was doing it)...

I reply that I prefer to be understanding about the situation and offer to reschedule the appointment.

A culture defining moment

Culture defining moments don't come along all that often in practice, but when they do the value is much bigger than the specific event that caused it. Responding to a no show situation (one that may have upset your staff) in a surprising way that sets your practice apart from others, is such a moment. Culture defining moments are valuable to your practice for two reasons:

  • Patients realize they were just treated extremely well and that impact is huge. Patients who push you to the edge realize they are on shaky ground even if they don't act like it. They may have a personality that makes them tough to deal with and have had confrontations with businesses in the past that have not gone well. They may be very good at getting their way and even approach it as a sport. When a business surprises them with a pleasant, unexpected response, they are extremely impressed. They become a major goodwill ambassador for your practice and tell everyone they know how great you are. Before you tell me that you don't want that kind of person in your practice, think hard. I'll tell you that I need all of those people I can get.
  • Staff members realize they don't work at the typical eye care office. They may not initially understand the kill ‘em with kindness approach, but if the practice leaders are firm in their convictions, there is no better teaching tool. Real world applications of the mission statement are what shape the office culture. It's not what you write down on paper that matters; it's what you live.

Best wishes for continued success,

Read Past Tips Neil B. Gailmard, OD, MBA, FAAO
Editor, Optometric Management Tip of the Week

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Send questions and comments to neil@gailmard.com.

Dr. Gailmard offers consulting services to eye care professionals through Prima Eye Group; information is available at www.primaeyegroup.com.

Please Note: The views expressed in Management Tip of the Week do not necessarily reflect those of the sponsor.

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