Janet Hagerman discusses dentists’ resistance to the concept of selling and how the whole team can help double case acceptance and improve the patient experience.
DSOPro: Tell us about your background and what brought you into the dental space.
My background is in dental hygiene, and I struggled early on. I thought I was really good at communicating because we learned patient education in school, but I experienced some unfortunate situations that were both funny and sad. That piqued my curiosity in finding out how to get through to patients better.
The average case acceptance in this country is only 30% to 50%, based on surveys taken by Dental Economics. So, we are missing a huge opportunity. It’s not just lost revenue, it results in a lot of patients walking around with undiagnosed oral disease, which we now know is related to systemic disease.
I began to do various types of coaching—hygiene coaching, full practice coaching. And then I became the director of dental hygiene for a group practice with more than 100 offices. That’s where I was able to really start refining and sharing my communication skills and strategies.
A DSO is like a laboratory because you can test new ideas and very quickly see what works, what doesn’t, or why it works better in some offices than others and works differently with different people. That’s when I honed and scaled my communication skills and wrote my book, Selling Dentistry.
DSOPro: Tell us about your book and philosophy.
There’s this resistance in dentistry to the concept of selling.
A lot of dentists would ask me, “When you coach my team, could you teach them how to sell dentistry because I know it’s walking out the door? As a matter of fact, I could take some tips myself. But whatever you do, don’t call it sell.”
The best salespeople are those who are also the most relationship oriented. I think that now more than ever, although we’re more technology-oriented and living life through devices, relationships are becoming more important all the time. In fact, leadership books and posts now rate “soft skills,” such as empathy, as a top requirement when recruiting for management and C-suite positions.
So that’s really what the book and my work is all about. My program is designed to help dental teams to double or triple their case acceptance, based on where they’re starting out and where they want to go. All of these “strategies” are communication techniques and soft skills that anyone can do because they are relationship based. You don’t have to be an extrovert, or even an outgoing person, to utilize these skills.
There are four big reasons for focusing on and increasing case acceptance. The first one is the oral-systemic connection. We know that oral disease will contribute to other major systemic diseases. The second reason is maintaining a strong immune system. COVID highlighted that there is still a lot of confusion about whether vaccines work. But one thing we know for sure is that a strong immune system is one of the best ways to avoid and resist disease, including viruses. By increasing case acceptance, you are helping your patients stay healthy overall and resist diseases.
The third reason is the revenue that you’re leaving on the table. The first thing I recommend is, look in your practice management software and see how many dollars’ worth of untreated treatment-planned work there is. Practices are always marketing for new patients, but typically there’s already a gold mine of untreated dentistry in your virtual file cabinet.
Finally, the fourth reason is something that people don’t think about but is really important for group practices (in an effort to be consistent), and that is your brand reputation.
The fact is that when your patients leave their appointments, what you tell them, what you and your team say to them, is what they will repeat to their friends, whether they accepted treatment or not. They may go on social media and complain, “I just had my free cleaning and they said I need $8,000 of work,” or, “Wow, that was the most thorough exam I’ve ever had! I never knew I needed that much dental work and they’re going to help me figure out how to do it. We’ve got a plan in place.” Social media is like word-of-mouth on steroids, so you need to be sure that what your patients hear in your practice is what you would want loudly repeated on social media.
Particularly for group practices, where you’d strive for consistency from office to office. If one office team has lousy communication skills or makes mindless negative comments that get repeated outside of the office, this can do a lot to destroy the reputation that you have worked so hard to build up.
So, it’s a matter of being case-acceptance aware as a reflection, basically, of your patient experience.
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DSOPro: Are group practices and DSOs taking a broader view on staff and how staff works together within the company culture?
Whether it’s a DSO with 150 offices or a group of seven or eight practices, managers can’t be in every office all the time observing staff and patient interactions. So how else do you manage? Well, there’s only one way…and that is through KPI (key performance indicators), the metrics, the performance numbers. I think that’s where you get a broader look at the team, because you have the ability to ask, “Why is this team doing so much better by the numbers than this team?” Then you go into the offices, see the dynamics, assess the leadership or lack thereof, and identify who’s had training and who hasn’t. When effectively communicated, these numbers can be elegantly connected to performance improvement. Many well-run DSOs recognize the importance of ongoing team training, and if it’s done properly there are so many advantages to being in a well-run DSO.
I think communication and training are the two top keys when it comes to the culture. Leadership must ask, “Are we committed to ongoing training? Are we committed to learning new communication tools to really reach out to our patients?” If so, how do we implement that? This means not just speaking or talking to them about patient education but also having good listening skills.
I help teams create a really great core-values mission. This includes what they really believe in as a team, what the doctor believes in, and what the group brand stands for. They need to show that to prospective employees when they’re recruiting to determine if a candidate can stand behind it. They can ask, “Is this part of your personal professional culture as well so we can be congruent in that?” And on their first day at work, give it to them as a reminder that, “This is our culture. Every decision we make, and want you to make, needs to support our core values.”
As you’re training a new employee, you can refer them back to the core values and assess what part of clinical behavior is supporting that, and how to support and help the staff member do that better. Remember to ask, “What can I do to help you?” in a spirit of support.
I see success in the dental office as a big pie cut into three pieces: clinical expertise, communication expertise, and business success. You must have all of them. I’ve been in dentistry for 30 years and there was a time when clinical expertise was all you needed. If you were good clinically, it was like, “Well, I’m a hygienist or a dental assistant. I don’t need to worry about the business side. That’s the office manager’s job.”
But all those pieces of the pie are integral and everybody on the team must understand how they all work together. Everybody should know how to do handoffs together, or why calling scaling and root planing a “deep cleaning” is the kiss of death. Everybody needs a basic understanding of periodontal disease and how it affects the whole body. Everybody should understand certain basic KPIs, certain metrics, and how they personally impact those metrics and how the metrics impact them.
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DSOPro: It sounds like this is a very important part of the successful practice.
Absolutely. And it’s ongoing because you will have turnover, you’re going to hire new people. And even if you have a consistent team, the very best teams have regularly scheduled, productive meetings. That’s why I wrote the manual Meetings Make Money. If you’re not having productive meetings, if you feel like they’re a waste of time and everybody complains they never finish on time, you’re not doing the meetings correctly. They should be organized with an agenda and well-structured, and you should make money from them. Who learns something one time and then implements it all? That’s why my program has both a learning section and implementation sections to practice. Even adults don’t learn from just doing things once.
There have been studies about attending conferences, for example. If you just go and just listen, you retain something like 10%. If you go and take notes, you retain something like 30%. But if you go and actively participate, do some experiential learning such as practice new ways to greet patients and ask good open-ended questions, it is much more effective. Some call it role-playing and hate it. But that’s where you get your stumbling out of the way, in front of a group of supportive people, before you actually speak to a patient. If you have that interaction in a course, it bumps up your retention to around 70%. But even then, it still needs to be reinforced. I include a lot of reinforcement strategies and exercises in my material, because I think it is so important.
We now know from many studies that the majority of buying decisions are made using the right side of our brain, not the left. They are made with emotion, not logic. All you have to do is watch a few car commercials to see they’re appealing to people’s emotions. Then we back those emotional decisions up with logic.
How do we do that in dentistry? How do we appeal to people’s emotions in the short period of time we have while doing all the things we have to do during an appointment? We’re also at a disadvantage because patients don’t get up in the morning and think, “I’m going to the dentist and just can’t wait to spend some money there.” We practitioners must really think about the value of dentistry, and what value it’s going to have for that person, which we won’t know until we ask the right questions and listen carefully. That’s all part of developing soft communication skills.
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DSOPro: Tell us how you help DSO leadership and staff members learn soft skills.
I teach the strategies they can use to trickle down to their patients. It’s a ripple effect. I have written a lot on my Linked-In blog and, of course, I wrote the book and manuals. I am beginning to create a short video series that can be purchased on my website. Each module is anywhere from 5 to 15 minutes to accommodate busy lives and busy schedules. These are designed to watch on their lunch break, as a team, and then do the accompanying exercise for another 15 to 20 minutes.
I think as we get more highly technologically oriented, we need to become more skilled at communication and relationships. When you think about how we communicate on digital devices through emojis, and then have to switch to being in front of a patient, expected to look them in the eye and talk about a several thousand dollar plus treatment plan. It’s unrealistic to think that they’re going to automatically be successful. I think the more technology we use, the more we need soft skills. Storytelling is becoming critical for sales and marketing. It’s the new 21st century communication skill.
The flip side of that is, we now have artificial intelligence diagnosing x-rays for us. I think it’s an interesting dynamic that we’ve got these two polar-opposite dimensions coming together, the technology and the human communication. When we combine the two successfully it will be exciting and powerful.
DSOPro: Where do you see dentistry evolving in the future?
From what I’ve read, it’s either scary or it’s exciting, and it’s almost impossible to predict because it is changing so fast. AI radiographic diagnosing is just an example. It’s fascinating. As human beings age, we slow down. As technology ages, it gets exponentially faster, right? We’re going to see a lot more AI coming down the pike to automate things. It’s going to be increasingly important that we practitioners keep up with technology, so we can help guide it in directions that are helpful for us and our patients. Our communication skills need to keep up with it, too.
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Janet Hagerman is known as THE Case Acceptance Coach. Janet’s communication systems help dental teams to double their case acceptance and elevate their patient experience. A Medical College of Georgia graduate, Janet’s experience includes over 30 years of clinical and coaching experience with both solo and small-to-large group practices, and leadership as a corporate Director of Dental Hygiene, managing 100+ practices. An international speaker, author, and consultant, Janet is the author of numerous articles, podcasts, webinars, and the signature programs “Selling Dentistry – Ethically. Elegantly. Effectively.”℠ and “Meetings Make Money – Productive Meetings for Best Dental Practices”℠.
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