management & leadership



Scheduling mistakes practices make in a world gone digital.


Just the other day, my 19-year-old daughter, Erin, felt a sudden need to connect with her Grammy Anderson, who is going strong at the age of 91. With many miles between Erin and our matriarch, this meant using suitable tech. Email wouldn’t cut it. As I told my daughter, Grammy might check it once a week. And, forget about texting, which is not Grammy tech.

“Just call her at home,” I told Erin. “How do I do that?” she said. “How do I call somebody at home?”

I still laugh about her bafflement, which was real. It makes sense, though. For my daughter and her age group, the old-time home phone has no role in routine communication. This is increasingly true for the 50% of America (and growing) that has ditched the home phone.

Erin and Grammy illustrate the challenge of communicating with different generations of patients today. One channel of communication won’t work like it used to. One size does not fit all. But no matter the channel of communication your patients prefer, there are some things that remain irrefutable: The manner in which you communicate will determine your success. Through digital, analog, voice or print, the secret of stopping cancellations rests in the content of the message, not just the carrier.

The payoffs of tailored, multi-channel communication are substantial. With trained-in messaging and verbal skills, you will:

  • Stop cancellations cold and eliminate no shows
  • Keep follow-up appointments scheduled and make sure they are kept
  • Manage a full, highly productive schedule


Sending out timed, tailored texts and emails gets ever more effortless, thanks to an array of software products to automate the process. Take your pick, train your team on every aspect of the software you choose, and then use your REAL killer app – your words — spoken and digitally transmitted.

No matter the app, it’s the content that influences patient behavior. Using a high tech app with the wrong message will destroy the schedule. Every word of communication, no matter the channel, should flow toward desired, positive patient outcomes. In the realm of scheduling, that means:

  • Patients in the chair for first appointments every time,
  • Hygiene appointments on the books and conscientiously kept by patients, and
  • Appointments regarded by patients as high priorities.

Though the technology and channels of communication keep changing, the words and underlying messages remain quite consistent. It is all about training patients and teaching them the right, responsible way to treat you. You show the way by establishing high expectations for both sides – patients and professionals – and living up to them. So, no matter the channel of communication, here are some underlying philosophies on managing the relationship with your patients and maintaining a predictable schedule:

You teach patients how to treat you.

The medical world has come unraveled. With managed care, capitation, and ever stressed physicians, nurse practitioners and physician’s assistants, patients have figured out that if they cancel or no-show, no one will notice. That’s why your patients do not come trained. You cannot assume they will respect the schedule in your office when they are regularly in medical offices where the schedule is chaotic and rarely respected. Assume they will disrespect the schedule in your office, unless you train them otherwise… and you will most likely be right!

Patients learn how to treat you from the way you treat them.

The most valued asset that consumers have today is their time. Time is money, and consumers treat it that way. The day of keeping patients in the waiting room indefinitely until the doctor is ready are long gone. In fact, many patients today have the attitude that their time is just as, if not more, valuable than their doctor. So, if you want patients to respect your time and your schedule, respect theirs! By placing a high priority on your patients’ scheduled appointment times, they will get the underlying message that the respect of time is a value in your practice and they will be more likely to behave accordingly.

If you respect their time, it will be much easier to ask them to respect yours with the right words. Disrespect their time, and it won’t be long until they start returning the favor!

Patients place exactly as much importance on their appointment time as you do.

It is unlikely for a patient to place more importance on their treatment and their scheduled appointment than you do. No big deal to you, no big deal to them.

Take, for example, the typical apologetic cancellation call from a patient: “I am so sorry, but something has come up, and I won’t be able to make my appointment today.” Because the patient apologized up front, the temptation is to say, “Oh, that’s OK.” NO, IT’S NOT! If it were that easy to cancel, the appointment must not have been that important in the first place. And now, you have just trained the patient that scheduled appointments are really not that important. You might as well say, “Come and go as you please. This is Burger King, where we do it your way!”

Start communicating the importance of the treatment and the treatment time in everything that you do and say. The more important it is to you, the more important it will become to them.

Give them a choice

Right from the get-go, inquire about the patient’s preferred method of communication – voice, text, email, or yes… snail mail, or a combination thereof. Note the preference and save it into your practice management software, so the channel is correct for each patient. There’s a slim to none chance that the preferred channel of communication for Erin, age 19, is going to be the same as Grammy, age 91. Nor does age always dictate the channel. That’s why you have to ASK, and then stick to it. To each patient, their own channel.

Prevention is better than a cure.

Stop new patients from cancelling before they ever have a chance to start bad habits in your practice.

The patients with the highest risk for cancelling are new patients. They don’t know you, and you don’t know them. The social and reputational risk they take when cancelling, or even no-showing, when they have never been in your office before is low. You know that. So, set up the system to give them every possible chance of making good on their first commitment in your practice. It sets the stage for the entire relationship.

So, here’s the 100 Percent New Patient Cancellation Killer. It will prevent almost every new patient from cancelling or no-showing on their first appointment.

A quick call from the dentist (that’s right, THE DENTIST) on the day before each scheduled first appointment goes like this:

Ms. Gilbert, this is Doctor Ben Richardson at Happy Dental. I am looking forward to meeting you during your first appointment tomorrow at 3 pm in our office. I want you to know that we will have everything ready for you tomorrow. If there is anything we should know before you arrive that would make your appointment more comfortable, please give our office a call at 333-444-5555. Otherwise, we look forward to seeing you tomorrow at 3 pm. See you then!

Speaking these six sentences takes 40 seconds tops. If you are calling, you’ll likely go to VM, but it may be the most impactful message they every receive. If they told you that text or email is their preferred method of communication, consider sending the message through that channel.

No matter the channel, the message changes the entire emotional dynamic. For one thing, patients will be astonished to personally hear from the doctor before they ever step foot in the practice. This will probably be a lifetime first for most patients. The wordage carries another important message – You’re making a special effort to be ready to go at the appointed time. And gone, just like that, is the sense of disconnection and anonymity that makes it feel so low-risk and easy for patients to brush off first appointments. Now they know: The doctor knows where you live!

Frontends forever!

The backend of each appointment is the frontend of the next desired, positive outcome, i.e. the next appointment. Whether sooner, for needed treatment, or later, for hygiene or regular check-ups scheduled months out, it must be on the books before the patient walks out the door. The mark of a practice that is on top of their scheduling game is a 90%+ pre-appointment rate. There will always be exceptions, and they are just that – exceptions. For everyone else, they always schedule their next appointment before they leave.

It goes something like this:

“Does this day of the week and time work well with your typical schedule?” After giving them a choice for future appointment times and scheduling the next appointment, the conversation continues:

“The last we talked, you said your preferred communication was ____. Is that still correct?

After verifying their preferred method of communication, ask,

“How do you keep track of your scheduled commitments? On your phone calendar, maybe, or your datebook at home?”

After the patient’s answer, say,

“Great! Could I suggest that you go ahead and write this commitment down today, just like we’re putting it in our schedule right now? That way, when a potential conflict comes up, you can say you have a prior commitment. And that commitment is to your health, and your smile. Does that make sense?”

These simple sentences elevate the importance of the next appointment and prime the patient on how to address potential conflicts. Then you continue…

“With your permission, we will send you periodic updates regarding your appointment, so we stay in sync. Once it’s scheduled here, it’s set in stone. That way you can plan on it.”

Spoken with warmth, and a smile in the voice, it is firm and friendly. You’re sending a clear message about the importance and priority of their health, as well as the appointment times you schedule in your practice.

Words matter.

From here on, up until the actual appointment, the heavy lifting is done by a few strategically worded e-messages or follow-up calls.

A couple words, that are commonly used and seem innocent, are absolutely verboten.

Your messages are not reminders. Reminding means that the patient has forgotten, or might forget. This implies a lack of organization and gives a way out of the prior commitment, which you also devalue by implying it might be forgettable.

Nor do you ask patients to confirm. That says that the commitment is not already firm. Again, you kick open the door to cancellations and rescheduling that cost time and money. Instead, do a simple and strong, “We look forward to seeing you on (day, date and time) for your (nature of visit) appointment.”

Patient contact programs get it all wrong by providing Yes or No response options for appointment confirmation. This is an open invitation to cancel, with no embarrassment involved, because you’re dealing with a machine! Lose such features and say, “If there are any questions, regarding this appointment, please call this number…” Do not – I repeat not – make it easy to cancel, with only remote push-button responses. If there is a serious issue, as there sometimes is, direct voice communication is the rule in your practice.

If you find yourself continually frustrated or complaining about cancellations and no shows in your office, seriously consider the philosophies above. Continuing down the same path will generate the same results. Different actions – different results.

The seven philosophies above are just the start to constructing and maintaining a productive, predictable schedule.

Join us for the upcoming STOP CANCELLATIONS webinar on August 1, 2018 at, where we will cover even more systems and verbal skills for maintaining a productive schedule today and every day.

steven j. anderson
founder of total patient service institute

Steven J. Anderson is the founder and Chief Creative Officer of the Total Patient Service Institute. For a free e-book packed with ideas, techniques, and systems for stopping cancellations, click here.