No-Show Rates – Who’s Avoiding You?

Man waiting for someone while looking at watch.

First things first…no one likes to be stood up! But do you know who is avoiding you? Are those who no-show their appointments equally present across all types of customers, or is there a smaller segment of your customers impacting the metric?

Your No-Show Rates are an essential metric yielding clarity for your office. Let’s take a deeper look and see what we find.

Hate the Waste

Missed appointments within an office are more than a frustration. The opportunity cost of a no-show or late cancellation is the loss of productive work hours never to be regained.

Applying business acumen dictates a deeper dive into this metric for missed appointments or late-cancellations. But what should we explore? And how do we do this?

Listen in on how you can gain clarity on who is avoiding you.


Finally, dive deeply into root causes for your missed appointments. Understand it more fully by turning data points into actionable information. You can most easily do so by remembering a few essential tips:

  • Separate Active from New Patient appointments
  • Define what is considered “no-show”
  • Differentiate additional variables for New Patient appointments
  • Determine different goals for Active and New Patient No-Show Rates

Confirmation Call – “I’m confirming [beeeep]”

Bored woman listening to confirmation call

We have all experienced it, right? Thanks to Caller ID, we let the answering machine or our voicemail answer the call. It’s only a confirmation call. It serves to remind us to show up to an appointment or obligation. But the usual result is a quick [DELETE]…beeeeeeep.

The Ritualistic Confirmation Call

We have a love-hate relationship with such calls. On one side we appreciate a reminder of our upcoming appointment in case we did not write it down correctly. On the other hand, once we begin hearing the details, we hit “delete.” The usual confirmation call barely hovers above a level of mediocrity.

So why do we think we are doing something different by simply having a live voice instead of an automated voice do the same thing?

Change the Purpose – Connection Call

We want to be different than the usual confirmation call; let’s set out a plan.

Change the purpose from merely confirming and reminding to connecting and drawing upon the authority of our doctors. We can let the future patient know we are anticipating and preparing for their visit. This goal is easy to accomplish by referencing the status of their new patient forms.

Notice that by using this as an opportunity to thank or remind the caller about the forms we demonstrate we have taken an early initiative in preparing for their visit. It is not saying, “if” they haven’t filled it out to do so. It is actually knowing and personalizing it to them.

Thank or Remind Them

First, review the patient details to see if they have filled out their forms. If so, thank them. Conversely, if the items are not yet submitted, remind them. Either way, employ one of Cialdini’s principles of influence and draw upon the authority of the doctor.

Here are some examples:

(First, for completed forms)

“Good evening, this is Mary from Dr. Smile’s office. As Dr. Smile was reviewing your records he/she said you had completed your new patient forms and asked me to personally thank you for having completed them. Dr. Smile is looking forward to meeting everyone involved so he/she can answer everyone’s questions about his/her recommendations.

Again, this is Mary, and I will be at the front desk to meet you when you come in for your consultation tomorrow at 8 am. Should you have any questions before then, please call or text me at 555.555.5555. Again, that number is 555.555.5555. Have a great day.”

(Secondly, for incomplete forms)

“Good evening, this is Mary from Dr. Smile’s office. As Dr. Smile was reviewing your records, he/she noticed that the new patient forms were still not in our system and asked me to ensure you still had the appropriate link/email to those forms. After this call, I will email you the link. Additionally, the online forms are located on our website at

If you are unable to submit those tonight, Dr. Smile requests you arrive 15 minutes early, so you have time to complete those forms and ensure all the details are prepared in advance of your one-on-one time with the doctor. Dr. Smile is looking forward to meeting everyone involved so he/she can answer everyone’s questions about his/her recommendations.

Again, this is Mary, and I will be at the front desk to meet you when you come in for your consultation tomorrow at 8 am. Should you have any questions before then, please call or text me at 555.555.5555. Again, that number is 555.555.5555. Have a great day.”

Either example demonstrates you have taken the time to prepare and anticipate their visit. We want to sustain the great experience of the first call to validate we are unique. Be different…be excellent!

Try it out and watch how the small details add up to a better prepared new patient visit ready to say “yes” to your recommendations.

Get Your Posture Straight – Understanding the Difference Between Deference and Guidance

Good posture at all times.

Leaders understand the importance of posture. There is more to posture than sitting tall or standing up straight. Posture also relates to a frame of mind or attitude when communicating with our customers.

Posture – Two Differing Attitudes

There are two primary postures used throughout the day. They are deference and guidance.

During the day a leader must toggle between these deferring and guiding attitudes. And while everyone on the team must understand and use the proper posture, there is no one who needs it more critically than your front office team and those communicating via phone.

Why is this?

Phone conversations lack the visible cues of body language, but even so a caller perceives posture and attitude over the phone. So let’s empower these valuable leaders who are on the phone.


A dictionary definition says that deference is, “respectful submission or yielding to the judgment, opinion, or will of another.”

Simply put, it is being courteous and respectful. This is appropriate for our offices. Examples of when this is used is when we:

  • Offer a greeting and say, “How may I help you?”
  • Ask permission to place someone on hold and say, “May I place you on a brief hold?”
  • Wrap up a conversation by asking, “Is there anything else I can do for you?”


Guidance is providing direction, leadership, and advice.

Even in an elective-based business, it is still appropriate to guide. We politely guide. Examples of when to do so are:

  • Setting appointments and saying, “The doctor can see you at [Option A] or [Option B]. Which one works best for you?”
  • Advising of the best option with, “My recommendation is to…”
  • Providing awareness of consequences by saying, “Yes, we can look for a late appointment; that will impact treatment time. Do you wish for me to continue to look for the last appointment of the day or explore an option closer to what the doctor recommended?”

The Switcheroo

All too often there is a switcheroo, and team members are unaware. A majority of those on the phone self-report 100% compliance with the proper posture of deference and guidance.

My evaluation of tens-of-thousands of calls verifies differently.

A classic example of the switcheroo is when callers get told they will be put on hold and then broadly asked when they want to come in for an appointment as if you have 24/7 availability.

Oh no!

The Solution

First, talk with your team about the difference between deference and guidance. Rehearse the examples above.

Second, evaluate phone recordings and provide appropriate feedback. Consider this with a caveat. Giving feedback in a way that encourages change is not always in the wheelhouse of the skills of most doctors and managers.

Finally, consider hiring a team coach for communication training.

“Know your powers. The power of your words, your silence, your mind, your body language and your body itself. Control them.”

Sonya Teclai

Do You Have a Plan on What You Say?

Plan ahead or risk boring your customer.

Blah, Blah, Blah

Is this what you sound like to your callers, potential customers, or customers? You might if you don’t have a plan.

You must find the sweet spot of providing enough information to demonstrate appropriate knowledge, while also coordinating it with brevity so it can be absorbed. The balancing act is like walking a tenuous tightrope.

Have a Plan

The best way to stay on topic appropriately is to follow a defined plan. That plan can be an outline of what to cover and at what level of detail. Or it can be a fully scripted monologue. The key is to not “wing it”.

What does the absence of a plan, outline, or script do? I can tell you with absolute assurance after evaluating over 10,000 calls a year, that without a plan, team members ramble, omit, or goof critical details.

Guideline by Scenario

On the phone: The first thing to remember is that whenever you are on the phone, provide details at “sentence” length. Full education on the phone is confusing, tedious, and boring. Make the point or answer the question succinctly, then move on.

In person: Here is where explanations can expand into full paragraphs. You have the benefit of reading body language to assess if the message is landing effectively and then adapt as necessary.

Empower your team members with this distinction. “Sentences” on the phone…”Paragraphs” in person.

Add Aids When Necessary

Finally, remember to draw upon other aids and tools to help clarify complex topics. Complex topics include insurance, appointment policies, and detailed instructions. Add a pictorial handout to such discussions to provide greater comprehension.

As they say, “A picture is worth a thousand words.”

Does Your Office Communicate Excellence?

The Search

I remember moving to a new city and having to get established all over again. It was agonizing enough to think of finding new stores, a church, and a favorite library for my family. But to think of doctors and getting that right was agonizing. As a single mom at that time I was hoping we would not need to use those services too often so that meant I needed to nail the decision from the beginning. When you only have once or twice a year to visit and get a feel for a place you don’t want to waste your time.

My first big decision was finding a dentist. I had no idea where to go as I had no friends to ask. I ended up going to a large practice in Charlotte, NC that advertised on the local Christian radio station. It seemed as good as a place as any. (Please note this was before marrying an orthodontist so my dental IQ at the time was moderate, at best.)

I remember calling the location to set up appointments for myself and my 3 young kids. I was taken aback…in a good way, by the voice I heard on the phone. Tracy was amazing! She had me at, “Hello.” She paid attention to me and answered all my questions. Tracy told me what to expect and reassured me we were in great hands. She caught my attention from the first contact. But wait…there’s more…

The day arrived with 3 freckled kids in tow when we walked up the stairs to the reception room. The greeting we had was as if we were long lost, friends. Tracy looked at my oldest son and asked, “And you are?”

“Jesse,” says my 10-year old.

The Super Powers

Tracy then drew upon her powers of deduction (and the pre-patient paperwork) to greet my 8-year old daughter and 6-year old son by name! By name, y’all! She greeted each one personally and with a compliment that made each child beam. Now you know what that did to this momma?! I was sold! But then I wanted to see if this was her authentic self so I strategically placed myself in the reception room to keep an eye on her.

As we waited I witnessed her greeting and sending off everyone with true joy and the same enthusiasm she provided to my kids and me. And this happened time after time…year after year!

The key thing is, SHE is the ONLY one I remember from the practice. That practice was so huge I never saw the same hygienist or dentist twice in my entire 8 years in Charlotte…or at least I don’t think so. The care was fine. I actually would have preferred a smaller practice where I could have some consistency, but I STAYED because of Miss Tracy! She sold me on the practice!

The New Reality

THIS is how important not only your administrative team is, but everyone on your team to create a lasting and impactful experience.

Chris Bentson nails this on the head when he was on Episode 3 of Elevate Orthodontics podcast. Around minute 29 he states the following:

“That’s what we’re worried about, making the telephone ring and then…how do we effectively communicate…I think that will be the next generation of practice-management and skill-set learning that practice owners are going to differentiate themselves with. Are they delivering excellence in the communication chain with consumers…if they can get the phone to ring first, and then after they do, are they NOT losing those people? …we’re moving from a very clinically-centric specialty to a hybrid business-centric, clinically-centric in this business aspect. We know the nuts and bolts of where our numbers should be, we’ve heard a lot of lectures about that and we share a lot of information about that. But these softer sides of business are really the differentiators and you think of companies like Apple…Google…Mercedes…Tiffany’s…Pottery Barn Kids, and things like that where they can really have an experience that their consumers have with them that’s predictable and repeatable and that occurs over and over again and then this whole word-of-mouth thing begins to happen and THOSE are the practices that tend to be doing very, very well in today’s environment.” (20170214)

That is what Communicate Excellence is all about. We provide training and coaching to ensure the experience your team provides is positively memorable. We want your team to communicate excellence so consumers would never consider going anywhere else.