Stephen Thorne builds long-term patient relationships at Pacific Dental Services

Improve systems

When you hear feedback about issues that are under your control, it may mean a more drastic fix.

Managers should tackle individual instances, but your focus at the CEO level should be on improving overall feedback scores in general areas. So you need to monitor overarching trends and watch for patterns of unsatisfactory service.

“We’ve been doing (surveys) the same way for about a decade, so we have very, very good data,” Thorne says. “The key with those surveys is consistency. … We realize there’s variability in the responses, but when you look at it over long periods of time, you look at it on scale.”

For example, wait-time scores were lower than Thorne’s expectations a couple of years ago. To rally the organization around improvement, he had to boil down the desired change into a catchy program with very specific goals. The initiative was called “4 for 45,” and it illustrated a commitment to speed the process by accomplishing four services for a patient within 45 minutes.

“They’ve got to have an understanding that there is a problem,” he says. “So we have the scoring mechanism to show and we have the patient feedback to educate [them] that there is a problem.”

To disseminate the problem as well as the solution, Thorne uses the companywide communication system, Daily XP. Each office follows a standardized meeting format to start each day with a morning huddle covering the day’s schedule and priorities. First, he made sure the 4 for 45 message was included.

Deploying a change across 190 locations can be a challenge, but technology makes it easier and even adds benefits. The development team creates training modules with built-in tracking mechanisms to guide employees through new initiatives.

“So let’s say there’s a 30-minute module,” Thorne says. “We can track exactly who was on it, who was on it for 30 minutes, who was on it for two minutes.”

Gauging the execution of improvement initiatives isn’t quite so cut-and-dried.

“We can create the tools. We can get them educated the best we know how. And then it’s up to them on the execution,” Thorne says. “That last step is the key. … It ferrets out in the results of an office. It could be (patient satisfaction surveys) or it could be financial results.”

When you’re specific about the improvement you’re seeking, success is easier to track.

“If they were very diligent on the 4 for 45 over a six-month period, you would see their wait-time scores creep up,” he says. “If they weren’t diligent on it, you would see no change or even a decrease.”

When changes come directly from customer feedback, it’s pretty likely they’ll approve of the new method. But especially when you modify a process based on a best practice that bubbles up internally, you need to roll it out slowly to get the customer’s nod.

For example, Thorne concluded that cost was a sensitive topic for most patients. He realized that they often viewed the financial coordinator as a “money guy or gal” with negative connotations. So he re-engineered the system by renaming the position “patient advocate” and refocusing their conversations on maximizing the patient’s benefits.

Those kinds of changes begin as an experiment in a single office. If the feedback is favorable, it progresses to an alpha test at a couple of offices. When it passes that level, it spreads into a beta test, perhaps across a region, where you start pouring more resources into the change. Finally, if that goes well, you plan how to roll it out companywide.

By constantly improving the patient experience with a long-term patient relationship in mind, rather than viewing satisfaction on an appointment-by-appointment basis, Thorne has built a growing operation. Pacific Dental Services reported 2009 patient revenue of $309 million across 190 offices, up from $272 million across 170 offices in 2008. More offices are projected to open as Thorne keeps reminding employees that patient satisfaction is a marathon, not a sprint.

“Over time, new patients tend to dwindle off at a specific location,” he says. “If you have not built up what we call continuing care, the practice will slide and you won’t see growth.”

How to reach: Pacific Dental Services Inc., (714) 508-3600 or