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

Stephen E. Thorne IV thinks schools have it all backward. Since he founded Pacific Dental Services Inc. in 1994, he’s worked with thousands of dentists who have been trained to believe they’re the best of the best — and technically speaking, many are. But they’re rarely educated on the crux of the business.

“My idea of the perfect dental school would be a school where the first year they come in and they’re taught a ton about the soft skills, about human interactions, how to talk to people, how to relate to their patients, chair-side manner, questions to ask to get an understanding of their patient as an individual,” says Thorne, whose father was a dentist and tuned him in to the industry early on.

In his ideal curriculum, dentists-in-training would progress to clinical work only after they mastered patient interaction.

Thorne hasn’t infiltrated the medical education system, but he still strives to educate dentists on that all-important piece when he partners with dental practices, providing support on everything from selecting locations and negotiating leases to strategic planning and finance management.

“Oftentimes, dentists forget that attached to that tooth is a human being, a real live person,” says Thorne, president and CEO. “They’re not fixing teeth, really. They’re helping people out.”

Thorne’s focus on the end-user means better business in any industry, whether you’re dealing with customers or patients. He wants his affiliated dentists to understand that patient satisfaction is not a pleasant one-off experience; it’s really about building long-term relationships.

“Why are those relationships so important? Well, you can go straight to the financial side,” Thorne says. “It’s a lot more expensive to acquire a new patient than it is to retain an existing patient. … If a patient is a one-and-done, and (the practitioners) try to do as much as they can right there, the patient spends maybe $2,000. If a patient stays in a practice for about seven or eight years, they’d spend over $6,000. Which would you rather have? I think it can absolutely be applied to other industries.”

Consider the cycle

Pay attention to every step of the customer experience, beginning before customers even walk in your door.

“It starts at the very, very front end: How did they call, were they referred in, did they see an ad, did they go through the website?” Thorne says. “The look and feel and how that all worked is where it all begins.”

Increasingly, customers are likely to find your company on their computer screens. About 20 percent of patients come to Pacific Dental Services through some sort of digital media, and that number is growing. Thorne has to be conscious of how those outlets look and feel to the end-user.

You can make the online experience gratifying by providing information and easily accessible tools — even when your service requires that customers come into a physical office. That may be as simple as letting them tackle some necessary tasks on their own time before they see you.

“As an example, patients do all their paperwork online, hopefully, before they come in,” Thorne says. “Home at night, watching TV, they can enter their patient information so when they come into the office they have no paperwork to fill out.”

That convenience and attention has to continue throughout the entire customer cycle for the result to be positive.

“They have to have a good overall experience,” Thorne says. “That includes the entire team.”

To keep the process smooth as patients move from one interaction to the next, Pacific Dental Services developed a system called the Perfect Patient Experience.

Employees in each function receive specialized training specific to their role. The most important piece of that looks beyond their individual responsibilities and zeroes in on the transition when they pass the baton to the next person in the cycle.

“We define what each role is responsible for and what they’re responsible to do to set the next person up for success,” Thorne says. “Then we really drill down on that at a very detailed level and train on best practices.”

Employees should understand their colleagues’ roles. The receptionist needs to proactively prepare for the dental assistant, the dental assistant must anticipate the dentist’s needs and the dentist should know what the financial coordinator requires.

The steps for those transitions will vary with each position in each business, but the one steadfast consideration is time.

“We just did a study where the No. 1 element of the overall satisfaction of patients was dependent on how the team cared about the use of their time,” Thorne says. “Teams that work fast and care about helping patients [get through the] process quickly do better.”

Consistency is the biggest challenge in maintaining long-term customer relationships, so educating across the board is key.

“The more consistent we can make it, the better,” Thorne says.

Listen to feedback

As customer needs change, so should your process for building relationships with them.

Every month, Pacific Dental Services receives feedback through tens of thousands of patient satisfaction surveys.

“The patients are telling us what they like and dislike — hopefully more of what they like,” Thorne says.

Surveys should be simple to increase the likelihood that customers will respond. Currently, Thorne’s survey consists of eight questions and scaled options for answering.

Some general catch-all questions are important, such as, “Would you recommend us?” and, “Were you processed in a reasonable amount of time?” But to identify breakdowns in your customer service, solicit feedback specifically for each step of the cycle.

Direct a question at each interaction a customer has. At Pacific Dental Services, those include: Did the receptionist greet you nicely? How was your cleaning from your hygienist? Did you understand the cost of the treatment?

“We look at each role, so (the survey) mimics our Perfect Patient Experience model,” Thorne says. “We can pinpoint if they have a rude receptionist. We can pinpoint if they have a rude doctor. We can pinpoint if their hygienist is outstanding.”

If the feedback is going to have any effect, you need a system for sorting, scoring and recording it. Start with specifics so each department can see feedback regarding its function and make necessary adjustments.

“Any comments are posted once a week to the teams in the field so they can respond to any positive or negative ones immediately,” Thorne says.

He requires that operations managers personally respond to comments directed at their area, and he tracks whether they take action. For positive responses, that may mean a simple thank you or a request for referrals.

“Any negatives, they’re expected to call the patient and document what they did to resolve it,” he says. “A lot of times, you can resurrect a bad experience by just calling and talking through it with the patient.

“Maybe they can call and say, ‘This is Steve from Dr. Smith’s office, and I was just responding back to what you wrote in our satisfaction survey. I see you’re unhappy with whatever it may be, and I want to do my best to make it right for you.’ A lot of times, they just want to vent. You just have to empathize wit
h them: ‘I understand.’”

Sometimes, customers may be dissatisfied about things that are out of your control. You can’t just adjust your entire business model to make one customer happy. So explain why your process is set up the way it is and why their contention may be out of your hands.

“We don’t subscribe to the philosophy that the patient’s always right,” says Thorne, who hears from many patients who are frustrated with the amount covered by insurance. “In this business, the patient’s often wrong. So we have to spend a lot of time educating.”

His goal is that patients see him as an advocate and partner who will do whatever possible to please them.

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