How to Keep Patients from Falling Through the Cracks

Learn how to use practice data to improve patient retention

Filling Those Holes

Dr. Green in Oklahoma reached out to me because she was spending thousands of dollars on marketing trying to get more new patients to fill the holes in her schedule (sound familiar?) After several months of expensive marketing, she still had holes and not much else to show for her efforts. Together, we stripped all the emotions and guesses out of the practice to discover what the real solution was to her problems. The findings for this dentist were shocking and, at first, a little embarrassing. I reminded her that we shouldn’t use her results as a weapon to punish herself or her team, but instead, we’d use what we discovered to know where her practice was so she could identify steps to improve.

First, Stop the Leaks

 Imagine you see a small child with her sippy cup tipped upside down with and milk dripping onto the floor. What’s your first step? When I recently saw this happening with my youngest daughter, I told Ocean, my ten-year-old daughter, to help clean up the mess. As I sat back to watch, what happened next surprised me. Ocean grabbed some paper towels and started to clean up the floor…however, she was cleaning up the floor as the sippy cup continued dripping.

One of the most common frustrations within a dental practice is an incomplete schedule. Today we’re going to link the example of a dripping sippy cup and your incomplete schedule. We’ll then create an action item for your practice to be consistently full every day, week after week. Are you ready? Put on your helmets, this is going to be mind-blowing.

Changing the Status Quo

As we looked at Dr. Green’s schedule, here is what we discovered:

  • In January, she had 2004 active patients. In October of the same year, she had 2109 active patients, meaning she grew her active patients by 105.
  • From January to October she added, on average, 50 new patients per month for a total of 500 new patients!
  • This means that in October, she should have had 2504 active patients = 2004 (active patients in Jan) + 500 (new patients through October.)
  • In fact, she lost 395 patients: 2504 (the active patients that she should have) - 2109 (actual active patients in Oct) = 395 fewer active patients.

How did this happen? And more importantly, is there anything that can be done to fix it?

We lose patients for one of 2 reasons:

  1. Patients get marked inactive because they died, moved, didn’t want to see you anymore, or you didn’t want to see them anymore. This should not equal more than 8-10% annual patient attrition.
  2. Patients who are marked active but have not been in the office for over 18 months. Studies show that only 5% patients who haven’t been in the office for 18 months will return.

These facts being true, what would you do if you experienced something similar within your practice?


When we dove into this practice’s data, the team saw how many patients were being lost each month and acted quickly. They didn’t want any patients to be lost, of course. With these new insights, the team decided to call all active patients that didn’t have a scheduled appointment. Additionally, they decided to send a “come back and see us” letter to the patients that hadn’t been in the office for the previous 18 months. Both of these action items were great. That being said, I still felt like I was watching my 10-year-old clean up the floor as the sippy cup continued leaking.

As humans, we want to fix problems - when we see a mess our natural reaction is to try and clean up the mess. But if we first take time to think, we’ll likely discover how to realize our vision and eliminate the situation, not just clean it up temporarily. My daughter wanted to clean up the mess on the floor, so she grabbed a paper towel and started cleaning. Although her intent was good, the floor would’ve taken much longer to be clean.


After the team made quite a few phone calls, we saw that out of 100 patients that were contacted, 20 of them picked up the phone. And out of those 20 patients who answered the phone, 80% of them scheduled, meaning out of 100 phone calls, 16 patients get scheduled. I then asked the team, “Do you like making phone calls?”. Sara, the team member who made most of the calls, quickly said “no!” When asked why, she replied, “I feel like I am wasting my time calling these patients.” Was it really a waste? Sara got 16 patients back onto the schedule. If the average production per visit is $300, then Sara brought back $4,800.00 into the practice. And every phone call (answered or not answered) was worth $48. She wasn’t wasting time, she just FELT like she was wasting time. Why?

My daughter who was cleaning up the floor also felt like she was wasting time, but why?

When Sara and Ocean stepped back to see the cause of the “mess”, they both came up with an inspired action item. That action item was to STOP the mess from growing. Then the cleaning would be more productive.

Ocean’s first action item was to take away the sippy cup from her little sister, and then clean up the counter, and only then to clean up the floor. Each step was now progressive and productive.

Spilled sippy

This was also true for Dr. Green’s team. Sara’s new first action item was to make sure that every patient possible leaves with a future appointment, and for those that didn’t leave with an appointment, she would create a follow-up to call them on a specific date, and for those that didn’t have an appointment or didn’t have a scheduled follow-up, she was going to call or text those patients or send them a postcard.

Where before she and the team were looking at the mess and trying to fix that first, they now looked for the cause of the problem and created an action item to eliminate it. This can be done with setting appointments, increasing case acceptance, improving collections, and many other aspects of a practice’s growth.

Real Results

In their morning huddle, Dr. Green and her team began focusing on how many patients left the office without a next scheduled appointment and why. By focusing on the cause and creating an action item, Dr. Green’s patients are now getting better care and the team is performing at a higher level, which in turn means that the office is producing higher profits. Higher profits meant things like new equipment, team bonuses, training, and so much more.

Do you want to take better care of your patients, improve team performance, and increase profitability? Of course you do! Just as Dr. Green discovered, the process need not be difficult. Begin by finding and fixing the source of the problem – the “leak.” Dr. Green used Dental Intelligence’s tools to do this, which allowed her to quickly see what was happening and what needed to be done to address the root causes. From there, she and her team worked together to change some of their systems and processes in order to keep the leak from happening again.

As you work together to fix your practice “leaks” and implement the changes your data suggests, some really exciting things will start to happen. Be patient with the process. Growth takes time. But as you persist and keep track of the metrics that are important to you, results will surely follow. Good luck!