Presenting Fees and the Silo Principle
In my work with Treatment Coordinators, I stress the importance of having an effective structure – and sticking to it – when managing the patient-visitor consultation. It’s important to remember that most practice visitor(s) want and expect you to maintain a leadership role during this meeting. After all, you are the expert, this is your domain, and the visitor has never been to your practice before. The implications are simple and straightforward: You are in charge, and the patient wants you to be in control of the meeting.
This makes having a standard agenda, or structure, for the consultation central to making a professional impression and getting to ‘yes’. In my observation, having an agenda is the easy part.
Staying on track, however, can be another matter entirely.
It is easy to get to get side-tracked from the agenda – I call this “pattern interrupt” – during the course of an initial meeting. More often than not, the deviation is initiated by the patient(s). The most common example that I see is during the fee review, when the parent suddenly interrupts the TC’s fee presentation to ask a question about a subject unrelated to the one at hand, such as the appliances.
In other cases, the patient may make a comment about something related to the child’s behavior or personality, the TC has an anecdote of his or her own, and the conversation happily goes off in a direction unrelated to the topic at hand. From a rapport-building standpoint, this is a positive event, but if you and the patient find it difficult to remember where you were in the meeting when that conversation is over, the topic wasn’t helpful at this point in the meeting.
I want to stress that the message here is not to be unfriendly and business-like during the meeting – far from it! Establishing rapport and engaging in small-talk is one of your most important skills for success. However, there is a time for doing that. There is also a time for discussing appliances, a time for additional questions about appliances, a time for presenting fees, a time for making the decision to start treatment, and ample time for anything else that you and the patient would like to discuss after those things are completed. Think of these steps as “silos” – events that are independent of one another.
If you don’t stay in control of the meeting and execute the steps in sequence, this can water down the perceived value of your services, unnecessarily extend the length of the meeting, and occasionally, you may even see a patient talk themselves out of a decision to start treatment.
The structure that I teach TCs follows what I refer to as the Silo Principle, which basically means there is a time set aside for each step in the process. Typically:
- Establish rapport/review patient information
- Records and x-rays (this step varies by practice)
- Doctor assessment and treatment recommendation
- Review of appliances
- Presentation of fee options
- Address concerns properly / negotiate effectively
- Decision to start or schedule next meeting
- Loose ends/outstanding issues
- Rapport/small talk/conclusion
The “Silo Principle” means that each of the above steps are mutually exclusive, meaning that the TC usually avoids deviating or jumping from one topic to another; in other words, one is completed before the next one begins.
So how do we balance staying on track with maintaining good rapport with practice visitors? What do we do when the patient attempts to interrupt the process? Handling those situations is not at all difficult.
Remember that, in any communication, the person asking questions in in control of the meeting. This means that when a parent suddenly asks you a question such as “about this Herbst appliance; can’t you get the teeth to align properly without it?” they have temporarily taken control of the discussion. If you as the TC continue the Herbst appliance discussion now, you are following their lead. You are no longer following your plan, and have temporarily given control of the meeting to the person asking the question. So we need to avoid doing this now.
The appropriate ‘silo’ here from my list is “loose ends”/outstanding issues”, so, to put this topic into its proper sequence, the response should be:
“That is an excellent question, and if you will bear with me, I’ll be happy to explain why the Herbst appliance is the best approach in just a moment. In the meantime, I’d like to finish going over these financing options with you first. Would that be okay with you?”
The patient will say “that’s fine”, and you will stay in your fee-presentation ‘silo’ and remain on track. Note that the question “would this be okay with you?” returns control of the meeting to you. Following the completion of the fee presentation, you will address the patient’s question. Everyone is happy here; the patient gets their question answered, and you maintain control of the meeting.
The benefits of staying focused and treating the steps of the meeting as independent ‘silos’ does more for you than reinforce the perception of you as patient-focused, empathetic, and professional. It makes for better time management, keeps you organized, and improves your ability to start new cases.
