Richard Scarborough speaks to Guy Deeming, the owner of Queensway Orthodontics and former Director for Clinical Practice at the British Orthodontic Society, about how lockdown accelerated the practice’s digital services, the new rules of engagement with patients and what life will be like after the ‘honeymoon period’…
Richard: While practices were closed you were very proactive in terms of moving things online. Why did you think this was so important?
Guy: A lot of the things that we’ve implemented were on our ‘to-do list’ for a while. When COVID-19 happened, it was a case of thinking ‘we can batten down the hatches and disappear or let’s accelerate the things that are on our list’, because not only did they suddenly seem more important but we also had the time to do them.
We happened to be fairly well-positioned anyway in terms of our digital outlook on the world, and some of the technologies that we were already using. We’re a very Invisalign®-heavy practice and already used Dental Monitoring, so our team were adept at using some of these platforms.
We also didn’t know what kind of business we were going to be coming back into, not just from a clinical point of view but also in terms of how our patients were going to view us. So, we wanted to take a positive approach and use the opportunity to reaffirm that we were there for patients and we were trying our best. This situation really freed us up to be a little bit braver and try new things.
And we’re not going to go back. I’ve got no intention of saying, “Well okay, that’s all over. Let’s pack it all up and go back to doing what we were doing before.” It feels like a travesty if through all of the sadness and the loss we can’t manage to take things forward so that we do make the world, in a very, very tiny way, marginally better for the people that we have contact with.
Richard: Can you tell us more about what you were doing digitally before lockdown that meant you were fairly well-positioned to move forwards with this way of working?
Guy: I’ve been doing Invisalign® for eight years and that’s grown significantly to represent a large portion of our private patients. We do around 450 Invisalign® cases a year.
The practice has also been using remote AI solutions from Dental Monitoring for around three years, and we have around 500 patients being monitored through that system.
Before lockdown we were also starting to look at virtual consultations as a way of widening our network and reducing potential barriers in the patient experience. It’s fundamentally inconvenient for a patient to go to a dental practice in the middle of the working day, and we need to recognise that.
When we went into lockdown, it became more important as the only way we’d be able to see patients, not just conveniently but safely.
There are two things I keep coming back to. One is that we have to behave in an empathetic fashion and recognise or understand how patients will feel about the things that we’re doing.
Moving services online somehow acknowledges that patients are going to be feeling anxious, and coming to see you is a risk that they would rather avoid. If we can remove some of that anxiety for them to at least establish whether they may or may not be suitable for any treatment, that’s a fantastic step.
The second is that we need to engage with patients in the way they want to be engaged. It’s no good opening your practice between 3.30pm and 3.45pm every other Thursday or only answering the phone on every 17th ring.
Before they actually start treatment, patients are consumers, whether we like it or not. And consumers want to be engaged how they want to be engaged, whether that’s via WhatsApp or social media or online booking. We don’t get to make those rules; those rules have been written by the likes of Amazon, Uber and Deliveroo. That ship has sailed, we are not in control of that conversation.
If you’re not starting to adapt or change your service offering to reflect those consumer behaviour patterns, then it’s going to become increasingly difficult. The numbers of people that are going to listen to a voicemail or pick up the phone is going to potentially reduce. That’s not COVID-19-related, the pandemic was just the accelerant.
Richard: Can you tell me a little bit more about your virtual consultations specifically?
Guy: We have four categories of consultations:
- We have Dental Monitoring for our existing Invisalign® patients, which was already up and running. We have a team of Dental Monitoring champions who have a good network through the specialist orthodontists to make sure their treatment is supervised properly.
- We also decided to do Digital Reviews for our fixed patients in treatment, which was effectively a way for patients to upload their photographs. Patients would then have an online video consultation for us to check, “How are you getting on? Are your teeth clean? Is anything broken?”. That gave us a mechanism to triage those patients so we knew what condition they would be in when they returned to the practice.
- We did some NHS virtual consultations to begin triaging our existing referral patients. We’ve done several hundred of these now and they’ve gone really well. We’re not considering them to be a full clinical assessment, because they can never be that, but they are a useful way of assessing and prioritising who needs to come in.
- Our private virtual consultations were done through SmileMate. Patients upload their photos, a report is generated that we can edit and add content to about their options, etc. Once that is sent to the patient, they are invited to a video call. It provides instant value to the patient because they receive a report, feedback from the dentists and an invite to a video consultation. Only then do we invite them into the practice (after reopening) to actually do the physical treatment.
Richard: How have patients reacted to these kinds of consultations?
Guy: It’s generally been amazing. Patients have really engaged with it and they understand the concept – it’s just not that big a deal to them. It’s much bigger news to us than it is to them.
The quality of conversations is much higher than you would imagine. This could be because in a virtual environment, there are less distractions (i.e. noises, worrying about running late etc). Also, in a practice it can feel as if the balance of power favours the clinician or treatment coordinator so patients can perhaps feel inhibited to ask certain questions, in a way they don’t feel that when they’re sitting at home via video.
The quality of the engagements being much higher is reflected in the feedback we’ve received. We’ve had lots of really nice comments and reviews, and our conversion rate for patients who subsequently come into the practice is 100%, because we’ve done all the preliminary work beforehand via video. Which is brilliant because it’s more efficient and safer.
Richard: What has been the reaction since you reopened, and how have you found it?
Guy: I was quite trepidatious before we started but it’s been okay. We didn’t quite get everything signed off before we went back in the way that we wanted to, because we thought we would have more time – and then the announcement was made from Boris on TV, but we got up and running.
We’re doing everything in a phased manner. We have several sites, so we opened one site, phased through the procedures, opened the next site, phased through the procedures there, and so on. And we’ve been able to move through those procedures a little faster than we expected, which is great.
After a few weeks, there has been a little bit of pushback from patients, which is to be expected. I see it as part of our duty that we need to understand where any problems are, where the evidence for that is and where the guidance is that says we need to improve or do something slightly differently. I think we’re probably in a bit of a honeymoon period where patients are just happy to leave the house and be seen by the dentist, and that may fade soon.
But patients generally have been fantastic and they have recognised that we’ve been present throughout. There is clearly a backlog, but we’re hoping to have that backlog cleared within the next four to six weeks based on our current activity levels.
I’ve been going on Instagram and Facebook and doing little videos to explain what we’re doing, and people have appreciated that we’ve been present and willing to give out information, even if it’s not always the message they want to hear – such as ‘we can’t reopen yet’.
Even if you don’t have much to say, in times like these it’s important to be visible – especially as a practice owner. Your team and your patients will respect you for it.
Richard: Once this ‘honeymoon period’ is over, what are your thoughts about what lies ahead over the next few weeks and months?
Guy: Clearly there will be a lot of economic and public health issues that we will need to deal with during the forthcoming period.
There is going to be an economic crisis in terms of unemployment and it’s highly likely that there will be further localised outbreaks of COVID-19.
All we can do is try and keep a firm hand on the tiller during the storm, and what gives me comfort is that we’re not trying to be perfect, we’re just trying to be better. Rather than aiming for perfection, just aim to maintain a commitment to moving forwards and improving things.
We don’t know what the economic impact will be, or the length, breadth and scale of any further outbreaks, so all we can do is keep going. Once you start to stagnate and navel gaze at any stage of owning or running a business, then it’s problematic. But never more so than at the moment.
In terms of cash flow over the next three to six months, I am cautious. We’re beginning to unfurlough the team and we’re going to start to encounter all the lab bills and other costs. So, cash flow is going to be a particular problem.
We will be very careful about how we manage that over the forthcoming period. But we have to maintain business growth, which means that by hook or by crook, we need to find a way to continue to invest in our messaging and in our marketing.
Because without that, even if you manage the short-term and you’re just burning through your reserves, you’re eventually going to look up and there’s going to be nothing left. If you’re eating from the freezer, you need to find a way of restocking the freezer.
Richard: You’ve obviously adapted your business, your technology and your mindset, and that’s absolutely fantastic to see. Thank you so much for sharing that with us, and I can only wish you the best of success.
Richard Scarborough is the Head of Medenta. Richard has many years’ experience in the dental sector, including as an Area Manager for a dental group. Medenta provides patient finance, enabling practices to offer their patients an easy, affordable option to spread the cost of treatments. For more information about Medenta call 01691 684175 or visit www.medenta.com.
Guy is a specialist orthodontist at Queensway Orthodontics. This means he has completed an extended period of training in orthodontics, in addition to his general dental training. Guy qualified with honours in dentistry at Newcastle University. After working in a number of hospital oral surgery positions in Manchester and London, he completed his specialist training in orthodontics at Guy’s and Kingston Hospitals in London, where he was awarded the Professor Walther prize in orthodontics.
When not at work, Guy enjoys spending time listening to and playing music, as well as spending time with his partner Katharine, son Eli and daughter Anouk.