Case Study: Increasing Production, Decreasing Cancellations

Do you have gaps in your practice?

Dental Intelligence


September 8, 2021

Do You Have Gaps in Your Practice?

If you’ve ever been to London and have ridden the London Underground, you’re probably familiar with the phrase “Mind the Gap.” This warning is placed in spots where a gap exists between trains and walkways and is a reminder to pay attention to the “gap” so you won’t fall onto the train tracks. The phrase was first introduced in 1969 and has since become a metaphor for paying attention to the “gap” between desired outcomes and current realities.

mind the gap

So, how wide is the “gap” in your dental practice between what’s optimal and what’s happening right now? Just a few inches away from perfection? Grand Canyon-sized? Somewhere in-between? Do you know? Is it even possible to know? Paying attention to the business side of your practice is a good beginning, but insufficient. In contrast, knowing which key indicators to pay attention to, and knowing what to do to improve those mission-critical areas, can be transformational for your practice and patients.

Growing Pains

A few years ago the leadership team at CarolinasDentist, a fast-growing, multi-location general practice headquartered in Fayetteville, North Carolina, realized there were several gaps between where they were and where they wanted to be. Aggressive growth was great, but it was also causing some real challenges. Cancelled and “no-show” appointments were averaging 25-30% in some practices and were projected to cost CarolinasDentist $1.8 million in annual revenue.

Many patients were leaving the practice without a scheduled next appointment. Treatment was being presented, but if it wasn’t accepted while the patient was in the office, they often got lost and missed out on needed treatment. CarolinasDentist’s hygiene departments were also underperforming, or at least, it seemed like they were underperforming. These and many other issues were creating some real headaches for the leadership team.

Dr. Eric Roman and Dr. Clifton Cameron, co-founders of CarolinasDentist, had anticipated these challenges, and they believed the plan they had in place to respond to rapid growth would be more than adequate. Their combined experience from working in dental service organization [DSO] operations was the inspiration behind the formation of CarolinasDentist.

This included the creation of their Complete Dentist Process, a proprietary training program that combines 25 unique skills and philosophies in a manner that allows dentists, even new graduates, to produce more than double the national average for a general dentist by month nine of their time with CarolinasDentist. Top performers with The Complete Dentist Process will often eclipse the performance of the top 1% of dental providers in the United States and the process has proven itself time and again with more than 50 dentists.

Having this and other systems and goals in place were certainly a significant factor in CarolinasDentist’s success. And yet there was something crucial missing: Actionable data insights. The leadership team knew they needed to make some changes, and they knew doing so would have a positive impact.

But what could they change? And if they changed something, how would they know it was the right thing to focus on? Implementing change based on emotions or what one can visualize is one thing. But making adjustments or course corrections based on actual data is much more effective. Knowing this, CarolinasDentist began searching for a solution.

The Power of Actionable Data

After looking at different partners, CarolinasDentist chose to work with Dental Intelligence. Dental Intelligence helps thousands of U.S.-based dental practices to discover opportunities and develop processes within their practice that can be implemented, measured, and verified for effectiveness. CarolinasDentist wanted much more than just a way to view their practice data. They needed help in analyzing and interpreting the results of their data, so they could act.

Josey Sewell, Director of People and Hygiene at CarolinasDentist, recently shared some of the ways understanding the meaning of their practice data has impacted patients and team members.

Interview excerpt:

Dental Intelligence:

“What was an issue you were hoping to resolve using metrics?”


 “We’d heard complaints that our hygiene team wasn’t producing to their full potential. At first this seemed valid, but in reviewing our numbers, we learned that, as is so often the case, what we thought was the issue, wasn’t really the issue.”

Dental Intelligence:

 “So, what was the issue? What did you discover?”


 “Our real problem was cancellations and no-shows. In some of our locations they were as high as 25-30%. This meant that on an average day, three out of ten scheduled appointments weren’t coming into one of our practices, which meant we weren’t providing our hygienists with sufficient opportunities to diagnose and treat patients. With the patients they were treating, the data showed they were actually performing pretty well.”

Dental Intelligence:

 “With this insight, what did you do?”


 “It was all hands on deck. We focused our entire team on lowering cancellations and no-shows. This included our front-desk team, doctors, office managers, treatment coordinators, and schedulers. Scripting was created that discouraged cancelling or missing appointments. Team members focused on helping patients to understand how important it was to keep appointments. Within a few months, our cancellations had dropped to less than 10% — a phenomenal improvement.”

Another problem CarolinasDentist’s senior leadership were trying to solve was the number of unscheduled active patients. With a monthly marketing budget of 4-5% of revenue, they were investing significant resources in trying to capture new patients. One of their locations with four dentists had a goal of adding 75 new patients each month, for each doctor. Before working with Dental Intelligence, CarolinasDentist’s total number of unscheduled active patients numbered in the tens of thousands. This number continued to grow each time a patient left an office without scheduling their next appointment. They knew this was a problem, but they weren’t sure how to go about fixing it.

As part of their training with Dental Intelligence, CarolinasDentist learned about a resource called Auto Follow Ups. This tool captured all of the unscheduled patients in a practice in one place, based on settings customized by the practice. For example, they could set up an automatic notification each time they logged into their software showing all unscheduled broken appointments or unscheduled treatment. Armed with this powerful data, CarolinasDentist focused on how to reduce the number of unscheduled patients. In January 2018, before they began using follow-ups, CarolinasDentist rescheduled about $2,500 in treatment. In February they went all-in. Between February 1st and the end of March, at just one location, they added over $66,000 in unscheduled treatment back onto the schedule. According to co-founder Dr. Clifton Cameron, “We committed to making follow-up calls daily, including a ‘Power Hour’ each day where every available team member jumped on the phone to call unscheduled patients.” In one “power hour” for example, they added over $16,000 in unscheduled treatment to the calendar.

“The impact on our team unity and culture has been amazing,” Dr. Cameron said. “Being able to see our key numbers in one place and having a system that empowered us to act on those numbers has changed our practice. We now look at our key numbers together during our morning huddle — on our smartphones – and then plan around how to hit our goals for the day.” A recent example of how this impacted a patient’s health was shared by Gabby, the team leader at CarolinasDentist’s Fayetteville office.

"Our huddle was a home run!” Gabby said. “We had a hygienist who was doing a right-side SRP, and by using the Dental Intelligence app, she was able to easily see the patient also needed a filling on the right side. We spoke to the patient as soon as they walked into their appointment and added that production to the schedule right then!! The best part is how appreciative the patient was for only having to get numb one time!"

The compelling “why” behind all of these efforts at CarolinasDentist was simple: Improving patient care. Rescheduling cancelled/no-show appointments or unscheduled patients could now be directly correlated to an increase in the number of healthier patients. A meaningful side-benefit was the positive impact these efforts also had on the teams in each practice. Using metrics to drive performance wasn’t the real point behind all the work CarolinasDentist put in to these initiatives. Their vision was to provide more and better dentistry.

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