The stage-4 exercise: Lakeshore Print Co.

What a full-marks stage 4 looks like — the clinic

Below is the stage-4 response for Grand River Family Dental, with each R-psp-4 line labelled in brackets where it is earned. Read it for shape: the recommendation first and alone; the link to the matrix with the sensitivity in the same breath; the objectives checked one by one; the planted issue handled inside; the counter-consideration answered; the risk table; the numbered steps with a checkpoint. Then write Lakeshore's.

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Recommendation. [a single clear recommendation] Move to an online-booking system with automated reminders (option C). On the figures Tomas supplied and assuming the receptionists can be trained within a fortnight, it is the strongest of the four options.

Basis. [linked back to the criteria and the matrix] It scored highest, 3.90 against 3.75 for the hybrid, 3.10 for reminders alone and 2.20 for the paper book, on criteria weighted toward the two objectives the dentists named: fewer no-shows (0.30) and an end to double-bookings (0.20). The lead over the hybrid is not robust — moving 0.10 of weight from no-shows to ease of use puts the hybrid ahead, 3.75 to 3.60 — so the choice between them turns on training burden, and the recommendation would change to the hybrid if the front desk cannot absorb the training in a fortnight.

Against the objectives and values. [revisits the client's goals and values] Dentists: no-shows expected to fall from about 12 % — the evidence is the peer-reviewed review of reminder systems, not the vendor's figure — at about $1,800 a year; no disruption to clinical days if go-live is in a quiet week. Tomas: one shared calendar ends double-bookings. Receptionists: training is the cost, timed to a quiet week. Patients: booking online or by phone into the same calendar, and a reminder either way. [the ethical element, inside] The vendor has offered Tomas a referral bonus for signing; because Tomas is selecting the system, this is a conflict of interest. I recommend that he disclose the offer to the dentists and decline it in writing, that the vendor stay on the shortlist and be scored on the same criteria as the others, and that the dentists approve the final choice — so the recommendation can be relied on as independent.

Counter-consideration. [acknowledges the strongest counter-consideration] The hybrid keeps phone booking for existing patients and so asks less of the receptionists in the first month. Answer: the full system's calendar also accepts phone bookings — the difference is only whether new patients are steered online — and the no-show gain is larger with reminders on every booking; if the training risk materialises, the hybrid is the fallback at the checkpoint, not a reason to start there.

Risks. [names the top risk and a mitigation] Top risk: reminders reduce no-shows by less than expected — mitigation: no-show % measured monthly, and a review at three months with the reminder-only option as the fallback; owner: the dentists. Also: low patient uptake (phone bookings keyed into the same calendar; Tomas) and training landing in a busy week (onboarding in a quiet week; Tomas).

Next steps. [next steps with owners and dates] 1 Dentists approve — 28 March. 2 Tomas obtains two written quotes, declining the bonus in writing — 11 April. 3 Dentists select and sign — 25 April. 4 Onboarding and go-live — Tomas and the receptionists — week of 12 May. 5 Checkpoint: no-show % and double-bookings reviewed against the 12 % and two-a-month baselines — Tomas to the dentists — 15 August.

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Notice what is not there: no "it depends"; no "clearly"; no ethics paragraph at the end. The guarding phrases (on the figures supplied, assuming the receptionists can be trained within a fortnight) each name an assumption; the flip condition is a fact Tomas can check.

Now Lakeshore

You have every piece: the recommendation sentence and its flip condition (L7.1), the guarded wording (L7.2), the objectives check and the tickets paragraph (L7.3), the risk table and the buy-versus-lease counter-consideration (L7.4), the five numbered steps and the February checkpoint (L7.5). Assemble them in the shape above. Two rules from the module carry the most marks: the tickets are handled inside the recommendation — disclosed, declined, the vendor kept on merit — and the wording commits to one option without a single assurance.