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Article Date: 8/1/2001

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Patient Satisfaction: Part I
Unlocking the SECRETS . . .. . . to exceptional patient satisfaction.
BY STEPHEN COHEN, O.D., Scottsdale, Ariz.

If it ain't broke, break it." In my practice, this is the motto we live by, and it doesn't refer to equipment but rather to increasing patient satisfaction. When you think about it, it's rare to truly encounter outstanding service. And when we do, we don't forget it. The key isn't to do what others aren't doing. It's doing what others aren't willing to do.

From day one

Since I started in practice in 1985, my staff and I have placed a major, ongoing emphasis on increasing patient satisfaction.

I have yet to find a better formula for practice success than diligently and consistently making patient satisfaction the priority. Simply put, it merely requires a little more effort all of the time.

Although we recognize that other practices may offer longer hours, quicker service or lower prices, we had something that no one else had -- a unique mix of individuals who work well together. In essence, because "we" couldn't be found in any other practice, we had no competition.

This attitude has helped us address challenges from managed care, discount chains, mail order and decreased profit margins.

Catch Me Caring

We leave the following form in obvious places around the office -- in the reception area, in exam rooms and at the dispensary. When a patient positively comments on a staff member's performance, we hand the patient one of these forms to complete. The completed form then goes into the employee's personnel file. We might also discuss the patient feedback at staff meetings to offer positive reinforcement. Here's how the form appears:

Our goal is to always offer service "above and beyond" what is expected. You can help us acknowledge members of our team who achieve this goal. Please take a moment to fill out this form. Thank you!

Your name (optional):

Name of team member:



The benefits we've reaped

Offering a high level of patient satisfaction has helped me to successfully increase patient and staff loyalty, staff morale, referrals, efficiency and productivity, while also decreasing staff turnover and the likelihood of malpractice suits.

While many doctors might complain about staffing issues, I've had the opportunity to work with some wonderful people for many years. Staff turnover has been very infrequent.

Also, as a result of our efforts to focus on patient satisfaction, we see a high number of fee-for-service patients. It's gratifying to see so many patients who are willing to "go outside the plan."

Can you commit?

Before implementing any change, first and foremost you need to assess how willing and how committed you are to making changes that will enhance your practice. The real challenges are resisting the urge to try something new, fighting the inertia to maintain the status quo and having the willingness to break the traditional mold.

Just begin. The rest is easy

In the first part of this two-part article series, I'll touch on some key areas of practice that we've focused on to improve patient satisfaction. I think you'll see that these concepts require little time, resources and cost to implement.

  • Who are those people you work with? Staff recognition is the number-one factor in staff satisfaction. Unfortunately, many practitioners believe that if they give too much positive reinforcement, staff members will become complacent.
    I remember hearing one doctor say that he didn't offer many kudos to his staff because he didn't "want their heads to get too big." This approach is one that needs to be broken. Excellence begets excellence, and positive reinforcement creates a desire to earn more positive feedback.
    One simple way to begin is to say "thank you" to the people you work with. At the end of the day, sincerely thanking them for their efforts offers an outstanding return on investment (ROI). I've taken staff recognition one step further by producing a simple form called "Catch Me Caring" (see form). We conspicuously display these forms in our reception area, in the exam rooms and in the dispensary. When a patient tells us about how helpful a staff member was, we offer him a form to fill out, explaining that these completed forms are added to the staff member's personnel file.
    We sometimes review these forms at regular staff meetings, possibly including small rewards for the staff member, such as certificates, small bonuses or small gifts (for example, movie tickets).
    While considering the possible merits of this idea, ask yourself: When was the last time you didn't like being thanked, acknowledged or told you were doing a terrific job?
  • What you are speaks so loudly that I can't hear what you're saying. Perhaps the next question you need to ask is whether you lead by edict, or example. Your staff will intently listen to what you say, but they'll even more critically observe what you do. How you address, describe and interact with your patients will determine how your staff does the same.
    If you make disparaging remarks or roll your eyes when a difficult patient leaves your office, or if you put off calls from patients, can you expect your staff to treat patients with respect and consideration?
    How your staff treats patients boils down to four factors:
    1. what you say
    2. how you say it
    3. whether you mean it
    4. how you act it out.

As the old adage goes, "A leader without followers is merely taking a walk." So, if you see your staff displaying negative behavior toward your patients, don't chastise them until you've held the mirror to your own face.

  • Did you ever notice that wrong numbers are never busy? While analyzing staff issues, training is critical. Remember that worse than training your staff and losing them, is not training them and keeping them! As part of that training, we need to evaluate telephone technique. (I could fill an entire journal with discussions on this one item!)
    First, let's look at a relatively new technology in our offices: the automated telephone system. Consider how you perceive a business that offers you a recorded menu of options, supposedly designed to provide convenience for you, the caller. As optometrists, we're part of the service industry. An automated phone system suggests to callers that we're too busy to provide personal service. Is that the first impression you want to give?
    If you already utilize an automated phone system and consider it essential, make sure that calls are quickly routed and promptly answered and that callers aren't put on hold once they speak to a staff member.
    Now, let's focus on a specific question that your office probably gets daily. Answered incorrectly, this question illustrates a classic telephone pitfall.
    When a caller asks about the cost of an eye exam, how does your staff answer that question? I posed this question to a paraoptometric association group. One enthusiastic individual responded that when someone calls, she first asks: "Do you have insurance?" I asked her why she said this, and she explained that it could save time for the caller and herself because the office might not be a provider for a particular plan. She also said that knowing what type of insurance the patient has will help inform the patient of the exam cost. Although her explanation and approach made perfect sense, it probably wasn't the message the patient received.

Intent vs. impact

We need to understand the difference between intent and impact. The intent of what one person says has little or nothing to do with how another person receives that message (the impact). While the intent of the staff member was to assist in providing accurate information to the patient, the impact on the patient was: "They're only interested in how I'm going to pay for this."

There's a maxim in negotiations: He who mentions money first, loses. This can apply to prospective patients. Few people call to find out the cost of an eye exam. Instead, they're likely trying to form an impression of the office, but they don't know what else to ask so they resort to asking about the cost of an exam.

Learning from infomercials

Once a caller gets the quantitative answer to that question, he often doesn't hear anything else. Think about infomercials. Few people like them. But they're effective, primarily because they offer features before they offer the cost -- "How much would you pay for this? But wait, there's more . . . ." This approach maintains interest and creates a sense of value versus cost. I'm not suggesting you follow this often-obnoxious approach, but it does help illustrate why answers to callers' questions need to be carefully structured.

Another telephone pitfall involves subtle wording changes. There's a big difference between the statements, "We can't see you until Wednesday, August 22," and "We can see you on Wednesday, August 22."

Each statement relates to the same appointment. However, one describes what you can't do, while the other describes what you can do.

This example is similar to an optician in your office saying, "Don't come in between 12 p.m. and 1 p.m. to pick up your glasses," versus "Come in any time between 8 a.m. and 12 p.m., or 1 p.m. and 5 p.m." You can easily see which statement sends a message of accommodation and service to patients.

A look at the competition

One of the best ways to address these issues is to have your staff members call several offices in your community and also have someone call your office. Once the research is completed, schedule a brainstorming session with staffers. If you solicit your staff's input about which approaches worked best, they're more likely to embrace solutions.

To improve techniques in your office, try the following:

  • Have the person answering the call introduce him/herself.
  • Stress that the person remain positive and enthusiastic.
  • Describe the services your office provides.
  • Engage callers in conversation to ascertain their needs.
  • Ask whether the exam is for glasses, or contact lenses and glasses (not contact lenses or glasses).
  • Attempt to schedule an appointment.

Following the infomercial approach (but not its tone) can increase the probability that the caller will become a patient. Most important in all patient encounters, make sure that you and every staff member consistently tell patients what you can and will do, versus what you can't and won't do. As a litmus test, note that if the first question you typically get from patients is "how much," then they're probably not hearing enough about your practice's benefits.

  • Why is there time to do something over again, but not to get it right the first time? While we're on the topic of communication, consider how you and your staff convey information. As simple as it may sound, our busy schedules often cause difficulty ensuring that we transfer critical details.
    One suggestion is to personally introduce your patient to the optician (who can be described as the expert in glasses) and pass on pertinent information. "Shelley, this is Ms. Noble. Ms. Noble is getting bifocals for the first time, and we discussed the benefits of progressive lenses." What you're likely to see is the patient nodding her head in agreement.
    This approach conveys to the patient that you both understand the information discussed and that it has now been passed to the appropriate staff member.
    You could take a similar approach with a front-office staffer after you've completed a patient's exam. "Rachael, everything with Ms. Noble's eye exam looked great today. We need to see her again in 1 year because of her family history of glaucoma."
    This approach reinforces what you discussed with the patient in the exam room, and it indicates to the patient that your staff member, Rachael, must be a significant member of the team because you took the time to share this information.


Care Calls


Here's a short form that I keep handy when I see patients. If I have a need to briefly call the patient later that evening, then I fill out this form after I examine the patient and put the paper in my pocket as a reminder.





Transferring authority

The term for this process is "transfer of authority." This skill can be taught, learned and practiced. Companies such as Disney refer to these encounters as "moments of truth." Whatever you call them, you'll provide a service to patients by ensuring continuity in addressing their needs throughout your office. You'll also automatically diminish any possible miscommunications and misunderstandings and reinforce things such as optical sales and recall efforts.

If you're not sure you have time to follow procedures such as these, think about how much time you and your staff spend correcting mistakes and misunderstandings. This may help you to "break" the way you've always looked at this issue.

  • Patients don't care how much you know until they know how much you care. So often we hear people describe a particular doctor as "one of the best." I'd like to know where this list is kept and how can I apply for inclusion. The reality is that trust, confidence and a caring concern are the criteria by which patients judge clinical competence. For simplicity's sake, let's look at two of many ways that you can easily communicate these qualities.
    • Scenario #1. During an exam, a patient asks whether the contact lenses will arrive prior to her vacation to Hawaii. What do you say? In addition to reassuring her and making sure the "transfer of authority" occurs to ensure that the lenses arrive in time (and perhaps asking the patient if you can carry her luggage!), you can do one more thing. On the exam form, write down that she's "going to Hawaii next week." When she returns the following year, you'll likely review her previous exam. In your notes, you'll have a reminder about her vacation, and you can enter the exam room inquiring about her trip to Hawaii.
      As another example, if a patient is reading a book, a notation you write this year can prompt the question next year, "Read any good books lately?" Ironically, as you make these simple notations, you'll find that you often remember these details even before reading them on the previous year's exam form.
    • Scenario #2. You see a patient on an emergency basis who has a corneal abrasion. In this type of situation, would you routinely call the patient that night?
      The best answer to this came from a doctor who responded, "It depends upon how serious the abrasion was." The follow-up question to this doctor was, "What's the difference between major and minor surgery?" He answered, "general anesthesia." The response to his answer was, "Minor surgery is somebody else's body. If they're cutting on your body, that's major."
      The issue here is that although we might have seen many abrasions more impressive, this patient is in pain. What better way to demonstrate your concern and interest than to call him at home to see how he's feeling?
      Two types of healthcare providers are the best at doing this: oral surgeons and veterinarians. Although oral surgeons may joke that they call you at 8 p.m. so that you won't call them at 2 a.m., the message of caring concern is undeniable. Veterinarians often call, and they can't even speak with their patients!

The best intentions

Remember that the key is to do what others aren't willing to do. Many of us have good intentions to call these particular patients but may forget or have trouble finding the patient's chart at the end of the day. Others may feel that if they call patients in the evening, they'll be kept on the phone interminably. The reality is that our patients are busy, and they also respect our time. These calls tend to be brief anyway, and the bottom line is that if you care, then call.

I've found an easy way to remind myself to make these phone calls after a long, busy day. I designed a short form (see "Care Calls" ). I print two of these forms on an 8 x 11 sheet of prescription pads that I keep in each exam room. When appropriate, I complete the form and tuck it in my pocket as a reminder. You can then forget about it until you get home when you, amazingly, empty your pockets! Even several calls take only a few minutes.

Not only will this simple step help to solidify your relationship with your patients, you'll also likely garner referrals from them as they sing your praises to others. If you're feeling really enterprising, you can use the Care Call form to call new patients. Check with them to see if they have any questions, to make sure they were well-treated in your office, to thank them for coming in and to tell them you're looking forward to seeing them next year for their next exam.

Believe me, if you take the time to implement small, caring steps like these no managed care list or advertisement from a discount chain will easily entice these patients from your care. Again, the question to ask yourself is how you'd feel if you were on the receiving end of such a phone call.

The journey of thousand miles begins with the first step

Exceeding patient expectations isn't always easy, but it's always worth it. If your goal is to strive for excellence rather than merely settling for mediocrity, you need to commit yourself to doing a little more for each and every patient.

The ideas I've offered aren't costly and should take little time and effort to implement. Remember: To increase staff and patient loyalty and satisfaction, raise your right hand and repeat after me . . . "If it ain't broke, break it!"

(Next month in part two, I'll discuss ways that we've improved patient education.)

Optometric Management, Issue: August 2001