Article Date: 3/1/2010

The Essential Elements of LOYALTY
patient loyalty

The Essential Elements of LOYALTY

The first of this three-part series describes how patient loyalty can help you thrive, even in difficult economic times.

APRIL JASPER, O.D., F.A.A.O. West Palm Beach, FL.

Customer loyalty is the bulwark of a highly successful business. In fact, in a depressed economy as we are now experiencing, patient loyalty may very well be the essence of survival. Although we are highly trained health care professionals, we are vulnerable to the same economic dangers faced by any other business owner. This article is designed to help all of us who diligently care for our patients to ensure not only that patients receive the best care but also that we, as their providers, firmly secure the ability to provide that care for the foreseeable future.

Satisfied vs. loyal

It is helpful at the outset to differentiate patient satisfaction from patient loyalty. Although commonalities exist between them, these traits differ in that satisfaction is an attitude whereas loyalty is a behavior. As author and leadership expert Ken Blanchard explains, “customer loyalty occurs as a result of positive experiences with your office's services, personnel, policies, procedures and products.” In other words, you become a “habit” to your loyal patients, and you are indispensable to them. In his book Customer Loyalty Concepts (Lito Press, 2008), author Jeffrey Gitomer notes that “once you realize that satisfaction is the lowest level of acceptable service, you at once understand the power of loyalty.”

The study of customer loyalty has become a major part of all industries, including health care. The science of customer loyalty is called customer relationship management. Gallup research says that the biggest trend in all industries today is developing ways to turn all patients and customers into loyal ones. Many researchers and authors have gone so far as to say that we are in an age when we must maximize patient and customer relationships, or perish. In health care specifically, we must create a relationship with our patients that supersedes their relationship with the insurance companies.

How do we define patient loyalty? A loyal patient is one who wants to do business with you, and only you, whenever they are in need of your service or product. A loyal patient feels that they cannot live without you to such an extent that they will drive out of their way to see you even when you charge more than the doctor right down the street from them. Furthermore, a loyal patient does not consider your participation in their insurance plan to be a prerequisite to seeking your services.


There are at least 10 positive consequences associated with patient loyalty:

1 Improved Adherence

This component of patient loyalty requires that we understand the difference between compliance and adherence. Compliance implies an involuntary act of submission to an authority, akin to a parent-child relationship. Adherence refers to a voluntary act of subscribing to a point of view. Adherence is very important to the welfare of our patients and is much more likely to occur when patients feel that the doctor respects them and their concerns about their condition and treatments. The loyal patient has a much greater desire to adhere to medication and preventive behaviors because of the positive relationship they have developed with the doctor. Patient adherence is thus a direct result of patient loyalty.

2 Greater Trust in the Doctor's Recommendations

When a patient has a loyal relationship with the doctor, they have a genuine belief that the doctor is only going to make recommendations that are in that patient's best interests. They see their doctor as a friend who understands them and cares about their well-being. Consequently, the loyal patient does not question the doctor's intentions or recommendations. Fewer explanations by the doctor and staff are required because of the trust a loyal patient has in the motives of the office.

3 Greater Tolerance of Minor Problems

Every office will have days when minor problems occur. The phone isn't answered within three rings or the computers don't work or, worse yet, the patient care coordinator forgets a patient who is waiting in reception for a visual field test. These situations are difficult for the ordinary patient to tolerate, and such inconveniences might keep even a satisfied patient from returning. In contrast, minor shortcomings will not change the loyal patient's opinion of the practice. The loyal patient feels like part of the family and knows that these things happen. They may even laugh and enjoy the moment with you instead of being annoyed.

4 Fewer Complaints

A problem that may result in numerous complaints from a satisfied patient will fail to change a loyal patient's attitude about your office, and may even create in such patients a desire to help. Loyal patients provide feedback to your office that is most often in the form of constructive comments. They are active in providing suggestions for improvement because they have a positive relationship with the office and know you often implement change as a result of their feedback. Loyal patients can be the best source of ideas for positive change in your office.

5 Word-of-mouth Referrals

Loyal patients find you indispensable and therefore want you to remain in business. They have an emotional relationship that may even be stronger than that of a business partner because they have nothing to gain financially. As Michael Cafferky notes in the book Let Your Customers Do the Talking (Upstart Publishing 1995), the loyal patient enjoys being a point of reference for others as this helps the patient gain attention, increase their status, assert their superiority and demonstrate their awareness and expertise. Loyal patients have a fierce desire to tell their friends about you, especially after a great experience at your office. They know your treatment will make the referring patient look and feel good. In short, loyal patients will help you build your business one referral at a time.

6 More Frequent Visits

Loyal patients visit the office more frequently and with more consistency. The moment they have any need of your service or product, they call. They understand the value of your services, and follow your recommendations for return visits for themselves and their families. In fact, they look forward to their visits with you. In the book Customers That Count (Financial Times/Prentice Hall ), Tony Cram notes how this taps into basic human behavior: People seek positive experiences and avoid negative ones. The more positive a patient's association with your practice, the more readily they will present for care.

7 Full Service Customer with Higher Spending Patterns

As you expand your products and services, loyal patients are eager to experience new offerings. They trust that these are good for them because you recommend and provide them. Furthermore, they typically do not question the cost because they understand the value they derive from your practice. There is a well-established principle in economics called Pareto's Law or the 80/20 rule. It states that 80% of effects are achieved with 20% of the causes or agents of those effects. For optometrists, the implication is this: Twenty percent of our patients contribute 80% of our income, and 20% of our patients account for 80% of our complaints. Of course, those 20% are not the same patients: Loyal patients account for 80% of our income, but they generate few, if any, complaints. Thus, loyal patients are a practice's most valuable asset.

8 Fewer Malpractice Claims

In Risk Prevention in Ophthalmology (Springer, 2008), author Marvin Kraushar notes that patients do not come to a medical office with prior intent to sue. While patients may not be able to judge the level of medical care they receive, everyone knows when they are treated with respect. It has been established in many studies that patients don't pursue malpractice claims against doctors who listen to them. The establishment and continued nurturing of the physician-patient relationship can overcome almost any problem that arises. Loyal patients are typically quick to forgive because they feel that their doctor cares.

9 Defender against Unjust Criticism

Loyal patients are your champions. They will immediately and energetically correct others' misunderstandings of you and your office. By their words and actions, loyal patients shape attitudes and perceptions about your practice before others have had an opportunity to experience it for themselves.

10 Creation of the Raving Fan

Ken Blanchard and Sheldon Bowles state in their book Raving Fans (William Morrow, 1993) that if you really want a booming business, you have to go beyond satisfied customers and create raving fans. A loyal patient is your raving fan, one who is excited about your services and products and acts as cheerleader for your practice.

In conclusion to a discussion about patient loyalty, it's worth considering this famous quote from Ralph Waldo Emerson:

It is one of the most beautiful compensations in life that no man can help another without helping himself. OM

In the next installment, Dr. Jasper will discuss the foundations of patient loyalty and how to quantify loyalty over time.

Dr. Jasper is in private practice in West Palm Beach, Fl. She graduated from Nova Southeastern University and completed a residency in ocular disease at the Brockton/West Roxbury VA Medical Center. She is a fellow of the American Academy of Optometry, trustee for the Florida Optometric Association and a VisionSource administrator. E-mail Dr. Jasper at

Optometric Management, Issue: March 2010