Article Date: 4/1/2010

How to Create LOYALTY In Your Practice
patient loyalty

How to Create LOYALTY In Your Practice

The second part of this three-part series challenges doctors/practice owners to take steps to build long-term growth.

APRIL JASPER, O.D., West Palm Beach, Fla.

In the first installment of this three-part series, Dr. Jasper reviewed what she defined as the essential elements of patient loyalty. This month, the author discusses how to create loyal patients in your practice.

A number of doctors have told me that in the “old days” all we had to do was our job, and the patients would return year after year. Many go on to tell me that they cannot figure out how and why patients have changed. My response to both these statements is that it seems in the “old days” the doctor's focus may have been on building patient relationships and although patients have changed, I would argue that the behavior that has resulted in fewer loyal patients is that we, the doctors, have changed. As Jill Griffin, the author of the book, Customer Loyalty: How to Earn it, How to Keep it (Jossey-Bass, 2002) says, “Since the 1970s American companies have waged a fierce battle to win market share. Pursuing market share has made many companies more concerned with finding new customers than with holding on to old ones.” Research also shows that most businesses spend significantly more money on attracting new customers than they do on keeping existing ones. For example, how much money do many of us spend on phone book advertising? In most markets, such ads have been shown to be one of the least useful forms of marketing for established practices, yet we have a difficult time giving it up.


Loyalty starts with you

Patient loyalty must start with the doctor, or the CEO, of the practice. I like the illustration of the inverted pyramid Nordstrom uses to describe its philosophy and structure (as pictured above). What this illustration depicts is the doctor, or CEO, as the foundation of the entire company and more importantly, the inverted pyramid demonstrates that the most important people in the company are the customers (or patients) — as they appear at the top — and then the employees. Once we start to think in this way, we change our approach to businesses.

For example, if our patients are most important and they most often deal directly with the staff, then shouldn't we provide the staff with the training and tools they need to best serve the practice's patients?

Take it to the bank

All of us want quick fixes or a fast process we can initiate to make things happen. However, when developing patient loyalty we must think deeper. In his book, The 7 Habits of Highly Effective People (Free Press 2003), Stephen R. Covey discusses the metaphor of the “emotional bank account” — that is, the amount of trust that's built up in any relationship, whether it be in marriage, in business or with our children. We have to do things regularly to put deposits into the other person's account in order to develop a relationship with them. Expressions of respect, kindness, concern, fairness and appreciation can build up the account. On occasion the things we do — or the things we don't do — can actually cause a withdrawal from the account. If the account becomes overdrawn, the loyalty relationship is gone.

What makes this even more interesting is that because we are not all the same, an action that might create a large deposit in one person's account might not deposit anything in another. For example, developing a practice website that allows patients the opportunity to fill out paperwork and make appointments online may delight some patients (creating a deposit in their accounts), while it will have no impact on those who don't regularly use a computer.

Note that it is also not enough just to do what the patient expects, as that creates no deposit. It simply prevents withdrawals. Therein lies the argument against satisfaction as opposed to loyalty. Learn which actions will produce deposits, and then continue searching to find ways to create more deposits with each opportunity.

A genuine deposit

Remember that everything we do to create deposits in this emotional bank account has to be genuine. Our patients and employees know when we aren't sincere. To ensure sincerity, look back to your pre-determined mission for your business, and make certain that all decisions and all actions reflect and fulfill your core mission and values. The most genuine deposits occur when we put employees' and patients' interests ahead of our own. Such deposits are the foundation of enduring growth. Myopic-thinking leaders look only for financial gain in the short term. Yet as many businesses have demonstrated, the way to long-term growth is to build lasting relationships with employees and customers.

The staff connection

In the inverted pyramid, the staff is situated between the doctor and the patients. Our staff are the frontline, the people who have the most interaction with our patients. So, if we want to create loyal patients, it follows that we must develop a loyal staff.

A study done by Bain and Company, Boston, published in December 1999, found that fewer than half of the employees of U.S. companies consider their employer worthy of loyalty. I would again attribute this lack of loyalty to a lack in leadership in businesses. The way we treat our staff will dictate how our staff treats patients. The most successful employees are those who work for a leader they can believe in, trust in and emulate. They look for a leader who respects them and wants to grow their organization through their staff's success — and not at their expense.

In the Harvard Business Review article “The New Society of Organizations” (September-October 1992), Peter Drucker writes, “All organizations now say routinely that ‘People are our greatest asset' yet few practice what they preach, let alone truly believe it. Most still believe, though perhaps not consciously, what nineteenth century employers believed: people need us more than we need them. But, in fact, organizations have to market membership as much as they market products and services and perhaps more. They have to attract people, hold people, recognize and reward people, and serve and satisfy people.”

We establish a strong foundation for loyalty when we live and breathe our values and principles. When we develop our mission statement and principles, we are, in effect, creating a measuring stick by which we can judge all that we do. We must communicate these principles to employees on a regular basis and be sure to explain the results we expect from following them.

Measuring up

Now that we understand the foundations of patient loyalty, how can we measure it in a way that is meaningful for our practice? Just as we use financial benchmarks for our business, we should establish loyalty benchmarks. As we determined that employee development is essential to patient loyalty, I would recommend that you create a staff metric first.

One method of measurement is simply to look at the past five years, and note what kind of employee turnover you've had. How long does your average employee work for you? A good benchmark for the eyecare industry is a minimum of two years. If your employees leave you before two years, you may have a problem. You can determine where the problem exists by conducting exit interviews with every employee. Ask leading questions, such as:

► Why are you leaving?
► What could we have done to encourage you to stay?
► Are you leaving for a similar position?

Another way to evaluate staff turnover is by a percentage benchmark, which in most industries is 24% annually. Simply put, if you have four employees you shouldn't have more than one leave you per year.

You should also create a survey for your current staff to take. One survey I found in my research that I would recommend as a model is the Loyalty Acid Test survey, created by loyalty expert and author Fred Reichheld (see Table 1, below). His surveys have been used extensively by many Fortune 500 companies with great success. You can find the most updated survey online at You can take the outline of this survey, and personalize it for your business. Be willing to share the survey results with your staff, and make the changes necessary to promote employee loyalty.

The same website includes a customer survey which you can adapt to your practice as well (see Table 2, below). Remember to keep the staff surveys anonymous. Patient surveys can be given to everyone if you would like, however Mr. Reichheld suggests in his survey tips (that are also on the website) that you may want to pay special attention to the results sent back by the 20% of patients that are responsible for 80% of your revenue. If you wish to benchmark your results of the two surveys, the results of the top-performing companies can be found under the “results” section on the website. OM

The final installment, which will appear in the June issue, discusses the costs of failing to achieve patient loyalty and how to foster such loyalty within your practice.

Dr. Jasper is in private practice in West Palm Beach, Fla. 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: April 2010