Article Date: 8/1/2001

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.

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.

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:

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.


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.

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