Article Date: 10/1/2004

patient loyalty
Satisfied Patients Don't Refer
Satisfied patients don't necessarily refer others to you. Loyal patients are the ones keeping your practice afloat. So cater to them.
BY JERRY LIEBLEIN, O.D., Montara, Calif.

During all my years of practice, I've always believed that if I satisfied my patients they'd refer others back to me. However, this wasn't always the case. So what happened? These satisfied patients didn't break down the door with referrals as my college instructors told me they would.

I've looked through my charts to see which patients referred other patients to me and how many they referred. I also asked my colleagues to do the same. What I've learned is that satisfaction alone isn't enough to build the loyal patient base we need to survive in this competitive industry. So let's take a look at how to build and keep loyal patients.

Reality check

All of the management experts I've spoken with explain that I need to exceed patients' expectations and find ways to make them happy. But no matter how hard I tried, I couldn't make them happy. I started to look at various books on loyalty, and I came across the following statements.

► Forum Corporation reported that 40% of the customers in its study who said they were satisfied switched to a new person with no hesitation.

► Harvard Business Review said that 65% to 85% of customers who did switch did so even though they were satisfied.

► Dr. Robert Petterson at the University of Texas reported that 85% of the patients who said they were satisfied switched to other providers.

Reading these statements caused me to step back and do some real thinking. If a satisfied patient doesn't refer, then who does?

Identifying the referers

One of my colleagues recently mentioned how he frequently conducts patient satisfaction surveys. He also mentioned that his satisfaction score is up again for the fifth year in a row. "Now," he asked a group of us, "Will someone explain why my practice is declining?"

All of this information tells me that we need to take another look at how we define satisfaction. And if we base our practices on satisfying our patients, then I believe we're being unrealistic. We need a new measurement and that's loyalty.

I looked up the definition of loyalty and found that it's a behavior pattern, not an attitude, as is satisfaction. If a patient is loyal, then he'll behave in a purchase pattern of multiple units, and will buy more and thus spend more. But loyalty doesn't come overnight and it requires a length of time for us to build this relationship. The longer our patient remains loyal to our practices, the more they'll spend.

Lessons of loyalty

All of the marketing studies show that it costs six times more to bring a new patient into your practice then it does to market to your existing patient base. The bottom line is that we end up with price shoppers who will leave you for a better price. Simply stated, it costs less to sell and service a loyal patient.

I don't believe we can make every patient into a loyal patient. Some people will price shop no matter what and will leave you for the simplest reason no matter how you treat them. What we do need are the true, loyal patients who will build our practices the fastest. You know who they are in your office. They're the ones who tell all their peers about you; they're the vocal advocates of the practice.

Unlike satisfaction, which is an attitude, we can define loyalty in terms of a buying behavior. And loyal patients will make repeat purchases, refer others and most importantly, be immune to the pull of your competition.

Inspiring loyalty

So how do we develop and train our patients to become true, loyal patients? The first step is to make sure your staff understands the value of loyal patients. Your employees are patients' first contact and an employee's actions can turn off a patient. The reality of this is frightening in that you (the doctor) aren't involved in this first contact.

Many offices lack an effective program for hiring and training employees. If you understand what builds loyalty for the practice, then you can train your staff to encourage patient loyalty. Your office(s) should have an office manual that contains your well-written and easy-to-understand loyalty program.

Next, you need to develop trust in your patients. Without trust, there's no credibility and for patients to consider you credible, you must impact them a minimum of four times (e.g., someone mentioning you, reading about you or seeing you). The more times a patient hears about you, the greater your credibility becomes. It takes time and patience to build credibility in your patients, but once you attain it, they'll trust you and that's the first step in building loyalty. See "Steps for Building Loyal Patients" on page 80 for more tips.


Can't Get No Satisfaction (But That's O.K.)


Business experts agree with Dr. Lieblein that loyalty far outweighs satisfaction. In fact, customer service pro Jeffrey Gitomer wrote a book about it: Customer Satisfaction is Worthless, Customer Loyalty is Priceless (Bard Press). Mr. Gitomer discusses the company that boasts a 97.5% customer-satisfaction rating. He say that means that 2.5% of the customers are mad "and they're telling everyone" about the experience.And what might be worse, Mr. Gitomer adds, is that the other "97.5% of customers will shop any place the next time they go to the market for a service or product."

Why won't satisfaction create loyalty? In optometric practices, doctors and staff alike are expected to provide quality service to patients. When a practice fulfills that expectation, the patient is satisfied but the practice has only met expectations -- it didn't exceed them and it didn't necessarily make an impression. While dissatisfied patients likely won't return to a practice, raising satisfaction ratings and building loyalty are two separate and different processes.

Mr. Gitomer looks for start-to-finish approaches to service that lead to memorable experiences for the patient. He finds examples in upscale stores and organizations noted for exceptional service, such as Ritz Carlton Hotels.

The bottom line for optometrists: Satisfied patients will shop around while loyal patients will stay. Think of the businesses that hold your loyalty. Can you adopt any of their practices to create unique, memorable experiences in your practice?

Creating the right environment

Never take a patient's loyalty for granted. For a practice to develop loyalty and grow, you must develop and create the environment. We understand that referrals are the most powerful tool we have available to help us grow our practices. That's because they come from a second party, someone who knows you, trusts you, and is confident of your ability to recommend your services with no monetary benefit. How many times have you found a patient pre-sold by a referring patient?

Think about how much less time you spend in selling when patients come in already prepared to buy. This is the start of the loyalty culture in the new patient, but more importantly, a personal recommendation is by far the best advertising available.

Think about this concept and let's look at the strategies that we can build on this idea:

► You want patients to talk about you so create the opportunity for them to do that.

This occurs when the patient gets home and feels so completely delighted with the service that they can't wait to tell their friends.

► Look for new ways to create this need for the patient to talk about you. Whatever you decided to do, make sure it's so unique that few are doing the same. A doctor told me a short time ago, that he delivers glasses to the patient's work place. He even goes to the extreme for the busy executive who can't leave the office, by having his optician bring frames to the work place.

► Don't be shy about asking for a referral. If you did your job properly, then the patient will feel that you're the best eye doctor in the area. The patient wants you to be successful and wants you to continue in your location so you would be available for him.

By talking about you, patients help you to be successful, but more importantly, when you satisfy the referred patient, you make the referrer look good.

► Don't be afraid to ask for endorsements. Use them in your newsletters, promotions, and have them posted in the office. This is a positive tool in building credibility.

Why do patients leave?

As I've said, it's the long-time patient who's the most loyal and will therefore spend more money in your practice. But what happens when a long-time patient stops coming back? What does it really cost you when you lose a patient? Based on the benchmark of $300 for each patient over a 10-year period of time, the cost will reach upwards of $150,000. So why would a patient leave? See what the Rockefeller Foundation Study on lost customers reported:

► Fourteen percent of customers leave because of complaints that weren't handled in a timely manor

► Nine percent of customers left because of the competition

► Another 9% left because of relocation

► Sixty-eight percent left because their [eyecare practitioners] failed to tell them that they cared. They made it easy for their patients to leave.

Don't let them go

How would you keep patients from leaving? Stop making it easy for them to leave and find service elsewhere. Develop a method to contact patients repeatedly in a programmed manner. It will let them know that your practice cares.

You don't have to shoulder the full burden of developing a loyalty program on your own. Vendors offer established programs that contact patients. Sauflon Pharmaceuticals, for example, has developed a program that touches patients on a quarterly basis. The company delivers lenses and solution, along with a personal note from the doctor, directly to the patient. Instead of making it easy to buy products elsewhere, the program makes it easy for patients to receive products quickly and timely when needed. This creates a loyal patient that will in turn build the practice by repeat referrals.

Keeping up with change

Building loyalty in your patient base requires a constant awareness of the changing demands and the needs of the patient. So keep challenging yourself to continue to provide value. There's no magic formula for building loyalty, but there is a formula available that requires constant modification.


Steps for Building Loyal Patients

Here are some steps you can use to build loyal patients in your practice:

Say "Thank you." This seems hard for some doctors and their staffs because many practices don't have this culture. But saying "Thank you" will set you apart and will start a more personal relationship between you and your patients -- and your staff, for that matter.

Ask for feedback. For a patient to want to return to your practice, he must perceive that you have solved his problem. Follow up quickly with a survey to find out if you have in fact solved the reason for his visit. If not, resolve it at that time and don't wait. Don't use this survey for any other reasons, as it will take away from what you are trying to find.

Mailing. Always follow up the visit with a letter telling the patient about the problem and how it was resolved. More importantly, use this as a reminder of the need for the follow up you discussed in the office.

Reinforce your value. Patients' mindsets are on value. Therefore, implementing a value-added strategy would build the patient-doctor relationship rather then forcing it. We understand that the patient seeks more value for their time and money spent in the office, so the value must be specific to their wants and needs. That's what we need to communicate to patients. Good service isn't enough. We need to remind patients of what we have to offer. We need to build this relationship rather than force it. This can only happen if we earn it.

Communicate your full range of service. Start this in the chair and include it in your "Getting to know us " brochure, which you should send to each patient before they arrive at your practice for their first appointment. All correspondence should touch on your complete range of service available.

Develop a patient promotion kit for each specific patient. Have the receptionist present this kit to the patient at check out. Include in the kit a brochure of the practice, sample drops, eyeglass cleaner, a list of the doctors at your location and their specialties. Also be sure to list the services that are available at your practice. Include an introductory savings coupon for a member of the family, but more importantly, include a "Recommend a Friend" card. The front of the kit should read, "Welcome to our practice" with your name and the back should say, "Thank You."

Keep in touch. Touch base with your patients each quarter by direct mail and delivering of contact lenses and/or solutions on a quarterly program. Use newsletters, cards or even a phone call from the office to see how they're doing.



Dr. Lieblein is president of Visual Alternatives, Inc. He is an internationally known facilitator for information-sharing groups and lectures on practice management. You can reach him at (650) 728-9779.


Optometric Management, Issue: October 2004