Article Date: 5/1/2005

practice management
The Power of Appreciation
Thank your patients with good service, kind words and thoughtful gifts, and they'll thank you back with referrals.

Imagine how you feel when you receive a "thank you" from someone. Doesn't it bring a smile to your face, along with a sense of appreciation? Yet in the practice of professional optometry, we underestimate the powerful impact of a "thank you" on creating new referrals and increasing both patient and staff satisfaction.

I've benefited from letting patients and staff know that we appreciate them, and I'm going to explain how. I base my perspective, procedures and policies on almost 20 years of managing a professional optometric practice. I've also worked in cardiology, orthodontics, psychology and plastic surgery offices, as well as the banking industry. Tried and true, they clearly work for us.

Let's review why showing your appreciation is so important and how you can do it in your practice.

Your office is a mirror

Patients present to your office for their appointments. One of your staffers greets them promptly with eye contact and a smile. No distractions exist between the receptionist and the patient. The receptionist administers necessary paperwork. Organization is the key! The receptionist or a staffer answers the patient's questions and deals with any issues. (This first step will set the mood for the time the patient spends in your office.) Are your patients thinking, "Not only will this office meet my visual needs, but I don't object to spending my time and money in this office"?

Once the patient completes the necessary paperwork, your receptionist reviews it for accuracy and invites the patient to relax for no more than 15 minutes before going back to start the care process. In the meantime, what does the patient do? Read current and popular magazines, or a 1993 issue of Field & Stream? If left idle, do they look at the dust built up around the room, the torn wallpaper, scraggly carpet and the holes in the upholstery or do they see a clean, nicely decorated, modern facility that gives them the impression that germs aren't the majority of the occupants in the office? What does your office reflect?

Let them know you care

After a brief, but enjoyable stay in the reception (not the waiting) room , the doctor's assistant greets the patient. This is another important encounter. The assistant is the closest person to the doctor during the exam process. Eye contact and taking a believable interest in the patient is a stepping stone to trust.

On the flip side, patients who see employees coversing with co-workers perceive it as being ignored. I can't emphasize enough the importance of being professional, speaking knowledgeably, innately knowing your job and addressing the patient's needs. The patients will judge you as a representative of the practice as you tend to them. Also, pondering over lunch options, weekend events or anything unrelated to work or to patient care says that you're not practicing "patient on pedestal," or POP. How do you rate your team of assistants (who can make or break patients' impressions before you meet them)?

Now it's time for one of the most important encounters of all: the patient's visit with you. Your selection of office personnel has already represented and given an impression to the patient of) your office. When you greet the patient and make the all-important eye contact, you should instantly and astutely read the following (because your staff already communicated all developments and issues pertaining to this patient to you):

What's at stake?

Why does all of this matter? If you fail to connect with your patients and make them feel you genuinely care about them, rather than their income, you lose their trust, referrals and return visits. Even though the procedures you perform -- whether a routine exam, a contact lens fitting, an eyeglass concern, an eye injury, pathology, post-op care or other vision need -- determines the time you spend with the patient, remember that the patient covertly analyzes, interviews and judges every step of the way.

Optically speaking

Once you've completed your encounter with the patient, if your ancillary personnel escorts them to the optical area, this person also becomes a reflection of you. What happens in this arena can make or break your practice's bottom line.

In this age of cut-rate vision insurance plans, it's critical to employ sales staff capable of working the system and being creative to maximize every sale. Leaving frame benefits unused is a costly mistake. Allowing a patient to re-use a frame when insurance benefits will completely cover the purchase is ridiculous. How many of your opticians never conclude a sale without asking to see a patient's current pair of sunglasses? If they don't ask this important question, just think of the revenue potential you're losing every day.

Practice growth and income become stagnant when optical staff can't or won't sell properly, judge patients' spending power and undersell. Also bad is an optical staffer who's bothered by a patient and who rushes the process, displays negative body language that causes the patient to walk with their script in hand, or when a doctor tells the optician what to sell in front of the patient, thereby limiting the optician's skills.

The patient must have a positive experience in this area. If your optician has a bad attitude, then you can bank on the patient wondering why a fine doctor would employ a person who has such business faults and consequently risks alienating his patient base. What is the status of your optical department both in terms of patient feedback and revenue? Ask yourself: Does your staff have the health of the practice and the requirements of the patients as their number-one priority, or are paychecks and social contacts more important?

Painless payments

Once you and your staff have completed all requirements of patient care, direct patients to the infamous check-out station where they meet their new best friend, "the money grabber." Here, it's helpful to implement two rules:

1. Never tell the patient that he "has to" do anything

2. Never say the word "dollars"

(Both of the above are highly unprofessional.) It's also unprofessional for co-worker conversations to take place when a member of your staff is presenting fees or for a patient to drag the doctor into the process. Give patients a reason to ignore a request for payment and they will.

We instituted a change this year that's been working fabulously. We present the A to Z's of a non-refundable contact lens fitting fee to patients in the privacy of the exam room. If the patient has no intention of paying for this procedure, we find out before the doctor begins and before the patient reaches the check-out desk and lunges into a mini meltdown, bodily distortions and unfamiliar verbal choices that could scare children and small animals.

Because you've accomplished everything possible to ensure patient satisfaction and you are presenting the fees, just imagine what patients might be thinking. Will the total shock them? Have you spent their time well? Will they feel as though they're getting their money's worth? Has your staff impressed them? Have you addressed all of their concerns? Will your staff ask them to take care of the fees in a professional manner? Has your staff answered their insurance questions? Are you maximizing their insurance benefits? Is the patient glad to get out of there? Do you and/or your staff rush patients through the system? Was anyone rude to the patient? Will they refer others to your practice?

Patients may not always verbalize what they're thinking to you, but they'll eventually tell someone. So on that note, consider what you can do to influence that interaction.

End on a high note

Once your staff and the patient has successfully and pleasantly finished the payment encounter, it's time to place the proverbial icing on the cake. Think about how patients will feel when the "money grabber" suddenly hands them a gift bag and says, "Thank you so much for coming in today." Well, I can tell you that patients will always produce a huge smile, no matter how much they just paid, or whether they were taken aback by the fees, or what happened during their visit. Now that's to end an appointment.

Note: We present thank-you gifts to new and returning full-exam patients only. We don't give them to patients who were rude or disrespectful or to those whom we asked to leave the office. Thankfully, those numbers are few and far between.

Putting it into action

If your practice style is to show appreciation to patients and you find that this article helpful, then please read further to learn how to implement the "thank you" program.

Present gifts in a colorful gift bag the size of a standard brown lunch bag. You can purchase them in bulk from (We usually buy the 12-dozen solid color variety pack for $18.) There's no need to add tissue paper and the gift shouldn't cost more than $5. Below are a few ideas:

Be mindful of patients' genders and ages. Avoid giving members of the same family the same gift and exercise good judgement with religion-specific holiday gifts. Stay clear of candy and other perishables, as you may not always be aware of patients' health issues.

Have a staffer view the upcoming day's schedule, pull the number of gift bags needed and put each patient's name on the front of a gift bag every day.

Now, with all the managed care-related cut-backs, why would you want to spend money on thank-you gifts? Because you want to stand above the rest.

We also have a "thank you" gift policy for our staff. Each staffer gets 15 minutes a day of paid, non-work-related chatting time (this time can occur 30 minutes from when we open, 30 minutes before lunch, 30 minutes after lunch or 30 minutes before we close). The rest of the day's discussions are work and patient-related only. (This "chatting time" represents 22 hours of non-productive paid time every month for five staff in our office.) The doctor(s) and manager are exempt and can initiate any appropriate and necessary conversation with staff.

An infraction results in the staffer receiving an error note. If a staffer receives more than five during the month, they don't qualify for a "thank you" gift. (Staff gifts are random, gift-wrapped and range in value from $5 to $20.)

Worthwhile practice

Our office is more productive, we provide our patients with better care, we've minimized interruptions, decreased staff errors and employees go out of their way to avoid receiving an error note -- they take pride in being the staffer with none or the fewest error notes and everyone is happier. I hope you consider our policies and procedures as food for thought to help improve your practice.

Jan Lebow has managed a professional optometric practice for nearly 20 years. She is the office manager for Dr. Kenneth A. Lebow.


Optometric Management, Issue: May 2005