Article Date: 3/1/2006

What Eye Care Patients Expect
Consumer focus groups reveal what doctors need to hear.

A perennial maxim in management books about customer service is that service providers must exceed customer expectations to be successful. Customers who have merely have their expectations met and are "satisfied," are not particularly loyal and will seldom talk about or recommend the service to someone else. Creating enthusiasm among customers is likely to pay big dividends in retention and referrals.

To explore what eye care customers expect from their eye doctor and what level of satisfaction is commonly achieved, the Management & Business Academy conducted four focus groups late in 2004 in Atlanta and Chicago. Participants were people who had recently received an eye exam from an independent optometrist; half were contact lens wearers and half were spectacles wearers.

Participants were asked to relate in detail their most recent exam visit and whether the visit satisfied their needs. They were also asked to give their perceptions of the doctor and staff in the role of providing information about corrective device options. Finally, they were asked whether there were any displeasing aspects of their recent visit. Here, we'll discuss the results, what they mean for our profession and how you can use the data to improve your practice.

Most satisfied, few enthusiastic

Nearly all patients surveyed appear "satisfied" with the service provided by their eye doctor and staff. Most judged the exam as thorough and felt they were provided a competent diagnosis. Most said both doctor and staff treated them in a friendly, engaged manner. The consensus was that the doctor "did his job" adequately.

A typical office visit lasted 45-60 minutes, with 15-20 minutes spent with the doctor. Few said they experienced any wait, either to get an appointment or while in the office, suggesting that the doctors of this sample of patients were not that busy.

The discussion made clear that what patients value most from their eye doctor is the long-term custodial care they provide. Patients achieve a sense of security from an on-going relationship with a medical professional who understands their ocular history and personal needs. As people age and their vision deteriorates, an even higher value is placed on an enduring relationship with the eye doctor.

Many participants also had previous experience with retail optical chains. They considered the continuity of care and individualized attention the most influential reasons to favor their private practitioner over chain providers.

It's apparent that the human, emotional dimension of the doctor-patient relationship weighed more heavily in patient evaluations than technical competence. Participants consistently cited the doctor's attentiveness, warmth and approachability as the traits they liked most. None of the focus group participants mentioned the technical reputation or skill of the doctor as their primary reason for remaining loyal — a basic competence seems to be assumed.

While most patients intended to remain loyal to their current eye doctor and very few had any intention to shop around, the typical depth of loyalty was not great. Because diagnoses and advice do not have a life or death or sight-threatening consequence, the relationship with the eye doctor is not as strong as with a personal physician. No one seemed particularly concerned if a new associate optometrist were to conduct their eye exam in the absence of their regular doctor. Few were able to cite any instance in their relationship when the doctor had exceeded their expectations. For most patients a visit to an eye care office is a routine, unmemorable event.

Few respondents said that they had ever recommended their eye doctor to another person. For these patients living in large metropolitan areas, the consensus was that if a patient were to move beyond a fifteen-minute radius of the doctor's office, they would likely switch in eye doctors. Convenient access was the most frequently mentioned reason for selecting their current practitioner.

Above and beyond

When asked what constitutes an unexpected level of service from their eye doctor, patients mentioned a follow-up call after treatment for an acute condition or after purchasing a new type of corrective device; ready accessibility during emergencies was another popular answer. Some also referred to instances when the doctor's office became the patient's advocate in a dispute with a managed care provider. Still others mentioned a doctor's effort to achieve total patient satisfaction with eyewear constitutes great service.

Patients observed specific examples of how their personal needs were met including: being greeted by name, being asked about changes in vision since the last visit and about their satisfaction with current correction device(s), an understandable explanation of any changes in vision revealed by the exam and receiving a recommendation about a product that offers higher performance.

When asked whether there were any disappointing aspects of the service they received during their most recent exam, most patients had no complaints. A few described the doctor's frame selection as inadequate, resulting in them buying eyewear from a chain location. Others felt resentful of being rushed through the practice. Dated décor in some offices gave patients the perception that the doctor may not be medically up-to-date. No one volunteered any dissatisfaction with fees, suggesting this is not a major area of concern for patients.

Product education expectations

While not a source of strong complaint, there is a gap between what patients expect to learn about new eye wear products and what is typically presented to them during an office visit.

In many cases there is no dialogue about products during the office visit. Patients who are asymptomatic and express no problems with their current vision correction device are seldom presented new options. The staff and doctor implicitly assume that the patient wants to reorder the same type of device when updating their prescription.

Satisfied eyeglass wearers are seldom offered the chance to try contact lenses. Most spectacle-only patients did not know whether their current lenses had AR or anti-scratch protection, suggesting neither doctor nor staff had discussed these upgrades with patients before their glasses were dispensed.

Patients infrequently ask about new product technology, having invested little or no time to investigate the options before their visit to your office. They assume that you, the doctor, will be their product counselor and will bring to their attention any new device that might better satisfy their needs.

Doctor and staff roles

About the Management & Business Academy (MBA)

In 2005 CIBA Vision and Essilor of America launched the MBA program to educate independent eye care professionals about advanced management strategies and techniques. To develop the program curriculum, the sponsors assembled a distinguished faculty of practice management experts, each of whom has written and lectured extensively about practice enhancement.

During 2006, the program will expanded with the addition of a Web site focusing on effective hiring, training, motivation and retention of optical staff.

The primary relationship patients have in eye care practices is with the doctor, who is the source of any loyalty that develops. However, the staff plays an important support role in signaling the practice's concern for the patient's welfare.

Most patients put their eye doctor on a pedestal, preferring not to think of the doctor as a merchant. They want you to recommend the best solution for their corrective need and expect your advice to be motivated exclusively by concern for their ocular health and functional needs. Patients will almost never question a brief product recommendation with a medical or performance rationale. Only if they perceive your recommendation is motivated by profit does any distrust surface. Patients do not expect you to be an expert on style and fashion or to discuss the vanity aspects of eyewear options.

Patients also seek out staff members' advice and recommendations. They expect optical assistants to relate other patient reactions to eye wear and to offer advice and reinforcement during frame selection. They also expect staff to explain add-on features and bundled options, which should cover all the commercial aspects of the transaction. Patients are much more comfortable questioning staff recommendations rather than those of doctors.

Room for improvement

Survey results show the average independent eye care professional's service received a solid "B" grade from this sample of patients, who were satisfied, but not enthusiastic, about their most recent office visit. There were a few cases of remarkable service, but loyalty was shallow and referral uncommon. There is considerable opportunity to upgrade your service and performance and differentiate your practice from the competition.

Typical optometric practices also tend to do a mediocre job in presenting new product technology to patients, adopting the, "If it ain't broke, don't fix it," mentality. Patients expect to hear about new solutions and to receive product recommendations from their eye doctor. This expectation is not routinely met today. Don't miss another opportunity to increase your patient's satisfaction and practice's revenue.

About the authors: The authors are the faculty of the Management & Business Academy (MBA), a professional education service co-sponsored by Essilor of America and CIBA Vision. To assist optometrists in realizing the full business potential of their practices, the MBA conducts management seminars and publishes materials that provide real-world advice on practice improvement.

Optometric Management, Issue: March 2006