Patient Care at a Premium

In many commercial sectors, including medicine, the “experience economy” is now a powerful force. It’s an upgrade to the service economy, where rather than simply delivering a service, businesses must ensure that the time customers spend with them is memorable – the experience itself becomes the real product of the business. In the case of ophthalmology practices, this translates to making patients feel not just comfortable, but happy with their visits. It isn’t enough just to offer excellent eye care; ophthalmologists in private practice must ensure that every step of a patient’s appointment, from preliminary research to aftercare, is as carefully tailored as possible.

Because of this, customers expect excellent service no matter where they go – and ophthalmologists’ offices are no exception. Because so many patients have to pay out of pocket for additional services, you need to create a more welcoming environment to not just draw them in, but reinforce their purchasing decision. There are a lot of clinics offering cataract and refractive surgery, so patients don’t need you like they did in the past; you need them more than they need you. Certainly, reimbursement reductions in the US and austerity policies in Europe mean that practices’ margins have decreased, so surgeons offer elective options like premium lenses, laser cataract surgery, or aesthetic procedures to make up the difference. Essentially, the landscape of the healthcare community is changing, and doctors need to change with it if they want to continue earning at the same level. Here in the US, there’s a measure called the “cataracts per Cadillac ratio” (1) that reflects the change in reimbursements: in theory, it used to take six cataract surgeries to buy a Cadillac, whereas now it takes something like 20. So you need to consider what measures you can put into place to help promote the practice’s premium options, which will take that pressure off your front desk and telephone staff so that they can focus on other aspects of creating a seamless and efficient experience for your patients.

The Face of the Practice

The staff who come into direct contact with the patient, either face-to-face or by telephone, are vitally important. Doctors spend a significant amount of money on advertising, but there’s far more bang for the buck if they simply train their patient-facing staff. There have been secret shopping studies where clinics spend a lot of money on advertising a given service, and then when patients call to inquire about it, the front desk staff aren’t aware of it and suggest online research. That’s the worst thing they could possibly recommend, because those patients might actually find the clinic’s competitors while looking for information. So it’s key to educate your front desk staff and phone team – even if you only teach the most basic of information – just so you don’t risk sending your patients away.

First impressions count, and the environment your patients experience upfront – even before they come into contact with the clinical staff – has a significant effect on how they feel about your practice and whether or not they come back. You want to create a “boutique” environment with a higher level of customer service. A recent study revealed that, in many cases, it wasn’t even the surgeon’s experience that was the deciding factor for patients – it was the practice environment. The Zagat rating service recently expanded to include physicians, allowing patients to rate their doctors. But under this rating system, the top criterion is trust, followed by communication, availability and office environment. I find that interesting because overall, factors like the outcome of the patient’s procedure or the experience of the surgeon aren’t even in the top four considerations for patients.

Checking Into Patient Satisfaction

Some high-volume practices have begun using “check-in kiosks” like the ones travelers use at airports, and they’re surprisingly popular. You can’t sacrifice the human factor for it, but it’s an excellent method for increasing efficiency. One clinic I know has a receptionist to greet patients with a smiling face and to explain the kiosks if the patients haven’t used them before, and lets the machines take care of the rest. You give the patients a card – they can swipe it and their information is pre-populated, and you can change it if necessary. The kiosks can also collect unpaid balances, verify insurance details and so on. Automating these tasks will free up staff members’ time, meaning that they can have more personal interactions with the patients.

Some kiosks even take it to another level by asking a single targeted marketing question based on the patient’s age or the physician that they’re going to see. If they’re of an age where LASIK is possible, it may say, “Have you or a loved one ever considered having laser vision correction to reduce your dependence on contacts or glasses? Yes or no?” If they say yes, the doctor immediately receives a text message that says, “John Smith, who is going to see you in five minutes, has an interest in laser vision correction.” The administrator or the nurse gets a similar message that says, “John Smith has an interest in lasers. Have a package ready for him.” And it reminds the patient, too – “I’m interested in this, but I forgot to mention it last time I was here. Now is a good time to ask!” The questions are tailored, so that you can ask different patients different things, phrasing each question the way you think is best for your practice.

I love the kiosk concept for its marketing possibilities, but it’s also great from an operational standpoint. I asked an older lady who was using a kiosk how she liked it, and she said, “It’s so much easier for me to push a button on the screen than it is to fill out forms by hand. It’s difficult for me to hold a pen because my hands are so arthritic. I can’t see very well, either, and the font on the paper forms is small and grey.” She really liked the kiosk and I just thought, “This is genius.” The benefits of being able to accommodate visually impaired patients with things like font size and contrast are obvious – but I hadn’t even thought of patients with accessibility considerations like arthritic hands, who can also benefit.

A Direct Line to Assistance

It’s a good idea to ensure that all of your patient-facing staff start their conversations with exactly the same ingredients. Everyone who answers the phone answers the exact same way– acknowledging the caller’s needs and assuring them that the practice can definitely help. You say “I can certainly help you with that” no matter what they’re asking, because nine times out of 10 someone in the practice is in fact able to assist them. Because of the fact that there’s a consistent greeting – the acknowledgement and reinforcement – it gives them reassurance that they’ve called the right place. It helps them to feel like they’ve made a good decision by choosing your practice.

Then, if you ask for more details about their chief complaint, you can schedule their appointments accordingly. For instance, if you have a caller who wants a LASIK evaluation and you learn by asking standard questions that they are 70 years old, you know they are more likely to be a cataract patient. So if you do block scheduling – say, LASIK on Tuesdays and cataracts on Thursdays – you can place that patient in the appropriate slot for their condition. I’m a firm believer in block scheduling, because that way you know exactly what you’re going to be doing all day long, which makes things easier for both doctors and patients.

You’ve also got to make sure that your patients don’t end up in “voicemail jail,” where instead of having the chance to explain their chief complaint to a real person, they have to leave a message without knowing when their call will be returned. Or worse, they have to go from one voicemail inbox to another trying to reach a human being. So it’s important to have enough people on staff that they can actually speak to patients. It helps patients feel like they can cross one obstacle off the list – they’ve talked to someone and scheduled an appointment, or gained reassurance that they’ve administered their medications correctly, or whatever the reason for their call. Patients should never feel like they’ve been left in limbo, and your front desk and telephone staff are the people who can resolve most of their issues and leave them happy.

Maximizing Motivation

In my clinic, our telephone interactions used to be recorded on a regular basis and we were graded on our performance. All of the staff members got a link to see the grades – “Suzie’s got an A, Jen’s got a B, Laura’s got a C…” Because we could all see the grades, it was embarrassing if you didn’t keep up with everyone else – so there was an element of competition there, and you didn’t want to be the weakest link in the office. That experience taught me to constantly reinforce good patient interaction techniques, because it’s easy to become complacent and fall back on bad habits. If you have a weekly staff meeting and you take the time to review telephone recordings, you can turn them into learning experiences. It’s money well spent.

Many clinics reward staff who perform well. Some do it financially with group incentives – if their clinic’s business plan states a target number of premium procedures, then there’s a bonus for the staff when they meet that target. Other practices will “secret shop” their own staff, and when they’re overheard saying or doing the right things, they’re rewarded with things like cinema tickets or special lunches. There are a lot of different ideas as to how you can recognize and reward good performance, but most of all, it’s important to have a good relationship with your staff so that you understand what they need in order to be happy. Not everyone likes the same things – some people prefer private or group recognition, while others might prefer a financial or otherwise tangible reward, so it’s good to get to know your staff. No matter how you choose to accomplish it, having a happy staff will result in better service for your patients.

Most ophthalmologists understand that the skills and successes they bring to the table are vital to growing and maintaining their patient populations. But fewer are aware of the impact that their front desk staff and office environments can have. With a few simple tactics – educating your patient-facing staff, maximizing your use of technology, and rewarding good performance – you can turn your practice into a place where your patients feel safe and confident.

Laura Hobbs is a practice development specialist who has worked at high-volume refractive clinics in the United States and Europe.