November 18, 2019
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Satisfied customers: The end result of a successful patient journey

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Every step of a patient’s journey through a clinic must be carefully considered in the current landscape of digital reviews. Patients have more of a voice and more power to influence the success of a private practice or health care system than ever before with the increasing popularity of rating doctors, clinics and appointment experiences online. From check-in to check-out, the patient experience can have a direct impact on the referral base, the bottom line and the staff morale of an ophthalmology practice.

“The voice of the patient can be heard and seen through stars, be it one star or five, and those online reviews absolutely can impact the number of potential future new patients to a practice. Most new patients are looking for their doctors online, and the more positive reviews you or your clinic has, the more patients will gravitate to you,” OSN Cataract Surgery Board Member Cynthia A. Matossian, MD, FACS, founder and medical director of Matossian Eye Associates, said.

In a 2018 survey of 1,718 U.S. adults, 80% said they used the internet to make a health care-related search in the previous year, 63% said they would choose a provider based on their online presence, and 81% said they would read an online review before making an appointment, even after being referred to that provider.

Cynthia A. Matossian, MD, FACS
Ultimately, the clinic doctors set the tone for the work that the staff performs and the experiences that patients have, according to Cynthia A. Matossian, MD, FACS.

Source: Thomas Robert Clarke Photography

Ultimately, the journey begins the moment the patient signs on to the internet, Matossian said, so having a web-savvy presence is necessary.

“Your website must be mobile device-friendly; it must be current, captivating, informative and up to date. If it’s old, stale, includes incorrect information, has pictures of doctors who are no longer with you, it’s going to leave a poor impression on a potential new patient,” she said.

The first point of contact through a website is essential to engage the potential patient, according to OSN Refractive Surgery Board Member Jason P. Brinton, MD, owner and founder of Brinton Vision. At his practice, staff are trained to answer web and social media inquiries by the “60-second rule” to ensure patient engagement, he said.

“When patients provide their name and phone number to us online, our call center staff’s goal is to reply within 1 minute. They measure their work as a team starting with this metric,” Brinton said.

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The 60-second rule is easy to test.

“Fill out your own website contact form asking for more information about LASIK; call or send a text message to your practice from your spouse’s or child’s phone. You may be surprised to find out how long it takes to receive a response, how many times the phone rings before it is picked up or how often your call goes to voicemail,” Brinton said.

Customer service

Jason P. Brinton, MD
Jason P. Brinton

The front desk and hospital call centers offer patients a glimpse into the quality of service and responsiveness provided by an eye care facility, so the first impression is important. Wills Eye Hospital in Philadelphia has integrated scheduling matrices to guide call center representatives to ensure patients are triaged appropriately and easily, in a timely and friendly fashion, and scheduled with the proper department or referred correctly, Jennifer Rita, MBA, OCS, director of clinical operations at Wills Eye Hospital, said.

Patients are greeted at the front desk with personalized service, state-of-the-art equipment, a bright, clean environment and an open, modern, inviting floor plan, Rita said.

“There is no one-size-fits-all model when it comes to patient experience. We make sure every point of entry is a positive encounter and user-friendly for the patients and their caregivers, whether they are seeking preliminary information, diagnostics, clinical care or a second opinion. We provide options for how best they would like us to communicate with them: text, call, email. Frequently, our staff goes the extra mile, for example, by helping to schedule and coordinate other subspecialty appointments and follow-up,” she said.

Customer service is the basis of ensuring patients return to a practice and increase a clinic’s referral base, Healio/OSN Board Member George O. Waring IV, MD, FACS, founder and owner of Waring Vision Institute, said.

The barometer of a clinic’s success is a healthy referral base and positive word of mouth from clients, he said.

“This is echoed in our reviews, it’s in our referral patterns, and I’m hearing it personally from our clients. All of this leads to growth and, just as importantly, transcends into a positive and healthy culture that can be attributed to our team. When our team is energized about the lives that they’re changing, and when they are working with their hearts, that’s when it’s reflected in our client experience,” he said.

Engaging the staff

When Healio/OSN Board Member Darrell E. White, MD, founded SkyVision Centers in 2004, he based his clinic’s work on the theory that a business can aim to provide a great outcome, a great experience and low cost, but it is impossible to provide all three at the same time.

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Darrell E. White, MD
Darrell E. White

Excellent vision outcomes would be “the table stake” for the practice, but giving patients a “truly different and unique experience” through elite customer service techniques would be the second goal, he said.

To that end, White and his staff embarked on a “SkyVision customer service field trip,” where the group visited medium- to high-end retail and hospitality industry venues as “customers.” White then looked at efficiency, accuracy and safety in manufacturing industries.

White believed he could apply principles from these different industries to how patients were moved through their visit in his practice.

“Rather than just seeing it, on the ‘field trip’ our staff felt the difference between good customer service and best-in-class customer service,” White said. “Every single process that we put in place at SkyVision has aimed to provide that unique experience, one that made our patients feel like they were visiting a five-star hotel rather than a doctor’s office. One example of applying total quality management principles from leading manufacturers like Toyota was when we changed our protocol for how we educate patients before their cataract surgery. We incorporated highly efficient, safe and accurate flow processes, but we had them running behind the scenes. Our patients may not see our efficiency, but we try very hard to make them feel like they are the only patient there.”

Being a customer at hotels, restaurants and retail outlets of different levels of quality service taught the staff to view the clinic experience from the patient’s point of view, to be “patient-centric.”

“Our staff members have learned to feel what the patient feels,” White said.

This is how a smaller clinic such as SkyVision can compete with larger clinics in Cleveland. The Cleveland Clinic and Case Western Reserve University Hospital are two of the largest ophthalmology providers in Cleveland, with brand awareness that is “off the charts,” White said.

The only way SkyVision can compete is to provide top-of-the-line service and give patients a great customer service experience that they may not necessarily receive from one of the larger providers, he said.

“Having this laser focus on the patient experience has allowed us to remain competitive. We could get buried; we’re a tiny boutique. Those are big organizations with sterling reputations that do great work. But our ability to control all aspects of the patient experience and journey has allowed us to stay in the game,” he said.

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Maintaining referral base

Some traditional approaches to serving patients are not conducive to business in the modern health care landscape, according to Brinton.

In-person patient care starts from the first text message to a practice, phone call or website chat.

“Sometimes we inadvertently place barriers between our office’s team members and our patients. What does it say if our reception staff sits behind an enclosed area and patients have to ring a bell so staff know to slide open an opaque glass window to talk to a patient? How would our offices be set up differently if rather than being optimized for patient flow and efficiency they were optimized around the patient experience?” he said.

George O. Waring IV, MD, FACS
George O. Waring IV

Now, the challenge is evolving a practice away from the institutionalized way of providing care. It is common for patients to expect doctors to give them their cell phone number or email address to be able to contact them outside of an appointment. It is a challenge to evolve to this, but if the goal is to provide world-class customer service, this is to be expected, Brinton said.

Training staff

Training and continued education for staff and providers are crucial to achieve this new form of medical service, Matossian said. At Matossian Eye Associates, all front desk staff are trained in proper customer service techniques, including how to speak clearly and enunciate properly, and given educational courses to understand ophthalmology terminology, disease states and procedures to make scheduling appointments easier for all parties involved.

Staff members receive ongoing 1-hour weekly training sessions to stay current on new procedures, medications and changes with the insurance process.

“A lot of it is education, and some of it is also customer service tips. Smile, make eye contact, help the patient out if they’re struggling to fill out a form or if they need help getting into a chair. Anything we can do to help leave a positive impression at every touch point through the practice leads to a cumulative feeling, a positive perception by the patient for their entire office experience,” Matossian said.

This can make a huge difference in referrals, Brinton said. Employees at Brinton Vision are trained to greet patients by name, stand up and walk around the office desk, and invite patients and their guests to sit down. Menus are provided for patients to order various drinks or finger foods while they wait, Brinton said.

Staff aims for patients to wait less than 5 minutes at Brinton Vision before being brought back to their own examination room by a technician who will stay with them throughout the entire appointment. The technicians are educated beforehand on the patient’s background, reason for scheduling an appointment and medical history.

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“We call it a warm handoff, where our receptionist introduces the patient to their technician and shares something interesting about the patient or technician that may help the two to connect. Each technician stays with his or her patient for the duration of the 90-minute appointment. Patients undergo all of their testing in a single room,” Brinton said.

Taking time

A study published in Clinical Ophthalmology found patient wait time is strongly correlated with patient satisfaction. In a survey of 104 patients, the results suggested that to maximize overall patient satisfaction, actual waiting times should be less than approximately 30 minutes.

Doctors at his practice schedule at least 30 minutes with each new patient, which is possible in “cash pay” medicine, Brinton said.

“It’s not about driving efficiency or how many people we can move through the system. It’s not about being high volume. It’s about being high touch. High touch over time leads to strong word-of-mouth referrals and good moderate volume, but we never want high volume in and of itself to become the goal at the expense of the patient experience. If we’re going to be the best LASIK practice of our kind in the world, we’ve got to be laser focused on the experience and outcomes of each individual patient,” he said.

Educating patients about their billing and taking the time to clear up confusion when it comes to payments, insurance questions and copays can also go a long way to making a patient feel comfortable, informed and happy to return, Rita said.

At Wills Eye, employees accurately verify insurance benefits with patients and are transparent about any out-of-pocket costs that may be due at the time of their appointment, she said.

“We also notify our patients if their insurance plan requires authorizations or referrals that must be obtained prior to the visit. We aim to prevent surprises on the day of the appointment and help navigate them through the process in the most seamless way possible,” she said.

This pre-appointment discussion helps expedite the check-in process and ensures a smoother visit, Rita said.

Checking out

The patient experience from beginning to end can be quantified through feedback, Matossian explained, and the data from this feedback can be used to further improve clinic performance.

At the conclusion of each appointment, patients are sent an automated text message from Matossian Eye Associates. The message asks patients to rate their experience during their appointment with either a “thumbs up” or a “thumbs down.”

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If the patient rates the clinic with a thumbs up, a “thank you” message is sent. This follow-up message contains links to online health review websites and asks the patient to leave a positive review on one of the sites.

“If it’s a thumbs down, that message comes to me as the medical director, and it goes to our practice administrator. We contact the patient right away to see why they were dissatisfied. We’re nipping it in the bud before they get a chance to post something negative online to try to resolve their displeasure or discontent,” Matossian said.

Each review is logged into a document and reviewed each week. Improvements and areas of concern are addressed in clinic, she said. Employees who are singled out in a positive review are recognized during weekly training sessions and rewarded with a small gift certificate, Matossian said.

“It’s not really about the gift certificate, but the public recognition in front of peers, that is the bigger reward. It boosts staff morale, and the happy staff helps with our referral base. It just makes the clinic a better place to work,” she said.

Ultimately, the clinic doctors set the tone for the work that the staff performs and the experiences that patients have during their visits. If doctors show appreciation for their staff, the staff, in turn, shows respect for the patients they see every day, Matossian said.

“The entire office culture has to be patient-centric. We read our mission statement every week at the start of our educational sessions to keep it front and center so nobody forgets what we’re about. Our patients appreciate our culture, and it keeps our phones ringing,” she said. – by Robert Linnehan

Disclosures: The sources report no relevant financial disclosures.

Click here to read the Point/Counter to this Cover Story.