That All-Important Word-of-Mouth

Enhancing the patient experience creates loyalty — and referrals.

BY JERRY HELZNER, SENIOR EDITOR

The stereotypical physician's waiting room consists of a small number of uncomfortable chairs and a few old — and usually uninteresting — magazines scattered on a table.

When enough patients remark about the less-than-inviting atmosphere, practices tend to spruce things up with some newer magazines and perhaps an aquarium with a few tropical fish.

However, some practices have made the connection that providing a patient-friendly environment is the critical first step in enhancing the entire patient experience, which in turn builds patient loyalty and the positive word-of-mouth that leads to numerous referrals.

Upgrading the office and surgery center environment requires a multifaceted effort. It includes such elements as staff training, a safety audit to correct potential hazards, inviting interior design, smoothly functioning electronic systems that impress patients, and the seemingly small features that patients will notice, appreciate and mention to their friends.

Outside of their actual medical facilities, practices can build favorable word-of-mouth through such initiatives as participating in clinical trials, building good relationships with referring optometrists, being available to the media and having an active community outreach program. However, it is interesting to note that while other professional activities — such as publishing articles, lecturing to colleagues and making instructional videos on surgical techniques — will bring personal prestige to a physician, they tend to have little impact on expanding the patient base for the practice.

Dr. Amir Arbisser honors wife Lisa's 20th year in practice by bringing the circus to Moline, Ill., for a day. Here, he presents her with a bouquet of roses.

For example, Uday Devgan, M.D., of Los Angeles, has made a number of videos on surgical techniques that he has placed on YouTube.

"Some patients find me via the Internet, and the material that is Google-searchable is helpful, but typically not the reason why the patients select me," says Dr. Devgan. "So, yes, the trials, videos, articles, etc. help patients to find you, but they don't necessarily influence patients to choose you."

Andrew Rabinowitz, M.D., a glaucoma specialist based in Phoenix, says that a decade of going around the country lecturing 40 to 60 nights a year and making surgical videos for the Baerveldt glaucoma shunt won him "personal notoriety within the glaucoma world" but added no value to his glaucoma practice.

"Although we hoped professional prestige would add value, it never really did," says Dr. Rabinowitz. "Also, patients have little to no concept of the value of these activities or lectures."

So while a stellar reputation among colleagues is certainly to be desired, this article will deal with ways to build positive word-of-mouth in the local community, where the real potential exists to expand your patient base.

Participating in Clinical Trials

One way to both enhance your professional reputation and attract patients is exemplified by Michael Korenfeld, M.D., of Washington, Mo., who recently served as a key investigator in a phase 3 trial that resulted in FDA approval for Durazol, a corticosteroid for pain and inflammation associated with ocular surgery. Dr. Korenfeld says that participating in clinical trials can serve as the signature for a forward-looking, ever-improving practice.

"Our participation in clinical trials really conveys to patients our mission to offer the best, most up-to-date care available anywhere," says Dr. Korenfeld. "We often have the opportunity to advertise in the local paper that we are conducting a clinical trial for some common ailment, and with a steady presence in the press, we have been able to set the character of our practice apart from the practices that simply deliver eye care. This is exactly the persona that I have hoped to project. I believe, rightfully, that patients see a doctor who is trusted to perform FDA clinical trials as special and different, and likely to be more in touch with the science of medicine, and not just its economics."

The Circus Comes to Moline

Probably no practice in the United States has ever made more of a patient-friendly gesture than Eye Surgeons Associates, led by the husband-and-wife team of Amir Arbisser, M.D., and Lisa Arbisser, M.D. This large practice, with 18 doctors and five offices in Iowa and Illinois, received international news coverage in 2003 when Amir Arbisser brought the Ringling Brothers Barnum & Bailey Circus to Moline, Ill. for one day to celebrate Lisa's 20th anniversary in practice. A total of about 8,500 patients, some of whose surgeries dated back 20 years, attended the two performances.

"This was really just a way to say thank you to our patients. It took a year of very detailed planning," says Dr. (Amir) Arbisser. "We do have many ongoing community outreach initiatives, but bringing in the circus was not meant to build business or get our name out there."

Little Things Mean a Lot

On a simpler and more practical level, Dr. Arbisser believes that one of the best ways to build patient loyalty is simply to keep to the appointment schedule.

"Many patients are already tense when they walk in," he notes. "Keep them waiting for 45 minutes and they become miserable and angry. If there has to be a delay, let the patient know about it right away and even offer them a chance to reschedule the appointment. Patients will accept a delay if you tell them the reason for it. We like to think of patients as our guests and treat them the way we would like to be treated ourselves."

Dr. Arbisser says that patient-friendly policies are also likely to be good business practices as well.

"Our surgeons call our postop patients on the day of the surgery," he notes. "The patients are thrilled, but by making the calls the surgeon obtains new information on how patients are doing and whether there are any problems that need our attention. The patients' phone numbers can be programmed into speed dial by a nurse so that the surgeon can make a number of calls quickly. In the same way, spending some time with cataract patients talking about their hobbies and lifestyles lets us help them in making the best IOL selection. You would be surprised at some of the people who choose premium IOLs."

Happy Staff = Happy Patients

Dr. Arbisser says that patients will pick up on whether a practice presents a smoothly functioning team atmosphere or if there is tension among the staff.

"You don't want to have a compensation arrangement which leads to the doctors trying to steal patients from each other," he asserts. "I've seen that in other practices and it creates bad situations."

The Arbissers' practice has an extensive community outreach program, including participation in this "Boo at the Zoo" Halloween event.

Dr. Arbisser says that Midwestern practices such as his tend to put a priority on being patient-friendly and active in the community.

"It could be somewhat of a regional thing," he says. "We tend to have newer, well-lit offices and surgery centers that you might not always see in the older urban areas such as New York City. Also, practices have been quicker to consolidate in the Midwest, which has led to the construction of modern, well-equipped medical facilities."

In terms of community outreach, Eye Surgeons Associates is available to provide speakers to community groups and makes a number of charitable donations, such as for local education and arts programs.

"Our marketing director comes from the banking industry, where customer service and customer retention is a high priority," says Dr. Arbisser. "So we think in terms of community outreach and ways to interface with local service organizations."

One more example of the practice's community outreach: "We own a snow-cone machine and we lend it out for Little League games and other community events," says Dr. Arbisser. "We give them the cups and the syrups. That way, whoever uses the machine can use it for fund-raising at no cost to their organization."

Themed Offices in Amarillo

Though it might be difficult to top the patient-friendly gestures of the Arbissers, J. Avery Rush, M.D., of Amarillo, Texas, probably has no peer in creating a memorable patient experience that gets people talking.

On the high plains of the Texas panhandle, Dr. Rush is widely known for his innovative and pioneering efforts in cataract and refractive surgery. But ask any of the patients sitting in his exam lanes what they like most about Dr. Rush and they're likely to focus on his interior design skills, according to his marketing consultant, Michael Malley of the Centre for Refractive Marketing.

What began 15 years as little more than a hobby collecting Coca Cola, baseball and rock-n-roll memorabilia, has today turned Dr. Rush's practice into one of ophthalmology's most eye-catching eye centers of its kind. That's because every exam lane in his office has been meticulously ‘themed’ from top to bottom with extensive memorabilia from Dr. Rush's favorite hobbies.

"Initially, we used to dilate patients in our exam lanes and leave them there for about 15 minutes," Dr. Rush points out. "I was simply looking for a way to keep them entertained in the rooms while they were waiting for me to see them."

Years of collecting rock ‘n roll memorabilia has allowed Dr. Rush to decorate entire exam room walls with themed items.

He started with a just a couple of rooms with memorabilia he enjoyed collecting over the years. Since he's fond of rock-n-roll, baseball and Coca Cola, the first few lanes were easy to outfit with posters, ticket stubs, bats, balls and signed photos. A quick glance into any of these rooms will confirm that he's still contributing to them today.

Once he noticed how popular the first three themed lanes were, he added a Corvette room, an Elvis exam lane, a cowboy exam lane and a University of Texas room. "When patients from our rival Texas A&M University come in and ask why we don't have an A&M exam lane, I politely inform them that actually we do… and then shuffle them down to our Marx Brothers exam lane!"

There's not a day that goes by that at least five to 10 patients comment to Dr. Rush about the lavishly outfitted exam lanes. "It's actually a really nice ice-breaker, especially with our new patients," Dr. Rush says. "As soon as I walk into the lane, they'll comment right away about something in the room, which makes it much easier to bond with patients."

After the first few lanes were completed, patients would talk at length about them and actually request a specific room for their return visits. It wasn't hard to get patients back for appointments because they wanted to see the other rooms he had decorated. "It's been over 15 years now and it's been fun to start some of the new rooms from scratch," he said. "We even have patients bring us their own personal items to put in the rooms. I have an old Elvis record album with the actual LP still inside the cover. Just last week a patient brought by an old plate with a cowboy on it."

The rock-n-roll room has concert pictures, posters and actual tickets from events that were attended by Dr. Rush. He also has ticket stubs and pictures from the University of Texas vs. USC Rose Bowl. "I really try to personalize the rooms, and have my cousin Alan Jenkins in Austin to thank for a lot of the memorabilia and artwork that hangs outside of each lane."

The staff enjoys directing patients to the "Corvette room" or the "cowboy room" instead of just saying lane number one or number two. "The staff also enjoys helping me outfit the rooms," he said. "When they're out on vacation, they'll come back with some really fun and enjoyable pieces for the rooms."

"My favorite lane has to be the cowboy room," he said. "There's a picture of me when I was about 6 years old wearing my full cowboy outfit. I guess deep down I've always wanted to be a cowboy, but this is probably as close as I'll ever get!"

And for added fun, Dr. Rush has also showcased his practice with four saltwater aquariums featuring sharks, seahorses and electric eels, six miniature chihuahuas and a well-versed umbrella Cockatoo.

Another of Dr. Rush's interests is baseball. His collection of signed photos, posters and ticket stubs fill an exam room wall.

A More Basic Approach

Not every practice can match the high-profile practice-building efforts of the Arbissers or Dr. Rush, but the Center for Sight in Sarasota, Fla., has been successful in converting approximately 40% of its cataract surgery patients to premium IOLs through a more basic outreach program that has made the practice well-known and trusted in the community.

"These are people who talk to each other about health," says James Dawes, the practice's chief administrative officer. "If you satisfy these patients, they tell their friends. We get 54% of our patients through word-of-mouth referrals."

The Center for Sight is a large practice, with 18 doctors and six locations, so it has the scale to put significant resources into educating cataract surgery patients and informing them of the range of lens choices.

The practice has referral programs that offer "friends and family" discounts. It also runs newspaper ads and has a community outreach program in which its five patient counselors and physicians give talks on eyecare options to social groups and at community events. In addition, the Center for Sight builds productive relationships with referring optometrists.

The patient-centered approach exemplified by the Arbissers, Dr. Rush, the Center for Sight — and their record of developing patient loyalty and positive word-of-mouth — easily shoots down the notion that having up-to-date magazines is the epitome of a "patient-friendly" office atmosphere. OM