Get Serious About Patient Satisfaction

How to capture it. What to do with it.

By Kay Coulson, MBA

The worry runs like an endless loop: “I need a better Web site, with good video clips. Video! How much is that going to cost? Are we mobile-optimized? Maybe we should add a practice app? Patients want apps. But isn't Facebook where I should be focused? Is my Facebook page working? Who's keeping it updated? How come we only have nine Likes? Will people think we're not ‘likeable’? What was that conversation I overheard in the break room about a bad Yelp review? Since when does an enhancement deserve a bad review? What about Angie's List? Do I care about Angie's List? I need to check my Healthgrades rating. Are we keeping up with other physician rating sites? I'm exhausted. First thing tomorrow, I'll update my blog, tweet something from surgery, shoot and upload a clip on Facebook… and then see patients. I hope they're happy. I bet they are.”

If this sounds familiar, you're not alone. These worries are common among physicians attempting to keep their finger on the pulse of a consumer, and an industry, that is moving fast and screaming every detail from the desktop. On one hand, we have patients broadcasting about us — the good and the bad. On the other, we have Medicare lurking with its planned physician report cards, which will eventually incorporate patient satisfaction surveys.

These issues boil down to one question: Are our customers — our patients — happy with us? How should you monitor and report the quality of your service, and the excellence of your outcomes, before someone initiates a dialogue that leaves you out of your own loop? It's interesting that our increased sensitivity about patient satisfaction corresponds with the explosion of social networking. Before, if they loved us, they sent a nice card or letter. If they didn't, they complained privately to family or directly to us, but the audience that heard complaints was limited. Now that any disgruntled patient can reach a large network of Facebook friends, and an even larger group of strangers on rating sites and review services, it's time to get serious about satisfaction.

Your focus must remain rooted in attracting new patients, serving them well, protecting their vision and encouraging referrals. Don't get distracted by the myriad ways to reach out to, and engage with, patients. Instead, follow these simple steps to solicit feedback, and use it to propel practice growth.

Stop Chasing

There are two topics you care exclusively about when measuring patient satisfaction:

1. Did we improve their vision?
2. Did they enjoy the experience provided while treating them?

A majority of patients seeing ophthalmologists are age 50+, when pathology and aging eyes require more specialized care. Younger, healthier patients typically visit ODs for routine/wellness eye care, which you may or may not offer as part of your practice. For the 50+ age group, it's important to consider how they want to communicate with you. Every communication tool invented does not need to be a conduit of conversation between you and your patients.

Fewer than half of patients over the age of 65 today are on the Internet (Figure 1).¹ Only 11% own smart phones.² They are not even a measured population on Facebook.³ So if your patient base is made up largely of Medicare-aged patients, you care deeply about their satisfaction — but your communication with them is best managed personally, and in printed or written form.

Figure 1. For patients over the age of 65, use of both the Internet and social media remain low.

Seventy-four percent of patients aged 50-64 are on the Internet. Twenty-four percent own smart phones. Only 4% are on Facebook. This group makes up the balance of your surgical and pathology practice. Again, their satisfaction is paramount. They will be searching for you online, and visiting your Web site from their desktop. But this is not an audience widely participating in mobile viewing, social sharing or online review posting.

Perhaps you have a strong LASIK practice, lots of wellness eye care, contact lens fittings and an optical shop? Most of your patients are under age 50. Roughly 90% of adults 18-49 use the Internet, 50% own smart phones and 75% are on Facebook. This is the patient who is talking up, or tearing down, your practice online. This is the audience that needs mobile access to your site, online scheduling, video communication and a strong social presence. If this isn't your practice today, don't panic. You have time to evolve before they'll need your care.

If we hone in who we serve, the type of patient we'd like to see more of, and consider how they are most comfortable communicating with us, we will have taken a great step in improving patient satisfaction. Stop chasing every review, and focus instead on the experience and result people visiting you today achieve.

Ask and Ye Shall Receive

We know if patients are satisfied by asking them. Yet I find very few ophthalmology offices employ consistent, reliable patient surveying. Even fewer use employee surveying. How do you know how good you are if you don't ask? Focus on what you want to know: “How's your vision? Did we change it, improve it, stabilize it? Is your vision what you expect? Are you happy with the procedure or solution you chose? What would you do differently?” Secondarily, you want to know how they like the experience you provide. Your office? Your parking? Your doctors? Your staff? Only ask about things you can fix. If parking is awful, and you're locked into that building with that garage, don't ask, because you can't change it.

Two words of caution as you construct a satisfaction survey: be brief! Consumers are surveyed to death, from the phone provider to that last hotel stay to survey pop-ups when browsing an article or making a purchase. Survey exhaustion is prevalent. Keep your questions to the point, concentrating only on those areas you want to improve.

You can deploy a transactional survey (How satisfied are you with this encounter today?) or a relationship survey (How satisfied are you with us overall? Or with your cataract surgery results? Or your glaucoma therapy?).

I generally field relationship surveys, since we're measuring satisfaction with specific vision outcomes. We establish a baseline, then monitor improvement or decline over time. When measuring lens replacement satisfaction, we send out a written survey and/or an online survey to every IOL patient from the prior 2-3 years. These results serve as a benchmark for all future performance reporting.

How many responses do you need to gain meaningful results? Figure 2 shows statistically significant sample sizes at varying confidence intervals.⁴ If you implanted 500 IOLs over the last two years and want to survey this population, you need 217 responses to have 95% confidence in the results at +/- 5pp of accuracy. This is easily doable if you ask for and acknowledge participation appropriately.

Figure 2. Here's a guide to the size of the survey sample you will need to obtain results you can trust.

How should you distribute your survey? Historically, we've provided surveys in written form, handed to patients as they leave a specific post-surgery visit. Response rates are 25-35%. We are transitioning our surveys online, using tablets. Although we previously gave the survey with a stamped, self-addressed envelope to patients as they checked out and asked them to return it to us, we now hand the patient a tablet with the survey loaded as they check in. They fill out the survey before they are taken back for the visit. This improves response rates to 80%+. We never use phone surveys, as refusal for participation is at 60% or higher, according to AC Nielsen.

There are many excellent sources for survey development and deployment. We use Zoomerang (www.zoomerang.com) but you may also consider SurveyGizmo or Survey Monkey, or simply google “customer satisfaction surveys.” Each offer templates for survey design, easy set-up and deployment, and advanced reporting and graphing that will make the data easy to collect and interpret.

What questions should be included? Our general template asks who you are, what procedure you had done, how satisfied you are overall, how you rate your visits, how you rate the staff/doctors, and a comments box asking for anything else they'd like to tell us. We want someone to be able to fill out the survey in five minutes online, and no more than seven minutes written. Zoomerang offers an excellent white paper, “Measuring and Tracking Customer Satisfaction.” Download it at www.zoomerang.com/whitepapers.

Believe the Feedback

We can control the experience and results we provide. We can improve. And we can encourage more people to share their feedback with us. But we can't control what people will say. One of the great truths of social media is users can sniff out insincerity in a heartbeat. Don't try to be something you're not. Don't participate in blogging, Twitter and Facebook superficially. If you have a dated, cluttered office, if you always run 45 minutes late, if your new patient count is shrinking, if patient and professional referrals don't make up a majority of your surgical volume, you have a patient satisfaction problem. So fix the problem. Then you'll not worry about what people might say.

One of the biggest barriers I face after fielding benchmark surveys is disbelief among surgeons of the results. Generally, surgeons think their results are better than they are, and that patients are happier than they are. Interestingly, administrators and staff are almost never surprised by the results. So prepare yourself that the data will point out holes in your organization, and perhaps your outcomes. This is exactly what the survey is designed to do! Don't be a practice that cherry-picks who receives the survey. If you've been fudging outcomes, or artificially inflating satisfaction, or simply hypothesizing these results, the jig is up. Even if you're not hearing disgruntled patients, they are telling their story. Don't fight the bad stuff. Just fix it.

Use satisfaction surveys to uncover how well people say they see and compare it to how we thought they'd see. Use this data to tighten your IOL calculations and LASIK nomograms. Use it to share practical vision results with presbyopic lenses vs. monofocal lenses. Use it to reward team members who are consistently mentioned for great service, and discipline those who are called out as rude or disinterested. Pay particular attention to open-ended comments. People take time to type or write them, and they don't graph neatly. But they are often the richest source of what is excellent, and poor, in your practice.

Share the Love

Now that you have an active method of tracking patient satisfaction, look back at those questions keeping you up at night concerning patient reviews and posts. Use real results to share great things about your practice.

Use Outcomes: Use the data gathered about a specific aspect of the practice — for instance, visual acuity from lens replacement, LASIK outcomes, glaucoma therapy — and create an outcomes report (Figure 3). We post these on Web sites, use them in patient education brochures and have laminated copies in the lane that a surgeon can use when discussing options and treatments with new patients.

Figure 3. Use surveys to gather data about a specific aspect of your practice. Just keep your questions to the point.

Encourage Reviews: In-practice tablets are helping generate positive reviews (Figure 4). Download apps for Yelp, Google Reviews and Facebook to the same home screen where the satisfaction survey lives. When they're done with the survey, encourage them to post about their experience in your office. At the very least, the wow factor for tablets is high and reinforces the notion you are an advanced practice. Just be careful that tablet doesn't walk out the door!

Figure 4. On your tablet's survey page, download the apps that will let patients spread the word about your practice.

Post Good News: Let's be honest. No one is beating down the door to post on your Facebook page. So you have to help build your narrative of greatness. The “Anything Else You'd Like to Tell Us” comments box is a rich source of satisfied patient quotes and stories. We post these on Facebook, with patient approval, so the library of happy patient stories builds. Although your older patient population may not be using this social network yet, their kids are, and this allows you to stay current and active as you build toward that next generation of patients.

Don't Forget Your Team

Once you've conquered the task of measuring and monitoring patient satisfaction, consider employee surveys. Our employees are great resources for practice improvement. Using online survey tools to quickly capture the best and worst of your operation. Every week send a two-question survey to your staff, or subgroups of your staff. Ask two things:

1. What was the best story a patient told you this week about us or about their vision?
2. What was the worst experience you had this week with a patient, and what do you think caused it?

This simple effort will give you all the information you need to share your greatness, and head off potential problems, in real time. That's our challenge — real-time correction and real-time celebration. This connection with the day-to-day is where social networking excels. Practices fell behind because you didn't take enough care ensuring the day-to-day experience with you and your team was good. Commit this year to real, documented, 90%+ patient satisfaction and vision delivery. After all, you can't know if you're winning if you don't keep score. OM

Kay Coulson is president of Elective Medical Marketing, a Boulder, CO-based consulting firm that helps surgeons grow their elective vision service lines. You can reach her at kay@electivemed.com.