Two things make a successful business. First, you must have a great product. Apple has the iPhone. Nike has the shoes. Ritz-Carlton has the legend of luxury. As ophthalmologists, we can offer great vision. Many times, we underestimate the “worth” of our abilities, which can greatly change a patient’s quality of life.

Our product, a wide range of spectacle-free vision, is obtained with precise surgical skills, detailed ocular testing, and IOL calculations and IOLs that correct astigmatism. It is a great product, and we work diligently to make it better and better.

The second thing that makes a successful business is outstanding customer service. Walk into a Ritz-Carlton and you feel like you are the only guest at the hotel; it is always “my pleasure,” from the staff. At an Apple Store, you are greeted with a smile and attention to detail and “feel good” about your purchase as you leave. Shop at Nordstrom and the salesperson steps away from the counter to hand you your purchase, shakes your hand and sincerely thanks you for your business. This great customer service is where many of us as eye-care professionals fall short. If we can add outstanding customer service to our great product, there is no limit to our success in running our businesses.

We want our patients to “feel good” about their experience in our clinic as they do when shopping at an Apple Store or checking into a Ritz-Carlton. This experience can take our business to a new level of success. An important component to achieving this outstanding customer service is what I call the “Patient Experience,” which is the process of the patient flow through our clinic.

Several years ago we made a major change in the process of our patient flow: All testing and counseling are now done before the patient sees the doctor. This was a challenge for us, as we are all creatures of habit and are resistant to change. Within 3 months, our patients were spending less time in the office and were much happier. This new efficiency, in turn, made our staff and doctors happier.

We have seven steps in this process of the Patient Experience. Most of you already do a great job with all of these steps. Changing the order of the steps is what made the difference in our practice.

1. CALL CENTER

This is where the appointment is made and is the “first impression” of your practice, so it is important for those individuals answering your phone to be professional and well trained. They should have basic training in eye care to be able to answer standard questions, such as “What is a cataract?”; “What is cataract surgery?”; and “What will happen during my appointment?” Teach these individuals to “smile” over the telephone — we have mirrors at each station.

These employees are so important that we have “secret shoppers” (colleagues outside our practice) call periodically to make sure we are accomplishing our goal of a great first interaction for our patients.

2. FRONT DESK CHECK-IN

This is the second “first impression.” We have three requirements for our front desk employees: Make eye contact with the patient, smile and say “Welcome to Virginia Eye Consultants. We are so glad you are here.” We have found that there are personality types that feel uncomfortable making eye contact and smiling. Employees identified during hiring with such personalities don’t work at our front desk.

3. MEASUREMENTS/TESTING

All testing for a cataract evaluation is done first so that all the important data is available to the technicians, counselors and doctors. All employees are “scripted” for interactions with the patient. As the patient is first escorted to the testing area, the technician explains what will happen in some detail over the next few hours. As each test is performed, whether it is the Lenstar biometer (Haag-Streit), topography, the OPD-Scan III (Nidek), OCT or a refraction, our staff explains the importance of the test in preparation for the recommendation from the doctor.

An example of scripting might be, “I see that you are here to see Dr. Smith. He is a wonderful cataract surgeon. Are you excited about having better vision”? Whatever the scripting might be, all staff give the same messaging throughout the process: This is a great time to have cataract surgery, this is your one opportunity to select your IOL and we will give you the information you need to help you make this important decision.

4. HISTORY TECHNICIAN

This is a well-trained technician, many times a COMT, with a lot of experience. We task this individual to review all of the testing and to start the decision-making process with the patient about IOL selection. This technician documents pertinent ocular history for the counselor and the doctor, such as contact lens wear, successful (or not) monovision, prior LASIK/PRK and previous ocular surgery. With this information, the history technician opens the discussion with the patient about different opportunities for vision with or without glasses. For example, if the patient has 2 D to 3 D of astigmatism, the technician talks to the patient about astigmatism and toric IOLs. A patient who is active and appears to have healthy eyes hears about multifocal IOLs that give a full range of vision without glasses. Importantly, the history technician identifies patients who have significant vision-limiting diseases, such as macular degeneration, diabetic maculopathy or severe glaucoma.

Then, the technician communicates this information to the counselor by way of a handwritten “routing slip” that is not a part of the medical record. The message may be that the patient has a lot of astigmatism and may be a good candidate for a toric IOL or that the patient may be a good candidate for a multifocal IOL. On the other hand, the message may be that because of ocular pathology the patient is probably only a candidate for a standard monofocal IOL with the manual surgical technique.

5. COUNSELOR

The single change with the biggest impact on our patient experience was having the patient see the counselor, who is not a technician, before the doctor. Now, we have better educated patients, fewer questions for the doctor and increased efficiency for the entire system. The counselor takes the information from the history technician on the routing slip to continue the patient education and messaging. All patients learn from the counselor the basic anatomy of a cataract and the process of cataract surgery. They learn about the advantages of the femtosecond laser and that there are several options for IOLs. They understand astigmatism and the difference between monofocal, toric and multifocal IOLs. Importantly, they are informed of the additional cost and even offered financing.

Depending on the information from the history technician and the patient’s interest, the counselor reviews the following options:

1. Custom correction. The counselor explains that a multifocal IOL (in our practice, Alcon’s PanOptix) provides a greater range of vision with less use of reading glasses and describes rings and halos to the patient.
2. Astigmatism correction. The counselor describes enhanced clarity of distance vision (or near vision in myopes) by using femtosecond LRIs or a toric IOL and explains that glasses are still required for intermediate and near vision (or distance vision if left myopic). The counselor can replicate monovision in appropriate patients.
3. Basic cataract surgery. The counselor describes monofocal IOLs with manual cataract surgery and explains that patients should expect to use prescription glasses for both distance and near.

Finally, the counselor completes the routing slip for the doctor. The counselor’s note may indicate, “Patient appears to be a good candidate for the PanOptix and would like this technology.” Or, the routing slip may indicate, “Patient elects standard IOL with manual technique with glasses full time,” or “Patient would like good distance vision and doesn’t mind wearing reading glasses.” The direction offered by the slip is key to making the doctor’s visit efficient.

6. DOCTOR ENCOUNTER

All the steps above have reduced the doctor time with the new cataract patient to 5 to 10 minutes, down from 20 minutes, a significant improvement. Our motto is “A doctor should do what only a doctor can do.” Everything else, including all patient education, is delegated to our very capable staff.

Before entering the exam lane, the doctor reviews the routing slip with the notes from the counselor. If the note states, “Patient can only afford what insurance will cover,” the doctor will not mention astigmatism or advanced technology IOLs (AT-IOLs). Our goal is to still ensure that the patient “feels good” about having a great outcome after cataract surgery and wearing glasses. In this case, the time with the patient is typically reduced to about 5 minutes.

When I ask the patient if he has any questions, the most common answer is “No.” If the routing slip indicates that the patient is interested in astigmatism correction (femtosecond LRIs or toric IOL) or a multifocal IOL, I make a specific recommendation of the AT-IOL and use of the femtosecond laser if the patient is a good candidate for it. Because of the process, the patient anticipates a recommendation from the doctor; keep it straightforward and simple.

7. SCHEDULING

In surgery scheduling, the patient is greeted with the smiling face of the surgical coordinator to bring closure to this process. The high probability of a great outcome after cataract surgery is reinforced, and confidence in the surgeon is instilled. We want patients to “feel good” about the product they selected, so the patient is assured that they have made a good decision about their IOL selection.

CONCLUSION

This process of the “Patient Experience” in our practice has resulted in high patient satisfaction and, just as important, happy staff and doctors. The efficiency has reduced patient time in the office and substantially reduced the time doctors spend with patients. Therefore, our doctors are able to see more patients and schedule more surgery. As an added benefit, our conversion rate to AT-IOLs doubled from 12% to 25%. We are now consistently at 42% for our conversion rate for AT-IOLs and astigmatic correction.

The “Patient Experience” has been a win-win for our practice. As we did at my clinic, I would ask you to take a closer look at patient flow in order to give your own patients both a great product and outstanding customer service. OM

About the Author

Stephen V. Scoper, MD, is a partner at Virginia Eye Consultants and associate professor at Eastern Virginia Medical School, Norfolk, Va. He is fellowship trained in cornea and refractive surgery.

Financial disclosure: Dr. Scoper performs clinical research for Alcon, Novartis and Topcon. He serves on the speakers bureau for Alcon, Novartis and Eyevance.