By Brian Chou, OD, FAAO
Brian Chou, OD, FAAO, of EyeLux Optometry in San Diego, Calif.
and Ronald Krefman, OD, FAAO
Survey patients regularly on everything from wait time at reception to shopping in the optical dispensary. The results can point you down the path to profits.
Ronald Krefman, OD, FAAO, describes survey instruments for measuring the patient experience in all aspects of the office visit. This video first appeared on the web site of the Management & Business Academy.
Your reputation and your financial success hinge on your patients’ experience. Are you are providing an exceptional patient experience consistently? By surveying your patients, you can even-handedly measure what they experienced and their likelihood to return and recommend your practice. For about 10 years, Brian Chou, OD, FAAO, has been surveying his patients to gauge their experience in his office. For the last few years, he has been working with Ronald Krefman, OD, FAAO, who has a proprietary survey tool, eyecareScore, which allows a doctor to easily roll out and measure patient satisfaction survey responses. Here is the advice which Dr. Krefman and Dr. Chou have for readers thinking of rolling out their own survey.
Why Survey Patients?
Dr. Chou: Asking for social media reviews may not be your best strategy for building your reputation, especially if your goal is to genuinely improve practice operations. You need a more proactive approach to build the best possible patient experience and enhance your reputation, which will, in turn, maximize the likelihood that your patients become promoters rather than detractors of your practice. If you need motivation to implement a robust survey system, consider that dissatisfied patients will tell up to 10 times more people about their experience than satisfied patients. So, if you are not already systematically surveying your patients, now is a good time to start.
Use Statistically Valid, Reliable Surveys
Dr. Krefman: Surveys provide essential feedback to gauge the performance of your business–to understand what’s working well and what needs improvement. Your survey should not just ask about “satisfaction,” but precisely measure those “moments of truth” or touch-points where you make or break the bond with your patients. Asking the right questions, in the right way, can tell you exactly where there are opportunities to improve your operation. As with your clinical or financial decisions, you need a data-driven practice, armed with validated and reliable insights about the patient experience. Ad-hoc, do-it-yourself surveys that lack validity, reliability and benchmarks ultimately fail to provide the insights you need to guide decisions in a data-driven manner for maximizing the patient experience and improving your practice reputation. Providing the best possible patient experience remains the best way to build loyalty, advocacy and financial growth.
Ask About the Whole Visit
Dr. Krefman: Typically, surveys ask about scheduling appointments, wait time and courtesy. Questions in standardized surveys, like eyecareScore have been scientifically tested for statistical validity and reliability and are limited to the key questions proven to drive advocacy. For example, the proprietary questions ask patients how quickly you answer the telephone, your professionalism and how much you respect their privacy. Your survey needs to look at what’s important to patients in judging their experience.
Surveys are typically five to 25 questions and take about one to five minutes to complete. The response options are usually on five-point rating scales, but the key here lies in the labeling of each point on the scales so there is consistent interpretation among responders. Most customer and patient satisfaction surveys suffer from “ceiling effects,” meaning everyone gets very high ratings. High ratings sound great at first, but if you think about it, how can you tell if you offer a differentiated experience, or what to improve? Consistently high marks are a sign of a poorly designed scale, not necessarily that all doctors and offices are top performers. This can be remedied if the scale labels are carefully tested to provide separation between a good and a great performance.
Dr. Chou: You can increase patient volume by setting goals and surveying whether other family members were offered an appointment at the time of scheduling. You can also ask how patients first heard of your practice, to help direct your marketing dollars. Over five years ago, I determined through a patient survey that yellow page advertising had an unacceptably high cost-per-lead which brought a highly negative return on investment. Another example: You can ask if ophthalmic lens options were discussed in order to help drive per-patient revenue. Rewarding staff on hitting response targets (i.e., 75 percent of patients responding affirmatively) should yield a lock-step increase in collections per patient while encouraging selection of premium product.
Survey As Many As Possible–and Often
Dr. Krefman: Most surveys have alert functionality built in, so that an extremely low score or a patient with an ongoing complaint can be quickly addressed, providing that the patient is willing to identify him or herself. You never know when a disgruntled patient may surface, so why not survey as many as you can? It makes sense to survey after each encounter, especially if the survey tool is offered at a flat price, independent of volume. Your goal is also to get a representative and valid sample of your patients’ feedback and occasional surveying will not accomplish this. Typically, consumer satisfaction surveys have response rates below 10 percent. However, health care surveys enjoy a significantly higher response rate (about 20 percent) so long as the patient is assured of confidentiality and intent to improve quality based upon responses. Invitations hosted by an independent third party (your survey vendor), and the promise of anonymity not only improve response rates, but improve candor. Informing patients that their feedback is meaningful for quality improvement initiatives improves participation rates as well.
Compare Performance to Standardized Benchmarks
Dr. Krefman: Comparing your performance to standardized benchmarks is a winning strategy for bettering your practice. Asking the right questions, in the right way, drives knowledge, which, in turn, drives decisions and changes to improve the experience and improve the business. Finding mismatches in patient expectations versus reality represents opportunities to delight more patients.
Dr. Chou: One of the common missteps is asking patients to indicate their overall level of satisfaction without having a reasonable benchmark. For example, if asking a patient to rate their satisfaction on a scale of one to five, with five being best, you want a barometer to compare against. Say, one month you average 4.5 and the next one 3.5. When comparing your practice against itself over time, you need to know whether a drop is statistically significant or if it’s due to chance variation. If it is significant, then to affect the result, you need to identify the root cause. This is often difficult to do because “patient satisfaction’ is ambiguous and multifactorial. A better indication of global performance is having the results benchmarked against a pool of similar practices.
Cost-Effective Guide to Practice Improvement
Dr. Krefman: With printing, postage and data entry, paper and postcard surveys can cost more than $10 per completed survey. Telephone surveys are both costly and potentially annoying to patients. E-mail surveys are cost effective and typically you pay a flat fee for unlimited surveying–so, you can ask each and every patient for feedback. Basic web-based surveys may be included in patient messaging solutions which cost about $200 to $400 per month (e.g., Websystems3, Solution Reach and Demandforce), but check their survey for eyecare specificity, benchmarks and for proof of validity and reliability. More robust, stand-alone validated survey solutions like eyecareScore from focalCenter, start at $89 per month, and with unlimited surveying, costs are pennies per completed survey.
With such cost-effective solutions available and so much to gain in practice improvement, there is no excuse–roll out your first (or vastly enhanced) patient satisfaction survey!
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Brian Chou, OD, FAAO, is a partner with EyeLux Optometry in San Diego, Calif. To contact him: chou@refractivesource.com.
Ronald Krefman, OD, FAAO, is president of focalCenter. To contact him: rkrefman@focalcenter.com.
