Make patients think, Wow!

April 1, 1997
"Service is just a day-in, day-out, ongoing, never-ending, unremitting, persevering, compassionate type of activity."

The `mystery patient` sheds light on the three levels of patient service.

Suzanne Boswell

"Service is just a day-in, day-out, ongoing, never-ending, unremitting, persevering, compassionate type of activity."

-Leon Gorman, of L.L. Bean

Prior to being a Mystery Patient, I was a Mystery Guest for hotels. I stayed at properties undercover and rated the facility as to quality, service, impression management, self presentation of staff etc.

I continue to work with the hospitality industry on these same issues and find many similarities in comparing the challenges of the hospitality industry to the challenges of the dental profession. There are two obvious and significant similarities in the importance of service and guest/patient loyalty.

Little Things, Big Difference

As in dentistry, the smallest things can make the biggest differences in perceptions of service for hotels.

This was beautifully illustrated in a conversation I had with a couple of hotel valets. I`d visited a 5-star plus facility that repeatedly traded places for #1 or #2 hotel in the country. Their international and celebrity clientele demanded the very best and they provided it.

I asked one valet, "So are you #1 or #2 this year?"

He responded, "Oh we lost the #1 slot and we`re #2 this year."

"So what happened that you dropped a slot?" I asked.

"Well we had a `spotter` stay undercover to rate the hotel. We were tied for the #1 spot nationally until he came out to get his car. He was given change in dirty, wrinkled, torn dollar bills. That`s when we became #2."

The second valet laughed, as he pulled his wallet from his pocket, fanned out the dollars and noted, "So that`s why I`ve been getting only brand new, crisp dollar bills in the morning when I go in to get my change for guests!"

It was a dramatic story that shows just how much the little things can make a difference.

That same challenge holds true for dentistry. If you want to differentiate yourself, if you want to stand out as superior, you`ve got to attend to the little things. You`ve got to get rid of the dirty dollar bills! And you`ve got to have departing patients thinking, "Wow! This office really is special."

When that occurs, the experience is burned into the patient`s brain. If patients leave your practice for a managed-care plan or for another office on their list, they`ll make comparisons and you want the comparisons to be dramatic.

You want the void between your office and the patient`s next office to be so great that they want to return to your practice, where they received exceptional service. That`s your challenge, and in that challenge are innumerable opportunities to provide your patients with remarkable "Wows."

Moments of Truth

Every point of contact with a patient offers opportunities to the practice and moments of truth for the patient. That means the way the phone is answered, how questions are answered, the attentive body language while in conversation with a patient, your awareness of patient-confidentiality issues, your concern about patient sensitivities, how you say good-bye to a patient, etc.

All of these, among so many more, "speak" to the patient about your service attitude, and each of these interactions offer you opportunities to cement relationships. A most important aspect of the moment of truth is the consistent building of trust with the patient.

A Moment of Truth

I had an unforgettable experience as a patient in the office of a dentist, who was known for having very high rates of patient retention and treatment acceptance. I had heard a great deal about this doctor. I`d heard about the professionalism of his team, the quality of his clinical skills and the attention to detail provided in his new-patient process. I wanted to experience it myself, so I made an appointment as a new patient in his office.

On my arrival at the office, I realized this was not an ordinary day; the tension was so thick among the team members that I could feel it as I approached the counter. It was evidenced in the way team members spoke to and interacted with each other.

It felt a little like being around a married couple that was trying to hide the fact that they`d just had a fight! You know it; you can feel it-even though they`re doing a valiant job of trying to hide it.

It became clear very quickly that an emergency patient had just left the office. I overheard team members talking about a hygienist and an assistant, who were both out sick that day, and the schedule was full. The office was going to have a real challenge throughout this entire day.

This doctor, about whom I`d heard so many wonderful things, who was supposed to be so friendly and warm, came across as tense and focused on data. Following the clinical exam, he invited me to join him in the consultation room to discuss proposed treatment. This was the part of the exam that I had heard that he handled so beautifully.

He directed his attention on my file and the front desk, and positioned himself where he could see the front desk through the consultation-room door. He sat on the front half of his chair and was practically hyperventilating as he spoke. Throughout the consult, his eyes darted from me, to the file, to the door.

I had a hard time concentrating on what he was saying because of his obvious distraction from the moment.

Concluding his presentation, he mumbled a "pleased to meet you," and gave me a half-hearted handshake as he checked his watch and slipped out of the room. At the front desk, my paperwork was processed in a rushed manner. I felt like the entire team was racing through the steps, without any heart in it.

Window of Time

Patients and dental teams have very different views of the office. The dental team may view the office in a much larger "window of time" than that of the patient. The patient is able to view the office only from the brief interactions or appointments experienced. That is the patient`s reality of what your office is like. But, the dental team may view its performance over the span of a day, a week, a month, or even a year.

So, the patient`s view is vastly skewed from the view of the dental practice. It`s very difficult, if not impossible, for any member of the team to be aware of what the patient`s view really is. There`s just too much going on within the practice environment to separate the experiences of one person.

This topic is especially important in relation to perceptions of service today, and it offers special opportunities in the dental practice. The practice that actively educates the patient not only is perceived to be service-oriented, but there is an additional benefit to both patient and practitioner.

As the patient becomes more educated, the dental IQ rises. When this occurs and the patient has an increased appreciation for and value of dentistry, the likelihood is that treatment acceptance and referrals will increase as well

Here are some of the ways that patients in focus groups have indicated their responsiveness to patient education:

- If you have the patient watch a video or read a pamphlet about a proposed treatment, give the patient a pad and pen first. Ask the patient to write down questions, so that you don`t miss answering any of them.

- Patients like the laminated clipboards with illustrations that can be annotated. You are taking the time and effort to provide information to the patient and as a result, you are perceived more positively. Also, patients perceive the value you place on them.

- Use models or books in demonstrating conditions or treatments. Any time you use a visual, you are perceived positively by the patient.

Marketing and Service

Where does marketing end and service begin? Or, can these concepts be reversed?

In dentistry, I propose that these concepts are inextricably entwined. To patients, excellent service is the best possible marketing that you can do. It is low-cost and has the biggest impact on patient retention, treatment acceptance and referrals. We know this from feedback in our focus groups.

However, it`s exceedingly important that the practice not confuse these two concepts, though they are related. A practice can put so much meaning and money into marketing that service suffers. Be sure that you are able to deliver what you promise! If you talk "quality service" in your collateral materials or in your marketing efforts, you better be able to live up to your words, or patients will be let down.

Incongruence can lead to weakened trust, and that is something no practice can afford. Efforts of marketing become wheels spinning when the practice does not meet, anticipate, or exceed the patient`s expectations.

Being Thankful

A most important element of service is the skill with which you communicate to the patient your appreciation of the patient and the value of the patient to the practice. This is crucial today.

If your patient doesn`t know this, you have a weak relationship that can result in patients "grazing" from the practice. If you are sincere in communicating patient appreciation, the likelihood is patient perceptions of service will rise.

When it comes to this issue, however, the verbalization of appreciation must be genuine, and it must be sincere. Patients must see it, hear it, and feel it, in order to know it and believe it. Service is most appreciated when it comes from the heart, not when it is practiced and perceived as unfeeling.

For the bottom line here is, patients don`t care how much you know until they know how much you care! Help make your patients feel valued and important in your practice through finely-tuned service.

Suzanne Boswell is a dental-practice consultant and undercover mystery patient to dental practices nationally. This article has been adapted from her book, "The Mystery Patient`s Guide to Gaining & Retaining Patients." Call Pennwell Books, (800)752-9764. Used with permission.

Top Tips for Better Service

- When with the patient, be in the moment!

- Address the patient by the patient`s preferred name.

- Anticipate the needs of the patient as much as possible. This communicates that you are empathic and thinking of the patient more than yourself.

- Offer the patient options whenever possible. Patients like this and perceive the practice to be service-oriented.

- Avoid talking "office policy" to the patient. It makes you sound inflexible.

- Choose positive words to address challenging issues, instead of negative words. Patients want to know that you see the glass as "half full," instead of "half empty."

- Show the patient that you try to find answers to challenges as a team. If you don`t have the answer, ask a team member to assist you in finding a patient-friendly solution to a problem. Patents like to see more than one person working on their behalf!

- Make sure that the front-line people are empowered to handle problems, or don`t put them on the front line! This is a major irritation for patients and unfortunately, a common one!

A Touch of Class That Goes the Extra Mile

Three levels of service fall in the patient-friendly category. They are listed here in order of positive impact on the patient, with one level building on the previous level. Level III is the most highly-evolved and includes all elements of Levels I and II.

The following sections may be used as a basis for a staff meeting in which you determine the service levels in your own practice and consider the steps you can take to move to the next level.

Level I

Meeting Basic Needs and Expectations

At this level, patients find congruence among three stages of the patient process: pre-appointment, appointment, and post-appointment. Typically, the practice has communicated well on the phone, patient questions are answered competently.

Patients experience a smoothly-flowing appointment, with no untoward surprises. They get what they expected and are not let down. However, there is nothing stellar that occurs. Patients feel good about the experience and will return, but may not be as likely to refer others, as the patients who experience Levels II and III.

- Appointments Run on Schedule: If patients consistently must wait more than 15 minutes, it will have an impact on perceptions of your service attitude. Patients have said that they would be able to accept this situation more readily, if the team members would be open about it. If it`s going to be more than a 15-minute wait, can you notify the patient in a pleasant manner upon arrival? Some patients have said, "If they`re really running late, could the office just call and let me know? If they`re running 45 minutes behind, then I won`t break my neck getting there for an earlier time."

- Team has finely-tuned communication skills: This comes as no surprise, but it is becoming of increasing importance, as patients become more critical. An office that cuts the amount of communication time with patients will be perceived as offering inferior service Many patients associate communication abilities with clinical skills as well.

Level II

Anticipating Needs

The next level is acceptable for a large percentage of patients, but it doesn`t really separate you from other offices, as much as Levels II or III do. It is in Level II where the team starts to go beyond what is expected. The team anticipates patient needs that the patient may not have even expressed. When those needs are met, the patient finds it exceptionally caring. This can require a deep sensitivity to patients.

When it comes to anticipating needs, it means being empathic. If it appears that Mrs. Jones might be cold, before she asks for a blanket, ask her if she might like one. Help her with it. If the music is loud and she seems to not be able to hear you, indicate you`ll lower the sound, so it`s easier to communicate. There are so many ways that you can anticipate the needs of the patient, but it means extending outside yourself and into your patient`s moment.

The areas below address issues patients bring up in focus groups that also fall in this category:

- Appointment availability: The practice is "accessible" to patients within a reasonable time frame and hours are varied. Patients find it "unfriendly" if a practice only is open Monday to Thursday between 7 a.m. and 4 p. m.

- The team establishes positive feedback loops: Team members ensure patient comprehension and indicate an interest in the patient via asking the right questions and listening actively.

- The office is "up-to-date" in continuing education and technology: Up-to-date is a term consistently used by patients in focus groups. They want to know that the team, particularly the dentist(s), are staying current on clinical issues, infection control, and technology. This may be reality in your office, but it`s crucial that you let your patients know, and that may be via your answering machine, on-hold tape, newsletter, office discussion, etc.

- Strong emphasis on patient education: Teaching the patient is one of the ways that the patient perceives value. Make sure that patients leave your office understanding more about their oral health and oral hygiene than when they entered.

- Rapid emergency contact and response: This type of office is highly accessible to patients; in many cases, it makes the doctor`s home phone number available for emergencies. The office responds rapidly to patient calls. How you handle patient emergencies will have an enormous impact on your patient retention and referral rates. Here is where you can truly earn a reputation for being service-minded for patients.

- The team is cohesive: Patients often tie the concept of a cohesive team with that of service. When patients view team members communicating seamlessly with each other, there is a perception that the office is operating in an efficient and effective manner. Patients also remark consistently about the importance to them of staff continuity and what it means to them. When the team members know the patient, they feel more important and more a part of the practice family.

- Complaints are handled well: How the office handles a problem or a complaint is a major predictor of how satisfied and how long a patient will remain with the practice. Problems arise. You`ll always have them. However, they also might be looked upon as opportunities to build stronger bonds with patients. Frequently, the patient who experiences a problem, and finds it handled well by the team, becomes a more loyal patient than if he had not experienced the problem in the first place.

Level III

Offering the Unexpected: WOW service

It`s here where the practice self-actualizes and reaches the highest levels of service for the patient. There is a focus on the patient. Team members think more about the patient`s needs than their own needs. However, they go beyond Level II in this area. They now offer unique and special benefits that aid in helping the patient feel comfortable in the office and increase the patient`s awareness of being special and valued to the practice.

Here are some comments we`ve heard in patient focus groups that relate to this level:

- "I couldn`t believe it; the doctor actually came out to the reception area to greet me. It was my first time in the office and I`ve never had a dentist or physician do that. It blew me away!"

- "My car had broken down and I couldn`t get to the appointment. I was floored-the office sent one of the staff members to pick me up and drive me home. I thought that was remarkable!"

- "There`s always something great going on in my office. Last visit, I was there around Mother`s Day and they had long-stemmed roses on the counter. At the end of the appointment, they gave one to every patient-including the men!"

- "I had an appointment on my birthday, and the whole team came into the treatment room and sang happy birthday to me. They gave me a birthday favor and funny paper hat. I hadn`t even said anything about it being my birthday. I went back to my own office and kept the hat on my desk all day!"

- "The doctor not only called me the night of my surgery, but he called my home every day until I could report that I was feeling back to normal. I really felt that he cared for me. I thought that was a rare thing to do, and I`ve never had another doctor do this. I trust him tremendously, and I`ve told a lot of other people about this."

It`s a matter of going beyond the extra mile into the exceptional. These are truly WOW experiences. It`s at this level that you are most likely to increase referrals from proud patients!

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