The customer is always right ...

Feb. 1, 1998
Customer-satisfaction surveys validate the assumption that dental patients desire a doctor who looks out for them while rendering quality care.

Customer-satisfaction surveys validate the assumption that dental patients desire a doctor who looks out for them while rendering quality care.

Scott Trettenero, DDS and

Gregg D. Martin, PhD

It`s no secret that we dentists feel more comfortable with the technical side of our profession! You need look no further than the tremendous strides that have been made in our clinical procedures, treatment methods and materials. The spectacular results in the last few decades have benefited both doctor and patient alike.

But what about the people side of this? What about dental practice management? Experts abound, but of necessity, their recommendations are based primarily on intuition, opinion and hearsay. This is understandable because there have been no valid scientific studies to validate the best way to run a dental practice ... not until now!

Yet, such studies of customer satisfaction (quality of service) have been done in other fields with stunning results. These include the lodging, restaurant and banking industries. So why couldn`t these same, proven techniques be used to measure patient satisfaction in dentistry? After considerable study, we came to the conclusion that they could!

The authors met with Joel Ciaccio of Creative Endeavors in Cologne, Minn. At his suggestion, we decided to gather information from patients using an instrument referred to as the "Data Acquisition Box" (DAB for short).

Through further research, we discovered a survey format called "SERV-QUAL," developed by Parasuraman, Berry and Zeithmal, working under a grant from the Marketing Science Institute in Cambridge, Mass. (See related article.) The SERV-QUAL survey was electronically loaded into "DAB." As it turned out, DAB served us well. Patients were quick to respond to our questions because it was easy to do. Of course, "SERV-QUAL" was adapted for use in the dental profession.

Areas covered

We studied more than 90 dental practices representing all major regions of the country using DAB, which is distributed by Creative Endeavors. In all, more than 6,500 patients were surveyed, adding up to a database that would be universally judged as being statistically valid, with an applied error factor of only one in 10,000.

All dentists volunteered to participate and patients were randomly selected at each practice.

Each participating patient was asked for his/her perceptions in five areas relating to patient satisfaction. These perceptions were grouped into five dimensions of service quality or patient satisfaction.

The five areas of service quality measured were:

(1) Responsiveness

(2) Reliability

(3) Empathy

(4) Assurance

(5) Tangibles

A ranking system of one to five gave the patient the opportunity to score the dentist and his staff on each of these areas. A percentile ranking was given to each doctor, based on how the patients graded the practice. This gave each doctor a comparison against a large population of other doctors.

Diagnostic tool

A comparative line analysis was done for each practice to show the doctors how well or how poorly they were doing in each dimension of service quality. This alone is a tremendous diagnostic tool - the ability to be able to pinpoint areas of deficiencies.

In addition, questions concerning practice-management styles were asked of the doctor. Specific questions related to number of patients seen in a typical week, dollars collected, percentage of overhead, number of staff members and the number of hours worked in a week.

Then, all the answers from the doctors were correlated with the patient responses to service quality. All computations were done by the Department of Business and Public Administration Research Lab at the University of Missouri. All data was handled and processed as it was delivered, and no manipulation of data preceded analysis.

Convincing results

The results were both conclusive and convincing. From this research, it was clear there are now definite, scientifically validated aspects of a doctor/patient interaction that are most significant to the patient. Also, the research revealed there is a definite type of dental practice that delivers the highest level of patient satisfaction.

Surprising to some

Overall, the research shows a dental practice that is physically and philosophically set up to deliver a high level of personal attention and caring to its patients will produce the highest degree of patient satisfaction. Specifically, it showed that patient satisfaction decreased in direct proportion to a greater number of patients seen in a week. Surprising to some, it also declined with an increase in the number of staff members.

It also went down with the number of dollar collections made in a month, proving that high production practices were less satisfactory (note we did not say net dollars)!

It might surprise some dentists that patients ranked the subjective aspects of their dental treatment as having a much greater importance to them than anything objective has. Patients clearly stated in this study that they wanted understanding, caring and trust. They want a dentist who has their best interests at heart and who will provide them with the best possible care.

Patients also want this type of relationship in a smaller, less hurried practice where the doctor spends enough time with them to handle their individual concerns. We realize that many practice-management consultants and practicing dentists have stressed this style of practice for years, but now it has been validated.

What does all this mean?

Many benefits can result from this work. They include:

x- A model of dental practice has been defined that can lead to maximum patient satisfaction.

x- Consultants can use this research to help their dental clients move their practices in ways that create more meaningful improvements and do it with greater speed and accuracy.

x- Individual dentists can see how they rank against their peers in patient satisfaction.

x- Each dentist now can pinpoint his/her weakness and strengths as they relate to patient satisfaction.

Dentistry now has a highly effective and extremely accurate practice-management tool. We welcome questions and comments about this study. Individual doctors interested in pursuing an analysis of his/her practice should contact Joel Ciaccio at Creative Endeavors, 8570 Maple View Drive, Cologne, MN 55322; phone (800) 214-7576 or fax (612) 466-4728.

A tool for measuring five areas of service

Since the early 1980s, the consumerism movement has brought about an increased focus on the quality of service and products. Quality always has been a responsibility of true craftspeople and those with professional responsibilities. However, in recent decades, it seems the consumer has joined producers in expecting quality and their search for value has become more diligent.

To aid those responsible for delivering good quality service, three researchers developed a measurement instrument to assess service quality. Working under a grant from the Marketing Science Institute in Cambridge, Mass., A. Parasuraman, Leonard Berry and Valarie Zeithmal created SERV-QUAL, a generic instrument for measuring service quality. Their work focused on measuring the quality of service in the lodging, restaurant and banking industries. After years of study and responses from thousands of subjects, these researchers concluded that service has five areas in which providers must excel to be competitive.

The five areas of service provision identified were: 1) Tangibles, 2) Responsiveness, 3) Reliability, 4) Assurance and 5) Empathy. To assess these areas of service provision, the researchers wrote questions to be given to customers so that the customers could respond by ranking the respective level of service quality on a scale of one to five. As a result, it is now possible to measure and report quantitatively the level of service being received by a particular clientele in all of these aspects of service.

To establish the reliability of this instrument for use in the dental profession, Scott Trettenero, DDS; Joel Ciaccio, Creative Endeavors; and myself adapted the instrument by editing questions to read more specifically for dentistry. Like the previous researchers, we used the instrument in a study of thousands of patients who subscribed to one of 88 practices that were studied. The results were enlightening.

The adapted questions all had high reliability coefficients (Tangibles: Alpha=.80, Responsiveness: Alpha=.92, Reliability: Alpha=.86, Assurance: Alpha=.90 and Empathy: Alpha=.93), meaning that the perceptions of the patients that were studied remained consistent from practice to practice and that if this instrument was used in the dental profession, the results would be credible.

In summary, the benefit to dentists is substantial. A previously nonqualifiable construct is now quantifiable. Industry averages for each aspect of dental service can be established and, consequently, dentists can identify their practice`s strengths and weaknesses. Further, if dentists want to pursue practice improvement, they can focus their efforts in the right direction.

- Gregg Martin

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