Practice reputation management a priority in digital world
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In the era of digital communication and social media, establishing and protecting the reputation of a medical practice have become even more critical.
In the past, reputation was built on face-to-face interaction, personal recommendation and word-of-mouth referral among friends, family members and colleagues. Marketing statistics said that, on average, happy customers would share their experiences with three people and unhappy customers with 20 people. But nowadays, when sharing means posting on the internet, the potential recipients of the message, good or bad, are countless, with no boundaries of space and time.
Source: Samantha Williams
“Social media and the internet have been both a blessing and a curse for practice reputation management,” Healio/OSN Board Member Neda Shamie, MD, partner at Maloney-Shamie Vision Institute in Los Angeles, said. “If you’re thoughtful about your web presence, you can really benefit from the ability to propagate your brand and positive patient messages, but if you are nonchalant, a single negative message could project more loudly, leading to significant reputational damage.”
In the past few years, the number of sites that allow people to rate physicians and discuss their experience, in an unfiltered manner, has greatly expanded.
“Some practices operate under the mistaken assumption that their online reputation doesn’t matter because their schedule is filled with elderly patients. This is a canard. Many patients in their retirement years are savvy with searching and reading online comments and reviews, and even if the patient doesn’t do the research, their family members will,” OSN Refractive Surgery Board Member Jason P. Brinton, MD, medical director at Brinton Vision in St. Louis, said. “For offices like ours that limit our practice to LASIK and refractive surgery, online and offline brand reputation is everything; we ignore it at our peril.”
Word-of-mouth referral is still critical, he said, but has expanded from the dinner table, the church and other social events to a much larger public space: the social web.
Patients are customers
As hard as it may be for some physicians to accept, patients are also customers. When they have more than one option, they will choose what they judge to be the best for them, according to Shareef Mahdavi, president of SM2 Strategic.
“The model of ‘I’m the doctor, you’re the patient, I tell you what to do, and you will do as I say’ belongs to the past. The internet has broadened access to information and amplified the voice of the customer. Prior to review websites, if a customer was unhappy, the only people who would get to know it were a few friends, and that would die down. Now, patients write reviews that travel in the cyberspace and stay there potentially forever,” he said.
Mahdavi believes that this is not necessarily as unfair as physicians may perceive it. Whether it is a restaurant, a retailer or a medical practice, consumers judge which business to continue using based on their experience, he said.
“For decades, health care was not held to the same standards of customer service and customer satisfaction as every other industry. Meanwhile, the expectations of customers have gone up and up in every other part of their life, and it’s time for medicine and health care to catch up,” he said.
Physicians need to understand that clinical care is not the only thing that matters and that customer experience has more to do with how patients are treated and made to feel.
“That’s just as important. And I would tell you that it’s actually more important, particularly early on, because if you want to develop trust with patients, if you want them to listen to you, they have to feel like they’re valued,” Mahdavi said.
Staff training
In 1697, when the Russian emperor Peter the Great wanted to understand what life was like in Europe, he dressed up as a commoner. He wanted to ensure that his visit to London and the Netherlands gave him an accurate view of everyday life. Physicians need to do the same in their offices. To develop a true understanding of the patient experience, providers should put themselves in the patient’s shoes, according to Brinton.
“Call your office and notice whether the phone is picked up on the first or the fourth ring. Are phone team members consistent about employing a warm tone and cadence? Can you hear a smile in their voices? (Smiling loosens up the soft palate, allowing for a smile to be ‘heard.’) Do staff demonstrate empathy and come across as knowledgeable?” he said.
A patient experience is defined by not only the clinical aspect, but by every touchpoint with the practice, whether that be on the practice webpage, over the phone or at the reception desk.
“We train our team to communicate with patients by aiming for 100 hours per year of staff training, or about 2 hours per week. Everyone needs to buy in to the mission of providing unparalleled customer service, and team members together need to keep each other accountable for upholding agreed-upon standards. In the end, the standard of customer service in your office isn’t about what you say it is; it’s what you tolerate,” Brinton said.
“It is important to empower your staff to take an active part in elevating the practice and the patient experience to the level that you want it to be,” Shamie said. “Encourage them to give you constructive feedback, to speak up when they see a problem and to brainstorm together with the whole group on how to fix it. We have weekly meetings with our staff to discuss what didn’t work well and what could be done better. We share suggestions and best practices, and in their quarterly review, staff members are given positive feedback for being vocal about opportunities to improve our processes.”
“Periodically, a consultant is hired to provide specific training on patient communication by observing, listening and giving constructive feedback at every step of the patient experience,” she said. “In making this investment, we not only gain great insight into ways we can improve but also further emphasize to our staff the value we place on the patient experience.”
Patti Barkey, COE, chief administrative officer at Bowden Eye & Associates in Jacksonville, Florida, said that her practice has successfully adopted a combination of cross-training, peer-to-peer learning and external specialist consulting.
“Sometimes you need to bring in somebody from the outside because when you’ve worked with your staff for a long time, you become like mom and dad, and they need an unbiased, independent perspective to their work. But we also do a lot of peer-to-peer training. For instance, if a physician has been able to get more premium lens patients than everyone else, we ask that physician, ‘What are the key words, the scripts, the approach that you use to make the patient feel more comfortable that the choice you’re offering them is the best for them?’ We share successful experiences and learn from each other in a very collegial atmosphere,” she said.
Physician-patient communication
In a physician-patient relationship, positive communication and good bedside manner matter as much as the outcome and promote positive word of mouth for the clinic.
“If you have a stellar surgeon who doesn’t have good bedside manner, the patients won’t value the outcome but rather report a perceived negative experience. Conversely, if a surgeon is pleasant, good at listening and easy to talk to, patients will forgive an outcome that is less than stellar,” Barkey said. “Empathy and good interaction are major components of relationships with peers as much as with patients.”
Studies have shown that it is not the quantity but the quality of time spent with the physician that affects the patient’s level of satisfaction.
“Looking the patient in the eye, facing them directly rather than typing to the side, assuming an open posture, listening and showing empathy foster and strengthen the patient-physician relationship. It is a powerful healing agent and increases practice reputation,” Brinton said. “We have a rule in our office that the first question we ask a patient is open ended, and when listening to the patient, we focus on what it’s like to be in their shoes rather than on what our response will be.”
Mahdavi works with physicians by observing their interactions with patients. He said that the language they use is often too complex, and patients end up disengaged because they are confused.
“I focus on the elective area where the patients have a choice to pay out of pocket for something additional, may it be a refractive outcome, a specialized dry eye treatment or something that’s not reimbursed to help with glaucoma management. If the patients do not clearly understand what you are offering and the true advantages of it, they will just go for whatever the government pays for. And we know that this happens a lot,” he said.
He is strongly convinced that if the proportion of refractive IOL adoption is still only 15% to 20% despite the great advances of the technology, it is because communication and the patient experience overall are not good enough.
“It’s simply the failure of the practice to communicate effectively,” he said.
Online reputation management
People trust what they hear from family and friends but still put a lot of weight on what they read online, and this trend is likely to continue growing.
Therefore, reputation management involves tracking and reacting to brand mentions across a range of online channels, Brinton said.
“There are channels you can control, such as your own website and other sites like Google, Healthgrades or Yelp, where you can register and fill out a profile, add pictures and tell a story about your business. Take care to ensure that the information you provide is easy to access and accurate. If you write that your office closes at 5 p.m., a patient should never be in the situation of calling or dropping by at 4:45 p.m. to find that the office is closed. Beyond setting up your practice profile, you then have little to no editorial control over what patients share; your results and customer service experience need to be consistent with the way you want patients to write about your brand,” he said.
“Negative reviews cannot be fully avoided. No matter how committed, skilled and thoughtful you are, there’s always going to be a patient who may not be happy with the results or their experience,” Shamie said. “And if you don’t yet have a robust positive web footprint as far as your reputation is concerned, then that negative voice will speak much louder.”
Shamie believes that reputation management should not be defensive in response to negative feedback. Rather, it should be proactive and prepared to manage crises to establish a strong footprint and reduce reputation risks.
Proactive strategies
When Robert Maloney, MD, founded his institute in Los Angeles 20 years ago, he could count on his strong personal reputation as an academician, researcher and innovator. Shamie joined him in 2018 and also had the advantage of an academic background and a well-established reputation as a surgeon and researcher.
“Having an academic background is a wonderful way to launch your reputation. It was easy to market myself because of that. I had managed very complex cases, I had taught other surgeons, and this put me in a position of leadership when I went out in private practice,” Shamie said. “In addition, Dr. Maloney and I have truly streamlined our practice and consolidated our focus on surgical anterior segment, allowing us to focus our expertise, fine-tune our approach and truly optimize the patient experience.”
“We, of course, do not take for granted the advantage we have to be located in an area such as Los Angeles, where the practice can attract people who are considered media and online influencers. Our practice does not actively seek out such influencers; they come organically because we have a reputation of being the best in class as far as cataract surgery and laser refractive surgery. And when they post about their experience with us on social media, it reaches a wide audience, one we would not otherwise reach,” she said. “It is not unusual for them to find out about the post after the fact when they’ve tagged the practice. We do have an internal marketing director who is instrumental in managing our brand. He also helps guide us not-so-savvy surgeons when a known ‘influencer’ undergoes treatment with us and can speak about their experience. His role in our practice has helped maximize such opportunities that help fortify our brand in the mainstream.”
Their goal as a practice is to offer patients a transformative experience.
“Every touchpoint for the patient needs to be thought of and optimized to create a uniformly positive and elevated experience. That is, from the moment they come across our website, to the phone conversation with our phone team, to the interaction with our front desk, clinic team, surgeon, surgical coordinator and so on, all are evaluated and fine-tuned. The surgeon and the surgical outcome are only part of the journey, but the process from start to finish should feel transformative and memorable in the most positive way,” Shamie said.
One important aspect of good customer service is being considerate of patients’ time. In Shamie’s practice, the goal is that idle waiting time at any step in the patient’s evaluation should be no more than 5 to 10 minutes, and if that goal is not reached, the clinic coordinator evaluates the reason, and as a team, they look at ways to improve the process.
“We also take great care to establish and maintain contact with the referring physicians, who are held in high regard. And we constantly evaluate the efficiency and quality of that communication. Every week we assess how we are doing and modify the processes to improve them if there are any issues,” Shamie said. “Complacency does not lead to growth. Looking within for ways to improve is the fuel that will improve outcomes, elevate patient experience and fortify our reputation.”
Websites and social media
Medical practices may find it worthwhile to assign either a staff member or an outside expert to manage and monitor the practice’s website and social media.
“Not all doctors have the willingness and time to write their own posts and blogs, but telling patients’ stories while talking about conditions is very engaging and educational,” Mahdavi said.
Websites are part of the first impression a patient has of a practice. They should be thought of as the “online front desk,” and first impressions count in the digital world as much as in the real world.
“A website with a clean, fresh and beautiful look immediately gives patients a good feeling of the place they are about to visit, while a dull or confusing website will make them search for a better alternative,” Barkey said.
Social media requires a good targeting strategy.
“People in their 20s and 30s consume social media differently than people in their 50s and 60s. If you’re trying to target people in their 20s or 30s, then focusing on Facebook may not be your best move,” Brinton said.
Another important aspect of social media is that happy patients will comment on posts, providing social proof.
“When we post on social media, often the most powerful information isn’t what we write in the post; it’s what our patients write on their own when they comment on our post. We recently shared a video about refractive lens exchange and were pleased to see that some of the first comments came from our own patients. Several commented about their own RLE experience in our St. Louis office. One said it was the ‘best decision I ever made,’ and another commented, ‘I wish I had done it sooner.’ Organic social proof from your current patient base is priceless,” Brinton said.
Patient feedback
Collecting patient feedback is always important, and many times it can be an eye-opener.
“I’ve considered having a roundtable of patients to help us discuss the pluses and minuses of the services we provide and get suggestions on making the overall patient experience better. However, this might be opening Pandora’s box, and not everyone in the practice would accept it. But we have online ratings and reviews, which are a good way to get feedback. We always thank those who write a positive review and try to handle negative ones with a grain of salt,” Barkey said.
Getting reviews is important for a practice because people look at them when they need to see a physician.
“That’s why reputation management is so important. If what I read isn’t very good, I’ll just go to the next and find another doctor,” Mahdavi said.
Therefore, he said clinicians should have a system in place to consistently gather reviews. There are tools for sending automated review requests that, if carefully worded, can have the same impact as individual emails while requiring a fraction of the time.
“Eventually, your goal is to continuously improve rather than be five stars on every review. Bad reviews are inevitable. As a consumer, if everything is perfect, I get a little suspicious because nobody can please everybody,” Mahdavi said.
Some practices send out patient surveys by email. This can help supplement the view they get from comments posted online, Brinton said.
“In the end, the most important step is to ensure that your team is ‘all in.’ Every member of the staff needs to be committed to providing a world-class customer service experience. This requires training staff to seek feedback, listen to patients and continually strive to do better,” he said. “It may be painful because no team or individual likes to hear things that we need to improve on. It’s not fun or good on the ego, and yet it’s invaluable. If we have a listening ear, we can learn a great deal from our patients, both from positive and negative comments.”
- References:
- Dugdale DC, et al. J Gen Intern Med. 1999;doi:10.1046/j.1525-1497.1999.00263.x.
- Honavar SG. Indian J Ophthalmol. 2018;doi:10.4103/ijo.IJO_1760_18.
- Kim L, et al. Otolaryngol Clin North Am. 2022;doi:10.1016/j.otc.2021.08.005.
- Linnehan R. Satisfied customers: The end result of a successful patient journey. https://www.healio.com/news/ophthalmology/20191112/satisfied-customers-the-end-result-of-a-successful-patient-journey. Published Nov. 18, 2019.
- Romano R, et al. J Med Pract Manage. 2014;29(6):369-372.
- Williams AM, et al. BMC Ophthalmol. 2016;doi:10.1186/s12886-016-0315-0.
- For more information:
- Patti Barkey, COE, can be reached at Bowden Eye & Associates, 7205 Bonneval Road, Jacksonville, FL 32256; email: pattibarkey@hotmail.com.
- Jason P. Brinton, MD, can be reached at Brinton Vision, 555 N. New Ballas Road, St. Louis, MO 63141; email: jbrinton@brintonvision.com.
- Shareef Mahdavi can be reached at SM2 Strategic, 555 Peters Ave., Suite 100, Pleasanton, CA 94566; email: shareef@sm2strategic.com.
- Neda Shamie, MD, can be reached at Maloney-Shamie Vision Institute, 10921 Wilshire Blvd., Suite 900, Los Angeles, CA 90024; email: ns@maloneyshamie.com.
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