Targeted surveys reveal thought process behind patient satisfaction
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Every successful enterprise must focus on the voice of the customer.
In an ophthalmology practice, the primary customer is a patient. A happy staff and happy referring doctors are critical as well, but generating happy, satisfied patients will usually result in a happy, satisfied staff and referring doctors. Therefore, the critical focus for an ophthalmology practice is the generation of happy patients. We are all familiar with the saying “happy wife, happy life,” which today has evolved to the more appropriate “happy spouse, happy house.” For an ophthalmology practice, I would modify that quote to “happy patient, happy practice.”
The core topic of this issue’s cover story is cataract surgery, especially premium cataract/IOL surgery in which the patient is asked to share significantly in the cost of the procedure and perioperative care. Cataract surgery has always been critical to the success of a comprehensive ophthalmology practice, and every year premium cataract/IOL surgery increases in importance. The most successful virtual educational program ever presented by the American Society of Cataract and Refractive Surgery, organized by David Chang, MD, was focused on premium cataract/IOL surgery and titled “20/Happy.” How can we know if we are generating 20/happy patients in our practices? The answer is, we have to ask them with targeted surveys.
I utilize OpenTable for many of my restaurant reservations. After every meal, I am asked to grade my overall dining experience from very poor to excellent using a five-point so-called star rating system. A five-star rating is excellent, four-star very good, three-star good, two-star poor and one-star very poor. This rating system is simple to use and very popular. Any practice can ask their patients to rate their overall experience from one to five stars, and patients who report a one- or two-star experience can be contacted for an interview to determine the cause of their low rating.
The overall rating of a restaurant is much more than just the quality of the food. It is the quality of the entire experience including service, location, environment, ambience and perceived value. The same is true in an ophthalmology practice where each step in the patient journey from scheduling the first appointment to the final visit plays a role in the patient’s rating. Today’s 20/happy patient desires not only quality surgery but prompt and outstanding service from the entire practice team in a clean, attractive and convenient environment at a reasonable cost. A great physician can make up for some of the deficiencies found in many of our practices, but five-star ratings are not generated by the surgeon alone. Asking your patients to rate you and their patient journey in your practice is critically important in today’s competitive environment, and an average rating of less than four stars is cause for concern and intervention.
Another useful benchmark to follow is “willingness to recommend.” This is a question that can be asked not only of patients but of staff, referring doctors and even vendors. How many of your patients, staff and vendors would recommend your practice to their family and friends? Here, an average score of less than 90% is cause for concern and intervention.
Some more sophisticated practices and businesses use net promoter score (NPS). In this method, patients rate their experience from 1 to 10 and are divided into three categories: detractors, passives, and promoters. The NPS is promoters minus detractors. With the NPS system, lower scores are typical, and the goal is to increase promoters and decrease detractors with continuously increasing NPS. Promoters tend to sing a practice’s praise, but detractors can do significant reputational damage. All detractors are contacted by phone, interviewed and offered remedies to resolve their dissatisfaction.
For many practices that have not regularly monitored patient satisfaction, a skilled and experienced consultant is wise at the start. I have learned that it is possible to have a poor objective outcome and a patient dissatisfied with their vision after premium cataract/IOL surgery while still retaining a patient that is very happy and satisfied with me and my practice. It is also possible to have an amazing objective outcome and a very unhappy dissatisfied patient.
The most common clinical causes of dissatisfaction with the objective outcome of a premium cataract/IOL procedure are discussed in the accompanying cover story and include residual refractive error, ocular surface disease, media opacity, IOL decentration, and retinal or optic nerve disease that reduces quality of vision. Several studies have shown that patient satisfaction with a premium cataract/IOL procedure is closely correlated with the visual acuity outcome generated. Using Snellen visual acuity, a 20/25 uncorrected visual acuity outcome at every distance targeted will nearly always generate a patient who is 20/happy with their IOL selection. In a healthy eye and with appropriate enhancements, which may include secondary surgical intervention, we can expect to generate a 20/happy outcome in 95% to 98% of our premium cataract/IOL patients, similar to that achieved with laser refractive corneal surgery.
This is an amazing outcome and places premium cataract/IOL patient satisfaction rates ahead of nearly every other surgical procedure in medicine. The goal is to provide the premium cataract/IOL patient a five-star surgical outcome complemented by a five-star patient journey resulting in a practice promoter who is willing to recommend you to their family and friends.
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