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Practice Builders

Secrets To Bolstering Patient Satisfaction

   Most podiatrists equate marketing with advertising. However, advertising is the most expensive and often least effective facet of services marketing. Internal marketing is the most cost effective, most time effective and usually the most dignified form of marketing. Internal marketing within your practice occurs continuously even if you are unaware of it.    Patient satisfaction opens the door to internal marketing of your practice and comprises the bulk of services marketing. We all know DPMs who are only average clinically but do extremely well. Conversely we all know great clinicians struggling to stay afloat in today’s rapidly changing healthcare environment. The difference is usually patient satisfaction.    Some patients are delighted with us despite a result we would rather not have our colleagues see. On the other hand, other patients may angrily leave our practice us for some trivial reason despite a great clinical result.    Numerous unconscious impressions comprise the remainder of these perceptions. A patient’s perception of any healthcare service is colored by a vast array of prior experiences that set up current expectations. The patient is pleased to the extent that his or her current perceptions exceed the preexisting expectations. This encompasses far more than the clinical result (within a relevant range) and includes such non-treatment issues as the demeanor of the staff, condition of the physical premises, psychological comfort during the visit, etc.    Remember, all patients talk about doctors anyway. Happy patients will tell four other people you are a nice doctor. These patients are more likely to complete treatment and follow instructions. Accordingly, they have a better chance of having a good medical outcome. These patients also tend to generate additional fees for the practice in that they pay quicker and are less likely to be the source of bad debt.    An unhappy patient vehemently tells nine others that you are a nasty rip-off artist. This is sad but true. They are not as likely to complete treatment and subsequently have a less than optimal result. They generate less in fees. They pay slower, if at all, and may create a stressful environment that has a detrimental effect on the attitude of other patients in the office.

How Patient Satisfaction Can Benefit The Practice

   Keeping patients satisfied is not only a vital component of patient care, it can bolster the referral rate and economics of your practice in several ways.    Increased patient retention. Patient satisfaction increases patient loyalty. This translates into other factors remaining the same, more billable services given and more retail goods sold per year. All practices lose patients through death, relocation, etc. Nothing can be done about it. However, other patients defect to other practitioners or do not seek additional required treatment at all. If no other patient satisfaction program exists, other than best effort on a case-by-case basis, the techniques listed below can dramatically decrease that defection rate. Retaining a patient is more cost effective than replacing one. Note that even a 1 percent improvement in patient retention, an extremely low result, can mean thousands of extra pre-tax dollars available for practitioner salary.    Increased new patient referral rate from current patients and staff. Not only do you retain the referral potential of current patients, but the rate and enthusiasm of existing patient referrals also improves.    Decreased overhead percentage rate. The relative amount of profit increases secondary to improved staff efficiency as more revenue is generated on fixed expenses like rent and decreased advertising costs.    A fee premium for being the area’s de facto preferred provider. Increased patient satisfaction skews the usual price/quantity tradeoff of patient consumerism in your favor. This is especially important for non-covered services without third party reimbursement.    Decreased time for accounts in the accounts receivable cycle and a decreased bad debt ratio.    Improved office morale, less stress and increased joy from practicing your profession.

How Internal Marketing Can Make A Difference

   Internal marketing becomes especially important when the public does not perceive differences in practitioner skill as significant. Internal marketing can also be beneficial and/or in an area saturated with other practitioners.    For example, the world’s best heart transplant surgeon does not have to worry about his or her location, office dynamics or personality adversely affecting patients. A suburban podiatrist does need to worry about such things if surrounded by other DPMs, orthopedists, physical therapists and an ambulatory surgery center, all competing for the same patient base.    One example of internal marketing through increased patient satisfaction occurred a few years ago. Some patients were concerned, perhaps subliminally or overtly, about contracting AIDS, hepatitis or the West Nile Virus in the DPM’s office. If staff is trained to point out the existing sterilization controls, how the office exceeds OSHA requirements and how meticulous you are, these patients relax. This “marketing” merely points out to the patient things you take for granted and removes a psychological barrier to full compliance. It is not bragging or manipulation. There is a remarkable positive cycle of benefits for everyone. There is no downside. Nobody is displeased to see you maintain a clean office. Today, one can accomplish the same thing with the HIPAA statutes given the heightened sensibility about patient confidentiality.

Understand The Variables That Can Affect Patient Satisfaction

   Patient satisfaction can be affected by many variables. Most patients do not predefine what would be “acceptable” from their encounter, but have vaguely defined ranges of prior expectations that are gleaned from a lifetime of healthcare related experience. Any variance between this “acceptable” range of expectations and each trivial encounter invokes some degree of positive or negative feeling in the patient.    The total perception of the office experience is an aggregate of multiple trivial and often subliminal observations. Patient satisfaction is complicated by:    Inter-patient variables. There may be a significant difference among patients in their “podiatric expectations.”    Intra-patient variables. A single patient can perceive the same thing or situation differently at different times, depending on uncontrollable variables like mood or context of occurrence which the practice could (sometimes and/or partially) control.    “Luck of the draw” in physical variables. Does Sally or Mary escort the patient to the exam room? Was it the blue or green exam room? Did the last patient who used the restroom leave a disgusting mess? Try to eliminate problems that might cause negative perceptions and implement controls to help ensure positive perceptions.    Heterogeneous staff variables. Even with appropriate training, people have their own individual quirks.

Emphasize Problem Prevention

   When trying to manage variables in the office to bolster patient satisfaction, it may be easier for most practitioners to start with avoidance strategies.    One can anticipate and prevent detrimental patient encounter issues. Have the staff list everything they have seen as problems in the past. These problems may include things like prolonged waits, dirty bathrooms, getting an answering machine instead of a person, loud patient arguments over bills, etc.    The first priority one should address is any haphazard, sloppy office procedures. From the patient’s perspective, any administrative mix-up (double billing, lost records, staff problems) can create a perception of poor practice management and patients may even take this a step further and link it to poor clinical quality. Logically streamlining operations can eliminate many possible impediments to patient satisfaction.    Revamping your scheduling procedure can help reduce the wait. Remember, solutions have to work for you as well as patients. One must balance decreased waiting time with optimal work capacity. Again, perception is important. An empty reception area, while optimal for minimal wait, may make patients wonder why you are not busier.    Freeing the receptionist from other duties at crucial times may ensure patients always get a person on the line. Emphasizing phone etiquette training may help phone efficiency. Getting other staff members to pitch in when needed is another possible solution.    Modifying billing policies and having a soundproof room in which to discuss them may help isolate one irate patient’s squabble.

Taking Appropriate Action After A Problem Arises

   What action can one take to remedy a problem such as a billing dispute? In any potentially detrimental situation, delineate what the staff can do to make it right. A service paradox exists and timely, appropriate action can sometimes build more patient satisfaction than if the situation had never occurred.    A dispute over price should not occur in front of other patients. Many receptionists find that genuine, cute little quips like, “I know it seems high, but (wink), I’m expensive to maintain,” defuse the situation by gently pointing out the overhead factor. When a patient balks at fees, gently and politely imply that we could inquire if the local plumber was available to do the exam, procedure or surgery. A little humor brings training and relative cost issues into play while making them smile. Costs are high but justifiable.    Another common problem is a long patient wait. It is not enough to just have policies in place that help prevent a prolonged wait from occurring. There must also be policies in place that ameliorate an adverse situation when it does arise. This can involve placating a patient over long wait or reassuring a patient about an empty waiting room. An apology from you and/or the staff might be one technique, in the form of saying “I’m so sorry to keep you waiting. The doctor and I really try to stay on schedule because we know how valuable time is for our patients.” Offering some refreshments might be another approach. In extreme cases, giving patients a beeper and turning them loose until you need to see them may work.    Many patients will be impressed that you have even considered how the wait affects them. If the wait is not too long, sometimes the above management techniques can actually build more patient satisfaction than just seeing them on time.

In Conclusion

   By proactively anticipating the entire visit from the patient’s perspective, the DPM can structure and arrange things so patients have mostly positive perceptions. This can be done despite all the potential variables in the mix that can affect and shape patient perception. Patient satisfaction can be improved in any office and anyone can improve it.    Obviously, there is no standard cookbook recipe to ensure patient satisfaction. Try to get the big picture. Identify the worst areas and fix them. Identify the best areas and reinforce them. Proceed slowly. It can be done one facet at a time. Adapt things to your own managerial style and personality. Be completely open to suggestion and change. Dr. Marcinko is a Certified Financial Planner and Certified Medical Planner for, sponsor of the Certified Medical Planner charter designation program. He can be reached by phone at (770) 448-0769 or by e-mail at Dr. Bode is the CFO for He is a noted author and Certified Public Accountant with a Master’s of Science Degree in Accounting.

Practice Builders
By David Edward Marcinko, MBA, CFP, CMP, and Gary L. Bode, CPA, MSA
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