Patients as Customers

The customer lens makes the retention problem one of customer satisfaction.  More importantly, it puts the onus on the clinic to manage the entire customer experience. In this view, it is not the price of each visit (e.g. the copay), that is the problem, it is the patient's perceived value of each visit. How can you demonstrate the value of treatment?

On average, 40% of all patients that start a course of rehabilitation drop out by the third visit.  According to a reliable source who managed a multiple-hundred clinic organization, that’s our number.  Whenever we share this with a clinic director, we are told that the number for their clinic is a bit higher or a bit lower.  We rarely hear that it is not a problem.

Patient retention is a serious problem.  It’s serious because the most expensive visits to deliver for a clinic are the first visit and the last visit.  Intake paper work, discharge paper work, setting the patient up in the system for the first time all incur cost.  Cost, for which the clinic is not adequately compensated.  It’s those middle visits that make up for the extra work on the first and last.  It’s those visits that are lost when patients choose to not come back after the third visit.

It’s also serious because it is de-motivating to clinicians.  The clinicians I have met are invariably working with patients because they want to make them well.  It’s frustrating to them when they’ve just started with a patient and they turn up amongst the missing.

What’s really going on here?  How do we understand and solve this problem patient retention?  How could it be the case that almost half of all patients that are seen in an outpatient clinic fail to come back for a fourth visit?  After all, they are getting exactly what they expected when they came to the clinic – rehabilitative treatment for their condition.  Or, are they?

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How we understand the problem for patient retention is determined by the lens through which we view it, and the lens makes a difference.  It’s our observation that the typical view clinics take is that the people in their waiting area are patients.  Therefore, they have come to the clinic with the expectation that they will receive treatment that will return them to function.  That’s the sum and substance of their expectation, and that’s what clinics focus on providing to meet that expectation.

In this framework, the problem comes to be a consequence of the outside entities that are setting copay charges and deductibles.  It works like this.  Because the clinic is providing what the patient is seeking – rehabilitative treatment for their condition, the reason patients choose not to come back is that the cost is too high.  If the cost were only lower, or even zero, then the patient would of course come back and complete their course of treatment – because that’s what they expect and they are getting it.  Are you sure?

We invite you to break the patient lens and change to a different lens.  Let’s look through the lens that views the people in your waiting room as customers.  If we do this, the way we understand the problem is broader, deeper, and more nuanced.  That’s because as customers, the people in your waiting room will have the expectation that they will receive rehabilitative treatment for their condition and that they will be treated like a customer.

Treated like a customer.

We all know what that means because we have the same expectations when we are the customer.  In no particular order, as a customer we expect

• to be acknowledged and greeted courteously
• treated with respect and dignity as an individual
• paid attention to when we have a question or concern
• made to feel that we are important and matter
• value for the time and money we are spending

The people in the clinic waiting room have the same expectations and more.

The customer lens makes our problem one of customer satisfaction and meeting and exceeding all their expectations.  More importantly, it puts the onus on the clinic to manage the entire customer experience of coming to the clinic.  In this view, it is not the price of each visit (e.g. the copay), that is the problem, it is the fact that the patient/customer is not perceiving that they are receiving value for those dollars, nor are they being treated particularly well in the process.

Think about the experience in your clinic by asking yourself these questions.

• What does a new patient see when they first walk in the door?
• What does the waiting room look like? Smell like?  Sound like?
• How are they greeted by the receptionist?
• How are they asked to complete their initial paperwork?
• How do they understand what their first visit will be like?
• How long do they have to wait until they see a therapist? Is the therapist on time?
• What is their first visit like with the therapist? How are they made to feel unique and cared for?
• How do they understand the course of their treatment and how it will benefit them?
• What will progress look like?
• How are they escorted out of the clinic? How is the scheduling of their next appointment managed?
• How are they asked if their first visit was satisfactory? How is a negative response to this question addressed?

How does your clinic stack up?

Dave P. Briggs, Ph.D.
Vice President of Domestic Sales