HOT TOPIC A new look at old problems

Patient Complaints

How to cool down hot situations in the dispensary

By Allan Barker, OD, and Greg Stockbridge, OD, MBA
Illustrations by Jon Krause

Do you give patients an easy way to register complaints and concerns? Do you keep track of those concerns and take action? Here's how one 55-location company—Eyecarecenter, OD, PA, based in Rocky Mount, N.C.—has handled these challenges.

In 2004, just as the Internet was becoming a more important tool for communicating with patients, Eyecarecenter instituted a President's Hotline on its website. It's become a more important tool with each passing year.

On the hotline page patients are encouraged to contact the president directly. The reasoning? The typical consumer tells nine or 10 other people about a negative experience, and only five of a positive one. That means each patient can refer multiple people or tell them of their unhappiness. The President's Hotline acts as a pressure cooker valve for patient problems. When launched the assumption was that generous refund policies and well-trained staff members would help minimize Hotline complaints.

TOTAL COMPLAINTS

Here's what came through the Internet during the first five years after the President's Hotline was implemented:

• Negative patient comments totalled 64. With 55 locations, that amounts to 1.09 complaints per office and is about the same as the number of positive patient responses generated over the Hotline. Most of the complimentary ones singled out an individual staff member.
• In all, 33 offices registered zero complaints. Of the remaining 22 locations, five complaints were the most received regarding any one office. Each time, the patient was contacted by the president, and the problem was resolved. To ensure patient satisfaction, the president personally followed up on each complaint.

What are the problems that couldn't be handled at the office level and that bugged patients enough for them to seek satisfaction at a higher level? More than half, 51.5 percent, indicated the optical department as the source of their primary complaint.

TACKLING TOPICS

■ CONTACTS VS. GLASSES. Only 9.4 percent of complaints dealt primarily with contact lenses. Though optical material revenues were 2.7 times more than contact lens revenues, optical complaints outnumbered contact lens complaints 5.5 to 1. One speculation on this finding: the doctor is often more directly involved in the contact lens transaction than with what goes on in the optical department.

■ RUDENESS. More than one out of five (21.9 percent) complaints listed rudeness as the primary problem. These were divided equally between rude staff members and rude doctors.

It's logical that rude staffers would result in patients complaining to a doctor and/or manager at the specific location. This would most likely not be the case with a rude doctor. Thus, the only outlet for perceived rudeness by a doctor would be a device such as the Hotline.

What if you don't have a mechanism like a Hotline? The logical outlet for perceived doctor rudeness would be to leave the practice and possibly to spread negative public relations.

■ INSURANCE. Only 12.5 percent of patients listed insurance as their primary problem. Eyecarecenter doesn't do business with insurance companies that have poor customer service reputations. Also, its centralized insurance billing alleviates many administrative problems. It could also be argued that insurance companies bother providers more than they bother the patients.

■ MEDICAL. Only one medically related complaint was registered on the Hotline in five years—a surprise considering that 12 percent of the company's revenue comes from “medical.”

■ MONEY. Also, only one complaint dealt directly with money. Money may have been a factor in many complaints; however, only one patient registered money as a primary issue.

■ OTHER. Just over three percent were classified as “other” and these complaints ran the gamut from alleged HIPPA violations to patients' accounts going to collection.

PROBLEM AREAS

Since optical represents over half of patient complaints to the Hotline, let's look more closely at this area.

Complaints fell into three areas.

■ LATENESS. The number-one complaint was glasses not ready when promised. Almost half (45.5 percent) of the optical complaints dealt with this problem area.

■ ADAPTATION. Almost as critical was the complaint, “I can't get used to my glasses/lenses!”

Almost 40 percent (39.4) percent of complaints fell into this area. Very few of these complaints dealt with progressive addition lenses, however. One reason? Extensive staff training and a liberal refund policy help here.

■ SINGLE VS. MULTI. Single vision lenses comprised 18.1 percent of lens complaints. Bifocals, progres sives, and lined, combined, totaled 81.9 percent—bifocals were 4.5 times more likely to produce patient complaints than single vision lenses.

All told, there were a few surprises in the numbers. Progressive addition lenses produced no more relative complaints than lined bifocals. Contact lens complaints were fewer than expected. Money and insurance were both less of a factor than expected.

On the other hand, doctor complaints were more than expected, and the optical department seemed to be the major area of patient complaints. So, if we want happy patients, this is where we should concentrate our patient satisfaction efforts.

Complaint Data

1. One in 40 complaints make it to upper-level management, all others are expressed to staff members.
2. About 96 percent of dissatisfied patients don't complain.
3. Also, 65 to 90 percent of these dissatisfied patients will not buy again from you.
4. Four percent of dissatisfied patients do complain—30 to 46 percent will not buy again from you.
5. People who are dissatisfied will tell nine to 10 others.
6. People who are satisfied will tell five others.
7. A low assumption: one out of 100 complaint recipients do not come in/return.

COST OF DISSATISFACTION

How important is it to improve patient satisfaction in a practice? The chart above references research data that helps place an estimated dollar figure on the cost of dissatisfaction.

Assuming that out of every 100 current or potential patients who have heard complaints from existing patients, one of those people would decide not to come to you for your service—a conservative assumption.

Using the lowest values in the ranges of data to arrive at the most conservative number, we concluded that a complaint that makes it to upper level management can jeopardize more than $217,800 in potential income. Hopefully, seeing that one direct complaint could be costing a practice over $200,000 in potential revenue is enough to consider addressing some of these issues.

Not only do we need to know how to avoid complaints, but we also need to know how to handle them and alleviate the core problems.

From 30 to 46 percent of people who complain will not buy from you again. That's a lot less than the 65 to 90 percent of dissatisfied patients who don't complain.

Patients who complain are likely to get some form of resolution to their problems. If they feel their problem was handled appropriately they will likely return for additional products and services. It's the silent patients who are a real loss.

SATISFACTION SCORES

This is why it is so important to get patients' input about their satisfaction after a visit. Improvement in patient satisfaction is a key issue that can be easily worked on and that will help carry a practice through tough economic times.

A bit of data to help support this is that, during the recession of 2001, companies in the Dow Jones Industrial Average with higher-than-average customer satisfaction scores far outperformed the market, stressing the importance of customer service in an economic downturn.

COMPLAINT MANAGEMENT

To better manage problems, practices need to formulate in-office complaint handling systems.

■ POINT PERSON. Systems should promote upward communication from technician, front desk, and optical staff to a “complaint manager.” This person will likely be the office manager or the doctor.

In order for this to work, staff must be told to pass all complaints, no matter the size, to that designated person.

■ STAFF EDUCATION. Educate the staff on what a complaint is and that you want to hear everything. Too often, employees don't think comments out of a patient's mouth are actually complaints. In reality, they may be legitimate ones. Also, staff members may feel that certain types of complaints are not important or that they will not be resolved even if mentioned so they are reluctant to report them to the complaint manager.

■ OVERCOME BARRIERS. It is important to determine communication barriers and facilitators within the office. One likely barrier is that staff members never want to report anything bad about themselves or their close co-workers. The complaint manager must make it clear to staff that the company is going to take a patient's complaints and learn from them in order to benefit every staff member's performance along with the practice as a whole.

■ NOTAWEAPON. lt must be made clear that the complaint management system is not a tool to criticize individuals or staff as a whole, because this will quickly shut down the upward communication that is so important to achieve.

They need to understand that the complaint manager wants to hear everything and then make the decision of what is a legitimate complaint that needs to be addressed.

■ INCREASE RESPONSIVENESS. It is important that staff knows that the goal of complaint management is to allow the office to become more responsive to patients' needs and that they will also allow the office to change policies and procedures that ultimately will help prevent the recurrence of problems.

■ SATISFACTION SURVEY. One step is to create a patient survey questionnaire. It is an excellent way to measure the level of patient satisfaction and to help further monitor your progress.

■ ACTION PLAN. Compare the complaint data and the patient questionnaire/survey data and pick two or three key things to focus on at a time. Any more will be too cumbersome for you and the staff. The Sigma Six Solutions section on p. 38 will walk you through the steps for changing the first set of issues, then you can work on the next set. Remember that one ignored complaint can cost a practice huge amounts of money. Hopefully, this analysis of one company's complaints—and suggestions for addressing the problems—will assist others in improving patient satisfaction, employee morale, patient care, and financial success. EB

Greg Stockbridge, OD, MBA, graduated from New England College of Optometry and received his MBA from Duke University. Allan Barker, OD, is president of Eyecarecenter, OD, PA, and serves as president of the North Carolina State Optometric Society. Both are practicing optometrists. Sources for this article include: Yale, Laura J. (1991), “Dynamics of complaint management in the service organization,” Journal of Consumer Affairs; andZetocha, Dale (2002), “Retaining Customers by Handling Complaints,” Michigan State University Extension.