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Winter 2010

Customer Satisfaction: A Necessary Element For Group Success

Mark F. Weiss, J.D.
Advisory Law Group, Inc., Los Angeles, CA

Saturday afternoon. The store’s crowded and you’re in a rush. You’ve found two pairs of pants. You head to the counter to complete the purchase, only to find two sales clerks talking to one another about their evening plans. Five, ten seconds pass, they don’t make eye contact with you. Fifteen seconds, twenty seconds...

If you’re like me, you would have waited about five seconds before abruptly interrupting their conversation. If that didn’t work, you would have walked out. But that’s the entire point. No matter how wonderful the store’s selection and no matter how high its quality and reasonable its prices, it’s often the “details” like inattentive service that make or break the experience.

But you run an anesthesia group, not a store, so the lesson is not 100% transferable to your world — just 99%. If you were running a store, it would be obvious, should you take the time to watch, what your employees are doing. You could see them on the floor and observe their interactions, or non- interactions, with customers.

Granted, it’s a bit harder to watch your fellow partners or shareholders and your employed and subcontracted physicians and other staff members. But it is possible. And, what they are doing might just be destroying the future of your practice.

Multiple Problems + Few Direct Complaints = Big Problem For You

It’s no secret that disgruntled customers tell stories of their poor experiences and that this results in loss of business. In fact, a study conducted in 2006 by the Wharton School of Business and the Verde Group provides proof of this long-held general belief.

According to the study, which looked at retail customers, only 6% of disgruntled customers made a direct complaint. But 31% of disgruntled customers told their friends, family or colleagues what happened. And then those other people repeated the story, multiplying its effect. Altogether, the “Retail Customer Satisfaction Study 2006” found that for every 100 customers with a bad experience, a company stands to lose 32 to 36 current or potential customers.

Multiple Customers and Multiple Points of Contact

In the retail world it’s easy to identify your customer. It’s a bit more complicated in yours.

Anesthesia group “customer” interactions involve multiple interested third parties and multiple points of contact. There’s the patient and sometimes the family and other influencers. There are the surgeons, nursing and other technical personnel, hospital administration, the medical staff, and third party payors. As to each of the customers, the number of points of contact vary from the single instance to the continual stream.

And, to complicate things, in some cases the expectations of one customer group negatively impact upon another. Take, for instance, the example of case turnover time. Surgeons don’t want to “waste time” between their consecutive cases, but pressuring anesthesiologists to pick up the pace might adversely affect immediate post-surgical patient care (a key customer service factor if there ever was one) as well as the pre-surgical interaction between the anesthesiologist and the subsequent patient.

Setting the Stage for the Customer’s Great Experience And for your Great future

The first step in the solution may be the hardest: Stop kidding yourself that the delivery of expert, even world- class, medical care is sufficient to guarantee your group’s future. An “A” in anesthesiology does not automatically equate to even a “C” in customer service. Expertise from an anesthesiologist is simply expected; it’s just the down payment on your future. Expertise must consistently be supported with extraordinary customer service in order to guarantee that you will thrive.

Of course, this begs the question of what great customer service is.

On one level customer expectations are simple to discern: Customers want to be treated with respect, they want you to be courteous, they want you to listen to them (really listen to them) and to respond fully to their questions and concerns. They want you to be friendly, they want you to smile, they want you to say please and thank you, they want you to show up on time and they want you to follow through with what you say you will do.

In addition to those common expectations (which are often forgotten in terms of delivery) you must identify the specifics of ideal customer service at your institution, not through your eyes, but through the eyes of your customers. As the study discussed above reveals, you can’t do this simply by relying on complaints that have been brought to your attention, as only a small percentage of disgruntled customers will have ever informed you of the problems.

Certainly, you can conduct formal or informal surveys of your patients, surgeons and other customer service touch points. In fact, as your group begins to excel in customer service, surveys, especially those that reveal high patient satisfaction levels, have the benefit of not only spurring you on to even higher levels of performance, they become an important tool for leverage in the larger context of group/hospital relations.

But to begin, I suggest that you take a more practical, “down and dirty” approach: draw on your own knowledge base — not only as physicians in terms of how you value the interactions your colleagues have with you, but also with respect to the interactions you have had with your physicians when you have been a patient as well as your interactions with retail and wholesale establishments, both in regards to products and services. Ideally, you are aiming at creating what I term an “experience monopoly” for your customers: an experience of such a high quality that your customers would not consider obtaining it from any other source.

Don’t attempt to “benchmark” to other physician groups; instead, if you must benchmark at all, aim to compete with the Four Seasons or the Ritz-Carlton in terms of the experience that they provide.

To illustrate, let me provide you with two examples related to the anesthesia world, one directly, and the other tangentially, that describe this concept of experience monopoly:

In the late 1980s, I had minor outpatient surgery at a world-class hospital. More than 20 years later I recall the experience clearly. From a technical standpoint, the anesthesiologist must have been an expert: I felt no pain, had no complications and was back at work the next day.

But, shortly after the physician introduced himself to me in the pre-op area he walked a few feet away to make a phone call: several minutes of screaming at his divorce lawyer about his soon-to-be ex-wife, whom he did not describe in particularly endearing terms. He was so visibly upset that I wondered about his ability to concentrate on my care. Despite the fact that everything went smoothly, I would never consider having another procedure performed at that facility.

Contrast that with the following experience:

A few years ago, immediately after checking out of the Hilton Tapatio Cliffs Resort following speaking at the ASA’s Conference on Practice Management, I met Chester Haymore, the bellman.

Chester greeted me warmly, just as he did each and every person who passed him. He asked each person waiting at the hotel’s entrance if he could help them. He offered chilled bottles of water and suggested that people wait in the shade.

He quickly summoned cabs or town cars and arranged for valet parked cars. He loaded luggage into trunks and helped people into cars. He told a particularly tall man that he would adjust the seat in his rental car. When he overheard a man comment that he had cut his finger, Chester asked if he needed a band-aid!

Chester isn’t just a bellman, he is a one-man customer service king with a mission. He elevated the entire experience of the hotel, which otherwise was a slightly aging, unmemorable place.

Once you’ve examined your knowledge base of customer service experiences, my advice is that you look at each possible interaction between the members of your group and your customers and devise a set of expectations. I’m not talking about setting hard and fast rules for all conduct, as we’re talking about professionals and, in any event, you do not want to institute robot-like performance. However, there should be minimum expectations and those minimums should not simply be aimed at meeting minimum levels of customer satisfaction, but, rather, at hitting high levels of service that will delight the customer.

Next, you need to document your group’s customer service expectations and train your group, both physicians and other staff, in exceeding them. Importantly, you need to incentivize, both financially and socially, your group to take customer satisfaction expectations seriously. This means that your group’s compensation plan must take into account customer service factors in determining total compensation. It also means adopting a plan for the recognition of service excellence.

In order to accomplish these goals, you must coordinate your customer service plan with, and into, the provisions of your group’s organizational documents, subcontracts, employment agreements, and compensation plans.

For example, if your partnership agreement and employment agreement simply reward production, providing no incentive for better customer service, then you have abandoned the legitimate right to claim to be shocked when your group’s physicians rush for volume, even with an eye to patient care standards, but ignore the quality of customer interaction, only to have complaints, reported or unreported, destroy the foundation of your practice.

Addressing this issue as far as your physicians go is only a part of the process. You must take similar steps with any support and office personnel who come into contact with any identified customers. This extends to the employees of your billing service provider – one cranky interaction can destroy the improvement that your group, internally, has worked to achieve. Your contracts with, and policies adopted in respect of, these entities and individuals must support those requirements and provide for penalties in the event of breach.

Why Care?

Why do you need to care about customer service when your group has the exclusive contract at the hospital? After all, your customers can’t go anyplace else. Because customer service is directly related to customer satisfaction which is directly related to support from the medical staff and from administration. That support is essential in respect of renewing your exclusive contract and in obtaining necessary financial support from the hospital.

Sure, you may be the only game in town, but if you don’t pay attention to customer service, someone else will be the next only game in town.

Mark F. Weiss, J.D. is an attorney who specializes in the business and legal issues affecting anesthesia and other physician groups. He holds an appointment as clinical assistant professor of anesthesiology at USC’s Keck School of Medicine and practices nationally with the Advisory Law Group, a firm with offices in Los Angeles and Santa Barbara, Calif. Mr. Weiss provides complimentary educational materials to our readers. He can be reached by email at