Customer Relationship Management

Recently, I've been working with a pharmaceutical company in development of some consultative tools their sales team can use with customers. One topic the company asks I comment on is customer relationship management (CRM). CRM is broadly defined as strategies designed to manage a company's interaction with customers and prospective customers. Typically these strategies involve the use of computer software organize and automate the various business functions such as sales activities, marketing of products, customer service and other support.

CRM in itself is very interesting to me as most organizations view the CRM strategy from a company centered point of view. That is to say, a company will use these strategies only to the extent the system is beneficial to the company. For me, that seems backward.

As I have written many times, I have never seen a case where excellence in customer service was bad for business. Likewise, I've never seen any computer software deliver excellence in customer service. Excellence in customer service is always delivered by PEOPLE!

Now I do not discount the value of technology helping house customer data, making it easily accessible to those who need and the ability to mine data to help a company understand their customer better. But in the end, your business cannot depend on computer systems to deliver the service your customers expect. In today's technology driven business world, too few companies really train their people in customer service.

I am reminded of the customer service story I found as part of my research. A well dressed lady visited the local Nordstrom's shoe department. She jokingly asked saleslady, "I bet you won't sell me one shoe. As you can see I have only one leg." Well the lady lost the bet. This story exists because of Nordstrom's commitment to developing a customer oriented customer service policy. It should be no surprise that Nordstrom continues to be very successful clothing retailer.

Using technology to help you gather and maintain customer information, but remember to invest in the people who interact with your business's customer.

Office Efficiency

This week a client asked me, "Robert, just how do you make an office more efficient?" Well the answer is my favorite answer, "It depends." That sound like a flippant answer, but it is so true.

Every medical practice operates in differently and, thus, recommendations to improve one office's efficiency differ from the next. The most common cause of inefficiency and area to improve is the physician's patient schedule.

First, is the physician's scheduled based on seeing a given number of patients per hour? If so, you probably are not taking into consideration the reason for the patient visit. We all know that a new patient requires a bit more physician time and should therefore be schedule for a longer appointment. A general rule of thumb is have three distinct time slots for the schedule. For now let's call them brief, intermediate and long time slots. By establishing this type of schedule, you can better take advantage of the physician's time while respecting the patient wait time.

There is a catch. Implementing a variable time schedule requires training for your schedulers. It becomes their responsibility to properly triage patients as they schedule the appointment. Some of you may be thinking, "this is impossible," but believe me, with proper development and training; your staff can become quite adept at properly scheduling patients in the proper time slot.

Secondly, I am a big believer in arranging the schedule with two "brief" appoints at the top of each hour in any given clinic session. This is particularly important for the first appointments at the start of the day and first appointments after lunch. Having these brief appoints at these times aides the staff in getting into the swing of that session.

Thirdly, NEVER, NEVER, NEVER schedule two "long" appointments back-to-back. This is usually a recipe of behind in the overall clinic session. Instead, to the extent possible, limit "long" appointments to only one per given clinic hour.

Depending on the physician capacity, your staff's capacity and the physical layout of your office, there are scheduling templates available to assist you in getting started with this strategy. Implementing a variable time slot appointment schedule can go a long way into improving your productivity. This in turn is beneficial to your patients and your bottom line.

Running On Time?

Do you measure whether or not you are on time based on finishing your clinic at 5:00? If so, you are an inwardly focused business. Now, how many of your patients would say you are on time? Results for many patients surveys nationwide report that "wait time" is their number 1 complaint about their doctor. In fact, of all the various metrics used to measure patient satisfaction, wait time rates the poorest....consistently. Most service industries strive to be outwardly focused. That is to say, these businesses are focused on providing the best in customer service possible to ensure customer retention and future sales. Medical practices should be doing the same.

There are many tactics you may choose to improve your overall efficiency, but simply implementing without first knowing the cause is like doing surgery when the patient presents with a cough. Surgery may be indicated, but it probably is a decisions reached by first understanding the cause of the cough.

Medical practices, like many businesses, look to improve revenues by adding patients to the schedule. Certainly this is a reasonable solution, provided you have the capacity in terms of physical space, adequate staff and proper provider scheduling to execute that plan. I would suggest you first invest in a professional flow and efficiency evaluation. This evaluation reveals efficiency leaks that rob you of productivity and potential practice revenue.

About a year ago, I was asked to conduct such an evaluation for a fairly busy dermatology practice. While the evaluation revealed several areas for improvement, their biggest inefficiency came from medical assistants answering patient phone call regarding biopsy reports, blood tests, etc. Here, the recommendation was to hire another staff position, preferably an RN, as the phone nurse. Her responsibility was to field patient's phone calls and to add an extra level of expertise in the back office. At first the physician felt that adding another staff position, an RN no less, was a budget breaker. After determining the improved efficiency that allowed the doctor to see 2 extra patients per day, AND, improve overall wait time, the practice realized a cost pay back in just a few months. All revenue after that fell straight to the bottom line. In this case, the practice realized an additional $75,000 in revenue after expenses. Not bad!

More than anything else, you have the opportunity to improve your patients experience when they visit your practice. You also have the opportunity to begin and finish your day with greater satisfaction. Your patients and staff will appreciate it.

Customer Service

Over the years I have worked with many medical practices conducting surveys and efficiency studies. Oftentimes physicians fail to recognize that their patients, dare I say customers, measure the customer service from a single perspective...their own. That is to say that your patient's customer service quotient is the same for all business. From the local coffee shop to the mega department store to your office, the quotient is the same. So what does that tell us?

In short, you the physician owner, is competing not only with other doctors, but also every other business in your community. Question: How many of us would tolerate a restaurant telling us there is an hour wait before seating even though we have a reservation? I suspect very few of us would wait. I also suspect most of us would have something to say to the management. Yet, too often, this is common, or even expected, when we have a doctor appointment.

Most people are really not looking forward to their next doctor appointment. Partly because of what the doctor might tell them, but also because of undue wait time which the patient interprets as poor customer service. Taking steps to improve overall patient flow, realistic scheduling and a welcoming smile and hello go a long way in providing good customer service.

Here are few additional tips your patients will appreciate:

• Doctors, please introduce yourself. It is not enough for patients to assume you are the doctor. Remember, patients are already nervous. Make sure they know who you are.
• HIPAA already requires patient privacy. Make sure your receptionist is conversing with your patient in a secure fashion regarding reason for visit, insurance verification, co-payments. Believe it or not, I have observed the receptionist calling out across the reception area verifying this information.
• When patients are escorted to the exam room, protect the privacy of other patients. Make sure doors are closed. When entering a room, make sure other cannot peek in.
• Knock before entering an exam room. This holds true for all back office personnel.
• Schedule accordingly! If you are comfortable seeing 4, 6, or 8 patients an hour, then schedule that way. There is no reason to book, or double book, patients. It serves no one's best interest.
• And for the last tip - BE ON TIME! If you clinic starts at 8:00am, you and your staff should be seeing you first patient. Tardiness to the office only makes you run late, it also says something to your patients about your practice. And it is probably not very good.

Delivering superior customer service is really not hard. Here's an exercise for you. The next time you are in your local coffee shop, your favorite restaurant or department store, check out their customer service. Imitate those activities you observe; your patients, and your balance sheet, will appreciate it.

What Consultants can Help You With

My last blog asked a simple question, "Do you use a business consultant?" Since then, I compiled a list of items I routinely work on with practices. I am sure other consultants can add or take away from the list, but you can see there are many things consultants can help you with.

• Business Planning
• Strategic Planning
• Overall financial performance
• Understanding revenues sources
• Physician collections
• Hourly collection rates, and their influences
• Mid-level provider collection rates
• Ancillary resources collection rates
• Key metrics to your practice's financial health
• Budgeting
• Account receivables management
• Check-in processes
• Back office processes
• Check out processes
• Patient flow and efficiency
• Telephone skills
• Patient Scheduling
• Staff management
• Patient/physician interaction
• Patient/staff interaction\
• Super bill management
• Cash management
• Insurance co-pays
• Job descriptions
• Employee work performance reviews
• Handling discipline issues
• Staff surveys
• Quality improvement
• Internal marketing
• External marketing
• Physician referral processes

The Consultant Advantage

Are you working with a consultant? Maybe you should be. Consultants are a wealth of information and can help you navigate issues that may arise in your practice.

Most consultants come from business backgrounds, either from running their own business, or from corporate America. In either case, they have the business knowledge and experience, most physician do not have. I've met some really sharp physicians who happen to be really good business people, but sadly, most of their learning comes from the school of hard knocks.

Business consultants have resources that most physician owners would love to tap in to. For example, consultants have access to financial benchmark data that can be so important to doctors. Yes, physicians can, and should, conduct their own benchmarking, comparing financial data from quarter to quarter, year to year. But how many physicians have access to broad range benchmark data to measure themselves compared to other like practices?

Consultants can also serve as your contract employee should you have the need to implement a new initiative or conduct a special project. Projects such as practice performance surveys, staff surveys, annual review processes are good examples. Your staff may simply not have the time to conduct these projects, or may not know just how to get started. Consultants can help you in these environments.

Fee structures for consultants vary, but generally fall into one, or a combination, of these structures:

• Hourly rate
• Project rate
• Retainer

Hourly rates are good if you need is simple and need only a few hours time. Project rates work well if you a sure of a specific project you want to conduct, e.g., practice performance survey. Lastly, the retainer affords you the best option. With a retainer, you can use the consultant as much or as little without the worry or inconvenience of frequent billings. Retainers can also be budgeted much more easily. And I would suggest you discuss any fee questions with your consultant prior to any commitments. As a final note regarding fees, there are a lot of consultants who will talk with you about your issue at no charge. Take advantage of that.

At Primoro, Inc. our philosophy is "thought medical practice consulting." We are here to assist you where we can and to offer solutions or other resources where needed. Be assured that at your consultation, Primoro, Inc. will have your best interest at heart.

Leadership and the Grocery Store

My wife and I celebrated our 26th wedding anniversary yesterday by having lunch at our favorite Mexican restaurant. On the way home, we stopped by a local grocery to pick up a few things and my wife said, "I hate this store." Of course, I was curious and asked why. She went on to tell me they have very poor customer service and the employees are not very friendly. She finished her story by saying, "I am not sure why this is, other grocery stores are much friendlier." As you might imagine, being a consultant, I have an answer.

Clear and simple, poor customer service is the result of poor leadership. For years customers of a leading computer manufacturer enjoyed some of the best customer service; that is, until the founder retired. Sadly, today, this company is struggling because their product quality has slipped and their customer service is poor. But, how does this happen?

As I stated, poor customer service is the result of poor leadership. Simply put, if the owner or senior management doesn't put customer service as a priority, nobody else in the organization will. And, it goes further. Simply stating the goal does not make it so. Owners and senior managers have to live it! You have to know what is going on in your business - Inspect What You Expect!

Living and breathing excellence in customer service is everyone's responsibility, but it begins with the owner. Make sure you are delivering your very best every day. Train your staff properly. Inspect what you expect. Conduct a practice performance survey to find your weak areas and improve them. Enhance and broaden those aspects of your practice's customer service that already excels. Think about the businesses you like doing business with and emulate their level of customer service.

Delivering good customer service to your patients should be an expectation. Believe me, your patients expect it.

How is Your Practice Doing?

Knowing how your practice is doing, from the eyes of your patients, is critical to success. Having done countless Practice Performance Surveys, I can tell you there are things happening in your practice that do not necessarily spell overall quality. While I readily admit that most physicians are providing high quality medical care, how does the overall quality of the patient visit rate?

Remember, in previous blogs I have touched on the patients' perspective of "value." Value is the emotional aspects your patients feel when they compare price, access and quality to virtually any other business they use. Yes that's right; you are competing for high quality and value to every other business in your community.

It is important to recognize that patients can only compare their perspective when comparing their experience with your office as compared to other business. That is to say to their local Wal-Mart, Target or Publics. They look at the overall experience. Do the sales people or clerks treat them with respect? How about real interest?

In a recent Practice Performance Survey, the practice rated pretty well in all categories. Funny, the physician was concerned that perhaps his fees were too high for the community. The survey revealed that price was not an issue. Instead, patients reported that certain staff members and departments were less than customer oriented. Patients love the doctor, but had pointed comments about the staff. Of course, the doctor is taking corrective action. Without the survey, he may well have gone on for some time before knowing what his patients really think about his practice.

If you are getting complaints, or even suspect there is something not quite right, do a survey. Ask you patients what they think of the practice, ranging from getting an appointment, seeing the medical assistants, seeing the doctor and finally checking out. You may find new opportunities to improve your patients' perception of a quality practice.

Practice Performance Surveys

Understanding your patient's views of your practice, particularly in today's economic environment, is an essential need for the physician-owner. While, most of us think we are providing solid customer service, in all likelyhood, customers/patients may have a different opinion.

Over the years, most business assume that because they have operated a successful business, then, we will always run a successful business. In other words, the attitude, "If it isn't broken, don't fix it" can lead us down a declining path. It is the business owner's responsibility to continually challenge the business process, to ensure excellent customer service is delivered.

A friend of mine asked my to edit his manuscript about the business of medicine. Through the pages I continued to see references to good customer service. And he's right. My favorite concept in the writing was, "Inspect, what you Expect." That's great advice and sounds an awful lot like one of the tenets of Leadership. Inspecting your staff's work, how they interact with patients, check-in/check-out, how your medical assistants escort patients and take patient histories, etc.. are all elements of "inspect what you expect."

Another tool to gain knowledge about the patient experience is to conduct a survey. I have conducted many over the years. There has never been an occasion where the survey revealed no improvement opportunities. Measuring the patient experience from the moment your patient makes the appointment, till the moment they check out, is vital to your delivering the patient experience you hope to deliver.

Primoro, Inc. conducts "Practice Performance Surveys" and can benchmark your results year-to-year. Continually improving your practice's performace, both in terms of medical care and customer service, is simply good business.