How to offer a great experience - Part 1

The rule of the 3 Ps

Lessons from the best human medicine hospital

In 2003, Professor Leonard Berry (Texas A&M), one of the world’s top experts in health services management, carried out an in-depth study on the internal operations of the Mayo Clinic at its three main campuses in Arizona, Florida and Minnesota 1

Leonard L. Berry & Neeli Bendapudi. Clueing In Customers. Harvard Business Review, February 2003.

. The Mayo Clinic is probably the most recognised hospital brand in the world and its prestige is legendary. During his research, L. Berry and his team interviewed over 1,000 doctors, patients, nurses and managers of the group. They attended and were present at over 250 medical appointment interactions between patients and doctors and they analysed the operation of 14 different medical departments (including neurology, oncology, orthopaedics, gastroenterology and urology, among others). In the conclusions of their study, the authors of this research identified three pillars on which the exceptional level of service provided by the Mayo clinics are based and the resulting exceptional patient experience: the People, the Process and what they call the Physical Evidence. This is the rule of the 3 Ps.

People (Box 1). The creed of the Mayo Clinic’s founder (“the best interest of the patient is the only interest to be considered”) pervades all staff actions. The clients who were interviewed explained how “My doctor calls me personally at home to find out how I am” or “When I had a colonoscopy, the doctor personally explained to me that I had a polyp, as she remembered that my husband had died from cancer of the small intestine and she knew that I was scared that the same was happening to me” or “My oncologist is the kindest person I have ever spoken to. I was much more than a medical problem to him. He talked to me about his personal life. He treated me like a person”.

Box 1

💡 How to improve the client experience through people

Don’t pay income production-related variable incentives, as these can lead to inappropriate behaviour that does not prioritise the interest of the client/patient. Measure client satisfaction and track the results back to the staff who attended to that client. Share the results individually and acknowledge those who obtained the best metrics (i.e., NPS). Train, train, train! Encourage not only technical training, but also client service-related skills. Film/observe young vets during appointments and work with them to identify areas that could be improved. Select staff not only according to their clinical skills and credentials, but also according to their communication and client-focus abilities. Formalise the clothing worn and greeting made by veterinarians during appointments. In the context of complex, life-threatening cases handled in large units where the client interacts with more than one vet, identify a “veterinarian in charge of the case” who can take care of the key interactions with the pet owner. Select veterinarians and support staff who own and like cats or at least are accustomed to handling them. Make sure that clinic owners lead by the example every day: the points above are of no use if the team does not see their bosses practice what they preach. Incorporate client communication skills in veterinarians’ performance appraisals.

 

Process (Box 2). As far back as 1910, Dr. William Mayo said, “for the sick to benefit from scientific advances, it has become necessary to develop medicine as a cooperative science”. This foundational vision translates into an integrative medicine approach to cases: Mayo Clinic patients never feel that they are being passed around among a series of disconnected doctors who exercise their specialities in a standalone manner. Much to the contrary, all of the clinic’s systems and processes promote teamwork among professionals: for example, all doctors receive fixed salaries to prevent personal interests in dealing with specific cases and, therefore, invoicing higher amounts that could result in commissions.

Box 2

💡 How to improve the client experience through process

Work with scheduled appointments whenever possible. If managed correctly, appointments result in a reduction of waiting times and enable vets to prepare proactively for the consultations, clearly improving client experience. Define telephone standards and measure them regularly (i.e., with a mystery caller service), correcting areas of improvement through training activities. Schedule in feline patients at certain times of the day and with longer time frames. Teaching our clients how to bring their cats to our centre in the least stressful way possible. Regularly call the owners of hospitalised patients to explain any change to the treatment plan and/or estimate. Systematically call all clients the day after patients have undergone surgery (even if they have a follow-up scheduled soon), to show interest and answer any queries. Always provide a written consultation report summarising the most relevant events during the visit. In complex cases involving the work of more than one vet at the centre, appoint a head veterinarian who gathers all key information relating to the case for the owner. Encourage your staff to use the services and products offered by the clinic (such as wellness plans, food, anti-parasitic drugs): what is best known is best sold. Ask your clients for their preferred contact method for vaccination and de-worming reminders (none, email, telephone, SMS, letter) and comply with this. Define a formal discount policy in the clinic: whom you can give a discount to, which clients and under which circumstances. Few things confuse and frustrate a client more than sometimes receiving a discount and other time not, depending on who serves them or without a clear reason.

 

Physical evidence (Box 3). The Mayo Clinic’s facilities are designed to minimise stress, to provide a welcoming and professional environment, designed for families… This is appreciated not only by patients and their families, but also by workers. And the 2,800 medical staff — unless they are in operating theatre or performing specific medical procedures — dress in business attire, in order to convey competence, respect and professionalism.

Box 3

💡 How to improve the client experience through premises and physical evidence

Parking (own or agreement with a nearby parking area) The toilets should be kept clean at all times. Consultation rooms should always be cleaned after every visit Whenever possible, the switchboard should be separated from the reception desk, to enable undivided client attention Clear- and professional-looking signage in all areas of the clinic Directory of practice services and staff placed in a visible location in the reception area Presence of furniture and relaxing decoration in non-medical areas of the clinic (sofas, coffee maker, relaxing images of happy pets) Dedicated consultation room for cats Separate reception (or, at least, a dedicated area) for cats, with spaces and furnishings designed for them  Separate hospitalisation (or, at least, a dedicated area) for cats

 

Most veterinary clinics worldwide can certainly learn lessons and gain ideas from this example in order to improve their clients’ experience… Below are some ideas in this regard.

The first moment of truth

After the client has selected a veterinary practice through various channels, the moment comes when they arrive at the clinic. If pet owners have had a positive experience thanks to a well-designed homepage and a professional telephone reception and are able to find a parking spot without any problem, they tend to be in a good mood on arrival.

Of course, clients are always a bit stressed when visiting a vet, even if they assume that their pet is healthy and that “their” practice will provide the best possible care for their companion. However, if the client had a choice they would most likely not be going to a vet but playing with the pet or taking it for a walk. This is the reason why excellent design is so essential — welcoming the client and relaxing pet and owner.

Exterior design

• Complete cleanliness and maintenance for the practice surroundings, i.e., plants, pavements, entrance, outdoor seating;
• Easily visible and well-maintained entrance signs and car park with a logo and best possible lighting;
• Attractive design of window surfaces, e.g., with adhesive foils highlighting the practice logo and enhancing corporate design;
• Protected (sun/rain) seating, wastebaskets, bags for animal waste and fixtures to temporarily “park” nervous dogs so that the owner can check in at reception quietly.
  

The exterior is the first part of the practice that the client experiences when they come with their animals to see you. Treat them like a welcome guest and show them your best side — at any time of the day and night!

Reception

From the carefully designed exterior, we move to the interior of the practice and this area also needs to have a continuous client-friendly design that is supplemented with a great reception team. The combination of a pleasant and interesting ambience and attentive, highly specialized employees trained for this important job are what make a practice unique and impresses clients deeply. This includes greeting clients immediately when they enter the practice — a smile, eye contact and a nod may be sufficient if applied properly (e.g., when the receptionist is on the phone). The next most important factor is having the practice staff take care of the pet owner, listen to their requests, provide them with sufficient information (about waiting time, the upcoming consultation, appropriate offers or innovations for the pet) and accompany them to a seating area. Even if doing so is not possible 100% of the time in a busy practice, the team still needs to be aware that a client’s reception sets the path for the entire relationship and is essential for establishing a good relationship and creating a long-term loyalty. Always remember that the client is the basis for our business — no client, no revenue, no profit and no growth!

The style of reception in the practice has a strong impact on client relations. Upon entering the practice area, the client should be approached as quickly and professionally as possible, helping him feel secure, acknowledged and respected.

Interior design

• A bright, pleasant smelling and air-conditioned reception area
• Comfortable seating (recommendation: test your seats by sitting down for ten minutes!)
• Interesting and up-to-date reading material about animal health and related issues
• Racks and small tables for transport containers (cats, small mammals, birds)
• Information about the practice services, i.e., veterinary services and other services such as examination techniques, check-ups and nutritional counselling
• A select range of animal food and sensible accessories (e.g., transport baskets, toys)
• Presentation of the practice team with professional photos, skill sets and special interests

If you want to do something more for your clients’ comfort and emphasize your client-friendly image, we recommend the following items:

• Drinks for people and their pets, i.e., water taps and bowls or coffee machines and mineral water
• Information about seasonal topics such as parasite prevention in spring and autumn, joint health in winter, travel prophylaxis (medicine, food) in summer
• A “children’s corner” with smaller furniture, animal books, crayons and paper
• Waiting room television with informative videos for various animal species and interesting practice services — always including and presenting the practice team

More for cats!

2. Special furniture

The cat area needs to have racks or small tables for cat carriers (Figure 3). The colours of the “cat space” should be soft and the lighting mild and indirect, as cats prefer things a bit “cosy”. Pleasant photos of cats and the practice’s “cat team” on the wall add an extra personal touch.

3. Special service

The cat area is also the ideal place to promote services and products the practice offers for cats, such as special health checks, care programs, nutrition and accessories. Do not go for all you can show at the same time, but rotate the focus using posters and brochures. If you have enough space, a food display with a small, select range of premium cat food, sensible toys and “good” cat transport containers is a big plus. The client can then use the waiting time to find out more about the practice´s services in pleasant surroundings (Figure 4).

The practice team

A practice is only as good as its team! Even though optimum design of the practice space is essential to a good image, without a caring, attentive and client-oriented practice team that actively cares for clients, even the most perfect design will be ineffective. But when an awesome interior design meets extraordinary employees, the combination of these two elements has a tremendous impact on the client.

Defining the difference

What is the difference between an average and an extraordinary practice team? What makes a client so loyal that they will not even consider visiting some other practice, never mind switch vets?

The answer is both simple and complicated: communication! Simple because everyone knows communication is important and plays a crucial role. Difficult, because there is still not enough training and expertise for the implementation of client-oriented communication in veterinary practices. Examples of important characteristics to look for in front desk staff enabling extraordinary client care include:

• Natural friendliness and enjoyment of being around people and animals
• Stress resistance and the ability to maintain a clear head in difficult situations
• Commitment to do more than “just” complete tasks
• Client-focus or the capability to see the world through a client’s eyes and provide the best possible service to owners and their pets
• Being able to communicate, inform and counsel in a clear and simple language, so that the client understands every word

2. Opening the consultation: Once the client has entered the room and is fully concentrating on the vet, the consultation can start. The vet should initially keep the cat in the basket and the dog on the floor to ensure the client’s full concentration. Having a vet multi-task by asking about the medical history and examining the animal at the same time is not ideal. The client deserves full attention, because this is what they are paying for. If we as vets attempt to perform multiple tasks at the same time, we miss important signs clients give us and — even worse — we create the impression that we are doing something completely mundane because we can do it “on the side”, hereby dramatically reducing the value of our services. How can we expect the pet owner to pay a suitable price at the end of the consultation if we act as if the task is nothing special?

To start the consultation after greeting client and pet the following phrases are ideal:

• How can I help you today? This question works if the vet does not have enough information, e.g., with new clients, or to check on details obtained from a phone call (discrepancies often occur).
• How has Max been since the last treatment?
• How does Toby like the new diet?
• How was your holiday in Spain with Milo?

These questions link to consultations and information from the past and signal interest in the pet’s health and client needs — they send the message, “I want to provide the best possible service for you!” They also connect to the consultations that have already taken place and refresh the client´s memory.

5. Comprehensive physical examination with comments, summary, prescriptions and agreements regarding therapy and diagnostics (Figure 6): Vets should always first perform an examination starting at the tip of the nose and working to the tip of the tail and then move on to special examinations of individual organs. While doing so the vet should take the client on a journey in which they explain the findings on individual body regions and organs to the client, so the pet owner always knows what the vet is doing. At the end of the examination the vet should summarise the findings, present a diagnosis and explain the planned therapy and/or further diagnostic procedures to the client. When explaining it´s vital to use media such as leaflets, posters and models to create a picture in the client´s mind that will help them to understand the facts. In the event of further diagnostics and complex therapy, it makes sense to talk clearly with the pet owner about the price and the possible outcomes. In this case, agreement from the client for suggested therapy and diagnostics should be obtained by asking: “What do you think? Can I schedule an appointment for the X-ray?” Should the pet owner hesitate or have objections, a Plan B can be worked out with options better suited to the client.

6. Linking one consultation to the next consultation (or contact): If vet and pet owner agree and therapy or diagnostics are to be carried out, it is a good idea to end the consultation by linking the “now” to the next contact. Possibilities include a follow-up consultation, the appointment for the next check-up or noting the next endoparasitic or ectoparasitic treatment. Maintaining contact with the client is vital, reminders for specific consultations can be sent per email, text message or via post. Regular reminders for checks on chronic diseases such as atopy, renal, cardiac or joint disorders help assure compliance and illustrate to the client that the practice takes care of both client and pet!

7. Check out: The final stage in a consultation involves repeating the arrangements briefly, bidding the client farewell and then directing him to the reception for billing and scheduling the next appointment.

Working with appointments

As everybody today has less and less time and life moves quickly, working a practice by appointments only has clear advantages over an “open hours” set-up:

• The client´s time is valuable and by giving and keeping an appointment the practice shows respect for the pet owner´s situation. Nobody likes to wait and sit around not knowing, when (or if) something is going to happen.
• The vet´s time can be planned more precisely so that the calendar is never too full and never too empty.
• Vets can prepare for the client´s visit — they know who is coming and when. This way, they can already think about the best possible offers for pet and owner before they are in the consultation room.
• Appointments keep the stress of daily vet practice at bay, because there are not so many pets and clients waiting, moving in and out, and the noise level is reduced greatly.