Moments of Truth

by William D. Esteb

One of the exciting results of investing in a systematic patient education program is the creation of demanding patients. Educated patients become more critical of knee-jerk medical approaches to health care. Educated patients become more discerning in other areas of their lives as they look to "cause" rather than the treatment of symptoms. Educated patients expect more accountability and ask better questions. When you combine chiropractic care with a regular dose of information dispensed in a non-confrontational style, you change a patient's health attitude while changing a patient's spinal biomechanics.

Chiropractic isn't the only health care profession faced with the challenge of changing patients' attitudes. Imagine the frustration of the cardiologist helping a patient recover from a stroke. More than likely the patient is a heavy smoker. It's estimated that within two years of a stroke, against all the warnings and evidence supplied by personal experience and the recommendations of the doctor, half of all stroke victims who smoked have resumed smoking!
Stroke or not, there are chiropractic doctors (and staff members) still smoking. Imagine patients taking these doctors' recommendations seriously!

Changing ingrained health attitudes is difficult and requires more than a 20-minute report of findings (that actually takes 45 minutes) on the virtues of a natural approach to healing.

Considering patient perceptions, the doctors of chiropractic who are still smoking or are 30 pounds overweight do more than sabotage their own health; they threaten the credibility of the entire profession. The old adage, "physician, heal thyself" comes to mind. It's like the bumper sticker: "Take my advice, I'm not using it."

Finally, equality

Chiropractic faces the same type of challenge women entering the corporate workplace face. To compete, women often must do their jobs twice as well as men to be considered equal to their male counterparts. So too with chiropractic. Doctors of chiropractic must constantly exceed patients' expectations for service, sensitivity, and quality as health care providers just to achieve parity with medical doctors. These critical patient perceptions are formed by a succession of "moments of truth" in your office.

A moment of truth is any interaction with a patient that causes an opinion or attitude about you or your profession to be formed. It starts with the doctor's reputation in the community, shaped by word of mouth, cheaply produced TV commercials, or screaming yellow page ads. It's reinforced by the telephone manners of staff members, scheduling availabilities, fee structures, patient education opportunities, and dozens of other procedures, policies, and office details. It is affirmed on those occasions when a patient has the opportunity to share, defend, or deny his or her chiropractic experience with others.

Those who overlook how patient perceptions are formed reduce chiropractic to a mere clinical procedure. "I just do a better job," crows a chiropractor smugly into the camera and ultimately into my living room in a local TV commercial. I don't believe him. Everything else about his cheaply created commercial suggests the opposite.

Read Jan Carlzon's book, Moments of Truth. In 1983, this 38-year-old took over S.A.S. Airlines, the worst-rated airline in the world. He and his managers identified the moments of truth in which passengers formed an opinion about their airline. During the next three years, they set out to improve each moment of truth; everything from curbside baggage check-in to the airplane interiors. The result? Today, S.A.S. Airlines is one of the few profitable airlines around and ranks among the best rated in the world!

First impressions

At your next staff meeting, list every significant moment of truth a patient experiences in your office. There are lots of them. Start with the probable tone of the word-of-mouth advertising shared by past patients and even past employees. Try to record the probable first impressions of your location, parking, signage, staff, and office environment. And list the patient's likely feeling during the report of findings, timeliness of the appointments, and the way transitions from one type of care to another are handled. How many of these moments of truth can you identify and then work to improve?

Improving your moments of truths may not instantly improve your bottom line. Like cancer, hypertension, or heart disease, the disease process (poor word-of-mouth) exists undetected long before obvious symptoms appear. Explaining your approach to health and bringing the look of your office into the 1990s won't result in more new patients the moment the paint dries. The effect is long term. Your office and procedures communicate a subtle form of nonverbal language. They give patients important clues about your self-image, social awareness, outlook, and the value you place on the care you deliver. Why should I trust your recommendations or refer my friends when your office looks like a prehistoric hippie-dippy-American-cheese-boring-beige-earth-tone-standard-issue medical office?

Attention new staff members

Patients don't usually volunteer their perceptions of the moments of truth that are weak or inconsistent with your clinical objectives. When they do, the comments are often ignored because they come from your most verbal and assertive patients, the "complainers" or the "whiners." In some offices, staff members are reluctant to mention inconsistencies for fear of losing their jobs. Or their opinions are discarded during the first couple of days on the job when the discrepancies are most apparent to them. New staff hiring policy: every new staff member must offer 10 suggestions for improving the delivery of care and the image of the office by the end of their first week on the job. By the second or third week, the new employee has adjusted to the office, overlooks the grimy light switch, and no longer sees the dead leaves around the ficus tree.

Look for ways to get honest feedback from your patients. Using your list of moments of truth, hold a focus group with some of your more articulate patients to identify the weak areas of the practice. Invite six or seven of your most demanding patients. You're not looking for praise or to hear how wonderful you are. You're looking for the rough edges, the weak links, and the incongruencies in a patient's total office experience. The more "bad news" you can extract, the more direction you have in making changes that will eventually enhance patients' feelings about your office--and ultimately their comfort in telling others.

The mystery shopper

Another idea, used extensively in retail stores and fast food franchises, though rarely seen in chiropractic offices, is to hire a mystery shopper. A mystery shopper is a friend or business associate you trust. Maybe a chiropractic friend or staff member from another community who goes through the motions of becoming a new patient in your office. Their job is to keep notes, recording how they are treated, their impressions, and the way moments of truth are experienced in your office.

Of course this is subjective, but so is every patient's opinion. (Your patients might not be correct, but they are always right!) Start with the first phone call, go through interactions with the staff, and end with the report of findings. Get an objective opinion by keeping their mission a total secret. Have them use an assumed name and call for an appointment at the busiest time on the busiest day. Obviously you'll have to account for the personal preferences of your mystery shopper, but the objective is to encourage someone who cares enough about your success to tell you what most patients won't.

If everything is in great shape, at least you'll have a renewed confidence in your office appearance, procedures, and staff training. If not, you'll have a great "to do" list for making needed improvements.

Exceeding patient expectations

Why question the status quo? Most chiropractic doctors have modeled their offices after the generally accepted medical model. Right or wrong, patients have a certain set of expectations about the procedures, environment, and style of their health care provider. To be taken seriously, chiropractic must outperform a patient's medical experience.

This challenge is even greater for offices committed to providing long-term spinal rehabilitative care. Offices that want to see patients not once or twice like a medical doctor, but 50, 100 times, or for a lifetime, must look closely at every dimension of their practice which might be precluding just such patient commitment.

If you must depend upon advertising, why? If patients are not referring, why? If most patients are not inclined to stay beyond symptomatic relief, why? Sure, it's easier to treat the lack of new patients medically, treating the symptoms with advertising, mall shows, coupons, and direct mail. Yet, when you uncover the cause you'll see the relationship between form and function in a fresh new way. Remember, good will is won by many acts and can be lost by one. Which moments of truth are sabotaging your practice potential?

Buy the book
A Patient's Point of View
Originally published in 1992
240 Pages
US $19.95

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