Talking about patient retention in an open forum can be a taboo topic. But does it need to be? The Discussion about business as a health practitioner can be a source of conflict. The desire to help someone and do all you can to get them better but as a business having a bottom line to keep a close eye on. Some business’ look to combat this with KPI’s, some never let a patient go and others don’t address it at all.
Does the fact your available appointment times is consistently 60% full a good thing, a bad thing or indifferent?
Every business owner will answer this differently and will in fact have a different reason for why this may be. But at the very least are you keeping an honest track of why that may be the case?
Not just a story you tell yourself about why you don’t have growth or why you have a good week or a bad week but the solid details of why this is the case.
In the following article we will look at ways to measure patient retention, strategies in improving patient retention and why saying goodbye to a patient is not a bad thing.
Can you over service a patient?
Well, yes you can, but a lot of this comes down to the justification being used for the treatment (why are we doing this) and the evidence for that treatment.
Just because a patient may not be an elite athlete, does that mean they should be treated differently to an elite athlete?
What is your justification for re-booking?
Justifying why a patient needs to be seen regularly can be based on a number reasons. Quite commonly patient goals, physiological adaptations and treatment protocols can dictate what is necessary, what is extra and what is extravagant. Much of this comes down to educating the patient on how your management of their condition is a process, rather than a quick fix and providing a structure to there management will lead toward their goal much sooner.
What is your endgame or do you have one?
Patient goals are incredibly useful in helping patients and yourself see the light at the end of the tunnel. Having a major goal that can be broken down into smaller goals gives patients a positive outcome to reach for in a process that can take months. For this reason it is important to have a goal that is objectively measurable, not subjectively, Why? Because having a goal such as “to be pain free” has the potential not be associated with tissue load or damage at all and can be directly affected by stress or psychological state.
Therefore make the goal measurable but make it personal!
A patient won’t be too excited if they can do 25 single leg calf raises but refer that clinical measurement back to the relationship between lower limb strength and injury risk and why that means a faster return to activity, and all of a sudden you have a patient who is engaged in their management.
Strategies for retention:
Creating a Journey – The patient journey begins well before they enter the doors of your clinic. It begins from the moment they decide to find someone to help them with their complaint. That may be through search engines, friends, signage or social media and how that drives them to your clinic can be as simple as how your information is 
communicated. Where are you located, where are the nearest parking bays, who are your practitioners and what is your point of difference to the clinic 500m down the road?
Once they are booked in and arrive at the clinic what are they going to remember most about the experience? Remember the presence of pain brings frustration, anxiousness, feelings of sadness and even anger. The smells, sights and sounds all add to how a patient is feeling and can make things better or worse. Being greeted with a smile and a hello should be standard these days but how does your reception look as a whole? Is it cluttered with posters and A4 sheets of paper with promotions on it or is it spacious, neat and minimalist in appearance – think of how each of those environments may affect both your patients and staff. Are the odours you have in your clinic counterproductive or offensive – will someone with hayfever be irritated by natural flowers? Is vanilla just a nice smell to waft through the reception or does it stimulate feelings of hunger? Not a great addition if you have nutritionist or dieticians working in your establishment.
Making Impressions – Your initial consultation with a patient gives you the best opportunity to sell your service as a practitioner and as an organisation. Adding to the patient’s journey through their interactions with you and your staff is paramount for a good experience. In the initial appointment you should be looking to educate the patient, assess their presenting complaint and set goals that resonate with that person. Once that information has been gathered and relayed about how your findings directly affects your patient, you can set in place a plan moving forward so the patient knows exactly why they are returning for care and the importance in doing so. Making a positive impression on a patient while they in a high motivation state (addressing their issue) can be a key driver for further referrals to your business also.
Staying In Touch – Keeping the communication lines open is an important part of a patient’s journey from the time they book right through to post-discharge. There is a fine balance between communication and harassment but get the balance right and you make the patient part of your community rather than your customer.
Measuring Retention:
Patient Satisfaction – How do you measure patient satisfaction, when should you measure and how often should you measure? Well if you were to give a patient a questionnaire regarding how satisfied they were at the end of their treatment, chances are that your management of that person and the feedback you receive will be positive – the issue however, is in delivering a questionnaire at discharge only targets those who made it too discharge and not those who have dropped off during their journey. Issuing a patient with a questionnaire within the first 2 weeks of contact is a reasonable task. By that time the patient should know of their management plan, have built report with their practitioner, been educated on their condition and given some tools to use at home. This will allow you to see how confident the patient is moving forward in their management. The next request may be sent after a certain number of appointments, depending on how you as a practitioner schedule for reviews, lets say 10 appointments later – this allows you to see how the patient is feeling regarding the progress of their treatment and if they are still confident in the process which is taking place. This can be a really good time to see if patient expectations are being met/managed appropriately.
Then finally on discharge another questionnaire may be used to find out about a patient’s overall journey, whether they would recommend your services, would they come back and any comments which can be used to better your practice.
Missed Appointments – How many appointments are being missed each week or month in your practice and why are they being missed? This is an important question to know the answer too as it may be related to the business systems you have in place.
If a patient missed an appointment because they forgot, did you do all you could have to remind them they had an upcoming appointment? Text messages and emails are cheap, can be automated and are very often part of the program you will be using for your patient bookings.
Did the patient feel like the appointment wasn’t required? In this case how has the practitioner communicated the importance of each appointment to the patient? If the patient is pain free that should not necessarily mean discharge from service – preventative medicine and referral not only reduces the risk of recurrent injury but referrals to other practitioners internally or externally will help boost patient numbers.
Each appointment missed is an appointment that could have been used by another client. It does not matter that half your diary for the day was empty, that appointment slot may very well have been at a time someone else may have been able to attend. Having a policy around missed appointments will lead to patients respecting that appointment time and at the very least are more likely to let you know in advance about their inability to attend.
No Upcoming Appointments – How many people have you seen in the previous months that currently have no follow-up appointments booked and why? In the best possible scenario they have been discharged from care 100% pain free and have met all criteria to return to activity or even better return to performance.
However, what about the ones who have fallen through the cracks? Jim who said he’d check his work roster and get back to you, Sarah who you referred for scans and told to book in 2 days after they were done, Sam who cancelled due to uni exams and hasn’t got back in contact yet?
How do you address these issues?
The important thing is to maintain a dialogue, personalised phone calls (from the practitioner not admin), emails and text messages are all simple, inexpensive and effective ways to have the patient not feel like they were just a number but an important part of your day and that you truly do want to help them get better.
Patient retention is important.
Done ethically and consistently you can get fantastic results for your patients while meeting your business requirements. Education and communication is the key to attaining this. If a patient does not attend an appointment you want to know why. If a patient does not have an upcoming appointment, you want to know why. Whether it is your fault, the patients or intrinsic/extrinsic factors out of your control – this is the time to take control – own the responsibility and look to remedy it.
Jackson McCosker
Director/ Chief Editor
FootNotes Publishing 