Turn frowners into fans: How to gauge client satisfaction

We all know that the key to success is customer service and word-of-mouth referrals. Happy clients refer friends and family, those new clients refer their friends and family, and so on. But how do we measure customer service? How many smiles at the front desk does it take? How many warm, wise words in the exam room equal a referral? How do we develop a baseline and seek to improve it?

Leave it to businesspeople to find a way. In 2006 Fred Reichheld, a partner at Boston consulting firm Bain & Co., published The Ultimate Question (Harvard Business School Press, 2006). This smart book promotes the use of NPS, or net promoter score. There's only one question you need to ask clients to set the baseline: "How likely is it that you would recommend our practice to a friend or colleague, on a scale of 1 to 10?" You then sort the responses into three groups: promoters (9s and 10s), passives (7s and 8s), and detractors (0s through 6s). The percentage of promoters minus the percentage of detractors is your NPS number. For example, a practice with 75 percent promoters and 15 percent detractors would have an NPS of 60.

The bottom line

Once you figure out this number, you can work to improve it. It's that simple. According to Reichheld, the average U.S. company has an NPS of about 15 (which I think is really low). In veterinary practices where I've used the NPS concept, I've found an average of 40 to 45.

Can we talk?

Reichheld also suggests you ask a second question as you gather your NPS number: "May I follow up with you at a later date?" The permission clause is key. The goal is to get constructive criticism from willing clients. You then contact those who agreed to talk and ask them one final question: "Why did you give us this rating?" Some of the most useful feedback comes from detractors. Unhappy customers will give you an earful, perhaps revealing some serious shortcomings in your business. Cure what ails this tough crowd and convert detractors into promoters. Then watch your NPS score climb.

Here's an example: We contacted a detractor who gave a "2" rating at one practice. The client said she'd be willing to talk to us, and it turns out she was upset because her bill was more than the estimate and no one offered an explanation or even made a comment about the difference in price. Once we apologized and explained why there was a difference, she was much happier and appreciative of the services rendered. We then held a meeting with the entire team and reviewed how to present medical care plans to clients. In addition, we built in a double-check system to make sure this didn't happen again.

At another practice, a detractor gave the hospital a measly "1" rating. Ouch. When we contacted the client, she was upset with a doctor who was "rough" with her pet and unfriendly. "The doctor acted like she hated my pet," the client told us. Other detractors made comments about this same doctor. We tried to improve this doctor's bedside manner. And when that didn't work, the manager fired the doctor. In the six months that followed, the practice experienced a 10-point increase in its NPS.

Get the word out to get words coming in

So how might you use this information in your practice? Send a postcard, letter, or e-mail to all the clients your practice has seen in the past six months or year and ask them the first question: "On a scale of 1 to 10, how likely is it that you would recommend our veterinary practice to a friend or colleague?" Then ask if you may follow up with them at a later date.

When the responses come in, determine your NPS score. Everyone on your team should know this score and what it means. Post it throughout the hospital, and then work on improving it. How? By contacting your detractors and finding out what their concerns are and, hopefully, resolving them.

There are always clients who are never pleased or who are unrealistic in their requests, but you can sift them out and learn from the others. You might also follow up with your promoters—those fans who gave you a 9 or 10—and thank them and ask if they'd be willing to recommend you to their friends and associates. (See "Footprints = profits" for more ideas on encouraging referrals.)

Good NPS? It's bonus time!

To get your team really motivated, consider tying your NPS score into a bonus program for your team. I've long promoted an employee incentive program that uses employee evaluations as the basis for determining individual bonuses. In my program you perform individual employee evaluations that are scored and then adjusted based on the number of hours an employee worked during that quarter. That score would be used to divide up the bonus fund. (For more on bonus programs, read "A winning bonus program" or "Give your team a cut".) In the past that fund has been determined by taking 10 percent of the increase in gross from one quarter compared to the same quarter of the previous year. But what if we used the NPS score instead? If your practice has received a score of 45 in the past, you could set a goal to hit 50. If the practice achieves an NPS of 50 or more, you'd pay out 10 percent of the increase in gross or possibly use a fixed figure, such as $5,000, for the bonus pool.

In order for this program to work, every employee must be involved and must know how the NPS score is determined. More importantly, they need to know what they can do, individually, to help to improve it.

Critics of NPS say it's too simplistic, but I think that's what makes it attractive. You don't need a degree in statistics to use it—just one number can tell you a lot about your practice. NPS is easy to use, effective, and inexpensive. You can't improve your practice until you know what to work on, so make sure your whole team is aware of the score, and get them involved. It's all in the number.

Mark Opperman, CVPM, is a Veterinary Economics Editorial Advisory Board member and owner of VMC Inc. in Evergreen, Colo. Send comments to ve@advanstar.com.