“Excellence Wins” in Healthcare: Three Kinds of Customers (and Three Ways to Lose Them)

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For the next several weeks we are using the book titled, “Excellence Wins”, by Horst Schulze as a resource for Thursdays Thinking TIPs.

While having a copy of the book is certainly not needed to enjoy the next several BLOG posts, if you’d like to grab a copy to follow along, feel free to pick it up at Amazon here, or of course at your favorite book store.


“The minute we start thinking and acting as if we own the customer, we are nurturing a dangerous fantasy.” (1) It’s easy, especially so for some physician practices, to assume the patient will always remain loyal to the practice simply because of the patient-provider relationship. While that relationship is very important, today’s millennial generation may not be as loyal, and the next generation even less so. According to American Academy of Family Physicians, almost 50% of 18 to 29-year-olds say they don’t have a primary care physician.

Three Kinds of Customers

Mr. Schulze classifies customers into three categories. (2)

  1. Dissatisfied Customers
  2. Satisfied Customers
  3. Loyal Customers

At MedicalGPS we group patients into the same three classifications, however, MedicalGPS uses our patent pending software, M3-Advocate®, to evaluate the patient’s office visit to classify the patient’s experience. By measuring the patient’s responses to their M3 questionnaire, identifying the key touch points of the patient’s experience that correlate to advocate-loyalty, MedicalGPS scientifically determines the likelihood that your patients will fall into one of three categories, 1) advocate-loyal, 2) satisfied, or 3) potentially dissatisfied. The reason we classify the third category as potentially dissatisfied is because of M3’s Service Recovery/Follow-up Monitoring capabilities. Even if the patient’s office experience was sub-par, M3’s service recovery capabilities allows the office manger the opportunity to reach out to the potentially dissatisfied patient, offer an apology when appropriate, express compassion and empathy, and otherwise, turn the patient around. A potentially dissatisfied patient is often transformed from dissatisfied to loyal. It’s simple, powerful and it works!

How to Lose “Your” Customers

Mr. Schulze makes the following statement, “When a company loses the trust of loyal customers, it usually does so in one of three ways. The first two are subtle, while the third is dramatic.” (3)

Three ways to lose “your” patients. (4)

  1. You Start to Cut Back on the Promise of Your Brand
  2. You Start to Get Careless
  3. You Start to Become Arrogant

Let’s examine first:

You Start to Cut Back on the Promise of Your Brand

With a background in Industrial/management engineering, I have seen it happen time and time again; it’s called right-sizing! I have personally led right-sizing initiatives in two different service industries — some of them I’m proud of and others not so much. My first assignment after entering healthcare in 1994 was to right-size physician practices all across the country. I was hired by a physician practice management company that was in the process of purchasing large, multi-specialty physician groups. Typically, we would use FTE per Provider ratios to compare similar (and sometimes dissimilar) practices. The practice with “best” FTE to Provider ratio would typically set the benchmark, and all other practices would be encouraged, or even required, to reduce their support staff until their FTE to Provider ratios reached levels closer to the “better performing” practices.

If real process improvement opportunities are discovered or created, AND high-quality levels of service can be maintained as promised, perhaps a reallocation of resources is needed. I am certainly NOT an advocate of right-sizing when customers/patients are delivered a sub-par product or service. For the right-sizing projects that I lead, I encourage the right-sizing team to first look for opportunities to increase revenue, oftentimes making better use of the existing workforce.

Mr. Schulze mentions that it is not unusual for corporations to mandate the following edict, “Okay, everybody cut staff costs by 10 percent.” (5) When customer service feedback is made part of the process, that type of 10 percent reduction or right-sizing, across-the-board, often results in increased numbers of dissatisfied customers/patients. At MedicalGPS we have a motto that we have lived by since our inception in 2003, and it reads as, “If it’s good for the patient, it’s good for the business.” Always put the patient first!

You Start to Get Careless

“It’s very easy to stop looking at things through the customer’s eyes, not paying attention to seeing what they see.” (5)

It’s usually the small things that go overlooked. When is the last time you had someone from outside of your practice or healthcare organization take a walk through your facility? Are the floors clean or are they soiled? How about the furniture? A little old and starting to look worn and dated, or does it look modern and new?

When I was in the airline business we had a saying that went like this, “a clean airplane is a safe airplane.” That applied to both the outside of the aircraft as well as inside the cabin. If a passenger let down their tray table and saw coffee stains from the previous passenger, the passenger might think to themselves, “If they don’t have the time and discipline to clean the tray tables, do they have the time and discipline to maintain the engines?”

As your patients are waiting in the check-in area you can rest assured that they are examining: the carpet, the furniture, the cleanness of the windows, the ceiling tiles, indeed every aspect of the waiting area that they can access and see. As humans we make associations that are real to us; meaning, if the carpet is dirty and unkempt, maybe the medical equipment is also full of germs and unkempt.

TIP: You’ve heard of the secret-shopper approach I’m sure. You can use that same approach, but keep it simple and affordable by asking someone from outside of your practice/facility to take a walk through your facility and then let you know what they saw and experienced. If your practice/facility is part of a larger organization, ask the manger from the facility across town to visit your practice/facility, give you their feedback, and then you do the same for them. There you go — you’ll have insights from a fresh pair of eyes and all it will cost you is some time and effort.

You Start to Become Arrogant

Mr. Schulze describes when he first came to America and worked as a waiter at a French restaurant in San Francisco. All of the other waiters were French, with Mr. Schulze being the only German waiter. Mr. Schulze described how the French waiters would talk down about their American customers by pointing out how the Americans, “didn’t even know how to properly handle a knife and fork.” (6) I’ve worked with thousands of physicians over the years and some had the belief that they were so busy, and in such high demand, that if they ever lost a patient, they could simply replace the lost patient with a new one. A wise business office manager of a large multi-specialty practice once said, “a patient that leaves your practice can never be replaced.” I would suggest that believing a unique person can be replaced may be rooted in arrogance. I’m not talking about dismissing a patient for clinical or behavioral reasons that justify the dismissal. What I’m referring to is allowing a nonchalant attitude to creep in. When practices are super popular and very busy, casually waving good riddance to patients simply because the patient complained about substandard service is a sign of arrogance.

Each one of us are unique individuals and cannot be replaced. A lost patient, that never comes back to the practice or organization, is indeed a lost patient.

Join us next week for Chapter Five: MORE THAN A PAIR OF HANDS

Please let us know if you have comments or questions, and subscribe to our Email Updates , so that you can be assured to receive Thinking Thursdays TIPs.
Thank you!

Jerry L. Stone
MedicalGPS, LLC.

Names: SCHULZE, HORST, 1939 author. | MERRILL, DEAN
Title: Excellence Wins: a no-nonsense guide to becoming the best in the world of compromise / Horst Schulze, with Dean Merrill
Description: Grand Rapids, MI : Zondervan, [2019]


(1) Page 62
(2) Page 62
(3) Page 62
(4) Page 62
(5) Page 63
(6) Page 64
(7) Page 65
(8) Pages 67 – 69

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