1. Telephone Improvement Project – Year 2
Ongoing Assessment of Refractive Surgery Providers
8 Shareef Mahdavi • SM2 Consulting • Pleasanton, CA 7
Refractive surgeons and their staff face the ongoing chal- also scored among the four lowest across all the calls.
lenge of successfully attracting consumers to learn more This study demonstrates that much room for improvement
about their services. Increasingly, providers are becoming still exists, and the practice’s ability to enhance their tele-
aware of the high cost of marketing promotion and the desire phone effectiveness has a strong affect on creating sustain-
to carefully handle each and every inquiry, whether via phone, able growth in procedure volume.
internet, or in person.
SM2 Consulting has just completed analysis from the second Introduction
year of a long-term study that assesses skills in handling con- For most service-oriented businesses, the telephone func-
sumer phone inquiries. The study is supported by CareCredit, tions as the essential link between consumers and the offering.
a division of GE Consumer Finance (Costa Mesa, CA), as part Creating a good “first impression” during the initial telephone
of a corporate objective to help practices improve patient inquiry is crucial to developing rapport and trust, and strong
conversion. phone skills are correlated with greater likelihood of the
A survey tool was developed to evaluate 12 different aspects caller's desiring to move forward in the decision process. SM2
of a phone call deemed essential to success. Forty-four prac- Consulting was engaged by CareCredit to independently mea-
tices from around the nation participated, with some, but not sure and assess telephone skills across a wide range of practices
all, having also participated in Year One of the study. Each site offering LASIK. The results from this research are being used
received five or more phone calls, with calls being made by to provide feedback to the practice as well as develop metrics
different phone caller personalities at different times of the which can be used repeatedly over the years as a means of
day and week, all intended to simulate real-world scenarios. assessing improvement.
Each call was recorded and graded using a standardized set
of criteria. Recordings and Methodology
Figure 1: 12-point Survey Tool
scores have been given to A 12-point survey tool
the participating practices as Basic Elements Advanced Elements was employed (modified
a teaching tool to help them • Initial greeting warmth • Pricing and financing options slightly from the 13-point
• Time to reach a counselor • Building perceived value
improve their telephone • Control of the conversation • Practice differentiation version used in Year One) to
answering skills. • Qualifying interest level • Technology and benefits objectively score phone calls
• Knowledge of LASIK basics • Call to action
Results overall show an (see Figure 1). Each of the
improvement in average call Other Elements
12 elements was classified
score for Year Two (57.8 out • Did they ask how you heard about the practice? as either basic, advanced,
of 100) when compared with • Did they offer additional resources to learn more? or other and given different
Year One (52.4 out of 100). Score 1 2 3 4 5
weighting based on its impor-
However, fewer than half Poor Good Excellent tance and relevance to the pri-
the calls (45%) scored 60 Q3.: How Seems rushed, Polite, but Friendly and Takes control Immediately mary objective of helping the
well does bothered, does not in willing, but of call, but takes control
or higher, which would be the indifferent, any way
as in “What do convey
doesn’t seem to does not
take control of respond
in confident
manner, and
caller move forward by sched-
Counselor
considered ‘good’ according take control you want?” interest in the call; doesn’t specifically to
taking the call. ask focused
engages in
caller’s needs. dialogue to uling a LASIK consultation.
of the call? Does not ask questions; address caller’s
to the scoring criteria. any questions. lets caller specific A total of 54 locations
ramble. questions.
Analysis of the data also representing 44 unique
revealed that three of the twelve aspects are crucial to suc- practices participated, and all practices reviewed and signed an
cessful conversion of initial patient interest into a consultation. informed consent agreeing to have calls recorded and graded.
Specifically, these are 1) ability to qualify the caller’s interest Phone calls were made by Interaction Metrics (Portland,
level, 2) ability to create perceived value, and 3) the use of a OR), a firm specializing in Customer Experience Research and
call-to-action (“next step”) with the caller. These three aspects Training. Acting as a person interested in the LASIK procedure,
1

2. callers assumed the role of one of five unique persona for each Figure 2: Percentage of Completed Calls
call: “no nonsense,” “curious,” “aggressive,” etc. These persona
were developed specifically to represent the different issues typi- Completed Call Dropped or Mishandled
100
cally encountered by LASIK phone counselors.
90
Each of the 12 topics was given a score on a scale of 1 to 5,
with 1 representing poor skill, 3 representing good skill, and 5 80
representing excellent skill. An example of the specific grading 70
criteria can be seen at the bottom of Figure 1. Each topic was 60
weighted according to its overall importance and an indexed 50 92% 86%
score was created with 100 possible points. Positive and nega- 40
tive findings regarding the call were noted and given as addi- 30
tional commentary to each practice.
20
A total of five calls were made to each location, with calls
10
scheduled to occur at different times of day and week and using
0
different persona.
Year 1 Year 2
A report was given to participating practices summariz-
ing each call, along with an audio CD recording of the calls.
In addition, recommendations for skill improvement were Seven of twelve elements scored well Using the indexed
provided, and follow-up training was offered by CareCredit's scores (scale of 100) to evaluate each aspect of the call, seven
Practice Development Managers. of the twelve elements showed average scores of 60% or higher
In total, 297 calls were made as part of the Year Two study. (equivalent to a raw score of at least 3.0). Figure 3 shows the
Where applicable, findings will be compared to the Year One average scores for each element listed from highest to lowest.
second round calls to show areas that have, on average, either Most of the basic elements scored the highest, including time to
improved or worsened across the participating practices. reach a counselor (86%), control of the call (69%), and prac-
tice differentiation (69%).
Findings When analyzing the scores on the advanced elements,
One in seven calls did not reach a counselor Of the 297 average scores are lower, demonstrated by a score of 61% on
calls in the study, 43 (14%) did not reach a counselor to be ability to describe technology and its benefits and only 51%
handled in real time. This 1:7 ratio represents mishandled calls.
Further analysis (see Table 1) reveals the following major root
Figure 3: Indexed Scores for Each Call Element
causes of not completing the call:
This compares unfavorably to Year One, where 92% of the Ask how heard about practice 29%
Qualify interest 42%
Table 1: Root Cause of Mishandled Calls
Value 50%
# CAUSE
Call to action 50%
16 Counselor Not Available
Pricing and Finance Options 51%
13 Put to Voicemail Technology 61%
5 Dropped or Disconnected Knowledge of basics 62%
2 Counselor Out to Lunch Add’l resources offered 68%
7 Other Warmth 69%
43 Total Practice Differentiation 69%
Control 69%
calls were answered and only 8% were not properly handled
Time to reach 86%
(see Figure 2). Timely access to information is key with emo-
tionally-driven purchase decisions such as refractive surgery. 10% 20% 30% 40% 50% 60% 70% 80% 90%
2

3. when describing procedure pricing and Figure 4: Average Scores From Other Findings While not as strongly cor-
Other Call Elements
financing options. related with conversion rates, performing
Caller was asked, “How did Did the practice offer
you hear about our practice?” additional resources? well on the other nine elements is consid-
Three Weakest Links Identified ered good business practice. This concept
No
Of the four lowest-scoring topics, 32% is illustrated by analyzing results from the
No No No
three of them have been shown to be 62% 61% two other call elements and changes from a
71%
critical to conversion and will be dis- year ago. As shown in Figure 4, callers were
cussed in terms of their impact on over- Yes asked how they heard about the practice in
68%
all call scores. Yes Yes Yes less than three of every ten calls, which is a
38% 29% 39%
decline from Year One. Asking this question
Issue # 1: Qualifying the caller's inter- Year One Year Two Year One Year Two on a consistent basis is essential to under-
est (average score 42%) – The ability to standing how callers are finding the practice.
understand the caller’s level of interest and why they are inquir- This is vital data for practices that spend money on external
ing about LASIK is essential to setting the tone for the entire promotion and a requirement to determine the effectiveness of
phone call. The average raw score of 2.1 (1 to 5 scale) is slightly the advertising spend as a means of improving efficiency (e.g.
lower than the result from last year’s study. The inability to cost per lead) of future spending.
determine the caller’s needs up front keeps the phone call from A significant improvement from last year has been seen in
being focused on the caller, with counselors typically retreating the offering of additional resources to callers, such as provid-
to the more comfortable position of talking about their practice ing the website address and inviting the caller to speak with
and surgeon(s) rather than listening and responding responding other patients who have already had LASIK. These and other
to the caller's individual needs. resources were offered 68% of the time compared to only 39%
a year ago. This is an important business practice because it
Issue # 2: Creating perceived value (average score 50%) – accounts for the fact that people process information and learn
The ability to help a caller understand the value of this pro- differently; some people learn best by hearing (auditory), some
cedure relative to other discretionary spending opportunities is by seeing and reading (visual), while others learn best through
key to allowing the caller to form a logical “return on invest- touch (kinesiology).
ment” scenario in his mind. The inability to create this per-
ceived value with the caller keeps the LASIK procedure in the Overall Call Scores The average indexed total score across
realm of being considered expensive and unaffordable relative all the calls was 57.8 out of a possible 100 points. This is an
to other goods and services the caller is considering for pur- improvement over the Year One average score of 52.4. Figure
chase. Because consumers have numerous wants
Figure 5: Distribution of Practices by Average Call Score
and needs, it is key to give the caller enough con-
text to properly value the benefits of LASIK. 50%
Year One (206 calls) Avg. Score Year One = 52.4
Issue # 3: Proposing a clear call to action (average Year Two (254 calls) Avg. Score Year Two = 57.8
40%
score 50%) - The role of the counselor is to close (100 points possible)
the call by offering one or more “next steps” to
Percent of Practices
the caller, such as asking if they’d like to schedule a 30%
consultation or attend a seminar. This year’s average
raw score of 2.5 is virtually unchanged from that 20%
found in Year One. Failure to propose a next step
often leaves the caller “hanging” and wondering
10%
what he should say or do next; poor scores on this
topic are strongly associated with poor overall con-
version rates. Proficient counselors know that action 0%
21-30 31-40 41-50 51-60 61-70 71-80 81-90 91-100
is the next logical step following education. points points points points points points points points
Range of Average Call Score
3

4. 5 shows the distribution of call scores by decile, overlaying the and promotion as a means of building this demand, the TIP
distribution of Year Two calls immediately to the right of Year study shows that many providers those investments would be
One calls within each decile. There is a noticeable improvement highly inefficient and largely wasted. The scores shown in this
in the distribution in Year Two, which can be observed in the study – and the accompanying recordings of the calls – make it
graph as a shift to the right of the peak and shape of the Year clear that tremendous improvement is needed by most practices
Two curve versus Year One. prior to engaging in any form of external marketing.
The operating leverage that can be gained from focusing
Summary and Conclusions on internal improvements rather than external marketing can
This type of study is key to helping practices understand the be seen in Figure 6. Conversion rates from earlier studies show
foundational issues affecting patient conversion and the impor- that typically only one of every two inquirers will eventually
tance of receiving objective feedback as data to be used for schedule and have LASIK. For each 100 calls, 69 schedule a
improvement. Using a standardized tool allows practices to be consult but 15 of those cancel or fail to show. Most of the
compared on a national basis; it also gives practices the ability remaining 54 will go on to have a procedure once in the office.
to identify specific areas that need to be addressed. These ratios are important when one examines the cost-compo-
While there was a definite improvement in overall call scores nent of generating those leads. Data from earlier studies shows
in Year Two when compared to Year One, analysis of the data the marketing cost per patient at $280 ($140 per eye). Applying
shows three elements of the phone call that are strongly corre- those same ratios in the opposite direction shows a cost per lead
lated with lower conversion rates: in excess of $500.
Figure 6: Lead Conversion vs. Lead Cost
1. Ability to qualify the caller’s level Every improvement in con-
of interest CONVERSION LEADS COST version rate has a direct affect
2. Ability to create perceived value >$500 per lead in reducing the cost of market-
for the procedure and its benefits 100% ing per surgical patient. For a
3. Ability to propose a clear next Scheduled practice doing 50 LASIK proce-
69% Consult 69%
step for the caller. dures a month, a 10 to 20 point
All practices seeking to improvement in conversion will
15% Cancel - No Show 15%
improve their conversion rates most likely result in a $100,000
would be well served by focusing to $500,000 increase in LASIK
54% Consult 54%
more closely on each of these ele- revenue over a 12-month period.
ments. This can be done by ensur- While the cost per lead stays
50% $280 per
PROCEDURES
ing that the scripting allows the patient the same, doing a better job on
counselor to ask questions of the conversion leads to more proce-
caller at each step in the discussion. Three example questions dure volume, higher revenue and reduced marketing cost per
are: How long have you been thinking about this?, What other patient...without spending more money!
big-ticket items have you considered lately?, and What if you Finally, our research team believes that the “good” score of
could speak with someone like you who had LASIK? 60 is, in reality, not good enough. Callers considering spend-
By shifting from a monologue to a dialogue with the caller, ing $5,000 for LASIK or upwards of $10,000 for a premium
counselors can simultaneously offer a better initial experience IOL procedure should encounter a dramatically better initial
while achieving control of the call. This effort will have a sig- experience when first calling a practice. For example, not hav-
nificant payback in the form of improved conversion rates (see ing counselors available during normal hours, or telling call-
Figure 6 in the Discussion section below). ers “sorry, the counselor is out to lunch” is simply not good
business practice. We view this report as a call to action for
Discussion every practice that is serious about growing their business and
With the technology for the LASIK procedure having expanding overall demand for refractive surgery in the U.S.
advanced greatly with improved safety and efficacy during the
Sources: Mahdavi, S., Telephone Improvement Project, March 2006
past ten years, it is now time for the profession to turn its atten- A Skills Assessment of Refractive Surgery Providers
tion to other means of expanding demand for refractive surgery Mahdavi, S., Closing the Gap in Refractive Surgery March 2006
in the population. While it is tempting to look to advertising How Financing is Perceived by LASIK Patients and Providers
© Copyright 2007, SM2 Consulting. All rights reserved. 4