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Up Front | Jan 2009

Recruitment, Patient Selection, and Reengineering Your Refractive Center

Following set guidelines is crucial for successful implementation of modern phakic IOLs.

This is the second of three articles on the steps and strategies to grow your total refractive clinic. Now that we have established the four phases of growth and discussed how phakic IOLs fit into the practice (see Strategically Incorporating Phakic IOLs into Your Practice, October 2008, pages 75-77), we will discuss the subject of recruiting patients.

Each center builds its own routine, and if this yields successful results, most surgeons do not see the need to change. Surgeons usually think they have a good understanding of what that goes on in the clinic; however, there is a huge difference between perception and reality. You may think that your conversion rate for phakic IOLs versus LASIK is high, but there is no way of knowing unless you perform frequent audits and data analyses. It turns out that many refractive clinics struggle with patient recruitment, especially when trying to convert LASIK candidates into phakic IOL candidates.

Changing how your clinic runs is a big step, and you will encounter many barriers; however, differentiating your clinic is a key to its success. Although advertising may help increase awareness of the modern phakic IOL, it is better to start from the inside with the clinical audit. This process allows the surgeon to know how many patients are walking into the clinic and what kind of services they receive. In essence, it is important to use the audit as an opportunity to gain a full understanding of what areas your practice needs to work on.

In this article, I outline basic guidelines to use for your own clinical audit. Clinics that choose to perform frequent audits are well prepared to run the refractive clinic as a business. As an example, I will focus on how to assess the promotion and implementation of modern phakic IOLs.

Many centers treat a large number of patients; however, they do not know how to categorize the patients, what to do with the data, or how it should be analyzed. There are six areas to focus on: (1) first impression, (2) data analysis, (3) handling inquiries, (4) follow-up systems, (5) introducing the modern phakic IOL, and (6) practice standards.

First impression. Impressions are important, especially the first. The overall general impression of your center must be evaluated from the perspective of a patient. Assess everything starting with the first point of contact, whether it be through the Web site or by phone, through the first office visit and through interaction with administrators, technical staff, counselors, and the doctor. Patient experience forms part of the impression and can influence a patient's decision to undergo treatment. The patient must feel confident that your refractive center is the right option; his perception of the center will not only factor into his decision, but it will also determine if he will recommend your clinic to someone else. In addition to providing a good impression and experience, the service must be perfect and provide excellent outcomes—the ultimate goal of seeking a procedure. Table 1 lists some elements for consideration.

Data analysis. Analyzing data provides a yardstick to decide if any changes implemented are having an impact. This area can be quite involved, and the extent of analysis will become more sophisticated and detailed in time as you see the benefits of the exercise. Early analyses are simple; they measure the number and sources of contact and the number of consultations and conversions in each area. Because the purpose of this exercise is to increase the phakic IOL component, the conversion rate for patients who are clearly candidates for phakic lenses is important. After a few months of reporting, you should be able to determine what means are effective in bringing patients into your center.

Inquiries. Once data analysis has been completed, there is a need to further determine how patients are handled. In this stage, you develop strategies for getting more patients through the door and determine how those seeking refractive surgery can be converted to phakic IOLs.

Two main sources of inquiries are Web site visits and phone calls. Determine how quickly a response is made after the prospective patient contacts the center. Once the prospective patient calls the center, is an informational packet sent, and does this include information on phakic IOLs? Best to do this at an early stage to introduce the option rather than surprise the patient on the day of consultation—a sure way of putting them off altogether. Ensure patient information is complete so that inquiries can be followed up. First, ensure that there is a process for follow-up calls for those who have inquired and are indecisive. One to 2 weeks as an interval is usually adequate. Table 2 lists possible recommendations for a center that may not be adequately handling inquiries.

Follow-up. Preoperatively, calling the patient 1 to 2 weeks after his consultation is useful to ensure patients are not forgotten. Some find it useful to send a letter summarizing the consultation and providing the patient with a rationale for the choice of procedure. Additionally, informing patients of upcoming seminars provides a reason to contact him and provides another opportunity for him to visit your center.

After treatment, maintaining contact with the patient is useful for generating word-of-mouth referrals. A number of avenues exist, including a short thank-you note or even a small gift or token. This is common practice in North America and works in Europe if conducted tastefully. Lastly, newsletters and e-communication to previous patients is a further point of contact that hopefully will generate more referrals.

Introduce the phakic IOL. Centers that incorporate the phakic IOL as an equal procedure to LASIK will have the most success. This reflects confidence in the procedure and avoids the issue of using the phakic IOL as a last resort. We find it useful to have our technicians introduce and educate patients. Conducting this early in the patient care pathway leads to greater acceptance. Means of communication that are useful include brochures, which ideally should already have been sent in advance, PowerPoint presentations, and animation videos, such as those produced by Eyemaginations (Towson, Maryland). All information that relays the message is important and also a great way to occupy the patient during the process.

It is a given that all staff involved in the patient pathway must be familiar, comfortable, and convinced about the value of the procedure. Even a hint of hesitation can put a patient off completely. Sales training and education about this treatment option is useful to instill a sense of enthusiasm and motivation; however, the level of enthusiasm must be tempered, and the message that the final decision is up to the surgeon and patient must be emphasized regularly.

Practice objectives. A component of the measures in your practice is analyzing procedure volumes and proportions. Establish a target: Consider converting 10% to 15% of your LASIK patients into candidates for phakic IOLs. Once an objective has been established, development of a strategy usually follows. Once excellent outcomes are observed, boundaries can be pushed with treatment at lower magnitudes. An increase in the proportion of phakic IOLs will lead to an increase in revenue and profitability, as will be demonstrated in the third and final article in this series.

Being practical, an action plan such as this takes several months to 1 year to implement and continues to be an iterative process. The process itself provides a sense of accomplishment and confidence, which in turn helps in making decisions. In my observation, the latter is not a strong suit for doctors, including ophthalmologists. Implementation is difficult, and perserverence is vital and certain to be rewarding.

Reengineering your clinic is a strategic process. It will be unsuccessful if the entire center does not work together to implement change. Everyone must incorporate the phakic IOL in a way that works for your center. The elements will come together when you do them step-by-step.

From my own observation over years of practice, introduction of technology is a great practice builder; however, acquisition is only one component. An overall strategy for incorporation is required and one that can be measured. It is this strategic process, involving the components included in this article, that helps ensure success. Success resulting in happy patients, staff and a healthy practice will occur as processes are incorporated and continuously improved.

Sheraz M. Daya, MD, FACP, FACS, FRCS(Ed), is Director and Consultant, Centre for Sight and the Corneoplastic Unit and Eyebank, Queen Victoria Hospital, East Grinstead, UK. Dr. Daya is the Co-Chief Medical Editor of CRST Europe. He may be reached at e-mail: sdaya@centreforsight.com.