In 1996, laser vision correction was hardly known beyond the circles of eye care professionals and a few thousand patients. In October 1999, however, LASIK became known to all as Tiger Woods' became the most famous pair of eyes among more than one million that had undergone the procedure. The skyrocketing awareness of LASIK between those two dates occurred without any organized promotional launch or national media effort. It took place in spite of the fact that going forward with refractive surgery is perhaps the most seriously considered decision that consumers make in their lives. It occurred because of the phenomenon called word-of-mouth.
THE “EPIDEMIC” OF LASIK
As a group, refractive surgery providers have been quite fortunate to receive the benefit of word-of-mouth marketing. The end result of the LASIK procedure is typically so effective and is achieved so quickly that patients are eager to tell their friends and families about their newly improved vision. As word spreads, more and more people become aware of, develop an interest in, and actually consider having LASIK. Malcolm Gladwell, author of The Tipping Point, compares this rapid rise in popularity to the way a disease such as the flu becomes an epidemic; the progression is geometric rather than linear.
In retrospect, LASIK's strength as a consumer product has also been its weakness. The outcomes of the procedure are so good so often that in many ways the product “sells itself.” The rapid progression from one group of patients to the next became a nearly automatic cycle measured closely by those practices that understood the importance of tracking referral sources. Refractive surgeons have often heard exclamations such as, “I should have done this years ago,” “This was the best money I've ever spent,” and “I can't believe what a difference this makes in my life.” In general, the emotional benefits of the LASIK procedure as described by patients were significant, usually well exceeding those of any other medical procedure or similarly priced retail purchase.
Why then, hasn't this geometric progression continued over the past few years for LASIK? Continually hearing patients' cries of joy lulled providers into thinking that the LASIK love affair would continue forever. However, markets don't stand still, and neither do consumers. By comparison, Gladwell reminds us that epidemics rise and fall, and he cites the phenomenal, yet short-lived, popularity of Airwalk sneakers (Airwalk International LLC, Golden, CO) as well as the dramatic drop in New York City's crime rate in the mid-1990s.
Consumer expectations have risen for LASIK as well as for providers' level of service. In a world where LASIK is priced from $299 to $2,800 per eye, consumers need to perceive clear differences in the levels of service offered. Now, with the advent of customized ablation and customized flaps, the product has the potential to meet those rising expectations. However, the level of service offered must follow suit. In other words, LASIK's problem at this point is less with the product than with the service that delivers the product.
REKINDLING THE FIRE
Very little attention has been paid to patients' overall experience, which transcends the procedure and its clinical outcome. Why is their experience so important? Because, in the mind of consumers, many components of the product are common to all providers: it involves a laser, a doctor, and their eyes. Beyond this, however, the entire equation is defined by the provider. If you want your offering to be valued as something more than a commodity, then you need to focus as much effort on all the nonclinical aspects of the patient experience as you do on optimizing the clinical result.
The effort pays off in what Gladwell calls “the stickiness factor”; that is, your continual focus on improving customer service will create a long-term bond between you and your patients. In the context of refractive surgery, your patients make sure that those in their circle of influence come to you when they're ready for treatment.
You can draw from your own experiences as a consumer to see the power of word-of-mouth marketing. It's easy to recall an experience that was greater than the product itself—whether a hot new restaurant, an exciting cruise, or a visit to a spa. Chances are, you told those around you about it and left a positive impression that will likely influence their future buying behavior.
HANDING OUT TORCHES
Most surgeons know that word-of-mouth is the ultimate form of advertising. Unlike the advertising we see on TV, hear on the radio, or read in the newspaper, word-of-mouth works because it is personal, relevant, and credible. Although you can't buy or pay for this type of marketing, you are well advised to invest in boosting your staff's morale so that they deliever such a high level of customer service that they truly “infect” the patient with the desire to speak about your practice highly and often. Exceptionally good customer service will trigger word-of-mouth that transcends the procedure and helps differentiate your practice, both in the mind of your patient and in the minds of everyone he talks to about his experience.
It is essential that you begin to recognize those who are the real drivers of word-of-mouth within your patient base (Hint: it isn't the person who asks for a discount in exchange for referrals). The Tipping Point describes three distinct personality types that are not financially motivated to offer word-of-mouth referrals. Word-of-mouth is hard-wired into the DNA of those whom Gladwell refers to as connectors, mavens, and salesmen. These three types of people, he concludes, “Are distinguished not by worldly status and achievement, but by the particular standing they have among their friends.”
FOCUSING ON THE LITTLE THINGS
As an industry, ophthalmology has benefited greatly from the wildfire spread by consumers who have undergone the LASIK procedure. Those flames may have died down, but they haven't been smothered. Some practitioners are pessimists who keep gazing in the rear view mirror, believing that the glory days are behind us. However, Gladwell proves conclusively that the little things—“a small but precisely targeted push”—can ignite a trend seemingly instantly.
Customer service is all about those little things, and the rebound in the popularity of LASIK will depend on many providers' doing the little things right. Collectively, this effort is what will cause the refractive market to once again “tip” toward renewed growth. There really is no other choice; the penalty for not raising the bar on the level of service in refractive surgery is that history will repeat itself: great technology will drive rapid adoption, but a lack of differentiation among providers will lead to price competition and lower profitability for the entire industry.
A CALL TO ACTION
My challenge to you is to devise your own potential tipping-point ideas and put them into action. For help, read the book What a Great Idea by Chic Thompson, perhaps the world's greatest idea-generating resource (see Shareef's Summer Reading List). Ideas don't have to be fancy or expensive; they just need to be tried and tested to see if they work. I encourage you to try an idea and then share it with the rest of us. If you're worried about other readers' stealing your idea, then don't share it, but realize that what this industry needs right now is a little bit more creativity and a lot more focus on the fundamentals of good customer service. E-mail your ideas and their impact to me, and we'll publish the best in an upcoming column. The very best idea (as judged by the editors of Cataract & Refractive Surgery Today) will earn a nice dinner at the upcoming AAO meeting in Anaheim, California. Good luck!