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Cover Stories | Jan 2020

New Expectations in the Patient Experience

Valuable information on what patients expect from their surgical journey.

Welcome to the Relationship Economy

By John R. DiJulius III

Today’s illiterate are those who have an inability to truly make a deep connection with others. There are skills we can develop, however, and there is one that, when mastered, will without question have the biggest impact on us personally and professionally.

That skill is the ability to build an instant connection with others. This is far more than a mere communications skill. It is the ability to communicate with a purpose—to build your community at every stage of your life. Building a relationship with someone else, whether an acquaintance, friend, customer, coworker, or total stranger, is far and away the most important skill every human being should be taught at an early age and then should hone throughout life. This skill should be taught at home, in school from prekindergarten to graduate school, and, of course, in business. Unfortunately, it is rarely taught in any formal way.


Today we are living in the digital disruption era. Technology has provided us with unprecedented advances, information, knowledge, instant access, and entertainment. We have computers, mobile phones, tablets, the internet, social media, apps, and AI—assistants like Siri and Alexa, chatbots, virtual concierges, facial recognition, and self-driving cars.

However, as convenient as these advances make our lives, they also have changed the way we communicate, behave, and think. And they have led to a dramatic decline in our people skills. As a society, we are now relationship-disadvantaged. We no longer become curious about others or eager to engage in conversations. The younger generation primarily communicates electronically, and the explosion of e-commerce means we go out less and less. In business, multichannel communication has dramatically reduced phone calls to companies; customers can get answers and place orders via email, on websites, or through social media channels.

The pendulum has swung over to high tech and low touch. Consequently we long for a sense of community, belonging, and purpose, a world in which people actually know our names, what we do, and what is important to us, and have trust in one another. Today, trust is an endangered value. Those who understand that human touch is the most important part of any experience—especially a great customer experience—will flourish. Personally and professionally, success is increasingly about creating and building human connections.


Understand this: There is an Uber coming to every industry. Uber is part of the digital disruption that completely turned the taxi and limousine industries upside down. But you can track similar developments in other realms. Amazon has disrupted nearly all retail businesses—grocery stores, health insurance, banks, home security, entertainment, pharmacies, and shipping—and it continues to expand into other fields. Airbnb has disrupted the hotel industry. Netflix wiped out video rental stores.

No business is safe. In the past, cutting-edge innovation had a much longer shelf life in overcoming competition. Now, however, many of your competitors can replicate your innovations and quickly reduce any temporary advantage you had in the market.

The answer cannot just be about technology, either. To be sure, technological advancements are critical to every business staying relevant. However, technology by itself is not a differentiator. The more you place technology between the company and the customer, the more you remove the human experience.

People crave human interaction. Customers desire recognition and a personalized experience; technology can never be empathetic or build relationships. In short, technology cannot provide genuine hospitality. It cannot express empathy, make people feel cared for, express emotions and vulnerability in a relatable way, or make people smile and laugh.

For any person and any business to thrive in the future, they will have to master the art of relationship-building.


In a relationship economy, the primary currency is made up of the connections and trust among customers, employees, and vendors that create significantly more value in what we sell. These relationships and connections help make price irrelevant.

The relationship economy is about building a culture that recognizes the importance of each individual and of making everyone a part of a community that is working toward something bigger—a community that makes everyone feel cared for.

The relationship economy is how strongly you feel about the people and businesses in your life. Relationships are the biggest differentiators in customer and brand loyalty. Relationships are at the center of all we do.

You need to make your entire organization relationship-centric from the inside out. Customers don’t recommend businesses they like; they recommend businesses they love. When you accomplish that, you make you and your brand competitor-proof and irreplaceable. (Editor’s note: This article was excerpted with permission from Mr. DiJulius’ book, The Relationship Economy: Building Stronger Customer Connections In The Digital Age.1)

1. DiJulius JR III. The Relationship Economy: Building Stronger Customer Connections In The Digital Age. Austin, Texas: Greenleaf Book Group; 2019.

Refractive Surgery: The Infinite ROI

Shareef Mahdavi

In my 25 years of consulting in refractive surgery, I have rarely met a surgeon who doesn’t want to grow his or her practice, and for good reason: Helping more patients become less dependent on glasses or contacts is a noble goal. Sadly, though, the adoption rates for both LASIK and premium IOLs are below our expectations. The problem is that practices have focused too much on patient outcomes and not enough on the patient experience.

Look at the agenda of any professional meeting focusing on refractive surgery. You are likely to find that 90% to 100% of the presentations are devoted to improving the safety or efficacy of today’s available procedures—even though these procedures already have outstanding outcomes. Further technical improvement won’t add much toward the goal of growing the market. If that were the case, we would have seen it by now. Additionally, the technology available today is far superior to the technology available in 1996, when PRK was approved by the FDA, or in 2005, when CMS approved patient pay for refractive IOLs. We can’t wait for yet more new technology to create a breakthrough in consumer demand.


In my view, the biggest opportunity to grow the refractive surgery market lies in improving the patient experience. Many physicians believe that their practices already do a good job in this area, but, if your goal is to attract the discretionary spending of consumers, then I would suggest that you are not yet good enough.

Being nice is necessary but not sufficient. Even if you and your staff are extremely nice to your patients, they can still leave your practice frustrated and less than satisfied. This was part of what inspired the title of my upcoming book, Beyond Bedside Manner: Insights on Perfecting the Patient Experience (see New Resource on Patient Experience).1 You and your practice must have the cultural values, defined protocols, and systems in place to respond to your patients’ increasing needs and desires as customers.

New Resource on Patient Experience

Written as a series of insights that fall under one of the six key value drivers for today’s practices, Beyond Bedside Manner1 (www.beyondbedsidemanner.com) builds upon many of the concepts from Shareef Mahdavi’s monthly column in Cataract & Refractive Surgery Today, which ran from 2001 to 2007, and from his work with clients on The Experience Economy2 methodology. The book is written for doctors, administrators, supervisors, and front-line staff—all of whom have the opportunity to positively impact the patient experience and help the practice grow.

The book, published by Story Seven Publishing, is scheduled for release in April.

Across most industries, customer experience has become the key battleground for differentiation and competitive advantage; the profession of health care is just late to the game. The Experience Economy, by Pine and Gilmore, was a groundbreaking book when it was published 20 years ago.2 Today, the philosophy it set forth has evolved into a widely adopted means by which businesses can continue to grow. Companies of all sizes are realizing that, in addition to charging for the goods and services that consumers purchase, they can charge for the time spent in an experience.

Wine tasting used to be free; now wineries routinely charge a tasting fee. The American Girl store is free to enter, but there is a cost to join your child and his or her doll in the salon, theater, or café. The popularity of TopGolf as a social activity for family and friends validates what the experience economy is all about: People want to save money on increasingly commoditized goods and services in order to spend more of their money (and time) on experiences.

Another classic example is Starbucks. Over the past 20 years, the coffee chain has gone from less than $2 billion in revenue to more than $26 billion.3,4 During that same time, the price of coffee as a commodity has not increased (Figure 1).5 Clearly Starbucks isn’t selling just coffee; they have succeeded in getting us to pay $4 to $5 or more for an item that costs less than $0.15 to make.

Figure 1. Starbucks’ growth in revenue and units from 1999 to 2019 (see infographic below line graph)3,4 versus the commodity price cost of coffee in the same time period.5 This shows the power of both customization and commoditization, two opposing forces in the experience economy.


In the latest edition of Pine and Gilmore’s book,6 they introduce several ideas that have particular relevance for refractive surgery. First, the nature of competition has changed with the introduction of the smartphone. If what you offer isn’t compelling or engaging, it’s as easy as pulling out an iPhone for your potential customers to find something that is more worthy of their attention. The authors emphasize that you are competing for customers’ time, attention, and money. You should think about all three when asking, “How can we get more patients to choose our practice’s refractive surgery offerings?”

In our increasingly busy world, competition for the time and attention of consumers is fierce. Advertising and marketing are expensive, and these have limited effect in capturing their attention. If you want their business, you must be engaging and make their experience with you time that is well-spent.

In this edition, Pine and Gilmore also introduce a new framework, the money value of time (MVT), which quantifies the value you are creating based on the time spent by the customer. For Starbucks, the MVT is about $0.05 to $0.10 per minute; for a 2-hour movie it is $0.10 to $0.15 per minute. The play “Hamilton” commands $5 per minute, whereas a skydiving session runs about $200 per minute (Figure 2).

Figure 2. The MVT demonstrates the value consumers are willing to pay for measured on a per-minute basis.

Courtesy of Strategic Horizons

Applying this concept to LASIK, the MVT is approximately $15 per minute, if pre- and postoperative care is included, or $133 per minute if it is not. These are the numbers from your perspective. What about from the patient’s perspective? The benefit they derive from what you do will be realized 16 hours a day for the rest of their lives. From that perspective, MVT becomes fractions of a penny per minute. The authors call this infinite ROI, and you can use this concept to help consumers understand what an investment in their vision can bring to them relative to their other spending options.


The answer to future market growth lies in the customer experience and in your dedication to improving it for your patients. Differentiating your practice on anything besides your patient experience is futile: Your surgical experience, choice of technology, and (should you so choose) low price points are not sustainable approaches. But developing a practice culture that pays attention to customer service paves the way for you to design a patient experience that is unique and memorable.

Services are about what you do (ie, the task), but experiences are about how you perform the task. Practices that are dedicated to treating people as both patients and customers are reaping the rewards. The patient experience that their teams work hard to create does the heavy lifting, and less energy (and money) is spent in marketing and advertising. Concentrating on the patient experience just makes good business sense.

1. Mahdavi S. Beyond Bedside Manner: Insights on Perfecting the Patient Experience. Oklahoma: Story Seven; 2020.

2. Pine BJ, Gilmore JH. The Experience Economy: Work is Theater & Every Business a Stage. 1st ed. Brighton, Massachusetts: Harvard Business School Press; 1999.

3. United States Securities and Exchange Commission. Starbucks Annual Report 1999. https://www.sec.gov/Archives/edgar/data/829224/000089102099002151/0000891020-99-002151.txt. Accessed December 12, 2019.

4. United States Securities and Exchange Commission. Starbucks Selected Financial Data, 2019. https://www.sec.gov/ix?doc=/Archives/edgar/data/829224/000082922419000051/sbux-9292019x10xk.htm#s14B68583CA895857B93E38650FA902B3. Accessed December 12, 2019.

5. Hodari D. Coffee Prices Plunge Even Though We Can’t Stop Drinking the Stuff. April 22, 2019. Wall Street Journal.

6. Pine BJ, Gilmore JH. The Experience Economy: with a new preface by the authors: competing for customer time, attention, and money. 2nd ed. Brighton, Massachusetts: Harvard Business School Press; 2019.

A Little Mindset Surgery May Be in Order

Vance Thompson, MD, FACS

There’s nothing in my professional journey that means more to me than how I make someone feel. The practice of medicine involves supreme trust between two individuals and is, therefore, so intimate that it is an amazing opportunity to touch someone deeply.

Service is the action of helping or doing work for someone. Quality service is highly important in a business. I see the experience we create as something special we do with our service to make someone feel—hopefully—special. If service is the bone, then experience is the meat on the bone.

You can greet someone at the front desk in an efficient manner with no wait and provide good instructions as to what is going to happen next, and that would be considered giving good service. Or you can do the same thing with a smile on your face, and in your eyes, while standing up from your seat and shaking the patient’s hands and remembering his or her name from the last time he or she was there (Figure 3). Is it the good service or the heart-touching, experiential, personalized greeting that the patient will remember most?

Figure 3. Smiling and calling patients by name can elevate the patient experience.

Courtesy of Vance Thompson, MD, FACS


As a professional who takes care of people, you can imagine the difference between providing a good service and providing a good service that makes someone feel more special than he or she ever has felt in a medical or business interaction. As a result of this mountaintop feeling, that patient’s expectation for how other businesses should treat him or her also goes up. More businesses today are understanding the importance of the experience, and this is what I see as new in modern-day medicine.

Patient expectations are going up in medicine because high-performance businesses are showing them experiences that they have never had before. Doctors provide a service that is often a need. You will most likely have a busy practice and business, even if you don’t work on the experience. But do you want to be average, do you want to do traditional medicine, or do you want to be above average—not only in the practice of medicine but in how you make your patients feel?


I know what I want to be, and it starts with my looking in the mirror and asking myself certain questions, of which the first is how I treat my team (Table). You see, you must have a great team culture before you can ever create a great patient culture. As a matter of fact, when it comes to culture, I say the patient comes second. These are delicate words in the practice of medicine, when we’ve taken an oath that we will do no harm and do our very best for the patient. Of course, we’re going to follow through with that oath. But when it comes to creating a great patient experience, starting with a great team experience is crucial.

To create a great team experience, you need to invest time and money, and you need to allow activities to take place that lead to a great team culture. We are all busy doctors, and we don’t have the time to be the implementers of the great team culture that is necessary to lead to a great patient experience. That is why we need to invest in and allow the business leaders in our practice the time to attend meetings that teach them how to build a great team culture and patient experience.

In our practice, our business leaders start every day in a huddle with the team, which allows them to start the day with each other—just like a family does. During the huddle, everyone hears what’s going on for the day, and they learn something new and experiential.

The doctor-leaders need to allow time and resources for things such as this. We also close our whole center periodically for retreats that are dedicated to building a team culture and a patient experience. We read books and do breakout sessions to choreograph the patient experience at every touchpoint, from the phone call to the goodbye and everything in between. And when there’s a patient complaint, we take the time to dissect it in such a way that we can see where and how things went wrong and try to put systems in place to minimize the chance of that happening again.


In trying to create a great team culture and patient experience, a practice needs to look at its mindset and make sure that it’s not fixed and resistant to change, but rather flexible enough to do what I call mindset surgery, which is to change in a way that catapults the team into modern-day medicine that goes way beyond providing the patient’s needs and includes caring deeply about how the patient feels.

I could write on and on about this topic, and I welcome readers to write to me with any questions about details. In brief, this is what’s new in modern-day patient care. As a matter of fact, I like to say that what is new is actually old. It all comes down to how we treat people. In this digital age, personal interactions have diminished, and I believe that it is for this reason that personal interactions are so valued when they do happen.

Be progressive in your technology and skills, and be old fashioned in the people part of your business. Patients want to know how much you care before they care how much you know. And practices that understand this and implement it the best will be the most successful. Not only will it increase you and your team’s joy and job satisfaction, but the patients you touch will tell the world.

John R. DiJulius III
  • Chief Revolution Officer, The DiJulius Group, Cleveland
  • john@thedijuliusgroup.com
  • Financial disclosure: Author of the book from which his contribution is excerpted (with permission)1
Shareef Mahdavi
Vance Thompson, MD, FACS
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