Managing Patient Expectations Part 1 - Botox Training MD

Managing patient expectations are crucial to the success of any aesthetic practice.

If you are not 100 % on board with understanding and dealing with patient expectations, I believe it's going to be difficult to be successful with any aesthetic practice.

The way that I manage patient expectations starts from the initial correspondence with my clinic. My front desk staff typically will notify me if anything out of the ordinary is discussed on the phone at a new patient's consultation request. So, if for instance, they have a request that's perhaps out of the ordinary or they're perhaps not comfortable with the way the conversation went, they'll let me know so I'll have right off the bat, I'll have a little understanding that maybe it'll take a little bit more time with describing what can be done or perhaps the mode where I am not going to perform a procedure.

It's just as important and more difficult sometimes to actually refuse to perform a procedure than it is to do a procedure, have an unsatisfactory outcome, and recover from that. So I want to make that kind of clear again that if somebody presents to you that you do not feel comfortable treating, it may be more difficult to refuse that treatment than it is to actually deal with somebody who develops a complication or unsatisfactory result. However, interestingly enough, if you take the time to explain to a person why you don't feel you can't perform what they want, it can actually turn into a positive experience in the form of her/him recommending other patients to you. Or maybe that person selecting a different treatment that you offer. So, again, we start off right out of the bat, by making sure that our front desk is well aware that I need to be informed of anything out of the ordinary when a patient calls or comes in for the first time, not matter what it is.

There are two things I'm looking for. Out of the ordinary being number one, and number two would be behavior that is really not acceptable social behavior, like anger or overly demanding behavior. I like to know that too because if somebody is angry or demanding with the front desk in an unacceptable manner, then that is a clue that perhaps their behavior will be the same after I treat them.

If you're in this field long enough, you're going to hear some strange requests.

We get calls not too infrequently, once or twice a year from clients that are in the process of changing from a male to a female or a female to a male and they would like to have some, not only surgical procedures but some nonsurgical procedures like Botox or Dysport and a filler like Restylane or Juvederm. Typically, they are often required to have psychiatric evaluation before they undergo the actual transgender operation. So I've had a few instances where I had to contact their psychiatrist or actually put them in contact with a psychiatrist before treating them. So that's a little out of the ordinary.

And the other out of the ordinary are extremes of age. Teenagers calling for Restylane to augment their lips or Botox and knowing how to deal with that. And that would simply be... they have to be over 18. I mean you have to understand the..or appreciate the indications for Botox and it's right on the label.

Read: Managing Patient Expecations Part 2

About: Marc S Scheiner MD is a plastic surgeon who teaches Botox and filler injection technques to physicians and clinicians through Botox Training MD and his 14 credit CME two-day hand's on seminars.

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Marc S. Scheiner MD

Dr. Marc S. Scheiner completed his undergraduate studies at the University of Delaware, and received his medical degree at the University of Texas. Following his residency at the University of Florida, he practiced family medicine in the small town of Elkton, Maryland during the 1990’s. During that time, Dr. Scheiner was forced to refer patients from rural Cecil County to Baltimore or Delaware for plastic surgical procedures. His interest in this type of surgery and his desire to provide these services for the local community led him to begin plastic surgery training.

Dr. Scheiner was accepted at the Nassau University Medical Center in 1999, where he entered the General Surgery Program. Following the completion of his general surgery residency, he began training with the oldest and largest plastic surgical group in the United States, the Long Island Plastic Surgical Group in New York.

In June of 2004, Dr. Scheiner completed his plastic surgical training and moved back to Cecil County to open the O’Leigh Aesthetic Surgery Center, LLC, filling a much needed gap in locally provided plastic surgical care.

In 2006, Dr. Scheiner, along with several other local physicians, began construction of a new medical facility in Elkton, Maryland. This building, in addition to being Dr. Scheiner’s new office, houses Cecil County’s first ambulatory surgery center, the Upper Bay Surgery Center. Upper Bay Surgery Center offers ambulatory surgical procedures in a private, comfortable, and safe environment.

Dr. Scheiner has lived in Cecil County since 1984 and currently resides in North East with his wife and three children.

How Are Employees Working In Your Medical Spa?

By Arlen Meyers MD

Who is working in your medical spa?

Employee engagement refers to the bond employees have with their organizations and the amount of connectivity they have with their organizations' missions. Current thought is that employee engagement is a greater indicator of productivity than employee satisfaction. When employees really care about the business, they're more likely to go the extra mile. Numerous studies show that employee engagement is correlated to a company's bottom-line success.

In the late 90's the Gallop Organization developed the Q12, a tool for measuring employee engagement. Those who score high on the survey instrument are more engaged and their employers benefit with hgher profits and market shares.

Here are the questions.

  • Do you know what is expected of you at work?
  • Do you have the materials and equipment you need to do your work right?
  • At work, do you have the opportunity to do what you do best every day?
  • In the last seven days, have you received recognition or praise for doing good work?
  • Does your supervisor, or someone at work, seem to care about you as a person?
  • Is there someone at work who encourages your development?
  • At work, do your opinions seem to count?
  • Does the mission/purpose of your company make you feel your job is important?
  • Are your associates (fellow employees) committed to doing quality work?
  • Do you have a best friend at work?
  • In the last six months, has someone at work talked to you about your progress?
  • In the last year, have you had opportunities at work to learn and grow?

    After administering this test to thousands of employees, Gallop found that only 40% of employees are engaged. The rest , in the best case, show up and do their job, while in the worst case, 15% are disengaged and sabotage the organization or create problems. As you know, misery loves company.

     The questions concern having the tools and authority to do your job, getting honest feedback, feeling appreciated, and having a learning and growth plan.

    Whether you are the employer or the employee, the Q12 can help you pinpoint holes in how you are treated or how you treat your employees. The sooner you identify gaps and fix them the better. Disengagement is contagious and most antibiotics no longer work.

    Arlen Meyers MD MBA is the cofounder, and Chief Medical Officer of MedVoy, a medical tourism company. He is also a Professor of Otolaryngology, Dentistry and Engineering at the University of Colorado at Denver and CEO and President of the Society of Physician Entrepreneurs. He blogs at Freelance MD

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    Service In Your Medical Spa

    Your medical spa service is determined by what client's feel about it.

    This weekend I was eating at one of my favorite restaurants when I noticed something different with the experience.

    Usually, after ordering the waitress brings over a basket of magnificent, crusty rolls and cinimon butter. (They're really good and something everyone enjoys.) However, on this night our bread-basket arrived with just three rolls in the basket for a table of four.

    When we inquired about this, the waiter informed us that the 'ration' had been cut in order to keep costs down AND prevent diners from filling up on free bread in the hope that they'd order more items from the menu.

    I gues that's somewhat logical, but the effect that this actually had was very different. What could have been another great experience was overshadowed by this relatively small event.

    This experience and some other posts I've read got me to thinking; there are times when we're all providing 'three roll service'. In the same way that this restaurant made a slight change that saved them a couple of dollars a day, and cost them many times more in lost business. Are are times when I drop the ball with the small things that people remember? I know that there are. Perhaps I don't call someone back as quickly as I could, or I don't take the time in an email exchange to pad the message with a sentence or two and it comes across as terse and angry.

    There's a lot we can learn from a three-roll experience. It's always the small things that differentiate an experience.

    Interview With Jessica Wadley, Former COO Of Spa MD

    This episode of the Medical Spa MD Podcast introduces us to Jessica Wadley, former COO of Spa MD, who brings years of Medical Spa business experience to share with our members.

    In part 1 of this podcast we discuss a host of issues around medical spa operations, sales, marketing, startup costs and staffing. We've got some agreement and you'll want to listen to how our thoughts (and strategies) differ around commission structures for staff and internal operations and training.

    We also discuss how Spa MD went from $3m a year in revenue to over $12m in gross revenue within four years so you'll want to hear that.

    Your Medical Spa Patient Care Coordinator

    What is a Patient Care Coordinator?

    As Jeff mentioned in his post entitled Your Medical Spas Front Desk, it is very important in the cosmetic industry to find a competent and friendly front desk person.  It is equally important to find a dynamic and motivated Patient Care Coordinator.

    In most Plastic and Cosmetic Surgery Centers, Patient Care Coordinators are few and far between. This is unfortunate because a motivated Patient Care Coordinator can exponentially increase your profits.

    A first-rate Patient Care Coordinator usually possesses a business/marketing degree and can not only handle your website marketing, blogs, and Facebook, but can also field inquiry calls in a professional and effective manner.

    Oftentimes Patient Care Coordinators will even start the initial consultation if they are “complimentary” in your office. Then when a patient is interested proceeding forward with a surgery, they are ushered in to meet with the Surgeon. This way, the Surgeon is not wasting his/her valuable time speaking to someone who is simply gathering information or price shopping. Also, if your Surgeon is not a “warm and fuzzy” type, the Patient Care Coordinator is a good go-between, and is able to relate to the patient on a more personal and friendly level. Patient Care Coordinator’s usually handle all aspects of patient financing and have the ability to help the patient choose which financing plan works best for them, sometimes calling in for the patient to seek approval.

    In addition, if any areas are lacking in your practice, such as your employees taking lousy before and after pictures, A good Patient Care Coordinator does not mind stepping in to take over the picture taking or train the right person to handle this task because high-quality before and after pictures are crucial for marketing during a consultation and your photo gallery on the internet.

    If you have an employee that you feel is up for the position of Patient Care Coordinator  but is unpolished, don’t worry because there is help out there. The best course I have attended is offered once every few months by Michele Tyler from Dr. Todd Malan’s office in Scottsdale, Arizona.  I myself was literally thrown into this course by my husband, who was taking a fat grafting course from Dr. Malan and wanted to make sure I had something to do while in Scottsdale (although I tried explaining to him there is much to do there!).

    As I have been a Patient Care Coordinator for 5 years, I came to Michelle’s course with an overconfident attitude that I most likely knew all there was to know about this position and there was nothing I could be taught. Although I knew from both my own training and trial-and-error on the job training, much of the material being presented,  there were many excellent tricks and pointers that I learned that were worth their weight in gold and paid off many times over the relatively small price we had to pay for the course. One such topic was “What to do when a potential patient is calling and is asking how much a procedure costs?.” I’m not going to give away any of Michelle’s secrets but, if your Patient Care Coordinator or Receptionist does not know the answer to this question and consistently does not get patients into your office who ask questions such as these,  your employee probably needs to take the class!

    If you are uncertain if your office employees are answering patient inquiry calls adequately and successfully, drop me an email and be sure to include your office phone number. I will “mystery shop” for you and give you a free of charge brief assessment of whether or not you need a Patient Care Coordinator in your practice.

    Wendy Hovorka B.S.  M.L.A.  Valley Laser Surgical Solutions Vein Center,  McAllen, Texas

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    Your Medical Spa's Front Desk

    Your medical spa already has a receptionist of some sort... perhaps a few.

    Sometimes, they're merely a guardian, a sentry to keep the riffraff in the lobby. Or, as in the case of many medical spas or laser clinics, a prettier than average female with lip fillers and clear skin that's supposed to be asperational for the majority of patients.

    Other times, though, a receptionist can change the entire tone of an interaction. If you've got someone answering your phone, greeting your clients (who have traveled a thousand miles to visit your office) or otherwise dealing with the outside world, I think it's time to do some simple cost/benefit analysis.

    If your front desk greets just 10 people a day, that adds up to 2,000 people a year.  How much is that worth to your business? Is it worth a dollar per interaction to transform all of those interactions into something spectacular?

    In many if not most medical offices, the front desk staff sees incoming patients as just another person to get through the process. For some it's just another headache. And the patients feel that in all of the interactions. Fill out this paperwork. Sign here. Wait there.

    But what if instead of hiring the cheapest person, or sticking with the existing person because it's easier, what if you invested in a truly remarkable experience?

    American Laser Clinics Trouble In Iowa

    Armed guard protects ALC patients from the supervising physician who is supposedly overseeing their treatment.

    American Laser Clinics operations are stopped by a medical board yet again.

    This reminds me of the armed guard that American Laser Clinics stationed in the laser clinic to prevent the supervising physician from seeing patients... while they treated those very same patients under his 'medical direction'.

    According to the Quad City Times:

    A doctor who led a medical spa in Bettendorf has been sanctioned by the Iowa Board of Medicine.

    Anthony O. Colby, of Iowa City, was the medical director and/or supervision physician at American Laser Center in Bettendorf, Coralville and West Des Moines, documents from the board said. The Bettendorf location is at 852 Middle Road.

    The center’s West Des Moines office was also issued a cease-and-desist order by the board, saying that the center must stop “the unlawful practice of medicine in Iowa,” records indicate. The board says a person at that office performed medical services without proper physician oversight.

    A spokesperson for American Laser Center, a chain with 225 clinics nationwide, could not be reached for comment. Colby could not be reached for comment, either.

    According to board documents, Colby has insufficient training or experience to supervise individuals performing medical aesthetic services in Iowa. The board also alleged that Colby failed to properly supervise those who performed such services.

    Specifically, at least one patient suffered serious burns on her arms after receiving treatment for hyper-pigmentation on her face and arms by a person under Colby’s supervision.

    The board ordered that Colby not serve as the medical director for a medical spa that offers specific types of services or supervise anyone who performs those services.

    He was ordered to pay a $5,000 fine and warned that any more violations could result in further disciplinary action.

    As for American Laser Center in West Des Moines, the board determined that non-physicians were performing examinations, diagnosing medical conditions, offering treatment recommendations and performed medical procedures, including the use of lasers for the treatment of hyper-pigmentation and cellulite removal.

    Medical Spa MD Training Courses

    Finally available! The Medical Spa  MD Training Courses for Laser Clinics, Medical Spas, Plastic Surgery Centers and Cosmetic Dermatology Practices.

    Your medical spa staff's knowledge and expertise is a critical componant to your medical spa or cosmetic clinic's success.

    From IPL training to skin typing, Botox, Restylane, and Juvederm filler injections, the Medical Esthetician Training Manual & Study Guide, and the Advanced IPL & Laser Training for Non-physicians is required material for smart medial spas, plastic surgeons and cosmetic dermatologists.

    Now it's easy to train every new hire on what non-surgical cosmetic proceedures you offer, how they work, and what alternatives there are. Ensure that your front desk, estheticians and laser technicians have the information that they need to answer patient questions with confidence.

    For the first time, your laser clinic or medspa staff has the latest information on the newest nonsurgical medical treatments. From Botox, Restylane, and the newest filler injections, to fractional CO2 laser resurfacing, skin tightening and IPL treatments, now you have a uniform and tested training system. This is a must have for any serious cosmetic clinic.

    Download Advanced IPL & Laser Training TOC
    Download Medical Spa Aesthetics Training Course TOC


    Advanced IPL & Laser Training Manual


    The Advanced IPL & Laser Training Manual for Non-Physicians is required training material for every new hire working in a medical spa.

    From IPL to fractional laser treatments, this manual covers the non-surgical IPL & Laser treatments your staff should know. Give your staff the information that will make you successful.

    Advanced IPL & Laser Training - $227




    Medical Estheticain Training Manual & Study Guide

    The Advanced Medical Spa Esthetics Training Course & Study Guide is a two part learning cirriculum for non-physicians.

    With 165 pages of quality content, this course is delivered in two parts that include a text book and a study guide. Already being used by leading medical spas and esthetician schools.

    Medical Spa Aesthetics Training Manual & Study Guide - $247



    Get all three and save: The Medical Spa Aesthetics Training Manual & Study Guide AND The Advanced IPL & Laser Training Manual

    Buy the Medical Spa Aesthetics Training Course & Study Guide AND the IPL & Laser Training course and save almost $200!

    Medical Spa Aesthetics Training, Study Guide, and Advanced IPL & Laser Training - $297



    These training manuals are a critical component to the success of any Laser Center, Med Spa, Plastic Surgery or Cosmetic Dermatology practice. Use them to train every new medical spa staff member on what cosmetic proceedures are available, how they work, and what alternatives there are.

    Written for non-physicians, both of these advanced training courses are already being used in leading medical spas and laser clinics to provide every new medical estheticians, laser techs, and front desk staff with current information about cosmetic information, and test their knowledge before they're hired.

    Written by Paula D. Young, RN, these training manuals are designed to meet the real-world needs of cosmetic practices by those who know how to run a succesful cosmetic practice and how important it is that your staff is trained and has the information they need to become trusted avisors to your patients.

    Everyone who has owned or run a med spa or cosmetic practice knows how long it takes to train new staff, and how much damage can be done with the wrong information. These new manuals and study course from Medical Spa MD make it easy to provide consistant, quality information to staff and ensure that everyone is on the same page from day one. Your entire staff now knows what your education expectations are and have the materials to meet them.

    From Thermage to IPL to fillers and chemical peels, how they work, who they're for and when to use them. These courses give your laser techs, medical estheticians and front desk staff a deep understanding of the landscape of nonsurgical cosmetic medicine and save you endless hours of repetitive individual trainging. It's the single best investment you'll make in your medspa.

    Give your staff the benefits of insider knowledge and make sure they're making the right decisions.

    The Medical Spa Aesthics Training Course & Study Guide for medspas & laser clinics.

    The Medical Spa Aesthetics Training Course & Study Guide for Medspas, Laser Clinics & Cosmetic Medical Practices.


    Written by Paula D. Young, RN, the Advanced Medical Spa Esthetics Training Course & Study Guide is a two part learning cirriculum for non-physicians. The course is delivered in two parts that include a text book and a study guide.

    This is an invaluable tool for any Laser Center, Med Spa, Plastic Surgery or Cosmetic Dermatology practice to train every new medical spa staff member on what cosmetic proceedures you offer, how they work, and what alternatives there are.

    This study course is being used in medical esthetic schools and leading medical spas and laser clinics to provide every new esthetician and laser tech with a study course, and test their knowledge before they're hired.

    For the first time, your laser clinic or medspa staff has the latest information on the newest nonsurgical medical treatments, from Botox, Restylane, and the newest filler injections, to fractional CO2 laser resurfacing and IPL treatments.

    Your medical spa staffs knowledge and expertise is a critical componant to your success. Now you can be confident that your front desk, estheticians and laser technicians have the information that they need, and can answer patient questions with confidence.

    Memberswill only be available to existing Medical Spa MD Members so be sure that you've signed up for your free membership.

    Laser Clinics & Plastic Surgeons: Can I call you sometime?

    Dear Physician and Medical Aesthetic Practice Owner,

    You attended numerous training and certification courses, hired a top notch staff, have the latest products and equipment, designed an aesthetically astute office environment, invested in a comprehensive marketing strategy, and probably hired some consultants along the way. So the million dollar question is... who’s answering your phone?

    Your entire investment was focused on getting new patients in the door, but let’s face it, they just don’t walk in, they call first. Surveys show that more than 80% of all business transactions involved a phone call at one point. And, if the person on the other end of that line doesn’t have the right demeanor, personality, knowledge base and selling skills, you might as well list your lasers on eBay.

    Are the associates responsible for answering your phone pleasant, easy to understand, knowledgeable about policies and procedures, know how to effectively utilize the HOLD button (if absolutely needed!), how to leave a message, how to get consults in the door, and, most importantly how to handle a difficult caller?

    This is truly a marketing and business strategy you should be focused on even more so than what form of advertising you should use. Advertising only works if you can get people in your door.

    At our laser clinic, we use effective strategies to help our associates take ownership of what they do. All of our associates responsible for phone calls are trained on all our procedures and FAQs of the procedures. They also need to know our website and menu of services inside and out. We have phone scripts at a finger’s touch and I ask them to smile when they answer the phone because it will show in their voice.

    It may seem like a “Big Brother” tactic to most, but I have randomly recorded calls through our pay-per-click campaign which helps me take a quick pulse of what their strong points are (so they can be praised) and what their weak points are (so I can redirect them).

    In the long run, we all win. We’re getting solid leads coming in the door and they receive bonus checks for consults they have been able to schedule from cold calls. It truly gives them a feeling of ownership and accomplishment!

    So, can I call you sometime?


    Mystery Caller

    Author: Paula D. Young RN runs internal operations and training at Young Medical Spa and is the author of the Medical Spa Aesthetics Course and Advanced IPL & Laser Training course for medical estheticians and laser technicians.

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    How to run a medical spa staff.

    You're staff is running the business. Try to make sure they're running the business as though they owned it themselves.


    1. Realize that your clinic or medical spa succeeds via the efforts of the staff.
      Just because you're in charge doesn't mean you deserve all the credit for the work being done. Your staff is responsible for much if not most of the work. When you're working in a clinic as a physician, you're working as a technician. You're working 'in' the business, not 'on' the business. There's a difference.

    2. No one really works for you.
      Perhaps you think that your staff works for you since you pay them. They don't. They, like everyone else, work for themselves. You need to devise a system and business that makes working in your clinc the best individual choice for them. Fail this one and you'll have constant turnover and strive. The mark of a true novice.

    3. Delegate responsibility and then trust your staff.
      Micro-managers are never appreciated. Once you've trained someone to handle a task, allow them to handle it. Different people have different approaches, and their way of doing something may be just as efficient as the way you would do it, so before you step in and force your way on them, give an honest evaluation to their method, and if you find theirs works just as well, even if it's different from yours, let them be. Constantly correcting them undercuts their confidence and does not allow them to exercise their own style and can often be detrimental. An esthetician or technician who's intimidated or criticized for asking for help will stop asking, putting you at risk for unwanted outcomes.

    4. Know your employees to know your strength.
      Watch your staff, get to know them as individuals. The cream always rises to the top, and it's your job to figure out which employees do what is required in their jobs, and which employees do all they can in their jobs. There's a distinction. When I hire I'm very clear about what is expected: Whatevern needs to be done. I don't have time for prima donnas.

    5. Clone yourself - many times.
      Once you've identified the best of the best, teach them your job. That's right. Teach them to be you (as much as possible). Most bad bosses are under the (mistaken) impression that there is something unique that makes them indispensable. The truth is, the best boss trusts his staff and re-creates himself many times over so that in case of emergencies in his absence the Good Boss has excellent help that can be utterly relied upon. Cloning yourself means that you don't need to go to work as much, freeing you to do as you please and knowing your business is earning as much today without you there as it would if you had to go there and slave away. And remember, too, that you're creating another good boss! Give your staff some rope. Some will make bows and some will hang themselves.

    6. Empower your staff to make critical decisions, and don't second-guess them.
      This is a big one. If you've done a good job of training your people to be your proxies, then you must know they are doing their best to act in your (and your company's) best interest. Even if they make a wrong decision, or handle a situation in a way you would not have, don't second guess or berate them. Instead, use it as yet another training opportunity. Hear out their reasons for their action - most of the time, when taken in context, there was a logical basis for what they decided to do. My staff is expected to make all decisons in this order:
      • What's in the best interest of the patient.
      • What's in the best intereste of the business.
      • What's in their own best interest.
    7. Create a clear chain of command. If you are the owner and have a manager, be sure the rest of the staff understands the chain - they are to take problems to their direct manager first, and only then escalate that problem to you if they are still unsatisfied. When leaving, say, "Joyce, you're in charge." This lets any additional staff know who's the boss in your absence, plus, goofy as it sounds, it makes Joyce square up her shoulders and realize that she now 'has the bridge.'

    8. Help them learn to work out issues without your intervention. Sometimes one or more of your staff may experience friction with others. If they come tattling on one another to you, listen to them carefully. If someone is not fulfilling their responsibilities or is mistreating another employee, you'll need to step in and resolve the conflict yourself. But if you're satisfied it's only an issue of competition or a simple personality clash, urge them to settle it between themselves.

    9. Deal with any problems quickly and directly. Any boss who is terribly busy totally understands this concept: "I don't need all the details. Bottom line it for me." You don't have to be so blunt that you crush people, but being direct and honest is a big timesaver, and frankly, appreciated in the end. When you see a problem, deal with it quickly and don't nag your people about it later - let done be done.

    10. Tell your staff how much you appreciate them - in front of others if possible. (Some authoritarian doctors have a real problem with this one.) Never hesitate to pat your employees on the back, compliment and thank them for their excellent service - if customers are there, letting them know how you value your people can go a long way toward the customers actually having more faith in the services your business provides. When your staff feels valued and appreciated, their job means more to them than simply a paycheck. When your customers know that you, as the owner (or manager) think highly of your staff, they feel confident that they're in good hands, and it leaves you more freedom to leave your customers in the very capable hands of your staff. See how this becomes a "win-win-win"? By lifting up your employee while your customer was watching, ALL of you got something good from it - with zero downside.

    11. Show your appreciation by doing things for them. They go the extra mile for you. You do something nice for them. Buy everyone lunch every other Wednesday. Be sure there's a supply of their favorite sodas in a small fridge for them. If you get extra tickets to something you know they would enjoy, offer them to them as a bonus for work well done. Remember their birthdays, at least enough to wish them a happy day, or buy them a cupcake. (I try to make an occasional Starbucks run.)

    Take care of your staff and they'll take care of you.

    Via: be a good boss:

    Protecting your medical spa from embezzlement.

    tn_embezzlement_2000.jpgEmployee (and accountant) embezzlement is rampant in medical clinics. Medical spas, laser clinics, and plastic surgeon offices are no different. We've even had the unpleasant experience of a physician embezzling from one of our clinics. 

    Download the free, members-only report: Medical Spa Embezzlement & Employee Theft Scams

    Submit your own story about medical clinic embezzlement or theft here Protecting your medical spa from embezzlement.

    So what should you do to ensure that you have controls in place to minimize the opportunity for embezzlement at your company? Here are some tips:

    1. Don’t leave cash lying around in an unprotected spot. It can easily disappear, and you don’t want to tempt people by being careless.

    2. Don’t use signature stamps for checks. They're too easy to misuse. Sign the checks yourself with a pen.

    3. Minimize the number of employees who have signature authority on your bank account. Too many hands in the pot can lead to disaster.

    4. Make deposits nightly so that excess funds aren't left onsite...

    Top 10 reasons why loyalty programs don't work.

    Medspas consultants will often promote loyalty programs as a way to reward your best clients and build their loyalty to the practice. But loyalty programs are often not all they're cracked up to be.

    10 reasons whyloyalty programs won't work in your medical practice?

    1. Loyalty programs are based on discounts, which ‘train’ existing patients to expect 'sales' and wait out your normal prices.
    2. They attract your most loyal patients who would happily pay a premium.
    3. They confuse patients and staff and create customer service problems.
    4. they discourage new patients by making them feel punished or excluded.
    5. they encourage competitors to retaliate with me-too programs.
    6. they damage your perceived image by making you a 'discount' store.
    7. they reduce profit margins from your best patients.
    8. they reduce your ability to serve patients at the highest levels.

    Ok, there were only eight. But the point is, patient loyalty can’t be programmed. As soon as patients begin to feel ‘stalked,’ they choose ‘fight’ or ‘flight.’ They either figure out how to game the system, or else they seek care elsewhere.

    Chaos causes medical mistakes, not incompetence.

    How to "survive" an ER visit.

    (and as bonus: Complexity causes 50% of all returns.)

    97912882_54b9f5cd7e_m.jpg"The main culprit isn’t incompetence but chaos: The nation’s emergency rooms are overburdened and underfunded, treating ever more patients with ever fewer resources. "You don’t want to scare the public, because hundreds of thousands of patients get cared for very well in emergency rooms every day," says Gail Warden, president emeritus of Michigan’s Henry Ford Health System, who chaired a trio of studies of emergency care released in June by the National Academies’ Institute of Medicine. "But the system is stretched, and it could be at a breaking point in three to five years."

    Federal law requires that ER doctors and nurses treat everyone who shows up, regardless of ability to pay, but there has never been enough federal money to cover those costs—and that money is dwindling."

    And from Complexity causes 50% of product returns.

    Half of all malfunctioning products returned to stores by consumers are in full working order, but customers can't figure out how to operate the devices. Product complaints and returns are often caused by poor design, but companies frequently dismiss them as "nuisance calls.

    The average consumer in the United States will struggle for 20 minutes to get a device working, before giving up.

    Most of the flaws found their origin in the first phase of the design process.

    This last one might be viewed as the most important. During the design of a system program or product, most of the problems with interface or use that are going to crop up are built into the system. .


    The 5 Stages of Consumer Decision Making that all your patients use.

    decision-making.jpgWhen patients buy your services, they all engage in a decision-making process. Research shows that one of the major problems with businesses is that they fail in supporting the customers in this process. By understanding your patients needs and concerns as they progress through the decision-making cycle, you can build better and more successful medical practice.

    The consumer decision-making process

    Imagine that you need a new cell phone. The first step is recognizing your need. (You can insert 'want' or 'desire' instead of need.) Though you may have an idea of which phone you would like to purchase, you research your options to narrow the possibilities.

    If you're a male, you go online and investigate manufacturers, resellers, and independent consumer organisations. You ask friends and colleagues for advice, and you visit a few stores to "kick the tires." You compare you options and finally decide to purchase what seems to be the best alternative, based on criteria like design, features, price. For men, this is a linear process.

    If you're female you go through a much different, non-linear, decision making process that takes into account different variables than males typically choose. Men perceive this process as introducing a lot of extraneous noise into what should be a straight forward decision about cost vs.. benefits. Women are actually much harder to please because they're also buying a cell phone based on: What color it is. How it fits in their purse. cute factor, etc. They're deciding how much 'faith or trust' to put in the business. One process is not 'better' than the other, they're just different.

    Warning: This is where many men don't get it. Women are using criteria that men don't understand so men tend to disregard this process. While women are harder to please, they are much more loyal consumers if you can satisfy them initially. Men look for features, women look for faith. 

    After your purchase, you assess whether it lives up to your expectations. You might find that the phone is able to do what the manufacture promised, but that the navigation is unmanageable. You decide that you will never buy this brand again.

    Your decision-making process can be described as five different stages:

    The customer decision-making process and its five stages

    The complexity of this process can range from careful analysis to pure impulse. While an impulse buy, such as adding additional services or products to an existing appointment, can take place instantaneously, complex purchase decisions stretch over a long period of time. This buying process is an iterative process, where patients may collect information from different sources and repeatedly return to re-evaluate and compare the information they have found. Women are particularly adept at this and consider any number of points that you may not be aware of in this decision making process. One of the most important of these could be described as 'feel'. (Men typically descry this type of methodology, often causing them to dismiss what women see as the most important part of their decision making.)

    The customer funnel

    The Web is a great tool for information research. Studies show that the Internet is now the primary means by which people get key information. This counts for commerce in particular. People expect to be able to find information about products they are considering buying, even if a company doesn't sell its products online.

    Considering peoples' high expectations about the information and services available online, it's disturbing to see just how bad commerce web sites are at selling.

    Lets look at a study on consumer buying patterns online as an illustration: From their tests of consumer commerce, researchers from the usability consultancy UIE have discovered that the buying process acts as a sieve, where customers are inadvertently filtered out at each stage of their decision-making process. UIE's studies show that out of 100% of purchase-ready customers completely intent on buying, only 34% will actually make the purchase.


    Studies show that  buying process acts as a sieve, where customers are inadvertently filter out at each stage of their decision-making process.
    At the information search stage, 9% weren't able to find the products they were looking for because they couldn't identify the right product category or find product options. 8% of the shoppers who succeeded in finding products gave up because the product lists didn't provide enough information to identify purchase options, or because they were confused by going back and forth between product lists and product description pages in order to decide if the products would fit their needs.

    UIE's researchers found that the major problems occur when customers want to evaluate alternatives. Only 25% of the shoppers who reached this stage proceeded to the next. Some stopped because they realized none of the products would fit their needs, but most because the product information was so inadequate that they couldn't tell if the products they were interested in satisfied their needs.

    At the purchase stage, 13% dropped out because they didn't want to go through the required registration process or because they where disappointed by poor shipping charge policies.

    UIE also found a surprisingly high amount of problems in the purchase evaluation stage. 11% percent of the shoppers where either so unhappy with a product that they returned it. Some of the shoppers told UIE that they returned a product because it wasn't what they expected, which suggest a failure in setting up the right expectations in the product evaluation stage.

    Knowing the customers' decision-making process

    The most interesting thing about the study is that while they observed critical usability problems because of inadequate or poor information:

    • Customers couldn't identify purchase options
    • Customers couldn't decide if the products would satisfy their needs
    • The product presentations and descriptions raised wrong expectations, which made customers unhappy with their purchases

    Businesses simply fail in supporting the consumer decision-making process by not taking their customers' information needs into account.

    1419520199.01._BO2,204,203,200_PIsitb-dp-500-arrow,TopRight,45,-64_AA240_SH20_SCLZZZZZZZ_V65571311_.jpgRecommended reading: Marketing to women.

    As a Physician, you will have little chance of knowing exactly which information needs patients have when evaluating specific services or treatments. To support the ' decision-making process, you need to understand which needs and concerns they have when making a purchase decision. There will often be patients who unintentionally mislead you by discussing a number of issues that appear to be of equal weight when they really have an overriding concern. You need to recognize how to discern exactly what a patients hierarchy of wants is.

    The most effective way of discerning what is motivating your patients is to ask a number of very specific questions during a consultation. Surface physicians are trained, sometimes through trial and error, to ascertain the specific motivations that brought a patient in so that they can support the patients decision-making process.

    Information search

    The basic prerequisites for patients making their way through the information search stage is that they are able to find services that fit their perceived needs, and that they can easily identify their available options.

    In order to support the decision-making process at this stage, you'll need to know:

    • How will potential patients be inquiring about purchase options?
    • What basic information do patients need in order to identify purchase options?
    • What information do patients need in order to decide which product criteria are important to them?

    Evaluation of alternatives

    The problem with the operations in most clinics is that there's systems in place to effectively solicit this information. We saw above how a large number of customers dropped out at this stage simply because the information provided was inadequate. They couldn't decide whether the products they were interested in would fit their needs. All of your staff (especially the physician) should be acting as a skilled educator, and have answers ready to any question or concern that the customer might have.

    Some of the critical questions that you need answers to are:

    • What information does the patient need when evaluating treatment alternatives?
    • Which product evaluation criteria will customers be using and which are most important?
    • Which concerns will the customers have and how can we address them proactively?
    • How can we encourage patients to maintain contact with the clinic?

    Purchase decision

    At this stage emphasis should be on providing the easiest possible way for patients to carry their purchase through. In the UIE example, we saw how obstructive policies made the process difficult. Patients want an easy way to find out where and how to buy.

    Purchase evaluation

    The outcome of the post-purchase evaluation stage is a level of customer satisfaction or dissatisfaction, which is determined by the customer's overall feelings about the effectiveness of the treatment and the experience.

    The number on effect on patient satisfaction is the management of patient expectations. Most patient dissatisfaction is a consequence of not encouraging accurate customer expectations at the product evaluation stage. In order to avoid this, we have to make sure that the entire system, from initial contact to treatment, sets up the right expectations.

    Designing for customer decision-making

    Once we feel confident about customers' needs and concerns, our next challenge is to decide how to present the information to the customers in a way that supports the decision-making process. This is as much science as art. It is common for physicians to inflate their abilities in this regard. It's been my experience that every physician can benefit from constructive criticism and  training in presentation. Patient feedback to physicians is clouded by the patient/physician relationship. The result is that physicians feel that they are perfect communicators when they are not.


    The decision making process happens in every instance. When confronted with the poor state of customer service and retention in medical clinics, patient are left to choose between providers. At each step of the decision making process, these clinics lose patients because staff never perfectly addressed their perception of what would be a 'perfect solution'.

    Your medical spa staff should  be supporting patients no matter where they are in the decision-making process. They should address their needs and concerns at every point. Understanding the decision-making process, and how specific customers engage with specific needs is a prerequisite for any clinic with an ambition to turn visitors into patients.

    Customer Service Obsession: Love your patients the Amazon way.

     Is obsessive customer service part of your medical practice?

    Amazon is taking a page from Nordstrom's 'heroic customer service' book. Why? Because it's good business. I posted on the oft-induldged stupidity of price wars. One of the differentiators that drives business is customer service. Notice I did not say 'patient care'. Customer service is outside of the medical care you're providing. Customer service is the touchy-feely warm and cozy perceptions that your patients have or don't have.

    From my friend Shmula's blog on Amazon's customer obsession:
    blockquote.gifpushing 300,000 - 600,000 units of product per day through a fulfillment center is no easy task. gratefully, Amazon’s home-grown software and efficient processes help to deal with the immense volume. sometimes, if there are inventory gliches or poor product flow, an activity known in warehousing as “product chasing” occurs. “chasing” is when a product is ordered, but it is nowhere to be found in the (1MMft^2) facility. in reality, it is somewhere, but according to the inventory software the product is supposed to be in its assigned bin, but it has been moved somehow, drifted to another bin, or stolen. this defect is called Inventory Record Defect Rate and is one of the most important metrics at Amazon, and is highly scrutinized and reviewed by Bezos and his senior team.

    customer_lifecycle_experience.gifWhy is it important? because when the front-end Amazon store allows you to order something, the precondition is that the product and the quantity desired is currently in an Amazon facility: the software follows a very complicated algorithm based on network optimization, shortest path techniques, and traveling salesman routing; a check is made against the inventory database — in real time — how many are available, which facility, and how many have been committed already. when the order drops into the assigned facility, the picker goes to the bin where the product is supposed to be, but because IRDR is poor, the item is not there. this situation leads to two following options: (1) go to a local store and buy the item and ship it to the customer or (2) do a “network flip”, where the assigned facility “flips” the order to another facility that has that product. option (2) is ideal, but during the holiday season, it is very difficult to do. during the holidays, option (1) is common.

    doing option (1) is heroic and is a true example of customer obsession at work: it’s not about serving all customers as an aggregate, but it’s about serving one really well, several million times. at Amazon, they really believe this and live this.

    This kind of take-no-prisoners approach to customer service is absent in most clinics I see. You're asking your patients to spend their money inside of your business. Great customer service is your obligation.