This study assessed the telephone skills of 77 refractive surgery practices through mystery shopper phone calls. Calls were scored based on 13 criteria like greeting, discussing pricing, and anticipating caller needs. After interim results, practices improved some skills but struggled with others. Overall scores improved from 49 to 52 points out of 100. While most practices enhanced basic skills, more focus is needed on advanced skills like directing conversations. The study shows telephone training can boost business but requires continuous effort to maintain excellence.

1. Telephone Improvement Project:
A Skills Assessment of Refractive Surgery Providers
Shareef Mahdavi • SM2 Consulting • Pleasanton, CA
In the refractive practice, the “point of entry” for virtually all Introduction
interested LASIK candidates is via an initial telephone call to Success as a refractive surgery provider depends on a strong
the Provider to learn more about refractive surgery services. blend of clinical skill as well as business expertise. As an emerg-
Given the significance of the telephone as a tool to convert ing consumer category, refractive surgery is a hybrid of medical
interest in LASIK into the next step in the consumer decision and retail consumer behavior. The telephone serves as a key tool
process, SM2 Consulting conducted a study designed to in helping consumers move from interest in refractive surgery
quantify the level of skill employed in answering phone towards active consideration of a procedure for themselves.
inquiries from prospective LASIK patients, with the goal of SM2 Consulting was engaged by CareCredit to create a
helping practices improve conversion rates. Telephone Improvement Project (TIP) that would accomplish 3
A survey tool assessing 13 aspects of a telephone call objectives:
was developed and tested for validity prior to the study. 1. Independently assess and measure the current abilities and
Enrollment was conducted by Practice Development skills by refractive practices in answering phone inquiries.
Managers of CareCredit (Costa Mesa, CA), with 77 practices
2. Provide feedback to practices that allows them to improve
recruited to participate, both geographically and by procedure
upon current skill levels.
volume. All phone calls were recorded and graded, and results
have been provided to the participating LASIK practices. 3. Create a survey tool that can be used repeatedly to gauge
A total of 10 different calls were made at varying times of improvement at both the practice level and as an industry.
the day and week to eliminate bias. At the halfway point, an
interim analysis was done and results from these calls Methodology
(“Round 1”) were presented to each practice by CareCredit A survey tool was developed that covers 13 aspects of a
representatives, followed by recommendations for improve- phone call between a potential refractive patient and a refractive
ment in telephone skills. Several months later, an additional counselor. The topics cover virtually every aspect of a phone call,
round of calls was made (“Round 2”) and the practices were from the initial greeting when the phone is first answered all the
given these results and a comparison between the first and way through the skill at closing the phone call (see Table 1).
second set of calls. This survey tool was reviewed by an independent group of
Two-thirds of the practices saw an improvement in their ophthalmic administrators and validated in a pilot study of 6
scores in Round 2. A significantly higher percentage of calls centers from around the country.
were answered by a “live” person vs. being put to voicemail,
and while gains were made in ability to discuss procedure Table 1: Survey Tool
pricing and financing, practices continue to struggle in their Initial greeting Review of procedure pricing
ability to direct the conversation and anticipate caller needs.
EVALUATION CRITERIA
Time to reach a counselor Review of financing options
Only 3 in 10 practices had call scores that would be consid- Control of the conversation Technology and benefits
ered “good” using the scale in this study. Qualifying interest Practice Differentiation
The study demonstrates that with attention and focus, Knowledge of LASIK basics Call to action
refractive practices can improve their telephone skills. There How well did the counselor anticipate needs?
is still great need for an increased emphasis on telephone Did they ask how you heard about the practice?
skills training and an ongoing effort to measure and monitor Did they offer additional resources to learn more?
quality of the interaction between phone counselors and Score 1 2 3 4 5
INITIAL GREETING
Poor Good Excellent
those inquiring about LASIK. The payback on such invest- • Pleasant, not
How was the • Lack of • Pleasant but
rushed
ment is immediate, as better phone skills translate into greeting by
the person
warmth or
friendliness
rushed
• Answers with
practice and
higher percentages of inquirers moving forward to consulta- answering
the phone? • Generic • Answers with own name
identification practice name
tion and LASIK surgery. • Helpful
1

2. A total of 77 centers were recruited to participate, with Data Collection and Scoring
national representation by geography as well as average A total of 77 practices participated in Round 1, and 50 of
monthly LASIK procedure volume. All centers signed an these practices also participated in Round 2 (the additional 27
informed consent agreeing to have the calls recorded. practices were recruited after the cutoff date for full participa-
Phone calls were made by employees of OptiCall (Sarasota, tion). A total 508 completed phone calls from both rounds
FL), a specialty call center that provides call coverage for were used in the analysis of the results. In Round 2, 5 of the 50
refractive practices. Their employees are professionally trained centers were satellite locations whose phone answering proto-
and skilled in handling incoming calls from interested patients cols prevented completion of the attempted calls.
and are thus well suited to playing the role as a mystery shop- Once each of the 13 topics were scored, the entire call was
per posing as an interested LASIK candidate. graded using a weighted index totaling 100 possible points.
Each of the 13 topics was graded on a 1 (poor) to 5 (excel- Raw scores for each topic were converted, with more weight
lent) scale. Specific criteria were used to define a score of 1, 3, given to topics 6 through 10 and the highest weight given to
or 5, with a 3 considered “good” for purposes of this study. A topic 11 (anticipating the needs of the caller). A total score for
score of 2 or 4 could be given when the caller believed that the each call was given, and the average among the five calls in each
score fell in between the defined criteria. An example of the cri- round was calculated to give the practice an average call score.
teria can be seen at the bottom of Table 1. For the weighted index, scoring at least 57 out of 100 possi-
A total of 10 separate phone calls were attempted for each ble points would be considered the benchmark for a good score
participating practice in the study. Calls were scheduled to be on the call.
made at different times of the day and the week to eliminate
Results and Operational Significance
bias. Additionally, the length of call and comments regarding
the call were noted on the data collection form. Calls Answered “Live” vs. Voicemail
If a call was put to voicemail or if the caller were put on In Round 1, 72% of the 419 calls were answered by a live
hold for more than 3 minutes, the call was discontinued. If person while 24% went to voicemail. 3% of the time, callers
either of these events occurred 3 consecutive times, then the call were put on hold for longer than 3 minutes and the call was ter-
was considered incomplete. minated by the caller. Following the
At the midpoint in the study, an Figure 1: Percentage of Completed Calls interim report, results for Round 2
interim analysis of the data was com- improved significantly to a level of
Voicemail
pleted (called “Round 1”) for each 92% of the 225 calls were answered
Completed Call On Hold > 3 mins
practice. CareCredit Practice live and less than 10% went to voice-
100
Development Managers met with the 90
mail or were put on hold for an
physician and practice administrator to 80 extended duration. (See Figure 1).
discuss the interim results, which 70 The importance of having a live
included scores for all the calls, com- 60 person answering a call is based on call
parison to study averages, and audio 50 behavior exhibited by consumers look-
recordings of each phone call. 40 72% 92% ing into refractive surgery. Typically, a
Recommendations and resources for 30 consumer will get contact information
20
improvement on each of the 13 for 2 to 3 providers in their area. They
10
assessed topics were provided, and the will call the first on their list and, if put
0
practice typically held a staff training Round 1 Round 2 to voicemail, will either leave a mes-
session to address specific issues identi- sage or plan to call back later.
fied in the interim report. However, the caller will not wait for a return call from a coun-
Several months later, a follow-up series of calls were made selor at practice #1 before contacting practice #2 and/or practice
(called “Round 2”) using the same criteria as in Round 1. Data #3. Their tendency is to continue calling until they find someone
from these calls were also provided to each practice, allowing to talk to who can answer their questions. For that first practice,
them to compare the two rounds of calls and determine areas the voicemail system has a strong possibility of resulting in a
that had improved and/or that need continued attention. lost candidate. Regardless of the root cause (impatience, fear,
etc.), this scenario underscores the value of having live people
2

3. available to speak to candidates, especially at the point in time next step are foundational to a successful phone call. However,
when the consumer overcomes fear sufficiently to pick up the the more advanced skills that are required to direct the flow of
phone call and inquire. the conversation and to be able to anticipate questions/concerns
were shown to be lacking and actually declined as measured in
Specific Topics Addressed on Each Phone Call this study.
The 13 topics measured during each completed phone call Topic 12 (see Figure 4) provides a good example of the need
are comprehensive in nature and designed to uncover strengths for continuous rigor in the area of telephone skills. It measures
and weaknesses during a typical telephone encounter between the frequency with which phone counselors asked callers how
an inquiring LASIK candidate and a counselor. Using a 1 to 5 they had heard about the practice. Overall, this occurred 32%
scale with specific grading criteria, average scores across all of the time in Round 1, improving to 38% of calls in Round 2.
completed phone calls are shown in Figure 2. While this improvement is good, it is still insufficient. Given that
At the completion of Round 1 and Round 2, only 3 of 13 a key element of marketing is to understand the source of cus-
topics measured generated an average score of 3 or above (con- tomers, this question should be asked 100% of the time.
sidered “good” for this study). Warmth of greeting and time to
reach a counselor both scored in the good range after Round 1 Figure 3: Change in Average Scores by Topic
(Round 2 minus Round 1)
and Round 2.
As shown in Figure 3, the change in scores between Round 1
IMPROVEMENT
Anticipate Needs
Call to Action
and Round 2 allows us to quantify the impact of the feedback
Differentiation of Practice
DECLINE
process with each practice. Overall, 7 of the 13 topics showed Technology
improvement, 4 stayed the same, and 4 declined in average Financing
score. Significant gains were made in the ability to discuss price Price
Basics
(0.9 point improvement), the ability to qualify the level of inter-
Qualify Interest
est of the caller (0.4 point improvement) and and discussing a Control of Call
next step “call to action” (0.3 point improvement). Time to Reach
Warmth of Greeting
Conversely, declines were seen in two critical areas: ability to
-0.5 0 0.5 1
control and direct the conversation (0.3 point decline) and the
ability of the caller to anticipate caller needs and proactively Monitoring the source of phone calls is the type of data needed
raise questions to the caller (0.3 point decline). to objectively assess the value of advertising, public relations,
The ability to successfully conduct an initial phone call from direct-mail campaigns, and any other areas where money is
a prospective LASIK patient can make all the difference between being spent to get the phone to ring. Even for those practices
scheduling and not scheduling a consultation. The improvement that don’t spend significantly on external marketing, it is critical
across most of the topics between the two rounds is indicative to understand where (potential) customers are coming from
of the desire for practices to handle these calls better. The skill when they call. This will allow the practice to put more focus
at which counselors can discuss pricing/financing, ask questions and attention on the aspects of internal marketing that are
to qualify interest, and bring the call to a close by suggesting a working and eliminate those that are not.
Figure 2: Average Scores by Topic Total Call Scores and National Averages
Anticipate Needs
Once graded, the 13 topics were converted into a
Round 1
Call to Action weighted and indexed total call score with 100 possible
Round 2
Differentiation of Practice points. Scores for each of the completed calls were aver-
Technology
aged to come up with an average call score for each
Financing
Price practice for both Round 1 and Round 2. Average call
Basics scores in Round 2 ranged from a high of 85 to a low of
Qualify Interest
31. The mean score for Round 1 was 49.0 and for
Control of Call
Time to Reach Round 2 was 52.4.
Warmth of Greeting When comparing Round 2 to Round 1, there was a
0 1 2 3 4 5 7% improvement in the mean score. Of the 45 practices
3

4. Figure 4: Was the caller asked, phone counselor) and lack of resources (eg, time to conduct staff
“How did you hear about our practice?” training) negatively impacted their scores.
100%
Conclusions
No No
68% 62%
1. Using a scoring tool over a large sample of telephone
50%
calls, we are able to objectively measure telephone skills and
provide feedback to refractive surgery providers as a means of
improving their business operations.
Yes Yes
32% 38% 2. While significant improvements were made in several of
0%
Round 1 Round 2 the basic areas (price, call-to-action), more focus and attention
are needed to achieve good scores in more advanced skills (con-
with valid data for Round 2, over two-thirds (n=28) improved trolling the discussion, anticipating needs).
their average call score while the remaining practices (n=17) got
3. Improved telephone skills is the single greatest point of
lower scores in Round 2 vs. Round 1. At the conclusion of
leverage to improving business results. The 7% improvement in
Round 2, 33% of practices had scores which exceeded the
Round 2 would likely translate into 5-10 more procedures each
“good” benchmark of 57 total points. This compares with only
month in a practice receiving 100 inquiries per month.
24% of the practices achieving this benchmark in Round 1.
This overall improvement can be seen in Figure 5, which 4. Achieving and maintaining excellence in telephone skills
shows the shift in distribution of average call scores for partici- requires dedication and continuous improvement. It is not a
pating practices. In Round 2, there are a higher percentage of one-time training session or event.
practices in the 51-60 and 61-70 ranges, and a lower percentage
in all the ranges below 40 points. Discussion
TIP was the first national study of its kind in refractive sur-
Figure 5: Distribution of Practices by Average gery. TIP addresses an area of the refractive practice that is often
Call Score (100 points possible) assumed by providers to be fully operational and in control.
50% Data collected from these two rounds of phone calls suggest
Round 1 Round 2 Average Score Round 1 = 49.0
Average Score Round 2 = 52.4
otherwise.
40%
“Good” benchmark = 57 It is encouraging to see that the majority of participants took
the feedback seriously and put mechanisms into place to improve
Percent of Practices
50 Participating Practices
30% the way they handle incoming calls from first-time inquirers into
LASIK. Prior to this study, the feedback loop was “quiet,” mean-
20%
ing that practices didn’t have visibility as to why prospective
patients fail to move forward in the decision process. The TIP
10%
Study creates a feedback loop so that practices can learn via
more objective feedback and compare their performance against
0%
21-30
points
31-40
points
41-50
points
51-60
points
61-70
points
71-80
points
81-90
points
91-100
points a group of their peers from around the country.
Range of Average Call Score
As a young but emerging industry, refractive surgery needs
more of these types of studies to give providers the knowledge
Four of the practices improved their average call score by and tools to improve the business side of the ledger as a comple-
more than 20 points, and 13 of 50 improved by more than 10 ment to all the gains made in outcomes through better technol-
points. Another 11 practices improved by up to 10 points. ogy and surgical technique. It is our hope that TIP and similar
By being able to measure and deliver feedback on phone studies and programs will become commonplace in the coming
skills, the majority of participating practices were able to months and years, and that these efforts will help providers
improve their effectiveness over the telephone. Practices that greatly expand demand for refractive surgery by placing much
didn’t improve reported that staff turnover (ie, losing the key greater emphasis on the non-surgical aspects of the procedure.
© Copyright 2006, SM2 Consulting. All rights reserved. 4