Building Staff-to-Staff Relationships in Physician Offices that Add New Patients to your Practice

Editor’s Note: This text course is an edited transcript of a Sycle.net live webinar on AudiologyOnline. Download supplemental course materials.

Learning Objectives

• After this course learners will be able to explain concepts of internal marketing and how hearing healthcare practices' staff can either directly or indirectly affect the patient care experience.
• After this course learners will be able to describe the expectations of the referring physician for the hearing healthcare specialist prior, during and post patient referral.
• After this course learners will be able to explain what a "Total Office Call/Strategy" means and how this knowledge can influence the development of long term relationships in physicians offices.

Introduction

Robert Tysoe:  I have spent the last 40 years in physicians’ offices developing relationships with the physicians and staff in a pharmaceutical company marketing role, in a pharmaceutical company management role, training role, and I have also carried the bag.  I have spent the last 11 years in the audiology industry implementing the pharmaceutical company marketing model to primary care physicians with a significant amount of success.  My experience validated the marketing research done by Better Hearing Institute in the early 2000’s.  That research was conducted in order to determine if pharmaceutical company marketing strategies would work in the audiology industry as a way to add new patients to their practice. 

Relationship Marketing

Relationship marketing was first defined as a form of marketing from direct-response marketing campaigns.  This medium emphasizes customer retention and satisfaction rather than a dominant focus on sales transactions.   As a practice, relationship marketing differs from other forms of marketing in that it recognizes the long-term value of customer relationships and extends communication beyond intrusive advertising and sales promotional messages. 

Relationship marketing refers to a long-term arrangement where both the buyer and seller have an interest in a more satisfying exchange.  This approach attempts to transcend the simple purchase exchange process with a customer to make more meaningful contact by providing a holistic, personalized purchase.  It uses the experience to create stronger ties. 

Internal Marketing

Do you focus on internal marketing?  Before we can reach out to primary care doctors and develop these relationships, we have to look at what we are doing internally to prepare our staff to develop relationships with primary care physicians and their staff.  While traditional marketing communications play a small role in creating customer love, marketing is not what marketing people say it is.  Marketing is what customers say it is. 

As far as the customer is concerned, every point of contact with your company or clinic is an opportunity to evaluate you and your services so they can make a decision as to whether they would refer you to a family, friend, or co-worker.  That is marketing.

While every point of contact with customers is a marketing contact, it is easy to see that everyone in your clinic, well beyond the marketing department, affects your marketing.  Everyone is a marketer, even those who never talk directly to customers have an effect on the customer/patient experience.  This influences your reputation and referrals.  

Hearing health care clinics that practice great internal marketing recognize that the most valuable marketing media of all are the people who work inside the clinic.  The best companies focus not only on customers outside the clinic, but also on those within their own four walls.  This means keeping everyone informed when you have a new strategic initiative related to marketing.  When it comes to physician marketing, provide the internal staff with the same information as your external staff who have the responsibility marketing to physicians’ clinics. 

Brand Promise

To practice internal marketing, you need to ask yourself, “What is my brand promise?  Why should customers and patients care about what I do?”  If I phoned your clinic and asked one of your staff, “What does your clinic stand for?” what you say about your clinic in a sentence or two is your brand promise.  Each staff member has to be able to answer that question the same way with the same content.  That comes from a strong internal marketing training program.  How much better would your clinic perform if everyone in the clinic were able to give a clear, compelling, enthusiastic answer? 

Your external market-facing brand can never be better than your internal brand, because it is the people inside your clinic who create the customer experiences that make possible your external brand.  Send your staff to training programs so that they understand the marketing strategies and concepts and have regular business meetings.  I recommend that you have at least a weekly meeting directly related to the marketing strategies that you are trying to implement to grow your practices. The best measure of a strong internal brand is if everyone in your clinic has a shared belief of who you want to be.  This aim will unify your team to create an overall experience of what we call brand harmony for your patients and your customers. 

Internal marketing is hard to do successfully.  However, employees of all job levels are eager to learn what it takes to “Be the Brand,” and once engaged in the process, they will act effectively to reinforce your brand story.  “Be the Brand” is an empowering imperative.  It is an invitation and encouragement, not an order from the boss.  We seek to create a participative, interactive program that engages employees about what they need to do to “Be the Brand.”  This is particularly important when it comes to marketing your clinic and your services to primary care doctors, because that strategy is all about developing brand name recognition and brand name loyalty.  We will talk a little more about loyalty marketing as we go through the program. 

External Marketing

I am frequently asked, “What do doctors want from a hearing health care specialist?”  Recently, Harvard Medical School published an article titled Selecting a Specialist (Choudhry, Liao, & Detsky, 2014).  The specialist type can can be a cardiologist, audiologist or endocrinologist, for example.  This article is for professionals who wants to develop relationships with primary care physicians in the United States, in order to add new patients to their practice. 

Doctors want to know if the audiologist has enough expertise with the problem for which the patient requires consultation.  They want to know about your training, your background, the focus of your practice, and the length of time you have been in practice.  In your conversations, explain where you graduated, what part of your practice has particular focus on patient care, and if other physicians also refer their patients to you.  I recommend that you develop a list of physicians who refer to you, ask for their permission to share that information, and then share that with primary care physicians, specialists, medical assistants, and other members of the medical community.  Social proof does work in this environment.  If other physicians trust their patients with you, then that physician may say, “I can trust my patients with you, too.” 

Characteristics of the Audiologist and Clinic

Physicians are looking for validation that you are the right person for them to refer patients.  Do you have other experiences or have you published research that represents expertise in this particular clinical area?  They also want to know if you are affiliated with a good institution, hospital, ear/nose/throat (ENT) specialist, balance clinic, or other clinicians that you may refer to as necessary when a patient is outside your scope of practice.  Share that information with them so that they know that you are part of the medical community and that you do have specialists who can help take care of that patient when a referral is clinically necessary. 

Can the patient schedule an appointment with the hearing care professional in an appropriate time frame for their needs?  Sudden hearing loss would obviously break into your schedule immediately.  Some doctors want to know how soon patients with chronic hearing loss can get in.  Is your practice location easy to find?  I provide maps to primary care doctors of the location of all the clinics that I represent.  Make it easy for a patient to find their way to your clinic.  If the average age of a first-time wearer of hearing aids in the United States is 69 years of age, then findability becomes very important from an age and competency standpoint. 

Does your clinic accept insurance?  What are the out-of-pocket costs for a consultation and other services?  It is important for them to know about your cost structure and payment options.  Does the hearing care specialist communicate well with patients and their families?  Are they empathetic?  Did they make it easy?  Were they accommodating?  Did they provide quality customer service?  Did they change technology when one technology did not work? 

All of that finds its way back to the primary care physician.  It is something for you to talk about when you are talking to nurses and physicians.  What is the quality and promptness of the audiologist, support staff, and the facilities?  Take a photo of your clinic internally and externally, and a photo of your staff with smiling faces and put those on your clinic brochure.  They need to see that you are a friendly, welcoming place where patients would want to come to get care. 

Do you and your associates have a genuine concern for the well-being of his/her patients?  No matter what kind of day you are having, every single patient who walks in the door can read your body language and they know when you care more about them than about yourself.  Physicians want to know if you are like them.  Are you willing to give up what is good for you so that the patient might prosper? 

Does your practice style match with the expectations of the patient?  Sometimes patients say to a doctor, “I only want to go to a female practitioner,” or, “I do not want to go to a young provider just out of school.”  It is in your best interest to explain to primary care physicians the nature of your staff and your practice, especially if it is a broad-based practice encompassing a span of ages.  Let them know as much about your practice and staff as possible so that you ease the concerns of customers or patients who need to be referred to you. 

Interactions

Interactions between the referring physician and consultant are important.  They want to know how well the specialist will communicate with the referring physician.  I think that this also speaks to when you have findings that are outside your scope of practice.  Do you call or have someone from your clinic hand-carry the patient report to the primary care doctor’s office?  Do you provide electronic communication with the audiogram about your findings and recommendations for care?  As we move more towards electronic medical records, it makes sense for us to develop patient and family histories reports that can be communicated back to the referring physician in an electronic manner.  There are companies in the hearing healthcare industry that provide this service. 

Does the audiologist provide good continuity of care and follow-up communication?  They want to know how long you are going to take care of that patient.  Do you churn out patients, fit them with hearing aids, get the payment, and then turn them out like some people accuse big box retailers of doing, or do you develop a long-term care relationship with them?  Physicians do not know what you do in your practice, and it helps you if you can explain in detail how you develop your care plans.  That is important information because they can relay that to their patients when they are thinking about referring a patient to you. 

Another concern that physicians have is do you have the infrastructure for communication during an emergency or after hours.  People who suffer from sudden hearing loss can have an emotionally traumatic experience.  They want to know if someone can take care of this patient after hours or on the weekends.  What happens if their hearing aids break down on a Sunday and they have to catch a plane on Monday?  Do we have a plan to take care of that patient?  The more likely you are to be able to provide heroic services, the more likely they will be to refer their patients to you. 

Will you, as a provider, return the patient to the referring physician for ongoing care?  It is a legitimate question physicians have.  We should be prepared to answer it.  We should reassure them that the patient will come back to them for ongoing care.  Will the audiologist or hearing instrument specialist refer other patients to the referring physician in return for having referred patients to him or her?  Can you cross-refer?  Will you send patients to me if you have unusual findings?  The answer should always be, “Doctor, may I have some of your business cards?  I will be more than happy to do that.”  It is important to note that groups such as Press Ganey, along with a number of other websites, such as Health Grades and Angie’s List, are working to measure and publicize information about patient satisfaction more systematically.  This is an opportunity for you to do surveys in your own clinic, publicize them, and promote them when you are talking to primary care physicians. 

Building Staff-to-Staff Relationships

Create a List

How do you get started in building staff-to-staff relationships in physicians’ offices?  The first thing is to create a list of primary care doctors who are close to your own practice.  Patients do not like to be referred long distances.  In that list, you want to have physicians who currently refer to you, because you can easily continue that relationship and expand upon the list of patients who should be referred to you.  Keep physicians who are in multiple physicians’ offices on your list, because your time is limited outside of your practice and you want to get the biggest return on your investment.  Call on physicians whose practices are busy and who have a high potential to refer to you. 

Create a primary care physician target list by getting permission from each patient to mail their audiogram to their family doctor.  Now you are health care partners.  It is my belief that the quickest way you can develop a relationship with the primary care physicians in your given area is to make sure that an audiogram with a patient report is sent to every patient’s primary care physician that you see in your practice.  They then understand that you have mutual patients. 

Another good reason for sending that report is to ask for their help in getting a patient into care who might not otherwise do so, particularly if the patient is hearing impaired and is not following the doctor’s orders.   Therein lies a true partnership between you and that primary care physician, working collaboratively to provide the best care possible for the patient. 

Whenever there is an abnormal audiometric result or other findings requiring a further referral, phone the primary care physician immediately, particularly with sudden hearing loss, and explain the results of your evaluation.  As I said before, you are now partners in the comprehensive care of the patient, and your interventional skills may do more than diagnose hearing loss.  Your findings may point to other health issues that the primary physician can diagnose and treat.  The fact that you sent that report to them enhances the likelihood that that patient may get interventional care, and they will thank you for your report being sent to them, especially if you validate it with a clinical research paper. 

Introduce Yourself

Next, you need to send out a letter of introduction expressing your interest in providing quality care for their hearing-impaired patients with a patient-centered approach.  Focus on the needs of their practice and their patients’ needs.  During this conversation, you want to promise to show up with a patient referral folder they can use.  These folders need content that can be used as a sales and marketing tool, as well as a patient referral folder.  The list of documents included should be carefully thought out so that it serves both clinics’ purposes. 

Show Up

Pharmaceutical companies know that the most important thing to do in establishing a relationship with primary care physicians is to show up.  They want you to show up in their offices once a month; not more, not less.

Not only do you have to show up, but you have to show up with commitment and consistency.  Commitment and consistency are a part of integrity.   If you show up at a doctor’s office, do not park right in front.  That is for patients.  If you are waiting in line to see the receptionist and patients walk in behind you, step out of the line and go to the back of the line.  Patient care comes first.  They recognize and appreciate when you do that, and you become more acceptable in their eyes, because you know the rules. 

Be respectful and quiet because people often do not feel well in the doctor’s office.  Ask the receptionist for their rules governing medical industry representatives and follow them.  The more information that you have about how to interact with the office, the more likely you are to be successful in developing a long-term relationship, which allows you to solve their patients’ needs.

Make Contact with Staff

It is okay to ask for a couple of minutes of the staff or doctor’s time.  I recommend that you ask if you can see the medical assistant first.  That is not as big a decision as asking to see the doctor, and you are more likely to have that request granted.  If the request is granted, do not steal their time, as you may not be invited back to the office again.  Be aware that presentations in doctor’s offices are better left short.  A short presentation, in which you are focused on facts and disseminating information, is the best kind of presentation. 

If you are granted an audience with the physician, respect that time and be sure to provide the latest clinical research that validates your request that they use your services related to hearing loss.  Coming from the pharmaceutical industry, I rarely have a conversation with a doctor or nurse unless there is a clinical research paper in my hand about the subject that I want to address that day. 

If I find when I arrive at a doctor’s office that they are busy, I ask the receptionist if it is okay to leave information and attach a personal note to the promotional literature.  The reason I do that is it is more likely to end up on a recipient’s desk.  If it is not read, at least they see the personal note with your brand name, logo, clinic address, et cetera.  They know that you were there and they see your commitment and your consistency.  They are more likely to refer patients to you because of that. 

Always thank the receptionist on your way out of a clinic, because she is the gatekeeper to the people in the back office.  I give them a candy or a packet of ear plugs as a parting gift.  It is your responsibility to let them know that you like them first.  Take the first step and let them know that you like being there.  

Be Consistent

Making consistent contact with each member of the physician’s office staff is just as important as meeting the doctor.  This is called the total office call strategy.  A lot of people say they called on a doctor’s office, but they never got to see the doctor.  They use that as the criteria for determining if developing relationships with that clinic is going to be successful.  In fact, the doctor is the revenue engine, and everyone in that clinic revolves around them trying to keep him or her busy.  The physicians' office staff all wear each other's hats when patient care needs dictate. Everyone can benefit from the information that you bring to them about the practice of audiology and the treatment of your mutual patients. 

You also want to make friends with the office manager because frequently he or she is responsible for employee morale and marketing profitability, and she needs to know that your practice is similar to theirs and you have mutual concerns.

The referral coordinator in a doctor’s office handles insurance and payment plan information.  Any folder that you give to a doctor’s office has to include that information.  About 45% of all the prescriptions that are written in the United States by physicians are never filled.   However, pharmaceutical companies make a very nice living from the 55% of patients who do get their prescriptions filled.  With that, you should know that when they make a referral to your clinic, there will be dropout rate.  You can lower that dropout rate if you do a good job of educating the referral coordinator on how to get a patient from their clinic over to your clinic successfully. 

The referral coordinator is your ally.  Inform them that you do all of the paperwork and that you make access to hearing healthcare easy.  Marketing research in the United States shows that 65% of patients will not get care from a hearing instrument specialist or an audiologist if you do not do the paperwork for them.  A lot of them are not computer-literate and some may not be able to read.  Be sure that you do that paperwork for them. 

I do recommend that you assign a learning champion in each office so they can represent you after you leave.  Usually the receptionist knows which person in a physician’s office has responsibility for interacting with medical industry representatives.  Find out who that person is.  If it is the medical assistant, he or she becomes your best friend.  Direct your communications through him or her and have them disseminate it to the rest of the staff.

I schedule a lunch-and-learn each quarter and present something new, whether I have a new provider, a new product, or a new service.  I believe that developing a strong personal relationship with everyone in a doctor’s office allows them to choose you when they want to refer a patient to you for hearing health care. 

Educate about Audiology

Doctors may have some preconceived ideas about the efficacy of hearing aids.  Some older doctors’ experience with hearing aids may be from their parents, and that old technology will bias them about how the new technology may work.  Offer an in-service on these technological marvels during a lunch and learn.  Explain how new technology will benefit their patients, particularly those technologies that treat tinnitus and hearing loss at the same time. 

Physicians do not have a strong patient care management strategy for patients with tinnitus, but you do.  Bring a demonstration kit, which can be obtained from the manufacturers.  Show them the different colors, sizes, and styles of amplification and tinnitus technology and explain how technology works.  Add in some old technology so they can see how much progress has been made.  They are fascinated by science and they want to learn about it, because it helps them explain and validate the reasons why they are referring a patient to you. 

Physicians may want to provide input where your patients are concerned, especially if the patient does not have a caregiver or a family member to help guide the patient’s decision-making.  If they are referring a patient who may have some early signs of dementia and may not be capable of making a good decision, be sure to let the physician know that when you see that kind of patient that you will be back in touch immediately to let them know your findings and the reasons for your recommendations, as well as to get any input from the physician on how to effectively get that patient into care.  They will appreciate your integrity, and you are more likely to treat the patient because of your better communication. 

I provide patient education brochures that I get from the National Institute of Health (NIH).  They are free and available in English and Spanish.  There are about 50 different brochures that you can get from the NIH, which can be ordered in any quantity.   They are beautifully written, and you can put your own clinic logo and name on them so that you can place them in a physician’s waiting room or in the back office where the medical assistant can use them to educate patients. 

Obtain each physician’s business card for your direct mailing programs.  Provide the physician with the latest clinical research on the deaf and hard-of-hearing patient.  Provide anatomy of the ear posters for patient exam rooms with your logo on them.  Explain other professional skills you may have that may benefit the physician’s practice.  Provide pure-tone screeners with the Patient Type Guide (pdf) for which patients are most susceptible to hearing loss.  Provide professional courtesy discounts where appropriate. 

Make sure that you update the physicians’ office with your business cards.  Make sure that the information about your clinic is in their referral database of specialists.  A bio card is especially important in validating who you are, your background, and your qualifications.  If you provide free screening, provide those certificates in the outer office as well as in the back office.  Have a list of insurance plans that you honor as well.

Physicians’ offices want to know about efficacy, side effects, and cost.  Validate your ability to diagnose, treat, and provide the highest quality of care, and improve patient outcomes.  If you have only five minutes to talk about your services, then I would recommend that you address efficacy first, which is related to your qualifications, professional training, and the technologies that you use. 

Most of us like to be around upbeat, can-do, problem-solving people who are not greedy and have a healthy level of compassion and altruism.  We care more about the patient than the paycheck.  This is not an environment for a greedy sales person.  Building relationships with physicians means taking a consultative approach where you are more focused on their business needs, their patient care needs, and their practice development needs than yours.  This is an environment where they like people who are altruistic.  Smile a lot and exhibit a positive attitude no matter what you find in each clinic.

Do not expect physicians to understand an audiogram.  Physicians may receive a two-hour lecture on the anatomy and physiology of the ear in medical school, but they do not do a rotation through audiology.  Be patient with them and explain your findings, however long that takes.  When you do a lunch-and-learn, you can center it strictly around how to read an audiogram.  In my experience, they appreciate this.  Keep the patient education materials well stocked in the front and back offices, and provide promotional samples.  You cannot give away a technological instrument valued at more than $100 or you are out of compliance with the Food and Drug Administration (FDA).  If you are going to give out any technology, make sure that it does not exceed $100.  If you are going to give out free services, be sure you are in compliance with any contracts you may have in place.

Brand name recognition and brand name loyalty are vital in this marketplace.  Anything that goes into a doctor’s office should have a sticker on it with your name, address, and logo.  When a doctor says they already refer to someone else, respect that.  It is better to say, “The reason I came by today was to bring you some new information that may be appropriate for some of your patients.  Would it be okay if we take a couple of minutes of your time to explain these new products and services?”  It brings them new information and cause them to make a decision about new services or products that may be appropriate for some of their patients. 

Create Goodwill

Volunteer to provide free hearing screenings at local health fairs.  Speak at smoking cessation groups.  Speak at diabetes support groups.  These are all activities that enhance the relationship between you and the primary care physician.  Keep an accurate record of the content of your phone calls, staff names, titles, with whom you spoke, what promises were made, and any follow-up required for the next visit. 

I believe in handwritten thank you cards at every opportunity.  I believe that you should send a thank you card for every patient referral that you get from every primary care doctor every single time.

Literature

There are a couple of books that I like that will help you in building these staff-to-staff relationships.  One is The Power of Nice, by Linda Thaler and Robin Koval (2006).  Nicer folk always finish first in this environment.  This is a soft-sell, patient-centered, long-term marketing approach.  Remember not to burn any bridges, because you have to come back next month, next year, and 10 years from now. 

I also like Influence: The Psychology of Persuasion (Cialdini, 2006).  We seek to influence people to do what is in their healthy best interest, with integrity, as opposed to selling them something that benefits ourselves.  This is not an environment for being manipulative; this is an environment for caring about patients and their needs. 

Communication Strategies

Many people want to know how to communicate with various staff members in the doctor’s office.  The following are communication pathways I suggest using to enhance your messaging: 

1. Email blast.
2. Internal Learning Fairs/Conferences.
3. Learning Websites.
4. Informal Video Testimonials – loop videos.
5. Radio-Style podcasts, conference calls, or webinars with CEUs.
6. PDF Posters/Flyers or brochures with fresh messages.
7. Postcards for each person or physician you wish to reach with a specific message.
8. Build the information into a test, performance planning, annual review, next-visit discussions, et cetera.
9. Leverage intra-organizational social media – highlight and offer an instructor-led training offering/educational resources through intranets/SharePoint/Skype or other internal communication methods.
10. Short videos from your clinic, provider, or opinion leaders about new ideas, resources, updates on patient care strategies, your mission.

The audiologist should be a part of the comprehensive team of caregivers that assists the hearing-impaired patient so that we minimize impairment and maximize function.  Our goal is to “educate to obligate” the primary care providers regarding the premature hearing loss in patients with co-morbid conditions that predispose the patient to an increased risk of hearing loss.

Resources

Finally, these organizations have all validated the increased number of patient referrals when hearing health care providers practice interventional audiology and enter into patient care partnerships with primary care physicians.  The companies include Better Hearing Institute, Sycle.net, hearing aid manufacturers, and major otolaryngology (ENT) groups, especially Johns Hopkins University in Baltimore, Maryland. 

Conclusions

I trust that you have learned some important new reasons and strategies for establishing and perpetuating relationships with primary care physicians and their staff.  Our collaboration with a patient’s medical care home can result in better and more consistent care.  It is worth our effort to cultivate these relationships for the good of our patients.

References

Choudhry, N. K., Liao, J. M., & Detsky, A. S. (2014). Selecting a specialist: Adding evidence to the clinical practice of making referrals. Journal of the American Medical Association, 312(18), 1861-1862. doi: 10.1001/jama.2014.12963.

Cialdini, R. B. (2006). Influence: The psychology of persuasion. New York, NY: William Morrow and Company.

Thaler, L. K., & Koval, R. (2006). The power of nice: How to conquer the business world with kindness.  New York, NY: Doubleday.