Almost all optometry practices are reliant firstly on the revenue generated from the sales of spectacles, closely followed by contact lenses. However, there is little clinical research into the effect of patient communication within optometry practices. Morgan and Efron1 evaluated the impact of a proactive approach to contact lens fitting and showed that practitioner-led discussion on contact lenses resulted in an increase in new fits. It is therefore somewhat surprising the relationship between the consultation and the number and value of spectacle dispenses is yet to be evaluated.
Effective communication skills are considered an essential part of the clinician/patient relationship. Both the College of Optometrists and the General Optical Council emphasize the importance of patient communication in their respective Guidelines and Standards of Practice for Optometrists and Dispensing Opticians.2,3
The authors conducted a clinical study to evaluate the change in conversion rates (CR%) and the average transaction value (ATV) for eye examinations conducted by seven optometrists before and after the introduction of an innovative chairside engagement/education tool.
What do we know so far?
Patient satisfaction, trust and commitment are good predictors of loyalty within optometric practice.
Dillehay5 stated that 85% of patients who defect to other optical service providers were satisfied with the service received just before defecting. As the cost of acquiring new patients has been estimated to be upwards of five times the cost of retaining existing patients,6 identifying factors influencing patient loyalty are essential to growing and maintaining a successful practice. To investigate these factors, Van Vuuren and colleagues7 conducted a questionnaire sampling 357 patients who had visited an optometric practice two or more times over a six-year period. The questionnaire utilised a five-point patient rating scale to determine the role of three independent variables (customer satisfaction, trust and commitment) in relation to customer loyalty.
Multiple regression analysis was used to investigate the relationship between these independent variables and customer loyalty. Their results showed that customer satisfaction, trust and commitment accounted for 76.8% of the variance in patient loyalty. In other words, according to the authors, 76.8% of the positive change in the level of customer loyalty could be interpreted as resulting from increased patient satisfaction, trust and commitment.
The authors7 also investigated which of the variables had the greatest influence on patient loyalty. They found that patient satisfaction had the greatest influence on patient loyalty, followed by trust. In their conclusion, the authors proposed that increasing consultation time could improve patient satisfaction. Furthermore, trust could be increased by better determining the personal needs of patients and training staff to be more knowledgeable on products. Improvement to the third factor, commitment, could be achieved by employing staff skilled in social bonding and adhering to ‘promises’ made – such as the timely delivery of spectacles / contact lenses.
Communication skills affect patient satisfaction with the practice, the clinician and products.
Researchers from Australia have demonstrated that practitioner interpersonal skills can have a significant effect on the influence of patient outcomes and perceptions.4 In a study involving 65 subjects aged between 20 and 24 years, the investigators collected subject questionnaires evaluating motivation, satisfaction and the subjects’ impression of the clinicians’ interpersonal skill after the consultation. The relationships between these aspects were investigated statistically using factor analysis. Their results showed that satisfaction with the optometrist/standard of care had significant correlations with the clinicians’ interpersonal skills – namely empathy (p<0.01), information exchange (p<0.05), willingness to explain (p<0.05), clarity of instructions (p<0.05), and optometrist comfort in the interaction (p<0.05).
Satisfaction with the clinic in general was related to clinicians’ interpersonal skills of empathy (p<0.05), clarity of instructions (p<0.01), and optometrist relaxation (p<0.05). Interestingly, patient satisfaction with their contact lenses (subjects were all neophyte contact lens wearers) was higher when clinicians were perceived to be willing to explain (p<0.01) and provided clear instructions (p<0.05).
The results of the above two studies may be used to create a model for patient loyalty (figure 1). The authors have further added revenue generation to the model as research also indicates that consumer satisfaction, trust and commitment are related to purchase.8
Figure 1: How loyalty and product purchase may be related to patient satisfaction, trust and commitment
A new consulting room tool
Recently, Optimed Ltd (Coventry, UK), launched a new product called CAPTIV8+. According to the developers, the product specifically addresses the needs of the practitioner to intuitively and quickly explain the results of an eye examination. Explaining medical conditions using video animation is useful where such content can be played in a waiting area, website or delivered to the patient electronically, but they are cumbersome in the consulting room for the following reasons:
- Increases consultation time.
- Requires the practitioner to be a ‘presenter’ in that he or she must be able to speak at the speed of the video and follow the video script.
- Requires prior knowledge of the video.
CAPTIV8+ is a fully interactive 3D model of an eye. In addition, disease and surgery can be applied by the clinician, at the pace of the clinician. The digital eye model can therefore be interactively rotated and viewed from angle and zoom level by the clinician. The model includes a vision simulator that assists in creating empathy with the patient. CAPTIV8+ therefore allows the clinician to consolidate the results of an eye examination using visual cues to increase patient understanding (figure 2).
The CAPTIV8+ system also has the facility to email or SMS over 150 pre-scripted animated patient education videos. If required, practitioners can record their own interactions with the model using their own voice and share more personalised content with patients.
Preliminary study
An initial study was carried out to evaluate the effect of CAPTIV8+ consultations on conversion rate (CR) and average dispensing transaction values (ATV). Seven optometrists took part in the study at BBR Optometrists Ltd, Hereford. A total of 94 patients were examined without CAPTIV8+ and 111 patients with CAPTIV8+. The optometrists were trained on the use of CAPTIV8+ before the trial. However, they were not experienced in the use of CAPTIV8+.
CR and ATV were calculated for each optometrist and averaged to determine the overall CR and ATV for all optometrists as follows;
Conversion rate (%)= (Number of dispenses) / (Number of eye examinations) ×100
Average transaction value (£)= (Total dispense value) / (Number of dispenses)
The ATV was determined on the day of the eye examinations. In other words, spectacle dispenses occurring on a day other than the day of the eye examination were not included in the calculation of conversion rate.
Optometrists were asked to conduct pre CAPTIV8+ examinations in the normal manner. The CAPTIV8+ examinations involved summing-up the results of the examination using the 3D model eye program. The optometrists would navigate around the various structures of the eye to demonstrate that the anterior eye, crystalline lens, optic nerve, macula and peripheral retina were examined. Furthermore, patients were shown the vision simulator to transition to a discussion on the patient’s vision and optical prescription. At this point optical recommendations were discussed.
Results
The results are shown in table 1. Average conversion rate increased by 9.84% for the seven optometrists using CAPTIV8+.
Table 1: Results of overall conversion rate and average transaction value for seven optometrists before and after use of CAPTIV8+
Overall, average transaction value for spectacle dispenses increased by £32.82. The large standard deviations for both conversion rate and average transaction values show there was considerable variation within the seven optometrists.
Figure 3: Average conversion rate for seven optometrists with and without CAPTIV8+
The present study evaluated the influence of CAPTIV8+ on ATV and CR for a number of optometrists, statistical analysis was performed using the Mann-Whitney test. Not surprisingly, with the large variance between the optometrists, statistical significance was not reached (p>0.05). Nevertheless, the results show an overall improvement in conversion rate (CR) and average dispensing values (ATV) with and without the use of CAPTIV8+ for the seven optometrists (figures 3 and 4).
Figure 4: Average transaction value of dispenses from eye examinations for seven optometrists with and without CAPTIV8+
Discussion
The results show there is considerable variation between optometrists in terms of conversion rate and average dispensing transaction values. Several factors can influence this such as the number of patients examined by individual optometrists, the opticians dispensing patients, as was as the fact there is an inherent variability between optometrists.
Overall, the study demonstrates that dispensing transaction values and conversion rates for seven optometrists on average increase with the use of CAPTIV8+. However, the difference between the samples was not statistically significant. There are few, if any, publications assessing the relationship between parameters demonstrating revenue generation and the optometrist’s consultation. Anecdotally however, practitioners and business owners are all too aware that a ‘good’ eye examination can lead to increased revenue. Although one may relate this to a discussion between the patient and practitioner on optical recommendations, it is more likely to be based on broader areas of the relationship between the practitioner and patient. Four key areas of practitioner communication have been identified to contributing to patient satisfaction:
- Empathy
- Information exchange
- Willingness to listen
- Clarity of information4
CAPTIV8+ patient engagement tools may help improve various elements of communication that are known to affect patient satisfaction. Thompson et al4 stated that ‘it is a common misconception that clinicians’ interpersonal skills are immutable.’ The addition of CAPTIV8+ consultation tools may help practitioners empathise better, create more consistency in discussing optical recommendations by making the discussion part of the ‘routine’ examination and demonstrate a clear exchange of information about the patient’s eye examination.
In summary, the preliminary study shows that average conversion rate increased by nearly 10% and average dispensing transaction value by more than £32 for a small group of Optometrists using CAPTIV8+ interactive patient communication platform.
Dr Trusit Dave is an independent optometrist based in Coventry and a director of Optimed Ltd. Nick Rumney is an independent optometrist in Hereford where Nickolas Black is a contact lens optician.
Disclosure
Nicholas Rumney and Nick Black have no financial interest in Optimed Ltd, neither are paid consultants. Dr Trusit Dave is a director of Optimed Ltd.
References
1 Morgan, SL, & Efron, N. (1996). The benefits of a proactive approach to contact lens fitting. Journal of the British Contact Lens Association, 19(3), 97–101.
2 College of Optometrists, http://guidance.college-optometrists.org/guidance-contents/communication-partnership-and-teamwork-domain/partnership-with-patients/#open:184.
3 General Optical Council. 2016, Standards of Practice for Optometrists and Dispensing Opticians.
4 Thompson, B, Collins, MJ, & Hearn, G. (1990). Clinician interpersonal communication skills and contact lens wearers’ motivation, satisfaction, and compliance. Optometry and Vision Science.
5 Dillehay, SM. (2006). Ways to improve patient loyalty. Review of Optometry, 143: 8-8.
6 Sujansky, JG & Ferri-Reed, J. 2009. Keeping the Millennials: Why companies are losing billions in turnover to this generation and what to do about it. Hoboken, NJ: John Wiley & Sons.
7 Van Vuuren, T, Roberts-Lombard, M, & van Tonder, E. (2012). Customer satisfaction, trust and commitment as predictors of customer loyalty within an optometric practice environment. Southern African Business Review, 16(3), 81–96.
8 Zboja, JJ, & Voorhees, CM. (2006). The impact of brand trust and satisfaction on retailer repurchase intentions. Journal of Services Marketing. doi.org/10.1108/08876040610691275.
