Worldwide medical and scientific journal for animal health professionals

Issue number 1 Marketing & Sales

The importance of the pet owner experience

Published 05/05/2021

Written by Philippe Baralon , Antje Blättner , Pere Mercader and Susie Samuel

Also available in Français , Deutsch , Italiano and Español

Vet practitioners are often not aware of their environment. They never stay in the waiting room of their practice for long. They sometimes even enter the practice through a different door than the one used by their clients. A bad pet owner experience is a matter of small detail but it is proven that it has a huge impact on the efficacy of the clinic. This chapter will also explain the concept of Net Promoter Score which is very useful to assess your clients’ satisfaction. Research based on the Net Promoter Score methodology shows how positive client experience results in higher revenue and improved profitability.

© Shutterstock

Key points

Every practice loses clients, but the amount of loss makes the difference between profitable and not profitable clinics. 


The NPS or Net Promotion Score is the best way to measure client satisfaction.


Negative or positive impact of client feedbacks and Internet review on your own staff should not be underestimated.


Self-assessment: find the 15 errors

Below is the story of a client that could have happened in your practice. Read it carefully and identify the “errors” made by the practice.

“On Thursday, shortly after 19:30, Marianne could hear Vicky meowing softly in her box in her car on her way back home. 

It had all started on Tuesday evening. Marianne was surprised that her young kitty was not trying to get her attention and her usual routine of strokes on coming home around 19:00; Vicky stayed in her corner. Preoccupied with finishing an assignment, Marianne was not worried right away, as Vicky could be rather independent. On Wednesday morning, Vicky had hardly touched her kibbles and Marianne decided to call the vet to set up an appointment with Dr. Samson.

After 6 or 7 rings, Marianne finally got somebody answering the phone (Figure 1) and Marianne was able to explain what was going on with her pet and to request an appointment for that evening, preferably after 18:00. She would leave work earlier, avoid rush hour, get home in about 45 minutes, pick up Vicky and, in about fifteen minutes, would have arrived at the clinic. The first person she spoke to explained that Dr. Samson was not in on Wednesday and that the late afternoon consults were completely booked. Why not come the next day, Thursday, a spot being available at 17:00 (but not with Dr. Samson). Marianne insisted on having an appointment the same day, or on Thursday but later in the late afternoon, but this was impossible, she eventually accepted the appointment Thursday at 17:00. On Wednesday night, Vicky’s condition had not really deteriorated, but she still had hardly eaten and remained in her corner. At least, Marianne had had time to arrange a half a day off on Thursday afternoon to drive her cat to the vet.

Figure 1. After 6 or 7 rings, Marianne finally got somebody answering the phone. © Shutterstock

Arriving in front of the clinic on Thursday at 16:45, Marianne was surprised to see that the car park was full. She had had to find a parking spot on a neighbouring street, which is never easy in that neighbourhood. After five minutes of unsuccessful searching, she decided to park in a public car park 700 metres away. After coming up from the second underground level and walking quickly to the clinic, she arrived at 17:10. Welcomed by a smiling and caring person, she was directed to the waiting area. There were only two free chairs, and Marianne chose the one farther from the big dog that was a little too interested in the box in which Vicky was curled up (Figure 2).

Figure 2. The waiting room was nearly full. Marianne chose one chair farther from the big dog. © Shutterstock

Around 17:35, Marianne started trying to get the attention of the receptionist. First she was busy responding to the telephone — obviously someone was asking for a very detailed update of a hospitalised dog — before welcoming another person and finally settling the bill for a client coming out of one of the consultation rooms. Around 17:45, the receptionist met Marianne’s questioning look and waved to her that it would not be long. It was around 18:10 pm that Marianne was invited to go to the consultation room number 3 where a young vet whom she did not know tersely welcomed her.

After a few minutes of reviewing the case history, the young vet began to examine Vicky, while asking some questions. She strongly suggested “for next time”, not to wait to bring Vicky to the clinic, “because two days lost before receiving proper treatment can make a difference”. Marianne tried to explain the difficulty in making an appointment and all she had had to do to be able to come that evening, but the vet had already dived back into the examination and the client judged it would be better not to bother her any further. The young vet explained that she suspected a urinary tract infection and that she proposed to take Vicky to the treatment room for a few moments to carry out a “cystocentesis” in order to carry out a urinalysis and a blood test for a “6-point, biochemical profiling”. Marianne agreed although she did not know what “cystocentesis” and “6-point, biochemical profiling” covered exactly.

After another 15 minutes in the waiting room, the client was invited back to the consultation room where she found Vicky. The cheery young vet explained that the urine analysis had confirmed the diagnosis of urinary tract infection and that she had immediately given the cat an antibiotic injection, adding that “things should go back to normal within two to four days” and that in the meantime “it was important that Vicky drink a lot”. She advised that the receptionist would take care of giving her the necessary treatment and Marianne realised that it was time to take her leave. After saying “goodbye” to the vet who already welcomed a client and her German shepherd, it was around 18:55 that Marianne headed back to the reception. As soon as she had hung up, the receptionist, still charming, explained the treatment to be given to Vicky: one tablet morning and evening for 7 days.

“Tablets?” Marianne replied, “but I have so much difficulty getting Vicky to swallow it. It’s a fight every time.” The receptionist explained that it was a pity that she did not report this point to the vet who could have opted for long-acting injectable treatment and avoided the use of tablets. She continued, “You know, it’s not so hard to give tablets to a cat and with a little patience, you always get there.” In conclusion, she gave the client an illustrated sheet with various drawing showing how to administer a tablet to an animal (in this case, a Poodle).

Then she announced the price to be paid: €177. Frankly surprised, Marianne expressed her dismay over the gap between the price of the consultation, €42, and the total amount of €177 (Figure 3). Calmly, and still smiling, the receptionist explained the breakdown of the costs. “The consultation at €42, the cystocentesis at €20, the urinalysis at €23, the blood sampling at €11 and the s6-point biochemical profiling at €38, one antibiotic injection for €13 and 14 tablets at €30 come to a total of €177.” Essentially, the bill was right.

 

Figure  3. Marianne was astonished to have to pay such a big amount of money. © Shutterstock

While handing over her credit card, Marianne asked the receptionist about the blood biochemistry test at €38 (excluding the blood sampling): “I understood the reason for the urine analysis, since that is what confirmed the diagnosis, but for biochemistry test, I did not hear about any results...” Without dropping her smile, the reception reassured her, “If the vet didn’t mention the results to you, then it probably means that everything is normal and compatible with a urinary tract infection. Any other questions?” At this point, Marianne thought it would be better not to pose any more questions, settled her account, grabbed the cat carrier housing Vicky and the packet containing the pills and the prescription, before heading out to the parking lot to fetch her car around 19:25."

What do you think of Marianne’s experience? Vicky probably benefited from an exact and well-founded diagnosis and subsequently received adapted and effective care. Medically, everything went well and that is obviously the point of it all. But is Marianne satisfied? Is she going to recommend the clinic to a friend or neighbour? This is not likely, because a large number of errors and shortcomings prevented an optimal experience for this client. Did you spot them all? (Box 1). Would they have happened at your clinic?
 
Box 1
 The 15 errors that damaged Marianne’s experience
1.  Marianne has to wait for 6 or 7 rings before somebody answers the phone.
2. The clinic is not very flexible to arrange an appointment at a convenient time slot.
3. The car park is too small or, maybe, busy with cars from staff members.
4. There is no area specifically designated for cat owners in the waiting room. 
5. Marianne has to wait for 35 minutes without any explanation about the reason of this delay.
6.  Marianne finally enters the consultation room one hour after her arrival in the clinic, that is to say exactly at the time when she initially wanted to have an appointment.
7. The vet takes a history and conducts Vicky’s physical exam at the same time, probably to save time, but as a result, she is not fully concentrating on Marianne’s answers.
8. The vet explains to Marianne she brought Vicky in too late after the onset of the condition despite the clinic was not able to offer an appointment the day before.
9. The vet does not explain what a cystocentesis, or a “6-points biochemical profiling” is.
10. The end of the consultation is very quick, Marianne is not asked by the vet if she has any questions, the next client and his pet are already entering the examination room.
11. The vet didn’t discuss with Marianne the issue of giving tablets twice a day to Vicky, although it might be difficult to administer them considering Vicky is a cat.
12. It’s a good idea to provide the pet owner with a leaflet explaining how to give tablets to a pet, but it would be more efficient to have a leaflet dedicated to cats.
13. The receptionist announces the total price without any explanation about the different billed items.
14. When Marianne requests an explanation about the bill, the receptionist gives comprehensive information, but only verbally and does not provide her client with a printed detailed bill.
15. The vet didn’t provide Marianne with any written results or even oral comments concerning the blood biochemistry, so she does not know the results and the contribution to the diagnosis when she has to pay €49 for the blood sampling and test.

 
Economic impact

Study on patient churn

Figures for client churn rates in veterinary clinics are devastating. In a study performed by VMS (Veterinary Management Studies) in Spain, they analysed the transactions carried out by over 515,090 patients from 485 veterinary clinics of different types and geographic locations over five years (2012 to 2016).

1. Methodology

For each of these patients, 5 possible “statuses” were defined according to their economic relationship with the clinic each year:

  • New active patient: when an economic transaction took place with the patient for the first time that year.
  • Recurrent active patient: when an economic transaction took place with the patient during that year and when, during the immediately preceding year, economic transactions had already taken place with the patient.
  • Recovered active patient: when an economic transaction took place with the patient during that year and when, during the immediately preceding year, no economic transactions took place with the patient, but transactions had taken place with the same patient in previous years.
  • Lost patient: patient who, in the current year, did not make economic transactions with the clinic, but who had made at least one transaction with the clinic in the previous year.
  • Active deceased patient: patient who, either in the previous year or in the current year has made a economic transaction with the clinic but dies during the current year.

2. Result n°1: Practices lose 50% of their patients every year.


The surprising results of these large data set analysis are summarised in Table 1.
 
Table 1. Patient flow analysis.
   2013  2014  2015  2016
 New patients  50.5%  47.2%  47.7%  45.1%
 Recovered patients  6.8%  7.6%  8.5%  8.6%
 Lost patients  50.0%  49.9%  49.4%  50.5%
 Deceased patients  7.6%  7.3%  6.8%  6.4%
 Net flow  -0.3%  -2.5%  0.0%  -3.3%

It should be noted that what we define as a “lost patient” does not necessarily mean a “defection”. In fact, experience tells us that many of these patients have not gone to other veterinary centres, but are merely in a sort of latency period (John Sheridan, an expert practice management consultant, refers to them as “lapsed patients”): they are peacefully at home without their owners perceiving the need to attend their clinic until something happens to justify a visit. Several of these patients end up returning to the clinic after two or three years, but others do not…

Many veterinary centre owners express their disbelief and even anger seeing these figures, but the experience of specialist consultants and a few rigorous quantitative analyses that have been carried out on this issue reveal that, each year, there are a substantial number of patients that do not return to the clinic on a regular basis.

3. Result n°2: lost patients vary from 35 to 75%

In this same VMS (Veterinary Management Studies) study, the percentage of patient defection was measured at an individual clinic level in 2015 for the 485 veterinary centres analysed. The aim was to measure whether the issue of defection was similar in all clinics or whether there were very notable impact. Table 2 summarised the results obtained:

  • The difference between the clinics that better retained their patients and those that did not (quartile 1 vs. quartile 3 of the distribution of patient defection data) revealed a difference of 40 percentage points (35,5 vs. 75.5% loss of patients).
  • If we take, for example, a centre with 2,000 active patients and €500,000 annual turnover (€250 per patient per year), this difference between “doing it right (best 25% of clinics) or doing it wrong (worse 25% of clinics)” translates into an incremental loss of 800 patients and a negative impact on annual income of €200,000.
  • For a centre of this size, an impact on income of this kind can mean the difference between being profitable or not, or between having a precarious versus a healthy profitability.

Table 2. Patient defection analysis.
 % patients lost per year  
 Best 25% clinics  35,5%
 Median  47,5%
 Worse 25% clinics  75,5%
   
 For a 2000-pet clinic  2000
 Spending per year  250
 Cost of low quality (in additional lost patients)  800
 Cost in euros per year  200.000

 

Net Promoter Score (NPS)

Empirical evidence shows that client satisfaction translates into higher retention and growth rates. In the last 15 years, the NPS (Net Promoter Score) has become a standard for measuring client satisfaction for many companies in various industries. Developed by Professor Frederick F. Reichheld of Harvard Business School, this methodology is based on a single question to a company’s clients: “How likely is it that you would recommend our company (clinic) to a friend?”

The answers are then grouped on a scale from 0 (unlikely) to 10 (definitely) according to the following scheme:

  • Answers with scores from 0 to 6 are considered “detractors” of the company.
  • Answers with scores from 7-8 are considered neutral.
  • Answers with scores from 9-10 are considered promoters of the company.
  • The NPS involves calculating the percentage of promoters minus that of detractors and monitoring it over time.

It is important to be aware that there may be cultural differences among countries which may affect the usability of the 0-10 scale.

Professor Reichheld showed, in various studies, that there was a positive correlation between companies that obtained better NPS metrics and those that obtained better sustained income growth over time. This correlation was demonstrated in industries such as airlines, Internet service providers and car hire rental companies.

It is critical to invest in improving the overall experience at the veterinary clinic: good medicine is not enough. Except in special cases, such as in referral centres, the business model for most veterinary clinics is based on generating a bond with the client, which translates into regular visits to the centre. Good medicine is necessary, but an insufficient measure of performance. Our clients want to find us easily, park securely, not wait long, be in a pleasant environment, contact us easily by telephone when they need to, feel recognised and respected, know how much and why our services will cost the amount they are quoted… in short, they want a full client experience that confirms to them that they made the right decision to choose us. Regrettably, many veterinary centre owners have a different set of priorities when it comes to setting their clinic’s medical standards or when it comes to considering these other issues that they sometimes consider to be “non-priority or more commercial in nature”.
Philippe Baralon

The business model for most veterinary clinics is based on generating a bond with the client

Philippe Baralon

Emotional impact

Internet reviews

We will now look at three real-life comments extracted from online reviews by clients who were unhappy with their veterinary clinic (All the comments below are genuine. Only the pet owners’ names were changed).

👎 Mr Jason Burn: Very poor now. Money is only concern it seems. Never see same vet twice and no time given for information. Even requests for medication repeats and advice is not done correctly. Not confident anymore they have time to deal with my animal.

👎 Mrs Julie O’Smith: Absolutely disgraceful display of ‘client service’ at XXXX this morning, which saw my cat left in his basket for over an hour, an impromptu Kangaroo court called in a consulting room, during which it was strongly inferred that I was a liar and where an insincere apology was offered as a last resort. All this from a comment in which I suggested it might be courteous to communicate to your clients if you are running 40 minutes late and why so that they are prepared and accepting, rather than endlessly walk past them discussing staff birthdays and cups of tea. Oh, and supposedly on their clock I was 5 minutes late and therefore didn’t deserve to be communicated with. So dreadful, it’s almost surreal. One-star rating, only because it is not possible to leave a zero-star rating.

👎Mr Bernard Shaw: I am very disappointed with the total lack of care for my pet, and a total lack of respect for my pet and myself.

Now, we will look at three examples of clients who were very satisfied and their comments on the Internet.

👍 Mr Oliver Smith: I have always received the highest standard of service and genuine, caring attention over the past 18 years. The reception staff, nurses and vets couldn’t have been nicer to myself and more importantly to my cats. The separated waiting area for dogs and cats is excellent making the visit much less stressful all round... I have nothing but praise for this practice.

👍 Ms Anne Durrell: Andy has looked after our two cats for over ten years. His staff are always friendly and helpful. You only ever see Andy or Lizzie — so you do get continuity of care. We took both cats in for their annual inoculations and Andy thoroughly examined both cats. Rosie was found to have lost weight and a blood sample taken. Andy has diagnosed a thyroid problem. This problem was only detected by his professionalism. I wouldn’t go anywhere else.

👍 Mr Bertram Shakespeare: I love this practice for my cats. They always make me feel welcome and put the cats first. I would never use another practice.

Most vets are aware of the growing impact that these opinions on social networks have on the reputation of their business. There are an increasing number of clients who, before choosing a veterinary centre, browse the Internet and check other pet owners’ comments.

How client experience impact the staff

However, these opinions also have a significant — and usually less understood — influence on another type of client, the so-called internal client: our own team. The vast majority of our team (both veterinarians and support staff) have a significant vocational component in their work and are emotionally involved in their professional activity (Figure 4). They like to feel that they are doing a good job, that they bring value to their patients and clients and that they work in a veterinary centre that is positively recognised in society. Due to all of this, it is easy to understand that our team is neither immune nor unaffected by permanent public judgement on social networks, etc.

Figure 4. The veterinary team are often emotionally involved in their work. They can be affected by public judgement on social networks. © Shutterstock

Throughout his or her career, a veterinarian may have over 50,000 personal interactions with clients. Various studies carried out with veterinarians show that conflicts with clients (due to money issues, communication issues, difference of opinion with respect to treatments, etc.) are the main source of stress and job dissatisfaction.

If we take a closer look at the client complaints shown at the beginning of this section, we can surely agree that neither the vets nor support staff at those clinics had any intention of disrespecting or misleading their clients or patients, but, for some reason, that was their clients’ perception. In a professional service activity such as a veterinary medicine (heavily based on personal interaction between the client and the professional), it is essential to define quality standards for various processes, in order to achieve the most uniform and satisfactory client experience possible.

Some authors 1 propose that the best strategy to achieve a good external client experience is to ensure that internal clients (our employees) also have a good experience in their daily business. Well-designed processes, functional, pleasant and well-sized facilities, technology designed to support the business processes (and not vice versa), collaborative environment that encourages learning, etc. All these factors would undoubtedly help to make our clinic a good place to work in and would consequently help our teams to transmit these good vibes to our clients. As the saying goes, “Charity begins at home”; the same applies to client service.


Conclusion

 Offering pet owners the best experience in your practice will have positive effects. It will induce positive word of mouth recommendations about your practice. It will motivate your team thanks to the enthusiastic feedback from the clients. Finally, it will ensure the economic future of your practice.
 

References

  1. McKinsey & Company, May 2017, When the customer experience starts at home by Sylvie Bardaune, Sébastien Lacroix, and Nicolas Maechler.
Philippe Baralon

Philippe Baralon

Dr. Baralon graduated from the École Nationale Vétérinaire of Toulouse, France in 1984 and went on to study Economics (Master of Economics, Toulouse, 1985) Read more

Antje Blättner

Antje Blättner

Dr. Blättner studied in Berlin and Munich and after graduating in 1988 she set up and ran her own small animal practice. Read more

Pere Mercader

Pere Mercader

Dr. Mercader established himself as a practice management consultant to veterinary clinics in 2001 and since then has developed this role in Spain, Portugal Read more

Susie Samuel

Susie Samuel

Dr. Samuel graduated from Cambridge University in 2001 and spent ten years working in both mixed and small animal practices. Read more

Other articles in this issue

Issue number 1 Published 10/05/2021

How to offer a great experience - Part 1

Based on studies on a human hospital, this chapter will outline the different steps in the pet owner journey in your practice, including the consultation that should be a “golden moment” for your client.

By Philippe Baralon , Antje Blättner , Pere Mercader and Susie Samuel

Issue number 1 Published 07/05/2021

How to attract clients to your clinic

Internet has changed the “pet owner journey”: before telephoning a vet to ask questions or actually taking an appointment, the client will search the Internet (sometimes just to find a telephone number) and will have first information about your practice through it.

By Philippe Baralon , Antje Blättner , Pere Mercader and Susie Samuel