Segmenting a Practice
An article entitled "Service Companies: Focus or Falter" in the July/August 1989 issue of Harvard Business Review makes a point that the most successful service companies have a strategy that limits their services to a homogeneous group of customers, identifies the group's needs, and builds a service that is attuned to those unique needs.
The authors describe the operation of Shouldice Hospital in Toronto as an example of how to make this process work. Dr. Shouldice perfected a simple hernia operation that can be performed under local anesthesia and require a minimal hospital stay, as I can personally attest.
Other hospitals can approximate what Shouldice does, but do not have nearly so successful an enterprise. Shouldice succeeds so well because it has a clearly defined and limited service strategy. Shouldice specializes in correcting hernias for people who are low medical risks, in a self-help environment that is conducive to their speedy recovery, with a staff that is highly experienced at just one job--hernia surgery. Its success would be diminished if it were to try to redesign its service plan to accommodate other kinds of surgical and medical services.
"People flock to Shouldice," the article says, "because they hear from former patients that being there is a great experience. The hospital earns this enthusiastic word of mouth because it adds significant (though intangible) value to its core service. Most people can't accurately judge the quality of the hospital's core service. What they can and do appraise, at least when they are not very sick, are experiences like the welcome received at check-in, the behavior of fellow patients, and the attentiveness and perceived experience of doctors and nurses."
The article concludes that great service companies segment their market into a homogeneous group of customers, find out what the customers really want, and design their services to meet the customers' needs. In addition, they find out what the customers' expectations are, and then they underpromise and overdeliver. Good service is not what the provider believes it is; it is what the customer believes it is, and customers' expectations can vary greatly.
If customers' (patients') expectations are set too high, the customers may not only be unimpressed by great service, but overly critical of anything that seems to be less than they expected. Orthodontists may have a tendency to set patients' expectations too high with regard to the certainty of a cosmetic result and the stability of the finished orthodontic case. Any posttreatment imperfection, no matter how slight, may be looked upon as failure to meet expectations. Some orthodontists not only promise more than they can deliver, but guarantee their results by promising to re-treat any post-treatment irregularity free of charge. Since there are two kinds of post-treatment irregularity--true relapse and physiologic change, which may occur in people who never had orthodontic treatment--it is foolhardy to make such a guarantee.
The Harvard Business Review article states and substantiates the idea that "service companies have discovered through painful experience that using the same organization to serve different market segments, or to provide very different services to the same segment, seldom works".
Orthodontic practices that provide orthodontic correction for adults and children, and also treat TMJ disorders and surgical-orthodontic cases, may be trying to offer too varied a group of services to too diverse a group of patients. This might be satisfactory for many practices, but orthodontists would do well to give some consideration to the Shouldice model and adopt a service strategy for a segmented market--for adults or children or TMJ or surgical orthodontics.
Not all adults--indeed, not all children--like to be mixed in with others in an open bay operatory. Also, the open bay discourages the individual attention and instruction that is a hallmark of good orthodontic service. The procedures needed for a diverse group of patients are also diverse, and that diversity can decrease the efficiency and effectiveness of the service delivery. Meeting the appointment needs of a diverse group--children and working adults or orthodontic patients and TMJ patients--can create scheduling rigidities that limit the ability to accommodate the needs of everyone. This is complicated by orthodontists' desire for maximum use of their time, leaving no leeway for satisfying all patients' service expectations.
Many orthodontists do not pay enough attention to that part of their practices in which their services are overused--including emergency appointments and treatment time beyond estimate. Not only are these patients overusing the service, but they are likely to bad-mouth the practice in addition. Efforts should be made to identify these patients early and to take steps for damage control.
Many orthodontists think they know what people expect, and so they never try to find out by asking patients. Some may find out and never act on what they hear, because it would be inconvenient or because it is different from the service they want to offer. It is much wiser to offer a service that satisfies the patients than to find the patients to satisfy the service offered.
A certain amount of patient satisfaction is subliminal--it is a normal consequence of the quality of the service and the consonance of the service with the expectations. Service is intangible and therefore, whenever possible, the patient should be made aware of the level of the service through communications that dramatize the benefits. The benefit of orthodontics is not a straight set of teeth; it is all the satisfactions that are the result of having a straight set of teeth.