The quick answer is nothing, but perhaps we should reverse the question, what can Optical Express learn from UK and Irish dentistry? An awful lot.
The purpose of this blog is to illustrate how far UK and Irish dentistry has developed in terms of the patient journey and in particular in the use of treatment co-ordinators (TCOs) in comparison with other providers of elective medical treatments. I apologise for the length of the blog but the detail is relevant.
The story starts three months ago. I responded to an unsolicited social media advertisement promising me 20/20 vision or my money back. Spending about 10% of my life looking for my specs I responded eagerly, and very quickly I received a phone call to welcome me to Optical Express, the caller explaining briefly that because of my age, laser would not work and what I needed was natural lens replacement which was something Optical Express were world leaders in — they carried out 1k operations a week. It sounded amazing so I booked an appointment at my local clinic in Truro for the next Saturday morning.
First appointment. The clinic was poorly signposted so it was quite difficult to find, my first impression when entering was that it was a budget operation, it felt more NHS than private, scruffy and not at all clinical. I was warmly welcomed by a guy I assumed was a clinician, then taken into a small office where I was talked at by a very excitable and heavy accented Spanish lady, who I later learned was a trainee. She explained the procedure clearly, the cost and the fact that the surgery would have to be carried out in Exeter, to be followed up by a series of follow up checks which would be in Truro.
She offered me 0% finance over nine months, I said great but happy to pay on my credit card, she replied that I should take the 0% as it was free, “Great,” I said. She then explained that I would have to have a few ophthalmic tests. I was shown into another room where the original guy got me to do three tests: he struggled with the pressure test and did not use the clinical wipes to wipe the chin and eye rests despite the fact that there was a big tub of them.
After this I was shown into the optician’s surgery where he clearly explained the procedure and that it is not suitable for over 30% of applicants. He then tested my eyes and confirmed I would be suitable, then spent a long time managing my expectations and reassuring me that in 96% of cases the patient achieves 20/20 vision. I paid my £500 deposit, agreed a date about four weeks away for the procedure and was told somebody would call me to sort the 0% and I would also get a call from my surgeon — so far so good.
Leading up to the procedure. A week after this appointment I got a call from a cheerful guy to sort out my 0% finance, which he said would just take a few minutes and that’s all it took to tell me I had been rejected on finance (I have never had finance refused, I own my own house and do not have a mortgage). I was very surprised but said it’s OK I will pay on my credit card. He then said he had another provider, he would talk to them and call back. I heard nothing until the Tuesday before the Friday the procedure was due to happen, when a lady called about the finance to check some details. She explained that Hitachi Personal Finance had rejected me because my home address was the same as my business address and she would try another provider.
On the Wednesday I received a call from Optical Express Glasgow office to see if could change my appointment on the Friday to 10.00 as opposed to 12.00. I explained that I could not do this as I would be traveling from Falmouth and it would mean hitting all the tourist traffic, they said “OK let’s leave it at 12.00.” On Wednesday afternoon I got another call I think from the Truro office asking me if I could change my appointment to 12.00, so I had to put them straight. Later that afternoon I had a very brief call from my surgeon introducing himself and asking me if I was fit and well. On Thursday morning I got a letter to say my appointment was at 10.00 on the Friday. I rang back and went a bit potty with them — they were full of apologies, “We will see you at 12.00…”
On Thursday afternoon at 16.00 I had a call from Optical Express’s Plymouth office wanting to rebook my procedure as I had been rejected on finance. At this point I really lost it and asked to speak to their clinical director but was informed I would have to follow their complaints procedure — real big company shite. I calmed down, became pragmatic and asked the lady very nicely to sort it. 20 minutes later she called me to say that she had managed to get me in tomorrow as originally planned (bizarrely I was grateful!). I paid for the procedure in full on my credit card, a process which required three calls — I am not sure why but they were very apologetic and offered me a discount of £340 for messing me around.
The day of the procedure. Finding the clinic was difficult using the map provided. As it’s almost across the road from John Lewis in Exeter it is amazing that the landmark was omitted from the map. Poor signage again, second floor office location, very much the NHS waiting room apart from an absolutely charming lady on reception. Lots of forms to fill in, actually I was starting to feel nervous and vulnerable. The procedure starts with a whole load of tests on various machines to test my eye pressures etc. The nurse doing this was gowned up but never once wiped any of the equipment despite the fact there were large tubs of wipes clearly available.
I then had my blood pressure and history checked, and felt relaxed. Then I was ready for the procedure. I met the anaesthetist who was gowned up and wearing gloves, but then left the room and did not change her gloves on return, I remember thinking to myself, “This is not good.” The procedure was completely painless and I was actually having problems staying awake. Afterwards (less than half an hour later) I was escorted out to the patient waiting room. I prepared to leave with my wife and was told, “We will see you here tomorrow at 09.00.” I said I was told I would be seen in Truro. “No that’s not possible,” I was told. I explained that I was categorically told that all appointments post-procedure would be in Truro. After getting quite upset they offered to pay for a Premier Inn room in Exeter. The following morning I saw an optician who checked me over and said I was fine. I was amazed by the speed of my eyesight improvement — actually I was euphoric and thrilled at the outcome.
7 day check up. Booked for 09.00 on a Saturday morning in Truro. I arrived at 09.00 to a locked door although the lights were on. I banged on the door but no joy. At 09.10 another person showed up who worked there. He rang the centre and they contacted a guy inside who I gather was the optician and we were then allowed in (apparently the optician is not allowed to open the door if he is the only person in the clinic). We got in at 09.15. The check up went well, I was told I had 20/20 vision yippee!
14 days. I started having headaches, called the central number and got instant attention. I was advised to come in asap but it would have to be Exeter. I made an appointment for August 21st at 14.00. I got call at 09.17 on the 21st asking me where I was. I was a tad puzzled but not surprised and said my appointment was at 14.00. It was the same guy I met on the first appointment who does not use medical wipes and cannot set the chair correctly for eye tests. He also can’t read the clock it would seem. He apologised and said that there was a machine that needed to be serviced (I have no idea why that would affect my appointment). I showed up at 14.00, had the tests performed by the same guy, no wipes again (despite me complaining to his manager), still struggling with the chair, then I saw the optician who was most helpful.
Since then. I received three phone calls from their lady in customer complaints unit but when I called back was unable to speak to her as they did not know who she was. I called her directly after I received a letter from her saying as she had not heard from me she assumed all was resolved. She was very patient, listened to my story then explained that she had tried emailing me but my email bounced. I asked her to to read out the email address: it was missing a full stop. You really could not make this stuff up.
I am not exaggerating any of this story. Later yesterday I received a call from a customer care manager who left a message asking me to call him on a number, and as I was driving I pressed recall, got through to the call centre and had to go through all the patient security before I could ask to speak to Mr Cooper, who they had not heard of. I persisted and after seven minutes they found out who he was and I left a message as he was not available. Incidentally I haven’t heard back, but I now realise what’s been happening with the phone: they are ringing out on their group number and if the patient presses ring back as opposed to calling the number they have suggested they end up in the silo of the massive contact centre — unbelievable.
Conclusion. Would I do it again? Definitely. It’s truly life changing. Was I charged a fair price at £8k? Definitely. In fact I would pay twice that. The clinicians and technologies are brilliant, the patient journey is in the wrong century.
What can practice owners learn from this? Process is key. However brilliant the clinician, the devil is in the detail of customer management protocols, the entire customer experience is always vulnerable to lazy, sloppy, arrogant, patronising and poorly trained individuals — you need robust systems to chase out poor performance.
Recommendation for Optical Express. For the non-clinical senior team: book a check up at your local private dentist and bring your note book.
I hope you find this useful. I’m happy as always to help you develop your process mapping and TCO role definitions and training.