April 2017




Presentation spotlight
Refractive satisfaction: Listen to your patients

by Stefanie Petrou Binder, MD, EyeWorld Contributing Writer


Frida Göransson
Quality Director, Memira AB


Refractive satisfaction survey outcomes
Source: Frida Göransson

“I would say that in refractive surgery, high patient satisfaction is even more important than in many other businesses, since we have a one-time sell. The patient has the surgery and is treated for life. You will see him again soonest for
presbyopic surgery, hopefully.”
—Frida Göransson

How patient feedback can improve your refractive practice

Gauging patient satisfaction is a key factor for quality assurance in refractive surgery. Surgical centers that achieve high-quality standards for visual outcomes, strive for professional treatment while a patient is in their care, and meet patient expectations create the right buzz, bolster patient confidence, and ultimately attract more patients. A Swedish investigation revealed what researchers learned from questionnaires about patient satisfaction and word of mouth and how it affects their practice, at the XXXIV Congress of the European Society of Cataract and Refractive Surgeons in September 2016 in Copenhagen, Denmark.
“To be able to work with continuous improvement, you need to know the patient experience during the whole time. We use a patient satisfaction survey with detailed questions about patients’ experience of the clinic, staff, the pre-examination, the surgery, the day of surgery, and of course, the results. Our survey has up to 40 questions, including the patient profile, why they chose our clinic, why they chose to have refractive surgery, for how long have they been considering a refractive procedure, and many more detailed questions. All of this information is important for a good analysis and to understand the correlations between results and different procedures. I would say that in refractive surgery, high patient satisfaction is even more important than in many other businesses, since we have a one-time sell. The patient has the surgery and is treated for life. You will see him again soonest for presbyopic surgery, hopefully. However, there are usually so many years between the refractive and presbyopic surgeries that I would not call it a resell. It leaves us in a reality where we are dependent on recommendations from formerly treated patients to recommend new patients. That is what is called word of mouth, and it is pivotal,” said Frida Göransson, optometrist and quality director of Swedish laser surgery at provider Memira AB, Uppsala, Sweden.
Ms. Göransson uses a web-based patient satisfaction survey that is automatically generated by email. She receives a 30% response rate, providing roughly 5,000 answers per year that evenly address the different services provided at the laser clinic. The surveys are sent out 1 month after a patient’s pre-examination if no reservation for surgery has been made, asking if the patient has decided against having eye surgery, whether a different clinic was chosen, and what the patient feels they might have done differently to improve their service. Automatic emails are also sent out at 3 and 12 months after surgery to gauge other aspects of patient satisfaction.

Word of mouth

Memira’s patient survey runs a large spectrum of personal and surgery-oriented questions. A particularly important survey question surrounds understanding which factor was most influential in a patient deciding to have surgery at Memira. When asked, 42% of patients said it was based on a recommendation from a friend, 19% decided through contact with a representative from Memira, 15% became interested through an offer from their employer, 14% were convinced by an online ad/offer, 12% from a promotional offer in TV/newspaper/radio, 5% from social media, 3% from a newspaper article, 3% followed their optometrist’s recommendation, and 16% had “other” reasons. Clearly, based on the high percentage of friend recommendations, good word of mouth seems to go a long way.
Ms. Göransson uses the net promoter score (NPS) to score and interpret survey questions, which are scored from 0–10, where detractors score from 0–6, passives score from 7–8, and promoters score from 9–10. Very unsatisfied patients will have negative NPS scores. The NPS is calculated by subtracting the percentage of detractors from the percentage of promoters in a given time period.
She investigated the 12-month postoperative data of patients who underwent either femtosecond (FS) LASIK procedures or refractive lens exchange (RLE) using trifocal IOLs at her clinic, from February to June 2015. When asked, “How likely are you to recommend Memira to a friend or colleague?” the results in the 287 FS LASIK patient collective showed 5% detractors, 16% passives, and 79% promoters, giving an NPS of 75; and 11% detractors, 15% passives, and 74% promoters, in the 422 patients who had RLE trifocal surgery, giving an NPS of 63.
“Seventy-five is considered a very high score, meaning that favorable word of mouth is very likely from our LASIK patients. The results don’t surprise us much because we have done this type of survey since 2012, and we know that RLE is a more complicated product than LASIK. It has more side effects and compromises that the patient first needs to understand, accept, and adapt to. With the product development that we have seen with bifocals and then trifocals in recent years, however, we have seen the NPS gap between LASIK and RLE decrease,” she explained.


Ms. Göransson revealed the outcomes at 12 months after surgery in FS LASIK and RLE patients from 2014, in response to the question, “How satisfied are you with your eye surgery?” Overall, 97% of FS LASIK patients and 90% of RLE patients were either “much more than satisfied,” “more than satisfied,” or “satisfied” with the surgical outcomes. Two percent of FS LASIK respondents were “less than satisfied,” along with 8% of RLE respondents.
Agreement with the statement “My experience of the result is in line with what Memira has described” was scored 9 in FS patients, 8.2 in RLE, and 8.8 in ICL patients. For the statement “my experience was in line with my own expectations” scores were 8.7 in FS patients, 7.6 in RLE, and 8.7 in ICL patients.
Ms. Göransson said that the survey results were highly satisfactory in terms of the refractive surgery center’s job in setting realistic patient expectations. “These are very high numbers, from 7.6 to 9. If we look at RLE, the numbers show that patients thought we were not as good in describing the results of what they should expect after RLE, as with LASIK patients. LASIK patients were more satisfied in that area, but the difference is not that big. Even more interesting is the 7.6 scored in RLE patients regarding the procedure according to their own expectations. How we describe outcomes to them is better than how they imagine it, and there is a gap there. So, improving the way we explain procedures and their outcomes to patients, and how the results will affect them in person, is something we continuously work on to improve overall patient satisfaction. It is all about communication,” she said.
Ms. Göransson urged researchers to generate more patient satisfaction data for future congresses, to be used as a reality check for clinical results and general patient satisfaction.

Editors’ note: Ms. Göransson has no financial interests related to her comments in this article.

Contact information

Göransson: frida.goransson@memira.se

Refractive satisfaction: Listen to your patients Refractive satisfaction: Listen to your patients
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