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Urgent message: Often, it seems that patients and families either love you or hate you. There’s a science to why they feel those extremes, though—and understanding it can increase your chance of engendering patient loyalty and positive reviews.

 Alan A. Ayers, MBA, MAcc is Chief Executive Officer of Velocity Urgent Care and is Practice Management Editor of The Journal of Urgent Care Medicine.

As a measurement of patient satisfaction, operations execution, and future business success, Net Promoter Score (NPS) categorizes every respondent to the question, How likely are you to recommend (your business) to a friend or relative? into one of three segments:

  • On a scale of 0 to 10, those who give a 9 or 10 are considered “promoters” and your greatest fans. Those 10s will not only return to your urgent care when they have a future need, but they will do your marketing for you by “evangelizing” their positive experiences.
  • Those who give a 7 or 8 are “neutral”—typically satisfied their needs were met but also lukewarm as to whether they’d return or try something different next time.
  • And 0s through 6s are “detractors” who will undermine your business by sharing their negative experiences with others.

NPS is calculated by subtracting the percentage of Detractors from the percentage of Promoters. And because the goal should be to have 100% Promoters, many organizations now just look at Top Box, or the percentage of 10s, as anything else can be considered a “service failure.”

In urgent care, NPS is a useful framework for providers and staff when interacting with patients. A high NPS is earned by giving “neutrals” that slight boost of intangible—a warm smile, upbeat and friendly demeanor, addressing the patient by name, and showing empathy for their situation. More importantly, the NPS framework helps providers and staff identify Detractors who, if they can’t be won over, can at least be “neutralized” by addressing whatever issue is the cause of their upset.

In the brain, neural pathways run deep; people don’t quickly forget, and love and hate can be all-consuming passions. That’s because there are distinct sections of the brain that correlate with sentiments of “love” and “hate.”

Brain activity associated with “hate” drives emotions like fear, anger and resentment. If a patient feels abused, cheated, or disrespected due to a negative experience with your service, emotions associated with hatred may be triggered. While patient vitriol over a long wait, unexpected charge, or clinical misdiagnosis may seem out of proportion to the actual problem, we must realize how the brain processes those experiences. To the brain, the vulnerability experienced is not much different than, say, having been robbed and assaulted. Humans are “hard wired” with a survival instinct, so the defensive mechanisms of fear and anxiety help people avoid situations that compromise their ability to survive. If you were mugged on the street, would you ever have good feelings towards the mugger, or would the thought of the experience always trigger anxiety?

Brands and companies can be compared to people in that brands have a distinct image and personality. Brands ranging from Amazon to Walmart can be described using human traits like “smart and fast” or “cheap and dirty.” When employees wear a uniform and represent a company, they are no longer viewed by customers as individuals but rather, the face of the brand. This means “Trevor” who works at Starbucks might as well be “Mr. Starbuck himself” while wearing his green barista apron. When patients are upset over a service experience, it’s critical to never take their reactions personally or defensively by remembering their angst is caused by an emotional response to a brand experience, not an individual.

When facing a bad patient experience outcome, unless you offer some type of service recovery to at least neutralize the patient’s emotions, every subsequent interaction with your brand—posting online reviews, complaining to the medical board, and interacting with friends—will reinforce those negative feelings. When the patient keeps you under a microscope of suspicion and distrust, they become almost impossible to win over. Every mention of your brand invigorates those initial negative emotions. The brain thrives on consistency, so patients will actually look for evidence that supports their belief you’re somehow “bad.” That’s why it’s so important to de-escalate angry patients before their “hateful” neural pathways become entrenched.

De-escalation occurs by “killing” the patient’s negativity with kindness. Have you ever known someone “giddy in love” who overlooks their partner’s obvious shortcomings, including tolerating mistreatment? That’s because when someone is a “fan” there are other parts of the brain that “light up,” suppressing judgment and logic. If a patient has a great experience with your brand, adopts and becomes experienced in your processes, promotes your brand to family and friends, and/or treats your business like a “partner,” they will be far more willing to forgive minor service missteps. When a customer “loves” a brand, the emotions triggered relate to belonging, security, and comfort. Can you think of brands to which you’re loyal because they just make you “feel good?”

Consider two different customer experiences with furniture delivery.

The first delivery driver showed up 2 hours later than the 4-hour window provided (meaning the customer waited 6 hours), the telephone customer service was defensive and unable to provide the customer with an arrival time, the delivery driver complained to the householder about his pay and working conditions, the merchandise was damaged, and the driver scraped the hallway wall—which had to be repainted. Because the customer was coming out of what he perceived as a helpless situation, already feeling victimized by the amount of time wasted, he was irate about the damage caused to the wall and filed complaints with the company, demanded compensation, and posted negative online reviews. He also vowed to never return to that store and told others to do likewise, including after the company provided credit to “make it right.” Many weeks later, the very mention of that store triggered feelings of anger and helplessness in the customer—emotions associated with “hate”—and despite the attempted service recovery, the customer still recounts the negative experience.

The second delivery driver from a different company likewise had difficulty lifting a heavy object up the stairs and also scraped the wall, which will have to be repainted. However, this delivery driver was prompt, neatly groomed, and was friendly with the householder, making conversation, introducing himself by name and sharing something personal about his family, complimenting the householder on her decorative tastes, and offering to provide additional services while in the home. Not only did the second delivery driver earn a great tip, the householder didn’t even raise an issue of the scraped wall. That’s because the driver had established “affinity” with the householder (and by extension, the brand) by activating the neural pathways associated with love, which subsequently lead to the householder’s grace and forgiveness. In fact, the householder would feel guilty giving the delivery driver anything less than a “10.”

In today’s fast-paced, highly polarized, and social media-driven society, it seems folks either love you or hate you. The reasons can be understood in neuroscience and survival instinct. The takeaway for your urgent care is, you can attain 10s by doing the things that cultivate good feelings about your brand and avoiding behaviors that enable negativity to become entrenched.

The Psychology of Why Your Patients Love You or Hate You

Alan A. Ayers, MBA, MAcc

President of Experity Consulting and is Practice Management Editor of The Journal of Urgent Care Medicine