RTCrawford’s Weblog

Studies indicate that it takes three times as many satisfied customers to overcome the damage to reputation from a single dissatisfied customer. Why? The satisfied customer will tell 21 of their closest friends about the negative experience, while the satisfied customer will tell just seven.

I’ve mentioned this statistic in previous postings, and I have gone so far as to note that it is not the average of three-to-one that is so compelling, but the disproportionate influence of the outlier. A single highly dissatisfied customer, possessing an abundance of motivation and friends, or one that is particularly well regarded in the community, can represent a business’s worst nightmare.

To illustrate this point, I tell each of my classes about Bill the barber of Morrisville, North Carolina – from whom I received the worst haircut of my life. This retold story strikes most as trivial, since few live anywhere near Morrisville and my female students are unlikely to darken Bill’s door. That is when I tell them about my nightmare experience flying American Airlines during a business trip to Portugal, which included being “bumped” from eight different flights, stranded overnight twice (on my dime), and, believe it or not, three separate “lost bags” instances. Averaging 30 students per class, teaching five classes per year, and having told these stories for several years, I have far exceeded that figure of 21. In fact, it has taken me just three years to exceed 450, and, lacking more egregious experiences to serve as teaching examples, I expect that figure to climb significantly.

I am, however, a mere amateur, it seems. Websites and personal blogs now give every disgruntled customer the sort of exposure that I’ve enjoyed over the years, and perhaps no other entrepreneurial enterprise lends itself as target so readily as does healthcare. With the possible exception of poor experiences with members of the clergy or victimization by an opposing army during war, little equals health care for the intensity, consequence, vicariousness, and salaciousness of negative experiences recounted (and re-told, ad nausea) at parties, social gatherings, or, even, in private confidences.

And the business consequences of internet free speech by dissatisfied patients can be significant, as this LA Times article indicates. This is why an increasing number of institutional healthcare facilities are turning to 360° assessments for their attendings. Despite the unavoidable bias and imprecision of such self-reporting websites, the lawsuits initiated by a small number of practitioners as legal rebuttal seem an untenable solution. No practitioner is likely to redeem his reputation by suing his patient.

Not only does this make bed-side manner increasingly important, it makes quality of care paramount. Not all medically preventable error ends in a malpractice lawsuit. In fact, just over two percent of medical error cases prompt patients to seek the services of an attorney. The other 97 percent, however, have never lacked a voice in expressing dissatisfaction, but now every disgruntled customer can be the overachieving purveyor of complaint.

In healthcare, as in the rest of business, it seems the customer is king, queen, and financier.