by Michael Egan

Okay, I'd like you to play along with me and participate in a little activity as you read. Please raise your hand (or just a finger if you're in a public place and don't want to attract attention). Now put your hand down if:

• You have NEVER read an online review of a product or service.
• You have NEVER been influenced to further explore or try a product, service, or provider as a result of an online review.
• You have NEVER been negatively influenced about a product, service, or provider as a result of an online review.
• You believe that your patients or clients are not influenced by online reviews when they are looking for a new doctor in much the same way as they would be when they are looking at any other service.

Let me take a wild guess your hand is still up. You can put it down now. Thanks for playing along in that exercise to illustrate how impactful online reviews and recommendations have become in our lives.

Public perception is a powerful force that is increasingly influenced by reviews and recommendations generated on the Web. The power of this force has significant impact on new customers or patients as they are introduced to products, services and, yes, doctors' offices. As more and more people turn to the Web to research a doctor or service provider, the abundance and tone of other patients' experiences with that provider directly affect which practice or provider they choose. Perceptions that are generated by public feedback on the Internet are a trend that can no longer be ignored.

Back in the early 1990s, Burson- Marsteller, one of the world's most respected public relations firms, repurposed the concept of perception management, which had been originated by the US military, to help companies better understand and influence consumer behavior. The principle behind Burson-Marsteller's reboot of perception management was that consumer behavior is driven by the perception of a product or service, not necessarily by the reality of that product or service. As such, it is important for companies to clearly understand and proactively influence how perceptions are being formed.

Fast forward 20 years to today's online world, where the flow of information moves at the speed of light. The concept of perception management, now more commonly referred to as reputation management, has become an integral part of any business' marketing activities, and medical practices are not immune. How people perceive your practice or service based on the reviews and recommendations of other patients or clients is a driving force in how well your practice will perform. Your practice may be providing stellar care to patients, but if the reviews posted on the Internet don't reflect that level of care, or don't exist at all, your practice may suffer as a result of poor online reputation management (ORM).

Four scenarios illustrate this perception-versus-reality dichotomy. Let's take a look at each of these four possibilities and the high-level actions one should undertake to improve the situation.

Bottom of the Heap: Negative Reality + Negative Perceptions

No medical practice wants to be in this place. Essentially patients have a negative experience and everyone knows it. Perceptions and reality match, but the match is negative and this is the beginning of the end for the practice unless something radical is done. All conventional wisdom points to fixing the reality before attempting to go out and proactively fix the perceptions. By approaching the situation in this sequence you may delay immediate rewards (new patients coming to your door), but in the long run you will have a much healthier practice.

Smoke & Mirrors: Negative Reality + Positive Perceptions

This depicts a state in which a perfect picture hides a less-than-perfect reality. The 'Smoke & Mirrors' scenario is often a fabricated state created by aggressive marketing tactics. Because it presents a false picture of an imperfect reality, it tends to be a temporary state due to the increased transparency of today's online world. Practices with negative fundamental patient experiences can work hard to reduce the visibility of negative reviews typically by attempting to supersede them with fabricated positive reviews or other controlled messaging (advertising). However, consumers are becoming much savvier in sniffing these situations out.

A patient's true lifetime value is highly dependent on repeat and referral business. Inviting a patient or client to your door only to have her experience a negative service and never come back does little for the long-term value of the practice. In almost every case, fixing the fundamental issues that cause the negative reality delivers a much higher return on investment than the investment of time and energy associated with trying to force a positive perception. And, if you don't fix the reality, you will eventually fall into the 'Bottom of the Heap' state as patients uncover the truth.

The Ugly Duckling: Positive Reality + Negative Perceptions

A beautiful swan of a practice can be perceived as an ugly duckling when popular perception is dictated by just a few negative voices. Typically, practices land in this situation because they haven't paid attention to what a few patients have said about them. If your office doesn't have any reviews posted online and all of a sudden a single, disgruntled patient writes a review about an isolated negative experience, then that review will be what tips perceptions in the wrong direction.

This is a dangerous place to be. You've invested in creating a positive reality, but you're not getting credit for it with new patients. In order to combat this, practices need to become proactive in getting the true voices of their patients out into the world.

Ultimate Goal: Positive Reality + Positive Perceptions

You really can never get enough of this scenario; it's where you want your practice to be. If you lead a practice where delivering positive patient experiences is paramount, you want to make sure people recognize it. Achieving this state converts leads to new patients because positive reviews bring them to your door. It also increases the lifetime value of each patient as they return to your practice for repeat appointments and drive referrals to you as well.

If you're already here, you can't rest on your laurels, however. You will need to be vigilant and highly protective of your good reputation and of how perceptions and reality are tracking over time. If one diverges from the other, you'll want to know it as soon as possible and take action.

How to Approach Reputation Management

You now know the issues that can arise when perceptions and reality diverge. What is the best way to understand where your reputation stands, and how do you set up a process to manage your reputation and drive your business to The Ultimate Goal? Six essential steps can take your practice where you want it to be:

1. Establish an Online Presence: The First Stop on the Road to Reputation Management

Your initial foray into managing the perception of your practice should involve ensuring there is a perception in the first place and to help seed it with reality. The primary action here is to make sure you have listings in key locations and that the basic information associated with those listings is accurate. Are you aware of which directory listings or popular community sites your competitors use? Make sure your practice is listed there as well. Does your practice have a website or an online profile? If not, consider creating one that will include helpful content about the services you provide.

2. Survey Patients to Find Out How You Are Doing

The second step in reputation management is to understand what your reality is. What do your existing patients think about you? This requires monitoring. Survey your patients soon after their appointments to find out their true experience with your office. These surveys should cover a range of patient experiences booking an appointment, wait time to see the physician, physician's care, billing, prescription refills, etc. Your aim is to uncover when, where, and why issues might arise among your patient base. In addition, your aim is to accumulate a volume of true experiences so that you can faithfully state that you know what the typical patient experience is.

3. Monitor Online Reviews

The third step in the process of reputation management is to monitor online reviews, recommendations and comments about you that are out in the marketplace. What are people saying? Can you attribute their comments to specific experiences? Do posted comments match what you've learned about your reality based on the surveys you've gathered from existing patients? This step is not easy. The Internet is a vast and dynamic environment and trying to keep an eye on it is very challenging; however, if needed, service providers can help you with this overwhelming task. Typically these providers will track the Web and can even help score online comments based on sentiment analysis to identify the degree of positive or negative feedback you are receiving.

4. Reinforce Your Good Reputation

Your fourth step is to acknowledge the positive feedback you've received. This is your opportunity to reinforce the positives and potentially turn the negatives around. Thank those commenters who give you kudos. Not only does the original commenter appreciate your response, but other potential patients reading your responses will see that you take the patient experience seriously and they will be more apt to view your practice in a positive light and book an appointment.

5. Respond to Public Criticism

Dealing with negative comments or criticism is an entirely different ball of wax. No matter how crazy or wrong a comment may be, you must do everything in your power to approach it in a non-confrontational way. Posting defensive rebuttals to negative reviews very rarely helps and, in most cases, hurts you.

Prospective patients will naturally side with other patients, so you must be seen as taking the high road. Your best rebuttal to a negative review is to apologize publicly in a professional tone. Your aim is to defuse, not refute. An example response could be, 'We greatly regret that you had a negative experience with our office. Providing a valuable and positive experience to each of our patients is very important to us. We would appreciate learning more about your experience and invite you to call our office directly so that we can better understand what happened.' Offering to discuss the matter with a disgruntled patient offline can be a pre-emptive strike they are less likely to continue posting negative feedback about you on the Internet once you invite them to communicate with you directly.

6. Ensure Positive Reviews Online

Many reviews posted in the marketplace are negative because negative experiences drive people to take action. Unfortunately, positive experiences don't tend to catalyze the same degree of action. The result is that fewer positive comments are posted online than negative ones. For this reason, you need to be proactive in getting your patients who are happy with your services to post positive reviews. Make it easy for them by letting them post via a computer in your office. You can even use patient feedback from your surveys to post authentic positive reviews. Don't let inertia prevail be proactive and creative in publishing positive patient feedback to help you achieve 'The Ultimate Goal.'

Perceptions drive behavior. These perceptions may or may not be aligned with truth and reality. As access to online reviews, recommendations, and comments increases, it has become critically important to actively manage your practice's reputation. The task may be daunting, but if you break down the issues and understand where divergence between perception and reality occurs, you can make significant and dramatic progress. This progress will lead to improved patient experiences and improved performance of your practice, a practice that lives up to its reputation.