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University of Southern California Dissertations and Theses

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Effective Messaging in the LASIK Industry

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Effective Messaging in the LASIK Industry

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Content EFFECTIVE MESSAGING IN THE LASIK INDUSTRY by Laurie Manger _______________________________________________________________________ A Thesis Presented to the FACULTY OF THE USC GRADUATE SCHOOL UNIVERSITY OF SOUTHERN CALIFORNIA In Partial Fulfillment of the Requirements for the Degree MASTER OF ARTS (STRATEGIC PUBLIC RELATIONS) August 2011 Copyright 2011 Laurie Manger ii Table of Contents Abstract iii Effective Messaging in the Lasik Industry 1 Bibliography 70 Appendices Appendix A: LASIK Survey 77 Appendix B: Interview with Linda Reily 79 Appendix C: Returns of Referral Sources Graphs 84 Appendix D: LASIK Survey Results Graph 87 iii Abstract This thesis focuses on how messaging effectively in the LASIK industry has changed over time and continues to evolve today. This paper begins by tracing the history of refractive surgery as well as eye conditions and terms that will familiarize readers to better understand the LASIK procedure. In order to study LASIK industry trends and consumers, Saddleback Eye Center will serve a platform from which to gather information on messaging and marketing techniques. By evaluating data that Saddleback Eye Center has gathered over the past ten years pertaining to patient referral sources, ROI, and trends of patient purchasing habits, messaging effectiveness can be tracked and improved upon as technology and this industry advance. To understand the impact messaging has on potential LASIK patients and their decision to undergo LASIK surgery, the process every person experiences to reach this point must be reviewed. Diffusion Theory will be referenced throughout this thesis as a basis for which to evaluate the steps potential patients encounter when considering LASIK. The six main steps in Diffusion Theory will be traced in terms of what a potential LASIK patient experiences from first hearing about this procedure all the way through the postoperative course. While the LASIK industry continues to grow and channels of messaging people rely on transition, the importance of creating messaging that differentiates one LASIK center from another has become pivotal. Knowing what attracts potential LASIK patients and gives them confidence to visit a particular facility is a key factor, so that marketing iv and media outlets can be utilized to their full potential. By studying past data and trends in the LASIK industry presented in this thesis, Saddleback Eye Center has utilized this information to create a new campaign: The 20/20 Promise. This campaign emphasizes quality results and utilizes media outlets that are evolving to become the most productive at gaining the confidence of LASIK patients. 1 Effective Messaging in the LASIK Industry I. BACKGROUND Through the examination of past approaches used in marketing along with people’s willingness to engage in rising technology, new and more compelling ways to attract consumers develop. 1 Such forecasts are particularly useful within the high-profit, highly competitive American medical industry. One particularly consumer-driven of this medical industry is ophthalmology, the study and treatment of disorders and diseases of the eye. Reports predict that the global market for eyeglasses will hit $95.66 billion in the next four years. 2 However, a major competitor to the eyewear industry is laser- assisted in situ keratomileusis, more commonly known as LASIK. One of the leading institutions that performs this procedure is Saddleback Eye Center, a privately operated LASIK clinic located in Orange County, which functions not only as a medical facility that helps patients, but also as a business that must attract customers. A comparative analysis of the efficiency of marketing techniques utilized by LASIK industry, and in particular, Saddleback Eye Center 10 years ago, five years ago and today will uncover what has changed and what has stayed the same. Such an analysis will indicate what new and advanced methods Saddleback Eye Center should adopt to acquire new patients. 1 Note: The author of this thesis is a relative of the owner of Saddleback Eye Center and works in the LASIK industry. 2 .“Global Eyeglasses Market to Reach US $95.66 Billion by 2015, According to New Report by Global Industry Analysts,” PRWeb, July 15, 2008. http://www. prweb.com/releases/prwebeye glasses_spectacles/lenses_frames/ prweb 4259644.htm. 2 Main Idea/Goal of Thesis The goal of this thesis is to identify which marketing techniques were most efficacious in the past, which techniques are most productive today, and determine which techniques will arguably be the most effective in the future for the LASIK industry. Identifying best marketing practices of the past, present and future will be key for the business to best dispense its efforts and resources in ways that reach and maximize the attention of prospective patients. By not assessing the efficacy of marketing modes, businesses will waste profits and patient-gathering efforts will fall short. A central focus of this thesis will be to look at message delivery versus message effectiveness. How Saddleback Eye Center delivers its message of quality LASIK to consumers varies, but there are five message delivery platforms currently in use: patient referrals, patient newsletters (mailers), Internet, LASIK seminars and radio advertising. The central message of quality conveyed through each medium is the same, but the way people react to this message will differ depending on the medium. This thesis will use past data and research to determine what message delivery system (medium) is most powerful in motivating people to consider and proceed with LASIK. Message reception varies since each channel reaches a different audience. The LASIK Procedure To understand LASIK, it is crucial to first consider key ophthalmologic terms and conditions, and look at the history of refractive surgeries, the category of which LASIK is a part. 3 Key Terms Three common, yet rarely understood terms relating to people’s visual acuity are nearsightedness, farsightedness and astigmatism. Nearsightedness, or myopia, is a condition that causes the eye to focus incorrectly and blur far away objects. 3 Farsightedness, or hyperopia, causes rays of light to meet the retina before they converge, thus blurring close objects. 4 Astigmatism occurs when the cornea of the eye is more football-shaped than round. As a result, the cornea is unable to properly focus images to the retina and objects become blurred. 5 Refractive surgeries only impact the cornea and have no effect on the condition of the retina. The retina lines the interior post chamber of the eye, which contains rods and cones and is connected to the brain through the optic nerve. The extremely light sensitive retina is unrelated to the cornea, which is the part of the eye that is corrected by refractive surgeries. Right in the center of the outer eye, the cornea is the eyeball’s outside layer, 2. “Nearsightedness,” Mayo Clinic Health Information, January 19, 2010. http://www.mayoclinic.com/health/nearsightedness/DS00528. 3. "Farsightedness (Hyperopia)-Topic Overview." WebMD - Better Information. Better Health. 5 Nov. 2009. Web. 10 Nov. 2010. http://www.webmd.com/eye- health/tc/farsightedness-hyperopia-topic-overview. 5 . Lee, Judith. "Astigmatism - What It Means, What To Do About It." Consumer Guide to Eyes, Eye Care and Vision Correction - LASIK, Contact Lenses and Eyeglasses. Dec. 2008. Web. 10 Nov. 2010. http://www.allaboutvision.com/conditions/astigmatism.htm. 4 which lets light in and partially focuses the image. 6 This is the part of the eye that is treated during most refractive surgeries, including LASIK. Two common eye conditions that occur as the eye ages are presbyopia and cataracts. Presbyopia is a normal part of the human eye aging process and occurs when the eye lens hardens and as a result becomes difficult to focus. Additionally, presbyopia causes a delay when the eye switches focus from a distant to a nearby object. This is the reason why people entering their forties and fifties have trouble with both their reading and their far distance vision. The topic of presbyopia will be discussed in depth, as it is central in understanding why the concept of monovision LASIK exists. Cataracts are a condition when the crystalline lens becomes cloudy, which causes vision to deteriorate and sometimes leads to blindness. Cataracts are most common in older people because in addition to genetic considerations, the eye condition may be the result of years of eye sun damage, smoking, drinking and a few other common causes. 7 Removing a cataract is an entirely different process than correcting vision through refractive procedures. Moreover, LASIK does not correct cataracts and can typically be done only after the removal of significant cataracts. 6 . Segre, Liz. "Eye Problems - Symptoms A to Z - AllAboutVision.com." Consumer Guide to Eyes, Eye Care and Vision Correction - LASIK, Contact Lenses and Eyeglasses. Mar. 2010. Web. 31 Mar. 2011. http://www.allaboutvision.com/conditions/eye- problems.htm. 7 . Staff, Mayo Clinic. "Cataracts - MayoClinic.com." Mayo Clinic. 20 May 2010. Web. 14 Nov. 2010. http://www.mayoclinic.com/health/cataracts/DS00050. 5 Refractive Surgeries The Greek philosopher Aristotle, who wrote about refractive error recognition in the fourth century BC, observed that myopia was an ocular disorder and presbyopia was a result of aging. Aristotle’s conclusions illustrate that although the ancient researchers might have studied eye conditions, their conclusions were often inaccurate and therefore their treatments were ineffective. In fact, refractive surgery would first become a possibility 2,000 later, because of the work of German physician Lendeer Jans Lans. In 1898, Lans used his basic ophthalmologic principles to develop the innovative Radial Keratotomy (RK), a surgical eye procedure that involves incisions on the cornea to reshape it and allow the retina to better focus images. 8 Initially designed to help treat myopia, RK became commonly used to help correct astigmatism. From 1939 to 1943, Japanese physician Dr. Tsutomu Sato used Lans’ studies to develop Posterior Keratotomy (PK), a procedure to treat myopia. 9 This surgical procedure was used by Sato to correct vision for people with myopia. Later on, Russian physician Svyastoslav Fyodorov went on to improve Sato’s PK procedure. In the mid to late 1970s, Fyodorov trained many US ophthalmologists in how to perform the PK procedure. 10 8 . "Radial Keratotomy (RK): The Vision Correction Website." LASIK, PRK, Intacs - The Vision Correction Website (PRK, LASIK, Intacs, RK, AK) - Laser Eye Surgery. 2010. Web. 12 Nov. 2010. http://www.lasersite.com/RK/index.htm. 9 . “Lasik Vision Correction,” North Andover, MA: Medical Management Services Group, LLC, 2010, PDF e-book. http://www.book-about-lasik-surgery.com. 10 . Casebeer, J. Charles. Casebeer: Incisional Keratotomy. Thorofare, NJ: SLACK, 1995. 8. 6 During the 1970s, American ophthalmologists studied the results of Fyodorov’s surgeries in an effort to improve Lans’ RK. One of the major studies, which produced highly valuable data for future studies of RK, was the Prospective Evaluation of Radial Keratotomy study (PERK), funded by the National Eye Institute. 11 Out of that research, the Casebeer Keratorefractive System was created, giving surgeons a straightforward way to consistently produce good results without having to solely rely on the “learn through experience” approach. The Casebeer System was integral in correcting myopia and astigmatism. As RK continued to develop, the procedure was soon able to correct up to four diopters (a measurement unit used to determine the eye’s optical abilities) of myopia and eventually more refractive surgeries and refined lasers emerged. One of those new surgical techniques was Automated Lamellar Keratoplasty (ALK), a procedure to treat more extreme cases of myopia and also the previously incurable hyperopia. In ALK, a small metal device called a keratome is used to reshape the front surface of the cornea through a layering technique. 12 Nineteen eighty-eight saw the introduction of a procedure known as laser ablation, in which the Excimer Laser was first used to sculpt the cornea of the eyes to correct the visual problems. 13 11 . Ibid, 7. 12 . Ibid, 151. 13 . Ibid,14. 7 Eventually, Photorefractive Keratectomy (PRK), an upgraded version of RK that can be performed topically and does not involve incisions, became the preferred procedure over ALK to correct mild to high myopia and cases of astigmatism, correcting up to six diopters. 14 A diopter is “the unit of measure used to define eye correction or the refractive power of a lens. Usually, adjustments to an optical eyepiece accommodate for differences in individual eyesight”. 15 However, many ophthalmologists at the time could not perform PRK because it involved expensive state-of-the-art technology and required special physician qualifications. Then, in November 1995, the Summit excimer was approved for PRK. The approval of the VISX excimer laser for PRK followed in 1996. 16 A few ophthalmologists started performing LASIK with the excimer laser in 1995 and 1996 because the procedure offers optimal results in a few hours with minimal discomfort. Based on their judgment of what was the best medical option for their patient, these doctors were either performing LASIK or prescribing a medicine. A medical term known as “practice of medicine issue” is what allowed ophthalmologists to perform LASIK prior to FDA 14 . Machat, Jeffery J., Stephen Slade, and Louis E. Probst. The Art of LASIK. Thorofare, NJ: SLACK, 1999. 4. 15 . "Night Vision Terminology & Definitions - Morovision Night Vision." Morovision Night Vision - Night Vision Goggles, Weapon Sights and Night Vision Equipment. 2010. Web. 15 Nov. 2010. http://www.morovision.com/terminology.htm. 16 . "LASIK and Refractive Surgery Timeline." Find Doctors for Breast Implants, Augmentation & Plastic Surgery | LocateADoc.com. 23 Aug. 2008. Web. 15 Nov. 2010. http://www.locateadoc.com/articles/lasik-and-refractive-surgery-timeline-1361.html. 8 approval. The FDA approved the LASIK procedure in 1999 17 , but the “practice of medicine issue” allowed well-qualified physicians to perform a surgery before then. LASIK involves removing tissue centrally in the cornea to correct myopia, while removing tissue peripherally to correct hyperopia. 18 LASIK became the preferred method over these previously mentioned types of refractive procedures for several reasons. Firstly, only LASIK corrects high myopia while also avoiding the corneal haze sometimes caused by PRK. Secondly, with LASIK the patient sees a rapid return of vision with recovery taking only hours as opposed to weeks with PRK. LASIK is also considered to only cause minimal discomfort. Finally, LASIK can treat higher levels of astigmatism if used with an astigmatic scanning excimer such as the Chiron Technolas Keracor. 19 LASIK Today LASIK continues to evolve and advance, due in large part to new technologies such as VISX Custom Vue and Intralase. During the first seven years after LASIK’s approval, the numbers used to correct vision were based on the phoropter refraction 17 . Johnson, Mark Q. "FDA Approved Refractive Eye Surgery." E-zine Articles. 30 July 2009. Web. 15 Nov. 2010. http://ezinearticles.com/?Lasiks---FDA-Approved-Refractive- Laser-Eye-Surgery&id=2687897. 18. VSP Home. 2010. Web. 10 Mar. 2011. https://www.vsp.com/cms/edc/videos/refractive-surgery-overview.html. 19 . "Understanding Custom All Laser LASIK." Crystal Clear Vision. 2009. Web. 15 Nov. 2010. http://www.crystalclearvision.com/understandinglasik.asp. 9 results, where the examiner essentially asks the patient: “Which is better, one or two?” Although this simple method was able to give patients 20/15, 20/20 or 20/25 vision, Custom Vue gives even more accurate measurements because it measures nearsightedness, farsightedness and astigmatism with laser precision. Custom Vue also detects localized imperfections in the eye (referred to as higher order aberrations), which were previously unmeasurable. 20 This more detailed measuring of the eye results in the ability to make corrections that improve clarity of daytime vision as well as better night vision. Additionally, LASIK can now correct presbyopia, so that people over forty no longer need reading glasses for most activities. A vision correction technique known as monovision is now performed on LASIK patients who are in their forties or older. The monovision procedure corrects one eye for reading and the other eye for distance. In a few days to a few weeks after the procedure, the mind subconsciously adjusts to the two eyes having different focus points. As a result, the patients no longer need to use reading glasses, except for small script (e.g., the back of a medicine bottle). Approximately half of LASIK patients make the personal decision to get the monovision procedure, while the other half prefers to surgically improve their eyes for distance vision and use over-the- counter glasses for reading. 21 20 . Ibid, http://www.allaboutvision.com/conditions/astigmatism.htm. 21 . "LASIK - LASIK Eye Surgery Information, Surgeons." DocShop – Medical Directory of Doctors - Einstein Industries. 2010. Web. 10 Mar. 2011. http://www.docshop.com/education/vision/refractive/lasik. 10 Even when using the latest technology, LASIK is not the right procedure for everyone. 22 To determine if someone is a good candidate for the LASIK procedure, the physician gives patients qualifying tests including vision evaluation, power of the eye test, glaucoma test, patient counseling, dry eye test, corneal topography, complete evaluation of eye health, dominant eye test, pupil measurement, corneal thickness measurement, wave print of the eye, dilation, topography and auto refraction. 23 Preliminary tests are important because they may determine if a patient has visual problems that LASIK cannot correct. 24 Some of the most common disqualifiers are major cataracts, glaucoma, macular degeneration and keratoconus. Approximately 80 percent of people who undergo LASIK exams are good candidates for the procedure, while the other 20 percent are declared unsuitable candidates. Risks associated with LASIK Surgery It is important for people to understand possible complications and side effects of LASIK before undergoing the procedure. The American Society of Cataract and Refractive Surgery (ASCRS) found that 95 percent of LASIK patients are satisfied with 22 . "When Is LASIK Not for Me?" U S Food and Drug Administration Home Page. 16 Apr. 2009. Web. 18 Nov. 2010. http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/SurgeryandLifeSup port/LASIK/ucm061366.htm. 23 . Saddleback Eye Center, ed. Charles Manger (Laguna Hills, CA: Saddleback Eye Center, 2008). 24. Ibid., https://www.vsp.com/cms/edc/videos/refractive-surgery-overview.html. 11 the outcome of the procedure. 25 The most common complications and side effects from LASIK include, permanent dry eyes, ectasia (keratoconus), LASIK enhancement, non- adaption to monovision, wrinkling of the corneal flap and unrealistic expectations. LASIK patients may not experience any side effects or complications, but they must still be educated about them before undergoing the procedure. Temporary side effects of LASIK including minor fluctuation of vision during the day, sensitivity to the sun, and glare and halos around lights at night. These last approximately one to four weeks after the procedure. Dry eye occurs because the corneal nerves are interrupted during the surgery; the corneal nerves control tear production in the eye and will regrow, but it can take six to 12 months for the nerves to regenerate. Dry eyes cause discomfort and fluctuations of vision as well as decreased vision. 26 Seeing glare and halos around lights as a side effect can be dangerous at night when the glare might prevent a person from accurately seeing streetlights and signs. Even though dry eyes are typically a temporary side effect for patients, it can be permanent in some cases. Intensive eye drop therapy including the prescription eye drop Restasis or even steroid drops may be necessary for these patients. People with 25. "95 Percent Lasik Patients Satisfied: Study." AVOID BAD LASIK DOCS - Lasik Patient Advocacy Approved Doctors - Lasik Eye Surgery Info - USAEyes. 2009. Web. 2 Feb. 2011. http://www.usaeyes.org/lasik/library/lasik-success-rate.htm. 26 . "LASIK Laser Eye Surgery and Dry Eyes." LASIK Surgery Laser Eye Surgery LASIK Surgeon Vision Correction Costs & Facts. 2010. Web. 21 Nov. 2010. http://www.seewithlasik.com/docs/lasik-dry-eyes.html. 12 permanent dry eyes often encounter discomfort, scratchiness, burning sensation and a lack of visual clarity. Ectasia is a complication that can occur after LASIK and very little is known about this condition. A patient is at higher risk of experiencing ectasia when too much tissue is removed from the cornea during the LASIK or if the patient has a genetic disposition to the condition. The common symptom of ectasia is blurred or distorted vision that cannot be corrected with glasses. The risk of ectasia can be greatly decreased if a patient undergoes thorough corneal topography prior to the procedure and if the patient knows whether keratoconus runs in their family. The likelihood of ectasia occurring is just three out of every 1,000 patients. But if LASIK if performed on a patient who has a predisposition for keratoconus, the complication could be detrimental for the remainder of his or her life. While the risk of ectasia not great, it is certainly something that must be thoroughly considered before proceeding with LASIK surgery. LASIK enhancement is a complication of LASIK and the risk of it depends on the experience and talent of the surgeon who performs the procedure. A LASIK enhancement is a “touch-up” following the initial LASIK procedure. The procedure is needed if the results of the initial LASIK were less than acceptable and the eye still has small amounts of residual nearsightedness, farsightedness or astigmatism. Complications requiring LASIK enhancement are usually due to differences in the patient’s healing pattern and cannot be predicted before LASIK. In the case of a less than acceptable LASIK outcome, the patient has the option of either undergoing a LASIK enhancement 13 or wearing glasses or contact lenses. 27 Approximately three to ten percent of LASIK patients need an enhancement. Since the surgeon is the person making the decision on how to reshape the cornea based on careful examinations and calculations, it is important that the surgeon is very experienced and detail-oriented. The surgeon ultimately determines patient outcomes after the LASIK procedure, so the experience level of the surgeon is of utmost importance. A risk associated most commonly with LASIK enhancement is epithelial cell ingrowth. The epithelium is the outermost four to five cell layers of the cornea and similar to the skin on the rest of our body. The epithelial cells divide and multiply rapidly when the corneal flap is moved. 28 It can take weeks for a patient to notice epithelial ingrowth, but if it continues and progresses, a patient can experience distorted vision. 29 Epithelial cell ingrowth often occurs when patients touch the eye socket area within the first 30 days after the LASIK enhancement. Epithelial cell ingrowth occurs more frequently in patients that have the LASIK enhancement done two or more years after their initial LASIK procedure. If epithelial ingrowth occurs, the surgeon typically relifts the flap, uses a sponge like instrument to clean away the epithelial ingrowth cells 27 . "LASIK Risks." LASIK Eye Surgeon Directory - Guide to LASIK Costs, Risks, Benefits, Resources and More. 2010. Web. 21 Nov. 2010. http://www.lasikeyesurgerycorrection.com/lasik_risks.html. 28 . ibid, http://www.usaeyes.org/lasik/library/lasik-success-rate.htm. 29 . "Laser Treatment of Epithelial Ingrowth after LASIK Shows Promise." LASIK Laser Eye Surgery - Refractive Surgery News and Information. 2009. Web. 26 Nov. 2010. http://www.lasiksurgerynews.com/news/laser-treatment-for-epithelial-ingrowth-after- lasik.shtml. 14 and then smoothes the corneal flap back down. To prevent the occurrence of epithelial ingrowth, LASIK surgeons recommend their patients not to touch or rub around the eye area for three months. Additionally, surgeons recommend that patients avoid the use of eye makeup for three months, apply preservative-free lubricating eye drops for three months, and wear a shield over their eye(s) for one month following the procedure. By not touching or rubbing around the immediate eye area for one month, patients can themselves greatly reduce the risk of developing epithelial ingrowth. Another possible complication from LASIK is not adjusting to monovision. To adapt to monovision, a patient must be willing to make the compromise of having vision that is functional but less than perfect at a far distance, at an intermediate distance and up-close. After the procedure, some patients may have perfect depth perception and experience slight blur when shifting from glancing at far away to up-close objects. 30 Every person has the subconscious brain ability to make the monovision adjustment, but analytical people allow their conscious minds to interfere with the process. If a patient has not adjusted to monovision after several months, the LASIK surgeon can go back and correct the up-close eye for better distance vision, leaving the patient with two distance eyes as well as the need for reading glasses. Wrinkling of the corneal flap (or LASIK flap wrinkle) is a risk that patients take when having LASIK performed. Touching or rubbing the eye within the first month after having LASIK can put a patient at risk for this complication. Even if a patient follows 30 Ibid., http://www.usaeyes.org/lasik/faq/lasik-monovision.htm. 15 the ophthalmologist’s postoperative care instructions, which typically include not touching or rubbing the eye for one month, a patient can still accidentally touch the eye(s) and cause wrinkling of the corneal flap. 31 The surgeon can easily smooth out these wrinkles should they occur, which in the end allows a patient to reach the same best possible outcome from the LASIK. However, the healing process typically takes a few days longer for a patient when LASIK flap wrinkles occur. One of the last but relatively common risks of LASIK is that the patient has unrealistic expectations of the results from the procedure. Testing for unrealistic expectations is very difficult. Typically patients with have either not been completely informed of the risks and side effects of LASIK, or they expect to get “perfect” vision. Also, patients might have chosen to ignore information that was given to them. This is a very worrisome trait, because he or she will likely be unsatisfied with the results of the procedure. Ways to combat this are outlined in the tactics portion of the following plan. Introduction to the LASIK consumer market Landscape The LASIK consumer market consists of people who wear glasses or contact lenses but who wish to be independent of them. The early adopters of LASIK were financially secure and unafraid people who felt frustrated with wearing glasses or contact lenses. Thus, the early adopters were motivated patients who had the LASIK procedure 31 Ibid., http://www.usaeyes.org/lasik/faq/lasik-striae.htm. 16 in the first few years after it became available to the public. 32 People who were not part of the early adopters of LASIK fit into one of several categories: people who are in their forties or older and either use reading glasses or fear having to use reading glasses as they begin to notice their up-close vision diminishing; people who have been thinking about doing LASIK for years but are still too nervous to have it; and, people who want LASIK but cannot proceed for personal financial reasons. Buying Habits LASIK consumers and their buying habits vary considerably, but can be categorized in three main groups: the First Wave (pioneers and early adopters), the Financers and the Fearful. First Wave The Pioneers were the very ambitious and motivated LASIK candidates who came forward during the first few years of development. This group of people makes up about 15 percent of the LASIK market. 33 These patients were typically ages 20 to 50, male or female, upper-middle class, well-educated and had enough confidence in modern technology to undergo a new procedure in its early stages of development. Essentially, 32 . Linda Riley (practice administrator at Saddleback Eye Center) in discussion with the author, Laguna Hills, CA, September 2010. 33 . Mahdavi, Shareef. "Today’s Refractive Surgery Patient." Eyecare Educators: Continuing Education for Optometrists. 2010. Web. 3 Mar. 2011. http://www.eyecareeducators.com/site/today_s_refractive_surgery_patient.htm. 17 these people were motivated to get LASIK because they felt frustrated with eyewear, trusted their surgeons and believed in the technology. 34 The Early Adopters – Many of these patients may be Baby Boomers who are experiencing diminishing eye sight. Because there is an overall trend of decreasing income of these patients, financing the LASIK procedure is becoming a much more popular option. In fact, a decade ago only 10 percent of patients financed their LASIK procedure, whereas today about one in four patients use a financing option. 35 In the current economic climate, financing has become a very popular option for people who undergo LASIK. In fact, a recent study showed that the cost of the procedure was an important issue for 78 percent of those polled. 36 While the early adopters are on average less educated than the pioneers, they are similarly motivated to undergo LASIK. Members of this group have typically waited to get the procedure because they thought that the price would either go down or their own earnings would go up. However, these people seem misguided about LASIK because it is a surgery and not a commodity. So with technology constantly advancing and surgeon experience increasing, it is unlikely that the price of LASIK will cost less in the future than it does today. Some bargain eye surgery centers charge less than average, but are also compromising the quality of the procedure. The poor quality associated with bargain LASIK centers can occur when 34 . "All About ILASIK." ILASIK: LASIK & Laser Eye Surgery. 2010. Web. 17 Mar. 2011. http://www.ilasik.com/6000-all-about-ilasik.aspx. 35 . Ibid, http:// www.eyecareeducators.com/site/today_s_refractive_surgery_patient.htm. 36 . Ibid, http://www.lasiksurgerynews.com/news/lasik-fear-cost-23aug07.shtml. 18 patients are misinformed by staff, when the surgeon uses the blade technique instead of the all-laser LASIK, or when the center uses outdated lasers to avoid having to pay royalty fees on the equipment. The FDA website specifically warns people researching LASIK about how the experience of the LASIK surgeon and equipment used are important in maximizing best results you can achieve. Centers with higher prices often offer financing plans under which patients do not pay anything until the day of the procedure. There are many types of financing available including one- and two-year no- interest, and no-finance fee plans. 37 The Fearful - Some people have been considering LASIK for years, but have put it off because of fear. According to these people are typically between ages 30 to 60 and moderately educated. Oftentimes these people use the Internet as their sole information source to decide whether or not LASIK is a good choice for them. 38 There are many websites and personal blogs on the Internet dedicated to individual nightmare LASIK experiences. Potential customers who research LASIK and read online about individual bad experiences may be frightened enough to actually change their mind altogether about wanting LASIK. An example of one such site is LASIKdisaster.com, which is dedicated to providing details of horrific LASIK scenarios, as well as telling people of risks that are 37 . "CareCredit® LASIK and Vision Care Financing for LASIK Surgery, Eye Care, Laser Eye Surgery, & Other Vision Procedures." CareCredit® Healthcare Finance - Payment Plans and Financing for Cosmetic Surgery, Dental, Vision, Hearing, Veterinary & Other Medical Procedures. 2010. Web. 20 Dec. 2010. http://www.carecredit.com/lasik/. 38 . Ibid., http://www.docshop.com/education/vision/refractive/lasik/choose-surgeon. 19 many times overlooked. 39 A recent consumer survey found that the “fear component” was named the main reason the majority of respondents gave for not having LASIK. 40 The results from this study on the fear components of LASIK found that 57 percent feared an unfavorable outcome; 54 percent feared post-surgical side effects; 53 percent feared the lack of adequate information; and 49 percent expressed a general fear of medical procedures. Trends The most common challenge for prospective patients is to differentiate between quality and price when choosing a LASIK surgeon. Not surprisingly, prospective patients are usually looking for a combination of high quality surgery at a low price. 41 Choosing a LASIK surgeon should not be a decision based on price, the type of laser or technology used or what is the most convenient location, it should be based on the surgeon’s experience and proven results. 42 Selecting a surgeon There are a few different things that people who are interested in getting LASIK should look for when finding a qualified surgeon. First of all, it is important to make sure 39 . LasikDisaster.com - LASIK: LASIK Risks Are Understated. 2009. Web. 10 Mar. 2011. http://www.lasikdisaster.com. 40 . Ibid, http://www.lasiksurgerynews.com/news/lasik-fear-cost-23aug07.shtml. 41 . Ibid, http://www.usaeyes.org/lasik/faq/lasik-striae.htm. 42 . Lasik, Goals For. "A Guide To Choosing A LASIK Eye Surgery Surgeon." Eye Care, Vision Correction, Contact Lenses, and Eyeglasses Guide. 2009. Web. 12 Dec. 2010. http://www.eyecaresource.com/procedures/lasik-laser-eye-surgery/choosing-a-lasik- surgeon.html. 20 the LASIK surgeon has state licensing, board certification and is a member of American College of Surgeons (ACS). 43 It is also pertinent to ask how many surgeries a doctor has performed as well as her/his success rates. 44 Statistics including success rates, percentage of complications and percentage of patients who need LASIK enhancements, are important to know; yet surprisingly many eye surgeons do not keep track of this information. It is also preferable to choose a surgeon that specializes in LASIK and performs the procedure exclusively or as a major part of his or her practice. 45 Lastly, prospective patients should investigate patient referrals which are seen as credible since these former patients have actually had the exact LASIK experience at the facility. 46 The remainder of this paper will focus on a specific LASIK practice, evaluating its current customer base and providing a detailed plan for continued growth. Company Overview Saddleback Eye Center was founded in 1980 by Dr. Charles C. Manger III, M.D., who currently serves as its Medical Director and Chief Ophthalmologist. The center is located in Laguna Hills. Unlike many of its competitors, Saddleback Eye Center specializes in LASIK surgery exclusively. Dr. Manger is a Board Certified Ophthalmologist with experience in several types of refractive surgeries as well as 43 . Ibid, http://www.allaboutvision.com/conditions/astigmatism.htm. 44 . Ibid, http://www.allaboutvision.com/conditions/astigmatism.htm. 45 . Ibid, http://www.docshop.com/education/vision/refractive/lasik/choose-surgeon. 46 . Ibid, http://www.allaboutvision.com/conditions/astigmatism.htm. 21 cataract surgery, and has been specializing in LASIK since the procedure first came out in 1996. Having performed over 65,000 LASIK procedures during the past 15 years, Dr. Manger continues to add to that number, making him the second busiest LASIK surgeon in the United States and the busiest on the West Coast. 47 Studies show that complication rates decrease dramatically with increasing surgeon experience, so the more LASIK surgeries a surgeon has performed, the better. 48 After the LASIK procedure, 99.7 percent of Dr. Manger’s nearsighted patients see 20/25, 20/20 or better, while 98 percent of his farsighted patients see 20/25, 20/20 or better. Since its founding, Saddleback Eye Center has progressively changed its marketing techniques. Quick, detailed and effective marketing is key to the Saddleback Eye Center because the LASIK procedure must sometimes be explained to prospective patients within a relatively short time frame and in a way that conveys the efficiency, attention to details and fine customer service quality the center offers. Saddleback Eye Center has previously used advertisements in print media and other traditional media categories, but has found, through its meticulous tracking of referral sources, that the best ways to reach the largest numbers of potential LASIK patients in a timely manner are 47 . “AMO Letter”, December 11, 2008, signed Regan Pierce 48 . "How to Choose a LASIK Surgeon." Local LASIK Eye Surgery Price Quotes - Complete LASIK Guide. 2009. Web. 14 Mar. 2011. http://www.lasik.md/learnaboutlasik/choosingasurgeonintroduction.php. 22 patient referrals, patient newsletters, LASIK seminars, Internet and radio advertising. Overall, television and print ads are less effective modalities for advertising LASIK in the Southern California media markets. II. BUSINESS GOAL A. To increase number of Saddleback Eye Center prospective and actual LASIK patients III. STATEMENT OF PROBLEM A key challenge for the Center is to help patients recognize that the price of a LASIK procedure is the least important factor when deciding where to have the surgery done. 49 It is equally difficult to convey to patients what high medical quality Saddleback Eye Center offers, until they actually visit the office. The initial LASIK consultation is the best opportunity to inform a patient about LASIK, its risks, and how this all applies to the individual. 50 For example, every prospective patient undergoes a series of 14 tests, all of which he or she must pass to be considered a suitable LASIK candidate. This thorough medical investigation gives prospective patients a good idea of Saddleback Eye Center’s meticulous attention to detail, cutting-edge technology and individual patient care. 49 . Dunn, Kathryn E. Ophthalmology Management. 2010. Web. 10 Mar. 2011. http://www.ophmanagement.com/article.aspx?article=85045. 50 . Ibid., http://www.eyecaresource.com/procedures/lasik-laser-eye-surgery/choosing-a- lasik-surgeon.html. 23 Gaining a better understanding of the LASIK procedure and the overall experience of prior patients is definitely something that potential patients value, which is why every exam room features patient testimonial booklets. Watching a LASIK procedure is also encouraged and prospective patients can do so in the patient education center, where live LASIK procedures are shown several times per day. The high level of patient care is demonstrated by the fact that three doctors, participate in the initial examination process. Saddleback Eye Center’s main challenge is to convince prospective patients before they visit the center that quality of care considerations should take precedence over price. IV. RESEARCH METHODOLOGY Research Goals 1. To determine how the Diffusion Theory can be effectively applied to the LASIK industry and how it applies to marketing LASIK. 2. To ascertain how most people gather information on LASIK and subsequently choose a surgeon(s) for a LASIK consultation and procedure. 3. To find out how and where LASIK patients first hear about the LASIK procedure and what sources they then go to in order to gain more knowledge about the surgery. Research Goal 1: To determine how the Diffusion Theory can be effectively applied to the LASIK industry and how it applies to marketing LASIK. 24 The Diffusion Theory provides useful insight into how prospective LASIK patients research when looking around for LASIK centers, since practices can maximize their marketing effectiveness by identifying these trends in LASIK consideration. Diffusion Theory is a six-step process and can be used to describe how new ideas affect a population. In this case of this thesis, the theory is applied to the new idea (LASIK) to examine its effects on the target population (prospective LASIK patients), by looking at awareness, information, evaluation, trial, adoption and reinforcement. 51 Examining every step in the process is essential in trying to understand how people go about choosing when and where to have LASIK. The ways in which patients move through the six-step process (awareness, information, evaluation, trial, adoption and reinforcement) vary in terms of length and influences. Awareness, the first step of the Diffusion Theory, is when a person learns about the concept of LASIK but still lacks details. 52 This initial awareness may come from experts, agencies, friends, neighbors, salespeople or mass media such as the Internet, 51 . Garson, David G. "Diffusion Theory." Quantitative Research in Public Administration. 2006. Web. 5 Mar. 2011. http://faculty.chass.ncsu.edu/ garson/PA765/diffusion.htm. 52 . Greene, Lawrence W., Judith M. Ottoson, Cesar Garcia, and Robert Hiatt. "Diffusion Theory and Knowledge Dissemination, Utilization, and Integration in Public Health." Annual Reviews. 2009. Web. 11 Mar. 2011. http://www.annualreviews.org/doi/abs/10.1146/annurev.publhealth.031308.100049. 25 radio, mailers and magazines. 53 In the awareness phase a person has learned about the idea of LASIK, but has not yet decided to gather more information about this idea. 54 Awareness of LASIK often make people interested in learning more, which will lead them to seek information and enter the second phase of the Diffusion Theory. When people seek to find out more about LASIK, they become interested in the procedure and also often begin to seriously contemplate LASIK as an option for themselves, a family member or a close friend. Just like during the initial awareness step, the most common media resource for seeking information is the Internet. The Internet has become increasingly popular among consumers as a source of health care information, particularly in the last few years. 55 Because there is no governing body that monitors Web publications, there are no guarantees that information about LASIK found in the Internet is credible. 56 Despite the credibility issue, the Internet is nevertheless the major source of information people looking into LASIK. The third step of the Diffusion Theory is evaluation. During evaluation, a potential patient considers LASIK while simultaneously weighing other alternatives such glasses or contact lenses. The opinions of family, friends and neighbors often influence 53 . Gailmard, Neil B. Optometric Management. 2001. Web. 1 Dec. 2010. http://www.optometric.com/article.aspx?article=70084. 54 . Diffusion Theory worksheet (Jerry Swerling) 55 . "LASIK Complications and the Internet: Is the Public Being Mislead?" Journal of Medical Internet Research. 2003. Web. 15 Mar. 2011. http://www.jmir.org/2003/1/e2/. 56 . Ibid., http://www.jmir.org/2003/1/e2/. 26 the evaluation process. 57 Since these are personal relationships, the ensuing conversations about LASIK are usually driven by emotion rather than fact and often turn the evaluation into a volatile process. Moreover, despite the fact that family, friends and neighbors often lack any expertise or actual experience of LASIK, their opinions are taken into serious consideration by the prospective patient. Typically, interest in LASIK will only persist through the evaluation phase if these third party judgments are primarily positive. Only those people sincerely interested in LASIK will continue to trial, which is the fourth step of the process. Trial begins when a potential patient contacts LASIK facilities and schedule exams to discern LASIK candidacy for themselves. A patient usually enters this phase with many questions about LASIK and seeks answers during the initial consultation. Thus, in this trial period, the salesperson or representative with whom the prospective patient interacts will be most influential. A prospective patient who feels confident and comfortable with the staff during a consultation is likely to schedule a LASIK examination or even have the procedure that same day. However, if a potential patient has a negative consultation experience, that person may consult with other facilities or halt all consideration. 58 For some people, the diffusion process may 57 . Ibid., Diffusion Theory worksheet, (Jerry Swerling) 58 . "MODELING FROM MASS MEDIA | Theories of Communication." Free Books Online. 2008. Web. 13 Mar. 2011. http://free-books- online.org/mastering_communication/theories-of-communication/modeling-from-mass- media/. 27 end here if they feel that LASIK is not the right choice for them. But for those who are ready to undergo LASIK, the diffusion process continues. The fifth step, adoption, is when a person actually undergoes LASIK. Adoption occurs only when candidates decide to proceed with the LASIK procedure. During this phase, the patient is fully experiencing the innovation LASIK. 59 While full confidence in the LASIK surgeon is required during this phase, family, friends and neighbors continue to influence because they are trusted regardless of authority or knowledge. The adoption phase is a critical step in the diffusion theory, since adopting the idea completely is what all the other steps of contemplating LASIK have led up to. The final phase of the Diffusion Theory is reinforcement, which implies the need for steadfast post-surgery commitment from the LASIK center to make sure that patients believe they made the right decision. 60 A LASIK center can aid reinforcement by issuing referral certificates, mailing thank you cards and placing follow-up calls. Furthermore, successful LASIK facilities check on patients during this process to ensure that they are happy, adjusting well and have no unanswered questions. Another means of patient reinforcement is through patient referrals. Word-of- mouth is still the most valuable medium for quality confirmation, because patients convey if they made the right or wrong decision with LASIK. Reputation reflects a 59 . "Diffusion of Innovations." Wikipedia, the Free Encyclopedia. 2007. Web. 11 Mar. 2011. http://en.wikipedia.org/wiki/Diffusion_of_innovations#CITEREFRogers1964. 60 . "Applying Diffusion Theory." The University of West Georgia. 2007. Web. 21 Mar. 2011. http://www.westga.edu/~byates/applying.htm. 28 surgeon’s skills, experience, and success. 61 A patient’s successful completion of reinforcement usually results in patient referrals to the LASIK procedure and to a particular LASIK center. From beginning to end, the entire customer service experience, including all staff interactions with the patient, are vital to reinforce a positive LASIK experience overall. Therefore, reinforcement is a key step for LASIK centers. When studying how potential patients proceed through the Diffusion Theory, it is critical for a LASIK center to study the key influencers of each step. Identifying and understanding the influencers is import for LASIK centers to reach the target audience and use effective messages. Research Goal 2: To ascertain how most people gather information on LASIK and subsequently choose a surgeon(s) for a LASIK consultation and procedure. Whether a person first hears about LASIK from an advertisement, a friend or a medical professional, subsequent research is always conducted. The best and most accurate way to research LASIK would be to consult a LASIK expert, but this is not the primary way that people seek out LASIK information. Most prospective patients first turn to other sources, particularly the Internet or friends and family. The FDA recommends a few websites that provide more factual and less biased information about LASIK than websites that are written by non-medical and non-professional people. These include; EyeSmart (American Academy of Ophthalmology and its partners), 61 . "How to Choose a LASIK Surgeon." Local LASIK Eye Surgery Price Quotes - Complete LASIK Guide. 2010. Web. 23 Mar. 2011. http://www.lasik.md/learnaboutlasik/choosingasurgeonintroduction.php. 29 ASCRS (American Society of Cataract and Refractive Surgeries), ISRS (International Society for Refractive Surgery) and the American Optometric Association. 62 There is an abundance of LASIK information available on the Internet and it can be difficult for people who are not LASIK experts to distinguish the reliable from the unreliable sources. 63 A Google search for “LASIK” returns thousands of results, including local listings, paid advertisements and top listings. One of the top search results is the United States Food and Drug Administration (FDA) website. The FDA’s LASIK page summarizes the procedure, lists Frequently Asked Questions (FAQs) and provides information on how prospective patients can determine if they are a good fit for surgery. 64 The FDA’s information about LASIK is very general and the site states that its “goal is to provide objective information to the public about LASIK surgery.” 65 While the FDA website lists all known precautions and possible complications associated with LASIK, it also provides sound advice and useful tips for how to continue 62 Ibid., http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/SurgeryandLifeSup port/LASIK/ucm061366.htm. 63 . Ibid., http://www.lasikmemorial.com/JMIR.htm. 64 . Ibid., http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/SurgeryandLifeSup port/LASIK/ucm061366.htm. 65 Ibid., http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/SurgeryandLifeSup port/LASIK/ucm061366.htm. 30 the research. It is important that prospective patients be aware of all the positive and negative aspects of LASIK, so they are well-informed before making any decisions. Often cited on anti-LASIK websites is a national news report by journalists Diane Sawyer and Lisa Stark of ABC. 66 The report is centered on an interview with Dr. Morris Waxler, a former FDA official who was working for the FDA during the approval of the LASIK procedure. Dr. Waxler was initially an advocate for LASIK, but changed his stance after several years. First, Dr. Waxler is introduced as “the official who led the drive to approve the procedure.” 67 In reality, FDA officials’ authority is limited to reviewing clinical charts and recommending or disapproving new medical procedures. 68 So leading a “drive” for a procedure is beyond the job and authority of FDA officials. Furthermore, Dr. Waxler states that “50 percent of LASIK patients have side effects and 33 percent continue to need glasses or contacts.” However, Dr. Waxler’s claim is unsupported by any medical literature or scientific study and his claim is further undermined by a 2009 ASCRS study that found a 99 percent satisfaction rate among LASIK patients. 69 66 . "The Dangers of Lasik - ABC News." ABCNews.com: Breaking News, Politics, World News, Good Morning America, Exclusive Interviews - ABC News. 23 Apr. 2008. Web. 4 Dec. 2010. http://abcnews.go.com/video/playerIndex?id=4709213. 67 Ibid., http://lasikblog.typepad.com/the_lasik_blog/2010/09/index.html. 68 Ibid., http://lasikblog.typepad.com/the_lasik_blog/2010/09/index.html. 69 Ibid., http://www.allaboutvision.com/conditions/astigmatism.htm. 31 Dr. Waxler’s statistics and data to defend his stance on warning patients against LASIK in a segment aired on MSNBC on February 19, 2001. He stated that when LASIK was first approved in 1996 there was only a 1 percent chance of adverse side effects and now, in 2011, there is a 20 percent chance of adverse side effects. When Dr. Waxler describes adverse effects he is mostly referring to dry eyes, and seeing glares and halos at night. The MSNBC interview with Dr. Waxler offers a significant takeaway lesson for LASIK centers. Since a significant portion of the general population is influenced by television news reports due to the medium's pervasiveness and ability to reach a large and varied audience, it can easily shape and sway opinions about a sensitive topic such as LASIK. 70 This influence proves to be especially strong when a trusted veteran journalist like Diane Sawyer presents the report. Additionally, since news programs sometimes straddle the border between information and entertainment, audiences are easily misled. 71 Stories about LASIK that highlight worst-case outcomes of the surgery are perhaps easier for journalists to do, but certainly are sensational and entertaining for consumers to watch. For organizations like Saddleback Eye Center, these stories are the most troublesome. 70 . Ibid., http://www.youtube.com/watch?v=RfpV89JZNYY. 71 . "Kathy Griffin on 'Glee' Mocks Palin and O'Donnell, Depicts Tea Party as Homophobic Birthers | NewsBusters.org." NewsBusters.org | Exposing Liberal Media Bias. 2011. Web. 14 Mar. 2011. http://newsbusters.org/blogs/noel- sheppard/2011/03/16/kathy-griffin-glee-bashes-sarah-palin-and-christine-odonnell- depicts-. 32 Another major component of LASIK-related content on the Internet is paid advertisements. Found especially on search engines, online advertising is typical of any industry. However, online advertising space usually allows for only a few words, which makes it difficult for online audiences to deduce what type of facility, category of doctor and quality of procedure the ad refers to. LASIK centers must effectively convey their messages to the public in ways that are unique and encourage people to schedule LASIK examinations and consultations. A better option for a potential patient to learn about the procedure, and one that more favorable for LASIK practices, are books and medical journals. Some well-known medical journals include the American Journal of Ophthalmology, Ophthalmology Times and Archives of Ophthalmology, which can serve as reliable sources. But medical journals are more difficult to access because of their paid subscription requirements. Furthermore, articles in medical journals are written for medical doctors and contain jargon and concepts that can be difficult for the average person to understand. But if one is familiar with medical terms pertaining to the eye care and LASIK, these journals can be valid and reliable sources of information on LASIK. The viewpoint of a medical journal can best be described in the words of Dr. Richard Lindstrom: “It is important for the dissatisfied LASIK patient to know that we, as LASIK surgeons, are listening, that we hear them, that we care, and that we are responding in a tangible and constructive fashion.” 72 This statement is a great example of how medical journals address all sides of 72 Ibid., 14. 33 LASIK and medical professionals answer all questions that surface, which is usually not the case with general inquiry websites on LASIK. Consulting books and journals require access to a library with current books on LASIK, or better yet, a medical school library. Medical periodicals that publish current studies and findings in the LASIK field include “Ophthalmology Times,” “ASC Review,” “Primary Care Optometry News,” “Ocular News” and “Cataract & Refractive Surgery Review.” Two comprehensive books on LASIK are “Casebeer Incisional Keratotomy,” and “The Art of LASIK.” Written by several ophthalmologists, these books are thorough, fact-based and help readers understand the procedure. However, in comparison to the ease and speed of Internet research, book and journal research seems an arduous and inconvenient task. While the Internet is the most commonly used tool for preliminary research, prospective patients conducting further research are more likely to call or personally visit a LASIK center than to consult books or medical journals. 73 LASIK centers must effectively market to steer these later-stage inquiries in their direction and get prospective patients to sign up for consultations. Research Goal 3: To find out how and where LASIK patients first hear about the LASIK 73 . Contributor, An EHow. "How to Research Information for Lasik Eye Surgery | EHow.com." EHow | How To Do Just About Everything! | How To Videos & Articles | EHow.com. 2010. Web. 21 Mar. 2011. http://www.ehow.com/how_2054322_information-lasik-eye-surgery.html. 34 procedure and what sources they then go to in order to gain more knowledge about the surgery. To gather data specific to the proposed Saddleback Eye Center plan, the author interviewed Saddleback Eye Center’s Practice Administrator, Linda Riley, regarding the center’s past trends of message delivery and effectiveness. (See appendix) i. To consider Saddleback Eye Center’s marketing data and determine which of the four main referral sources (patient referral, patient newsletters, internet, or radio) is most effective in bringing patients in for LASIK exams. To further aid the development of a plan, the author analyzed Saddleback Eye Center’s past marketing data from message as well referral data and overall trends. Looking back at Saddleback Eye Center’s past marketing data reveals vital information regarding the effectiveness of different modes of marketing and how they have changed over the years. The analysis tracks the four major referral sources including: patient newsletters (mailers), word-of-mouth (patient referrals), radio and Internet. The value of the return that each of these sources bring in for every dollar spent on them has changed in recent years. Tracking changes in referral sources will allow Saddleback Eye Center to improve its messaging and allocate marketing funds more efficiently to reach target audiences in the media avenues where they are more likely to respond. • 2006 Return on every one dollar spent: o Patient newsletter: $3.36 for every $1 spent. 35 o Patient Referral: 33% of all profits, no money spent. o Radio: $2.25 for every $1 spent. o Internet: $1.35 for every $1 spent. • 2007 Return on every one dollar spent: o Patient newsletter: $1.98 for every $1 spent. o Patient Referral: 42% of all profits, no money spent. o Radio: $1.87 for every $1 spent. o Internet: $1.41 for every $1 spent. • 2009 Return on every one dollar spent: o Patient newsletter: $1.41 for every $1 spent. o Patient Referral: 45% of all profits, no money spent. o Radio: $1.92 for every $1 spent. o Internet: $31 for every $1 spent. A look at the marketing data starting five years back reveal changes in the revenue that each of these four facets bring back to the center. A major drop in the revenue brought in my direct mail between the years 2005 and 2006 is evident. In 2009, the patient newsletter brought in only about one-third of what it did to in 2005. Patient referrals have remained a major source in driving LASIK patients to Saddleback Eye Center. Radio has decreased slightly in how much return each dollar spent brings back, but still remains a major media avenue used to increase public awareness and drive profits. Since 2005, there has been a huge 36 increase in the return per dollar that the Internet brings back. This makes sense, as most people tend to do more research on the Internet since they can usually most easily access the largest amount of information from this source. As printed mediums are becoming more outdated and Internet more prevalent, since this change in what medium people utilize most in the recent years, is understandable. ii. Survey on how patients researched LASIK. The survey was distributed randomly to 50 patients who had LASIK with Dr. Manger. There were 27 females and 23 males surveyed, and the average age was 44 years old. The survey findings provide information about where people are getting information about LASIK. About half of respondents initially heard about LASIK through a family member or friend. After initially hearing about LASIK, over half of the 50 people surveyed continued to gather more information about LASIK on the Internet. Most people who sought information on the Internet used search engines and typed in phrases such as: LASIK, LASIK eye surgery and LASIK Orange County. Of the 27 people who said they conducted Internet research, a little less than half of them read blogs. In general, the respondents who read blogs found that the information was mostly positive, but some found blogs that were more negative in tone. One of the questions that gave the most illuminating answers was asking how long it took the patient to actually get the LASIK procedure from the time they initially heard of this surgery. Twenty-four out of 50 patients said it took years to make the decision. The average time was 5.7 years. There were a few patients who only spent a day or a few weeks researching before following through with their decision to have LASIK. The notion that 37 people wait an average of 5.7 years to get LASIK reinforce the previously mentioned study which suggests that only 15 percent of potential patients in the LASIK market have already undergone the procedure. For more specific survey findings, please see the appendix. 74 2. Secondary Research i. Financial activity summary sheets (see appendix). V. SITUATION ANALYSIS A. Saddleback Eye Center i. Strengths The founder of Saddleback Eye Center, Dr. Manger currently serves as its Chief Ophthalmologist and is the busiest LASIK surgeon on the west coast and second busiest in the world. Dr. Manger has performed over 65,000 LASIK procedures since the FDA approved the excimer laser in 1996 and claims expertise based on his high success rate; 99.7 percent of his patients see 20/20, 20/25 or better, post-LASIK. 75 Since Saddleback Eye Center has only one location, Dr. Manger is always on site and available for examinations or surgeries. Furthermore, patients are never sent off-site for surgeries or clinical examinations because the Laguna Hills facilities are all-inclusive. 74 . "Future Growth in LASIK: Understanding and Reaching Generation Y." SM 2 Strategic. 2008. Web. 24 Mar. 2011. http://www.sm2strategic.com/files/AMO%20Paper08_5.pdf. 75 . Sadddleback Eye Center, ed. Charles Manger. 38 State-of-the-art Custom Vue and Intralase technologies are used on every LASIK patient. Most elite LASIK centers offer one or both of these technologies, but most do not typically use both on every patients, despite the fact that using both results in the safest and most precise LASIK outcomes. These technologies combined, are also used by military pilots and astronauts, who need the clearest and most precise vision possible. 76 Additionally, an advanced tracking device on the laser, known as the Active Trak 3-D Eye Tracker, that tracks the patient’s eyes 60 to 400 times per second prevents any eye movement from interfering with the surgery. 77 Because of Saddleback Eye Center’s careful staff hiring process and meticulous training, staff members are genuinely committed to making patients feel welcome and at ease. Daily morning meetings with the entire staff and with many departmental meetings held throughout a typical week ensure that all staff members stay knowledgeable about LASIK and the multitude of LASIK related office procedures. Also, patient testimonial sheets are given to every LASIK patient and any feedback on staff, whether it is positive and negative, will be discussed at office meetings and taken into account to continually improve the LASIK experience for patients. 76 . "Ilasik." Abbott Medical Optics Inc. (AMO). 2010. Web. 22 Feb. 2010. http://www.amo-inc.com/products/refractive/ilasik. 77 . "Northwest Eye Surgeons: LASIK and Cataract Specialists." Seattle LASIK and Cataract Specialists | Northwest Eye Surgeons. 2011. Web. 15 Mar. 2011. http://www.nweyes.com/spec01b_10.html. 39 iii. Weaknesses For people who live far from Laguna Hills and want to avoid commuting, Saddleback Eye Center’s location is problematic. 78 The Laguna Hills location is deemed “too far” for some prospective patients in Riverside, San Diego or Los Angeles counties, who are under the impression that post-operative care will be rigorous and frequent. Radio advertisements can be potentially misleading to prospective patients who might believe that Dr. Manger is a “celebrity doctor.” Their fear might be that they will not receive personalized attention or specialized care. People often trust unreliable sources of LASIK information, such as the Internet and family or friends, who might actually know very little about the procedure. 79 Unreliable sources can range from paid advertisements that skew a surgeon’s experience and record of successful surgeries, to blogs written by LASIK patients or others who have no expertise. Websites or blogs published by a non-professional or uninformed sources can be problematic since they often lack credibility and might publish misinformation about LASIK. Also, specializing in LASIK can be considered a weakness since the facility cannot help people who are in need of other refractive procedures. 78 . Ibid, http://www.seewithlasik.com/docs/lasik-dry-eyes.html. 79 . "Why Choose a Trusted Lasik Surgeon?" LASIK Surgery, Laser Eye Surgeons, Cataract Surgery Why You Select a Trusted LASIK Surgeon. 2007. Web. 17 Mar. 2011. http://www.trustedlasiksurgeons.com/why_use_a_trusted_lasik_surgeon.htm. 40 iii. Opportunities Saddleback Eye Center’s 20/20 Promise is an advantageous marketing opportunity to promote interest in LASIK at Saddleback Eye Center. With the 20/20 Promise, Dr. Manger is setting the bar high for Saddleback Eye Center and the entire LASIK industry, because it promises to live up to LASIK patient’s best possible hopes of perfect vision, or they get their money back. In today’s challenging economic climate, this is a great chance for letting people who are interested in LASIK know that Saddleback Eye Center promises the best possible results for their money. This approach emphasizes quality and not price, which is pivotal to what Saddleback Eye Center stands for. Another good marketing opportunity for Dr. Manger is to become the most in- demand LASIK surgeon in America by performing more surgeries in 2011 than in 2010. The new 20/20 Promise campaign presents a challenge and an opportunity for Saddleback Eye Center to find more media avenues in which to create consumer recognition of Dr. Manger as a provider of the highest quality LASIK. iv. Threats All the criticism of the LASIK procedure is definitely a threat to the LASIK industry. Negative criticism of all types can be found on the Internet, in journals, in TV interviews and elsewhere. A significant number of people uncritically accept information about LASIK found on the Internet. 80 The pervasiveness of LASIK criticism on the 80 . http://lasiksurgeryusa.blogspot.com/2008/04/dangers-of-laser-eye-surgery-yes- there.html 41 Internet is dangerous to the industry because sometimes it only takes one horror story about LASIK to scare people away from LASIK, even if there are 100 positive stories for every negative one. 81 Competing LASIK centers are copying Saddleback Eye Center’s marketing tactics and are increasing their market share of LASIK patients in the process. Other competing LASIK centers advertise low prices to attract uninformed and easily persuaded consumers. 82 In these economically uncertain times, people are particularly concerned with how and where they spend their money. Many times prospective patients will decide on settling for LASIK of a lower price but also of lower quality. The possibility of another good quality LASIK facility opening within a few miles of Saddleback Eye Center is a growing threat since several new LASIK facilities have opened recently in the Orange County area. Some people who are not well informed about LASIK might be fearful of the process as well as the risks and side effects of LASIK. Fear is the number one reason that prevents people from undergoing LASIK procedure. A recent survey by Refractive Surgery News found that of the people polled: 57 percent feared an unfavorable outcome, 81 . Ibid., http://lasiksurgeryusa.blogspot.com/2008/04/dangers-of-laser-eye-surgery-yes- there.html 82 . Ibid., http://ezinearticles.com/?Breaking-Down-LASIK-Eye-Surgery- Cost&id=1499110. 42 54 percent feared post-surgical side effects, 53 percent feared the lack of adequate information, and 49 percent expressed a general fear of medical procedures. 83 The Dr. Morris Waxler interviews on both ABC and MSNBC news continue to be a threat to the LASIK industry, especially since he was one of the FDA officials who helped get LASIK approved. To have someone of Dr. Waxler’s stature be so strongly against the procedure is definitely a red flag to consumers. This threat is not going away, as the FDA launched a study on LASIK in 2010. The FDA study focuses on three major facets: a web-based questionnaire to evaluate patient-reported negative outcomes that impact the quality of life after LASIK, Patient-Reported outcome study to be done by US military personnel at one, three and six months after LASIK, and a national multicenter clinical study. 84 The FDA studies are certainly a threat to the industry as a whole as it brings skepticism of the LASIK procedure into public view. b. LASIK consumer behavior overview Understanding LASIK consumer behavior is a critical component to Saddleback Eye Center’s business model. The number one obstacle in consumer behavior is a common misconception of what makes a LASIK experience “quality”. It is important that patients are taught how to define quality LASIK. Patients that have been to several LASIK facilities often have an easier time comparing quality of care. Since they have 83 Ibid., http://www.lasiksurgerynews.com/news/lasik-fear-cost-23aug07.shtml. 84 "FDA Outlines 'Secret' LASIK Study Details 10/19/2010." LASIK Newswire. 2010. Web. 5 Feb. 2010. http://www.lasiknewswire.com/2010/10/fda-outlines-secret-lasik- study-details-10192010.html 43 been through the exam process at two or more facilities and have noticed the similarities and differences throughout this process, these patients recognize how the interaction with staff and the surgeon might differ and will know where they feel most comfortable overall. By considering comments from every single patient, including the patient testimonial forms, Saddleback Eye Center can assess the strong points and identify the weak points in the overall LASIK experience. Price shopping and fear are the two most problematic consumer behaviors Saddleback Eye Center faces. By understanding what motivates and concerns consumers, employees can better handle and manage challenging consumer behavior. Saddleback Eye Center has progressively changed its marketing techniques to meet new challenges. Quick yet efficient marketing is key because the LASIK procedure must be explained to prospective patients rather quickly and in a such a way that they will recognize the efficiency, attention to details and fine customer service quality that Saddleback Eye Center offers. c. Trends Overview Saddleback Eye Center is accustomed to a variety of LASIK patients. During the first few years of LASIK treatments, patients were often fearless and motivated. Chronologically, the next group of patients started seeking LASIK in 2002, when Custom Vue and Intralase technology emerged and eliminated the need to use metal blades in the surgery. Like the early adopters, this group of patients was also motivated to get LASIK and encouraged by the new bladeless procedure. Today, it has been years since that important technological jump and one of the major patient groups are people with LASIK 44 fear who researched the procedure for years before feeling comfortable enough to consider it for themselves. d. Issues Overview i. Price — The financial concerns of potential patients are an everyday issue for Saddleback Eye Center. If employees quote a price to prospective patients over the phone, it would be nearly impossible to get some of them to come in because many shop around for LASIK centers based on price alone. 85 Employees need to avoid giving out the price to potential patients before a consultation and instead convince them to schedule a complimentary LASIK exam. During the initial phone conversation, it is the responsibility of the employee to emphasize following message points: Dr. Manger’s extensive LASIK experience and his success rates, the LASIK technology used, the post- operative care and the fact Dr. Manger is involved in every step of the process. It is key that those people who inquire about LASIK go through the initial LASIK exam to meet with Dr. Manger and experience Saddleback Eye Center’s commitment to quality. The average price of LASIK listed on the official Vision Service Plan (VSP) website is $2300 per eye, when CustomVue technology is used. 86 This price varies greatly depending on the surgeon’s experience and the LASIK technology used. Therefore, it is best for patients to come in for a LASIK exam, see what the facility is like and meet the surgeon instead of basing the decision solely on price. 85 . Ibid, http://www.allaboutvision.com/conditions/astigmatism.htm. 86 Ibid, http://www.vsp.com. 45 ii. The family and friends fear factor — Another issue that might occur after a patient has come in for an exam and already scheduled a LASIK procedure, is that they are sometimes discouraged by friends and family, who cite such factors as price or personal experiences. These outside sources tend to make potential patients second-guess their decisions and this typically leads to them delaying or cancelling their surgery. 87 e. Competitive Analysis To obtain information about competing facilities in Southern California, Saddleback Eye Center staff members mystery shop at 42 different LASIK centers once or twice per year in Orange County and the surrounding areas of Los Angeles and San Diego. Each public relations assistant at Saddleback Eye Center has a notebook with detailed information about the competitors, which is used in developing pre-counseling and consultation guides. The 42 centers that are included in the competitor notebooks are chosen because they are the best-known LASIK surgery centers in Southern California. In this assessment of the competition, staff also uses Yelp.com, a popular customer- review website, to review the other LASIK facilities based on punctuality, helpfulness, knowledge and overall quality. Ratings on Yelp.com are based on a scale of one through five, with one being poor and five is the best. Dr. Manger and Saddleback Eye Center have 15 reviews on Yelp, with an average rating of almost 4 stars. Saddleback Eye 87 . "Has Anyone Had Lasik Eye Surgery and Has Continued to Have Good Vision after a Number of Years? - Yahoo! Answers." Yahoo! Answers - Home. 2010. Web. 10 Mar. 2011. http://answers.yahoo.com/question/index?qid=20100604133236AAuuUiR. 46 Center has been reviewed by three times more people than any surgeon on the competitors list (see below). The following four LASIK facilities reviewed in a competitive analysis are the most substantial competitors to Saddleback Eye Center. It is difficult to get customer satisfaction data from these centers because they do not want to give this information to competitors and risk losing their competitive edge. The competitor assessment is based on observations made by Saddleback Eye Center’s secret shoppers and on customer reviews and ratings on Yelp.com and Facebook. i. Laser Eye Center (Dr. Fahd and Dr. Shamis) - Cost o $1000-$2420 per eye depending on what technology is used. o One year financing available. - Technology o Allegretto, Ladar 4000, Nidek, microkeratome blade, Intralase and Wavefront. o The chosen blade depends on the patient’s prescription. - Surgeon experience and practice o Dr. Fahd and Dr. Shamis are both board certified ophthalmologists with 23 years of experience each. The two of them have completed 250,000 LASIK procedures (This is what the receptionist stated, but no official documents prove this number). 47 o There are no certain days of the week allotted to LASIK, just according to when patients schedule. o Performs an average of five LASIK procedures per day. - Aftercare o Post-op care is offered for six months, but does not cover the antibiotic drops. o If an LASIK enhancement is necessary after the six-month follow-up care ends, the cost is $150 per eye, but only if enhancement is deemed necessary. - Consultation o Lasts about 90 minutes. o It is complimentary, but the surgeon does not examine patients. - Staff o Staff was friendly, but not too knowledgeable and lacking solid facts and data. 88 - Customer Evaluations o The surgeons are not listed on Yelp.com. 88 . LASIK Competitor Book, Cherrise Snedden, Saddleback Eye Center, 2010. 48 o The Facebook page has zero likes and no interactive dialogue, which makes it difficult to gauge consumers’ feelings about the facility. 89 ii. NVISION (formerly TLC, prior to bankruptcy) (Dr. Tooma) - Cost o $1750- $2999 per eye. - Technology o VISX and Intralase only. o Custom Allegretto used. o Prices go up depending on what technology is used. o The blade is used on some patients. - Surgeon experience and practice o Dr. Tooma is a board certified ophthalmologist. He has done LASIK since 1994 and has performed 80,000 procedures. o Dr. Tooma performs LASIK procedures on Wednesday through Friday, averaging thirty procedures a day. o Only performs LASIK. 89 "Laser Eye Center | Facebook." Welcome to Facebook - Log In, Sign Up or Learn More. 2011. Web. 16 Mar. 2011. http://www.facebook.com/pages/Laser-Eye- Center/173489465998588. 49 - Aftercare o Post-op six months of follow-up care is included. After six months, patients must have check-ups with regular doctors in order to meet the center’s requirements for the lifetime guarantee. - Consultation o Lasts 45 to 60 minutes. o Consultations are complimentary, but patients do not meet the surgeon unless requested. o Consultations are on Wednesday through Friday. - Staff o The person on the phone was pretty knowledgeable, but not very helpful; most answers revolved around the “lifetime guarantee” eligibility requirements. 90 - Customer Evaluations o On Yelp.com, Dr. Tooma has an overall rating of 5, but only 2 people have rated him. o Facebook page has 273 likes. They have a very interactive Facebook page where patients post testimonials online. The postings all seem to be on the positive side. 91 90 . Ibid., Snedden, 16. 91 "NVision Laser Eye Centers | Facebook." Welcome to Facebook - Log In, Sign Up or Learn More. 2011. Web. 01 Apr. 2011. http://www.facebook.com/NVISIONCenters. 50 iii. Excel Laser Vision (Dr. Moosa) - Cost o Starts at $1475 per eye, but depends on prescription. o Current promotion offer of less than $5000 for both eyes. o Financing is available. - Technology o Blade, Intralase and Allegretto. o Wavefront technology is used. o Blade is used depending on cost of surgery and what type of surgery is necessary. - Surgeon experience and practice o Dr. Moosa is a board certified ophthalmologist. He has performed LASIK for 11 years and has done 60,000 procedures. o Does LASIK surgeries on Wednesday in Encino and Thursday in Newport Beach. o Performs about 12 to 15 surgeries per day. o Dr. Moosa conducts the initial consultation. - Aftercare o Discussed with the patient in the office and determined on an individual basis. 51 - Consultation o Lasts about 90 minutes and is complimentary. o Dr. Moosa only meets with the patient if it is requested. - Staff o The representative on the phone gave contradictory information by first saying that Dr. Moosa personally conducts each consultation and then stating that the patient only consults with Dr. Moosa if requested. 92 - Customer Evaluations o On Yelp.com, Dr. Moosa has an average rating of 5, with five people having rated him. o Facebook page has 30 likes. Facebook conversations are very one-way, with posts only about the center, directed at consumers and almost no interactive dialogue. 93 iv. Advanced Eye Medical Group (Dr. Ghosheh) - Cost o $1400-$2400 per eye. o Financing is available through Care Credit. 92 . Ibid, "NVision Laser Eye Centers | Facebook." Welcome to Facebook - Log In, Sign Up or Learn More. 2011. Web. 01 Apr. 2011. http://www.facebook.com/NVISIONCenters. 93 . "Excel Laser Vision Institute | Facebook." Welcome to Facebook - Log In, Sign Up or Learn More. 2011. Web. 01 Apr. 2011. http://www.facebook.com/pages/Excel-Laser- Vision-Institute/31445657703. 52 - Technology o Only VISX, Custom Vue and Intralase. o Wavefront technology is used. o No blade is used. - Surgeon experience and practice o Dr. Ghosheh is a board certified ophthalmologist who has performed LASIK since 1994. He “stopped counting [his number of surgeries] after 30,000 surgeries.” (Website claims he has done 40,000.) o He does LASIK on Fridays only, typically five to 10 procedures a day. o He performs LASIK, surface procedures, corneal transplants, cataracts and lens implants. - Aftercare o One year of follow-up care includes enhancements up to one year. - Consultation o Sixty to 90 minutes at no cost. o Patients meet the surgeon during the exam. 53 - Staff o The person on the phone was nice and knew a sufficient amount of information, but was not very professional in terms of important technical facts. 94 - Customer Evaluations o On Yelp.com, Dr. Ghosheh has an average rating of 3.5. Three people have rated him. o Facebook has 24 likes. All content is by the office and there is very little to interaction with the Facebook community. 95 VI. Case Study: Re-launching Saddleback Eye Center with a new messaging campaign The new campaign is designed to increase visibility and attract patient attention by promoting Saddleback Eye Center’s new 20/20 Promise. This campaign emphasizes quality results instead of price. Since Saddleback Eye Center stands for quality and seeks to help patient understand this essential point, a campaign like the 20/20 Promise is well suited for the center. This campaign is designed to convince patients to put their trust and confidence in Dr. Manger’s LASIK expertise. The campaign focuses on the best possible 94 . Ibid, "Excel Laser Vision Institute | Facebook." Welcome to Facebook - Log In, Sign Up or Learn More. 2011. Web. 01 Apr. 2011. http://www.facebook.com/pages/Excel- Laser-Vision-Institute/31445657703. 95 . "Advanced Eye Medical Group | Facebook." Welcome to Facebook - Log In, Sign Up or Learn More. 2011. Web. 01 Apr. 2011. http://www.facebook.com/pages/Advanced- Eye-Medical-Group/102961008407. 54 outcome for LASIK patients: getting perfect vision. The 20/20 Promise guarantees that the patient has 20/20 vision by the time their post-operative visits finish (two years after date of procedure) or they will be fully refunded. The 20/20 Promise campaign places a focus on quality instead of price promises, helps the public recognize the importance of quality LASIK and, most importantly, distinguishes Saddleback Eye Center from the bargain LASIK clinics. Some strategies of the new 20/20 Promise campaign are: • Reconfigure Saddleback Eye Center’s web presence to focus on promoting the campaign. • Distribute promotional materials to patients who previously visited Saddleback Eye Center for a consultation to get them to reconsider LASIK based on the 20/20 Promise. • All marketing materials should be consistent with Saddleback Eye Center’s new 20/20 Promise campaign. Campaign materials should be designed to create hype that attracts new patients and emphasizes how the new 20/20 quality commitment is an important event for Saddleback Eye Center. In the process, the campaign should seek to bolster Saddleback Eye Center’s credibility by stressing that patients cannot get that kind of careful attention and quality care anywhere else. • Create enthusiasm around the premiere of the 20/20 Promise by offering special post-operative packages to get people to schedule a consultation appointment at Saddleback Eye Center as soon as possible. These post-operative packages will be an extended range of coverage from Saddleback Eye Center after the 55 procedure, so this incentivizes people that they will get getting even more for their money. • Publicly promote the 20/20 Promise by initiating media publicity outreach that emphasizes Saddleback Eye Center’s success and longevity. • Use the bimonthly LASIK seminars at Saddleback Eye Center as a means to further promote the 20/20 Promise. Pre-Launch activities • Create a catchy branding slogan or phrase for Saddleback Eye Center to help boost hype for the new 20/20 Promise campaign. • Reformat Saddleback Eye Center’s marketing materials, such as direct mailings and coupons, to focus on the 20/20 Promise. • Record new radio advertisements to promote the 20/20 Promise. • Pass out discount coupons to all LASIK seminar attendees. • Design promotional posters and banners for Saddleback Eye Center that highlight the new 20/20 Promise. Launch activities • Offer promotional packages for the launch of the campaign. Instead of a lower promotional price as an incentive to schedule a consultation right away, the promotion offers patients a longer post-operative period if they schedule within the first few months of the campaign launch. This extended post- operative period will incentivize people to take advantage of the premier of 56 this 20/20 Promise, which gives people more for their money without advertising price. • Begin circulating the campaign promotional products (pens, magnets, sunglasses, etc.). • Start airing new campaign radio advertisements aimed at inspiring potential patients to take advantage of the 20/20 Promise. • Continue to offer and distribute special prizes at Saddleback Eye Center- hosted LASIK seminars that focus on the 20/20 Promise, the center’s quality experience and the optimal results that are now available to all patients. Post-launch activities • Continue to use the 20/20 Promise campaign to keep momentum. Display a number of positive patient testimonials on the main website, on Facebook, in advertisements and in office testimonial books, so that people who are contemplating getting LASIK can hear about the experiences of those who already took advantage of this offer. • Communicate that consultation schedules are filling up as interest in the 20/20 Promise continues to peak, to make people who might be interested feel that it is urgent to schedule their own appointments. • Circulate campaign marketing materials to maintain an interest in the new 20/20 Promise premiere package to make people curious and encouraged to seek more information about LASIK. 57 VI. COMMUNICATIONS GOALS A. To motivate prospective LASIK patients to visit Saddleback Eye Center for a complimentary LASIK exam to find out if they are good candidates for the procedure. B. Persuade prospective patients that are found to be good LASIK candidates to undergo same-day LASIK. If a candidate declines to undergo the same-day procedure, get him or her to schedule a future LASIK procedure at Saddleback Eye Center. C. To educate prospective and current patients about the superior quality of care, treatment and experience that Saddleback Eye Center offers, including the new 20/20 Promise. VII. OBJECTIVES • Increase awareness about Dr. Manger’s 20/20 Promise and the quality LASIK experience Saddleback Eye Center provides among people researching LASIK. • Improve prospective patients’ perception of how patient-friendly LASIK is and how beneficial the procedure would be to their lifestyle. The 20/20 Promise promotion should instill them with trust in Saddleback Eye Center. • Raise awareness among potential patients’ about Dr. Manger’s success rate and reputation to ensure that they visit Saddleback Eye Center rather than its competitors. • Increase annual number of same-day LASIK procedures. • Increase annual number of LASIK exams. 58 • Increase number of phone inquiries, which will in turn yield a higher number of scheduled appointments and ultimately more surgeries. • Increase number of seminar attendees. • Decrease office “no-show” rates on LASIK exams. VIII. KEY AUDIENCES A. Those who are interested in LASIK, but have delayed due to fear. B. Those who are interested in LASIK and are currently researching facilities, but are unable to decide where to have LASIK. C. Those who have researched LASIK and who value quality over price, but have not been educated on how to measure quality. D. LASIK skeptics. IX. Key Messages A. Saddleback Eye Center is the premier LASIK center in Southern California and so vested in quality that its 20/20 Promise is now being made to all patients. B. Saddleback Eye Center is a well-established LASIK center committed to giving every patient the best quality LASIK results and experience. C. LASIK has the ability to improve quality of life. D. Saddleback Eye Center staff treat every patient as an appreciated customer and go out of their way to give every patient the best LASIK experience. 59 E. Patients who invest their confidence and trust in Saddleback Eye Center will be guaranteed 20/20 results. If not, they get their money back. X. STRATEGIES A. Motivate patients who are fearful and undecided about LASIK to come in for an exam now that the 20/20 Promise is made to all patients. B. Revitalize enthusiasm among patients who have had only a preliminary exam, using the new 20/20 Promise campaign, prizes at LASIK seminars, special mailing promotions, the website and Facebook. C. Offer promotional 20/20 Promise packages during the launch that include an offer of a longer post-operative period as an incentive for people to visit Saddleback Eye Center to see if they qualify for LASIK. The promise packages will attract potential patients who are concerned about money as well as quality of results. D. To leverage social media and web-based tools as a means to guide potential patient’s research and help educate them on how to determine quality LASIK from bargain LASIK. E. To effectively position Saddleback Eye Center’s messaging to reach people who want a quality experience and the best possible LASIK results. F. To leverage the “20/20 Promise,” by engaging audiences in interactive media such as Facebook, Twitter, etc. to gain momentum and success for this new marketing campaign. [this is a strategy] 60 XI. TACTICS A. Pre-Launch 1. Redesign Saddleback Eye Center’s image to emphasize the 20/20 Promise campaign. 2. Make the website more interactive. Add a quick online questionnaire that can determine if people initially qualify for LASIK exams. Also include a website function where people can connect live with a Saddleback Eye Center employee who will answer all of their questions and concerns about LASIK. 3. Offer special promotional packages to increase the incentives for consumers to come into the office at the beginning of the new 20/20 campaign. This includes offering an extended post-operative period of six additional months (on top of the standard two year post-operative period) to patients who come during the first six months of campaign. 4. Hold raffles via the company website and Facebook for patients who submit testimonials about their Saddleback Eye Center LASIK experiences. Three winners bimonthly will win prizes such Visa gift cards and discounted LASIK certificates that they can give to friends and family members. 5. Use key messages in marketing materials to promote the 20/20 Promise. 6. Send 20/20 Promise postcards to qualified patients who have had the preliminary exam within the past 4 years and offer them the special 20/20 Promise package that includes the extended post-operative period. 7. Raffle off special 20/20 Promise premiere packages at the LASIK seminars. 61 i. Social Media Tactics Facebook o Create contests for patients to submit testimonials of their experiences at Saddleback Eye Center to encourage people who are thinking about LASIK to go in for a complimentary exam. The top three winners will receive rewards, such as Visa gift cards, as a thank you for their inspirational testimonials. Contests should be renewed every two months as a way to sustain interest in the 20/20 Promise. o Have an iPad handy at Saddleback Eye Center so patients who come in for their post-operative visits can easily give and upload their testimonials to the Facebook page and the website. People researching LASIK value hearing about the first-hand experiences of others who have undergone the procedure. Testimonials help educate prospective patients and can lessen their fear of LASIK. o Respond to comments and feedback that people leave on the Facebook page, keep information current and monitor content. Start dialogue by posting Facebook posts with questions that people will want to respond to. Stay away from a one-sided business to consumer approach (only using social media to broadcast). o Announce on the winners of the 20/20 Promise Patient Testimonial contest on the website and Facebook. Include the winners’ names, testimonials and their rewards. 62 ii. Revamp Saddleback Eye Center Website o Redesign the front page to focus on the new 20/20 Promise. o Add a new platform of charts and graphs that offer a quick visual overview of the amount of LASIK surgeries Dr. Manger has completed and statistics on Saddleback Eye Center’s success rates. o Include an option where people can click to be connected to a Saddleback Eye Center phone lines/chat where they can easily ask questions about LASIK and get answers right away (during business hours). o Hold contests once per month throughout the entire first year of the 20/20 Promise for submission of patient testimonials. Patients who submit winning testimonials receive a substantial prize and are featured on the front page of the website. Another platform within the website will contain all submitted patient testimonials. These testimonials are important because patient feedback can boosts prospective patients’ confidence in Dr. Manger. iii. Search Engine Optimization Google o Add more phrases, such as “LASIK 20/20 Promise,” so that more Google users find Saddleback Eye Center’s website. If people hear about the 20/20 Promise campaign, but don’t remember the facility’s name, they should still be directed to Saddleback Eye Center. 63 Yelp o Saddleback Eye Center will give six-month post-operative patients a $10 dollar Starbucks gift card for writing a Yelp review. This is important so that Saddleback Eye Center can accumulate many more consumer reviews, since researching patients value reviews from other people. iii. Street Promotion (seminar and office celebrations) o Brightly colored posters, decorative elements and brochures should be placed around the office to highlight the new 20/20 Promise. o Pass out special 20/20 Promise promotional goods and materials to surrounding businesses. iv. Media outreach o Contact television shows that have previously featured Saddleback Eye Center, such as “Economic Report” and “Most Successful Business,” to pitch follow-up stories about Saddleback Eye Center’s new 20/20 Promise. o Invite radio and television personalities that have had LASIK at Saddleback Eye Center to attend and speak at the seminars. They will increase attendance and help drive publicity. iv. Direct Mailers o Send out new and brightly colored mailers to the residents of cities in Orange County to alert them of the 20/20 Promise. 64 v. Radio Advertisements o Air new radio advertisements announcing the 20/20 Promise on stations that Saddleback Eye Center currently advertise on. B. Launch • Air the new radio advertisements, circulate the direct mailers, promote the celebratory prices, offer new contests on Facebook and the website, hold seminars with the anniversary theme and decorate the office. • Pick new contest winners from Facebook and the website on a bimonthly basis, in addition to maintaining and updating these online spaces. • Begin media outreach. • Reinvigorate the anniversary celebration promotion by stressing that the special offer is ending in three months and the offer will not last. C. Post-Launch/ Sustain Even after the initial first six months, when the 20/20 Promise special packages offer has ended, efforts to boost Dr. Manger’s reputation should continue since the public will be either newly aware or freshly reminded of his long-term work and successful results. After the 20/20 Promise promotion is over, potential patients should be able to recognize Saddleback Eye Center’s credibility and feel a trust for the organization’s procedures. Although the Saddleback Eye Center 25th year anniversary and the promotional prices will have ended, knowledge of its successes and reputation will last. 65 XII. TIMELINE • March 2011 - June 2011: Begin Pre-Launch activities. • April 2011 - April 2012: Hold online contests for best patient testimonials, submitted to the company website and Facebook page. • April 2011 - October 2011: Begin the 20/20 Promise promotion by developing an improved company website, integrating Facebook and Twitter pages, decorating the office, running the new advertisements in print and on the radio, and distributing the promotional prizes. • January 2012 - December 2012: Distribute Saddleback Eye Center special 20/20 Promise packages promotional certificates (offering a 6-month extended post- operative period to patients that take advantage of this promotion within the first 6 months) to neighboring businesses to tap into their customer pool. • June 2011: Have John Kobylt, a KFI radio talk show host who underwent LASIK with Dr. Manger, speak at a LASIK seminar. • June 2011: Begin other media outreach to increase drive coverage about Dr. Manger and Saddleback Eye Center’s new 20/20 Promise. • November 2011 - April 2012: Launch the second half of the 20/20 Promise, to regain momentum and inspire potential patients to take advantage of the promotion while they still can. 66 XIII. EVALUATION The plan will measure success based on whether or not it met the following goals: A. To increase the number of people who undergo LASIK exams from the previous year. B. To increase the number of LASIK surgeries performed at Saddleback Eye Center from the previous year. C. To increase call volume during the launch period of the 20/20 Promise campaign. D. To increase “likes” on Facebook from 60 to 300. E. To update the Facebook page by allowing people to comment. Assign a staff member to monitor page and respond to all posts within 48 hours. Make Saddleback Eye Center’s Facebook presence highly interactive and engaging. Have patients at post- operative visits use an iPad in the office to post a testimonial of their experience on Facebook. F. To ensure that the number of people who respond to the 20/20 Promise promotional direct mailing is greater than the previous year’s responses. G. To achieve media coverage other than advertising in a local and major media outlets. H. To increase the number of seminar attendees from the previous year. I. To increase positive comments on Yelp.com during the first year of the 20/20 Promise. 67 XIV. CONCLUSION The success of the 20/20 Promise campaign will depend on how well Saddleback Eye Center conveys its message of quality to the public and engages them in a way that makes prospective patients want to take the next step towards better vision. Saddleback Eye Center must use messaging in a way that educates potential patients on how to identify what quality LASIK encompasses and how quality varies from surgeon to surgeon. How the audience engages with Saddleback Eye Center in its upgraded social media spaces during the 20/20 Promise campaign will also greatly affect the success of this campaign. Saddleback Eye Center should interact with people researching LASIK through social media and provide informational resources to help them educate themselves on the LASIK procedure. In the social media space, Saddleback Eye Center should emphasize that the best way to learn more is to schedule and exam and experience the LASIK examination process for themselves. Studying how people respond differently to messaging and using the Diffusion Theory process to study how people today adopt innovations (like LASIK) compared to 10 years ago is important to understand and take into account. The difference in marketing outlets’ efficiency has changed greatly within the past several years. Traditional marketing modes such as direct mailers have decreased greatly in returns in revenue. As people rely more heavily on the Internet as a primary research tool, the ways in which they move through the steps of the Diffusion Theory process have also changed. In general, since people increasingly rely on the Internet and information can be gained so quickly and easily that people, as a result, go through the Diffusion Theory process 68 quicker and schedule appointments sooner than before. This is why it is important for LASIK facilities to shift their messaging to be relevant and reach people online in such a way that they feel enough confidence in the facility to call and schedule an exam. To do this, LASIK facilities must establish a good reputation not only through word-of-mouth referrals, but also through an online presence. Building online audience engagement requires a strong reputation and starts with using messaging and credible information that makes potential patients gain knowledge and confidence in the facility. Prospective patients look for peer reviews, so the more previous patient feedback and testimonials they can find about a LASIK facility, the better. This is why Yelp reviews, Facebook posts, contests and more, must become a two-way interactive dialogue between the business and the consumer. The more that people can interact and learn, the more they will overcome their fears of LASIK and put their trust in a LASIK facility. Some LASIK facilities might have a hard time accepting that social media spaces can be used to create awareness because online dialogue cannot be fully monitored and controlled. But social media is an outlet LASIK facilities need to utilize in order to gain audience engagement, which is often converted into patients. In conclusion, it is important for LASIK facilities to convey, through their messaging, what it is they have to offer patients that no other facility has, and to highlight their uniqueness, especially in their online and social media spaces. LASIK facilities need to strongly convey to consumers what makes their facility and surgeon(s) stand out from for the competition and use those unique selling points as a means to incentivize potential patients to come in to the facility. Saddleback Eye Center’s new 20/20 Promise 69 campaign does exactly that and is centered on the high quality results Dr. Manger gives to patients based on his exceptional results and experience in this industry. These qualities distinguish Saddleback Eye Center from some competitors, who make their sales pitches based on their low prices. By centering its 20/20 Promise campaign on quality of results and offering patients a thorough experience before, during and after the procedure, Saddleback Eye Center can gain increased patient volume resulting in positive patient testimonials both in person and online. With the emphasis on Internet and social media presence continuing to grow, Saddleback Eye Center continues to update its marketing strategies and formulate its messages accordingly. By tracing years of statistics on what modes of communication attract most patients, Saddleback Eye Center rises confidently to the opportunity of channeling messaging most effectively to reach prospective patients in this increasingly interactive online space. 70 Bibliography "95 Percent Lasik Patients Satisfied: Study." AVOID BAD LASIK DOCS - Lasik Patient Advocacy Approved Doctors - Lasik Eye Surgery Info - USAEyes. 2009. Web. 2 Feb. 2011. <http://www.usaeyes.org/lasik/library/lasik-success-rate.htm>. "Advanced Eye Medical Group | Facebook." Welcome to Facebook - Log In, Sign Up or Learn More. 2011. Web. 01 Apr. 2011. <http://www.facebook.com/pages/Advanced-Eye-Medical- Group/102961008407>. "Advanced Eye Medical Group | Facebook." Welcome to Facebook - Log In, Sign Up or Learn More. 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Web. 12 Dec. 2011. <http://www.eyecaresource.com/procedures/lasik-laser-eye- surgery/choosing-a-lasik-surgeon.html>. "LASIK Laser Eye Surgery and Dry Eyes." LASIK Surgery Laser Eye Surgery LASIK Surgeon Vision Correction Costs & Facts. 2010. Web. 21 Nov. 2010. <http://www.seewithlasik.com/docs/lasik-dry-eyes.html>. "LASIK Risks." LASIK Eye Surgeon Directory - Guide to LASIK Costs, Risks, Benefits, Resources and More. 2010. Web. 21 Nov. 2010. <http://www.lasikeyesurgerycorrection.com/lasik_risks.html>. LasikDisaster.com - LASIK: LASIK Risks Are Understated. 2009. Web. 10 Mar. 2011. <http://www.lasikdisaster.com>. LASIK@Home. 2010. Web. 22 Feb. 2010. <http://www.lasikathome.com/>. Lee, Judith. "Astigmatism - What It Means, What To Do About It." Consumer Guide to Eyes, Eye Care and Vision Correction - LASIK, Contact Lenses and Eyeglasses. Dec. 2008. Web. 10 Nov. 2010. <http://www.allaboutvision.com/conditions/astigmatism.htm>. Machat, Jeffery J., Stephen Slade, and Louis E. Probst. The Art of LASIK. Thorofare, NJ: SLACK, 1999. Print. Mahdavi, Shareef. "Today’s Refractive Surgery Patient." Eyecare Educators: Continuing Education for Optometrists. 2010. Web. 3 Mar. 2011. <http://www.eyecareeducators.com/site/today_s_refractive_surgery_patient.htm>. "MODELING FROM MASS MEDIA | Theories of Communication." Free Books Online. 2008. Web. 13 Mar. 2011. <http://free-books- online.org/mastering_communication/theories-of-communication/modeling-from- mass-media/>. 75 "Night Vision Terminology & Definitions - Morovision Night Vision." Morovision Night Vision - Night Vision Goggles, Weapon Sights and Night Vision Equipment. 2010. Web. 15 Nov. 2010. <http://www.morovision.com/terminology.htm>. "Northwest Eye Surgeons: LASIK and Cataract Specialists." Seattle LASIK and Cataract Specialists | Northwest Eye Surgeons. 2011. Web. 15 Mar. 2011. <http://www.nweyes.com/spec01b_10.html>. "NVision Laser Eye Centers | Facebook." Facebook N Vision. 2011. Web. 14 Mar. 2011. <http://www.facebook.com/NVISIONCenters>. "NVision Laser Eye Centers | Facebook." Welcome to Facebook - Log In, Sign Up or Learn More. 2011. Web. 14 Mar. 2011. <http://www.facebook.com/NVISIONCenters>. "Overcoming Fear Of LASIK Surgery." Health Search Online. 2011. Web. 21 Mar. 2011. <http://www.healthsearchonline.com/overcoming-fear-of-lasik-surgery/>. "Radial Keratotomy (RK): The Vision Correction Website." LASIK, PRK, Intacs - The Vision Correction Website (PRK, LASIK, Intacs, RK, AK) - Laser Eye Surgery. 2010. Web. 12 Nov. 2010. <http://www.lasersite.com/RK/index.htm>. "LASIK and Refractive Surgery Timeline." Find Doctors for Breast Implants, Augmentation & Plastic Surgery | LocateADoc.com. 23 Aug. 2008. Web. 15 Nov. 2010. <http://www.locateadoc.com/articles/lasik-and-refractive-surgery-timeline- 1361.html>. Review of Ophthalmology. 2002. Web. 12 Dec. 2010. <http://cms.revophth.com/index.asp?page=1_214.htm>. Segre, LIz. "Eye Problems - Symptoms A to Z - AllAboutVision.com." Consumer Guide to Eyes, Eye Care and Vision Correction - LASIK, Contact Lenses and Eyeglasses. Mar. 2010. Web. 31 Mar. 2011. <http://www.allaboutvision.com/conditions/eye-problems.htm>. "September 2010." The LASIK Blog. Sept. 2010. Web. 6 Dec. 2010. <http://lasikblog.typepad.com/the_lasik_blog/2010/09/index.html>. Staff, Mayo Clinic. "Cataracts - MayoClinic.com." Mayo Clinic. 20 May 2010. Web. 14 Nov. 2010. <http://www.mayoclinic.com/health/cataracts/DS00050>. 76 "Understanding Custom All Laser LASIK." Crystal Clear Vision. 2009. Web. 15 Nov. 2010. <http://www.crystalclearvision.com/understandinglasik.asp>. VSP Home. 2010. Web. 10 Mar. 2011. <https://www.vsp.com/cms/edc/videos/refractive- surgery-overview.html>. "When Is LASIK Not for Me?" U S Food and Drug Administration Home Page. 16 Apr. 2009. Web. 18 Nov. 2010. <http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/Surgeryan dLifeSupport/LASIK/ucm061366.htm>. "Why Choose a Trusted Lasik Surgeon?" LASIK Surgery, Laser Eye Surgeons, Cataract Surgery Why You Select a Trusted LASIK Surgeon. 2007. Web. 17 Mar. 2011. <http://www.trustedlasiksurgeons.com/why_use_a_trusted_lasik_surgeon.htm>. 77 Appendix A LASIK Survey 1. How did you hear about LASIK for the first time? (CIRCLE ONLY ONE) • Family member/friend/neighbor • Mail • Newspaper/magazine • Radio • TV • Internet • Other_____________________________________________________ 2. After first hearing about LASIK, how did you next accumulate more knowledge or information on this procedure, before scheduling a consultation? (CIRCLE ONLY ONE) • Talked more to a family member/friend/neighbor • Internet • Medical Journal • Other______________________________________________________ 3. If you used Internet as a primary information source prior to a consultation, please list what term you typed into a search engine, and/or what websites you remember spending most of your time visiting? (i.e. LASIK Los Angeles) _________________________________________________________________ 4. If you used the Internet as an information source, did you read blogs about LASIK? • Yes • No *If yes, did you find the blogs to be more positive or negative? • Positive • Negative 78 5. How long did it take you from the time you first considered LASIK surgery for yourself until you had the LASIK procedure? (only if applies, otherwise skip) ________ Days. ________ Weeks. ________ Months. ________ Years. • Please circle your gender: MALE FEMALE • What is your age? _________ years old. 79 Appendix B Interview with Linda Reily • Q: In the 18 years you have worked as Practice Administrator at Saddleback Eye Center, have you seen a change in what marketing techniques are most effective in bringing in new patients? • LR: While we have seen a change in marketing techniques that are effective in bringing in new patients, our most effective marketing tool is still “word of mouth” or patient referrals, as over forty percent of our patients continue to be referred by happy SEC patients. Having said that, some of the (marketing) sources that we previously used are no longer effective. For example, newspaper ads used to be an effective tool in attracting new patients. However, as the Internet has become a more viable marketing tool and newspaper readership has declined over the past decade, newspapers are no longer effective at marketing to our audience. Newer ways of reaching people, such as Facebook or Twitter, are now becoming more effective not only in reach but are also much more cost-effective than newspaper ads. We are currently looking at ways of expanding our presence on sites such as Facebook to drive more patients to our center. • Q: Has the messaging that Saddleback Eye Center uses now versus ten years ago changed? How so? • LR: While it is important to continually update your message to attract new patients, we have found it most important to always stress the quality message to potential patients. Over the years we have found it most important to focus on the experience and 80 expertise of the surgeon rather than the technology used. Years ago we tried focusing on advanced technology when that technology was first approved and while that approach was somewhat effective, we were not successful at differentiating our message from other practitioners who used the same technology. We have refined our message to stress that LASIK is 90 percent surgeon and 10 percent technology and potential patients seem to respond well to this approach. • Q: What do you perceive as being the biggest obstacle in getting patients to actually come into the office for an exam? • LR: The biggest obstacle for patients to overcome in getting to our office is their motivation. Patients today have been considering LASIK for years – often for more than a decade – and while this is something they want to do, it is not necessarily something they need to do. It is our job to motivate the potential patients and we do this by stressing the benefits of the procedure, the ease in which it is done for the patient, and the quick recovery time so patients understand they won’t need to interrupt their busy schedules to have LASIK. • Q: Have you seen a decrease or increase in the amount of patients that convert to same day LASIK? Why do you think this is? • LR: We have seen an increase in the number of patients who choose to have Same Day LASIK. I attribute most of this increase to the confidence we have internally in promoting Same Day LASIK. As we have become more comfortable promoting this idea and making it easy for patients to take advantage of, the number of patients choosing this option has increased. It is important for us to “assume the sale” and making patients feel 81 that most people choose this option so it doesn’t seem to be an unusual or risky choice to have Same Day surgery. • Q: As far as patient profiling goes, what type of obstacles do you encounter now versus what you encountered with patients ten years ago? • LR: The biggest obstacles we need to overcome today are fear and money and those are the same obstacles we needed to overcome years ago. However, the patients themselves have changed and that makes the job more difficult. Patients ten years ago who underwent LASIK were more of the risk-takers, eager to try something new, wanted to be the first ones to have this done and were extremely motivated. Patients today are more fearful and careful. While motivated, they have the attitude that “I’ve already waited for ten years so what’s another few months.” This attitude makes it more difficult for us to try to motivate the patient to “pull the trigger” and have it done now. Additionally, many consumers today are much more concerned about the economy than they were 10 years ago and not as eager to part with their money. For the most part, they do have the funds available but are concerned about spending on what they consider a luxury item versus saving the money or paying off debt. • Q: What is one major selling point that Dr. Manger and Saddleback Eye Center has over competitors? How do you convey this to potential patients? • LR: Dr. Manger and Saddleback Eye Center have the reputation of being the place to go for LASIK on the west coast. Dr. Manger received a letter from AMO (Advanced Medical Optics) in 2008 that confirmed he is the busiest LASIK surgeon on the west coast and second busiest in the country. This is due to Dr. Manger’s 82 reputation as a skilled surgeon as well as the branding we have done over the years. Patients come in to our office and tell us they have heard about us for years, that they have many friends or co-workers who have had LASIK with us and they understand we are a quality surgical center. Many of our “competitors” are general ophthalmologists who do very little LASIK and don’t really understand how to promote themselves. They often do very little advertising and when they do advertise they list all the procedures they do instead of focusing in on LASIK. The competitors who are more challenging for us are those who advertise based on price alone and try to attract patients by offering a low price. This does a disservice both to the patients as well as the LASIK industry as many patients don’t understand that low cost LASIK equals low quality LASIK. It’s interesting to note that some patients don’t think the principles of quality and price apply to LASIK and truly believe they can get a quality job done for two thousand to three thousand dollars for two eyes. Again, this makes it more difficult for us as we then need to educate the patient so they understand. • Q: What changes in public relations and marketing do you foresee in the future as a means to convince patients to have LASIK at Saddleback Eye Center? • LR: We need to continue to provide our patients with a premium experience at Saddleback Eye Center. This means we need to surpass patients expectations and provide them with the highest quality and service both before, during and after they visit us. All of our marketing materials must reflect the highest quality, our customer service on the phone and in the office must provide patients with the optimal experience, and we must continue to offer our patients premium care during their post-operative period. 83 Unfortunately many patients today have become accustomed to an impersonal, rushed experience at a doctor’s office and usually have less than pleasant experiences. Our goal is to treat patients like friends or family members and doing this takes extra effort on the part of all staff members at Saddleback Eye Center. This means we need to continually train staff, who are not necessarily inclined to have public relations personalities, to develop these personal interaction skills while working at our LASIK facility. 84 Appendix C Returns of Referral Sources Graphs Returns That Paid Referral Sources Make On Every One Dollar Spent * Word of mouth referrals are not listed since they are not a purchasable source. Referral Sources 2006 0 0.5 1 1.5 2 2.5 3 3.5 4 Radio Internet Direct Mail Series1 85 Referral Sources 2007 Referral Sources 2008 0 0.5 1 1.5 2 2.5 Radio Internet Direct Mail Series1 0 0.5 1 1.5 2 2.5 3 3.5 Radio Internet Direct Mail Series1 86 Referral Sources 2009 Referral Sources 2010 0 1 2 3 4 5 6 7 Radio Internet Direct Mail Series1 0 2 4 6 8 10 Radio Internet Direct Mail Series1 87 Appendix D LASIK Survey Results Graphs * This survey was distributed to 50 patients at random at Saddleback Eye Center. Of these 50 participants, 23 (46%) were male and 27 (54%) were female. The ages of participants ranged from 18 years old thru 80 years old, with the average age being 44 years old. 1. How did you hear about LASIK for the first time? 2. After first hearing about LASIK, how did you next accumulate more knowledge or information on this procedure, before scheduling a consultation? 50% 6% 2% 25% 6% 6% 5% Family & Friends Mail Newspaper/ Magazine Radio TV Internet Other 88 3. If you used Internet as a primary information source prior to a consultation, please list what term you typed into a search engine, and/or what websites you remember spending most of your time visiting? (out of 27 participants) Talked to family/friends Internet Radio Newspaper/Magazine Other 52% 14% 14% 8% 8% 4% LASIK LASIK eye surgery LASIK Orange County LASIK surgery Dr.Manger side effects 89 4. If you used Internet as an information source, did you read blogs about LASIK? (out of 27 participants) * If yes (to having read LASIK blogs), did you find the blogs to be more positive or negative? (Out of 10 participants) 37% 63% Yes No 70% 30% Positive Negative 90 5. How long did it take you from the time you first considered LASIK surgery for yourself until you had the LASIK procedure? 24% 8% 20% 48% Days Weeks Months Years

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