Increasing Patient Retention/Referrals by Hiring the Best People

By: Mark Sanna, DC

In today’s fast-paced, harried world most people enjoy the opportunity to indulge themselves a little; to sit back, relax, and have someone else take care of and attend to them: their hairstylist, barber, manicurist, cosmetologist, and even their Chiropractor!

Over time they build a relationship with their service providers. Done well, this relationship may span weeks, months, and often years. The relationship will expand to include their family, friends, and associates. Satisfied patients return again and again and refer others to you. Dissatisfied patients don’t return and discourage others from trying your practice.

Think of what just a small improvement in patient retention could mean to your bottom-line profits: Fred Reinheld, author of The Loyalty Effect: The Hidden Force Behind Growth, Profits and Lasting Value, suggests that just a 5% improvement in retention would result in a 25% increase in profits for most practices.

How do you make sure that your practice is the type that builds patient loyalty? By hiring people who have the right skills and personal characteristics needed to perform the job. So where do you begin? Develop a comprehensive selection process.

Start by determining what is needed for your staff to be successful in your practice:

  1. What skills does each person need?
  2. What personal characteristics are needed to provide excellent service to your patients?

A good selection process typically includes a recruitment effort, prescreening, a realistic job preview, pre-employment tests, and a good structured interview. These elements are chosen or developed in a way to best measure the qualifications of job candidates and integrated into an efficient and complete selection process.


Attracting the right candidate (and discouraging the wrong one) through effective communication should be the first step in your selection process. Your recruitment message should clearly convey the job specifications, any special requirements (such as weekend or evening work), and the culture of the practice. Also, specify any specific license or experience requirements.

Realistic Job Previews 

A Realistic Job Preview (RJP) is any part of the selection process that gives the applicant a clear idea of what it will be like to work at the job in your practice if they are hired. The preview typically happens early in the selection process.

Why would you use an RJP? The purpose of the RJP is to give the candidate as much information about the job as possible, so that they can make an informed decision about their suitability for the job. In order for the RJP to be successful, it must objectively outline not only the positive aspects of the job, but also the potentially negative or unique aspects of the job as well. For example, it should include information regarding special characteristics of your practice, hours, specific procedural requirements, a “typical” day in your practice, etc.

Allow the candidate an opportunity to quit before he or she is hired. For best effect, there should be a pause in the selection process after the RJP—to give the candidate an opportunity to think about those requirements he or she might not like or be able to fulfill. The idea is to allow the candidate an opportunity to quit before he or she is hired.

What type of RJP should you use? There are a number of different Realistic Job Preview types. What works best for a practice depends on the flexibility, resources, and goals of your selection process. Realistic Job Previews can take the form of group sessions, work simulations, video presentations, or on the telephone.

Pre-Employment Tests 

Next, cost effective, objective pre-employment tests are used to measure the skills, competencies, and personality desired in the job. An effective pre-employment test measures seven personality characteristics related to positive job performance and patient satisfaction:

  • Positive Service Attitude—Favorable view of patients and the service role
  • Energy Level—Active and productive
  • Frustration Tolerance—Emotionally optimistic and resilient
  • Accommodation to Others—Willing to meet the needs of other people
  • Acceptance of Diversity—Tolerates others different from self
  • Social Comfort—Enjoys interacting with people
  • Integrity—Strong work ethic

For many candidates, certifications, licenses and curriculum vitae provide an initial evaluation of proficiency. This information should help you determine whether or not a candidate CAN do the job. However, in the case of a Chiropractic associate, you should ask for a skills demonstration as well. Have the candidate give you a series of Chiropractic adjustments and propose care plans for representative cases.

However, beyond basic skills, it is the individual’s personal characteristics which will foster or derail the patient relationship. These characteristics determine whether or not someone WILL build a loyal patient following.

How many times have you seen a skilled employee who has the right credentials fail in the job? These are people who don’t interact well with patients, who won’t take the extra step to please someone, who can’t handle pressure and take it out on others, who can’t focus to get the important tasks done, etc. These personality characteristics are hard to identify in an interview, but can be surfaced through well applied testing.

Select candidates who will:

  • Enjoy talking to and interacting with a variety of people
  • Show composure under stress
  • Work cooperatively with others
  • Enjoy the service role
  • Demonstrate integrity and a work ethic
  • Exceed patient expectations
  • Foster new and repeat patients

Structured Interview

While interviewing is the most commonly used selection procedure, in most cases it is considered to be the least valid. Why? Because in most hiring interviews, an untrained interviewer reaches his/her decision about the applicant during the first 3 to 5 minutes of the interview and spends the remainder of the time rationalizing his/her decision. Most interviewers think they have good ‘instincts.’ But they don’t. The good news for the applicant—first impressions make the difference. The downside for your practice—first impressions mean little in terms of predicting job success.

What do you really know about the candidate and their qualifications after only five short minutes? Very little. What you may know is whether you liked their choice of clothing, if they have a ‘firm handshake,’ or whether or not they appeared nervous. Are these the qualities that determine success in the job?

Generally, in-depth interviews are the last hurdle in the selection process. It is here that the interviewer (or the interview team) makes the final hiring decision. Most research indicates that the effectiveness of the interview will be greatly improved if you use a well-developed, structured, behavioral interview process.

A structured interview will greatly improve your odds of making the right decision. By asking all applicants a series of job-related, behaviorally based questions, interviewers will be better able to make objective comparisons between candidates rather than relying on intuition or partial information.

A good interview process will:

  • Focus the interview on the relevant job competencies
  • Encourage the applicant to describe their typical behavior rather than providing rehearsed answers
  • Provide consistency (all applicants are asked the same questions)
  • Help you to avoid asking illegal or inappropriate questions
  • Allow you to objectively compare candidates
  • Improve your hiring decisions

Implement a selection process that includes an effective recruitment effort, prescreening, a realistic job preview, pre-employment tests, and a good structured interview. You’ll find that by hiring the best people you will expand your practice by increasing both patient retention and referrals.

About the Author

Dr. Mark Sanna is the CEO of Breakthrough Coaching. For more information, visit the company’s website: