Article Text


Measuring client satisfaction
  1. Bal Bains


Customer satisfaction and loyalty are essential for retaining pet owners and running a profitable veterinary practice. However, without proper survey methods it can be difficult to obtain accurate client feedback. Bal Bains discusses different ways of finding out how clients rate a practice and how that information can be used to advantage. He also discusses some of the results from practice survey data collected by the Zoetis business consulting team.

Statistics from

Embedded Image

Bal Bains is a strategic consultant at Zoetis with over 20 years' experience in strategy, marketing, operations and resource management. He graduated in mathematics from Imperial College London and then studied economics at the University of Oxford. He is an associate of the Royal College of Science and holds a MBA from the University of Warwick.

NEARLY 40 years ago, in what many consider to be the first national customer survey, the US Office of Consumer Affairs asked consumers about the problems they experienced with products and services. The survey reported frequent complaints around poor customer service, inferior quality and out of stock products. Today, with all the effort organisations place on putting customers first and delivering an unrivalled experience to gain a competitive advantage, one might expect dramatic gains in the level of customer satisfaction. However, the 2013 survey reported that satisfaction is lower today than in 1976 (MIT Sloan 2014). To support this, research by Accenture (2013) suggests that many companies don't seem to be working hard at retaining customers, with about two out of three customers switching companies due to poor service in the previous year. This figure has increased year on year since first being measured in 2005. The importance of retention is shown by the research of Bain and Company (Reichheld and Sasser 1990). They suggest that it costs 6 to 7 times more to acquire a new customer than to simply retain an existing one, and that boosting customer retention by just 5 per cent can increase profits by between 25 to 85 per cent.

The bottom line is that customer satisfaction and loyalty are essential for running a profitable veterinary practice and the best way to find out how clients rate the practice is via feedback. Client feedback enables the practice to understand what it is really good at and the areas that need improvement, in order to keep clients loyal and returning to the practice. In fact, the very act of asking for customer feedback is positive in its own right. It demonstrates that clients' experiences are important to the practice and something worth understanding and investing in.

This article will look at the importance of client feedback, explain the different methods of capturing data and how the information can be used to a practice's advantage. It will examine what client satisfaction looks like nationally and what to consider when creating a bespoke in-practice survey. It's not just all about feedback. Many practices that have done a client satisfaction survey recognise that they need to have a follow-up action plan and many will include a consultation effectiveness programme as part of that.

What to measure?

Perhaps the single-most important facet of satisfaction for veterinary customers is the client journey, and the component parts of that journey are a good framework to use when trying to understand what exactly to get feedback on. Practices should try to embark on this journey from their clients' perspective by questioning how they would want to feel as a client about their experience. Every contact point in the client journey, from the initial telephone call through to paying the bill, needs to reflect the practice's culture and values. While every practice is unique, most customer journeys can be broadly divided up into the following steps:

  • First contact

  • Arrival

  • Check-in

  • Wait

  • Consult room

  • Admission

  • Discharge

  • Payment

Follow-up feedback from clients is immensely important, and the practice needs to demonstrate consistency and alignment of behaviours across the board.

Survey methods

Customer satisfaction data can be collected in several different ways, whether manually or electronically, such as by post, e-mail, over the phone, in person or via a combination of all of these. However, each has its advantages and disadvantages.


In-person surveys are typically conducted as one-to-one interviews when the client visits the practice. You tend to get a high response rate and can obtain immediate feedback. In-person interviews can be more personal and probing as the interviewer will be able to explore the respondent's answer in more depth and achieve a better understanding of the situation. Face-to-face interviews can also help build relationships, accommodate a longer survey and produce very good, in-depth and accurate data. However, this method is quite time consuming, can be a little intrusive and tends to be quite costly.


Telephone surveys have many of the same advantages as in-person surveys, offering high quality data and allowing interviewers to probe to clarify any points. They are also less costly than conducting a survey in-person. However, this method can be intrusive to the recipient and, therefore, has a lower response rate than in-person research. Consumer resistance to telemarketing can be such that it is hard to persuade someone to take part in a telephone survey even when they are customers of the business.

Post and e-mail

These types of surveys offer a relatively inexpensive way to reach a broad audience. Although the response rates depend on both the quality of the questionnaire and how well executed the survey is, they do tend to be significantly lower than for in-person or telephone surveys. Many small businesses use these forms of research because they are the easiest to administer and the least costly.


A sophisticated and practical method of conducting an electronic survey is to use an in-practice tablet device, which combines some of the advantages of the different survey methods. Clients can be asked to log their customer experience, reflecting on all aspects of the client journey, from booking an appointment through to consultation, and to the payment and administration of their visit. Such individual results are then transmitted to a secure central database to provide a comprehensive report, assessing the standards of customer service being delivered across the practice team. Collecting data using tablet device technology in the waiting room offers high visibility and means that questionnaires are completed on-site while clients' perceptions of the experience are still fresh in their minds. This kind of technology, and the reporting services, would, however, need to be bought or hired by the practice.


Customer feedback is most frequently obtained on different performance metrics. Such metrics can include, for example: the likelihood of recommending the practice to friends; customer experience versus ideal experience; and overall satisfaction. These metrics can be particularly useful when using the in-practice tablet device, as the reports will compare the results against a national basis.

One of these metrics, and a key outcome of any customer satisfaction survey, is the practice's Net Promoter Score. It is a solid customer loyalty metric and the key performance indicator a practice should track in order to really establish how well it is perceived by clients. This system is used across many different industries and is based on the premise that an organisation's customers can be divided into three types:

  • Promoters – loyal enthusiasts who will recommend the practice to others;

  • Passives – satisfied but unenthusiastic customers who can be easily wooed by the competition;

  • Detractors – unhappy customers who will proactively damage the practice's reputation.

These customer types can be identified using the key question: ‘Would you recommend this surgery to your friends and family?’ A Net Promoter Score is simply the percentage of a practice's promoters minus the percentage of its detractors. From my experience working with our clients, most vet practices have a high Net Promoter Score, which should bode well for growing a practice's business through word of mouth and personal recommendation.

Individual responses

Despite the sophistication of performance metrics, at times the greatest benefit can come from looking at the details given in individual responses rather than from a survey's summed averages. By delving into the detail, practices can identify specific issues, like certain times of day when there are increased waiting times or when client perception of the service provided is reduced.

Repeat sessions

Implementing a client survey should involve two survey sessions. Each should be done over a period of four weeks, so that any changes that are put into place as a result of the first set of client feedback can then be monitored. Practices are able to assess the effects of any changes and, if they are paying for a reporting service, also compare themselves regionally and nationally.


Implementing a client survey is generally cost-effective; the revenue secured by preventing just two clients from leaving can produce a return on investment. It is also a scalable solution for either one or many branches, which can be rapidly deployed. The most effective format has proven to be a mixture of open and closed questions and compulsory and optional questions.

An example of cost-effectiveness is a practice where there were 356 responses against a cost of £700, making it £1.96 per response. In this example, the average customer spend at a practice being approximately £245 per year, it has cost less than 1 per cent of spend to listen to the customers' views, which could prevent them from leaving. Put another way, the exercise has delivered a return on investment of £245/£2, which is 1250 per cent.

National results

The following are some national results from our own data which practices might find useful to think about and to compare with their own performance.

Based on 17,500 survey responses, veterinary practices fare reasonably well on accessibility, with 69 per cent rating the telephone response and helpfulness of advice provided as ‘very good or excellent’. A similar picture emerged on the convenience of appointment times, although this is an area where vet practices frequently make positive changes following the feedback from the client survey. When questioned about additional hours, clients stated they would like more appointments to be available; the survey results indicated early morning and late evenings would be the preference among pet owners.

On the subject of practice location, the feedback was less positive. Almost a third of clients thought their practice was ‘very hard to find on their first visit’ and nearly a quarter ranked the ‘parking as poor or very poor’, with only slightly over a third rating it as ‘very good or excellent’.

Practice reception teams were given the thumbs up, with 71 per cent of customers rating them as very good or excellent, although feedback on waiting times wasn't so positive with the largest group (30 per cent) being kept waiting for up to 10 minutes, while 18 per cent had to wait for more than 30 minutes. To add salt to their waiting-time wounds, 29 per cent of clients rated the reception teams at their practice as ‘poor or very poor’ when it came to keeping clients updated about waiting times.

Interestingly, client bonding appears to more commonly occur with the practice in general, rather than with an individual vet. Over a quarter of clients believe that it is not important for them to see the same vet each time and only 12 per cent stated that it was essential. This is just as well because, in reality, a third (34 per cent) of pet owners say they never see their usual vet, while only 13 per cent say they always see them.

The veterinary profession is sometimes criticised for not really listening to their clients and this is borne out in our survey results with over a quarter (26 per cent) of pet owners rating the vet's or vet nurse's ability to listen as ‘poor or very poor’. Also rated at that same level by about a quarter of clients were:

  • Putting the client and pet at ease;

  • Conducting a thorough examination of the pet;

  • Involving the client in decisions about their pet's care;

  • Explaining any problems and the treatments needed;

  • Demonstrating care or concern for the pet;

  • Spending a satisfactory amount of time with the client.

This raises interesting questions for what should be the ideal consultation time to deliver a better client experience, without bankrupting the practice.

Practices performed well when it came to their Net Promoter Scores, with a national score of 74 being achieved by the profession. However, when it came to finances, vet practices performed less well, with 27 per cent of clients rating practices as ‘poor or very poor’ in their openness about billing, and only 23 per cent believing practices offer ‘very good’ value for money.

Consultation effectiveness

Feedback is only useful if there are outcomes. ‘Consultation effectiveness’ looks at a practice's value proposition, understanding how the consultation affects the key performance indicators, revenues and performance of a practice. It examines how client agreement can be obtained, from dealing with objections and applying simple processes to help gain more client commitment, to encouraging clients to put recommendations into practice.

The first thing to consider is client relations. It is perhaps the single most important aspect of client satisfaction and consultation effectiveness. This can be examined on two levels. The first is self-awareness, which looks at how vets come across to people, based on body language and rapport, communication preferences, social styles and learning styles. The second looks at how vets can be flexible to a client's needs by adapting their social style, connecting and making communication more effective.

Consultation effectiveness involves a consistency that should work across the entire practice, so training should also focus on how to teach new graduates at an early stage in order to build their confidence and credibility with clients. The consultation room is the engine room of a veterinary practice; a veterinary surgeon can have the best clinical abilities but, if they aren't able to convey information to clients in a way that they can understand and then comply with, all that clinical expertise and value can be lost. However, if a practice offers a consistently high-quality experience in the consultation room, this will positively impact the wider business from client satisfaction and client loyalty to increased revenues and profit.


Vet practices, like many other businesses, need to work hard to retain customers and help increase profitability. With a typical business hearing from only a tiny proportion of dissatisfied customers it is essential that vet practices survey clients to understand their perceptions of, and attitudes towards, the practice. This information can be gathered in a number of ways and can be benchmarked against nationwide data, but what is most important is that action is taken as a result of the survey findings.

Remember that feedback is perishable and should be acted on straightaway. This can include changes such as: establishing improved parking provision; reducing waiting times; developing the training needed to deliver a consistent consultation; investigating the worth of longer opening hours; and smoothing out discrepancies to ensure interbranch consistency. It costs six to seven times more to acquire a new customer than to retain an existing one, so client satisfaction is vital for practice profitability.


View Abstract

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.