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Customer Experience is All About 'Internal' Marketing [Article]

Spending money on marketing is great for generating new customers. But what if there were a few simple and perfectly ethical things you could do right now, to make more out of your existing clients, while at the same time providing a better service? In this article, we outline 5 key performance indicators you should be tracking to ensure you’re getting the most out of your business, as well as 5 simple but surprisingly effective ways you can plug unnecessarily lost revenue, and add more profit to the bottom line.

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By Clare Carrick BSc, MCSP


There is no point spending time and money on the ‘external’ marketing of establishing your brand, building your authority and bringing new clients through the door, if you just haemorrhage patients and under-service them once they’re in your care.

A successful business is built by raving fans. As the customer service platform Zendesk quotes:

"The goal is to create raving fans that can’t stop talking to their friends, family, peers, and co-workers about the amazing customer service and overall experience they had with your business."

If the internal systems and processes in your business aren’t primed to deliver this experience, it doesn’t matter how many new clients you bring in, you’ll under-deliver to all of them, and you certainly won’t be generating raving fans (you’re also unlikely to be getting the best clinical outcomes you could achieve).

These internal systems and processes are often referred to as ‘internal’ marketing which is a relatively new concept to most practitioners.

Interestingly, in my experience, the level of client satisfaction is not proportional to the number of years in practice, or the clinical skills of the practitioner themselves.

In fact, many patients receive exceptional service from less experienced practitioners and admin staff, because it comes down to the ability to communicate. If you have an admin team, the patient experience starts and finishes there. Otherwise it starts with and ends with you.

Communication processes will dictate the ‘feel’ the client gets about your service Tweet This, even before their first session and establishes that all-important first impression.

So How do You Get Your ‘Internal’ Marketing Right?

Understanding and planning the ideal scenario of how your client will transition from being a prospective client, converting them into a booking and then ensuring they have a great clinical experience, is a skilled process that needs to be firstly defined and then managed and replicated well.

Think about what would make an outstanding customer experience for you, and then think about how you can offer that, in a cost-effective and time-effective way. What are the small, thoughtful touches, that can make an experience?

This customer-journey process is greatly aided by establishing a simple set of key performance indicators (KPIs), particularly if you have team members. As a business owner working alongside other staff, can you be sure they are attending to the client in the same way as you would? How are you going to monitor and measure this to achieve a consistent experience for the client time after time and ensure repeat custom Tweet This. As your business grows this is a challenging concept and fundamental to why some practices grow and others remain the same size.

If you work for yourself this process is just as relevant. You need to establish a simple workflow of what needs to happen, step-by-step, to give that patient an outstanding experience. As you become more successful, it is much easier to hire someone to help with administration if you have these processes established right from the word go.

Top 5 Internal Marketing KPIs

These KPIs are important regardless of whether you are a sole practitioner, or whether you work as part of a team. A good business will know their numbers for every therapist in their team, including themselves.

1. Number of new client assessments (per practitioner) and referral source

Some practitioners are always busy, but busy is not always good. If you (or other therapists) are churning through patient assessments, you could be missing out on potential revenue. Therapists with high retention rates of their clients and fewer new client assessments per month are likely to be significantly more profitable. Understanding these trends in your business, applied both to yourself, as other therapists who work with you, will help you identify missed earning potential.

Knowing the source of the referral means you can thank an individual or company for making the referral to you. A thank you could be a simple telephone call, email, thank you card or even better some sort of small gift, such as an offer of a free massage, a bottle of wine, or a small bunch of flowers. The beauty of this sort of gesture is that it costs very little, but is likely to have a huge impact.

It also helps you understand rises or falls in referral levels so you can adapt your external marketing efforts, or even recruitment strategies.

2. Know the average number of sessions each client will attend, after the initial consultation, for every therapist you work with (including yourself)

This gives you a treatment series value and helps you to understand the bigger picture value of a client, particularly for your external marketing budget. It also helps you build a picture of your ‘average lifetime customer value’. Some clients will end up coming back regularly which means the average lifetime value of your customers as a whole will be higher than just the treatment series value.

A therapist may be under-servicing a client by only seeing them once. A minimum of two appointments should be necessary to check that the advice and exercises you may have given at the first treatment have worked (or not). Depending on the clinical indications, you want to aim for a higher number. Regardless of the number of appointments, you need to know the outcome of every person that either you, or any other practitioners in your team, have assessed and treated.

3. Identify which patients received no follow-up after the initial consultation

Asking your client to fix a date for a new appointment immediately after, or as soon as you can following a treatment is crucial. If it’s left to the client to re-book, there’s a good chance the opportunity will be lost in the busyness of life. Every therapist in your team should do the same thing and there should be a process in place to insure this happens.

Occasionally there is a genuine reason why a client may only attend once but spotting this and taking action can make you hundreds of pounds or more each year.

4. Utilisation rate of a therapist’s time

This is the time spent face-to-face with a client, making money, as opposed to down-time due to a cancellation, or for general day-to-day administration tasks.

This is particularly important if you are contracting the services of other therapists, but also very important where employed staff are concerned, and critical if you’re a sole practitioner. You only generally earn money when you are seeing clients, so you need to optimise your time by getting people cheaper than your hourly value, to do the jobs that take you away from seeing clients.

Most clinics will look for a utilisation rate of 85% to 90% of a therapist’s time, dependent on their job responsibilities. If the utilisation rate increases then this should tell you it’s time to start looking for that new staff member, in fact if your business is growing quickly, arguably you should do this even earlier, otherwise other team members will start to feel frantic and stressed, and the quality of service being provided will drop.

5. Therapist earnings as a percentage of the gross amount taken from the client

This is the amount the clinic makes on the employee or contractor (gross). Ideally this should not rise above 40%, otherwise running a profitable health business gets challenging.

Contractor staff demand increasingly higher percentage splits of the takings and in my experience this is just not sustainable in order for the business owner to cover the costs of rents and rates and make any kind of profit themselves. Which makes the reason for absorbing all the stress of the business futile. Many business owners end up with a situation where contractors ‘piggy back’ off the clinic referral streams and earn as much (if not more than the owner) on an hourly basis. To operate a successful therapy model, the costs of the therapists in the team need to come in at no more than 40%. Changing to an employee model is the only sustainable way to grow a business and make a profit as a business owner.

The Top 5 Lost Earning Opportunities in Most Therapy Businesses

  1. Leaving the booking of the client’s next appointment open and to chance by saying 'see how you go and give me a call if you need another session'. Block-booking the proposed treatments ahead of time, after the initial consultation, and scheduling all sessions in advance is a much better approach. The client gets the dates and times they want and you can forecast and be more sure where your money is coming from in a few weeks’ time.

  2. Cancelled appointments and DNAs (did not attends) are not followed up in a systematic way, which means cases remain open and uncompleted, missing earning opportunity and vital days or weeks since the patient last attended to re-contact them.

  3. Patients who do attend for treatment need to get onto their own self-help management strategies at home and perhaps need an item of small equipment to assist them in their quest to reduce pain and improve their range of motion and strength. Make sure to hold stock of core items that clients can purchase to help them achieve this. It adds a few extra pounds to the bottom line and you could incentivise your staff to sell them, including the administration staff.

  4. You and your staff are not encouraging your existing clients to refer their friends and family. Be active and forward in mentioning to a client that you rely on word of mouth. Even better run a ‘refer a friend’ scheme. Co-Kinetic has written a detailed article explaining how to do this, as well as created all the material you need to do it, for more information click here.

  5. Consider selling packages of treatment up front, offering small discounts for these bundles of treatment. This can help you manage cashflow and predict future spend in your clinic. Remember you may want to review your daily sessional prices prior to implementing a package strategy.

How to Put this into Practice

Reflect on, and evaluate, these two Top 5 lists. Think through and write out step-by-step what your ideal patient pathway would be and observe what is happening and where the patients may be leaking from your pathway. Put processes in place to make sure that you (and any team members) follow the same pathway you’ve settled on. Once your systems are established and you are practising the vision for the patient pathway in your business, then it’s time to think about adding further value for the patient with their clinic experience.

Obtaining feedback from clients and taking the time to analyse this data will help you align a client’s wishes with your own vision and help you develop further. The more you know about your customer and what they want to receive the better customer service you will provide.

Further Resources

Key points

  1. Your internal systems and processes need to deliver great customer service so you don’t lose clients.
  2. Exceptional service comes from good communication.
  3. A set of simple key performance indicators (KPIs) will help you improve your customer-journey process.
  4. Know the source of your patient’s referral and thank them for it.
  5. Patients need at least two appointments to check that the advice and exercises are working.
  6. Know the outcome of every patient.
  7. Encourage patients to book their next appointment before they leave.
  8. Contract staff can be expensive – an employee model is a more sustainable way to grow your business.
  9. Encourage clients to refer friends and family – run a ‘refer a friend’ scheme.
  10. Consider selling ‘treatment bundles’ at a small discount.


  1. Consider the points in the two Top 5 lists. Do you know this information or can you identify gaps in your knowledge?
  2. Which processes would benefit your business the most?
  3. Think about the stock items you hold for purchase by clients – should you instigate this or revise your stock?

Quotations/important points

"The goal is to create raving fans that can’t stop talking to their friends, family, peers, and co-workers about the amazing customer service and overall experience they had with your business."

"Reflect on, and evaluate, these two Top 5 lists. think through and write out step-by-step what your ideal patient pathway would be and observe what is happening and where the patients may be leaking from your pathway."

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