Dealing with negative online reviews: evidence-based strategies for speech pathologists

Online review sites are fairly new in speech pathology and healthcare generally. Australian examples include Whitecoat and the NDIS-inspired Care Navigator.

Negative reviews hurt

Negative reviews on sites like these – or on social media platforms like Twitter and Facebook – hurt. They may make us angry, anxious, embarrassed, sleepless – even sick. They can decimate team morale and confidence. They can tarnish reputations. They can lose us business. In extreme cases, they can even drive practices into the ground.

To compound the problem, speech pathologists are constrained by legal and ethical rules about advertising (e.g. testimonials) and client privacy. In practice, these limit our ability to respond to negative reviews, even if the reviews are exaggerated, incorrect, anonymous or even fabricated.

Review sites are here to stay

Consumers have a right to be informed about their treatment options. Despite all the risks of review sites for speech pathologists and other health professions, it’s clear regulators (and some self-regulatory bodies) in Australia see review sites as an important way of promoting consumer rights.

Speech Pathology Australia’s Advertising FAQs state that:

“advertising is not considered to include…comments made by a patient/consumer about a practice or a practitioner where the comments are made on a social media site or account or patient/consumer information sharing site or account which is not used to advertise a health service, and that site or account is not owned, operated or controlled by the practice or practitioner referred to in the comments”.

Similarly, the advertising guidelines that apply to regulated health practitioners like occupational therapists and physiotherapists in Australia state that:

“There are many opportunities for consumers or patients to express their views online that are not affected by the National Law restriction on testimonials in advertising. Patients can share views through their personal social media such as Facebook or Twitter accounts or on information sharing websites or other online mechanisms that do not involve using testimonials in advertising a regulated health service.

For example, consumer and patient information sharing websites that invite public feedback/reviews about experience of a regulated health practitioner, business and/or service are generally intended to help consumers make more informed decisions and are not considered advertising of a regulated health service.”

Although hard to forecast with certainty, it’s likely that managing online reviews will be an increasingly important part of business for speech pathologists in private practice.

What do we know about negative reviews?

We can learn from the experiences of business owners who’ve been dealing with online reviews for years: owners of restaurants and hotels. These businesses have had to deal with sometimes very harsh reviews on sites like Yelp, Urbanspoon/Zomato, Menulog, OpenTable, and TripAdvisor. A growing body of research exists about these reviews. It shows:

1. Online reviews matter. Online reviews: (a) can attract a wide audience (Hennig-Thurau et al., 2004); (b) are perceived by consumers as credible and trustworthy (Flanagin & Metzger, 2013); and (c) play an important part in shaping client opinions and purchasing decisions (Sparks and Browning, 2010).

2. Online reviews can help improve the quality of services. In traditional management literature, customer complaints are often seen as positive because they give the business a chance to fix problems and improve services (e.g. Reynolds and Harris, 2005).

3. Reviews can also hurt you, your team, and your business. As noted above, negative reviews about your business can affect you, your reputation, your business, your employees and contractors; can affect your morale, health and finances; and may attract the attention of third parties, including government regulators and industry associations.

4. Consumers post negative reviews for lots of reasons and in different ways. Online reviews may be posted for personal, social and even commercial reasons. The trigger is usually a negative experience. The decision to post an online review depends on lots of factors, e.g. a client’s motivations, past experiences, general attitude to complaining, age, and familiarity with the Internet (e.g. Yagil, 2008). Posting reviews may provide an emotional release (e.g. to allay anger, embarrassment or disappointment, or even to provoke laughter), seek “revenge” for a perceived slight, or even the hope of economic gain (Cantallops and Salvi, 2014). Some may be heat-of-the-moment “rants”. Others may be fair descriptions of legitimate concerns. Some will be trivial. Others may allege civil wrongs (e.g. negligence) or even criminal acts. Some may be exaggerated. Others may be completely fabricated (e.g. by ex-employees with a gripe, or unethical competitors). Some are short. Others are encyclopedic. Some will be shared with one or two followers. Others may go viral. Some will be posted by named people you know. Others may be anonymous. Service quality is very much in the eye of the client, rather than the provider (e.g. Sparks, 2001).

5. Online reviews can be personal. They may name and single out individual staff (e.g. Bradley et al., 2015). They may even be discriminatory or defamatory.

So how can speech pathologists in private practice manage negative online reviews?

Again, we can learn from the experience of hospitality businesses. As with restaurants, most speech pathology private practices are small businesses with limited time and resources to dedicate to online review management. In this context, the research identifies four broad categories of strategies employed by businesses to manage negative reviews:

(A) Preventative strategies

Improve your services. In theory, improving the quality of your services will reduce problems, complaints and the risk of negative reviews.
Conduct “real time” checks on client satisfaction to identify and, if possible, fix small problems before they become big problems (e.g. Johnston and Fern, 1999).
Manage client expectations about your services.

These are sensible ideas. But, owing to the intangibility of services and the variability of client perceptions, expectations and preferences, preventative strategies are never going to eliminate the risk of negative reviews entirely (e.g. Sparks, 2001).

(B) Protective strategies

The emphasis of these strategies is to shape – not prevent – complaint behaviours to minimise damage to your business.

Give your clients clear encouragement and guidance as to where and how to comment and complain. This can be offered orally, via a leaflet, on your website, or an email. For example, I have a feedback and complaints policy I share with all clients.
Include a request in your feedback and complaints policy that complaints first be presented to staff or the practice directors before being posted online.
Have a physical and email suggestion box for anonymous comments and complaints.
Provide short in-house satisfaction questionnaires and reward clients for using these, rather than going online.
Monitor online reviews and respond:
- privately by email or, better yet, with a phone call or face-to-face open discussion; or
- publicly.

In the hospitality industry, public responses are increasingly viewed as a vital reputation management strategy. Review sites like Yelp and TripAdvisor have even published guidelines on how to do it. These guidelines encourage restraint, courtesy, a focus on specific concerns and an emphasis on the business’ positive qualities.

Jay Baer, author of “Hug your Haters: How to Embrace Complaints and Keep your Customers” says that when you don’t answer a complaint it decreases customer advocacy by up to 60%: when you answer a complaint it increases advocacy by 25%. Customer advocacy – i.e. the client advocating for your service.

Complaint-handling studies (e.g. Davidow, 2003; Bitnet et al., 1990), show that effective public responses often include:

acknowledgement of the problem(s) raised;
an apology for the business’ contribution to it;
an explanation for its occurrence; and
a commitment to take appropriate preventative or remedial action.

Two important points on public responses for speech pathologists:

It can make sense, from a business perspective, to respond to negative reviews in a constructive way, acknowledging the client’s concerns (even if you don’t agree with them). However, it’s also important to support staff and others affected by the review, recognising that there are always at least two sides to any story (e.g. Jung & Yoon, 2014).
As noted above, speech pathologists must comply with their codes of ethics and legal obligations when responding publicly. This means, among other things, that speech pathologists cannot disclose any sensitive, health-related or personal information about clients or their care, which means we need to be very careful when responding in a public forum. I’ve given some thought on how best to do this.

Most review sites have moderation guidelines or terms of use that prohibit defamatory or offensive comments. For example, Whitecoat’s Moderation Guidelines and Care Navigator’s Terms of Service (see Sections 9 and 12). If you feel a review breaches those guidelines, you should alert the review site citing specific breaches and ask that the offending review be removed.

(C) Positive strategies

In hospitality, it’s common for businesses to actively encourage positive reviews from happy clients. Evidence shows that this tactic can help push negative reviews down the list and “off the page” and also result in a more balanced picture of the business (e.g. Sparks and Browning, 2011). It can also help build staff morale.

Unfortunately, actively encouraging positive reviews is not an option for speech pathologists in Australia. As with regulated health professionals, we’re not allowed to encourage testimonials or positive comments from clients for ethical reasons.

Speech pathologists can – and should – gather and share unsolicited positive feedback with staff to bolster morale. But we cannot encourage or take active steps to share this kind of feedback with the public as this would fall foul of our advertising rules.

(D) Palliative strategies

These emotion-focused strategies seek to counteract the negative emotions and stress caused by negative reviews. Examples of these strategies include things like:

building physical resilience – going for jogs, joining gyms, etc.;
enlisting support from colleagues, families and friends, including through professional networks and bodies (online and offline);
recognising that reviews are transient, surmountable, and often of limited consequence in themselves;
providing professional and emotional support to any staff affected by a review; and
stress management activities, e.g. yoga, meditation, etc.

Although simple and perhaps obvious, these strategies provide powerful ways to combat feelings of powerlessness and isolation, and to keep the real effects of negative reviews in perspective.

Bottom line

Online review sites are here to stay and can help members of the public to make informed choices about their healthcare. Online reviews can help speech pathologists to improve their services. But they can also inflict significant emotional and financial stress on owners and staff.

Preventative, protective, and palliative strategies, like those used in the hospitality industry, may help speech pathologists in private practice to manage negative online reviews and their effects. But we need to take care when responding publicly to ensure we act ethically and in accordance with our privacy and other legal obligations.

Principal source: Bradley, G.L., Sparks, B.A., Weber, K. (2015). The stress of anonymous online reviews: a conceptual model and research agenda. International Journal of Contemporary Hospitality Management, 27(5), 739-755.

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