How ZocDoc Grew Its Healthcare Booking Site Into a National Business

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zocdoc-logoLast June, reports surfaced that ZocDoc the healthcare booking site was raising upwards of $150 million in a round that would value the company at $1.6 billion and put it on a tier with Uber, Airbnb and a handful of other relatively young billion-dollar startups.

These startups have at least two things in common: They grew fast and their technologies end with a physical, not digital, interaction. Paired together, that creates a whole new set of challenges for management teams as they deal with the typical problems associated with rapid growth — hiring, culture, etc. — as well as the delicate realities of offline behavior.

ZocDoc’s ascent has not been without consequence. But externally, the company has managed to retain the love and admiration of its users, retaining a Net Promoter score of well over 70 that puts the firm above both Apple and Amazon.

We recently caught up with Anna Elwood, vice president of operations at ZocDoc to talk about how the company built its customer service operations, balancing people and technology and the hackish way the company decides where to go next.

Zocdoc just entered Alaska, making it available in every state in the U.S. How do you decide which markets to enter?
We actually can tell a lot just by the traffic on our website. We know that if there’s a lot of traffic from a given area, there’s demand — and that’s where doctors will be successful.

Can you talk a little bit about how the company approached growth as it moved from a startup to a scaled business?
I think there’s a number of different ways to look at growth and scaling, and there are some obvious challenges that are presented in growing from a company of less than 20 people to now a company with millions of patients using it in each month. For one, you need to develop systems where you can actually track the experiences of users. And yet, at the same time, you need to make sure that those systems aren’t the ones controlling the experience.

The one that people don’t always think about is how culture scales — and I think that’s extremely important particularly for customer service. When you grow quickly, there are natural challenges that you encounter around hiring, and you go, how do you hire suddenly 10 people that you could get in the course of a month? And our approach has always been that we need to hire people that are better than we are, and that takes time, and so we’ve never hired just to fill a seat.

Read More: Why Local Marketing Is a Function of Commerce, Not Media

Culture is one of those esoteric terms to which most startups aspire, and yet it’s often ignored. What systems did ZocDoc develop to ensure that the company’s culture could scale?
One of the things that we introduced very early on was our service values, and we derive these from a number of different studies that we found online around what really makes people happy. One of the values is that nothing beats the human touch. Yes, we are a technology company, and yes, you are using a computer, but there’s actually a beating heart behind that computer. When things do get escalated, what’s most important to us is that we  contact the individual and let them know that we’re there to help.

Can you talk a bit about a technology developed by the company to help provide better service?
One product is our check-in service, which allows users to fill out forms before they arrive to the office. Obviously, there are times when things might not go right, so we actually introduced a way for a patient to send us a quick text if they have an issue in the office specific to this product. At the time of the appointment, we send a text with a reminder, and, and if they have any problems, to text S for support. If they do text for support, we can call the patient immediately.

Naturally, technology companies tend to favor technology over people. But in businesses such as ZocDoc, where the end goal is an interaction in the real world, there needs to be some semblance of customer service. Can you talk about how ZocDoc approaches the balance between technology and service?
I think we benefit from a very strong engineering team, and without them it would not have been as easy to scale as it’s been. We serve millions of patients, but luckily for us, that doesn’t actually translate into a lot of phone calls or a lot of work considering the size of our team because, I think, of the quality of the software that we’ve developed.

But, there are various degrees of technical prowess out there, and that does mean that, at times, nothing replaces the human touch. So, for any doctor who joins the service, we offer live training for them for us to review the technology with them, and that means that that live training could last 10 minutes because that person quickly reviews the account and understands basic conventions of technical architecture or usability architecture and can figure it out themselves. But sometimes that might take a little bit longer because the person that’s actually not as comfortable on the computer.

Are there parts of your customer service operation that could not have existed when you joined the firm six years ago?
Right before Hurricane Sandy, we invested in building out a new office, a second office in Phoenix, and the idea that it would create redundancy for us. A few months later, Sandy hit us, and closed our New York office. We actually sent kind of a rogue group of individuals out to Phoenix, both on sales and operations, to keep our business going, and that wouldn’t have been possible for a number of different things. If we didn’t have the VoIP telephony system that we employed, if we didn’t have our current system to manage all of our interactions, if we didn’t have those technical pieces that we had invested in over a period of time, we wouldn’t have been able to keep running as we did.

Uber and Yelp have grown primarily on a market-by-market basis, building offices in each major city that tend to manage that community. Do you think it’s important for ZocDoc to have a presence in each market it operates?
I think that there’s a number of different ways that you could think about that problem. The first thing is that from a scaling perspective, I think what’s great about technology is that we can actually create these great local solutions without actually having to be in each and every area. We are now in all fifty states. But to your point, the way that we were successful in these large, more urban areas was by literally having a representative there on the ground and really building relationships with these doctors.

As we grow, we will continue to have people on the ground in larger urban areas. But for places that might be more remote, we will be able to manage operations from our headquarters or from Phoenix. And we want to make sure also, as we’ve continued to scale, that our service is really where the patient demand is, and the way that we’ve been able to improve how we bring on our doctors is really based on where we know today they will be successful.

Steven Jacobs is Street Fight’s deputy editor.