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Imagine this medical encounter: The patient enters the office and walks to the reception desk, where someone looks up, says nothing, then continues working at a computer. (The patient doesn’t know this is a business clerk working on insurance claims.)
The receptionist arrives and hands the patient a stack of forms, including one that asks for the patient’s reason for the visit. A nurse ushers the patient into an exam room and again asks, "What is the reason you’re seeing the doctor today?"
Finally, the doctor arrives and asks, "So, what brings you in today?"
Needless to say, this patient might not give the practice great marks for efficiency, friendliness, and communication.
In contrast to this all-too-common scenario, many group practices are taking lessons from the hospitality and banking industries and are focusing on customer service. They are stressing phone manners, respectful and caring attitudes, and even basic listening skills.
"People are anxious when they come to the doctor," says Betty Dew, marketing director of the Pinehurst (NC) Surgical Clinic, which invited a speaker from a local bank to talk to staff about telephone techniques. "The front business people are the first ones they see. What impression are they making?"
Through customer service seminars for staff and physicians, Dew and others seek to create this impression: a friendly voice on the phone, eye contact and a smile from staff, and personal greetings and uninterrupted listening from physicians.
Employees who do this well, or who go beyond normal job duties to accommodate patients, often receive special accolades. (See related story, above.) Many practices have incorporated customer service issues into job descriptions, annual evaluations, and bonus pay.
At Oklahoma Heart Institute in Tulsa, a drive for service excellence includes the basic link a true dialogue between physicians and patients. During visits, the physician doesn’t write in the chart. Instead, a nurse takes down the information while the doctor gives full attention and eye contact to the patient.
"[The physician] is always communicating directly with the patient," says special projects manager Nancy Mozingo, RN.
In the latest patient satisfaction survey, 97.8% of patients at Oklahoma Heart Institute said they were very satisfied with how well the doctor listened to them. That compared to 89.5% responding "very satisfied" in a national database maintained by Sullivan/Luallin, a health care marketing and management consulting firm in San Diego.
In the same survey, 100% of patients said they would recommend the practice to family members or friends.
Even with that success, service excellence remains a perennial topic for internal focus groups and a continuous quality improvement council made up of staff and physicians. Recently, the group issued recommendations on communications:
• How do you address a patient in the waiting room?
• How should you tell a patient how much their bill is going to be?
• How can you present a professional appearance?
Improving service often requires just simple changes, says, says Mozingo. For example, the practice created larger signs for the "check-in" and "check-out" areas to reduce confusion. Staff are taught to be clear, concise, and professional when discussing co-payments, billing, and other such issues. When a nurse calls a patient with pre-appointment information, she introduces herself, then asks, "Do you have a pencil and pad to write down some information?"
"We want to make sure we are presenting information in a professional way, and that our nonverbal communication and manner are professional as well," says Mozingo.
The practice holds brown bag lunch sessions twice a month that address customer service issues. Attending at least half the sessions can help staff members qualify for a year-end bonus.
It’s obvious that medical staff or physicians should not be rude or curt with patients. But customer service also means taking their feelings into account.
While being direct is important when delivering information, a little empathy also helps soothe anxious patients, advises consultant Meryl Luallin of Sullivan/Luallin in San Diego.
Yet that is a failing Luallin sometimes finds when she visits practices as a "mystery patient" to conduct an analysis of their customer service needs.
During one such trip to a dermatologist, she recalls the physician looking at the red spots on her face and proclaiming, "Those are pre-cancer spots. We can freeze them off and be done with it today."
While that no-nonsense approach might please some patients, others want a moment of rapport with the physician or a bit more explanation before they hear the solution, Luallin says.
"[The physician] did later say removing them was just a precaution not because they would become malignant," says Luallin. But with a few words, she could have softened the diagnosis and reassured her patient immediately.
"It’s difficult for physicians to put themselves in the place of the patient," says Luallin. "But if they were nervous themselves, what would they want to hear? Don’t be concerned, because pre-cancerous doesn’t mean what it sounds like.’"
In a primary care setting, the physician might simply add comments such as, "I can imagine how tired you feel," or "Your throat must really hurt."
"Doctors, because they are very busy, forget those little phrases that can make all the difference in the world," says Luallin.
Luallin later met with the dermatologist and discussed communications techniques that could soften her approach with patients. Patient satisfaction surveys later showed a "marked improvement," with fewer rating her "somewhat dissatisfied" in spending enough time with patients. (For more on customer service standards, see box, p. 130.)
Sometimes patient complaints can be resolved through education. At Physicians Plus Medical Group in Madison, WI, patients complained that their mammograms were painful. Yet radiologists and technicians insisted that using strong compression was necessary for the best X-ray.
The solution: educational materials, brochures, and even signs in the waiting room about the importance of good compression. "They weren’t trying to hurt [patients]," says Pat Angvik Herje, RN, MS, director of education for the medical group. "They were trying to give them the best mammogram they possibly could."
Physicians Plus also redecorated the waiting room with more appealing colors and softer chairs. Then it gave a comment card to every patient. Complaints turned to compliments.
"I give a lot of credit to our customers," says Herje. "They expect really good service, and they expect to be in conversation with us."
• Agency for Health Care Policy and Research, Rockville, MD. Consumer Assessment of Health Plans Survey. Telephone: (800) 358-9295. Internet: www.ahcpr.gov.
• Associates in Process Improvement, Silver Spring, MD. Thomas W. Nolan. Telephone: (301) 589-7981.
• The Medical Quality Commission, Seal Beach, CA. Lori Bloomfield, Chief Operating Officer. Telephone: (562) 936-1100, Ext. 230. Internet: www.tmqc.org.
• Mid Carolina Cardiology, Charlotte, NC. Joanna Younts, Director of Outcomes. Telephone: (704) 347-2003.
• Pacific Business Group on Health, San Francisco. Telephone: (415) 281-8660.
• Physicians Plus Medical Group, Madison, WI. Pat Angvik Herje, Director of Education. Telephone: (608) 267-2770.
• Sullivan/Luallin, San Diego, CA. Meryl Luallin, partner. Telephone: (619) 283-8988.