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About a year ago, a man appeared at a doctor’s office in Pittsburgh for a 5 p.m. appointment. Four hours later, the doctor was finally ready to see him. "What is really amazing is that the patient was still there," says Martha Hamilton, CPA, executive director of Tri-River Surgical, a four-clinic practice in Pittsburgh.
The offending physician was not one of her doctors at the time but joined the practice as part of a merger a few months later. That physician still can run some 30 to 45 minutes late, Hamilton says. "We still kick him about it, but he is improving."
It’s no laughing matter when doctors are habitually late. "It makes patients feel undervalued," Hamilton says. "That equals bad public relations. Patients will tell their friends, and in a really bad situation, you can lose business."
There are other dangers, too, she says. In an era when managed care organizations and other payers are demanding data on patient satisfaction, persistent tardiness among medical staff can lead to declining scores. "How long a patient has to wait is a key factor in patient satisfaction," she says.
"Tardiness is a problem that can seem unsolvable," says Robert Westergan, MD, medical director of Jewett Orthopedic Clinic in Winter Park, FL, a 21-doctor orthopedic surgery group. "There is a balance between seeing the largest number of patients possible in a practice and being able to predict the unknown how long to see a patient and meet their needs, emergencies that might arise, or dealing with referring doctors who need attention. We just can’t schedule as much as we would like to."
Westergan believes there is a limit to how understanding patients can be when a physician is running late. "But they expect us to do what we can to minimize the problem."
Westergan says that patient satisfaction surveys are the best way to identify problem areas. "The perception and expectation of the customer/patient is more important than anything else. If patients are scoring you low on waiting times, then that identifies a problem even if you are really only five minutes behind."
But if patients are complaining in writing or verbally to staff, then the situation has already gone too far, Hamilton notes. "You have to find out before it gets that bad that there is a problem." The best way to do that is to make sure your staff are aware of patients from the moment they walk in the door.
Most people, Hamilton says, can tell if someone is impatient, bored, or upset. Getting your front desk staff to note the demeanor of patients is a good first step. Tri-River Surgical has gone further. Hamilton hired a retiree as an attendant. "He greets people, takes their hats and coats, and gets them coffee," she says.
Not only does this gentleman put patients in a good mood by his immediate attention, but Hamilton says he can let other staff know if a delay is getting on a patient’s nerves.
Once you know there is a problem, you have to understand why it occurs. There are four likely reasons a practice runs late:
1. Scheduling problems.
"Start out by looking at your schedules," Hamilton advises. "Do you have too many patients coming in for the number of doctors you have? Do you have a lot of emergencies and walk-in appointments? Are patients coming in late?"
All of this information is usually available from existing records. For example, practices can and should note the time a patient arrives for an appointment. If you look back at a particular day’s records and note that several patients arrived late, you can investigate further. Is a particular patient always late, or was there inclement weather that put everyone behind schedule? Hamilton recommends telling patients who are perpetually tardy to come early for appointments.
New patients also should be encouraged to come in early, Westergan says. "There are usually forms to fill out, and you should have them come in with ample time to do that."
Multi-office practices can have other scheduling problems, especially if all the offices engage in setting appointments for each other. Westergan says his practice implemented a computerized, networked scheduling program that allows any office to schedule an appointment for any other office without fear of double- or over-booking the medical staff’s time.
2. Poor communication.
Another problem might be a lack of communication among the medical staff and schedulers, says Hamilton. "If your schedulers don’t know a patient needs an X-ray, then they might not schedule enough time for that patient," she says. That one mistake can mean that X-ray gets backed up because of additional patients, and the physicians run late because patients are not ready when they are. "Just make sure that the schedulers ask what the appointment is for," she says. "You have to foster good communication."
3. Inefficient use of staff.
If you have physician extenders, make sure you are using their time efficiently, Hamilton says. "They can be a real asset to help ease the burden of a full patient load. We use physician assistants [PAs] to aide physicians in staying on time." While that is less possible in markets where PAs have their own patient base, in her market they can take on a team role that frees up more physician time.
4. The problem doctor.
Westergan says doctors are no more likely to be habitually late than any other professional. As with others, a doctor who can’t keep to a schedule needs to be talked to about his or her performance.
But that can be tricky, Hamilton says. The best way is to present information in a straightforward, scientific manner. If patient satisfaction scores for a specific doctor are declining, and a top reason is tardiness, show the doctor the numbers, she advises.
Hamilton says most physicians will react positively to information presented in a nonjudgmental way. Westergan agrees. "Show them data that compares them to their peers," he suggests. "Physicians don’t like being outliers and will go far to correct a problem that has them at the bottom of a heap."
If your physicians have productivity requirements that are tied to their salaries, they may react quickly to problems and work with you to solve them. Hamilton says they often will suggest scheduling changes or ask their PAs or nurse practitioners to take on more responsibility.
If your initial efforts don’t work, Hamilton says you may have to cut the number of patients that problem doctors see. "They are very competitive and don’t like that at all," she says. "They have certain productivity standards they have to meet, and if they fall behind, they really start to sweat."
Sometimes you can’t do much to avoid delays for patients. In those cases, the best way to prevent bad feelings is to be upfront with them. If you have any advance warning, call patients ahead of time and give them the option of rescheduling, Westergan says. If the problem arises less than an hour before an appointment, Westergan says, you still should try to contact the patient. If that fails, be sure to inform the patient as soon as he or she arrives at the office. "Get to the patient before they complain," he says.
Making your office a friendly place also can help ease any tension delayed appointments cause. For example, Hamilton’s practice offers coffee, doughnuts, and a selection of current magazines. Westergan’s provides telephones, modem hook-ups, and adequate space for business people to do their work.
"No one goes to work every day trying to mess up the lives of their customers," Hamilton says. "But we have to understand that we can’t just let the situation sit there unanswered. We have to work to find a solution."
• Robert Westergan, MD, medical director, Jewett Orthopedic Clinic, Winter Park, FL. Telephone: (407) 643-1201.
• Martha Hamilton, CPA, executive director, Tri-River Surgical, Pittsburgh. Telephone: (412) 367-0600.