When do you think about customer service in your practice?

When things start heading downhill? You overhear something that surprises you, complaints seem to be on the rise and you think, “time for another customer service seminar.”

The problem with this, of course, is that customer service is a day-to-day relationship. If you wait until you recognize the signs of things heading in the wrong direction, it could be too late. Just like other relationships, customer service in your practice needs consistent attention and creativity to keep things fresh and in the forefront of everyone’s mind. Just like other relationships, customer service is a living thing that needs care and feeding.

Here is what Customer Service isn’t:

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As we finish off another month here at MMP, we wanted to go back over some of our most popular posts from the month and get us ready for another busy, productive, and meaningful month. Presenting, The Best of Manage My Practice, September 2011!

• With the weather getting chillier, and coats and sweater getting pulled out of the closets again, it’s time once again to get ready for your patients’ flu shots! The CMS has released coding and pricing information for Flu shots given after September 1st, 2011, so bookmark the page or print it out for easy reference.
• Did your providers get their e-Prescribing done to avoid your Medicare rate reduction? If not, you’ll probably want to apply for a CMS Hardship Exemption for 2012. Find out how here!
• Mary Pat continued her series “Collection Basics” about Revenue Cycle Management in Physician offices with “Part II: Implementing Your Financial Policy“
• Do you dread patient complaints? Don’t! Patients with complaints are a GOLDEN opportunity to learn about your practice, gain new perspectives on your operation and connect and learn about your customers. Learn how to get everything you can from a complaint in “Why I Can’t Wait to Hear Patient Complaints“!
• And finally, everything you always wanted to know but we’re afraid to ask about a common, but sometimes vague office routine: “The Right Way to Do Write-offs.”

We’ve started this monthly wrap-up to make sure you don’t miss any of the great stuff we post throughout the month on Manage My Practice, but we also want to hear from you! What were your favorite posts and discussions this month? Did we skip over your favorite from September? Let us know in the comments!

I have not always been excited to hear patient complaints. As a younger manager I absolutely dreaded when a patient wanted to speak to me. I felt that I had little to offer a patient who expressed anger or frustration with something that had happened and I was very impatient to get past the complaint and get back to my “job.”

Now, I can’t wait to hear patients’ complaints. Complaints are the only opportunity managers have to understand the patient’s experience and hear in their own words what went wrong for them. By listening carefully, you have the potential to accomplish several goals.

1. You can heal the patient’s complaint, first by making sure the patient feels heard, and second by addressing the problem if something needs to be done.
2. You can gain insight into an experience in the practice and dissect it to see why the problem occurred and what can be done to fix it.
3. You can model to the staff how important patient complaints are and how seriously you take them.
4. You can retain the patient for the practice, and hopefully make them a fan who will recommend your group to friends and family.

In the past it might have taken a lot for a patient to complain to the manager as many patients will not risk disenfranchising a physician they really like. Today is the advent of the consumerist patient, and people are feeling empowered to complain about problems in healthcare ( a good thing!) Healthcare managers need to step up to the plate to meet them and make sincere attempts to cultivate a positive patient experience from beginning to end.

Here’s how I suggest you listen to patients:

• Instruct staff to prioritize patients calling and asking for the manager. Unless you are in the middle of a meeting, take all patient calls as they come in. If you cannot take the call, ask the staff to make sure to document the best time to return the call and the number. Prioritize returning the call.
• You can delegate patient complaints to subordinate managers once you feel completely confident that they can handle the complaints appropriately, but you should continue to take calls periodically and check complaint documentation to make sure everything is going as you intend it to.
• Listen to the patient until they are done talking. Apologize and let them know that their experience is not what you want for patients. Go back over the complaint and ask questions to make sure you understand what happened.
• Tell the patient you will investigate the complaint and give them a definite date and time when you will call them back to report on what you’ve found.
• Talk to all staff and physicians involved in the incident. Call the patient back and share any information that is appropriate. Most patients will be satisfied to receive a call back and hear that their complaint has been discussed.
• Offer your direct phone number to patients and invite them to call you if they have any further problems. A nice touch is to invite patients to ask for you when they come in next for an appointment so you can meet them face-to-face.

My husband and I went to our favorite restaurant for Father’s Day last week and had an unusual, but delightful experience when we were visited by Ruth.

We had been to this restaurant a number of times since we moved to Cary last fall, but had never met Ruth. A petite, grandmotherly woman with a heavy German accent, Ruth came to our table soon after we settled in. My first impression was that she was the owner of the restaurant. She chatted with us for a moment, then asked if she might sit down at our table. We welcomed her and she explained her job as the restaurant host.

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Do your employees “get it”?

If not, add this simple form to your tool box. These three concepts – customer service, professionalism, and HIPAA – are the basis for 80% of your everyday performance issues.

Tweak the language to fit your workplace, then print it. Ask existing employees to sign it and hand it back to you personally so you have the opportunity to ask them if they have any questions, and so you can discuss any behaviors they currently exhibit where coaching is needed. This constitutes verbal counseling and you have documented it in writing. Depending on your discipline policy, if the employee continues to perform poorly in the same area, follow up with written counseling, a performance improvement plan, or specific consequences.

Have this form in your new employee packet and review it with new employees as part of the orientation process.

Notice of Performance Expectations

Demonstrate outstanding customer service

• Smile with your eyes.
• Follow the 5-10 Rule. When you are 10 feet away from a patient, make eye contact. When you are 5 feet away from a patient, greet them. Apply the 5-10 rule to everyone.
• Thank patients, sincerely.
• Ask patients how you can help them.

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Many years ago when I started in healthcare I noticed a certain attitude of the staff toward the patients. It was as if the physicians, nurses and other staff were bestowing an honor upon the patients when they provided them with care.

It was not until later that I realized that exactly the opposite was true. It is we who are privileged to earn the trust and confidence of the patients who allow us to serve them.

Someone once explained it to me this way:

Imagine you are the host and you have invited several guests to your home. You’ve cleaned the house and prepared everything so that your guests will be comfortable. You’ve turned on all the lights and placed a welcome mat outside the front door.

Your guests have arrived at the front door and have rung the doorbell.

You open the door, see your guests…and slam the door in their faces!

This essentially is what you do when you open your doors for business, then treat your customers poorly. You have invited them to do business with you, then have not been welcoming and appreciative when they accept your invitation.

If you have staff who don’t understand how important it is to form relationships with your patients beginning with a warm welcome, help them to envision each patient as arriving with an engraved invitation in their hand.

Image by LexnGer via Flickr

In 2001, the Institute of Medicine (IOM) published Crossing the Quality Chasm: A New Health System for the 21st Century, which outlined fundamental changes that must be made in order to improve healthcare in the United States. Here is a quote from the book:

“The U.S. health care delivery system does not provide consistent, high-quality medical care to all people. Americans should be able to count on receiving care that meets their needs and is based on the best scientific knowledge–yet there is strong evidence that this frequently is not the case. Health care harms patients too frequently and routinely fails to deliver its potential benefits. Indeed, between the health care that we now have and the health care that we could have lies not just a gap, but a chasm.”

Although the concepts in the books have been widely implemented in the inpatient setting (100,000 Lives Campaign and now 5 Million Lives Campaign), not as much has been done in the outpatient setting, predominantly because inpatient safety has been (rightfully) highlighted by needless deaths and injury (The Josie King Story, The Dennis Quaid Story.) These same concepts must be applied in the outpatient setting to achieve improved patient care and patient satisfaction. Ultimately, patients will demand to know what medical practices are doing to provide safe, effective, patient-centered, timely, efficient and equitable care. This is a great book to read (you can read it online) and think about in preparation for the changes coming with healthcare reform, “Payment for Performance” (P4P) and electronic medical records promulgation.

Aim #1: Care should be SAFE: Patients should not be harmed by the care that is intended to help them. Current estimates from the Agency for Healthcare Research and Quality place medical errors as the eighth leading cause of death in this country. About 7,000 people per year are estimated to die from medication errors alone about 16 percent more deaths than the number attributable to work-related injuries.

Aim #2: Care should be EFFECTIVE: providing services based on scientific knowledge to all who could benefit and refraining from providing services to those not likely to benefit. Estimates are that about half of all physicians rely on clinical experience rather than evidence to make decisions. But should they? Experts say that physicians in most practices do not see enough patients with the same conditions over long enough time to draw scientifically valid conclusions about their treatment.

Aim #3: Care should be PATIENT-CENTERED, respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions. One study of physician-patient interactions showed that physicians listen to patients’ concerns for an average of 18 seconds before interrupting. Medical schools are beginning to place greater emphasis on the development of good patient-interaction skills.

Aim #4: Care should be TIMELY: reducing waits and sometimes harmful delays for both those who receive care and those who give care. Many hospital Emergency Departments (EDs) are symptomatic of a system that cannot reliably give timely care. One recent survey revealed the average wait at “crowded” EDs was one hour. One third of U.S. EDs report they must periodically divert ambulances to other facilities.

Aim #5: Care should be EFFICIENT: avoiding waste, including waste of equipment, supplies, ideas and energy. Some experts estimate that most physicians are productive only 50% of their time, in part because the system works against them. Working smarter, not harder, can reduce non-clinical work and increase “face time” with patients.

Aim #6: Care should be EQUITABLE: care that does not vary in quality because of personal characteristics such as gender, ethnicity, geographic location, and socioeconomic status. There is a growing number of studies showing disparities in care and treatment for some population groups. The implications can be dramatic: for example, the life expectancy of a black child is seven years shorter than that of a white child in Baltimore, Maryland, USA.

You can download a PowerPoint program from the Institute for Healthcare Improvement (IHI) that cover the concepts in the book for free here. Registration is required, but it is free and gives you access to lots of tools and resources.

You can also read the book for free online by clicking on the “READ” icon below. No registration is required.

What books, websites, blogs, organizations or people would you add to the list of resources to prepare us for the changes of the future?

A good “good-bye” or closure to the office visit can save the practice follow-up phone calls and can help the patient get the most from their time at the practice.

1. The provider should end the visit by having the patient or caregiver repeat back what the plan of care is so the provider can assess their understanding. Some practices give patients a takeaway form that has any medication changes and suggestions for diet, exercise, or repeat lab work, and others dictate the office visit and give the patient a paper copy of their visit documentation before leaving the office.
2. If the patient is having any lab work or tests, information about when the results are expected to be reported to the practice and how the practice will be informing the patient is important. Giving the patient very specific instructions in writing on calling the practice if they haven’t heard back can eliminate a lot of unnecessary phone calls for the practice and a lot of unnecessary worry on the patient’s part.
3. The medical assistant or nurse can walk the patient to the check-out desk and ask “Were all your questions answered today?” As an alternative, the check-out person can ask that question, and if need be, either bring the patient back to the clinic area, or page the assistant to come to the check-out area to speak with the patient if there are questions.
4. There should be very clear communication on when the patient is to return if a return appointment is needed. If the patient is not able to make the appointment at check-out for any reason, the practice should have a manual or electronic tickler to follow-up with the patient and schedule the appointment at a later date.
5. When on the phone with patients staff should always finish a conversation with a recap, repeating the information the patient asked for and making sure the patient had time to write it down. Trying not to rush a patient off the phone, but doing things in a friendly yet businesslike way is an art!

Note: Letting the patient know how your practice will handle their calls is an important thing to discuss with new patients. Will the patient get to speak with the doctor or the nurse? How soon will someone call back? How does a patient communicate an urgent need? Discussing these practice protocols before the patient needs to know can help a patient have confidence in your practice and reduce repeat calls and confusion.

Here’s a companion piece to my recent list “50 Ways to Attract New Patients to Your Practice.” Once a patient makes an appointment to see your provider, be sure to keep them coming back by wowing them with your customer service.

FRIENDLY

1. Introduce yourself to patients. “Hi, I’m Jane and I am Dr. Smith’s assistant and I’ll be working with you today.”
2. Wear a visible and readable name tag with your first name in large letters.
3. Smile and speak to all patients, family members, and vendors in the practice. If anyone has a question mark on their face or is hesitating, be sure and ask “May I help you?”
4. Always smile while speaking on the phone and always introduce yourself. “Good morning, Dr. Smith’s Practice, this is Jane. How may I help you?”
5. Providers should always shake hands with patients and others in the exam room. That first touch is so important!
6. New patients should receive a special welcome and should receive special attention, remembering that the patient doesn’t know how the practice works.
7. Have a patient information brochure that describes your practice’s services, providers, and policies on medication refills, after-hours services, filing insurance, filling out forms, and making payments.
8. Have multiple ways for patients to complete their registration information – forms mailed to them, online completion, completion in the practice at a computer kiosk, completion at the practice with personal help, or pre-registration by phone.
9. Ask patients how they would like you to communicate with them about lab/test results – telephone (home, work or cell), email, mail, phone retrieval and let them know (in writing if possible) when they should call if they haven’t heard from you.
10. Place tablets and pens in the waiting area so patients can write down questions for their provider while they are waiting.
11. Have computers in the waiting area for patients to use. Have Wifi for patients to use their own computers while waiting. Have instructions available for using the Internet to look up medical information and provide a written list of medical websites that your providers recommend. Place this information on your website.
12. Prior to touching a patient in the exam room, assistants and providers should wash or sanitize their hands and be sure the patient can see them doing it. Additionally, it’s good to say to the patient “Let me wash/sanitize my hands before I examine you.” so the patient knows you are practicing good infection control.
13. Provide staff with patient questions and preferred answers so everyone can answer most questions and no one tells patients “That’s our policy.”
14. Have a water fountain with cups in the reception area.
15. If you have a television in the reception area, make sure patients can change the channel or the volume.
16. Invite patients to become a friend of the practice on Facebook and communicate regularly with your patients keeping them up-to-date on practice news, health news and local events.
17. Pretend that every patient is a mystery shopper (and they are!) and treat them like a VIP.
18. Give patients a way to reach a real person on the phone, and a way to go through the automated attendant. Remember that not every patient wants or needs the same thing.
19. Have an annual open house or patient appreciation day and do blood pressure checks or home safety checklists. Serve healthy snacks and visit with your patients.
20. Call 2 days before the patient’s appointment and remind them of the date and time of the appointment. Ask them to press “1″ if they plan to keep the appointment and “2″ if they would like to cancel the appointment.
21. When the patient is checking out, ask “Were all your questions answered today?”
22. If you give out wrapped candies, make sure to supply sugar-free candies as well as regular.

EASY

1. Have multiple ways for patients to complete their registration information – forms mailed to them, online completion, completion in the practice at a computer kiosk, completion at the practice with personal help, or pre-registration by phone.
2. If your parking lot is shared with other businesses, make sure there are parking spaces marked specifically for your patients.
3. Use wayfinding systems to help patients navigate around your practice. Many patients will not read signs, but will identify symbols or pictures if you explain the system. Use themes for providers or services to help patients find their way when coming out of the bathroom or lab. Carpet or tile designs and art pieces can also be used creatively to direct patients in and out.
4. If you have a choice, front-load your practice space with patient rooms and leave the furthest rooms for non-patient activities such as offices and staff rooms.
5. Give patients their medication list and problem list on a wallet-sized card.
6. Bring services to the patient exam room instead of having your patients move around the practice.
7. Offer numerous payment options including financial assistance, Medicaid enrollment, medical loans, checking account drafts through debit cards and credit card drafts.
8. Offer a “chat with the insurance lady” feature on your secure portal.
9. Have new patient pre-appointments for patients to meet with staff to take baseline vitals, log medications and prep chart prior to their first visit.
10. Have maps available for patients for any place you might be referring them to, whether in town or out of town.
11. Give patients a sheet to take with them that lists medication changes, future appointments, referrals and has a place for them to write down questions between appointments.
12. Give patients a customized sheet that shows the name of their medication, what the medication looks like and how to take the medication.
13. Send patients emails or letters and post on your website any information relating to hot topics in the news – vaccines, radiation exposure, etc.
14. Make your website a one-stop destination for practice information, health information, practice forms and secure messaging with the practice.

UNEXPECTED

1. If a patient has a particularly unhappy experience in your practice: a long wait, a mixed-up appointment, give them a gift card with a sincere apology.
2. Hand-write an apology to a patient who has had an bad experience with a staff member.
3. Validate parking for patients if they have to pay to park to come to your practice.
4. Ask patients to rate your service – have forms in the exam rooms and in the waiting room and in new patient packets and on your website.
5. If your practice is near a shopping or eating area, give patients a pager to buzz or ring when it is time to see the provider.
6. Use your EMR or voice recognition to complete the patient’s medical record and print them a copy of it to take with them when they leave the exam room.
7. Have a blanket warmer to give patients who are sick, or have come in on a gurney a warm blanket.
8. Go through the daily obituaries to know when patients have passed and send condolences to the family.
9. Have an option on your phone system to speak to the manager and take complaints personally. Answer all complaints and call any patients back who leave messages, and any patients that employees tell you had a problem at the practice.
10. Call new patients the day after their appointment to see if they had any questions after their first visit.
11. Call particularly sick patients the day after an appointment to see if they are improving. (Thanks to Kristen Baird.)
12. Give patients who call a benchmark for when they will hear back from you (2 hours for same-day visits, 6 hours for questions, etc.) and exceed your own benchmarks.
13. Have a mystery shopper come to your practice and tell you what you don’t know about your practice.
14. Send your patients a birthday card.

What do you do in your practice that is Friendly, Easy for patients or Unexpected?