How patient satisfaction affects business

About 10 years ago, hospitals and clinics began rebuilding their relationships with patients. Two of the often-heard buzz words that began to arise were customer service and customer appreciation. 

For those of us on the front lines who felt we were the gatekeepers of patient care, we were personally affronted by this new endeavor. We strongly felt that the people that came to our clinics daily were not customers-they were patients. By putting the label “customer” on them, we were changing the dynamics of what it meant for the privilege to care for them.

Related: Clinic safety: Incidents, medication, consent

While the business of medicine is exactly that, a customer/business relationship, I think that we need to ensure separation from the business part of the office (such as the front desk, billing, insurance, etc.) from the clinical part (patients who are seeing you for clinical care and supplying the business).

Another way to look at it: A customer is someone who willingly chooses to enter a in a relationship with you and who has a direct effect on your bottom line. If your services are suitable to him, he stays. If they are not suitable, he leaves, thereby negatively affecting your bottom line.

Some words we began to see bantered about as the hospitals were converting their thought processes regarding patient service were:

• Patient encounter

• Customer service

• Achieving goals and benchmarks

• Mission statements

• Phone queues and check-in queues (“cattle mentality”)

Next: Focusing on the customer can hurt the patient

Focusing on the customer can hurt the patient

I found it very difficult to think of our patients in these terms because customer service does not translate well into the world of medicine. There are major differences between patients and customers.

One of those differences is abandonment.

The doctor/nurse/technician has an obligation to care for a patient even after the clinic-or the patient-has terminated the relationship. If the doctor fails to care for a patient, it can be grounds for abandonment. This obligation is not affected by whether the patient owes money or abuses your staff. This relationship also involves any potential emotional bond as well.

If you have a poor relationship with a local restaurant and decide you will never go there again, that’s that. The restaurant has no responsibility or liability to continue your relationship. While you will still affect its bottom line by removing your business, neither of you has any further responsibility to each other.

Related: Running a perfect clinic

This is not true in the medical field.

As the institutional mentality began to change and trickled down to the staff level, we started to see the “business” changes occurring, and in some cases,  increasing in the medical field:

• Penalties, including rescheduling patients’ appointments if they are late (even though the clinic was often running 30 to 45 minutes behind)

• Patients standing in lines (queues similar to a deli) to check in, ensuring that insurance cards were the top priority

• Clinic cancellations and reschedules when doctors felt the clinics were not busy enough to warrant their time in clinic that shift

Patients began to let us know that they were not happy with the shift. Managers and supervisors saw patients change their behavior in return, including:

• Angry phone calls. The patient, usually in a threat-filled rant, said he planned to sue the doctor because his new glasses were causing red marks on his nose

• Demands for the clinic reimburse them for the time that they waited in the clinic

• Refusals to pay the copays or balance due. One patient come to the business office with his son’s wagon filled with $25 worth of pennies to pay his copay, which he felt was the clinic’s fault

• Threats to report the clinic to Angie’s List, the Better Business Bureau, or Facebook with a bad review

• Return of the clinic’s 20th customer survey torn into pieces

Next: Listen to what the patient really wants

We learned that in order to achieve both a business relationship and clinical patient relationship, it was crucial to listen to what the patient really wanted. When we began to focus on these needs, we heard that their needs weren’t all that different than before-they were now simply being brought to a loud crescendo that became harder to ignore. We could no longer simply expect patients to fulfill their portion while we at times dropped the ball on our end. We had to have a two-way, equal relationship.

We found that patients wanted a few things:

• An exam focused on their needs

• Someone to talk to who cares

• Prompt resolution of concerns

Focused exam. Currently, patient exams are focused on the doctor’s needs. The last time the patient was here, the doctor wrote in his “orders” what he wanted for the next visit. This system is designed to see the patient in a timely, and efficient manner by ensuring that the staff conducts the exam that fits the patient needs.

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Well, not really. Because what the patient really wanted from today’s exam was another refraction check because she is still unhappy with her glasses. The doctor ordered a vision, pressure, and dilate check. The patient pressured the technician for the refraction, the technician performed the refraction, and tech caught heat from the doctor because-in his opinion-it was unnecessary.

Caring listener. With the emergence of EMR/EHR, most doctors and staff have their noses firmly implanted in a screen. Gone are the days of looking at the patient and having a conversation. And if staffers are looking at patients and talking, it is while they are at the slit lamp. Some offices added the patient “convenience” of a screen large enough so that the patient can see what is being entered. This is not what patients mean when they say they want to talk with their doctors.

Prompt resolution. If the concern is a copay, ask someone to look into the matter while you are performing the patient’s exam. Don’t let the patient leave the office unhappy-especially if he is voicing those concerns throughout the exam. Often the staff will get into an “It’s not my job” mentality and allow the problem to be passed down the line. Patient care is everyone’s job, and the patient is the job.

What can we do to improve this relationship with this customer/patient currently in the chair?

Lastly, we want them back. If we work hard enough to align the business and clinical part stogether, they will return. Hopefully, they will bring others along as well.

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