One of us (NHB) will never forget the young woman who took the orders of five people without writing anything down and correctly placed the food in front each patron. The waitress also did a few other things that made our evening memorable. As a result, her tip was 25% of the bill. In this article, we will describe what the best waiters and waitresses do to increase their tips and how this might apply to the delivery of outstanding healthcare with stellar patient services.
State Your Name
Every employee and even the doctor should clearly state their name and title when they meet a patient for the first time. This even applies to the receptionist who answers the phone. There’s a world of difference between “Doctor’s office, please hold” and “Good morning. This is [name of medical practice]. My name is [name of receptionist]. How may I help you?” In the former, a negative first impression is created; and as a result, the patient may not keep the appointment and may go elsewhere for his or her medical care. The latter phone response is polite and clear, and makes the patient feel that the office and doctor are there to serve patients and not the other way around.
One Size Does Not Fit All
In the restaurant industry, diners want their needs met. At a minimum, that means getting the food to the table in timely fashion with zero errors. Sometimes the diners want the waiter’s opinion on the wine, the specials, or the desserts. Sometimes the diners are interested in engaging in social banter with the waiter. Every group of diners is different.
There are times when one of us [JJS] responds to the ubiquitous “Do you have any questions?” with “Do you know what Avogadro’s number is?” The purpose is not to quiz the waiter on Chemistry 101. It’s to set the tone for the evening that social banter is OK and to make the table memorable enough to receive high-priority service. Incidentally, a surprising number of waiters do indeed know what Avogadro’s number is.
But a waiter’s small talk is not appropriate when business people are in the midst of a tense negotiation, or a husband and wife are in a heated discussion one inch away from a nuclear meltdown. At that point, discretion is the better part of valor. Top off the water, deliver the food, and get out of the way.
As a doctor, know when breaking the ice with engaging banter makes sense. It makes sense when you first meet a patient and hope to learn a bit more about his or her background. It’s more appropriate with elective care than urgent or emergent care. On the other hand, when you’ve been given the task to explain the options to a new patient who just learned that his or her diagnosis is cancer, you will have the patient’s full attention for just the first few sentences. At that point, every word must count, and you don’t have the luxury of chitchat.
An experienced doctor, like an experienced waiter, knows how to deliver the right amount of information mixed with the right amount of social interaction to each person.
Be Authentic and Be True to Your Patients
It is important to notice that waiters at both the International House of Pancakes and a Ritz Carlton restaurant can do well financially. But the work at each entity is dramatically different. At IHOP, it’s a low-cost, high-volume, quick-turnover process. At the Ritz Carlton, it’s a high-cost, low-volume, slow-turnover process. Diners understand this implicitly when they sit down. Their expectations are based on the reputations of the respective entities. Waiters who deliver service at or above this zone of expectation will be tipped well.
Every doctor’s practice is different. Some, like concierge practices, are high-cost, low-volume practices. Patients expect Ritz Carlton–like service. Other practices are focused on convenience. Some high-volume pediatric practices, for example, keep slots available for same-day appointments with the understanding that the child might not see his or her usual doctor that day, but the child will definitely see a doctor, and the problem will be diagnosed and treated. Some doctors’ practices are a hybrid of IHOP and Ritz-Carlton. The key to making this work is to set minimum expectations up front, then do your best to exceed them.
Be Honest With Your Patients
When a waiter says there are two specials — the grouper and the tuna — you might ask, “Which is the better dish?” If the waiter says, “They’re both good, it just depends upon your taste,” you’ve received no real response to your question. Perhaps they’re both tasty, but any additional information to help break the tie might be helpful. It’s often a breath of fresh air when a waiter states, “I personally don’t like the grouper. It’s been on the menu for a while, but it’s rarely ordered. And often when diners order the grouper, it’s overcooked. But that’s just my opinion.” That’s code for order the tuna.
In healthcare, patients are looking for answers and guidance. The more you hedge, the less confidence they have in your ability. As a spine surgeon, you can offer patients physical therapy or surgery for a herniated lumbar disc. After describing the risks and benefits of each path, a patient might say, “This is all very confusing. What would you do?” If you say little more than “Each patient is different; it’s really up to you,” most patients will perceive that response as below the bare minimum. You can and should qualify that each patient is different and that your tolerance for risk might be very different than that of the patient. But the patient wants the question answered.
Perhaps you can state that based on your experience, 70% of your patients choose surgery, and 30% choose physical therapy. The reason some patients typically choose surgery is that their window of time to be out of work is narrow. And the reason other patients typically choose physical therapy is that they have experienced a known risk with a different surgery in the past. You’re not telling the patient paternalistically what to do. You are helping the patient ask the right questions to make a better decision for him- or herself. Like successful waiters, doctors should give straightforward, honest answers.
If You Make a Mistake, Own Up to It, and Make It Right
When one of us [JJS] dined at a high-end restaurant for lunch, patrons who arrived later received their food before those at the author’s table, who had been waiting longer. The waiter explained that there was a mix-up in the kitchen, the food would be out shortly, the meal was free, and there would be 50%-off coupon that could be applied at a future visit. Mission accomplished, anger dissipated, and loyal customer created. And the tip was still on the full amount.
As a doctor, it’s inevitable that service errors and lapses will occur. For example, you may be running an hour late, you may have forgotten to return a call, or you may have inadvertently double-billed a patient. Fix the problem. Make it right. Then go above and beyond patient expectations. This is what outstanding waiters and waitresses do. If the food delivery is delayed, the staff will often provide a free drink or comp the guests a dessert. This often ameliorates the problem, and the guests feel that the restaurant has responded appropriately.
Medical practices can do the same thing. Some practices surprise patients with a $10 Starbucks card if a patient has to wait too long. Other practices might write off a small amount if there’s been an embarrassing clerical error. (Of course, this practice needs to be squared with state and federal regulations and any insurance contractual obligations.)
One of us (NHB) often will tell a patient who has a legitimate complaint that there will be no charge for the visit. Now some will say, “You can’t do that.” Let the truth be told, you can treat a patient for free. What you can’t do is waive the copay but bill the insurance company. That is illegal, and you can run afoul of the Office of Inspector General. What is our take-home message? If you underdeliver, own up to it, make it right, then overdeliver at your earliest opportunity.
Bottom Line: Let’s not forget that we, too, are in a service industry. We have an obligation to provide outstanding service just like the restaurant industry does. We have to make every effort to ensure that every patient has a positive experience with the practice. When we do that, we don’t have to worry about the Affordable Care Act or any other governmental intervention, because we will have a plethora of patients who appreciate outstanding care and are willing to pay for it.