Customer Knowledge
Today’s medical groups have episodic knowledge of the patients they see, typically focusing on the patients they see today and the patients who have chronic diseases. To succeed in the evolving healthcare environment, the group should have a knowledge base that includes the following:
Market knowledge and patient movement;
Population management of chronic diseases;
Performance of physician referrals;
Active solicitation of patient input regarding their satisfaction with the physicians and their practices, including an active discussion with physicians and staff regarding the findings of the results; and
Understanding of why patients exit the practice.
Market Knowledge and Patient Movement
Many practices do not understand their draw area and how new patients come to the practice. To answer these questions, a practice analysis can be done for an entire medical group or by individual practitioner. For multispecialty groups, it is best if the analysis is performed for each practitioner; if the entire practice is analyzed with no regard for individual practice variation, wrong assumptions could be made about the practice as well any strategic implications of how this data might be used. Components of such an analysis should include customer population sorted by zip code and tracking of how new patients select the practice, including referrals from external physicians.
This knowledge would help with external and internal marketing of the practice as well as broader services that a health system may provide.
Clinical Demographics
With the movement toward population management, it is important for the practice to track performance in chronic disease management. Insurers for most markets are already basing reimbursement on physicians performing to standard benchmarks. This would include such disease measurements as those for diabetes, asthma, congestive heart failure, osteoporosis, and similar chronic diseases. Most current EMRs are capable of tracking this information, as well as performance in relation to varying benchmarks.
Performance of Referred Physicians
Referred physicians — those physicians to whom a physician refers — need to be tracked for their performance. A referred physician’s performance is perceived to be an extension of the referring physician’s practice. If the referred physician’s performance is not positive, that could reflect on the referring physician’s personal practice. Referred physician performance can be measured in different ways, including clinical performance (i.e., how well the clinical referral was handled); whether the referred physician respected the referring physician’s opinion and managed him or her up; and how well the patient perceived the quality of care. For most physicians, the specifics of this information cannot be quantified. Some of this information is documented in the patient record but cannot be gathered in any meaningful manner. If a primary care medical home is pursued, this referred physician information will become critical.
Solicitation of Patient Information
For many small and rural hospitals, developing and implementing customer satisfaction surveys is costly. However, this information is critical to building a small or rural hospital integrated system. Once this information is gathered, meetings should be held with the physicians and practice staff to review patient data and discuss how they can improve customer satisfaction.
Patients Exiting the Practice
The fact that patients are exiting the practice should not necessarily be viewed as a negative. Patients leave for varying and justified reasons, including relocation or change in insurance provider. On the other hand, patients may leave due to dissatisfaction with care. Regardless, administrative/physician leadership should be aware of the reasons patients leave the practice. When patient information is transferred to another physician, information gleaned about the reason for the transfer can guide individual physicians as well as their staff relative to the need for improvement, particularly if the patient is leaving due to dissatisfaction.
Customer Access
Patient access to care is a critical point in patient satisfaction. The issues of access include the following:
Practice hours;
Ease of telephone communication;
Scheduling policies;
New-patient screening;
Directions to practice; and
Parking.
Practice Hours
Primary care practice leaders rarely perform a practice analysis to determine the appropriate balance of number of patients to hours available for patient contact. Some physicians expand their panels yet provide limited hours to see patients, creating patient dissatisfaction. An appropriate analysis can direct practice leaders regarding the number of patients who can be seen if the practice numbers are low. This is a double-edged sword, however, with one side being insufficient hours and the other being insufficient numbers of patients being seen during the access hours offered.
An analysis should be performed for primary care (i.e., internal medicine and family practice) regarding the capacity of patient access for each practice. This analysis would also determine the availability of acute and work-in appointments on any given day. See Table 1 for an example of such an analysis.
Table 1 shows that physicians A and B have a reasonably good match to benchmark performance, with physician B having the opportunity to expand their practice. Physician C is not meeting the patient demand (panel size) of the practice. This leads to patient dissatisfaction and the potential for patients to leave the practice.
This type of analysis helps administrative and physician leaders understand practice performance and provides a foundation to work with physicians in the employed physician network relative to patient access.
Telephone Etiquette
There are best-practice standards for telephone etiquette. One of the first measures is the number of rings before the telephone is answered. As a normal course of business, this should not exceed three rings. Additionally, a patient should not be on hold for longer than 30 seconds. Once a patient has made contact with the practice, responses to any physician-guided questions ideally should be provided within three hours, but certainly within the same day of the phone inquiry. This response time will vary depending on specialty type and provider availability.
Scheduling Policies and Screening New Patients
You do not want to lose a patient due to scheduling difficulties. Centralized scheduling should be considered as a means to ensure timeliness and accuracy of scheduling.
Each physician has his or her own method of scheduling, usually achieving a balance between complete physicals, complex patients, and rechecks or follow-ups. Each physician’s scheduling policies should be documented so staff members are always aware of the physician’s scheduling patterns. Documented policies help ensure efficiency and also help leadership be aware of any limitations to patient access.
Another scheduling issue has to do with new patients accessing the practice. Table 2 illustrates the percentage of new patients needed annually for a practice to remain viable on a go-forward basis. This calculation is performed by determining the new-patient CPT codes for the past three years of patients in the physician’s panel.
Even in practices that are closed to new patients — which is not recommended — new-patient access will be critical to maintain the vitality of the practice as primary care patients die, leave the community, or change providers due to shifts in managed care contracting.
The balance of scheduling Medicaid and insured patients is critical, as Medicaid patients may be more prone to noncompliance with clinical care and skipped appointments. The need to screen for new patients who may be seeking drugs also is important; once they are attached to the practice, it becomes difficult to terminate them as patients. Some practices have a no-charge interview appointment, but this can create more negative than positive feelings among patients looking for a new physician.
Although it is critical that patients be appropriately screened for appointments so the length of the appointment can be determined, it’s important to recognize that, at times, patients are not completely honest about the reason for their visit, because they do not want the scheduling staff to fully know the issues. It takes skilled staff to know the right questions to ask so that adequate time can be scheduled.
Directions to the Practice
The scheduling staff should have clear, concise directions to the practice and available parking. Driving directions and new-patient information can be mailed to the patient as well. Because today’s consumers are very tech savvy, an enhanced website that includes driving and parking instructions is important for a positive customer experience.
Customer Expectations
New as well as established patients should have a patient handbook that includes the following information:
Practice mission;
Patient rights;
Hours of access;
Prescription refill information;
Financial matters/expectations;
Preventive health guidelines; and
Provider information.
This information could be sent to new patients and provided to established patients. As for the practical application of meeting patient expectations, it should be routine for the staff and physician to note the patient’s primary complaint and reason for the visit. This information should be reiterated when the physician begins the initial visit with the patient.
Customer Service Team
The following are important traits of a practice’s customer service team:
Friendly staff members view customer service as part of their responsibility;
Staff members receive formal training in customer service standards and techniques;
Annual customer service training is conducted for practice staff members;
Customer service is a measure within each staff member’s performance appraisal; and
All staff members are well-trained in their technical role within the practice, and staff who are in training are appropriately identified.
A team built on customer service may not have been part of the history of the employed physician practices. Because the individual practices remained in individual silos, a team culture may not have been emphasized, particularly for primary care practices. Both administrative and physician leaders will be key in changing the past culture of this group.
Customer Service Culture
It is in the area of customer service that a departure from the Studer initiatives is most pronounced. The development of a customer service culture needs to be examined through the lens of innovation. The following framework represents a culture that is well on its way to having a mature customer service culture.
Hospitals post a bill of rights for patients; physician practices should do the same. The physician practice bill of rights should reflect elements from the hospital bill of rights but should stand alone for the physician practices, because the customer service standards are different in the office practice environment. The bill of rights should express the organization’s commitment to patients and their families.
Other points of difference for the physician practice include posting provider pictures in the patient reception area and recognizing staff for achieving customer service goals.
From an operational standpoint, weekly staff meetings and brown bag lunches should be scheduled to discuss customer service issues and how to improve the patient experience. Examples of high-quality customer service should be shared.
There should be no reluctance to experiment to improve the customer service experience. For example, physicians and staff members should record “social progress notes” about patients to act as reminders about grandchildren, hobbies, vacations, or other special events for the patient. These reminders can help forge a bond and improve customer service when patients visit and when they call for appointments or medical inquiries.
Customer Service Policies
As with any major initiative, customer service policies should be in place for the office practice environment. The following provides a framework:
Never criticize staff in front of patients. This should always be done in private.
Remember that the customer is always right. This can be a tough pill to swallow when dealing with a noncompliant or difficult patient or family.
Comply with all HIPAA regulations. Release of any information regarding a patient must be carefully considered.
Ensure that if a patient/customer expresses a concern, the first staff member who hears the concern owns the concern until it is resolved.
Document all patient/customer service concerns and review them during staff meetings.
Whenever appropriate, use patients’ names when addressing them.
Smile when interacting with a patient, whether in person or on the telephone.
Assist or chaperone patients. Patients’ ease of office movement is a top priority, particularly in larger facilities.
Acknowledge every customer complaint by sending the customer a signed letter from the provider apologizing for the frustration. Include a copy of the letter in the patient’s chart so it can be referenced when the patient returns for another visit. From a broader perspective, if the medical group is part of a hospital or health system, any complaint the patient makes about issues such as system services or quality of care should be summarized and reported to the appropriate personnel of these organizations.
Customer Experience
When it comes to the customer experience, physicians and staff members should view the practice through the eyes of the patient. Critical elements include the following:
Each customer should be greeted with a smile upon arrival to the practice.
If on the telephone, the person receiving the patient should notify the person with whom they are speaking on the phone that they will place them on hold briefly so they can greet a patient. Check-in is not necessary, but acknowledgment of the patient’s arrival is critical.
Soft music or medical education material should be streamed in the waiting room.
The reception area should always be clean and comfortable. Appropriate chairs should be provided for patients with bariatric conditions.
Patients should never need to guess about wait times — they should be updated frequently.
Reception staff should continually review waiting areas for any problems, such as soiled tissues or competitors’ material.
Up-to-date reading material such as magazines and newspapers should be available for the patients; staff should not be allowed to take the latest magazines home before patients have the opportunity to read them.
Exam rooms should be neat and clean at all times. There should be no signs of a previous patient’s exam.
Each patient should be thanked warmly upon departure.
Patient account issues should be managed cordially.
Excerpted from Integrated Ambulatory Care: Key Growth Strategies for Small and Rural Hospitals by James Hamilton, FACMPE, MBA.