Patients typically need to visit the doctor because something is, was, or could be wrong with their health. When it comes to personal health, even if a condition is not life threatening, patients want accurate and immediate answers and cures. When something is wrong, patients can be particularly sensitive to a few key elements of their experience:
- How long will it take to be seen?
- How much attention is given by the physician and the staff?
- If something does not feel right or remains inconclusive after they are seen, how long does it take to get a resolution?
If patients feels their current physician is not meeting their expectations in these areas they may quickly look for alternative solutions. In the second piece of this 3 part series we will focus on the second question.
How much attention are patients given by the physician and the staff?
The right amount of attention allows patients to feel more trusting of not only their physician but the entire organization. Being a patient-centric organization means putting the patient first.
There are three critical interactions that must be carefully managed in order to ensure high patient satisfaction: when the patient calls the organization, when the patient is entering or leaving the facility, and when the patient is being seen by the physician.
When the patient calls the organization
Patients call for many different reasons, but the most critical interactions are scheduling appointments and asking medical questions. The challenge is, how to efficiently and effectively schedule appointments, and answer medical questions when the only predictability is that there will be a lot of calls every day. The best way for a clinic or a medical facility to handle these types of calls is to build a centralized access point that can then forward calls to the appropriate clinical resource. This has two main layers: scheduling and responding to clinical questions.
Scheduling is not a clinical activity so it does not make sense for a nurse, nurse practitioner (NP), physician assistant (PA), or physician to participate. These types of calls need to be handled by an administrator who has impeccable customer service skills. The first layer of a centralized access point will be to schedule, make any adjustments (cancellation/reschedule) to existing appointments, and forward calls throughout the organization. The goal is to be able to process any incoming call courteously, quickly, and to answer them by a person (and not a automatic answering machine). Additionally, this will be the primary resource for answering messages, whether it means calling patients back directly or forwarding on to a clinical resource.
The second layer is to be able to field clinical questions. It is the complete opposite of scheduling, as these calls must be handled by a nurse, NP, PA, or physician in order to maintain regulatory compliance. Having non-clinically trained administrators answer medical questions (even ones they may know the answer to) puts the organization at risk of facing stiff penalties. Depending on the nature of the organization and the requests of patients, it may make more sense to have nursing or mid-level providers (MLPs, which are PAs or NPs) staff over a clinical support line. Typically, this decision comes down to the size of a practice and nature of a practice. Regardless of construct. this clinical access point should be able to handle 80%+ of incoming patient calls.
When constructing this central access point it is critical to define rolls and responsibilities well, have detailed all scripts, and provide tools to the team so they are best able to process calls quickly (since we know there will be many every day).
When the patient is entering or leaving the facility
Many patients are nervous when they visit the doctor, typically when something is, was, or could be wrong with their health. Being greeted by a kind and courteous person, who gives the patients very specific instructions about any forms they need to fill, out and does what everything possible to ensure that the patient is comfortable (remind them where the bathroom/water is) is an easy way to improve patient satisfaction.
Beyond customer service, however, is the challenge of reducing wait times. Having zero wait times is impossible in a busy facility. However, taking action to reduce wait times as much as possible will be a major delighter of patients. A great way to reduce these wait times is to follow the core lean principle of reducing waste.
In order to reduce waste, first you must identify it; this means a lot of observation and analysis. A great way to start is a multi-observational study (MOS), which involves categorizing activities of workers (or rooms/equipment). A team of people will observe workflows for multiple full days of operation by dividing up into a series of shifts. Each person will continuously walk the facility, noting down each activity they observe on their predefined path. The output is a robust set of data containing thousands of observations that each be classified as value added (VA), required non-value added(R-NVA), and non-value added (NVA). The R-NVA and NVA observations represent waste in the process and should be the focus of further analysis. The difference between the two is that an R-NVA is something which must be done to stay in business, such as cleaning the room after a visit has taken place.
Once you identify the target areas the next step is mapping the processes and observing them end to end. This provides the understanding of the root cause of the waste that has been identified. Once the current state maps are created, a cross functional team will analyze and design new processes that will eliminate as much waste as possible. By implementing best practices the facility will be able to reduce wait times for patients, thus improving their experience.
When the patient is being seen by the physician
This has become a concern especially in the past decade, as Electronic Health Records (EHRs) become the industry standard. During the same length appointment a physician will now spend much of that time looking at a computer screen checking boxes and significantly less facing and making eye contact with their patient. The problem is that patients feel less connected with their physicians than they did before the emergence of EHRs. The lack of eye contact can be perceived as a lack of empathy, regardless how excellent a physician’s bed side manner is.
How do we enable physicians to focus more on the patient and at the same time ensure they are documenting correctly in their EHR system? Depending on the nature of the practice, there are a few options that can be considered each with certain drawbacks that must be considered:
Dictation – allows a physician to focus more on the patient, but it does mean that sometime after the appointment they will have to listen to their recording and check all boxes in the EHR.
Voice recognition software – this type of software allows the physician to communicate directly with the EHR. Removing the need to process notes at a later time, they will simply need to review them. The drawbacks are that the physician needs to learn to speak in a way that the EHR will recognize, and that since this is a new technology it can be error prone.
A scribe program – having a medical scribe allows the physician to focus on the patient and reduce his administrative burden to reviewing notes and signing off on orders. The main drawback is that some patients may be apprehensive about having an additional person in the room. This is typically less of a concern at academic institutions, where patients are used to having residents observe their visits.
Each of these programs can be effective, but they require buy in from physicians and in the case of scribes buy in from the patients.clinic, clinic optimization, customer service, patient satisfaction, wait times