As patients pay more for healthcare, they will expect more from the patient experience. This means that the most successful practices will be those that are best able to meet—and exceed—those expectations.
By Jason Kraus
Although nobody knows exactly how the current incarnation of “healthcare reform” will ultimately be constructed, there are two things that most pundits agree on. The first is that there will, in fact, be some reforms to our nation’s healthcare system. The second is that more of the cost of care will be paid for by patients directly. This is not something new, but rather a continuation of a trend that began during the late 1980s. The cost of care has been shifting from employers and government agencies to the consumers of healthcare for the better part of two decades.
It is probable that in the future an even larger percentage of the healthcare tab will be paid by your patients. In turn, they will expect more from the patient experience. And this means that the most successful practices will be those that are best able to meet—and exceed—those expectations.
The shifting of healthcare costs onto patients has been somewhat cloaked in a number of euphemistic forms. Co-payments were introduced about 25 years ago and are now considered routine. Today most private insurance and many publicly funded policies require patients to make these payments at the time that service is rendered. The healthcare deductible, while older than its “co-payment” cousin, was actually an idea borrowed from other forms of insurance, where assets such as a home or an automobile were being protected. Finally, when there seemed to be no more room to squeeze dollars from their customers, insurance companies simply began to carve out certain previously-covered procedures, drugs and other health services from their policies. By doing so the insurance companies were able to further reduce their financial exposure and enhance profitability. Patients who required these “non-covered” services began to pay for them directly.
Patients become consumers
The timing of this generation-long shift has coincided with the Information Age, and the resulting perfect storm of change has had a demonstrable effect on patient behavior. Patients today are more knowledgeable and sophisticated in their healthcare relationships and they now act much more like consumers than simply the sick people of days gone by. Today’s patients are influenced by, and responsive to, traditional consumer stimuli such as price, customer service and convenience. They tend to be more demanding, more likely to compare their doctors the way they compare other professional resources in their lives, and not nearly as “brand” loyal as they used to be.
In many ways, medical practices are confronted with many of the same challenges and opportunities as other types of retail businesses. Medical practices have taken a page out of the corporate world’s book and have begun to design their practice processes in a way that creates exemplary patient experiences. Companies large and small have come to recognize the economic value of building “customer-centric” organizations. In many cases this focus on customer needs has required a complete reorganization of the enterprise. But the rewards for those companies who have successfully re-engineered their businesses to exceed customer expectations have been considerable. Those benefits include a much more positive work environment, greater job satisfaction for employees, enhanced practice profits and competitive advantages in the marketplace. Additionally, there have been studies that have demonstrated an inverse relationship between satisfying patient needs and their willingness or desire to bring a malpractice suit against their physician. In a study conducted by Stevens & Lee, a major legal and consulting firm,73.7% of the 239 malpractice claims they studied were linked to failures in service or communications – two critical factors in patient satisfaction.
Driven to exceed
Simply meeting your patient’s expectations represents the minimal level of acceptable service. Exceeding them will actually create “buzz” about the practice. Ironically, meeting expectations helps to create an even more demanding patient, while exceeding expectations makes patients more forgiving and understanding.
This is not as easy as it may sound. Every practice has deeply entrenched systems and cultures. In order to truly create a “patient first” practice, you need to begin with a clean slate and recognize that the patient has to be at the center of every practice process, from scheduling to collections. Do not assume that you already know your patients’ needs and preferences. A well-designed, objective patient survey will help to identify patient priorities and areas where the practice currently is under performing, in a way that decreases the impact of your prejudices and preconceived notions. At a minimum, you should acquire patient impressions regarding the condition of your office, waiting time, the efficiency and professionalism of your staff, convenience factors and administrative processes.
When developing patient surveys, practitioners should be careful not to phrase questions such that the answers are more likely to support their own prejudices. For example, if you want to measure the cycle time in your practice (the time required of your patients from arrival to departure), ask this question in a way that requires the patient to write in a time rather than pick from a list of suggested answers. By not offering multiple-choice answers to this question, you will be able to more accurately assess your patients’ perceptions regarding their waits.
The survey results should provide the blueprint for the “patient first” practice. Building the structure, however, will require determination and uniformity of purpose. Usually, one of the most difficult aspects of this process is to align the staff, culturally and functionally, to the goal of patient satisfaction. Occasionally, existing staff members have difficulty successfully coping with this transition. As humans, we tend to avoid change, and it will take strong leadership to help navigate the “patient first” redesign of your practice. If staff members are unwilling or unable to make the transition, they may need to be replaced.
For the organization to become fully engaged in this process, all team members need to understand the specific goals of the initiative, their roles in it, and your expectations. The more detail that is provided to the team, the better. Your staff needs to understand that your patients are:
- The lifeblood of your practice
- Part of your business, not outsiders
- Human beings with feelings
- People who come to you with wants and needs, which it is your job to satisfy
- Deserving of the most courteous attention that you can give them
- The source of the income that pays all salaries in the practice.
Once everyone in the organization is on the same page, a complete review of all processes will determine whether the current approaches are in alignment with the hierarchy of patient needs and preferences, as identified in the surveys. At a minimum, these should include:
- Scheduling procedures
- Office hours
- Invoicing and collections
- Insurance processing
- Proficiency and efficiency of support staff
- Comprehensiveness of services offered
- Referral practices
When the current approaches are not in alignment with patient expectations, you will need to change your approach. Analyze each step of the patient experience and determine whether there are ways to modify your existing approach to make the overall experience better.
It should be mentioned that the assessment, diagnosis and care of your patients has to embody this same culture of a “patient first” approach. Resist the temptations of assessment shortcuts, when you are running behind schedule. Try to avoid having the financial considerations being the primary consideration when developing your comprehensive treatment plans.
Special attention should be paid to the initial appointment, which will help to generate a lasting impression of the practice. For example, is your practice accessible in all the ways that are important to your patients? When they call your office, do they get an automated attendant or a live person? Does that person seem rushed or do they take the time to explain what to expect during the initial visit, give directions to the practice, or provide any other important patient instructions? Is your office easy to locate? If not, how can you help your patients arrive on time and without hassle? If they want to book appointments online or download their paperwork to save time in the waiting room, can this be done?
When patients finally make it to your office for the first time, the physical impression they experience upon arrival is important. Is your reception room comfortable, clean and up to date? Try to avoid clutter and disorganization. A staff member should be assigned to review the condition of the public areas within your practice on an hourly basis, to make sure that they are clean and presentable.
Review the signage on display in your reception area. Many practices use the wall space in the reception area to spell out all of the rules and regulations of the office; co-pay information, canceled appointment penalties, and countless other negative things. Consider more positive signage including a message of welcome and gratitude. It might be more useful to use signage to describe some of the services and unique benefits of the practice.
Office design also impacts the environment (see figure). A closed design, in which office personnel speak to patients through small openings between the reception area and the staff workstations, is not a welcoming environment. The more open the design, the greater the opportunity to build a relationship.
The only limiting factors in trying to create a truly pleasing environment and experience for your patients are your imagination and your budget. Once you put your patients’ needs at the center of your planning and process design, the rest will flow quite naturally.
Some examples of “patient first” ideas are listed on page XX. As you can see from this list, many of these items do not create a new cost center for the practice. The ones that do should be reviewed in the context of an overall marketing and business development budget.
Like all other practice processes, customer service is an ongoing and changing aspect of your business. In order to determine the effectiveness of your efforts, some objective measurement should be made periodically. This can include additional surveys, patient interviews and measurement of patient compliance ratios and patient referral statistics.
In the end, if you routinely exceed the expectations of your customers (patients), their loyalty and commitment will have made the effort well worth your time and energy and their appreciation will be manifested in return visits, prompt payments, and new patient referrals.
Jason Kraus is executive vice president of Langer Biomechanics and former partner in the practice consulting firm SOS Healthcare Management Solutions.