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What keeps patients coming back to the same practice? The author's answer may surprise you.

Fam Pract Manag. 1998;5(7):29-34

What prompts a patient to choose one family practice over another when both are conveniently located and provide quality care? The answer is excellent service. In fact, the quality of service they receive is so much easier for patients to evaluate than the quality of medical care they receive that it may play a disproportionate role in their choice of physician.

If patients perceive a high level of personal attention, you're more likely to see steady growth from word-of-mouth referrals. If patients perceive the level of personal attention they receive from your practice as unacceptably low, you will experience a higher number of complaints that require significant staff time to resolve, and more patients will leave your practice.

Employer groups in several areas of the country have begun publishing the results of patient satisfaction surveys, so their employees can see how area practices rank against each other. One aim of publicizing this data is to motivate low-scoring physicians to examine the structure and processes of their practices in order to improve. One effect is almost certainly to steer some patients to practices with higher scores.

What are your expectations?

Many organizations, including the United States government, have developed service guidelines that help employees understand the needs of their customers. These guidelines are designed to provide a basis for consistent employee behavior.

More than likely, you rely on the discretion of your staff to treat patients well. Unfortunately, this approach may produce mixed results. You may say: “I expect everyone in the practice to answer the phone courteously.” To one staff member, answering the telephone courteously means saying, “Good morning, it's a beautiful day here in Omaha. You have reached Dr. Lin's office and this is Donna. How may I help you today?” To another staff member, though, adding “please” to “Doctor's office, hold” is the mark of courtesy. Also, an individual's behavior can be inconsistent from one day to the next. You, for example, may be gracious most of the time but become abrupt and short-tempered whenever your in-laws arrive for an extended visit.

The individuals who work in your practice don't view themselves as rude, indifferent or unfeeling toward patients. Each member of the practice believes that his or her way of interacting with patients is appropriate. But without some concrete guidelines, their discretionary behaviors can be inconsistent, and inconsistency increases anxiety for patients and staff alike.

Service standards define for everyone what your expectations are. Good service standards help employees know what to do and help patients know when to be satisfied. If it seems odd that you need to help someone tell when he or she is satisfied, consider this: Suppose a hotel sets a customer service standard that bellmen will offer to get ice for arriving guests — and the guest satisfaction survey then asks, “Did the bellman who escorted you to your room offer to get you ice?” If he did, the guest completing the survey recalls the offer to get ice as good service.

Involving everyone in the process

You may be tempted to save time by sitting down with your practice manager and defining some standards, but it's far more effective to involve all staff in this process. Most likely, they have concrete suggestions about how they can do their jobs in new and innovative ways.

Start by asking staff members to make recommendations about their own areas of responsibility. Newer staff can contribute by sharing previous work experiences. Some staff members may draw upon their experiences as patients in other health care settings. Your goal should be to develop standards that can be easily understood by staff and patients. An excellent example is Federal Express' promise to deliver overnight packages by 10:30 a.m. the following day. Everyone understands exactly what that means. (For an example of customer service standards for a practice, see below.)

Once you have a set of service standards, resist the temptation to tell patients about them right away. You don't want your long-term goals to become their immediate expectations, so start by testing your ability to consistently meet the standards first. For example, don't post a sign saying that all telephone calls from patients will be returned in an hour, unless you've proven to yourself that you can keep that promise.

Service standards

The following standards are the author's “top 10” customer service strategies. You might adopt some or all of these strategies or substitute some of your own. They are designed to improve interaction with patients and increase patient satisfaction.

  1. We are the first to say hello when patients arrive.

  2. We answer telephone calls in three rings with a consistent greeting.

  3. We use the patient's name at least once during each conversation.

  4. We take a moment to observe the patient's communication style and respond in a manner that will make the patient feel comfortable.

  5. We explain to patients what is going to happen next.

  6. We listen to patients without interrupting them.

  7. We watch for verbal and nonverbal signs that indicate that the patient is not satisfied or is concerned about something. We are proactive in identifying and responding to problems.

  8. We respect patient confidentiality at all times. We do not divulge who our patients are, even to members of our own families.

  9. We do what we say we will do, when we say we will do it.

  10. When patients are leaving, we say good-bye warmly and wish them well. If they have scheduled a follow-up appointment, we say that we look forward to seeing them again.

Moments of truth

One way to begin creating service standards is to conduct a “moments of truth” analysis with your staff. The moments of truth approach was developed by Jan Carlzon, the former CEO of SAS Airlines. Carlzon turned around the failing airline by recognizing that every interaction between a representative of the airline and a customer had the potential to affect customer loyalty, retention and referrals. Every interaction, even if it lasted only 15 seconds, was a moment of truth. Working with his staff, Carlzon set out to identify all of the employee-customer points of interaction and then to define the behaviors during those interactions that would be negative, positive and memorable.

Moments-of-truth analysis is not a complicated or time-consuming exercise. Start by identifying the moments of truth — points of patient and staff interaction — in your practice. Typical moments of truth include making an appointment, arriving at the practice, meeting the receptionist, waiting in the reception area, meeting the physician, giving a laboratory specimen, waiting in the exam room, leaving the practice and receiving a bill.

Define what would make these interactions negative, positive and memorable experiences for patients. A memorable experience would be the kind of interaction that would cause a patient to comment favorably to another person about you, your staff or your practice. (See the chart below for responses given by the staff of one practice.)

Moments of truth

Calling your office
The line is busy. The patient is unable to reach a human being or hears, “Doctor's office, hold.”The phone is answered within three rings in a pleasant tone of voice. The name of the practice and employee's name are given.“Somers Medical Group. This is Jo Smith. May I help you?” The person answering takes responsibility to help the caller.
Meeting the receptionist
The patient has to speak first. The receptionist is chewing gum.The receptionist is polite, introduces self to the patient and smiles.The receptionist recognizes the patient, uses his or her name and asks if the patient needs anything to be more comfortable.
Waiting in an exam room
Uncomfortable temperature. Long, uninformed wait.Staff member updates the patient every 10 minutes if there is a wait; reading materials are available.A nurse provides patient education during the wait.
Meeting the physician
The physician reads the patient's name off a chart, does not introduce self, is abrupt and seems rushed. (Keeps looking at watch.)The physician gives a personal greeting and makes significant eye contact.The physician sits while speaking to the patient, listens to the patient and gives explanations that the patient can understand.
Obtaining test results
Lost specimen; inconclusive results; patient is never notified.The physician calls when promised and asks, “What questions do you have?”The results are given personally, within 48 hours, in a caring manner.
Receiving a bill
The first statement the patient receives says the office has turned the bill over to a collection service.The bill is sent within 30 days and clearly shows what is owed.The bill includes the name and telephone number of the person who can answer questions. The bill makes so much sense that the patient pays it!

Responding to patients' questions

Another tool that has helped many practices improve patient satisfaction is the creation of a database of responses to frequently asked questions. Having information readily available has three immediate benefits: 1) it helps even the newest employee feel confident about his or her ability to help a patient, 2) it increases the consistency of information that is given to patients and 3) it saves staff time. Some of these questions might include requests for information about the health plans you participate in, your billing procedures and your referral process. Some practices keep information in a three-ring binder; others use an electronic database. Whenever a patient has to be put on hold to obtain an answer from the practice manager or physician, the question and answer should be entered into the centralized resource. By using this strategy, you eliminate the need to ask the same questions again and again. Think of it as an encyclopedia for your practice.

Reinforcement: The key to success

Once your service standards have been defined, success lies in your willingness to model the desired behaviors and your readiness to recognize those individuals who use the standards consistently.

Physicians must be the first to embrace service standards and exemplify them every day. If staff agree, for example, that phones are answered “North Shore Medical Associates. This is Jane Smith. How may I help you?” then you must answer your phone “North Shore Medical Associates. This is Dr. Johnson. How may I help you?”

Patients have more trust in your competence when your staff is competent, and you have greater credibility when your organization runs in a professional manner that emphasizes the needs of patients. The combination of competence and compassion that service standards contribute to your practice can create a culture that is second to none for your patients and for you.

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Copyright © 1998 by the American Academy of Family Physicians.

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