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Retaining patients and attracting new ones can be a walk in the park if you concentrate on the two areas patients say matter most: your front-office staff and your office environment.

Fam Pract Manag. 1999;6(10):33-35

Studies have shown that patients most often base their level of satisfaction with a practice on the front-office staff and the office facility. (See “The top four factors influencing patient satisfaction.”) Yes, you read correctly. No matter how skilled a physician you are, chances are your patients won't be able to differentiate excellent care from average or even below-average care. But they do know when someone is rude or rushed or the temperature in the exam room is uncomfortably cold. While these may seem like innocuous inconveniences to you, they matter to your patients and, if left uncorrected, could cause them to go elsewhere for their medical care.


  • While you may not consider your patients to be customers, your patients expect to receive the same level of customer service from your practice that they would from any other business.

  • Patients most often base their level of satisfaction with a practice on the front-office staff and office facility.

  • Some companies make a mistake by investing too little in training for people in low-level jobs. Well-trained staff have more confidence, take more pride in their work and generally perform at a higher level.

The patient as customer

As a physician, you probably don't tend to think of your patients as customers. But your patients compare the level of service provided by you and your staff to what they receive as customers of any other type of business whether it be a department store, restaurant or even Walt Disney World. To position yourself for future success, it's important to realize your patients expectations of you now and respond with quality service. According to Tom Con-nellan, a leading authority on quality service and author of the book Inside the Magic Kingdom: Seven Keys to Disney's Success (Austin, Texas: Bard Press; 1996), all businesses would do well to emulate the customer-focused approach of the Walt Disney Co.

The top four factors influencing patient satisfaction*

  1. Front-office staff

  2. The ambiance of the practice facility

  3. Clinical support staff

  4. Physicians

* Ranked in order of importance to patients.

Source: The Horizon Group Ltd., 1997 Survey of Family Practice.

Invest in your staff

If you've ever visited a Disney attraction, you probably understand why Disney is recognized as one of the top-performing companies in the world in terms of customer satisfaction. Disney goes to great lengths to ensure its guests are happy and that they keep returning to Disney parks. (Almost 70 percent of guests to the Magic Kingdom are repeat visitors.)

Consider, for example, how Disney trains “cast members” for the job of street sweeper. Each member of Disney's custodial staff receives two weeks of training. That's not because they need to learn to use a complicated broom. It's because Disney realized that when their guests had questions, they were most likely to ask a member of the custodial staff.

Disney used to station special guest-relations representatives throughout the park. They were easily identifiable by their white shirts, Mickey Mouse ties and special name tags. The only problem was that, to guests, these cast members looked too important to interrupt with simple questions such as, “When does the parade start?” or “Where's the rest room?”

Disney quickly responded by making the most approachable cast members, the custodial staff, a resource for guests. They spend two weeks training custodial staff so that they'll have a working knowledge of the entire park and will be able to direct guests, or tell them when the next parade begins. And most likely they'll do so with a smile because the time and attention they receive during the training process makes the cast members feel that they are a valuable part of the Disney team. As a result they take more pride in their work and generally perform at a higher level.

This strategy can be applied to your practice as well. Given the opportunity, a patient is not likely to interrupt a busy physician who “may have more important things to think about,” but most won't hesitate to approach a receptionist or another member of the front-office staff, regardless of how busy they may be. Why? Because patients consider the front-office staff to be peers, and, as such, more approachable. Front-office staff also are more accessible. They're usually the people that patients encounter first and last during their visits, and they're typically the ones who answer the telephone when patients call. And, no matter how efficient your practice, most patients spend a large portion of their visit in the waiting room, in relatively close proximity to the front-office staff. Yet these are the people who often receive the least amount of training.

Providing less training for staff in low-level positions is a mistake many organizations make and one that contributes to poor job performance, decreased job satisfaction and eventually, increased turnover. Instead, take a tip from Disney and invest in your front-office staff, regardless of their position on the pay scale. Encourage them to share their knowledge with one another through informal lunch-and-learn sessions, job shadowing or cross-training. Send your staff to local customer-service seminars. Spend the time, money and energy to make them knowledgeable about their responsibilities and your general office operations. Doing so will enable your staff to work with increased confidence and improve the service your patients receive.

Improve your “castle”

Not only do Disney staff keep the park grounds immaculately clean, but they also spend an immense amount of time and money focusing on attention to detail. Every task is performed to the highest set of standards. A good example is the attention given to the horse-head hitching posts that line Main Street in the Magic Kingdom. Disney paints the high-wear spots on the posts each night, calculating the time they start painting according to the temperature and humidity levels so that the paint will be dry by the time the park opens the next morning.

Similar attention to detail can be applied to your medical practice, and it doesn't necessarily require a better office space or new furniture, much less repainting every night. The first step to improving the ambiance in your office is to schedule a walk-through with your custodial service. Show them what areas require more attention, and if they can't meet your needs, look elsewhere for help.

Next, evaluate the appearance of your front-office, reception and waiting areas. Ask your front-office staff to do this with you. What do your patients see? A silk flower arrangement in the reception area that's tired and dusty? A stack of out-of-date magazines in the waiting area? Workstations wallpapered with sticky notes and papers? Remind your staff of the impact they have on your patients and ask them to be accountable for the tidiness of these areas. If necessary, you may want to make it a performance-appraisal measure.

Walk the talk

While it's unlikely that most guests will notice its freshly painted hitching posts and other evidence of its attention to detail, Disney continues such practices because cast members tend to transfer this level of effort to their own job performance. In fact, these practices are promoted to cast members during their initial training. Why? Because it shows them that the organization does more than just “talk the talk.”

There's no better way to instill in your staff a commitment to quality service than for you to practice it yourself. Connellan refers to this as “walking the talk.” Part of the reason for Disney's success is that everyone on its staff walks the talk. For example, it's not just the custodial crew who keeps the park clean; it's anyone who spots a stray piece of trash. There's no official policy that requires cast members to pick up trash, but it's a learned behavior dating all the way back to Walt Disney himself. He used to take his daughter to carnivals and couldn't believe how dirty they were. When he began to envision what later became Disneyland, he imagined a place where parents felt good taking their children. Ultimately he made a clean environment a high priority, promoted park cleanliness to his staff, and the rest, as they say, is history!

Improve your feedback

According to Connellan, people treat people the same way they're treated. And, while most companies acknowledge the importance of positive feedback, many don't practice it enough. Unfortunately, no feedback at all is the most common response to good performance. And that can be just as distressing to employees as negative feedback. Connellan suggests this simple exercise to make sure you're providing your staff with enough feedback. At the beginning of the day, put 10 dimes in your pocket or in another easily accessible place. Every time you see one of your staff paying close attention to detail or providing excellent patient service, recognize that person's contribution. Then move one of the dimes to your other pocket. The next time you acknowledge a staff member's efforts, move another dime. The goal is to move all 10 dimes to the other pocket by the end of the day. Try it for 30 days and see if you have happier staff and, as a result, more satisfied patients.

The real magic

The Walt Disney Co. recognized years ago that the best way to turn its visitors into repeat guests is by employing people who are fans of the place themselves. The real magic in the Magic Kingdom is not found in the rides or attractions, but in the cast members and the special commitment they have for their work. This commitment isn't elusive, and it doesn't happen only at Disney. Your staff can develop it too. It's the result of thorough training, reward and recognition for a job well done.

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Copyright © 1999 by the American Academy of Family Physicians.

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