Five ways to transform the customer-service mindset among providers and clinic leadership.

By Irv Barnett, MBA, CMPE, V2V Founder and Transformationist

A few years ago, a primary care physician-client of mine was faced with an opportunity. Her patients started contacting her practice after receiving their insurance EOBs, wanting to discuss their charges with her. Not an uncommon occurrence, but their reasoning was extraordinary.

Turns out they were so thrilled with their experience at her practice, from their welcome to her exam, to the post-appointment follow-up, that they felt the payers’ reimbursements were too low.

Right?

Repeatedly, her patients told her things like “we saw our EOBs and we were shocked at how little you were paid.” She decided to go without insurance contracts and has never looked back. Her patients are happy and she has found sustainable success in her medical practice.

Then the other day, we interviewed someone for a new position with the V2V team. She’s just earned her degree in healthcare leadership. During our interview, we discussed her work experience as a restaurant server over the past several years. She paid for a good portion of her tuition by the tips she earned from happy customers.

She seemed apologetic for her lack of health care experience. However, given the transformation of our industry, her work on the front lines of customer service is exactly what this industry needs right now. So, I asked her, “How many patients do you think would leave a 20% tip at the front desk at the end of their appointment?” That one earned a chuckle and we had a great interview.

Let’s consider the patient experience at the practice I mentioned, earlier. Well before the appointment, patients receive reminders, based on their preferences. They’ve also received the documents they need to complete, whether for patient records or insurance verification. They understand the appointment purpose and duration, whether before or at the outset of the physician encounter. Their appointment exceeds expectations and instructions are understood. If other questions arise, patients know where to get help. They receive a follow-up, later that same day, asking about their experience.

Happy Patients and Payers Contribute to Your Sustainable Success

What would it be like as a patient working his or her way through your practice? Do you welcome patients? What do they expect during appointments? Does your practice exceed those expectations? With the work many clinics, hospitals, and medical groups are doing nowadays toward profitability gap closure and diagnose codes for billing capture or to increase physician productivity, patient care can be a foregone conclusion. We’re in the patient care business, of course.

As patient satisfaction and outcomes are aligning with compensation, it’s more important than ever. Consider for a moment or two, is my care so valuable to my patients that they would eagerly pay extra in gratuity for their care? To answer this question, you must see things from the frame of reference of your patients. Remember, most do not have the level of experience or even the lexicon of your specialty. So how does your practice acquire patient mindset? It requires specific intention and action.

Create Great Relationships with Your Patients – Five Steps

On the front lines of customer service, the #1 reason people are loyal to a brand is perceived high quality, value-for-price-paid, and great customer service. Translated into health care terms, patient loyalty includes ease-of-access, perceived quality of facilities, their first impression of the practice, the patient encounter, itself, their perception of your compassion, and your post-appointment follow-up. These factors greatly influence your patients’ experience with your practice and your care:

1. First impressions are crucial: My colleague, Deb Wiggs, just wrote about the Dust Bunnies in the Exam Room, and it cannot be overstated that your health care setting must reflect the highest standards. Your greeting must reflect that you are calm and ready to serve the patient in front of you, whether you are at the beginning or end of a 20-hour day.
2. Respect your patients’ time: At most clinics, if your patient is more than 15 minutes late for an appointment, he or she misses it, entirely. Some may even be charged a missed appointment fee that is far higher than the co-pay because it’s not covered by health insurance. With that in mind, don’t make your patients wait. Emergencies notwithstanding, make it your practice to not overbook, and to keep track of the time you spend, per appointment. If you consistently find that you take too much time, then either work with your schedulers to expand your appointment times or block out appointments that allow you to “catch up” and remain on track. Returning to our restaurant comparison, if you go out for a phenomenal dinner but have to wait almost two hours to be fed, wouldn’t that experience be reflected in your tip?
3. Go beyond communicating, help people understand: Level-set the appointment purpose from the beginning and ensure you exceed their expectations at the conclusion. And, the best way to do that is to begin by asking your patients, “Why are we here, today?” If they are seeing you for a pain in their knee, with an appointment length reflecting that and they launch in with a laundry list of other ailments, it’s your opportunity to manage their expectations. Follow up with “Do you understand? Do you have concerns?” And give them a way to reach out to you or your team after the appointment, because with some diagnoses you know that once your patients take the time to absorb what you’ve told them and to read their care or prescription instructions, again, inevitably follow-on questions will arise.
4. Read your patient satisfaction reviews…and take them to heart: If your patients care enough to say something, whether in formal surveys or on social media sites like Yelp, WebMD, or Healthgrades, they want to be heard. Their opinions provide valuable detail on how to improve or evolve your patient encounter practices.
5. Use technology advancements to their fullest extent, with the patient in mind: Today’s technology has gone far beyond the EMR. Tech can help you improve patient communication, including management of social media reviews and more, it can help you ensure timely appointment reminders, payments, patient follow-up, help with disease state management, and satisfaction. Without exception, strategic investments into the harnessing the right tech at the right place and time will more than pay for itself.

So, what aspects of their experience would motivate a patient to leave a tip for your practice? Our goal is to ensure you become ADEPT^SM at your healthcare business for years to come. Instituting patient care and communication programs with specific intent can effectively stem patient load erosion and outmigration, offering a Distinct Advantage^SM in business growth and development. What sets you apart? And, what’s holding you back from realizing sustainable success? We can help.

Two key elements for a successful organizational assessment

By Irv Barnett, MBA, CMPE, Founder

While advising our clients and helping them implement sustainable, healthy practice management solutions, we’ve experienced a common thread through every experience: The vast majority of the time we end up transforming their health care business by solving a very different or a bigger problem than we were initially asked to address.

Many people just don’t have the time.

Recently V2V conducted an assessment at a medical practice whose physician leadership held the belief that their EHR application was broken…maybe even unsalvageable. Applying our ADEPT℠ approach helped us find the real cause of the problem.

During our observation period, we noted very low compliance in following procedures with the EHR and inconsistent use of the tool, altogether. What we ultimately identified was that while the application needed optimization, the real problem was that their team was not fully-trained on the EHR. This created an array of ineffective, manual work-arounds and those were the actual cause of multiple errors, not the application, itself. At times, this caused enormous friction with staff and service commitments to patients and risked the reputation, or brand distinction, of the practice. We quantified a resulting exorbitant expense, noting how it stole from their bottomline, threatening profitability.

Our primary focus is to ask the right questions to the right people involved in the process. We look at every situation through the ADEPT℠ framework to discover specific barriers to transformation. In that process, we’ve found two key elements that consistently ensure a successful current-state assessment:

1. Ignore the foregone conclusion: Applying an objective framework, such as ADEPT℠, eliminates the risk of pre-conceived notions clouding our assessment at the outset. Ignoring these strongly held beliefs helps our observation to be answer-agnostic. When the results of the assessment are presented, decisions can then be made about implementing transformation with actions and programs that solve the program and create sustainable profitability and effectiveness.

2. Full transparency during the observation: Unfortunately, sometimes we don’t learn everything during our interviews and observations. People hold back. Later they tell us: “Well, we didn’t want to bias your assessment with our opinions or our concerns.” Bottomline, candid input only helps us understand. The opposite only diminishes the value of our investment into assessing current state. We simply must be in receipt of all data-both qualifiable and quantifiable-and that requires us to work on it, openly and honestly, together.

Armed with these two elements, we can effectively assess root-cause of organizational problems. When we achieve these two objectives during our observation period, our V2V team feels we add value to the entire A-I-M progression, because what is done during the Assessment phase, affects the ability to Implement and then Monitor/Mentor the entire transformation process. Understanding current state helps create effective solutions for the client’s health care business. Inevitably, ours is a partnership; the participation of our clients in the assessment phase provides a direct contribution to inevitable, sustainable success.

Respond positively and become ADEPT at the business of health care

In the more than three decades I’ve been consulting leaders in health care and medical practice management, I’ve learned that addressing broken processes always lead to a solution. If you’re looking to understand why something’s not working, most often you will find the process is broken. And, it’s not necessarily anybody’s fault. Don’t look for someone to blame. Time and time again, I see talented, capable professionals, who are being victimized by a process that a medical practice has become enslaved within. They are being held back by the broken process, almost all of the time they are not the cause of the broken process.

If you work past vilification of a person or group, you will find an unworkable procedure. Throughout the years, I’ve learned there are certain signs that a process is broken:

1. Application: Every medical practice has a variety of applications, from an EHR, to billing and other record-keeping software programs. Sometimes, there remains a long-standing paper-based routing procedure. Whatever the application, your warning sign is a time-consuming process because it is poorly implemented, being performed by the wrong person, or lacks measurable benefit to the patient or the practice.

2. Distinction. Does your staff lack a clear definition of success? People who lack a purpose will often remark, “If we weren’t so busy, we could do a better job.” The point is, your work is not patient-centered and your practice lacks a known or practiced brand or distinguishing characteristic that sets you apart from your competitors.

3. Effectiveness – For whatever reason and whatever-the-task, the job is simply not getting done., because it detracts rather than contributes to patient care or organizational performance.

4. Profitability – Your activity is not contributing positively to the bottom line, in fact it most likely detracts from it. It may be inefficient, expensive, redundant, or simply just a non-essential activity, because “it’s the way we’ve always done it.”

5. Talent – Do you experience frequent turnover or suffer through office culture clashes and poor morale? This is a familiar sign of a broken process. People need to know that they are contributing to mission or goals of an organization, appreciated and recognized by the patient and the team.

Amid the review of broken processes, it’s true that somewhere along the line a person created it, and further down that same line someone perpetuated it. This activity happened because someone or a group thought they had to do so, it did not come about due to any malintent. The key to success in your evaluation is to give an objective review to the processes and ask specific, and often hard questions to every process that is not operating well. These questions are direct and to the point:

• What are we doing?
• Why are we doing it?
• What would happen if we stopped doing it?
• Will it help us serve our patients better?

For example, one client of mine had a staff member who created a report, each morning, about the prior day’s activity which no one ever referred to. Creating the report took several hours to complete, per day, pulling the staffer away from important tasks that supported effective patient care. Essentially, the frequency of the report was not equal to the frequency of the review. After a critical assessment, we determined that the report could be generated in the same amount of time for a weekly or monthly review, rather than making it a daily task. And, with better results and insights needed for effective clinic management.

So, when you ask “Why do you do this?” and the answer is “Because we’ve always done it that way?” Or if you ask “Who uses it?” with the reply “Nobody.” Put that task in the funeral pyre and create an effective solution. Soon enough your improved processes will make your medical practice ADEPT^℠ at the business of health care.

The reason for standardizing the way we move patients through the practice is because of the high cost of variation. Alternatively, establishing processes creates predictability where it’s needed most, between physicians and patients, as well as between those same patients and the medical office staff. It improves organization and the overall efficiency of the practice. Allow me to explain.

I once consulted for a practice hoping to grow to three dozen physicians. Two groups of six docs, each, planned to merge into the group and, interestingly, they worked right across the hall from one another. My role was to manage the transition by establishing work flows and processes. Right away, I learned the corridor separating the two medical groups was the dividing line. And, it wasn’t difficult to see the difference between the two practices from the moment I walked into each of their patient care areas.

Walking into Medical Group Number One, I found a quiet, calm and, frankly, empty reception room. The patients were all being seen and staff were busy, either talking the phone regarding patients, completing work in charts, or walking down the hall toward a specific task. It was all very organized. Standing at the check-in counter, I could imagine how satisfied their patients must be with the efficiency and service at Group Number One.

At Medical Group Number Two, chaos reigned in the waiting room. Let’s be clear, it was a waiting room, not a reception area. With twice the staff, those on the phone were chastising the patients for calling in to get their lab results, because, of course, they didn’t know when those would be received. There were others searching for someone who could schedule a physician’s next appointment because only a specific person could do so, and still, others were on-the-hunt for some missing item or record. Everyone did have one standard practice, they were all complaining of stress. That was true for everyone: Patients, staff, and physicians, alike.

The difference? The first practice had good processes, standardized policies and procedures. The staff followed them and followed through with their promises, which included consistent, clear directions for patients. Practice Number One had half the staff, happier patients, and staff, and operated in a quiet, calm, organized environment. All of this administrative efficiency was due to the physicians agreeing on how-to set up and run the practice, consistently.

In Practice Number Two, I determined that the phrase “My Medical Assistant” was code for a separate, unique, process and plan of action, per physician. At practice Number Two, the standardization came in standard replies including the phrase I-don’t-know: “Let me find someone to help you; and I don’t know how to schedule for that physician.”

The very real object lesson while standing in that corridor between medical groups is this: If everyone does things similarly, then any patient can be helped by any member of the staff. The process for setting things up is the same.

I learned that along the way, the docs in Medical Group Number One had asked one another: “So, same type of patient – help me understand why each of us manages that patient differently from one to the other?”

Let’s be clear: The specific treatment, per patient, may differ. However, the actual process of scheduling and treating a patient, as well as following up to meet their care needs, can be the same. The process of efficient and effective workflow in the practice is the area to focus on reducing variation.

It gets back to answering the question: “Can somebody help me?” and the correct answer is “Sure, anyone can help you.” If there is some standardized process, the question can be answered by the first person on the phone, rather than having to put someone on hold, then seek out two or three other people, as was the case in Medical Practice Number Two.

I’m always amazed when I advise a small practice and look at job descriptions. There are only three or four people in the office, why are they so different? I’ve come to believe that these job descriptions end up defining what it is the staff member WON’T do. Unfortunately, these result in people not being aware of how the whole process works, and how to actually help the patient. So, I follow three rules when helping to standardize medical practice operations:

1. First and foremost, it’s about communication: The physicians, the staff and the patients all need to be in possession of the same information in order to work well together.
2. Agree on a process that everyone can follow, and then stick to it: It’s not okay to create a patient policy and procedure handbook if you don’t actually use it. Moreover, if a physician in the practice does not want to do something that way, then resolve it and create a new consensus on how-to do things.
3. Take a moment to conduct patient and provider education: It might be in the patient and provider handbook, but ensure you include that information on your website and possibly also in a brochure. Review it with them and ask if they have any questions. At Medical Practice Number One, the employees knew their “never” events: Never say to the patient “call us” for routine lab results and never say “call us” for prescription renewals. Patients were told what to expect, where to go for help and the staff followed through on their promises. All evidenced because phones weren’t ringing off the hook from patients calling with questions.

So, you wonder, how did things work out between Practice Number One and Number Two? Well, after the physicians and staff took a few tours of each other’s practice environment, the switch came quickly enough. Not without a few fits and starts; a few folks agreed to the new processes and didn’t follow them, at first, and a physician could be heard saying the phrase “My Medical Assistant,” now and then.

After a while, the pieces fell into place creating consistent efficient workflows throughout the entire practice resulting in happier patients, staff, and physicians. Can we succeed in the new business of health care? Of course, we can. And, it all happens when good workflow processes are in place, creating lower staff turnover, and happier physicians.