Patient Satisfaction Tip Book Improving Patient Perceptions

Patient Satifaction Tip Book Improving Patient Perception How to Ue thi Tip Book 2 Acce and Availability Tip 2 Survey Quetion 1 2 Survey Quetion 2 4 Survey Quetion 3 5 Survey Quetion 4 6 Suggeted Reading and Reource 7 Convenience Tip 7 Survey Quetion 5 7 Survey Quetion 8 8 Survey Quetion 13 10 Suggeted Reading and Reource 11 Staff Interperonal/Adminitrative Skill Tip 12 Survey Quetion 6, 7, 9, 30, 31, 32 12 Suggeted Reading and Reource 14 Staff Clinical Skill Tip 14 Survey Quetion 10, 11, 12 14 Suggeted Reading and Reource 16 Phyician Clinical Skill Tip 16 Survey Quetion 15 through 18 16 Suggeted Reading and Reource 17 Phyician Interperonal Skill Tip 18 Survey Quetion 14, 19 through 29 18 Suggeted Reading and Reource 20 General Patient Perception Tip 21 Survey Quetion 33, 34, 35 21 Suggeted Reading and Reource 22 25 Maachuett Avenue, NW Suite 700 Wahington, DC 20001 (800) 338-2746 Fax (202) 835-0442 www.acponline.org/running_practice 2011

How to Ue thi Tip Book After reviewing your Patient Satifaction Check Up data analyi report, ue thi tip book to initiate improvement meaure. The tip book offer uggetion grouped into the ame categorie (or cale) ued in reporting the urvey quetion reult to you. Ue the Table of Content to locate pecific tip for the cale and/or individual urvey quetion you wih to improve. Each tip heet lit poible caue for low rating followed by individual tip under the heading Conideration for Corrective Action. Like the urvey quetion themelve, the caue of weakne may be interrelated. Therefore, a tip heet often addree everal urvey quetion together. After conidering thee uggetion, elect thoe tip that eem appropriate to your own ituation and begin planning improvement meaure tailored to your particular practice. Since no two phyician and no two practice are exactly alike, cutomizing the uggeted improvement meaure i critical to ucce in enhancing patient atifaction. For your convenience, we have added a lit of uggeted reading and reource in each category to help you. Becaue both you and your taff influence patient perception regarding the care received, we trongly recommend that you work together a a team to increae patient atifaction with the ultimate goal of conducting the ideal patient viit in the future. ACP member may alo contact the Center for Practice Improvement and Innovation at 800-338-2746, with further quetion about improving patient atifaction or other apect of their practice. Acce & Availability Tip The following tip apply to urvey quetion 1 through 4 Survey Quetion 1: When I called the office for an appointment, the length of time before the telephone wa anwered Poible Caue for a Low Rating Inadequate number of telephone line to handle the volume of call to the practice. Inufficient taff aigned to anwer telephone. Telephone not readily acceible to taff. Unclear policie regarding the expectation for anwering telephone. Inufficient direction to patient on how to acce the practice. Introduction If your core i low on thi quetion, you probably need to review ome of your baic office operation, including your telephone ytem. Conideration for Corrective Action Make ure your telephone ytem ha ufficient capacity to handle the volume of call. When patient indicate there i a problem in calling your office, careful examination may reveal there are not enough telephone line to handle the volume of call received. Your telephone vendor or local telephone 2

company can ait you, at little or no cot, in conducting a urvey of incoming and outgoing call during the coure of your work day to clarify thi iue. You may need additional line; however, there alo may be way to reconfigure your telephone ytem to gain greater flexibility to handle your current load. Next, review the way taff are aigned to anwer telephone and whether there are enough taff aigned to accommodate the volume of call. If more line ring than there are taff to anwer them, your problem i taff, not equipment capacity. You may have to add taff, involve non-receptionit taff in anwering call or reprogram the flow of call. It alo may be neceary to reaign ome taff during peak call-in time. Make telephone eaily acceible for taff. Adding taff at peak time will not olve the problem if they do not have telephone intrument conveniently available to ue. Simply relocating a telephone from a dek to a wall ha improved the efficiency of ome practice. Alo, make ure there are enough total telephone intrument for the number of taff uing them. Set tandard and procedure for anwering telephone. Let taff know your pecific expectation about how each type of call i to be handled and the number of acceptable ring before a line i anwered. Written policie regarding anwering the telephone hould be readily available. Staff hould alo know who ha primary reponibility for anwering telephone. In many phyician office, taff have multiple reponibilitie and need to be told what priority hould be given to anwering telephone. Educate patient about when to call. A large volume of patient calling a practice for their lab reult during peak hour can paralyze a practice. So can a phyician offer to call me any time you want to talk to me. (Although every phyician might like to practice thi way, doing o become impractical and even diruptive with a large patient population). Inform your patient of your peak time and ugget they call during off peak hour if it i convenient for them. Give them guidance on how to acce your practice ervice and which taff handle what categorie of patient quetion (e.g. lab reult, referral, pharmacy refill.) Find alternative to help manage and reduce the overall volume of incoming call, epecially at peak period. Automated attendant ytem with voice mail have become more prevalent a patient volume increae. Again, look to your telephone vendor or local telephone company to provide you with direction on how to proceed. Conider pecial need for the elderly and the hearing impaired. Try pecial line or other arrangement for precription refill and reporting lab reult, o that thee high-volume type of call do not clog your appointment line. Ue the full capacity of your exiting telephone ytem before inveting in more feature. The ytem you are currently uing may have more feature than you realize. It i prudent to carefully review the capability of your exiting ytem before looking at expanding or purchaing a new one. Many of u have a tendency to learn only thoe function we abolutely need. Take advantage of free conultative ervice offered by your local telephone carrier or communication vendor to determine whether you can atify mot of your requirement by fully utilizing what you already have or by making a modet invetment in enhancement. Survey Quetion 2: The length of time I pent on the telephone to et my appointment Survey Quetion 2: The length of time I pent on the telephone to et my appointment Poible Caue for a Low Rating 3

The office taff i handling too many tak while cheduling appointment. Staff i not well trained on the computerized cheduling ytem. The cheduling peron i trying to gather too much information over the telephone. Patient are attempting to get additional information beyond imply cheduling appointment. Introduction Uually, a le than optimal core in thi category i related to a few pecific iue concerning your taff. Examine the demand placed on them and the procedure they follow. Conideration for Corrective Action Free up the appointment cheduler. In many practice (epecially maller one) the patient cheduling function i pread among everal people in the reception area. Thee cheduling taff may imultaneouly be reponible for handling other telephone call, receiving patient payment at the end of appointment, typing, record filing and retrieval, and a myriad of other function. Thi multi-taking can reult in patient who are calling to chedule appointment being placed on hold for long period of time while other tak are performed for patient in the office. It help to deignate a peron whoe priority reponibility i to handle telephone appointment cheduling, and whoe other dutie can be delayed while appointment call are completed. Train taff thoroughly in the ue of your computerized cheduling ytem. Be ure that all taff reponible for cheduling appointment have had ufficient training on the ytem. If taff member are inecure about uing the ytem, they may keep patient on the telephone too long. Make ure that omeone truly knowledgeable about the ytem i available to train new hire a change in taff occur. When implementing a new ytem, have taff practice cheduling everal mock appointment and give them a chance to ak quetion about the ytem before they attempt to chedule live patient on the ytem. Develop procedure to help taff handle call efficiently. Learning to manage a ignificant volume of telephone call while cheduling appointment require creativity and patience. Staff mut be helpful and courteou to all patient but at the ame time minimize the time pent with each individual caller. Teach taff what eential information i neceary to chedule an appointment while keeping the telephone call brief. Intruct them to handle the iue at hand without getting into long converation. Since thi can be difficult with patient who are een often, remind taff that they mut manage the entire patient population of the practice. Help your taff by making ure eential reource information, written policie, check lit and other helpful tool are readily available. If neceary, end taff to local eminar on handling telephone call and telephone etiquette. Let patient know if you have an overwhelming number of incoming call. If the practice jut can t handle all of the cheduling call imultaneouly, be honet with your patient. Have taff tell patient they are welcome to hold but that it may be a while before omeone can help them. Staff hould offer patient alternative, uch a: Calling back later at a time expected to be le buy. Leaving a number which taff will call back a promptly a poible. Uing the fax machine a an alternative method to communicate. Survey Quetion 3: The number of day between my call and my actual appointment 4

Poible Caue for a Low Rating Patient expectation of when they hould be een are unrealitic. Poorly adminitered cheduling ytem. Backlog in appointment due to inufficient phyician time cheduled per week. No defined patient triage ytem. Inufficient number of phyician. Introduction While there are different level of urgency baed on the everity of a patient medical condition, mot patient expect to be een quickly. Patient expect to be een immediately for acute condition, or within 48-72 hour for other matter, with the poible exception of follow up viit and routine phyical. If your practice cannot accommodate patient within a reaonable period, find out why thi i o. Careful attention to patient triage can help eliminate problem and patient complaint. Conideration for Corrective Action Manage the appointment chedule to meet the need of all your patient. Contantly monitor and update the chedule. Practice with well-etablihed patient bae mut be careful to keep appointment lot available to meet the need of both non-urgent and urgent medical problem. Strike a balance to inure there are ufficient appointment time available for routine viit and phyical exam, a well a time lot for urgent problem. If you are in the midt of practice building, take care to avoid alienating exiting patient in order to work in new patient. Make ure taff know the office protocol for cheduling patient. If you do not have a protocol for cheduling patient, develop one, put it on paper, and circulate it to the appropriate taff member o they know how to proceed when cheduling appointment. Phyician and cheduling taff mut work together to inure patient are een a quickly a poible. Frequent communication between the two group i imperative. Clearly identify who will handle triage and how it i to be managed for cheduling purpoe. Phyician mut be available to ait taff in prioritizing the daily patient chedule. Written criteria for eeing patient hould be given to the peron reponible for handling telephone triage. Scheduling deciion hould be baed on the medical neceity of the patient to be een. Well-known and etablihed patient hould not receive priority over other patient. Explain to patient why there may be a backlog in available appointment time. If there are legitimate reaon, uch a phyician vacation, CME or eaonal overload, patient will be more undertanding if given a reaonable explanation. Make ure ufficient phyician time i available in the office. Inufficient phyician time can prevent the prompt cheduling of appointment. National benchmark ugget general internit normally need to chedule 30+ hour of hand on patient time per week in the office. (In today health care environment much of the phyician time i eaten up by adminitrative and other buine reponibilitie). You may alo have to re-evaluate provider taffing to inure there are enough phyician to handle the office patient volume. The utilization of phyician aitant and nure practitioner can alo be a cot-effective mean of creating more appointment time and relieving backlog. Alo conider extending hour to include evening, early morning and weekend appointment time. 5

Explore other method of patient management that do not involve patient having to come in to the practice for an appointment. You may want to pend more time couneling by telephone, faxing information to patient, uing e-mail if available, etc. In a managed care etting, a well-developed telephone triage ytem can handle many patient complaint/problem over the telephone without adverely impacting reimburement or patient care. Survey Quetion 4: The taff helpfulne in cheduling my appointment Quetion Poible Caue for a Low Rating Manner in which the telephone call wa anwered. Could not meet the patient requet to chedule a particular day or time for an appointment. Staff did not comprehend the urgency of the patient need to be een. Introduction Patient judge a practice primarily by how they are treated by taff; therefore the perception that taff are unhelpful can be very damaging. At the ame time, patient can be difficult to atify. It i very important to employ the right peronnel and to prepare them to deal appropriately with all type of patient. Conideration for Corrective Action Select the right taff for the job. Hire people with warm, caring, helpful attitude to deal with the mot important component of your practice: your patient. Your taff hould be trained to anwer the telephone by identifying the practice and themelve. They hould diplay the ame warmth, caring and compaion they themelve would like to receive, and mut remain flexible and calm at all time. Intruct taff to demontrate a willingne to accommodate patient need and requet. Tell taff to attempt to meet pecific patient need whenever poible. If they are unable to give a patient the preferred choice of time, taff hould offer a many alternative a poible. Once again, you may have to look at expanding or changing office hour to meet the pecific need of your patient. Train taff to liten carefully and manage patient expectation. If patient often indicate that taff anwering call do not undertand the urgency for patient to be een, good telephone triage and open communication between taff and phyician can eliminate mot problem related to thi iue. It i helpful to explain to patient how appointment are et o they do not develop a pattern of expecting all office viit to be cheduled immediately. However, it i alo very important to liten cloely to what patient are aying o they can be accommodated in the mot appropriate manner. To prevent miundertanding, intruct taff to anwer a many of the patient quetion a they can and encourage open communication. Send taff to training eminar. There are proven technique for dealing with caller in a courteou, efficient, non-confrontational manner. Conider ending your taff to local eminar conducted by expert on how to handle telephone call and difficult peronalitie. Your patient deerve no le, and your taff need thoe kill to be ucceful. Suggeted Reading and Reource ACP Center for Practice Improvement and Innovation Deigning The Patient Schedule 6

Preton, Suan Harrington. The Bet Way To Improve Your Staff Efficiency Medical Economic, Augut 1997; p 58-66 Crum, Larry D. Do Patient Need A Uer Manual For Your Practice Today Internit, January/February 1998 Dahl, Owen J. 10 Quick Step To A More Efficient Practice Phyician Management, July 1996; p 30-42 Zucker, Diane. Surpriingly Simple Idea To Improve Your Practice Phyician Management, December 1996; p 29-36 Finger, Anne L. Don t Leave a Single Patient On Hold Medical Economic, December 1996; p 98-109 Carlon, Robert P. How The Telephone Can Tranform Your Practice Family Practice Management, October 1996; p 56-64 Need Relief From Patient Call? Try Thee Triage Tip... IM Advantage, July 1997 Streamlining the Patient Refill Proce IM Advantage, May 1997 Check Out Separate Check-In, Check-Out Area IM Advantage, May 1997 Convenience Tip The following tip apply to urvey quetion 5, 8, 13 Survey Quetion 5: The convenience o hour Survey Quetion 5: The convenience of office hour Poible Caue for a Low Rating The practice office hour do not offer alternative to patient who cannot chedule appointment during their regular workday. Early morning, late evening and weekend appointment are booked too far into the future to atify patient. The office cloe for midday break, o patient can neither be een nor call during their own lunch hour. Introduction A low core hould ugget looking at the day and hour your practice i open. Check to ee if there are appointment time available to addre the need of thoe patient who require appointment that do not conflict with their own work chedule. Conideration for Corrective Action Analyze your chedule. A imple aement of which appointment time fill up the fatet and which lot are the lowet may help you decide whether to alter your office hour or increae/decreae the number of phyician available during a given time period. Alo, ak patient to provide feedback on the convenience of your practice office hour. Find out if the current hour are meeting their need, and if not, what hour they would ugget. Make ure your chedule include enough hand on patient hour. It i important to make ure you pend enough time with patient per week and ee enough patient per day to accommodate your patient need and cover all expene. Conultant advie that a primary care phyician normally need to pend 30+ hour per week actually eeing patient in the office and handle a 7

patient load of 100 patient per week. Of coure thee number depend on the ize of patient bae and other practice- pecific factor. Prioritize the ue of available appointment time. Unfortunately, ending taff home during low period of the day and aking them to return during buy period uually ha a negative impact on taff retention. Therefore, you need to pread the workload evenly over the day by reerving lot during the buiet period for thoe patient who need them mot. For example, it may be poible to chedule your non-working enior citizen into lower time period in order to ave more high-demand time lot for patient who have conflicting work chedule. Stay open during the lunch hour. If you are in a group practice, have at leat one phyician available to ee working patient who wih/need to be een during their own lunch hour. If you are in olo practice, try to vary or adjut your own lunch hour o that it doe not alway coincide with your patient lunch hour. Alo keep telephone line open during lunch hour o patient can call in for appointment, lab reult, etc. Keep in mind mot employer require employee to make peronal call on their own time; the lunch hour i the mot convenient time for them to do o. Conider taggering office hour in order to include ome late evening and/or early morning appointment time and weekend hour. Extending hour can be an important marketing tool in erving working patient and other who find eeing the doctor during regular buine hour inconvenient. When adding provider, a growing practice can ometime delay or forego inveting in additional office pace by intead extending hour in exiting pace. The availability of late hour can alo reduce expenive ER viit in managed care environment. Be ure to keep your patient advied of any change in hour or day of operation, epecially if you provide any ervice (injection, BP check, blood and pecimen collection, etc.) on a walk-in bai. Prominently diplay the day and hour of operation of your practice and keep ign and information heet up to date. Staffing conideration. Altering office hour i no mall undertaking, and it take a lot of coordination and cooperation between you and your taff. Staff mut be given lot of advance notice if their work chedule are to be altered. You may loe ome office taff if they prefer and are accutomed to working et chedule. Conider mitigating the problem by hiring ome part-time taff for off-hour, o mot full-time taff can remain on regular chedule. Staff mut be made aware that flexible office hour may be a requirement to remain ucceful in today medical marketplace. Hire new taff with thi clearly undertood. Patient demand will drive the need for change. Survey Quetion 8: The length of time, if any, I had to wait pat my appointment time Survey Quetion 8: The length of time, if any, I had to wait pat my appointment time Poible Caue for a Low Rating Late arrival by patient. Patient not arriving early enough to complete paperwork before appointment time. Patient cheduled too cloely together. Staff or phyician running behind chedule. Late arrival by taff or phyician. Introduction 8

Exceive waiting time are a major complaint among patient even though they ometime are part of the overall problem. There can be many contributing factor. Some of the mot common caue are lited below. Conideration for Corrective Action Addre potential problem created by the way patient utilize ervice. One problem i that ome patient arrive very late for their appointment. Phyician and taff hould make patient aware of their reponibility to how up for appointment at the deignated time. Once a chedule tart to back up, it i difficult to get back on time; therefore managing the patient flow effectively i eential. The firt tep i to etablih and communicate to your patient your policie regarding late arrival and cancellation a well a the requirement that they how up early to fill out paperwork (you may want to allow more time for the elderly and other who may need extra time to fill out form). Every effort mut be made to get patient into the practice on time and to proce them efficiently. It i difficult to ay no to patient when they how up late for appointment, but at ome point you owe it to your other patient. Exerciing good judgment i critical to keeping all your patient atified. Develop teamwork and create an efficient method of proceing patient. Require taff and phyician to arrive on time and be ready to tart work before the patient chedule begin. Starting late guarantee that you will run behind and perhap get further behind a the day progree. Catch up before the eion end. If you do fall behind, try to catch up before the morning eion i over. Keep in mind appointment are cheduled for a certain length of time baed on patient decription of their medical problem(). Additional problem, tet or procedure which emerge during the viit may need to be cheduled for a future appointment. Schedule patient according to the nature of the complaint and the time required by a phyician to perform that treatment. Scheduling patient too cloely together will only lead to patient complaint and diatifaction. Staff and phyician need to be on the ame page when it come to defining the amount of time required for the variou level of care. If you are pending too much time with patient, look at the reaon why you require extra time and perhap eek guidance on technique for becoming more efficient. Employ efficient cheduling technique to eliminate gap between patient and to help expedite proceing. Wave cheduling, grouping like cae together and other technique can help you tay cloer to chedule and catch up when you are behind. Inform patient about abnormal waiting time. A oon a poible, have taff inform patient of any unuually long waiting time. Offer them option to rechedule their appointment or be een by another provider, including a PA or NP, if available. Make an effort to extend extra courtey during thee treful time. Routine and careful monitoring of the waiting room i a good idea. If exceive waiting time are a routine problem, you may want to obtain outide management aitance to help identify and reolve the problem. Survey Quetion 13: The length of time I had to wait in the examination room before I aw the doctor Survey Quetion 13: The length of time I had to wait in the examination room before I aw the doctor Poible Caue for a Low Rating 9

Phyician i running behind chedule. Lack of communication from taff regarding the reaon the phyician i delayed. Nothing to occupy patient while waiting (reading material, video, etc.). Uing exam room to reduce congetion in waiting room. Exam room environment not conducive to waiting (too hot/cold, dark, dirty, etc.). Patient left waiting for long period in tate of undre or partially clothed. Staff or phyician lack warmth once they encounter patient. Introduction Long wait in an examining room can produce coniderable anxiety and irritation for your patient. Every minute a patient wait can eem like an eternity. The fact that a patient may be ill, nervou, or both, only make waiting more treful. Conideration for Corrective Action Make ure your chedule normally run on time Patient will undertand and accept occaional brief delay due to unexpected event. But there i no reaon for them to tolerate routine wait in exce of 10 minute in exam room. If thi i the cae, a thorough review of your cheduling ytem, phyician efficiency and taffing i neceary. Trying to placate patient to cover up operational deficiencie i a loing battle. Frequently update patient while they are waiting in the exam room. Remember, a brief encounter with a nure or medical aitant i the lat contact a waiting patient ha with the outide world. The lat word they normally hear are omething like get undreed, put on thi gown, and the doctor will be with you hortly. To alleviate anxiety and concern, taff hould keep patient appried of the availability of their doctor, and how oon they will be een. Staff hould alo ue thi time to perform preliminary work-up activitie uch a blood preure, temperature and viion check a well a update patient medical information on medication, allergie, etc. Make ure the examination room i climactically comfortable and equipped with current reading material to help pa the time. Some wait are inevitable, but they pa fater if patient are comfortable and have omething to occupy their attention. Hold waiting patient in the mot comfortable environment available. If a phyician i not going to be available to ee the next patient for ome time, it i not wie to move the patient from the waiting room to the le comfortable, often tark, environment of an examination room. Although it may give the impreion of keeping the patient flow moving, mot patient would prefer to wait in the comfort of the waiting room. An exception would be if the patient i very ill and need to lay down. Give your patient a warm greeting and a brief explanation of the reaon for the delay before you examine them. Doing o can work wonder with patient, but too often thi i not the kind of greeting a patient receive from a harried phyician after a long, anxiou wait. Even though the demand on phyician are great, the extra effort to explain and comfort patient will go a long way toward relieving the tenion built up during the delay. Suggeted Reading and Reource 10

ACP Center for Practice Improvement and Innovation Deigning The Patient Schedule Preton, Suan Harrington. The Bet Way To Improve Your Staff Efficiency Medical Economic, Augut 1997; p 58-66 Cheanow, Neil. Can t Stay On Schedule? Here A Solution Medical Economic, November 1996; p 174-191 Majzun, Rick. The Role of Teamwork in Improving Patient Satifaction Group Practice Journal, April 1998; p 12-16 Dahl, Owen J. 10 Quick Step To A More Efficient Practice Phyician Management, July 1996; p 32-42 Crum, Larry D. Do Patient Need A Uer Manual For Your Practice Today Internit, January/February 1998 What Are You Waiting For? Only You Can End Patient Delay Patient Satifaction and Outcome Management, November 1997 After Five: Are Extended Hour Worth It? CBM On Call-Advantage for Health Care Provider, Firt Quarter 1998 Croby, Jame. Nine Way To Conduct More Efficient Office Viit Family Practice Management, May 1997; p 83-90 Staff Interperonal/Adminitrative Skill Tip The following tip apply to urvey quetion 6, 7, 9, 30, 31, 32 Survey Quetion 6: The taff courtey Survey Quetion 7: The taff promptne and efficiency Survey Quetion 9: The taff effort to explain the reaon for any delay Survey Quetion 30: The taff help with cheduling any follow-up viit, referral or tet Survey Quetion 31: The taff explanation of billing and payment/inurance iue Survey Quetion 32: The taff repect for my privacy Poible Caue for a Low Rating Patient perception that taff member() were rude, inattentive or evaive. Patient perception that the taff did not act in a timely or efficient manner during the coure of a viit. Patient were given inufficient or unacceptable explanation for any delay experienced during viit. 11

Staff competence, or amount of time taken in cheduling follow-up ervice and/or giving intruction wa not acceptable to patient. Patient did not undertand (or did not agree) with the explanation given regarding billing and payment/inurance iue. Patient believe there were breeche of privacy during viit. Introduction Although many of thee iue reflect patient ubjective perception, treat them a reality. It i virtually impoible to keep all patient happy at all time, but you mut convey to taff the critical importance of developing and refining their interperonal kill when dealing with the mot important part of your practice: your patient. Phyician, manager, owner and upervior mut et the tone for how taff are expected to interact with patient; keep in mind, taff uually follow your lead. Conideration for Corrective Action Begin with the interviewing and hiring proce. Manager of the practice hould identify the work experience, requirement and peronality type needed for the practice. The hiring proce i the perfect time to inform all new employee about your expectation when it come to patient-taff interaction. Let everyone know your patient are the number one priority. Do not dicount patient complaint. Alway repond to complaint by letting patient know you will look into the matter and take any corrective action needed. Staff working in a buy, treful environment may not alway interact in a manner that i acceptable to your patient. At the ame time, patient may interpret a hectic atmophere a ign of rudene, inattention or evaive behavior. It i the reponibility of each phyician and taff member to make a patient viit a poitive experience by diplaying a caring attitude, and providing ervice in a timely and efficient manner. Make patient feel comfortable in expreing their concern and complaint, becaue an open environment will often prevent them from diplaying diatifaction by imply leaving the practice. Routine meeting between taff and phyician can help identify and reolve many of the complaint. Give everyone the opportunity to participate in olving the problem. Carefully ae taffing, operational ytem and communication. Having ufficient phyician and taff available to handle the volume of patient erved will reduce taff tre and lead to better interaction between taff and patient. Well defined role for taff and good office ytem help make thing run moothly and reduce the potential for patient complaint. Having a good appointment cheduling and patient referral ytem in place i eential to efficient operation and patient proceing in today medical practice. Educating patient through newletter or handout will alo reduce miundertanding. Good communication can olve a multitude of problem. Write detailed policie and procedure on office procee. It i hard for a practice to run moothly unle office procee are planned, explained and undertood. If your office ytem are not well developed, you may need a conultant help to et them up on a ound bai. Staff cannot project an image of competence and helpfulne if the adminitrative ytem within which they operate i inefficient or chaotic. Billing, inurance and collection iue can be a ource of diatifaction for your patient for many reaon. When it come to finance, it i important to let your patient know your office policie a early a poible. Uniformity and conitency in applying policie hould be your ultimate objective. You will never pleae all of your patient, but you can manage the buine ide of the practice by diplaying trong ethic and 12

profeionalim. Many patient do not undertand their inurance coverage and what i expected from them. Help them undertand or direct them to reource that can provide them with anwer to their quetion. Develop a fact heet to hand out to your patient. Make ure that your taff thoroughly undertand the policie a well, o they can handle any quetion poed to them by the patient. If there are change in policy or adminitration, let taff and patient know a oon a poible. Protect patient privacy at all time. Everyone in the practice mut be enitive to protecting the privacy of all patient. There are many interpretation of patient privacy, and a perceived breech can come from many ource. Train all peronnel to be careful in the handling of document, in avoiding dicuion of patient in public area, and in utilizing treatment and exam room area, etc. Periodic reminder to taff and phyician regarding precaution to take to inure patient privacy hould be implemented. Teach non-verbal kill. Impreion can create a quicker, more lating impact than word. Shoulder back, engaging mile, good eye contact, warm greeting, confident, calm demeanor, friendly aured tone of voice: thee ignal convey the meage that taff know exactly what they are doing, care about the patient, and will therefore take the time required to deal with the patient problem. Provide all taff with interperonal and communication kill training. Outide cutomer ervice and communication coure and eminar are normally inexpenive and available in many communitie. Include one on how to deal with difficult people. Suggeted Reading and Reource Preto, Suan Harrington. The Bet Way To Improve Your Staff Efficiency Medical Economic, Augut 1997; p 58-66 Zucker, Diane. Surpriingly Simple Idea To Improve Your Practice Phyician Management, December 1996; p 29-36 Dunevitz, Brad. Enhancing Practice Performance Align Operation, Avoid Burnout Medical Group Management Aociation Cheanow, Neil. Little Thing That Go Over Big With Patient Medical Economic, April 1997; p 55-59 Humor I Important Phyician Management, January 1997; p 56 6 Step to Effective Reference Checking The Phyician Adviory, November 1997; p 6 We Advocate Naming A Patient Advocate To Staff The Phyician Adviory, January 1998; p 8 Employee Key, Epecially In Managed Care Era Phyician Practice Management, January 1997 Teamwork And Training Boot Cutomer Service Patient Satifaction and Outcome Management, March 1997 Dahl, Owen J. 10 Quick Step To A More Efficient Practice Phyician Management, July 1996; p 32-42 Staff Clinical Skill Tip The following tip apply to urvey quetion 10, 11, 12 13

Survey Quetion 10: The nure/medical aitant kill when taking my blood ample, blood preure, weight, temperature, etc. Survey Quetion 11: The clarity and thoroughne of the nure/medical aitant intruction Survey Quetion 12: The nure/medical aitant care Poible Caue for a Low Rating The nure or medical aitant wa ruhed or left that impreion. The nure or medical aitant may not have clearly explained what they were going to do and why it wa being done. The nure or medical aitant may have failed to anwer all of the patient quetion, or imply did not invite patient to ak quetion. The nure or medical aitant may have diplayed a lack of confidence in providing ervice to the patient. Introduction Low rating in thi category can reflect perception more than reality, ince it i difficult for patient to accurately ae the nure and medical aitant clinical kill. However, thee perception of deficiency in ervice mut be addreed and corrected. Conideration for Corrective Action Make ure you hire taff with requiite clinical kill, and train them thoroughly. When hiring clinical taff, firt take time to determine preciely the kill needed to provide ervice to your patient. It i alway better to require too many rather than too few clinical kill. If there are licening or certification requirement, make ure a propective employee ha met all of them and ha updated credential. Utilize careful interviewing technique to aure a propective employee alo ha the neceary training and experience to meet the need of your practice. If poible, obtain reference from omeone who ha actually upervied the clinical work of the propective employee and have the propective employee diplay their clinical kill through practice eion with current taff. After hiring a clinical taff member, train them thoroughly in your practice policie and procedure, give them plenty of opportunity to ak quetion, and carefully oberve them in the early day of their employment Require taff to explain their action. It i important for nure and medical aitant to explain to patient what they are doing and why there i a need for it to be done. Mot of the tep in taking vital ign require little explanation, but often patient may want to know, for example, why blood i being drawn. (Patient may alo have had bad experience in the pat, or a phobia about needle). Therefore, nure or medical aitant hould be enitive to the patient concern and repond accordingly. Set ground rule for how many attempt will be made to draw blood ample. Clinical taff need to keep patient informed and encourage them to ak quetion. Make ure taff are ufficiently confident in their kill to reaure patient. Teach them. It i important for nure and medical aitant to how confidence in their ability to provide ervice and care to patient. The more confident your taff appear, the more aured patient will be that they are receiving the quality care they expect. Create an environment where taff are encouraged to ak for aitance or training if they are unure about how to perform a procedure. Refrain from criticim and ue the 14

opportunity to teach employee the exact technique you would like them to ue. Phyician hould alo take the initiative in teaching clinical kill to taff a a regular part of the workday. Make ure you have adequate clinical taff. Saving overhead i important, but cutting back too much on nure and medical aitant can be penny wie and pound-foolih. If clinical taff are hort-handed and ruhed in proceing patient, both you and your patient will uffer. Patient will be unhappy, and your own workload will increae. Even a very efficiently organized general internit practice uually require one nure/medical aitant per phyician/provider. Exercie caution when uing temporary agencie to provide hort or longer term nuring ervice. Arrange to meet or have your office manager meet with temporary agencie before you actually need them, o you can ae the agency manager and the quality of ervice they provide. Check their reference. Find out how they recruit and the creening proce they utilize for hiring temp. No matter how many time you ue an agency, take time to review the qualification of each peron who i going to be working in your practice. Do not compound your problem by keeping a temp who i not meeting your expectation. Remember, the quality of temp ervice i not necearily linked to price. Finally, make continuing education and other training program available to your taff. In addition to continuing education program, taff may need more pecific training. Etablih a procedure by which taff can requet pecific training. Offer interperonal and communication kill training to aure that taff member properly project to your patient the clinical kill they poe and treat patient with the care and concern they deerve. Careful obervation of taff interaction with patient i part of the phyician overall reponibility for patient care. Enure your practice i taffed by competent, confident and compaionate nure and medical aitant. Staff training i a cot-effective invetment in your practice. Suggeted Reading and Reource Zucker, Diane. Surpriingly Simple Idea To Improve Your Practice Phyician Management, December 1996; p 29-36 Majzun, Rick. The Role of Teamwork in Improving Patient Satifaction Group Practice Journal, April 1998; p 12-16 Croby, Jame. Nine Way To Conduct More Efficient Office Viit Family Practice Management, May 1997; p 83-90 Carlon, Robert P. How The Telephone Can Tranform Your Practice Family Practice Management, October 1996; p 56-64 6 Step to Effective Reference Checking The Phyician Adviory, November 1997; p 6 Phyician Clinical Skill Tip The following tip apply to urvey quetion 15 through 18 Survey Quetion 15: The doctor undertanding of the reaon for my viit Survey Quetion 16: The doctor interet in my overall health Survey Quetion 17: The doctor kill in examining me Survey Quetion 18: The doctor thoroughne in examining me 15

Poible Caue for a Low Rating Patient felt that ome of their medical concern were not addreed during the examination. Patient expected more information or treatment than wa provided. Patient perceived omething lacking in the phyician examination kill. Introduction A low rating in thi category hould prompt phyician to take an intropective view of how they approach and perform clinical aement of their patient. Although a phyician routine for managing a patient encounter i honed and perfected over the coure of time, there are ome pecific action which you may want to conider adopting. Conideration for Corrective Action Ak each patient the reaon for coming. Ak each patient what pecific medical problem() exit at the time of the viit. Liten carefully and let patient know which condition you will be able to addre during the coure of the pecific viit. If there are too many iue to deal with during the coure of one appointment, tell your patient how you plan to manage their other medical concern. Give patient plenty of opportunity to ak quetion and be ure they truly undertand your anwer to their quetion. It may be helpful to repeat what a patient ha told you in order to clarify your undertanding of the problem. Organize the whole viit proce efficiently to permit thoroughne and enough time to addre patient concern. There i a growing conflict between preure on phyician to increae patient volume and patient expectation regarding the ervice that hould be rendered during a given appointment. Succeful management of thi conflict require you and your taff to develop a coordinated effort. It begin with the cheduling of patient appointment. Staff mut clearly identify the range of problem to be addreed during the coure of a viit and then chedule enough time for you to evaluate and treat thoe problem. Liting problem eparately or numbering them on patient chart can be very helpful. You can ue written checklit in examining patient to reinforce your own mental checklit. Of coure, it i alway important to have patient record in hand, along with any available tet reult. Teamwork and an efficient patient flow ytem are required to meet patient expectation. Reaure patient that he/he i in very competent hand. Although a phyician clinical kill are acquired through ophiticated training and experience over the coure of time, patient tend to evaluate thoe kill baed on their own expectation and limited undertanding. Thi i epecially true for the elderly and children, who can recognize and appreciate gentlene and attitude much more readily than hard clinical kill. Examination kill are judged baed on a combination of the phyician technical competence, attitude and interaction with patient. The thoroughne of an examination, and the clarity of intruction and explanation can heavily influence a patient perception of your clinical kill. Through your approach and action you can aure your patient that you are confident in your ability to provide the neceary treatment. It i important to be prepared, diplay confidence, provide re-aurance and develop a gentle and caring demeanor. Etablih an internal quality improvement mechanim. Conduct periodic obervation of phyician-patient encounter a part of your practice educational and quality aurance effort. Phyician in a group practice with pecial clinical kill hould be utilized to train and educate other intereted phyician or phyician extender. There are outide companie that provide uch aitance hould that be required. Carefully evaluate your interperonal and communication kill. 16

Becaue patient are prone to judge clinical kill baed on their peronal interaction with a phyician, your patient atifaction check up rating for interperonal kill may alo prove helpful in explaining a low clinical kill rating. Check your core on thoe quetion. If they are low, review the corrective action uggeted for thoe topic a well. Suggeted Reading and Reource Eddy, David N. What Define A Good Doctor I About To Change Medical Economic, April 1997; p 55-59 Crane, Mark. How Good Doctor Can Avoid Bad Error Medical Economic, April 1997; p 36-43 Carlon, Robert P. How The Telephone Can Tranform Your Practice Family Practice Management, October 1996; p 56-64 Elliott, Patricia L. How I Get Patient To Follow My Intruction Medical Economic, July 1996; p 195-198 Preton, Suan Harrington. You Can Be An Eight Minute Marcu Welby Medical Economic, October 1997; p 69-72 Vander Veer Jr, Joeph B. Pleaing Patient: It The Little Thing That Count Medical Economic, June 1996; p 177-180 Majzun, Rick. The Role of Teamwork in Improving Patient Satifaction Group Practice Journal, April 1998; p 12-16 Croby, Jame. Nine Way To Conduct More Efficient Office Viit Family Practice Management, May 1997; p 83-90 Apen Publication. Improving Patient Satifaction Now Copyright 1997 A Phyician Guide to Phyician-Patient Communication: The Mile Council for Phyician-Patient Communication Pharmacia & Upjohn. Take Time to Talk: Phyician-Patient Barrier to Communication For free copy of report, contact Manning, Selvage & Lee, Attn. Holly Shaw 404-875-1444, ext. 236 Difficult Clinician-Patient Relationhip and other workhop: Bayer Intitute for Health Care Communication 800-800-5907 Phyician Interperonal Skill Tip The following tip apply to urvey quetion 14, 19 through 29 Survey Quetion 14: The doctor effort to make me feel at eae Survey Quetion 19: The doctor explanation of each tep of the examination Survey Quetion 20: The doctor explanation of my diagnoi Survey Quetion 21: The doctor encouragement for me to ak quetion Survey Quetion 22: The doctor repone to my quetion Survey Quetion 23: The clarity and thoroughne of the doctor dicuion with me about treatment option 17

Survey Quetion 24: The doctor explanation of why I needed any tet Survey Quetion 25: The doctor explanation of when and how I would hear about any tet reult Survey Quetion 26: The doctor intruction (oral/written) about any precription drug Survey Quetion 27: The doctor reaurance about my diagnoi and treatment Survey Quetion 28: The doctor encouragement to call if I had any problem or quetion Survey Quetion 29: The length of time the doctor pent with me Poible Caue for a Low Rating Phyician did not make patient feel welcome or comfortable. Phyician did not give clear and thorough explanation and direction during the viit. Phyician did not encourage patient to ak quetion or to participate in the development of the patient treatment plan. Patient did not feel that the doctor pent ufficient time evaluating and dicuing their medical problem(). Introduction Although thi category include everal quetion, there are four baic iue that are addreed by thi ection of the quetionnaire. They are: making patient feel welcome; communication, including explanation, direction and anwering quetion; involving patient in treatment choice; and the amount of time the phyician pend with patient. Conideration for Corrective Action Make a concerted effort to make each and every patient feel at eae and welcome in your practice. A phyician ability to make patient feel welcome and comfortable i the key to maintaining and continuing the growth of a practice. Certainly, clinical kill and technical ability play a major part, but a phyician peronality and demeanor have a tremendou impact. Patient want to believe their doctor incerely deire to take care of them and i concerned about what matter to them. Furthermore, effective phyician-patient interaction can poitively influence treatment compliance, patient cooperation and, mot importantly, patient outcome. Although it may be obviou to you that you are concerned with your patient care, it may not be obviou to them. Making a concerted effort to extend a warm welcome and how your concern, even on your buiet day, can make a world of difference. Give patient clear direction and thorough explanation throughout the coure of the viit. Every phyician mut develop hi/her own tyle and method of enuring that patient receive clear and thorough information related to their medical problem. Whether verbal or written, all communication mut be undertandable to patient. Providing handout i helpful, but remember, they are only effective to the extent that patient can and will read and undertand them. There i no ubtitute for an oral exchange between patient and phyician. Encourage your patient to ak quetion and participate in the development of their treatment plan. 18

Including your patient in the development of their treatment plan and taking time to anwer their quetion will help gain greater patient cooperation and compliance. When appropriate, give them treatment option to conider. Patient ometime do not feel comfortable aking quetion; therefore, it i important to liten carefully to what i being aid and be mindful of any underlying meage. Do not treat any patient quetion in a dimiive fahion doing o cut off all future quetion. During the coure of the viit try to addre all of the patient medical concern that are directly related to the purpoe of that particular viit (if neceary, chedule another viit to addre other problem). Make ure patient have a thorough undertanding of their treatment plan and get all of their quetion anwered before departing. Finally, let patient know how they can get information or quetion anwered once they leave your office. Thi i epecially important ince patient do not alway proce all the information they receive at the time of their viit. Devote enough time to meet the need of each patient. Thi i much eaier aid than done, epecially in the managed care atmophere where patient want acce to their phyician at all time. Spending enough time with patient i a problem for every phyician today due to growing time preure. Meeting thi expectation require excellent time management on the part of the phyician, tremendou upport from office taff, and ome luck. However, phyician do have control over ome of the variable that affect their ability to meet thi expectation. Strive to do the following: Arrive and tart on time. Schedule the length and equence of appointment baed on the condition of the patient. Develop a work routine that allow you to tay on chedule. Develop an efficient ytem for proceing patient with your upport taff. Write a well-defined policy on how your practice will manage patient who arrive late for their appointment. Pot it in a highly viible location, and make ure your patient undertand it. During the firt few minute of each viit, focu intently on arriving at a diagnoi, thu freeing up the remainder of the viit for explanation, education, quetion etc. If you mut defer ome iue until another viit, let the patient know why and dicu how and when they will be handled. Learn to ak and anwer quetion and provide direction while imultaneouly examining patient. Give patient option for getting anwer to their quetion or concern. Many patient quetion can be anwered by other taff member at non-peak hour, but patient need to be informed of whom to contact. The perceived amount of time a phyician pend with a patient i a major factor in patient evaluation of care and ervice rendered. A patient perception of laped time i greatly influenced by the phyician manner and apparent thoroughne. By efficiently managing a viit, and diplaying a confident, friendly manner, the phyician can normally atify a patient need for thoroughne without devoting exceive time to a viit. Ue good non-verbal kill Patient perception of warmth, openne and even the amount of time pent with a phyician, are directly influenced by how the phyician preent. Shoulder back, big mile, eye contact, warm handhake and greeting, calm demeanor, aured tone of voice, hand off the door knob thee thing convey the meage that you care a lot about your patient, that you undertand exactly their need and will therefore take the time to atify thoe need. Note that none of them increae actual viit length, but they all increae patient perception of quality time. Conider attending phyician-patient communication training eion. There are well-developed technique for improving interperonal communication kill. Many indutrie offer uch training, and medicine i beginning to do the ame. Look for training program pecifically deigned for phyician and other medical provider. 19

Suggeted Reading and Reource Zucker, Diane. Surpriingly Simple Idea To Improve Your Practice Phyician Management, December 1996; p 29-36 Elliott, Patricia L. How I Get Patient To Follow My Intruction Medical Economic, July 1996; p 195-198 Cheanow, Neil. Can t Stay On Schedule? Here A Solution Medical Economic, November 1996; p 174-191 Majzun, Rick. The Role of Teamwork in Improving Patient Satifaction Group Practice Journal, April 1998; p 12-16 Apen Publication. Improving Patient Satifaction Now Copyright 1997 Anderon, Eric G. How To Rebuild The Doctor-Patient Relationhip Phyician Management, October 1997; p 64-67 Cheanow, Neil. Little Thing That Go Over Big With Patient Medical Economic, April 1997; p 55-59 Vander Veer Jr, Joeph B. Pleaing Patient: It The Little Thing That Count Medical Economic, June 1996; p 177-180 Croby, Jame. Nine Way To Conduct More Efficient Office Viit Family Practice Management, May 1997; p 83-90 Lipkin Jr, Mack et al. Conducting an Efficient Patient Interview Today Internit, March/April 1998 A Phyician Guide to Phyician-Patient Communication: The Mile Council for Phyician-Patient Communication Difficult Clinician-Patient Relationhip and other workhop: Bayer Intitute for Health Care Communication 800-800-5907 General Patient Perception Tip The following tip apply to urvey quetion 33, 34, 35 Survey Quetion 33: The doctor ability to meet my need Survey Quetion 34: My overall atifaction with the quality of care I received during thi viit Survey Quetion 35: My willingne to recommend thi phyician and practice to a cloe peronal friend or family member Poible Caue for a Low Rating A breakdown in communication between doctor and patient. Doctor failed to addre all of the patient medical problem for the viit. The overall quality of care during the viit did not meet the patient expectation. Phyician and/or taff failed to meet patient expectation during their viit. Factor not pecific to the viit or to quetion urveyed in the quetionnaire. 20

Introduction A low core in the overall performance of the practice i particularly eriou. Preumably, it hould coincide with low core on other more pecific urvey quetion. If thi i not the cae, keep in mind that the urvey aee a particular viit, and there could be other patient contact or other apect of the practice not aeed by the urvey. Conideration for Corrective Action Review the other categorie of the patient atifaction urvey report. Look for pecific individual iue that may have contributed to the low general rating and addre each one individually. Check out other poible explanation. If thi wa the only category that wa rated low, look for outide caue that may not have been identified through the ue of thi patient atifaction urvey. For example, examine the facility itelf or apect of the practice (e.g. billing proce) with which patient have contact outide the context of the particular viit urveyed. Contact a ample group of patient een in thi time period. Telephone patient directly or call them together for a focu group. Ak them open-ended quetion regarding any diatifaction they may have experienced with the practice and/or the care provided. Many marketing conultant offer the ervice of conducting objective focu group. Suggeted Reading and Reource Zucker, Diane. Surpriingly Simple Idea To Improve Your Practice Phyician Management, December 1996; p 29-36 Dunevitz, Brad. Enhancing Practice Performance Align Operation, Avoid Burnout Medical Group Management Aociation Majzun, Rick. The Role of Teamwork in Improving Patient Satifaction Group Practice Journal, April 1998; p 12-16 Dahl, Owen J. 10 Quick Step To A More Efficient Practice Phyician Management, July 1996; p 32-42 Anderon, Eric G. How To Rebuild The Doctor-Patient Relationhip Phyician Management, October 1997; p 64-67 Cheanow, Neil. Little Thing That Go Over Big With Patient Medical Economic, April 1997; p 55-59 Carlon, Robert P. How The Telephone Can Tranform Your Practice Family Practice Management, October 1996; p 56-64 Cheanow, Neil. Making Doctor Live Eaier - And Patient Happier Medical Economic, Augut 1997; p 118-131 Yerke, Lelie A. How To Attract And Keep Good Patient Phyician Management, March 1997; p 45-48 Crum, Larry D. Do Patient Need A Uer Manual For Your Practice Today Internit, January/February 1998 21

Nelon, Ann-Marie. Standard Make the Difference in Patient Care and Service Quality Group Practice Journal, November/December 1997 IMCARE Ideal Patient Viit Appendix C - Anatomy Of Patient Satifaction A Primer Improving Patient Satifaction Now, An Apen Publication book, Copyright 1997 Patient Satifaction & Outcome Management A newletter co-publihed by the Medical Group Management Aociation and American Health Conultant. For ubcription 800-688-2421 22