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The Patient Encounter

Delivering High Quality Customer Service

Today's economy has forced many podiatric practices and businesses to reevaluate the way they conduct daily operations. Some practices were fully prepared for a down economy and are actually growing. Other practices were caught unaware and are struggling. This article focuses upon the relationship you have with your patients. There are many factors that contribute to the patient encounter and many points of contact where the quality of the patient encounter can be affected.

Most consumers have been victims of poor customer service. Do you remember a time when your needs have not been met when you were a customer or patient? Was it at a restaurant, with an airline, at your personal physician's office? Do you remember the cause of your dissatisfaction? How did you handle the situation? Did you voice your dissatisfaction immediately? Most consumers don't voice their concerns at the time, so the management or business owner never really knows that the customer's needs were not met. For every customer complaint, there are 26 other customers who have remained silent.i

Most customers suffer silently and tell themselves something along the line of "I'll never come here again" and that is it. Then, they proceed to tell anywhere from 9 to 15 friends, family members, or acquaintances of the terrible service they received. This is not the way to build advocates for a business. A dissatisfied consumer will tell between 9 and 15 people about their experience. About 13% of dissatisfied customers tell more than 20 people.ii

Some businesses have initiated policies and procedures to make their job easier, to increase profit, or to streamline a process without taking into consideration how the customer will be affected. They've lost focus of what the customer needs and most importantly, they have forgotten where their revenue comes from.

Many companies fail to grasp the significance of delivering exceptional customer service. They continue to erect barriers that make it difficult for the consumer to do business with them. One of my personal favorite anti-customer service initiatives includes out-sourcing the customer service department to a third-world country. Another favorite is an airline charging you for your first piece of luggage when you check-in for your flight. Another great example is the automated, voice recognition, telephone triage system. These systems tend to lead the customer to believe that the goal is to take them on a never-ending journey of frustration.

These are examples of policies and procedures that are not customer friendly. Sometimes the customer will overlook these and simply deal with them. They feel like they don't have a choice and it "is what it is." The beautiful part of competition in the business world is that consumers often have a choice. If a company continues to provide less than satisfactory service, customers will vote with their feet and seek a company that truly appreciates their business. 91% of unhappy customers will not willingly do business with your organization again. This can also put unnecessary strain on practice finances because attracting a new customer costs 5 times as much as keeping an existing one.iii

Why is it that individuals or companies do not have a better grasp on their quality of customer service? Many times it is one of three reasons:

  1. The employees know they can get away with it.
  2. They don't know any better.
  3. They simply don't care.

All three of these scenarios can be addressed and eliminated through strong leadership and coaching. The first step is identifying and accepting the need for improvement.

Now think about the last time you received excellent service. Did the business make you feel that you were the most important customer that they have? Did they take a personal interest in meeting your needs? Did you leave feeling satisfied with the experience? Did you feel as if you were both listened to and that adequate attention was given to your needs? Will you go back? Did you tell anybody about your great experience?

There are many successful companies that deliver superior customer service. Some of the best based upon my own observations include Disney, Marriott, Apple, Lowe's, Publix, Lexus, and JetBlue Airlines. I mention these companies because they are consistent throughout their organizations. I encourage you to take the opportunity to observe their customer service skills.

Customer Experience Management

The businesses and medical practices that will prosper through this challenging economy truly understand the value of delivering the highest quality of customer care possible. The importance of improved patient satisfaction is crucial to medical practice success. It typically costs you 4 to 5 times more to attract a new patient than to retain an existing patient. An excellent goal for any practice should be to retain the highest number of existing patients and lead them down the path to becoming an advocate for the practice. Your advocates and happy customers who get their issue resolved tell about 4 to 6 people about their experience.iv Word of mouth is one of the most economically feasible marketing initiatives and has a high return on investment.

Have you ever had a day when it seemed like every patient you saw was in a bad mood and it felt like they were taking out all of their frustrations on you? Did you have to spend extra time just getting them back to a more positive state of mind before you could even begin treatment? If a patient has a negative first impression or receives inferior service when they arrive at your practice, a ripple effect occurs and has a tendency to magnify and inflate. If their concerns aren't addressed by the time they see you, the patient transfers their dissatisfaction to you, the physician. Oftentimes, these situations can be remedied through active listening and objection handling by your front office staff and medical assistants/nurses.

The Provider/Patient relationship is very important, but the patient's overall impression is formed throughout the entire office visit. The fact is that the patient encounter begins with the initial contact with your practice via your website or the telephone and ends with check-out and billing. Everything that happens in between can make the difference between a one-time patient and long-term advocate for your practice. Diagram one illustrates the patient's typical flow through the office. The outside boxes illustrate the patient flow and the circles represent the staff member or department that has the ability to affect the level of customer service.

Patient/Staff Practice Contact Points

Tactic: Measure Patient Quality of Care
Step #1: Inspect

It is often difficult for a physician to gauge how well the patients are being treated by the practice because they are typically in an exam room and isolated from the rest of the practice. A very useful tool for overcoming this obstacle and inspecting the level of customer service is a patient quality of care survey. This survey can be conducted in several ways. It can be web-based, by phone, or in the form of a questionnaire they receive at the end of their office visit.

Most physicians and managers have a tendency to make assumptions regarding the level of customer service being delivered by their practice. Few medical practices actually survey their level of patient satisfaction. Some practices are required to survey their surgical patients in order to maintain their certifications, but they often overlook many of the other patients.

When a customer survey is initiated appropriately, it can be one of the most effective tools for increasing patient retention and converting prospective patients into loyal advocates. Most of the time, when customers become dissatisfied, they do not stick around long enough to complain. They vote with their feet and disappear. But if you learn something's going wrong and, better yet, can correct it, you have a chance to retain and improve the satisfaction level of your patient. More importantly, you can make sure the same mistake isn't repeated.

Conducting a Patient Quality of Care Survey gives your patients an opportunity to think about what you do for them. If a patient is having a less than ideal encounter with your practice, you can capture this information and take corrective actions. The average medical practice never hears from the majority of its unhappy patients. They simply find another provider and create negative PR for you. The reality of the situation is that you will most likely never know this is happening if you do not measure your level of patient satisfaction.

Step #2: Evaluate

Once the completed surveys have been received, it is time to evaluate the data. The physician and the management team need to review the feedback together. Look for areas that are performing well in addition to areas that need improvement. Identify departments, personnel, processes, and trends that have the potential to improve patient experience.

Identify the strengths, weaknesses, opportunities and threats. It is important to not take the feedback personally. Use the results to respond constructively. Resist the temptation to react to the survey results. Analyze the results and use them to facilitate change.

The next step is to compare the results with previous surveys that have been completed in your practice. Identify areas that are showing improvement and discuss the trends that are emerging. If this is the first time measuring patient satisfaction then you obviously will not have data to compare it to. Use this as your baseline measurement for the future. You can also compare your results with external data, but it will be difficult to correlate unless you are using a standardized survey with benchmark data.

Step #3: Modify

A good place to begin making modifications is to hold a tactical meeting with your management team. Discuss tactics to either maintain or modify behaviors that will affect the patients' encounters with the practice. Once you have identified these areas and agreed on the actions that need to be taken, it is time to communicate with the rest of your staff. Review the survey results with them and solicit their feedback and their recommendations.

A good venue for discussing the survey results is during an all-hands staff meeting. The goal of the staff meeting should be to discuss the survey results and begin changing behaviors. This meeting will also serve the purpose of creating an awareness of the importance of each and every patient encounter.

Improving Customer Service

I like to begin with the positive areas followed with areas of opportunity. I always look for examples in which individual employees delivered exceptional customer service. When an employee is recognized by the patients as going above and beyond the call of duty, it presents the management team the opportunity to praise them publicly. This is a great way to begin offering positive reinforcement and rewarding those deserving praise. This is also important because employees who take pride in their work and deliver 100% will waste away without positive reinforcement. They may begin feeling like nobody notices their efforts. If that impression continues, their quality of work will decline.

Conversely, if an employee is called out for unsatisfactory performance, it is best to counsel the employee privately. It is acceptable to describe the situation to your staff as an area that needs improvement, but be careful to avoid naming specific personnel during the group discussion. When the meeting is concluded, the staff needs to have a very clear understanding that they will be held accountable for their individual level of customer service. Scrutiny in the area of customer service will be a priority moving forward and the bar has been raised.

Patients will appreciate the efforts you take in improving your level of customer service. When your patients are satisfied with your level of customer service they are less sensitive to the cost of cash pay services. Even in a negative economy, customer experience is a high priority for consumers, with 60% often or always paying more for a better experience.v Consumers find it difficult to justify paying premium prices for sub-par service. With improved customer service you should see increased patient retention. An increase of only 5% of existing patients can increase your profitability by 25%.

Challenge yourself to look at your practice through the eyes of your patient. Look for areas that put the convenience of the practice over the needs of the patients and change them. A high level of customer service is one of the few areas in which you can truly separate yourself from your competition. The competition can duplicate your offerings and they can obtain the same equipment, but they can't match your level of service if you make a concerted effort to be the best and get your staff to share the same vision.

i Source: Lee Resource Inc.
ii Source: White House Office of Consumer Affairs, Washington, DC
iii Source: Lee Resource Inc.
iv Source: White House Office of Consumer Affairs, Washington, DC
v Source: Harris Interactive, Customer Experience Impact Report
vi Source: Aberdeen report – Customer Experience Management: Engaging Loyal Customers to Evangelize Your Brand

About the Author: Page S. Piland is the founder and president of Core Healthcare Consulting. He has more than 20 years of management and operations experience. He has been a featured speaker and has lectured on the subject of Healthcare Practice Management at multiple national medical society meetings.

He is an Eagle Scout and a graduate of the University of Alabama. He is also proud to have served in the U.S. Army and Army National Guard for 12 years as a Cavalry Scout. Mr. Piland currently resides in Windermere, FL with his wife and two daughters.

He can be contacted at
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