Building Patient Relationships through Your Staff

While reviewing the next day's schedule, the staff at Overland Park, Kan.-based St. Luke's South Primary Care noted that an elderly patient scheduled to come in the next afternoon might have trouble getting to the exam room on her own. The medical assistant immediately made a note to deliver a wheelchair to the front desk in time to greet the patient and escort her back to the room - a plan that both pleased the patient and kept the office on schedule.

"Our experience is that when we plan or reach out to a patient ahead of time we can head off problems," says family physician Michael Munger, medical director at St. Luke's. "We find that patients like the extra attention and it tells them that we work as a team."

In the past, patients often felt connected to a practice primarily through their physician, but that's changing as healthcare moves toward team-based models. The physician-patient relationship is still at the core of the practice but other staff members are playing increasingly important roles in fortifying that tie and contributing to the overall patient experience.

Many patients feel strong personal connections with the medical assistants and advanced practitioners who manage a significant portion of their care, experts say. And those relationships increasingly impact patients' loyalty to the practice.

"Advanced practice providers are doing many of the things that physicians used to do and there's a growing recognition by patients of the role of the support staff in their care," says Julie Boisen, managing director for Navigant Consulting's Healthcare practice, based in the Plankinton, S.D., office. "Practices need to look beyond the physician relationship because every member of the staff has a role in serving the patient."

Creating a caring, efficient team requires more than telling staff what their roles are, experts say. Physicians also have to embrace the team concept and signal its importance by providing training, encouraging communication, and holding people accountable for their performance. Read on for tips on how to create a culture of customer service in your practice.

Set expectations

Patients' interactions with staff begin well before the visit when the appointment is scheduled. That's a critical time to make a positive first impression and set patient expectations so that there are no surprises when they arrive.

"The initial contact is so important," says Lauren King, director of customer service at DoctorsManagement, a medical and healthcare consulting firm based in Knoxville, Tenn. "How easy is it to make an appointment? Is the staff member trying to get me off the phone? Did they tell me what I need to bring and when to arrive?"

The scheduling call should include a brief discussion of the office's financial policy and the patient's payment responsibility on the day of the visit, says Owen Dahl, a practice management consultant based in The Woodlands, Texas. The key is consistency: If a discussion of financial responsibility is built into the scheduling process, patients will come to see payment as a routine part of their visit.

To ensure that patients get a clear message, the front-desk staff should undergo customer service training using scripted calls, says Boisen. That way, the patient experiences the same level of service every time they call, no matter who answers the phone.

Scripts dealing with common scenarios help staff establish standard protocols for greeting patients, interacting with them in the waiting room, and handing off to other staff members, she says. Throughout the visit, the patient should have the feeling that she is being cared for by a unified team rather than a series of disconnected individuals.

"If I call for an appointment and I can't get the physician of my choice, for example, the person handling the call should know to offer alternatives," Boisen says. "That way the patient begins to understand that this is a person who can help me and that the whole staff has my best interests at heart."

Another way to ensure a smooth visit is to anticipate individual patient needs in advance, adds Dahl.

"Generally, all patients want you to show them respect, answer their questions, and run on time," he says. "Then there are specific expectations of individual patients, such as the elderly woman who always brings a family member to talk to the doctor or the Generation X-er who is always in a hurry and expects to be in and out quickly."

At St. Luke's South, for example, one longtime patient typically arrives with a list of questions about her medications, says Munger. Knowing that, the nurse calls the patient ahead of time to go over her concerns, potentially alleviating some of the patient's anxiety and making it less likely that she will require lengthy explanations during the visit.

"We might ask her to put all of her pill bottles in a bag and bring them with her to the appointment so it will be easier for us to address her questions," says Munger. "It's a patient-centric strategy that also helps us keep things flowing."

Work as a team

A key component of the Patient-Centered Medical Home (PCMH) is having brief daily meetings, or huddles, to plan or review the day's schedule. It's an important time for physicians and staff to strategize and exchange information.

"In the morning huddle we go through our day and identify patients who might need more time or a different approach," says Mott Blair IV, a family physician at Vidant Family Medicine in Wallace, N.C., which has been designated as a level three PCMH by the National Committee for Quality Assurance. "We also identify our staffing needs for that particular day, such as a patient educator to help care for our diabetes patients."

A huddle might include a provider and an assistant or the entire staff, says Dahl. It's a good habit regardless of whether or not you have converted to a medical home.

 "It's critical to have open communication between physicians and staff about what's going to happen that day," he says. "You can also review what happened the day before and discuss what could have been improved upon."

The huddle is an extension of the pre-visit planning, says Munger. It gives the physician a chance to check in with staff about what's been done to prepare for specific patients and any potential issues that might cause delays.

"Typically my staff has gathered all the necessary documentation, such as notes from a specialist a patient might have seen since their last visit or information about hospitalizations," he says. "Nothing slows down a visit more than when you walk in the exam room and a patient says, 'Oh, by the way, did you hear what the cardiologist said about me three weeks ago?' If you don't have that documentation, you might have to make a call and the visit can really drag on."

The huddle is also a time for staff to alert the physician to emerging issues, such as a patient who called that morning with a swollen ankle, Munger adds. Knowing that, the physician might ask if the patient can get an X-ray beforehand, thus making the actual visit more efficient.

The huddle is key to increasing patient satisfaction because it helps the practice run on time and strengthens the team concept around patient care, says Boisen. However, many physicians don't consistently build it into their schedule.

"A physician might arrive 15 minutes after the start of clinic and as a result no one has a chance to connect about the patients that are coming in on that shift," she says. "If they also leave before all the patients are gone, there's no opportunity to touch base with staff about what went well, what didn't, and what might need more follow up."

Communication between physician and staff is crucial in the post-visit period because the medical assistant or nurse is often charged with following up with patients, she says. A quick debriefing helps them communicate effectively with the patient and conveys that you are working as a team.

Head off complaints

One of the biggest sources of patient complaints is time spent waiting in the reception area when the physician runs behind. You may not be able to eliminate waiting, but teamwork can minimize it, experts said.

"The physician should never do anything that someone else can do," says King. "For example, walking a patient into or out of the exam room adds an extra five minutes per patient."

Inside the exam room, working with a scribe allows the physician to focus on the patient interaction instead of a computer screen, she says. A scribe can input data and assign diagnosis codes, leaving the physician free to make eye contact with the patient and focus on explaining the treatment plan.

Although it may sound counterintuitive, contracting with large call centers for scheduling can help enhance the front-desk staff's interactions with patients, says Boisen.

"The call center schedules the appointment, validates insurance, and informs patients about their copays and expected balances, then stores that information electronically so it's easily available to the person at the front desk," she says. "In very well-run practices, the front-desk staff is aware of everything that has occurred prior to their first contact with the patient."

Issues related to prescriptions or refills are another major category of potential patient complaints, says Munger. The key to minimizing them is setting clear policies about how to order medications and contact the staff.

"We try to be very efficient with the way we handle refills because it's a real source of patient irritation and patients will always let staff know about any problems or delays," he says. "Our patients know they can contact us through the portal or by phone and if they don't talk to a live person, they can expect to hear back from us within two hours."

When complaints do occur, you need a process for handling them, says Boisen. She recommends placing complaint or suggestion boxes in the waiting area and on your website and clearly communicating your method and timeline for handling complaints.

Acting defensively or dismissively is one of the worst things you can do in response to a complaint, says King. Sometimes patients are upset about something that has nothing to do with you, such an incident at the hospital or a procedure not covered by insurance, but you can still help by listening.

"Listen without interrupting and let them know that you will do everything you can to help them, such as calling their insurer to check on what happened with a claim," she says. "A few days later, send them a note to let them know how the issue was handled. It's sign that you care and are willing to go above and beyond."

Janet Colwellis a Brooklyn, N.Y.-based freelance writer specializing in healthcare. With more than 20 years' experience as a journalist, she writes frequently about clinical and practice management issues for several national health industry publications. She can be contacted at editor@physicianspractice.com.