Giving your practice a checkup: Keeping patients happy

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None of us need to be reminded that the medical landscape has changed. We do know that more people will be seeking healthcare, and the delivery of healthcare will be far different than it was just a few decades ago. This flood of new patients will affect nearly every medical practice partly because we need to increase the number of physicians to care for them. We need help to maintain employees who are leaving the healthcare sector. In the meantime, what can you do to ensure the continued success of your practice? This four-part series focuses on four key areas or the "four pillars":

1. Keep existing patients happy
2. Attract new patients
3. Nurture relationships with your medical colleagues and other healthcare providers, such as physician assistants and nurse practitioners
4. Maintain the morale of your staff

I would like you to think of the four pillars as legs on a table. All the legs are necessary to maintain the stability of the table. If you remove one leg, the table is unstable. No leg/pillar is more important than the others; all four are necessary to guarantee a successful practice.

In this first blog, I explain why it is vital to ensure that every patient has a positive experience with your practice, from the moment they make their first telephone call for an appointment, through their time spent in the reception area, to the moment they are seen by the staff or the physician, and beyond—when they tell others about their stellar experience.

Getting new patients is nice but keeping the ones you already have is more important. In most professions and businesses, keeping an established customer is one-fifth the cost of acquiring a new one. Medical practices are no exception. If you need to do an excellent job with the patients you already have, spending thousands of dollars on a marketing plan to bring in new patients is a waste of your money. The patients you have right now are the backbone of your practice.

Give your practice a checkup

Today, knowing the needs and expectations of your patients and referring physicians is critical. Just like you recommend that your patients receive a regular examination, you should consider regular a checkup on your practice. The best way to do this is to ask your patients what they think, which also will reveal your practice's strengths and weaknesses. This information can be obtained easily by surveying patients about various aspects of your practice. (Even closed practices should evaluate their services periodically and listen to their patients. Changes always occur, and the cup may not "runneth over" forever.)

Tom Peters, the nationally renowned author of In Search of Excellence, has described two keys to success in business:

• Find out what the customer (patient) wants and give them more of it
• Find out what the customer (patient) does not like and be sure to avoid it

Techniques to gather the patient's perspective

There are five effective techniques for determining how patients perceive your practice and for evaluating your performance and reputation:

• Conduct personal interviews
• Conduct patient surveys
• Create a focus group
• Use a suggestion box
• Employ a mystery shopper

I have used all five techniques. However, my favorite and most cost-effective involves a survey card given to every patient on every office visit (Figure 1). The card is given to the patient when they check-in, and they can complete it in the reception area or exam room and return it to the receptionist before leaving the practice. The cards are reviewed by a nurse, who addresses positive and negative comments. Most negative comments are handled with a phone call. If necessary, I respond to the patient's complaint.

Figure 1

There is another benefit to the survey card. The reverse side of the card prompts the patient to write down three questions she would like you to address on her current visit to the office (Figure 2). Conducting the appointment according to these concerns can help keep patients from initiating a last-minute discussion that you didn't address during the doctor-patient encounter, often after you have closed the chart or electronic medical record. Since my office has implemented this survey card, we seldom receive follow-up phone calls from patients about issues they should have discussed. The survey card demonstrates that we are listening to the patient and want to ensure that all their questions have been answered during their office visit.

Figure 2

Develop an on-time philosophy

You know the adage: Timeliness is next to godliness. (It's cleanliness that's next to godliness, but timeliness is vital, too!) Patients' most common complaint about the healthcare experience is "waiting for the doctor." Spending excessive time in the reception area accounts for more patient dissatisfaction than any other aspect of medical care. In one recent survey, nearly one in four patients (24%) claimed to have waited 30 minutes or longer. This statistic will only worsen with so many more women entering the marketplace.

To gain an accurate picture of what is happening regarding the schedule in your practice, I suggest conducting a "time and motion" study. For a period of 3 to 5 days, place a sheet on each patient's record or superbill and log in the following:

• time of her appointment
• time she arrived
• time she left the office
• how much time she spent with her physician

You will be amazed to discover that patients are waiting 1 or 2 hours or longer to see the physician, and that the physician is spending only 5 minutes with the patient. Ask any patient on a survey if she feels she is getting bang for their buck, and they will answer, "No!"

By conducting a time and motion study, you will discover that there are predictable periods when backlogs occur. Often, these delays result from "working a patient in" to the schedule. Unscheduled patients who call to report a medical emergency are often told to come in without an appointment. Still, they inevitably displace patients already scheduled and delay the visit of those with scheduled appointments. This problem affects almost every doctor.

One way to avoid this scenario is to create "sacred" time slots. These are 15-minute intervals at the end of the morning or afternoon in which unscheduled patients can be seen without affecting the schedule. Instead of telling the patient to "just come in," the receptionist tells them to report at a specific time. These time slots must be filled with something other than routine appointments. They can only be filled after 9 a.m. each day. This leaves two or three places open for patients who must be seen immediately.

Few physicians can change healthcare policy. But all of us can be more sensitive to our patients' time and try to see them as soon as possible, eliminating one of the patients' most common complaints: the long wait to see their doctor.

Make the patient's experience Memorable

All of us who graduated from medical school can make a diagnosis and provide a treatment strategy for most patient's medical problems. But how many of us can make the experience memorable for the patient? Often, simple things that can be easily and inexpensively implemented make a big difference.

Look at the patient and not the computer. Patients' most common complaints about their experience is that the doctor was eyeball-to-eyeball with the computer instead of the patient. Make every effort to look at the patient and less time at the computer screen. This can be easily accomplished by enlisting the service of a scribe.

Use cloth, not paper gowns. There's a sharp contrast between a paper sheet, a paper gown, and a soft robe. You don't step out of the shower in a fine hotel and put on a paper robe. If you are offering five-star service, you need to provide five-star amenities. If you want to attract special patients, treat your patients special. Adding a few dozen robes to your office supplies costs less, laundering them after each use and placing them on hangers or in a plastic bag that each patient can use during their visit. I assure you that this idea will set you apart from most other physicians in your community.

Here's another idea: Use pads to cover the metal of the stirrups for the pelvic exam. Those stirrups are cold steel; no female patient wants to place her feet on those chilly structures. You can have lamb's wool pads created by a seamstress for a few dollars—or if you prefer, go low-tech and use potholders to cover the stirrups.

My wife told me how uncomfortable it is to have a metal speculum inserted and how much she appreciated her doctor warming the instrument with tap water before its insertion. I have found that this saves on the use of lubricant jelly, too, because the water serves as a lubricant!

Most medical offices are kept at 70° to 72° F to keep the doctor and staff comfortable. However, when a woman puts on her gown or robe, she often becomes cold and uncomfortable. When it is cold outside, or the office is cold, use an inexpensive heater to make the room comfortable for the patient.

You make points with your patients if you speak to them when they are fully dressed, and your eyes are at the same level as the patient. A woman lying on her back in a gown or robe does not hear or recall what her doctor tells her. However, if the doctor and nurse leave the room and allow the patient to get dressed, and if the doctor sits with the patient without barriers between them, she is far more likely to listen and recall what has been discussed.

I am often asked for my "best" idea to keep patients happy. Take a few minutes to call the patient at home. Which patients should you call? Patients undergoing outpatient studies or procedures, recently discharged from the hospital, and requiring a little more hand-holding and attention. You can be sure that every patient who undergoes a procedure or is discharged from the hospital has questions about the findings, any precautions, medications, and follow-up instructions. A call from a nurse or doctor does a lot to allay her apprehension— and it often keeps the patient from calling the office with their questions and concerns. My nurse identifies and contacts key patients at the end of the workday. She can usually answer all the questions but may identify two or three that require my attention. She tells the patient what time I will call so she can keep the phone line free. Calling patients usually takes no more than 5 to 10 minutes a day and provides me with great satisfaction. Patients are generally surprised—and happy—that their physician is calling them at home.

The advantages of this strategy include:

• fewer calls from your patients
• more efficient use of your time
• deep appreciation by the patient.

One patient I called at home wrote me a note worth mentioning: "This is the first time a member of your profession has taken the time to call me at home and check on my condition. Undoubtedly, it will foster a better relationship between you and me."

The bottom line

Word of mouth was the time-honored method of attracting new patients for thousands of years. That method still works today. Ensuring your patients have an outstanding experience during their visit is one of the best marketing strategies to promote your practice. Part 2 of this 4-part series will discuss attracting new patients to your practice.

Neil Baum, MD, a Professor of Clinical Urology at Tulane University in New Orleans, LA. Dr. Baum is the author of several books, including the best-selling book, Marketing Your Medical Practice-Ethically, Effectively, and Economically, which has sold over 225,000 copies and has been translated into Spanish.