Patient satisfaction surveys proliferate, but what should you do when your results indicate dissatisfaction with the physicians in your practice — particularly with their customer service skills?

Practice management consultants warn not to take your patient base for granted. Satisfied patients benefit your practice with patient loyalty and additional referrals.

The Medical Group Management Association (MGMA) recommends that every provider perform as if patient satisfaction were the key to protecting their practice’s existing revenue base and generating new market share. Some practices determine physicians’ compensation formulas based on their patient satisfaction scores. And keep in mind that satisfied patients usually don’t litigate.

So if your patient survey results are less than stellar, you can’t afford not to respond. A recent Commonwealth Fund study revealed that differences among the ways in which individual physicians operate their practice sites account for the majority of variability among patient care experiences — providing further evidence of the importance of focusing on patient satisfaction as a means for improving healthcare system quality.

Once you identify the specific problem areas in your practice, it’s important to develop a plan of action and follow through with it.

Shadow coaching

In shadow coaching, a trained consultant accompanies a physician for a day’s observation.

Meryl Luallin, an experienced shadow coach and partner in Sullivan/Luallin, Inc., a San Diego-based patient satisfaction consulting firm, explains how this works: “At the beginning of each encounter, the doctor comes in and introduces me as Meryl Luallin, or I introduce myself. Then the doctor explains that I am writing a report on a day in the life of a doctor — which is the truth — and we ask the patient if I can stay during the visit. The patient generally says ‘yes.’”

Luallin adds that shadow coaches take specific precautions to ensure patient privacy is protected at all times. “If the patient hesitates or says ‘no,’ I leave,” she says. “Furthermore, the coach does not write down the patient’s name. There is no way that the patient is ever identified in any publication or in the report that goes back to the doctor after the shadow coaching is completed. … While the coach does hear the presenting problem of the patients, she is never allowed to look at the patient’s chart. There is no breach of confidentiality because we ask the patient at the outset.”

After a day of shadowing, the physician receives direct, one-on-one feedback on her interaction with patients. The coach makes specific suggestions for patient service improvement.

Physicians who have the most trouble connecting on a personal level with patients stand to gain the most from shadow coaching, says Luallin: “The ideal shadow candidate is a practitioner with consistently low ratings concerned about the consequences and willing to explore options.”

The problems shadow coaches uncover aren’t always major, and they may be as simple as getting physicians off “auto-pilot” behavior, such as repeating the same instructions in a monotone voice. Luallin says one physician she coached whose patients had criticized for poor communication skills found that when he stopped speaking with his hand over his mouth, fewer patients asked him to repeat himself.

After observing a physician, the coach prepares a written report, providing the doctor and the practice’s medical director recommendations for improvement. Approximately two months later, patients are again surveyed to determine the effectiveness of implemented changes and to identify which areas may still need work.

Some common patient service suggestions include shaking hands with patients when first greeting them, making eye contact, taking a seat after entering an exam room, asking how you can help the patient, and actively listening to a patient’s concerns. It is also important not to interrupt patients when they are speaking, as this generally makes patients feel they are being rushed, says Luallin. A physician should also make a practice of writing down their instructions, since many patients often forget what they are told after leaving the office.

System analysis