Bathrooms “R” Us

Neil Baum, MD

Perhaps you have been on an airplane and pulled down the tray only to find food scraps and coffee stains on the tray. This may cause you to question the airline’s attention to details like engine maintenance or losing passenger’s luggage. A similar situation arises when our patients use the restroom in our office, only to find toilet tissue and paper towels on the floor and an overflowing trash can. What immediately crosses the minds of our patients? What do they think about our practice and the hygiene of the physician and the staff? Their thoughts might jump to, “If they can’t keep their bathroom clean, what about their attention to my healthcare records?

I refer to this thought transference as the Bathroom Experience (BE), a powerful metaphor for how seemingly minor details can dramatically impact patients’ perceptions of a medical practice. A clean bathroom goes unnoticed because it’s expected. But a dirty one? That sends patients a message that the practice might be neglecting other details.

The BE concept also extends beyond restrooms. The BE concept applies to all the small details that impact the patient experience with the practice, such as returning phone calls in a timely manner, the doctor and staff washing their hands before examining a patient, or the doctor checking for drug-drug interactions when prescribing a new medication.

My practice’s mission statement states, “We pay attention to the small details because they make a big difference.” This mission statement is posted on the website, in the employee lounge, and in the reception area.

An example of how the mission statement is used occurred when I walked past the restroom, which was in disarray. I gathered my staff and asked if they would feel comfortable using this restroom in its current condition. All the staff agreed that it was not a representation of the care we provide our patients. I took a picture with my mobile phone and said that we would discuss the situation at our next staff meeting. This issue was added to the agenda for the next meeting, and we brainstormed ways to prevent it from happening again. I asked the staff, “Is the situation with the restroom adhering to our mission statement?” Everyone agreed that we could do better. The best solution was to assign a staff member each week to check the restrooms midmorning and midafternoon to ensure that there was nothing on the floor, that there was ample toilet paper, and that all urine specimens were in the lab. Now, the restroom was always clean and no longer an embarrassment.

Examples from my practice

If we tell a patient that we will return a call to them in two days with a report of a lab test and the results are not available, it is essential to inform the patient of the situation and provide them with an alternative date for when someone will call with the results.

When the doctor is late for the clinic, and patients are waiting for more than 30 minutes, it is helpful to have a staff member enter the reception area (not the waiting room) and provide patients with an estimated arrival time for the doctor. If the patients have not arrived in the office, contact them to inform them of the delay and offer them the option to reschedule their appointment.

If prior authorization is required for permission to use a medication, for a patient to undergo an imaging study, or for a procedure, inform the patient of how this process works and keep them informed when a delay occurs.

If you are a surgeon, your patients don’t know what happens under the skin. However, like the BE, they do see how the incision and the wound closure look. It is a minor detail, but it is almost as important as the surgical outcome to the patient. Therefore, take a few more minutes to make a nice-looking closure.

The Bottom Line: Little details that seem insignificant to you might be a major concern to your patients. Failure to focus on the little details causes patients to make assumptions about other things that they can’t see.

Do you have a Bathroom Experience story to share? What small detail is your practice overlooking that patients notice and use to judge you and your practice? Finding and fixing these details doesn’t just solve small problems; it prevents patients from imagining bigger ones. Please share your stories for a future article at doctorwhiz@gmail.com.

This article inspired by Shep Hyken’s article appearing in Forbes Magazine

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.