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Focus on Customer Service


Medical practices have been slow to embrace the "customer comes first" mentality that defines corporate America - an operational oversight they can no longer ignore.

Dean Brown, administrator of Alabama Orthopaedic Clinic, is well aware that patients have options. Those who meet with an unfriendly front-desk clerk or are left to languish in the exam room can simply take their business to the other orthopedic group down the road. "Our patients really have two similar choices in this market and both have quality physicians," says Brown. "So about eight years ago, we got all our managers together for a strategic planning retreat and decided that customer service would be our distinguishing factor. In a competitive environment, service becomes that much more important."

Quite right, says Jim Saxton, chairman of the healthcare litigation group for Stevens & Lee law firm in Lancaster, Pa., and author of "Five-Star Customer Service: A Step-by Step Guide for Physician Practices." Patients who are treated with kindness and respect are more loyal to your practice. They are also more likely to refer their friends, which helps sustain growth. But the biggest benefit of delivering a positive patient experience, perhaps, is the legal buffer it provides. "We've long known that the single biggest driver of malpractice lawsuits is the lack of a relationship between the patient and provider, and that is directly related to customer service," says Saxton. "I've often told practices that it's really your best protection against lawsuits."

Despite the clear benefits, however, medical practices have been slow to embrace the "customer comes first" mentality that defines corporate America - an operational oversight they can no longer ignore. "Service excellence for physician practices is going to drive economics more and more," says Saxton. "With transparency upon us, patients can actually see the various customer service ratings that physicians get online and it can drive the market to them or away from them." Equally important, he says, many new pay-for-performance models from private payers are increasingly tied to patient satisfaction scores.

Thus, the onus falls on practice managers to develop concrete policies and training programs that create a culture of service excellence. Here's how to bring everyone in your office (including the doctors) up to speed with a smile.

Use a yard stick

For starters, of course, you'll need to find out how you're perceived by patients. Patient satisfaction surveys yield valuable insight as to what you're doing well - and where you need improvement. Though sophisticated survey tools are available for a fee, Saxton says you can glean most of what you need to know from a shorter document developed in-house. "You need to measure where you are, but it can be as simple as asking patients to fill out a one-pager at check out," he says.

Brown's staff, which created their own patient and employee satisfaction surveys, makes them available online and in their clinic, including their physical therapy offices and surgical waiting room - prompting patients to fill them out by offering monthly drawings for a $50 gift card. "We weren't getting a good mix of responses previously because it was just the people who were angry that bothered to fill them out," he notes. As a result of the survey responses, his practice created a second parking lot for overflow parking and made its patient registration process faster by mailing or e-mailing forms to patients before their appointment times. "Our wait times have gone from an hour to 20 minutes," said Brown.

Train, train, train

Next, it's time to train your staff. For his part, Brown asks all employees to view an in-house customer service training video called, "It's a Dog's World," which takes a comical look at healthcare interactions from the patient's point of view.

Marcy Wasiluk, front office manager for Gastroenterology Specialists of Oregon in Oregon City, meanwhile, favors the book "Hardwiring Excellence" by Quint Studer, which helps healthcare professionals "rekindle the flame" and develop a culture of customer service. Such training, she says, reinforces the practice policy of always "managing up." "That means that we try to put that next staff member, whether it's someone in our billing office or one of our providers, in a positive light to our patients so we're already relieving them of any stresses they may have about their appointment," says Wasiluk. For example, share something important about an employee's position, or what the provider or employee does particularly well. "I might say, 'This provider has been with us for 15 years and he has excellent patient care,' or 'May I have you step down and Debbie will assist you with your check out. She's excellent with scheduling," says Wasiluk. Such comments have the dual benefit of fostering positive morale among your staff as well.

To reinforce the message of service excellence, Wasiluk also likes to "throw her staff a curve ball" now and then that inspires and motivates. "I gave them each $5 one morning and told them their homework assignment was to go out and find a business in our community that they felt has a significant impact on our community and to try and figure out why they have such success," she says. Some went to Starbucks, others to McDonald's or Jamba Juice. "Part of the assignment was for them to observe how their business was run and what customer service nuggets of wisdom they could walk away with that we could apply in our own business," she says. "What they wrote down and observed was awesome."

Another practice that Saxton worked with distributes stickers for its staff to wear daily that read simply: "The First 10." "It's a low cost way to remind them how important those first 10 seconds are with a patient," he says. "First impressions make a big difference."


You'll get better buy-in from your staff, of course, if you reward for a job well done. Brown uses a quarterly bonus. "One of the core components of that bonus is patient satisfaction and that is derived directly from the survey score," he says. "All of the employees are aware that they're being measured on how well the patients are taken care of and how happy the patients are. That can be powerful."

Rewards, however, need not be monetary. Brown also makes an effort to acknowledge positive feedback about employees in front of their peers. "When people make positive comments about an employee, I personally summarize the response, highlight it, and write a nice note to them and take it around and thank them for doing a great job," says Brown. "It's positive reinforcement."

Wasiluk says her office holds a drawing each month on a Monday evening (the hardest day of the week) with names of everyone on staff who exhibited excellent customer service or received kudos from the staff or patients. "We put their name in the bucket and if it's drawn, they might get a gift card for lunch or tickets to the movies or a gift basket," she says.

Consistency is key

According to Saxton, customer service culture all begins with leadership. "It's got to start from the top with leadership making a conscious decision that they're going to make this part of the employee evaluation, get their staff trained, and integrate it into their practice," he says.

At the same time, he notes, the success of any training tools you employ hinges on your ability to be both "consistent and pervasive." "Consistently means not just when you feel up to it, but that you can turn it on even during your most demanding stressful times, and pervasively means it's not just the doctor or the receptionist but every single person on your staff," says Saxton.

It's worked out well for Alabama Orthopaedic Clinic, which has grown its business in seven of the past eight years - revenue was temporarily flat during one of those years due to the economic downturn. "We're one of the only surgical orthopedic groups that get more referrals from former patients than we do from physicians," boasts Brown. "For us, it's all about word of mouth."

Shelly K. Schwartz, a freelance writer in Maplewood, N.J., has covered personal finance, technology, and healthcare for more than 17 years. Her work has appeared on CNNMoney.com, Bankrate.com, and Health Family magazine. She can be reached via editor@physicianspractice.com.

This article originally appeared in the March 2011 issue of Physicians Practice.

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