Hurricane Irma and health care creativity

In 2017, Hurricane Irma was barreling down on South Florida, which predicted an exodus of nearly 7 million Floridians driving north to get out of harm's way. There was a likelihood that all of the northbound lanes would be packed with cars. Tesla received emergency phone calls and emails from customers concerned that the battery life of their cars with only a 220-mile range would not be sufficient to reach safety. One option was to charge customers who owned shorter-range Tesla models for more battery power to make the trip north without becoming stranded on the crowded highways. The Tesla software team quickly came up with the idea of providing additional battery power to Tesla owners in South Florida through a temporary software update to increase the battery driving range, enabling them to safely reach the north. This was a novel solution that enabled Tesla drivers to temporarily arrange to leave South Florida safely without becoming stranded in the crowded northbound lanes. The engineering and software team went to work, and within a few hours, the program was ready to immediately update the software and increase the battery life of 2000 shorter-range models to make the trip to the north. And guess what, the temporary update that extended the battery life for the car was free! This was a major public relations boost for Tesla and increased consumer confidence in buying electric vehicles.

The implication for the health care profession

Our profession needs to foster a culture in which physicians and other health care providers have the confidence to make decisions and take action that improves the efficiency and productivity for the patients we care for. This also calls for us to support these innovators when things don't go as planned. Certainly, mistakes will occur when innovators challenge the status quo. But change won't come easily if we penalize those trying to improve the care we provide. This requires leaders in the health care community to have the innovators' backs, encourage them to take risks, and reassure them that there is no penalty for trying to make the system better. We need to reward risk takers and have their backs when failures occur.

Establishing a risk-taking culture

To motivate creativity and risk-taking in health care, there must be guidelines and guardrails. There are three questions that leaders must instill in those whom they lead.

1. Will the idea or innovation hurt patients? We must go back to the advice of Hippocrates, who advised physicians to primum non nocere, or first, do no harm.
2. Will the change increase risk or liability?
3. What is the cost of implementing the idea?

These three questions will foster a culture in which physician leaders create an environment of freedom to make changes and adjustments that improve access, safety, and outcomes for our patients. Certainly, this attitude will increase creativity but is likely to decrease burnout and may even decrease the cost of care.

9 examples of innovation

1. Improve access to the physician and the practice. It is common today for patients with non-acute medical problems to be given appointments six or more months after they called the office. One suggestion is to consider the concept of “sacred time”. That means leaving a half-hour open in the schedule during the morning or afternoon office hours to accommodate add-ons, urgencies, or emergencies. The scheduler does not fill that half-hour until the office opens in the morning, when the phone is transferred from the answering service to the office phone. Do not worry about this open time slot. That half hour almost always gets filled, if not with patients, then with catching up on your medical records or returning phone calls. My practice had sacred time slots at 11:00 and 2:30.

As a result, patients who must be seen on the day they call or new patients you would like to see are not brought to the practice, which allows add-on patients to wreak havoc with your schedule or delay on-time patient appointments. The goal is that the last patient seen in the afternoon should be seen as close to their scheduled appointment time as those seen earlier in the day. If you don't have an open slot to accommodate these urgencies and emergencies, and the patient is merely told to “come on in”, and you “work them in”, then the patients who have previously scheduled appointments will be delayed, and you can be certain they will not be a raving fan.

2.Develop a reputation as an on-time physician/practice. A patient was always 30-45 minutes late for his appointment. When the receptionist asked about why he was always late, the patient said, “When I arrive at the designated time, I always wait at least 30-45 minutes. So, I thought I would do my waiting at my home or in my office!”

If the doctor is always late for patients, it sends the message that the doctor's time is more important than the patients. This is hardly the message that we want to send or the impression we want to make on our patients. The patient will often compare their appointments with their accountant, lawyer, dentist, or even their beautician or barber. Patients don't wait to see these professionals, and they don't expect to wait to see their physician.

Let me describe a scenario that is probably familiar to most physicians. Assume that a patient has the first appointment at 9:00 A.M. The patient arrives at 8:45 and is not seen by the doctor until 9:30. As a result, the patient is upset; the staff is trying to calm the patient who has been waiting for thirty minutes, and the staff is also trying to mollify the patients who are now more than 45 minutes delayed in seeing the doctor. The doctor is now anxious about the delays, and the doctor and the staff work through their lunch hour and will spend the day playing catch-up.

The result is unhappy patients, and your patient satisfaction scores will plummet. Your online reputation will hover at 2-3 stars, which is slightly below average. Your staff will be stressed, which will ultimately result in costly staff turnover. The doctor at the end of the day is exhausted and is inviting burnout into their lifestyle, which will negatively impact their health. The take-home message is that a cloud of negativity will hover over the practice.

On the other hand, if the doctor regularly arrives 10 to 15 minutes before the first patient and sees every patient on time or within 15 minutes of their designated appointment, patients will be delighted with their care. They will tell dozens of others about the positive experience with the practice, and the physician develops a reputation for respecting patients' time. This will create positive word of mouth for your practice and attract new patients. The staff will see their last patient on time and avoid costly overtime. Consequently, staff morale will increase, staff will be dedicated to enhancing the patient experience, and employee turnover will decrease. Also, it is important to understand that being on time is one aspect of your practice that you have reasonable control. The cost of being on time is negligible. The cost of being late can be incalculable.

Don't Let Patients Groan About Your Phone

Having good telephone skills helps build stronger relationships. Whether the call is incoming or outbound.

Consider applying the following suggestions for everyone calling the office.

Respond is 3 or fewer rings. Patients will hang up and call another practice if there is a long interval between the call and the time it takes to answer.

Enthusiasm - People like to do business with people they know, like, and trust, whether they are a patient or a referring physician. The amount of enthusiasm you convey over the phone adds to that. This doesn't mean sounding like you won the lottery, but it is important to convey a positive attitude over the phone.

Smile! Smile! Smile! - I used to think that it was corny when people put a mirror near their phone so they could see themselves smile while talking to a patient - until I tried it and it works! Smiling unconsciously adds to the enthusiasm of your voice. Consider placing a mirror in front of each phone so the person answering can receive immediate feedback. The caller can see the smile.

Strong Opening/Greeting - When answering the phone, does the person calling you feel that you might be an interruption by saying, “Doctors' office, please hold.” Or does the receptionist make callers feel like they are there to help, and there was no better time to call? Too often, people answer the phone as if it were an imposition. The phone greeting is the first impression and sets the tone for the interaction that follows.

Strong ending - How you end the phone conversation is even more important than how you start it. Make sure your call has closure and ends on a positive note. The last impression will linger, and you want it to be a positive one. Make every effort to mention the patient's name at the end of the conversation. Everyone likes the sound of their name—make sure you use their name.

3.Have a clean patient restroom. The cleanliness of the patient restroom reflects the quality of care and attention to detail the practice provides. Consider having a staff member check the restrooms mid-morning and mid-afternoon so they are as clean and tidy at the end of the day as they were at the start.

4.Improve patient onboarding. Have patients complete the health questionnaire, insurance information, and demographics before the appointment with the physician. This is accomplished by the scheduler or the electronic online scheduling program, informing the patient that there will be less waiting if they complete the information and either submit it electronically or print it and bring the forms to the practice. This suggestion is particularly attractive to GenX and Millennials, who are comfortable with completing information online. This also avoids patients clogging up the reception area for 20-30 minutes to complete these forms.

5.Reduce the number of forms requiring signatures from 5 to 1. Most practices require signatures on multiple forms to ensure payment, accurate information, and HIPAA compliance. With legal advice, these multiple forms can be consolidated into a single form for the patient to sign.

6.Arrange with pharmacies to deliver medications to patients at home or their offices. This option would be attractive to patients and to pharmacies. No patient wants to wait at a pharmacy to receive a prescription. For an additional fee, many patients would pay to have their prescriptions delivered.

7.Reward staff for improving productivity or decreasing overhead costs. There are a lot of fat overhead expenses. Staff, if motivated by financial rewards, will likely have ideas to reduce costs and improve efficiency in the practice.

8.For example, I had an autoclave that didn't work, and a new one cost several thousand dollars. The physician assistant brought the machine to the hospital's biomedical engineers and had a faulty sensor replaced for a few dollars. The PA and the biomedical engineer were rewarded with gift certificates to Amazon and a local restaurant of their choice.

9.Celebrate success- the best thing that happened to each staff member since the last staff meeting. Staff meetings are often boring and provide an opportunity to hear staff complaints. Instead, start the meeting by having each staff member share a success story from their personal life or the practice.

Bottom Line:

Hurricane Irma provides a metaphor for how health care organizations can encourage creativity, adaptability, and problem-solving. Health care should adopt a similar culture of innovation to provide each patient with a positive experience. Physicians, staff, and health care leaders should feel empowered and encouraged to develop new ideas that improve efficiency, patient care, access, and workplace morale. Leaders must support risk-takers, even when initiatives do not work perfectly, because meaningful progress rarely occurs without experimentation. However, innovation should still be guided by three key principles: ensuring patient safety, minimizing liability, and considering implementation costs.

Small changes can produce significant improvements in patient experience, staff morale, productivity, and decrease physician burnout. By fostering a supportive culture of creativity and calculated risk-taking, health care practices can become more efficient, patient-centered, and professionally rewarding and the doctor is able to go home for dinner!

Neil Baum, M.D., is a professor of clinical urology at Tulane University in New Orleans, Louisiana. 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.