Patient-centric office ensures excellent service
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Making 'extraordinary' your patient satisfaction goal

Physicians are in the service business.

“We serve other people. That’s really all we do. We don’t make a product, produce or manufacture anything. We’re not in the manufacturing industry. We don’t grow anything; so, we’re not in the agrarian industry. We’re a pure service industry,” said Victor J. Marks, MD, director of the department of dermatology at Geisinger Health System in Danville, Pa.

Like any service industry, health care is customer driven.

“We’ve been measuring patient satisfaction at Geisinger for 15 years, and we think it’s absolutely crucial. We use our patient satisfaction data to drive profits and personal improvement,” Dr. Marks said.

Dermatologists might want to phase out the term “customer service,” and replace it with “service excellence,” according to Charles Ellis, MD, professor and associate chair of dermatology at the University of Michigan Medical School in Ann Arbor.

“I hear from doctors they don’t like the concept of using the word customer. They don’t want to call their patients customers, because, of course, they have professional relationships with their patients,” said Dr. Ellis, who is working for the University of Michigan Health System in an effort to improve service. “By calling it service excellence,’ we don’t have to identify people by a specific title, like customers or patients.”

The department of dermatology at University of Michigan Medical School has been number one in the health system in patient satisfaction for a decade. But the benefits of being focused on providing great service go beyond patient satisfaction, according to Dr. Ellis.[pagebreak]

“We found out that this great service concept is not just for patients; it’s also for the physicians and staff. We found that our department is a much nicer place to work. We’ve retained our terrific employees for longer periods of time, and it has been easier to accomplish things,” Dr. Ellis said. “It also has reduced significantly the number of complaints that we’ve had to deal with. By reducing complaints, you can use that time for other more purposeful things.”

Service fundamentals

Dr. Marks breaks down service, or how a patient perceives his or her experience with a practice, into four categories: systems and processing, environment, amenities, and communication skills.

“We tend to think about the fifth, which is our diagnostic, clinical, technical skills,” Dr. Marks said. “Unfortunately, those are the things that patients have a lot of difficulty judging, because they don’t have the same expertise we do. So, they judge us by our systems and processes, environment, amenities, and communication skills that we exhibit.”

Systems and processing

This service area includes the processes by which patients experience their visits. How easy is it to make an appointment? How easy is the check-in process? How easy is the check-out process? How accurate and timely is the billing? What is the flow like in the office?

“Very often, patients will complain about a system that is not working. For example, they might say that it takes too long to check out,” Dr. Marks said.

People don’t like to wait, Dr. Ellis said.

“Part of providing good service is to analyze your wait times, and see if you can reduce the time that your patients are waiting,” he said.

Dr. Ellis said his department measured the times from when patients checked in to when they entered exam rooms.

“When we first measured it, it took an average 26 minutes. Now we’re down to an average of five minutes. We did this without changing the numbers of patients or workers. It took a long time, continually working on our scheduling template until we were able to reduce the time that patients had to wait,” Dr. Ellis said. “We don’t even call it a waiting room anymore; we call it a reception area.”

Environment and amenities

“We all experience the world through our senses: our sight, smell, hearing, touch and taste,” Dr. Marks said. “So, if you think about your practice, how is the patient experiencing your practice through those senses? What does the environment feel like? Smell like? Sound like? Taste like? Appear like?”

Physicians might enhance the experience for patients by having background music. A professional environment, where staff wears neatly tailored polo shirts, is an example of a small change that could enhance the office environment for patients.

These are little extras that patients aren’t expecting when they experience your practice. Do you offer up-to-date magazines in your waiting room? Fresh-cut flowers? Artwork? Refreshments? Samples?

There are certain things that are and aren’t desirable in a reception area, according to Dr. Ellis.

“For one thing, you don’t want a clock in the reception area,” he said. “Many offices have a water dispenser in the reception area. Of course, if you have a water dispenser, you want to make sure it’s full. I’d rather have no water dispenser than one that is empty.”[pagebreak]

Communication skills

Physicians, nurses, receptionists, secretaries — everyone who interacts with patients — should be skilled in and in tune to how they communicate, verbally and nonverbally, according to Dr. Marks.

“Each of us can improve our ability to communicate in a way that’s pleasing to patients,” he said.

There’s an easy way for physicians to improve communication, he said.

“I pause outside the door, before entering the exam room (to gather myself). Knock; then enter the exam room with energy and a smile ... introducing myself and shaking hands with the patient. That’s rather than rushing into an office,” Dr. Marks said. “One of the things we’ve taught our nurses: When you go to the waiting room to call a patient, don’t just stand at the door and call Mr. Jones. Rather, when you call Mr. Jones and see him standing up, walk over to him, help him, introduce yourself, shake his hand, and introduce yourself to his family. It’s a more welcoming way of greeting the patient.”

People want to be greeted warmly. They want to have their names used. They want to be listened to and cared for, according to Dr. Ellis.

“They want a warm goodbye as they leave,” he said. “These are the types of interactions that tell patients that they are really being appreciated.”

“We’ve found that one of the easiest tips is to say, when appropriate, my pleasure,’ instead of you are welcome,’” Dr. Ellis said. “You’re welcome’ is such a neutral phrase. My pleasure’ is a much warmer and much stronger statement about the importance of the patient. After you’ve said it a few dozen times, you begin to internalize it, and then continuously realize it is a pleasure to take care of patients and help people get better.”

Pinpointing patient concerns

One way dermatologists can gauge how their patients perceive their experiences with your practice, as well as whether or not the practice is improving in service excellence, is to conduct regular patient satisfaction surveys.

Ready-made surveys are available online or through companies that specialize in patient and customer satisfaction tool. Or, practices can develop their own survey questions and ask a sample set of patients. The American Academy of Dermatology offers an online survey tool to its members, which also helps dermatologists satisfy one of their MOC-D requirements (go to

According to Dr. Ellis, low-cost alternatives include having the office manager interview a few hand-picked patients about what they think of the services they’ve received. Practices might also create a card with three or four questions and hand it to patients for a few days.[pagebreak]

“You can collect those in a locked box upfront, on their way out. That’s the easiest way to do it,” Dr. Ellis said.

The staff would tabulate results after they’ve received 30 to 50 surveys and consider what changes if any should be made, before starting the process again.

Most surveys don’t ask questions about medical outcomes; rather, they are focused on the experience that the patient had and interactions during the visit, according to Dr. Ellis.

Nothing short of exemplary

The keys, according to these experts, are to monitor results, act to improve gaps, and survey patients on a regular basis.

“Here’s the most important thing: Most patients will rate you well. The real key is to use the data to achieve exemplary status. If a patient says pretty good, that’s not good enough,” Dr. Marks said. “Certainly, if you get a negative evaluation, think critically about it. Don’t just brush it off well it’s probably just a patient who is having a bad day.’ More often than not, it’s a breakdown in your system, or your process of communication, or the environment in which you provide the care.”

Use the negative and non-exemplary responses to improve, advises Dr. Marks. “If you don’t do anything about it, you’re not improving,” he said.

Whether using surveys or not, practices can successfully focus on service excellence, according to Dr. Ellis.

Derm leadership is essential

This is an opportune time for dermatologists to look at whether there are gaps in their service, Dr. Ellis said. The MOC-D program requires dermatologists to conduct periodic patient surveys. The 2010 health reform law offers physicians financial incentives to participate in programs like MOC-D. Further, the health reform law requires that patient experience information be published on the Physician Compare website in the future.

It’s important that doctors lead the commitment to service excellence, according to Dr. Marks.

“You can’t delegate this process to an office manager. I think that we, as physicians, are the leaders in our offices, and if we want our staffs to see this as an important aspect of our practices, we need to lead it. It needs to be a priority,” Dr. Marks said.

If physicians and their staffs make a commitment to service excellence, they can make substantial improvements, according to Dr. Ellis.

“It takes time. It’s often gradual. But I think if you’re focused on it and speaking about it in your staff meetings, everybody will be thinking about it from a patient-centric approach,” Dr. Ellis said. “I think you’ll see that you’ll have much higher patient satisfaction; you’ll reduce the complaints; and you’ll have a better workplace.”