Integrating patient satisfaction in your practice

Answers in Practice

James Zalla, MD

James Zalla, MD, discusses integrating patient satisfaction and ensuring good patient experiences at his group practice.

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Dermatology World: At Dermatology Associates of Northern Kentucky, what philosophy do you adhere to with regard to patient satisfaction?

Dr. Zalla: We treat patients as we would like to be treated. This philosophy is an expressed part of our office culture. It’s on our website and it’s a team goal a commitment shared not only by our physicians but also by our extenders and our office staff. A framed quote from Dr. William J. Mayo is prominently displayed on the wall in our reception area and says, “The best interest of the patient is the only interest to be considered.” The needs of the patients come first.

Dermatology World: How does this philosophy translate through your care?

Dr. Zalla: We try to provide reasonable access for patients when urgent problems arise, or when their primary care physicians call. We are often booked far out, but we try to accommodate those needs and try to work those patients into our already busy schedules. Patients who have acute problems whether it is painful shingles or contact dermatitis really seem to appreciate the fact that we have made an effort to get them in as soon as possible. There are often times when situations arise that might be inconvenient for a staff person or physician, but if we consider that the patients’ needs are first, it ensures that the patients’ perception of high-quality care continues. Also, our after-hours phone message lists each of our provider’s direct contact numbers. It’s not very often that we get contacted, but if there is an urgent problem we feel like they should have access to all of us.

Dermatology World: How many patients do you see each week and how do you determine the ideal number of patient visits per week?

Dr. Zalla: We have a low-volume practice. I might see 25 patients in a day, because we choose to spend more time with each patient. We like to take the time to thoroughly explain what’s happening with their skin, what to do and not do about it, and why. Patients who have a thorough understanding of what’s going on have better compliance, and are more likely to be cleared in one visit. Also, often we will do procedures during the course of that visit to save patients a return visit. We will treat and schedule a return visit for patients who may have chronic problems, with the understanding that if their problem clears up and is no longer symptomatic, it’s not necessary for them to keep that follow-up appointment provided they cancel it. I do not believe in having patients come back in just to tell me they’re well. I’d rather give that time to somebody else with more serious problems.

Dermatology World: What are some of the small things that you do to ensure patient satisfaction?

Dr. Zalla: In the reception and the exam rooms, we offer free Wi-Fi access. We have soft background music in the office and the exam rooms, and have a waterfall in our reception area. We also cater to the younger set in our office, by providing a small, insulated, sound-proof space that we call our Kids Cave with some quiet toys. It gives them the opportunity to pass the time if they’re waiting. It allows the parents to observe them, and separates them from some of the older patients who may be less comfortable with children. We also try to keep a broad array of current magazines in the reception room and patients are free to bring them into the exam room with them. If a patient finds a recipe they like, we offer to copy it for them and it will be waiting for them when they leave.

Dermatology World: How do you encourage open communication with your patients?

Dr. Zalla: I always end my office visit session with “do you have any questions?” and that gives them an opportunity to recall something else they may have forgotten to mention. Most patients appreciate this. We try to have a family member accompany patients whose comprehension is declining, so both the patient and the caregiver each receive the post-op instructions. We provide disease-related brochures to patients, including many AAD brochures, and have a link to the AAD on our website. We also have implemented a patient portal to our electronic health records for patient access.

If a patient has had an excisional procedure or Mohs surgery procedure, staff will routinely call them the next day just to be sure they’re doing well, and see if they have any questions. If there might be a need for dressing changes that they can’t handle, they know that they’re welcome to come back in that next day for a no-charge, post-op dressing change. We also call all of our patients about their pathology reports. Most patients appreciate knowing what the report shows, even if it’s a benign mole.

Dermatology World: How do you incorporate and manage patient satisfaction scoring in your practice?

Dr. Zalla: Since 2006, we have been using the Dr. Score patient satisfaction survey. It gives us information on all of our providers and staff, and measures the patient’s total experience in our office. In a couple of instances we had information from patients that we might not otherwise have found as soon. Within the first month of hiring a new receptionist, we had two patients comment that they were surprised at the rudeness of our receptionist. It gave us the information we needed to terminate that person and maintain the quality that we wanted. I like to personally hand my new patients the Dr. Score website card and invite their input. Patients seem to like the idea that we’re willing and open to solicit their impressions. Our EHR also offers the opportunity to input extra information on a sticky note about that patient some event that was important to them that they shared with us. I had a patient recently who shot a bull elk with a rifle he had made himself and field dressed it with a knife that he had made himself. We’ll remember that and he’ll enjoy telling me about that next year when he comes back for his follow-up visit.

Dermatology World: How do you encourage your staff to embody your patient satisfaction philosophy?

Dr. Zalla: We try to take care of our staff. They need to be treated with respect and have their actions affirmed. They’re an essential part of the team. From the patient’s first phone call, to checking in, to collecting medical history, to their treatment, to their checkout or contact with billing staff all of these experiences are important and we all need to be attentive to the patient’s needs. It can be as simple as being sure every time a patient gets up on our exam table that they know the head rest is adjusted for that individual patient so they’ll be comfortable. We encourage that sort of attention to patients and affirm that in our staff meetings. We meet with our front office staff and back office staff each month on an alternating basis, and then every six months we have a meeting with them all together. It’s a forum for us to get input from staff, to bring up any issues that might need attention, and any missed opportunities to meet patient needs. It encourages a real team harmony.

James Zalla, MD, opened Dermatology Associates of Northern Kentucky in Florence, Kentucky, in 1970 and practices with Drs. Mark Zalla and Susan Bushelman. Dr. Zalla is past president of the Kentucky, the Cincinnati, and the Noah Worcester Dermatological Societies and the Boone County Medical Society. He is a past member of the Board of Directors of the American Academy of Dermatology, and serves on several AAD committees.