By Jeff Brunken, President and CEO, The MGIS Companies
It’s always a learning experience when we look at claims and the story and situation behind a malpractice lawsuit. Some, of course, are straightforward. What would surprise most physicians, however, is how many lawsuits are the result of how patients felt about their physicians and their staff, regardless of the quality of care they may have received. If a patient feels a bond with the physician and the staff, that patient is less likely to decide to bring a lawsuit, regardless of outcome.
While of course physicians and staff must always focus on quality care and for ways to improve it, it’s also very important to consider the “warm and fuzzy” side of the patient experience. Be aware of those seemingly small factors that influence patients’ perceptions.
Examples to consider include the receptionist perceived as rude by a patient to a nurse who rushes a patient out of the exam room because other patients are waiting; or even the nurse or physician who takes a personal call, leaving the patient waiting. In the scope of all that happens in a medical office — the important clinical decisions made, and done correctly — the thought that minor events such as this could increase exposure are troubling. But let’s be honest, it does happen.
Poor interpersonal skills of front-office staff are often the number one complaint on patient surveys. Plus, anecdotal evidence shows us that even when a patient likes a physician, a negative outcome may entice the patient to sue if they perceived that the office staff was rude or disrespectful. Conversely, if the patient likes the physician as well as the staff, he/she will be less likely to sue.
The problem is, many physicians who have worked with office staff for years or who may have family members working in the office often don’t (or don’t want to) see the way patients are treated. The first sign of dissatisfaction might be a long-time patient who quits coming or who seems a little tense when entering the exam room.
Of course the opposite of this is also true. A properly trained and responsive staff can be your front line in recognizing potential negative patient situations. Often, it’s the busy and harried physician focused on clinical care who does not recognize a dissatisfied patient. An observant front-desk employee or a nurse can be the early warning system, recognizing when patients are upset by wait time, and may leave the office unhappy.
An important step is to find out what’s happening on the other side of the exam room door. Are patients acknowledged promptly (e.g., patient at counter kept waiting while staff is on phone), courteously and with respect? If there are problems, how does the staff respond? The best way to find out this information is through a simple survey — either e-mails to patients or a card/suggestion box at the front desk.
Another option to consider is the use of a “secret shopper.” Yes, there are firms that provide this service; however, we are also aware of medical practices who have asked friends or family (whom office staff doesn’t know) to act as patients and call in for an appointment, stop by without an appointment, etc., and gather insights into how they were treated.
Of course it is also critical that you listen to your front office staff — to the challenges and issues they face and the explanations they might have. If you are doing a survey, make sure to include questions such as, “What do you think the office staff does right?” or “Is there a staff person you want to recognize for their professionalism and attitude?”
Once you do have a better idea of what is happening, make a list of the actions and behaviors you expect office staff to exemplify. For example, all patients are to be greeted with a friendly “Hello” and “Can we help you?” upon arrival.
Now of course there are also situations where patients get upset and your office staff feels they have no power to address or help the situation. This often happens when scheduled appointments run late, and the front-office staff feels and endures the brunt of a patient’s displeasure. I’ve heard of offices that are acknowledging excessive wait times by offering free movie tickets, coupons, etc. The point is: Empower staff through information and protocols so they know how to handle situations when they do get tough, but also demand they have the highest level of professionalism in all situations.
Finally, remember that ultimately, the atmosphere and tone of the office is set by you and your colleagues. You set the standard. If you are friendly, show patience when situations are stressful, and strive to be courteous; your office staff will work harder to follow your example.