Exceeding Patient Expectations

Originally published on Pain Medicine News

Dear Arizona Pain Specialists,

I am a physician-owner of a pain practice in Mississippi, and have begun to hear complaints from several patients about my practice. These complaints primarily center around the staff on the phones being in a hurry, rude and generally unhelpful. None of these complaints are directed at the medical care that we deliver, but I find myself struggling daily to address these needs. What is the missing piece that is preventing my practice from satisfying my patient’s needs?

Sincerely,

Dr. Tele-path

Dear Dr. Tele-path,

A common misconception in medicine is that a patient’s experience, positive or negative, is defined by his or her experience with a medical provider. In reality, what happens before or after the patient visit is just as important as what occurs in the exam room. A great example of this is how your staff interacts with and treats patients on phone calls.

Providing excellent patient care involves making excellent clinical decisions and supporting patients’ needs in and outside of the office. Understanding C.A.R.E. and how it can be applied to your practice will improve the patients’ perception of your practice and of the medical community.

So what is C.A.R.E.?

C.A.R.E. stands for: Showing Compassion for patients, Acknowledging their individual needs, setting Reasonable expectations and providing Excellent customer service. C.A.R.E. is about understanding your patient, whether this interaction is in the exam room or over the phone. It is important to recognize that your phone staff’s contribution to patient care is no less important than the care they receive from medical staff in the exam room, and may dictate the success or failure of their treatment.

Compassion in Action

Compassion is an important attribute for all practitioners of medicine to have, and it is a virtue found throughout the most successful pain management practices. Compassion in pain management starts with understanding that patients often are experiencing severe and debilitating pain along with psychological comorbidities. As a result, pain patients already may be upset or irritable when they interact with your office staff. It is important that every staff member is sympathetic to patients’ pain and makes an effort to work with them so they can receive excellent patient care.

Let’s take this common example. The patient Mary Smith contacts your practice regarding what she describes as “horrible pain,” and demands to be seen immediately. Ideally, Mary Smith would be accommodated, yet in this example there are no available appointments for at least two days. Without a quick option for solving this problem, the response often is simply to tell the patient, “Sorry, there are no appointments and you will have to be seen later this week.” This reaction may be appropriate, but this answer lacks compassion. So what’s another option that may be a more compassionate response?

“Ms. Smith, I’m so sorry to hear that you are in so much pain. Unfortunately, we don’t have any available appointments until the day after tomorrow, but we are putting you on our call list if we have any last-minute cancellations. Please tell me a little bit more about your pain though, and I will see if there is anything that we can do for you in the meantime.”

Notice that, in this instance, a compassionate response doesn’t necessarily mean that Mary is going to be able to get an appointment any sooner. But this response shows that you care about her pain and are validating her condition. It also lets her know that you are working on her behalf and trying to seek an earlier solution to her problem. Providing this level of service shows that the patient isn’t “just another number” with your practice—even if you aren’t always able to meet each person’s immediate demands.

Acknowledging Individual Needs

Although you can establish guidelines or script how a call should go, one of the keys to excelling in customer service is to acknowledge the unique needs of each patient. Although you can’t “know” every patient, you can become an expert at recognizing different tones of voice and allowing the patient to dictate the flow of conversation.

Most patients can be divided into three categories. The first type, the “easy patient,” is going to rely on you to dictate the flow of the conversation. They typically will not ask a lot of questions and will allow you to walk them through the process. Handling this type of patient should be easy—you simply follow all of the normal steps to schedule an appointment and offer them any necessary information. Review important information with this type of patient even if you believe that they already know it, as they probably will not inquire.

The second type, the “busy patient,” wants his or her needs met quickly and is looking for quick and concise answers to questions. They are identified by an impatient tone in their voice, a tendency to talk over you and talk fast. The best thing that you can do for these patients is to rapidly identify their needs, address them, confirm that you have fully assisted them and allow them to proceed with their day. The last thing that you want to do is to keep them on the phone longer than they want to be.

The final type of patient, the “inquisitive patient,” is looking for either extensive information or somebody to talk to. Although these patients do not come along frequently, it remains important that you address their needs. Some of them are looking for a lot of information and are likely to ask many questions. This can be frustrating, but conveying information is important and they should not be faulted for being detail-oriented. Information relayed to any patient should be accurate, and it is especially important with these patients, as they may be taking notes and would remember your name if you say anything incorrect. Other patients are simply looking for somebody to talk to about unrelated matters. You should listen and participate in this conversation, but only up to a point. It is your responsibility to tactfully guide the conversation to a conclusion to avoid potentially jeopardizing other patients’ care by assisting just one person. For example, patient John Stevens, a 78-year-old widower, regularly contacts your practice to “confirm appointments” and to discuss his care plan, but routinely steers the conversation to stories about his life. It is important that you do not simply disregard Mr. Stevens, but also that you steer the conversation to a conclusion. For example: “That sounds very interesting, Mr. Stevens. You have lived a very interesting life. It’s unfortunate that we don’t have more time to discuss that in depth, but is there anything else that I can help you with?”

You are acknowledging that you are interested in his life, but are also reminding him that you are there to assist him and other patients with very specific purposes.

No person or practice will always successfully address every patient’s specific needs, but taking steps to recognize and accommodate individual needs will result in a higher level of satisfaction and, ultimately, more kept appointments.

Don’t Set the Bar Too High

Many medical practices set expectations that turn out to be unrealistic. For example, you might state that your practice “always schedules patients within one week.” If this is going to be one of your selling points, you must ensure that patients actually receive scheduling within one week. Such a statement becomes a requirement both for patients and referring providers. Failing to meet this standard may lead to dissatisfied patients and fewer referrals.

Therefore, do proper research and avoid setting unrealistic goals. You could have employees gauge and report back on the average time patients must wait for an appointment. You should only make the claim that patients are able to get an appointment within one week after verifying that this is indeed possible.

Even when you set realistic expectations, sometimes they will not be met. When this happens, it is important to identify the reason for the discrepancy. If the cause is something temporary, such as a physician being ill or on vacation, carefully explain this to the patient. If the cause is something more long-term—for instance, patient growth outpacing your ability to accommodate patients—the solution may be to temporarily revise expectations. Either way, communication with patients and referring offices is critical.

Making Excellence the Standard

Meeting patients’ expectations for care is important, but exceeding patient and industry expectations can give your practice an advantage. It helps to recognize existing trends in pain management and go beyond the standard. For example, pain management offices generally take patient calls between 8 a.m. and 5 p.m. daily. Although this standard meets most patients’ needs, keeping phones open from 7 a.m. to 7 p.m. provides a service that may accommodate patients whose work hours prevent them from reaching your practice. Finding such niches will set you apart and drive patient satisfaction and referrals.

Despite efforts to provide excellent customer service, mistakes will occur. Recovering from a mistake provides an opportunity for demonstrating excellent customer service. An example of this might be the following: Patient Emily Stone is ordered to receive an interventional pain procedure to treat her chronic low back pain. Ms. Stone is told this in her office visit and that she will be receiving a call to schedule after her insurance has been consulted and she is authorized to proceed. Three weeks pass, and Ms. Stone contacts the office inquiring about her procedure and complaining that she has not heard from the office. After looking into the patient’s chart, it is determined that the information was not properly communicated after her office visit and nothing has been done. Ms. Stone is likely to be upset and steps must be taken to rectify the situation.

Explain the situation to the patient, but also make sure to follow this information with a solution: “Ms. Stone, in reviewing your chart it appears as though we failed to follow through with communicating your procedure order to your insurance for authorization. Now that this has been recognized, we have alerted our authorizations staff and they are going to begin working on this immediately. We will do our best to make certain that this is expedited as much as it can be and will follow up with you regularly during the process.”

Honesty will go a long way with patients, especially if you follow it with a solution that shows that you are going to work to swiftly resolve errors. The person identifying this error should work quickly to communicate the situation to management so that the patient’s needs are met, and hopefully the error is not repeated. If the situation is quickly resolved and the patient is taken care of, he or she will be more likely to view the mistake as a rare occurrence and see the response to the situation as excellent customer service.

Keys to Implementation and Training

Providing adequate training and support for those members of the staff actively implementing the C.A.R.E model is critical to the success of this program. It is important to select staff with strong communication skills for roles involving direct interaction with patients. People filling these roles should complete role-play sessions in order to gauge their response to common situations prior to receiving additional training. A strong candidate should already possess the ability to come up with creative solutions to situations that may occur.

Team members should become well versed in the company’s expectations for dealing with patients. Throughout the training process, you should be clear that individuals will be held accountable for maintaining these expectations.

For areas that are measurable, begin to track and measure performance. Establish guidelines to reward those who promote excellent customer service by exceeding your expectations and consequences for those not meeting their goals. This will drive them to go above and beyond when dealing with all your patients.

Finally, you must be prepared to follow through with monitoring and enforcing those rules and guidelines. This means monitoring calls and interactions with patients to ensure that the messages relayed by staff are consistent with the standards and values of your practice.

Providing proper resources to your team members and following the basics outlined in the C.A.R.E. model will improve patient care outside the exam room, and should return the patient focus in the exam room to treating pain effectively.


Drs. McJunkin and Lynch founded Arizona Pain Specialists, a comprehensive pain management practice with three locations, seven pain physicians, 10 mid-level providers, three chiropractors, on-site research and behavioral therapy. They teach nationally and are consultants for St. Jude Medical and Stryker Interventional Spine. Through their partner company, Boost Medical, they provide practice management and consulting services to other pain doctors throughout the country. For more information, visit ArizonaPain.com and BoostMedical.com.