Patient satisfaction is a two-way street

Patient satisfaction is a two-way street

by Rich Daly EyeWorld Contributing Editor

Many of today's ophthalmologists want patients to perceive their practice as "premium." What is a premium practice? The surgeon and patient may view this differently. The surgeon may feel offering the latest technology and perhaps having a nice office surrounding embraces the concept of a "premium practice." Patients may have an entirely different idea. To a patient, a premium practice might mean being seen on time for a scheduled appointment. It might mean the staff and physicians are completely in tune with each other, with uncanny communication. More than likely, expectations for visual outcomes are going to be high, perhaps too high. The art of medicine is to provide the customer service a patient expects, diagnose and treat each clinical issue correctly, and take the time to answer all of the patients' questions. It's equally important to provide all of the information necessary for patients to make informed decisions and to ground expectations and goals of patients without sacrificing their satisfaction. The goal of every practitioner I know is to achieve 100% patient satisfaction with every interaction. This goal may be unreachable. Patient satisfaction is a very difficult thing to manage. Patients can be upset, angry, disappointed, or dissatisfied for a variety of reasons; some of them may be justified, some may not be. It's our job to manage all of it. Customer service and patient satisfaction are an integral part of a premium practice. In this month's Refractive corner of the world, I'm pleased to have Jason Stahl, Richard Hoffman, Jane Shuman, and Kevin Burns contribute their experiences and ideas for managing patient satisfaction.

Kerry Solomon, M.D., refractive editor





Sometimes the most important action to keep patients happy is listening
Ophthalmic surgeons go to great lengths to keep patients happy, with meals, gifts, and even chauffeured rides. But sometimes the most effective gift is listening.

Whether using patient surveys, giving patients a chance to ask the surgeon questions, or training staff to listen for patient concerns, sometimes the most effective customer service step a practice can take is to ensure the patient's perspective is constantly sought. "Be attentive, feel the moment, and always listen and be empathic to the needs of the patient," said Kevin Burns, founder, The Burns Institute, a medical subspecialty management consultancy based in Dallas.

It is the step of listening that surgeons and their staff can easily forget even when going to great lengths to anticipate their patients' needs, according to patient satisfaction experts.

For example, Jason Stahl, M.D., assistant clinical professor of ophthalmology, Kansas University Medical Center, Kansas City, noted that his practice has paid for meals, given gift cards, put patients up in hotels, and offered chauffer service at times to keep patients happy. But for most patients it is the regular flow of information from them back to the practice that is the key to patient satisfaction efforts.

Like many practices, Durrie Vision employs patient surveys to learn where they need to improve. Those survey responses are shared with all of Durrie's employees, and incentives are offered to encourage improved results in subsequent surveys.

Similarly, Drs. Fine, Packer, Hoffman, and Sims, Eugene, Ore., gives out questionnaires to about 50 patients every year and asks them to fill the questionnaire out anonymously.

"It is amazing sometimes to see where a practice is deficient in regard to satisfying patients," Richard Hoffman, M.D., clinical associate professor of ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland, said about the effectiveness of that approach. "The questionnaire is extremely helpful because most patients will not complain to you face to face."

The surveys are a tool encouraged by patient satisfaction advisors like Mr. Burns, who said the results of regular service excellence surveys should be reviewed by the entire practice and used as a training tool. "At the end of the day, it doesn't matter if a healthcare professional 'thinks' he provided excellent service. The judgment is made by the patient," Mr. Burns said.

Another key to patient satisfaction, according to Jane Shuman, president, Eyetechs Inc., Boston, is to encourage questions from patients for every practice employee—from the receptionist to the surgeon.

"One of the most overlooked patient satisfaction steps is the doctor leaving the exam room when the patient still has questions," she said.

Dr. Hoffman said he discovered from his practice's patient questionnaires that patients thought he was not spending enough time with them or answering all of their questions.

"Now I try to spend a little extra time with each patient, and I try to remember at the end of the visit to ask them if they have any other questions that I haven't answered," Dr. Hoffman said. "Most unhappy patients won't let you know in the exam room, they just won't come back and will tell their friends about their bad experience."

Of course, practices can anticipate many patient questions and try to answer them before they are asked with pre-op and post-op handouts that cover the most common questions and concerns, such as those used by Durrie Vision. Another step to prevent patients from having to voice complaints is by setting realistic expectations beginning at the pre-op exam and reiterating these expectations at every visit.

Despite such steps that aim to pre-empt patient complaints, Dr. Stahl said the practice aggressively elicits more feedback from patients. For instance, their staff is trained to ask open-ended questions and to provide reassuring answers.

Of course, eliciting patient feedback is not guaranteed to produce good results. For instance, Dr. Hoffman described a 19-year-old patient of his who seemed to be seething with anger throughout her exam. When he asked the patient why she was upset she blamed the 10-minute wait in the practice's lobby.

"Older patients usually don't mind waiting, younger patients do and sometimes have very unreasonable expectations," he said. "Sometimes you have to let the unreasonable patients go."

Dr. Hoffman said he does not hesitate to use apologies when needed, but he has found a good connection with patients goes a long way to defuse anger.

"If they like you and like what you are doing for them and they respect you, they will wait for you," he said.

The response

After putting so much effort into eliciting patient feedback and keeping lines of communication open, practices need to ensure they show the information is used to improve the patients' care and their experience there. Mr. Burns urged practices to authorize front-line workers to effectively resolve many patient concerns.

"First and foremost, everyone should remember that a sincere apology will go a long way to service recovery and retain patient loyalty," he said. "Nothing frustrates patients more than being manhandled by multiple levels of the organization. Don't let a patient wait for a director, doctor, or administrator to come out from the 'back office' to say 'I'm sorry.'"

If practices provide basic customer guidelines, Mr. Burns said, most employees can become proficient at providing a cure or a perk that is equal to the problem presented by the patient. He suggested keeping a variety of gift cards on hand, offering co-pay waivers, and offering tickets to local events.

"But always, always thank them for their patience and understanding," he said.

Editors' note: Mr. Burns, Drs. Hoffman and Stahl, and Ms. Shuman have no financial interests related to this article.

Contact information
Burns: keburns217@att.net
Hoffman: rshoffman@finemd.com
Shuman: jshuman@eyetechs.com
Stahl: jstahl@durrievision.com