Office Procedures Can Enhance Patient Satisfaction, Reduce Risk

Here are ways you can enhance your patients’ experience with your office.

Patient-oriented office protocols can enhance patient satisfaction and decrease liability risk. Dissatisfied patients are more likely to file a claim if they suffer a negative outcome. Satisfied patients who feel that you and your staff showed compassion and did the best you could, are less likely to file a claim. Following are ways you can enhance your patients’ experience with your office.

Improving Patients’ Telephone Interactions

Telephone calls may be your patients’ primary contact with your office. You can make their interactions positive by implementing some of the following patient-oriented protocols.

1. An overly complex phone system can frustrate patients, so find ways to simplify the options. Since patients are your most frequent callers, put their option early in the phone tree. If your phone system has layered options, try to avoid more than two layers. After the second layer, patients should get through to either a live person or a voice mail where they can leave a message.

2. If a large number of calls are medication refill requests, consider using a separate phone number for those calls. This will free up staff to handle calls from patients who need appointments or information about a health issue. The outgoing message on a refill line might tell patients what information they should leave. The recording might also tell patients how quickly they can expect a refill to be called in to their pharmacy.

3. Train staff to ask callers for permission before placing a call on hold. The caller may have an emergency that needs immediate attention. Establish a maximum two minute hold time for phone calls. If staff needs more time before helping a caller, they should take a message.

4. Establish guidelines for telephone staff defining the types of questions they are authorized to answer and the types of questions that should be passed on to a nurse, physician or other staff member.

5. If your office routinely receives phone calls from patients or caregivers that are urgent but not emergent, you may want to develop protocols for determining whether patients need to be sent to an emergency room or need to be seen in the office. Train staff to gather information and quickly pass it on to you or a designated medical professional. Office protocols should be designed to ensure that non-medical personnel are not giving medical advice.

6. When a patient asks to speak with a physician, nurse or other medical practitioner, staff should take a message and provide the patient a timeframe for receiving a return call.

7. If you receive a lot of potentially urgent calls from patients, you may want to consider having a nurse available during office hours to take these calls. This can reduce the number of calls you need to return. If you do employ a full-time nurse to handle patient calls, consider using a third-party triage system, which includes clinical decision support tools to guide medical staff in determining the needs of patients who call the office.

8. Let patients know how they will be informed of abnormal test results; by phone or via follow-up appointment. Keep in mind that waiting for test results can be excruciating, so try to call patients or see them in the office as soon as possible. Calling a patient to schedule an appointment to pass on test results is almost the same as telling them the outcome of the test was not good. If you anticipate that a test might have a bad result, schedule the follow up appointment at the same time you order the test.

9. Establish a procedure to ensure that all telephone calls addressing patient care are documented in the patient’s record. This includes after-hours calls related to medical advice, post procedure care or medication changes.

Convenient Appointment Scheduling

Your patients’ satisfaction is influenced in large part by how easy it is to see you, how long you spend with them and whether they have to sit in the waiting room for a long time prior to their appointment. Following are some ways you can enhance patient satisfaction in this area.

1. Arrange your schedule so that you have a realistic amount of time to spend with each patient.

2. Allow extra time for initial appointments with new patients. For patients with complex health issues, it may take more than one visit to fully address each issue.

3. Create a few longer time slots each week for established patients who have complex health issues. Maintain a list of patients who are permitted to schedule longer appointments.

4. Leave one or two time slots in your schedule each day for same day appointments. You may want to leave a few additional slots open on Mondays. If these appointments are not filled, you can use the time to return phone calls.

5. Consider establishing flexible office hours to accommodate patients’ work schedules. For example, you could start at 7 am or see patients until 6 pm one day a week.

6. When patients consistently have to wait more than 30 minutes for a scheduled appointment, it sends the message that you do not value their time. You may need to evaluate your scheduling to determine the reason for the long waits.

7. If some patients routinely exceed their allotted appointment time and you have difficulty cutting them off, ask the medical assistant to remind the patient in advance that you can only address their top two concerns. Another strategy is to have a staff member knock on the door when an appointment is running more than 10 minutes over the scheduled time.

8. When a long wait is unavoidable, patients should be given a general explanation of the reason and an opportunity to reschedule an appointment. Specialists such as OB/GYNs—who are frequently called away from the office—may want to have staff call patients if it becomes clear that their appointment will be more than a half hour later than scheduled.

9. Flag patients who are considered high-risk and send them reminders to schedule an appointment every 6 months or as you think appropriate. This lets patients know that you care about their health.

10. Telephone or email reminders of appointments can reduce the number of appointments missed due to simple forgetfulness.

Managing Patient Email

As more young adults begin to manage their own health, these patients will expect to be able to communicate with their doctors via email. Be aware that email sent via most consumer email systems are not HIPAA compliant. If your EHR or patient portal does not have built in email capabilities, you will need to find an email application that provides encrypted email and has an app for patients. Also, be sure there is a method for incorporating emails into each patient’s medical record. Following are tips for handling patient email.

1. Create a patient handout that explains your email protocols. Explain why patients cannot use their personal email to communicate with you and tell them how to create a login or download an app to use your secure email system. The handout might indicate the types of communication patients can send via email as well as the issues that patients should not communicate via email. Let patients know how quickly they can expect a response to a question or concern sent via email.

2. Allow patients to choose whether they prefer to receive appointment reminders and (negative) test results via a phone call or an email.

3. Try not to respond to patient email in a rush. Take the time to consider your response and how it might be received by your patient. If your patient expresses concern about a particular symptom, do your best to offer empathy even if you think the symptom does not warrant further evaluation.

4. When emailing a patient about a medication change, be sure to proofread the email to be sure you didn’t mistype a number.

5. If you receive a large number of patient emails, consider assigning a staff member to screen them. Establish protocols for how staff should handle email. For example, the screener could prepare medication refill orders so that they only need your review and authorization. When patients request refills on controlled substances, your screener could check the EHR and provide a note indicating when the medication was last refilled. Patient questions about chronic conditions or whether they need to be seen for a particular issue could be triaged by a nurse who has clear guidelines about the types of messages that require your review.

See Your Patient’s Point of View

By taking the time to consider how your patients see your office, you can sometimes find small ways to improve their experience. Following are a few tips that can make your patients feel welcome and cared for.

1. Consider conducting periodic assessments of your patients’ experience with your office. You could do this by asking individuals who are unknown to your staff call your office or walk in to your waiting room. Alternatively, you could survey your patients to find out how you are doing. If there are areas where your office needs improvement, it is best to hear about these in a survey rather than in a negative online review. You can download several types of surveys at: http://www.ahrq.gov/cahps/Surveys-Guidance/index.html

2. If you are accepting new patients, develop a welcome packet summarizing your office policies and procedures. You might also introduce key personnel in the kit.

3. Many EHRs allow you to print a summary of each patient visit, and you may want to routinely provide this summary to patients. Let the patient know what the summary includes; for example, information about a new medication, how to manage a medical condition that was discussed, or what tests you have ordered and how the patient can complete the tests.

4. If you give patients any forms to complete, be sure they look fresh and are not a photocopy of a photocopy. There is no reason to provide patients forms that look as if they haven’t been updated since the pre-computer era. If your new patient packet includes a medical conditions checklist, be sure it is routinely updated with the latest medical terminology.

5. Patient health apps are increasingly popular, and your patients may benefit from an app to help manage their medications. Ask a technology savvy staff member to find one or two medication management apps that you can recommend to patients. If many of your patients are over 65, ask a few less computer literate patients to test the apps prior to recommending them.

6. If you are part of a large practice that has a website, you may want to consider posting a monthly blog. The blogger could rotate among staff members and physicians. Each blog might address something important you want to communicate to patients such as how they can expedite medication refills by providing all the necessary information. You might also address basic health tips that are appropriate for the majority of your patients. Use caution in providing general health advice that may not apply to some patients.

When your patients are satisfied with their care, they are more likely to comply with your treatment recommendations and take active steps to manage their health. This increases the likelihood for improvement in their health and decreases the potential for legal action in the event of a negative outcome.

Sources

Eaton, P. Managing Messages. Fam Pract Manag. 2012 Sep-Oct;19(5):25-29. http://www.aafp.org/fpm/2012/0900/p25.html

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