Patient Care & Customer Service: How Does Your Practice Stack Up?

It is common knowledge that many malpractice cases originate for reasons other than poor patient care or bad outcomes. Disputes over bills, rude staff members, poor bedside manner and other situations are occasionally found to be the true reasons for the initiation of some suits. Study of these non-clinical situations shows they can all be placed in a common category: They are customer service issues.

Customer service is a concept that is often foreign to traditional health care. Traditionally, health care has not been concerned with customer service. After all, the people who enter for care are not customers; they are patients. We are providing health care; we are not selling tires, clothing, furniture, computers, hair care, plumbing, etc. We are here to help, but we decide what the patients need and will receive.

This attitude has prevailed for decades or longer in medicine. It also can be found in chiropractic, but to a lesser degree. Chiropractic has a better overall track record with customer service than medicine. Good customer service has been an essential part of chiropractic's survival strategy. (Dr. Jim Parker's "Lather, Love, Lavishly" is an example.) Many chiropractic practices have been built on customer service alone.

Nonetheless, while chiropractic exceeds medicine in the customer service aspects of providing health care, there are always areas for improvement. Here are a few observations related to chiropractic customer service needs.

Embrace the Power of Nice

Being nice is important in preventing patient dissatisfaction and malpractice litigation, but there is more to it than that. Common sense tells us that in all cases and in all aspects of life, being nice is simply the right thing to do.

Many large corporations (Apple, for example) hire personnel based on personality. Their premise is they want the best personalities and will then teach the people they hire what they want them to know technically for performing their jobs.

This is also a good idea for a health care practice wanting to increase customer service and patient satisfaction. Hire people with knockout personalities and train them. There are multiple programs in the profession that provide chiropractic assistant training to help enact this method of hiring personnel.

Don't Make Them Wait

For decades, waiting time has been the No. 1 complaint patients have had about health care providers and facilities. This is usually based on time spent in the reception area, but it also applies to time spent in exam rooms, waiting for test results and waiting for calls to be returned.

Since chiropractic care is usually a process and not a single event, excess waiting time can spell disaster for a practice. Routine care quickly becomes burdensome if there is a significant wait during each visit or in other situations. Prolonged waiting times can cause patients to discontinue care early in their treatment plans. Office and clinical procedures must be streamlined to avoid excess waiting time and to prevent patient dropout.

Perfect Your Phone Etiquette

The majority of telephone calls in a practice are incoming calls. This makes the number of rings the caller hears before the phone is answered, the amount of time spent on hold, the number of people the caller speaks to, as well as voicemail and answering services, extremely important.

Rings: All efforts should be made to answer the phone between the second and third rings. The trick here is to check the phone system to determine if the number of rings heard by the caller and the number of rings heard by the person answering are the same. Discrepancies can and do occur.

To test this, someone from the office should call the office from a place where they can hear the rings on the line and the rings from the office phone at the same time. Counting both will determine the presence or absence of delayed rings. If there is a discrepancy, the phone must be answered based on the number of rings heard by the patient on the line. If the patient is hearing two rings by the time the phone in the office has rung once, the phone should be answered between the first and second rings if possible.

On Hold: Avoid placing patients on hold at all costs. If it is not avoidable, the time on hold should be limited or the patient's name and number should be taken and a returned call scheduled.

If the person answering the call cannot assist the caller, the call could be transferred to or placed on hold for the appropriate person. The person transferring the call or placing it on hold should note the caller's name and phone number prior to the transfer or hold. If the other party does not pick up the call or the call is dropped, the information necessary for returning the call is available.

Busy signals tend to annoy patients. Most callers can accept an occasional busy signal, but frequent busy signals quickly become annoying. If office phone lines are always busy, it is an indication additional phone lines may be needed for the practice.

Voicemail: Office voicemail announcements should be clear and understandable for callers. Provider names, phone and fax numbers, hours and other details should be well-articulated.

Voicemail should be checked frequently and calls returned promptly. If a call cannot be returned promptly because information necessary to answer the patient's questions is unavailable, a call should be placed to explain the delay. The patient should not be left to wonder.

Answering Service: If the practice uses an answering service, the service should be well-vetted to determine if the employees are courteous and detail oriented. Their treatment of patients, and ability to convey accurate and timely messages, are crucial. It is a good idea to ask patients who have left messages via an answering service about the service they received. A practice should never tolerate rude or inattentive quality from an answering service. It goes almost without mentioning that these characteristics should not be tolerated from practice personnel, either.

Return Calls: Of the breakdowns in procedures related to incoming calls and patient dissatisfaction, failure to return calls in a timely manner seems to be the breakdown that annoys patients to the greatest degree.

When the patient experiences excessive ringing, busy signals or being placed on hold, they are not able to ask their question or express their concern(s). In a return phone call situation, however, the patient has asked the question or expressed their concern(s). If the phone call isn't returned promptly, the patient feels they are being ignored and the poor customer service becomes more personal for the patient.

Mum's the Word

HIPAA is a part of everyday life in health care. We are all well-versed in the appropriate release of information through written records, electronic records and phone calls. However, patient privacy can be violated in other ways.

An example is discussing patients with other practice personnel where the patient or others can hear. This should never happen. Practice personnel should never have conversations regarding patients or their health care information in public areas or areas that are not soundproof enough to prevent the conversations from being heard.

This situation can be made worse if practice personnel discuss other factors related to the patient. Remarks about the patient as a person, including hygiene, dress, personality, financial situation or any other personal topic, should never be made. Comments of this nature are often more difficult for the patient to forgive than comments that divulge protected health care information.

A Little Respect Goes a Long Way

Always address patients using their appropriate titles: Mr., Mrs., Ms., Dr., Rev., etc. This is the respectful thing to do, and should be done during the initial encounter and continue unless directed by the patient to do otherwise.

It is rude for practice personnel to immediately employ the use of a patient's first name. For example, Martha Jones should be called Mrs. Jones until she instructs everyone to call her Martha or by another name. The same holds true for patients who have earned or have been awarded academic or religious titles. They should be referred to by the title unless they request to be addressed differently.

It's All About the Patient

Patients enter your office seeking help for their problems and situations. They are not in the office for doctor and staff's sake. Everyone should be empathetic to the patient's needs and wants, and avoid placing additional burdens on them. This means practice personnel should avoid discussing personal and practice situations with patients. Patients are paying their health care providers to listen to their problems; they are not paying to listen to the providers' problems. It is all about the patient.

Health care is so technical today that it confuses many patients. Patients do not understand much of what is happening to them or what is going to happen to them. This is unfortunate, as people often begin to fear things they do not understand.

To avoid the confusion and calm fears, you must convey the thought processes behind current and possible procedures for the patient. Patients don't need to understand the thought processes and procedures completely – they just need to know there is reasoning behind the procedure and what to expect (pain relief, side effects, cost). No one likes surprises when it comes to their health.

Do's and Don'ts

Patients are frequently instructed to perform specific therapies and/or duties at home for the benefit of their conditions. They also may be instructed not to perform specific duties at home or work. The instructions can be written or suggested verbally.

It is always best for "Do's and Don'ts" to be provided in written form. Patients misinterpret health care instructions on a routine basis. Misinterpretations can lead to unpleasant outcomes and patient agitation.

Take the time to list all Do's and Don'ts you commonly make for at-home care and develop written instructions for each item on the list. This can increase patient compliance with home care and prevent misinterpretations of instructions that could have detrimental effects for the patient.

Everyone in your office should read this article and it should be discussed at the next staff meeting. Ask each staff member how they rate the practice's customer service. Ask everyone what is being done right and what can be improved. It will increase your patient satisfaction, reduce your liability and increase your practice's value.

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