Imagine walking into your doctor’s office where you have a scheduled appointment. It’s your first appointment in this office and you aren’t sure what to expect. You step up to the counter labeled “Registration” and the woman behind the desk does not look up but, rather, continues typing. After what feels like an eternity, she looks up with an expressionless face and, in a bored tone, says, “Yes?” Unfortunately, this is the first impression that many individuals have during their first encounters with medical practices. Why does this happen? Because the culture has permitted it, therefore making it acceptable.
HCAHPS has been the focus of hospitals across the country for some time now. The CAHPS (Consumer Assessment of Healthcare Providers and Systems) survey provides consumers and patients with an opportunity to report on and evaluate their healthcare experiences. While HCAHPS, a CMS regulated survey, has been widely discussed and is likely the most familiar of the CAHPS surveys, it is just one of a family of surveys that includes:
- HCAHPS: Hospital CAHPS
- NHCAHPS: Nursing Home CAHPS
- CG-CAHPS: Clinician and Group (ambulatory) CAHPS
While not yet required, CG-CAHPS is already being used through various state and regional initiatives. In addition to the CMS tool, Consumer Reports has begun publishing physician reviews on over 500 adult, family, and pediatric practices in the Massachusetts area. As with HCAHPS, it is likely that those organizations that embrace this opportunity to gain feedback from their key constituencies will be ahead of the game when CG-CAHPS becomes a national mandate. Now is the time to ensure that your culture is ready for CG-CAHPS.
Culture, as they say, eats strategy for lunch. Your patients are experiencing your culture in every interaction they have with you. These are the “moments of truth” that determine whether they are satisfied, dissatisfied, or gone! Why do patients leave? For a variety of reasons:
- 3 percent move
- 5 percent develop new relationships
- 9 percent prefer a competitor
- 14 percent are dissatisfied with your products/services
- 68 percent leave due to staff or organization attitude of indifference
As you can see, 82 percent of the primary reasons for people choosing another organization has to do with their experience. Translation: you have a significant opportunity to impact these choices.
There are three main areas that impact the patient experience in ambulatory care settings:
- Access. When your patients call, is anybody there? How quickly is the phone answered? Can they get an appointment when they want one?
- Office Staff Courtesy. Your office staff give the first and last impressions that your patients have with your healthcare organization. Do staff members project care and courtesy through their communication and actions? Each individual that your patients interact with leaves a lasting impression, often long before they interact with a provider.
- Provider Communication. Your providers are obviously a key piece of the overall patient experience. Patients want their providers to demonstrate that they care, establish a relationship based on trust, demonstrate competency, and communicate effectively.
What drives culture? Leadership. Leadership can effectively create and support a culture of service excellence by focusing on 5 Ps: priorities, people, process, purpose, and passion.
Although condensed for this article, the 5 Ps provide the framework for my book, Raising the Bar on Service Excellence: The healthcare leader’s guide to putting passion into practice:
- Priorities. Leaders must be clear about the organizational priorities as documented through the strategic plan. Is the patient experience and satisfaction prominent in the strategic plan? Do leaders continually make that priority visible through rounding, discussion, and holding people accountable?
- People. Hiring practices must mirror the desired culture. Training and coaching shouldn’t be considered as an expense but as an investment in support of the desired culture. Expectations need to be clear so staff know what do (standards), how to do it (training), and have the desire to perform (attitude).
- Process. It is important for leaders to have processes in place to maintain quality, including processes for rounding, coaching, and recognition.
- Purpose. Each individual in the organization needs to clearly see how their role ties to and supports the mission, vision, and values. Managers must be adept at reinforcing a connection to the organization’s purpose on an ongoing basis.
- Passion. Leaders must demonstrate a clear and visible passion about service quality and the patient experience. They do this by being visible, by making their passion known, and by telling stories that demonstrate a commitment to excellence.
As we move deeper into the pay-for-performance arena, medical practice leaders need to re-think priorities. Culture is king. If you don’t create the culture that builds patient trust and loyalty, someone else will. Don’t let an attitude of indifference lead to the exodus of your patients.