American Medical


HOW TO REMOVE WEDGES BETWEEN PATIENTS, DOCTORS
Managed health care has reshaped the practice of medicine in America, bringing monumental changes in the delivery, financing and administration of care. Unfortunately, these changes in the medical marketplace have wrecked havoc with the very nature of the provider-patient relationship. Long considered an art, the practice of medicine is now big business. And it is stressing both the patients and the healers. Technology, reimbursement policies, mergers and networks all threaten to drive a wedge between the provider and his or her patient. Conversely, pressure is mounting from another source - managed care plans, which frown on patient turnover and have begun to tie financial incentives and contracts to high levels of patient satisfaction and retention. Maintaining the integrity of the patient-provider relationship is key to your practice's viability. It's time to enhance the partnership, build trust and restore faith for patients and providers. The marketplace challenge What are the top five barriers that can come between, and threaten to erode, the patient-provider relationship? Here they are, in the order that our physician clients and their patients tell us annoys them most. How many are evident in your practice?	1. Bureaucracy Seeing the doctor has gotten complicated. Patients can't get an appointment unless they have been referred, or sign a waiver agreeing to accept financial responsibility for the visit. Physicians, too, navigate a maze of paperwork before they can either see a patient, or be allowed financial reimbursement to do so. This red tape frustrates everyone - patients, providers and the staff caught between. 2. Practice size It's a fact: In today's competitive health care environment, big is better. Solo practitioners are forming new group practices. Existing medical groups are expanding. Physician practices are merging to form networks and alliances. And many times, patients feel lost, overwhelmed and disconnected from their doctor as the operational infrastructure expands. As they call one office to discuss a bill, another to schedule an appointment, and visit a third to actually see a provider, they begin to feel their primary relationship is with administrators rather than doctors. 3. Reception Imaging that you have had a long, arduous plane flight and taxi ride to an out-of town hotel. It's midnight and you stumble up to the receptionist desk and wait. The receptionist, encased behind a glass window, takes a series of phone calls while not even glancing up to acknowledge your presence. Does this sound like your office? Patients are beginning to object.	4. Accessibility Practices are flooded with phone calls from patients wishing to make appointments, refill prescription or ask questions. The result for the patient is a brick wall of busy signals, lost messages and requests to "hold." Once on-site, patients complain, things can actually get worse. They can't find the practice, can't park once they get there, can't get the receptionist to get off the phone and greet them, or have difficulty negotiating the internal maze of corridors and rooms. The complexity increased fourfold when the practice is located on a hospital campus and the patient must seek services like phlebotomy from the system. 5. Perception Patients describe going to see the doctor today as running an obstacle course - jumping through a series of hoops to finally get what they want: face time with their physician. The patient perceives that he or she has less access to busy providers - either because the visit time has been constrained by physicians who are trying to meet productivity standards, or because a managed care plan has imposed controls that limit the number of visits. The physician response Amidst marketplace pressure, the goals remain the same. Physicians must strive to maximize the time they spend with their patients and to practice medicine the way they choose. Patients must be able to see their provider and understand how to get the service they need.

But these goals must be modified, as insurance carriers now also want a say in the relationship. They are beginning to measure patient satisfaction in terms of wait time and how easy it is to access the physician.

How does a physician practice begin to address these issues in a way that can be both economically efficient and administratively feasible and, at the same time, ultimately reflects the unique culture and style of the practice? It's a formidable task.

First and foremost, concentrate on delivering patient-focused care. While this does not mean deviating from the traditional goal of providing high-quality care, it does mean taking a look at your practice to redefine the manner in which that care is delivered. All successful businesses have a defined mission and can articulate what they do and why they do it well. They mange administrative burdens in a way that supports their mission. Despite the rising administrative burden being placed on practices, patient-care businesses must learn to do the same.

Second, elevate the importance of patient communication. While it has always been an integral component of a healthy provider-patient relationship, in today's environment it is paramount to patient retention. Encourage patients to ask questions about their care. Provide patient- education materials and written instruction sheets for care and medications. Literature, including patient brochures and letters, should reinforce service expectations. Deliver the same message to providers and staff in meetings, newsletters and job descriptions. Everyone - patients, providers and staff - must understand, and be able to articulate, the patient experience.

Third, encourage everyone - physicians and staff alike - to deliver high levels of patient services. Every member of the practice should be educated to recognize and act on service opportunities, be prepared to understand and defuse anger, and be able to resolve complaints.

Until recently, health care professionals rarely thought about attracting and retaining a strong patient base. Patients were not regarded as customers.

Ways to enhance relationships

Operationally, a practice can do a number of things to enhance the provider-patient relationship.
… Map out patient flow The patient experience in the office should be calm and disruption-free. Not only does an orderly flow of patients enhance the work environment for providers and staff, it is the key to patient satisfaction Put systems and protocols in place to manage patient flow - from a standardized exam routine and room configuration, to a predetermined check-out procedure. Be consistent so patients - and staff - know what to expect.
… Reduce conflicting assignments Conflicting tasks should be minimized wherever and whenever possible. Can the receptionist focus exclusively on greeting patients and managing the waiting area? Can nurse and medical assistants support the clinical effort without other responsibilities? Are staff schedules flexible to support providers who may hold office hours in the early morning and evening, or be on-call for emergency visits that day?
… Enhance face-to-face time Monitor the actual time that the provider and patient have together and work to increase the quality of that time so the patient feels more satisfied. Eliminate all unnecessary distractions such as paperwork and phone calls, which should not be scheduled during a patient visit. Indeed, physician contact hours should be defined - and uninterrupted.
… Schedule, schedule, schedule Schedule properly so that providers and staff are not rushed, and then stick to it. Plan for emergencies. Set up standard protocols for handling emergencies, so sick patients are not "forced" into the schedule, but anticipated. Extend on-call duty to office hours, not just nights and weekends, and make sure the on-call provider has slots available to take people who must be seen quickly. Consider using nurse practitioners or physician assistants to screen patients. The challenge is to schedule for, and manage smoothly, two patient-flow tracks - routine health care, and episodic care based on patient need - so neither one derails the other.
… Reduce administrative frustration Set up systems and procedures so patients can call a special telephone number for refills, referrals or billing questions. Delegate these administrative functions to assigned staff who do not have to concentrate at the same time on patient-care responsibilities.
… Make appointments easy Minimize the time patients must wait to get an appointment and, if possible, offer same-day accessibility.
… Respect the patient's time Do not leave patients sitting in the waiting room. Set up a wait-time standard. If it is extended, offer the patient an alternative slot, or the options of seeing a different provider. Set up practice standards so staff can act without physician approval. Encourage staff and providers to talk with patients who might be angry if they have been waiting or if their needs have not been met. Respect patients' time and understand that they, too, are busy.
… Ask patients for input Put up suggestion boxes, talk to people and then, act on opportunities to change the delivery of care, hours of operation or staff support. If there are limitations that you cannot change, let your patients know that you recognize the problem. For instance, if parking is an issue, ask patients to come early and explain that it may take them some time to find a space.

But in the managed care environment of increased competition and changing health care utilization, if service is not provided with distinction, patients undoubtedly will be lost to the competition. Customer service is not only a competitive weapon, it is a survival skill, and one key to enhancing the provider-patient relationship.

-- Jayne Oliva

Jayne Oliva is a principal with The Croes Oliva Group in Burlington, Mass., a team of practice-management professionals serving physicians and health care organizations throughout New England.