Find out why patients are mad, then get them happy

Misinformed patients send your office into chaos

Dissatisfied patients may not be telling you what made them mad. But you can bet that they’re complaining to their family and friends. And they’re costing you, and their insurer, money.

Unhappy patients are less likely to follow treatment advice, which means they may have poor clinical outcomes, says David Furse, PhD, founder and chief consultant for Solution Point/NCG, an outcomes measurement and decision support company based in Nashville, TN.

They are likely to switch physicians. And they may even spread ill feelings to other patients, Furse says.

How can you stamp out those fires of discontent? Furse has developed nine guiding principles of patient satisfaction to help physician practices and hospitals identify their customer service problems — and eliminate them.

1. Anarchists are in your process. First, you need to recognize that dissatisfied patients are uncooperative ones. "They’re irritated," says Furse. "They leave. The nurse tries to give them some instructions, and they don’t get it. They don’t do what they’re supposed to do. They make it difficult for your staff to handle them."

They also may result from your own poor planning. Too often, the medical process — the mechanics of the office visit — is a failure, from the patient’s point of view.

2. Patient dissatisfaction costs you money by draining resources. "When you have dissatisfied patients, more staff time is spent tending to the anarchists," he says.

In a study of the impact of patient complaints at a community hospital, Furse and colleagues found that patients with unresolved problems told a median of four other people about their experiences. However, dissatisfied patients won’t necessarily tell you. About half did not register a complaint, although 32% of dissatisfied patients said they would not return to the hospital.1

3. Satisfaction is related to functional health status. "Basically, people who are more satisfied pay attention better and follow advice better," Furse says. "It doesn’t mean every dissatisfied patient has a poor result. But the whole [health care] relationship falls apart."

4. Patient satisfaction is more than just internal performance. When Furse measures patient satisfaction, he tries to gauge impressions of the "total process" as well as "global satisfaction." More simply put, he wants to know about the "brag, recommend, and return" rate.

"Total process" targets the specifics, such as scheduling and billing, while "global satisfaction" measures the patient’s relationship with the staff and physician.

Furse asks these questions: "How satisfied are you with Dr. Jones? Would you choose Dr. Jones again?" (Thanks to the "forgiveness factor," many dissatisfied patients will still return.)

"Would you recommend Dr. Jones to a family or friend who needed care? Was the care so good on this experience that you’ve spoken about it to two others?"

That last question represents a high standard. But Furse says, "You’ve got to create an experience that’s so good that the patient will come back, will recommend it to family and friends, and will speak of it to others."

5. Educate the patient first, then improve the process. Often, patient satisfaction problems lie not with the process in the physician practice but with poorly informed patients. For example, patients may fail to follow prescribed treatment properly because they don’t understand the instructions.

Similarly, medical office staff should inform patients about medical emergencies that may delay a physician and offer solutions, such as a rescheduled appointment, Furse says.

6. Don’t just identify and label the problem; understand the root cause. "Patients may say they’re dissatisfied with the waiting time, but you don’t know which aspect of the waiting time they’re dissatisfied with," Furse says. "So you’ll say, I never want a patient to wait more than 15 minutes or half an hour.’ But you often can’t do that. It may be out of your control."

What can you do to keep waiting patients from climbing the walls — and griping to everyone else in the waiting room? "You want to alert the patient in advance that you’re going to be backed up," he says. If the doctor is running behind because of an emergency, staff may call patients at their office or home to allow them to reschedule or to come a few minutes later.

Secondly, "give them regular feedback," says Furse. Let them know when you expect the doctor to be available and how much longer they can expect to wait.

7. Most solutions are local, not global. An overall rating from your patient satisfaction survey may tell you that patients are upset about waiting times. But which patients are upset? Those who come on Mondays? Or only Dr. Smith’s patients? Or those with appointments at the end of the day?

You may need to conduct focus groups or surveys targeted toward that problem area to get more information. The details will help you define the "root cause" of your problem, and thus your solutions.

"You can find waiting time with two different physicians may have different reasons and you solve them in different ways," says Furse.

8. It’s possible to improve satisfaction dramatically without increasing costs. Gearing your existing staff to be more sensitive to patients’ concerns doesn’t have to cost you a cent. You just need to recognize the information and assistance that patients want, says Furse. "Physician offices can have a dramatic effect on waiting time without reducing it by one minute," he says.

After telling patients the status of the physician and their appointment, nurses may assess the condition of ill patients or take a more complete medical history. The patient then feels the waiting time has some value, says Furse.

Another area for improvement: intake. Who greets the patients when they come in? Someone from the office staff should make patients feel welcome, he says.

9. Make measurement a part of your process. If you don’t measure patient satisfaction, you won’t know how you’re doing. You should survey patients at least quarterly or semiannually, Furse advises.

To determine how you’re doing on specific issues, you can use a comment card system. For a day or two, give a comment card with specific questions to every patient. Then wait a week or two or three and do it again.

As you make changes in your processes and communication, you shouldn’t necessarily strive for great leaps in patient satisfaction, says Furse. Often those sudden gains eventually drop off. "The emphasis should be on small, gradual, and sustained improvement," he says.

[Editor’s note: For more information on reducing factors creating patient dissatisfaction, contact David Furse, Chief Consultant, Solution Point, 1321 Murfreesboro Road, Suite 210, P.O. Box 292169, Nashville, TN 37229-2169. Telephone: (615) 399-0408.]


1. Barkley WM, Brady R, Furse DH. The lost revenue implications of problems, complaints and complaint handling: A health care example. Solution Point Working Paper Series 1997; 1:1-10.