'Better late than never' doesn't win high marks
Better late than never’ doesn’t win high marks
Getting to the patient on time
About a year ago, a patient arrived at a doctor’s office in Pittsburgh for a 5 p.m. appointment. Four hours later, the doctor was finally ready to see him. "What is really amazing is that the patient was still there," says Martha Hamilton, CPA, executive director of Tri-River Surgical, a four-clinic practice in Pittsburgh.
In an increasingly patient-satisfaction driven health care environment, minimizing or eliminating such scenarios can mean the difference between a full schedule of satisfied patients and empty waiting rooms.
The offending physician did practice at Hamilton’s facility at the time but joined the practice as part of a merger a few months later. The physician still runs 30 to 45 minutes late sometimes, Hamilton says. "We still kid him about it, but he is improving."
But it’s no laughing matter when doctors are habitually late. "It makes patients feel under-valued," says Hamilton. "That equals bad public relations. Patients will tell their friends, and in a really bad situation, you can lose business."
There are other dangers, too, she says. In an era when managed care organizations and other payers are demanding data on patient satisfaction, persistent tardiness among medical staff can lead to declining scores. "How long a patient has to wait is a key factor in patient satisfaction," she says.
"Tardiness is a problem that can seem unsolvable," says Robert Westergan, MD, medical director of Jewitt Orthopedic Clinic in Winter Park, FL, a 21-doctor orthopedic surgery group. "There is a balance between seeing the largest number of patients possible in a practice and being able to predict the unknown how long to see a patient and meet their needs, emergencies that might arise, or dealing with referring doctors who need attention. We just can’t schedule as much as we would like to."
Westergan believes there is a limit to how understanding patients can be when a physician is running late. "But they expect us to do what we can to minimize the problem."
Determine if there is a problem
How do physicians at your organization stack up? Westergan says that patient satisfaction surveys are the best way to identify problem areas. "The perception and expectation of the customer/patient is more important than anything else. If patients are scoring low on waiting times, then that identifies a problem even if you are really only five minutes behind."
But if patients are complaining in writing or verbally to staff, the situation has already gone too far, Hamilton says. "You have to find out there is a problem before it gets that bad." The best way to do that is to make sure staff are aware of patients from the moment they walk in the door.
Most people, says Hamilton, can tell if someone is impatient, bored, or upset. Front desk staff should note the demeanor of patients as a first step. Tri-River Surgical has gone further. Hamilton hired a retired man to act as an attendant. "He greets people, takes their hats and coats, and gets them coffee," she says.
Not only does this retiree put patients in a good mood by his immediate attention, but Hamilton says, he can let other staff know if a delay is getting on a patient’s nerves.
Once you know there is a problem, you have to understand why it occurs. There are four likely reasons physicians run late. They are:
1. Scheduling problems.
"Start out by looking at your schedules," Hamilton advises. Are there too many patients coming in for the number of doctors available? Are there a lot of emergencies and walk-in appointments? Are patients coming in late?
All of this information is usually available from existing records. For example, it is important to note the time a patient arrives for an appointment. A glance at a particular day’s records will often show that several patients arrived late. This can trigger further investigation. Is a particular patient always late, or was there inclement weather that put everyone behind schedule? Hamilton recommends telling patients who are perpetually tardy to come early for appointments.
New patients also should be encouraged to come in early, Westergan says. "There are usually forms to fill out, and you should have them come in with ample time to do that."
Multi-office practices can have other scheduling problems, especially if all the offices routinely set appointments for each other. Westergan says his practice implemented a computerized, networked scheduling program that allows any office to schedule an appointment for any other office without fear of double- or over-booking the medical staff’s time.
2. Poor communication.
Another problem might be a lack of communication between the medical staff and schedulers, says Hamilton. "If schedulers don’t know a patient needs an X-ray, then they might not schedule enough time for that patient," she says. That one mistake can mean that X-ray gets backed up because of an additional patient, and the physician runs late because a patient is not ready when he or she is.
"Just make sure that the schedulers ask what the appointment is for," she says. "You have to foster good communication."
3. Inefficient use of staff.
If physician extenders are on staff, make sure their time is used efficiently, says Hamilton. "They can be a real asset to help ease the burden of a full patient load," she says. "We use physician assistants (PAs) to aide physicians in staying on time." While that is less possible in markets where PAs have their own patient base, in her market, they can take on a team role that frees up more physician time, Hamilton notes.
4. The problem doctor.
Westergan says doctors are no more likely to be habitually late than any other professionals. And, as with others, a doctor who can’t keep to a schedule needs to be talked to about his or her performance.
The best way to do so is to present information in a straightforward, scientific manner, Hamilton advises. If patient satisfaction scores for a specific doctor are declining and a top reason is tardiness, show the doctor the numbers, she advises. Hamilton says most physicians will react positively to information that is presented in a non-judgmental way.
Westergan agrees. "Show them data that compare them to their peers," he suggests. "Physicians don’t like being outliers and will go far to correct a problem that has them at the bottom of a heap."
If your physicians have productivity requirements that are tied to their salaries, they may react quickly to problems and work to solve them. Hamilton says they will often suggest scheduling changes or opt to have their PAs or nurse practitioners take on more responsibility.
But if initial efforts don’t work, Hamilton says problem doctors may have to cut the number of patients they see. "They are very competitive and don’t like that at all," she says. "They have certain productivity standards they have to meet, and if they fall behind, they really start to sweat."
Dealing with the unavoidable delay
There are cases for which not much can be done to avoid delays for patients. In those cases, the best way to prevent bad feelings is to be upfront with patients. If there is any advance warning, patients should be called ahead of time and given the information and the option of rescheduling, says Westergan.
If the problem arises less than an hour before an appointment and the patient can’t be reached, Westergan says, the patient should be told the situation as soon as he or she arrives at the office. "Get to the patient before they complain," he says.
Ease the stress of waiting
Making the office a friendly place can also help ease tensions that delayed appointments bring. For example, Hamilton’s practice offers coffee, doughnuts, and a selection of current magazines. Westergan’s has a business feel with telephones, modem hook-ups, and adequate space for business people to do their work.
"No one goes to work every day trying to mess up the lives of their customers," Hamilton says. "But we have to understand that we can’t just let the situation sit there unanswered. We have to work to find a solution."
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