For orthopedic practices, the quality of the overall experience of their patients is of utmost importance. However, with the rapid pace of everyday operations and the myriad responsibilities physicians and their staffs have, the need to keep a good eye on the patient's perspective can often be forgotten.
In order to evaluate how it was doing on customer service, one practice, Azalea Orthopedics in Tyler, Texas, turned to comprehensive surveys to measure the areas of patient satisfaction where improvement was warranted.
By focusing on the areas where they were weak, Azalea was able to improve its overall patient satisfaction scores and the quality of the office experience for their patients.
Why choose a survey?
Three years ago, Azalea decided to begin using a patient satisfaction survey tool to evaluate their patients' experiences at Azalea's (which was, at the time, in two locations, which have since combined into one facility). According to Michael Russell, MD, partner and orthopedic and spine surgeon at Azalea, the decision to participate in a patient satisfaction survey was practice-wide.
Although Azalea was the largest orthopedic practice in the East Texas market, Dr. Russell says that the organization was seeing pressure from local hospitals that were forming physician practices of their own. "It was a good idea to get a reliable measure of how customers perceived the practice," he says. "A satisfied patient who is pleased with our services will tell their friends and family."
Some areas measured by the survey Azalea chose included:
- scheduling (courtesy of the staff member making the appointment, helpfulness on the telephone, etc.);
- wait times (registration, before being taken back to the exam room, before seeing the doctor, information on why there was a delay, etc.);
- physician staff (friendliness of the receptionist, speed of registration, etc.);
- physician (friendliness, explanation of diagnosis, concern about questions, information on medication or follow-up care, etc.);
- amount of time spent with the physician;
- check-out; and
- clarity of the language used by physician, staff, etc.
According to Dr. Russell, the survey takes an anonymous sampling of recent office patients. He says the results of the first surveys saw Azalea performing reasonably well, falling in the 92nd percentile of the practices surveyed in the nation.
However, the numbers among the 19 physicians at the practice were not consistent. "Some physicians were doing much better than others," Dr. Russell says. "The survey gave us an accurate perception of the quality of service and satisfaction of our patients."
Determining areas of improvement
Once Azalea received the results from the surveys, the overall ratings were reported to the group. Physicians and staff discussed their individual results.
"We were given a 'top box' analysis, a list of the top 10 things we could work on that would improve our scores the most," Dr. Russell says. These top box scores included ease of scheduling or length of wait in registration.
After the first set of meetings and the next quarter's surveys, Azalea had improved its scores but still fell short of their overall goal of the 95th percentile in the nation.
Once Azalea received the next quarter's results, the practice decided to create a group-wide customer service team — consisting of nurses, physicians, back-office staff and supervisors — that focused on achieving the goal of a higher percentile. "We wanted to get everyone excited about customer service and overall practice improvements," Dr. Russell says.
One way the practice achieved this emphasis was to hold training sessions with office staff, focusing on the top priorities from the surveys. "If those areas are improved then scores will increase more rapidly," says Leslie Fossey, director of marketing and chair of Azalea's customer service team.
One area that Azalea had to concentrate on, and still continues to do so, is wait times, according to Dr. Russell. "What we discovered is that even if a patient has to wait, as long as the staff are concerned and communicate delays, the patient is more receptive to wait times up to a certain point," he says.
Aside from addressing group-wide changes, each physician and his or her staff worked on the top issues discussed in one-on-one meetings. Some of the areas individual physicians worked on were overscheduling patients, showing more concern about the patient's questions and spending more time with patients to make sure that their questions are answered.
Keeping staff motivated
In order to keep the staff motivated and on target, Ms. Fossey provided weekly reports on how Azalea as a practice and the individual physicians were performing. Dr. Russell says that although Azalea has been mostly successful, certain issues, such as the practice's plans to move all physicians and staff to one location, has caused the scores to fluctuate.
For the most part, the staff bought-in to the goal of a consistent 95th percentile rating. "The challenge was to maintain the excitement," Dr. Russell says. "It's easy to slip into old habits if you stop talking about it."
With weekly meetings, the staff was aware of what the goals were and stayed on task. "This is something that is continual," Ms. Fossey says, emphasizing the importance of consistency.
Getting the physicians on board with striving to reach this higher percentile proved more difficult. "Most physicians feel like they do a good job of caring for their patients," Dr. Russell says. "The low survey scores seemed like a personal affront to some physicians, so careful work had to be done to keep them from feeling like it was a personal attack."
One way to do this was to consistently present information in a positive way, even if the reports were less than exciting. "A key is knowing the personalities of your physicians and adapting accordingly," Dr. Russell says.
One physician's story
Azalea had one physician talk to the group about how he or she had improved his scores in order to bring the physicians on-board with improving their patient satisfaction scores. Dr. Russell, who was scoring initially low in the surveys, began sharing his progress with other doctors.
"It helps when you have one physician who is willing to open up himself, good or bad," he says. "I was scoring low with one particular patient population, those with chronic back pain. My first reaction was that they were a less happy, less satisfied patient population in general because there is little a spine physician can do to relieve their pain."
This attitude was understandable, at first, because he was receiving high scores from the rest of his patients — eight or nine points out of 10. However, Dr. Russell had not performed or could not perform surgery on the patients with chronic back pain; therefore, their only impressions of him as a physician were from the office visit, rather than a series of visits.
"Typically, I would tell the patient outright, 'I can't fix it; I can't do surgery,' which can come off as dismissive of their problems," Dr. Russell says. The low scores on the survey helped him to realize that he should focus on that patient population rather than quickly moving on to those who could be treated. "Instead of telling the patient that I couldn't help them and leaving it at that, I began offering to find them alternatives like pain management or physical therapy or someone else who could help."
By taking a little extra time and consideration, Dr. Russell was able to improve his overall numbers by giving patients these options.
Another area that Dr. Russell saw needed immediate attention as a result of the patient satisfaction survey was taking the time to listen to patient's questions. "We were trying to be more cognizant on our scheduling so that patients had less of a wait," he says.
However, by moving quickly from one patient to another, the surveys reported to Dr. Russell that patients perceived he was in too much of a hurry to answer their questions. "It doesn't take that much extra time to look unhurried," he says. "It takes maybe 30 seconds to stop and ask, 'What else can I do for you?'"
By working on these areas, Dr. Russell was able to move from one of the lowest-scoring physicians at Azalea to one of the highest. By sharing his story, other physicians could see how these simple changes to their day-to-day operations could improve their patients' perceptions.
Exceeding expectations
In the latest rankings from the surveyor, Azalea exceeded its goal of hitting the 95th percentile. The practice was ranked in the 97th percentile of healthcare facilities across the country. Within its region, which consists of Texas, Okalahoma, Arkansas and Louisiana, Azalea was in the 99th percentile.
Dr. Russell says for other practices considering using a patient satisfaction survey benchmarking tool, the key to success is consistency. He also suggests incentivizing the staff to achieve goals.
For example, if Azalea hits the 95th percentile twice consecutively in a year, the staff receives two days of paid time-off, according to Ms. Fossey.
Ms. Fossey also notes that having the buy-in from everyone in the practice is critical to customer service success. "This is a difficult task and happens slowly, sometimes just one person at a time. Employees care, and they want to be rewarded for their allegiance," she says.
Learn more about Azalea Orthopedics.