Different cultures have different norms when it comes to human interaction, making the healthcare field rife with issues regarding the provision of culturally sensitive care.  Some states, like New Mexico, New Jersey and California are requiring that healthcare providers receive access to training in culturally competent care as a measure to improve quality and communication between providers and patients.

Here’s an article from the Associated Press (via Yahoo! News) on the topic.

Medical providers agree there’s no one resource that can make a person culturally competent, but they say it’s important to be familiar with a culture, drop any stereotypes or bias and treat patients in the appropriate way.

One of the core services offered within the healthcare industry is time.  Time to ask questions of our physicians, one-on-one time with our physical therapists, and time for our providers to actively evaluate and make recommendations for us as patients.  As a core service, time is both a driver of revenue and costs within the healthcare model, making it one of the most important and most scrutinized variables by physicians, practice administrators and insurance payers.

The notion that a correlation between the amount of time providers spend with patients and the quality of service provided is conceptually valid and serves as a platform for many of the ethical debates waged in today’s healthcare arena between providers and insurance companies.  If providers are increasingly paid less by insurance companies for the time they spend on their patients, it’s easy to see that incentives will be in place to increase the volume of patients seen, and decrease the amount of time seen with each patient.  From a qualitative standpoint this sets the stage for the ethical and political battlefield between providers, patients and payers.

Interestingly, a recent systematic review of 5 studies performed in the United Kingdom has called into question the correlation between time spent between provider and patient and the quality of care delivered, bringing another variable into the equation - the way that the time is used.  Appearing in the Cochrane Library, the review suggests that patient satisfaction was not significantly higher when more face time with physicians was made available and physicians did not practice in a manner significantly different depending upon the amount of time they spent with their patients.

Now, I don’t believe this review in any way wipes out the validity of the argument that there is a correlation between time and quality in healthcare - it simply stands to reason that providing more time allows for the opportunity to provide better care.  It does however bring to the table fodder for discussion about the “elements” of time that are important as relates to quality of care, rather than simply the time itself.

Some patients might feel like they spend more time in the waiting room than actually talking with their doctor, but a new review of studies suggests that these consultations would not be much different if patients had more face time with their physicians.

In five studies conducted in the United Kingdom, doctors did not discuss more problems, prescribe more drugs, run more tests, make more referrals or do more examinations when they had a few additional minutes with patients.

Last month, Vantage was featured on the cover of PT Magazine in an article that focused on the topic of “healthcare consumerism.”  Healthcare consumerism is the shift toward the treatment of patients as “consumers” of their healthcare services, rather than simply passive recipients in their care.  As a result, the focus of many [smart] private practice owners is on the development of services and environments of care that will create loyalty and satisfaction among their patients.

Here is a link to the article - Thank you to PT Magazine for their coverage of such a relevant topic to today’s healthcare environment.

In traditional industry, says Quatre, businesses compete for customers by either lowering prices or improving product quality-say, by building a better widget. “In health care it’s much different because you can have a different service based on your training, your staff, your expertise, and so forth, but can you charge more for that because the quality’s a lot better? Your hands are tied to some extent, unless you’re on a strictly cash-based model. To compete for the customer, what you really need to do is make it an experience with which they would prefer to be involved.”

On a trip back to my hometown of Bend, Oregon from Portland this week, I had occasion to stop for gas in the small town of Madras, Oregon.  Madras is a great little stop because it’s the 45 minute mark before getting home from Portland, and because it has cheap gas.

For those that aren’t aware, Oregon law mandates that the pumping of gas is performed only by station attendants, requiring customers to sit idly by as fuel is purchased.  It’s easy to get used to, and I certainly consider it a benefit of living in the great state of Oregon.

Having the extra time to sit and do nothing provides ample opportunity to think about things like the cost of gas, your kids, and in my case - blogging.  The topic for today’s post came to me after the station attendant approached my window and asked if he could wash my window while he fueled my tank.

I should note that while it’s mandatory for a station attendant to fuel the tank in Oregon, it’s not mandatory (and it’s actually not too common) for the attendant to wash your windows.  It’s even less common for the attendant to do a good job if they wash your windows, and it’s almost unheard of for them to leave the window looking perfect.

This said, it’s no wonder that I was so impressed as the attendant began his work.  Not only did he have great technique, perfectly consistent strokes, and an almost flawless end result - but he was courteous, friendly, and engaging the whole time.  He truly enjoyed what he did, and took visible pride in his work.

Now, as the attendant was performing this work of art on my windshield and I should have been simply sitting back thinking of something entirely different, I couldn’t help but overanalyze the situation.  Was his boss working on the car next to me?  Was he training a new employee who was watching him from afar?  Was he working for a tip?  Anything I could come up with would have helped me to make sense of the situation - I mean, why on earth, in the absence of any external motivation, would this guy spend so much time and energy making my window look so perfect when he didn’t have to?

The answer to the question was in his courtesy, his conversation, and his overall enjoyment of the experience - this guy actually liked what he was doing, and because of it, he did a great - nay, fantastic - job.  He enjoyed the experience, I enjoyed the experience, and I will continue to stop at his gas station, not because of the cheap gas or the 45 minute rest break on my trip home, but because he earned my loyalty by taking care of me in a way that he didn’t have to.

I immediately drew a parallel to what we do in the healthcare field as relates to customer service.  Whether a doctor, dentist, physical therapist, or someone else in the field, we care for people - not windshields or cars.  In doing so, we are able to reap the rewards of benefiting real people who, in most cases, are experiencing difficult times influenced by illness or injury.  People don’t come to see us because we are cheap.  They don’t come to see us because we’re on the way home (patients will drive an average of 5-7 miles to see us).  They don’t come to see us because we’re a good alternative to a dinner and a movie.  People come to see us because they need our help and they want us to care for them just as they would care for themselves (better in most cases).

Not to speak for everyone who reads this blog, but if we can be won over by something as simple as a window washing at a gas station, how easy is it for us to win over our patients for life, simply by giving them all that we’ve got, and by enjoying our experiences with them?  By taking full pride in our services, smiling graciously, and conversing naturally, we’re forming bonds with our patients that are much stronger than can be broken by an insurance company, a referral source, or a patient co-pay. 

More and more I find that it’s easiest (and probably the most important) to learn from the simple experiences in life - those that can be learned from even a gas station attendant.
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Tannus Quatre is a passionate blogger and writer, as well as a principal/consultant with Vantage Clinical Solutions.

Mystery shoppers pose as regular customers in order to experience customer service from the customer point-of-view.  Used in conjunction with satisfaction surveys, mystery shoppers help paint a picture of the actual level and quality of services provided, helping businesses to continually improve the customer experience.

I’ve seen this used in the healthcare industry, and like many standards that find controversy when applied to healthcare, mystery shopping is no exception.  Some feel that mystery shopping with sham patients may interfere with the allocation of medical resources toward patients who are truly sick or suffering.  This case is most easily understood in the emergency department where seconds are critical and spending time with a mystery shopper may take away from the true needs of other patients in critical need.

Personally, I acknowledge that there are some tricky implications associated mystery shopping in healthcare, but I don’t think they warrant a rejection of the entirety of the concept.  Mystery shopping does two very important things for service providers, regardless of industry: (1) It provides a means by which to evaluate providers to ensure they are meeting the standards expected of them, and (2) knowledge that a medical practice uses mystery shoppers to evaluate service and performance helps to encourage best practices and good service in all customer interactions.

I feel that as healthcare providers we should be held to a higher standard than found in a number of non-healthcare industries, and we should expect that our providers are ethical, patient-centric and service-oriented in all circumstances.  Having worked in a number of healthcare settings myself, I know that this ideal is very much not the case and it is our responsibility as administrators and managers of healthcare organizations to place the proper systems in place to facilitate the best service possible.

This article in the San Francisco Chronicle discusses a recent potential endorsement of the concept of mystery shoppers in healthcare by the American Medical Association (AMA).

Now the ethics council of the American Medical Association is pressing the doctors group to endorse such practices. AMA delegates are expected to vote on the proposal, along with dozens of others, during their five-day meeting beginning Saturday.

Some doctors are outraged at the idea.

Dr. Richard Frederick, of the University of Illinois College of Medicine in Peoria, called it “official deceit” that could have disastrous consequences. He wrote a commentary in May’s edition of Virtual Mentor, the AMA’s online ethics journal.

“In some instances sham patients have presented to overcrowded emergency rooms with chest pain,” he wrote. “How could the hospital administration defend this exercise to someone who suffers an adverse outcome while waiting his turn behind the person who is only pretending to be sick?”

The proposal to the AMA does include restrictions that address that and other concerns. The recommendation is to have a system that: makes sure fake patients don’t interfere with treating real ones; gives doctors a heads-up that undercover patients might be visiting; and ensures that bad reviews aren’t used to punish doctors.

Building a brand in healthcare is a bit of a funny concept.  Not “ha-ha” funny, but funny that some practice owners simply don’t understand how important it is.  And whether you practice medicine, physical therapy, dentistry, optometry, or something altogether different, the importance of building a brand is all the same.

A brand is a promise.  When you deliver a product or service, consumers want to know 2 things: (1) what they can expect, and (2) how much it is going to cost.  Using those two pieces of information, the consumer can determine if there is enough value present to warrant the purchase (i.e. does what I can expect outweigh the price I feel is reasonable).  And while some will debate that the pricing/cost issue is less relevant in healthcare transactions that involve 3rd party payment, there is no doubt that in order for consumers to know what to expect when making decisions about where they receive healthcare, they have to believe in a practice’s brand - the promise.

Building a strong brand in your community can take a lot of shapes and forms.  From logo design/redesign to advertising campaigns to promotions, building brand recognition can be an expensive proposition.  The good news is that it doesn’t necessarily have to.

Remembering that a brand is a promise, a medical practice, dental facility or physical therapy clinic can build a successful brand simply by articulating a promise, and then delivering on it…over and over and over again.  Here are a few tips for building a brand without a corporate-sized marketing budget.

1. Craft a mission statement and communicate it to your consumers.  A mission statement often forms the essence of your brand as it speaks to your practice’s core identity, and what it is trying to do in your community.  Letting your consumers know of your mission is a good first step towards letting them know what they should expect from your practice.

2. Use scripts.  Ever notice that when you call your cell phone company you never talk to the same person twice but you always hear the same thing?  Without daring to suggest that your medical practice should be run like a cell phone company, there is definitely something to learn here.  The reason you always hear the same thing is because large companies have a lot to lose if their brand gets diluted by consumers not knowing exactly what to expect - so, they use scripts.  Believe it or not, the same is true of your small practice.  If your patients become disenchanted with just one of your staff, your brand can become tarnished because expectations are now in question.  Using scripts to better control (and refine) what is said by your front office staff as well as your providers can go a long way in protecting your brand by ensuring that your patients will experience consistent care no matter who they come in contact with.

3. Tell your patients what to expect.  Again, a brand is a promise, and what better way to communicate that promise than to get literal.  If I walk into a physical therapy practice and I see on the wall that I can expect to (1) wait no longer than 5 minutes past my scheduled appointment time, (2) always be able to get a call back from my provider in the same business day, and (3) always be included in the development of my own plan of care, I will know exactly what to expect and I will feel comfortable holding this practice to those standards.

4. Be nice.  Having a customer-service focus is one of the easiest and most effective ways to build a healthcare brand.  Healthcare is a service industry and the customer should be king (or queen).  If there is any part of your practice that thinks that it is acceptable to ever disrespect, insult, or ignore a consumer, you might as well throw in the towel now.  Just one staff member that doesn’t understand that it is their job to always be nice to your customers can quickly unravel any brand building you’ve done, no matter how much time or money you’ve put into developing and communicating your promise.

5. Be different.  Doing something different for your patients is a very effective way to build your brand in a short amount of time.  I’ve had a lot of cars and have bought a lot of tires throughout my life, but never have I had the experience with buying tires that I’ve had at Les Schwab Tires.  Every time I pull into Les Scwab I am greeted at my car door by a salesperson running out to greet me (that’s right, running - not walking).  This has made an immediate, lasting impression on me because I quickly realized that this company was different.  I’ve yet to receive services anywhere else where I’m greeted by someone running up to help me as I arrive.  My first experience with Les Schwab was 6 years ago and I’ve never bought tires anywhere else, and I don’t expect to.  Les Schwab is different in a way that focuses on me, and it makes me want to see them for my tire needs.  Implementing this same type of difference into a healthcare practice is just a matter of determining how you’re going to treat your customers differently, and then executing on it time and time again.

The importance of brand building in private practice healthcare is tremendous, and it doesn’t have to be expensive.  I’ve outline 5 simple methods for building your brand, and not one of them required a marketing dollar be spent.  In a nutshell: Figure out your promise, communicate it to your customers, and deliver on it - yes, it’s as simple as that.

Knowing what your patients think about their experience in your practice is important to long-term retention and positive word-of-mouth marketing within your community.  Using online techniques to survey your patients on a regular basis is a good, and cost effective way to do this.

This article from the Northwest Entrepreneur Network speaks to the use of online customer survey resources that can be used to survey patients (i.e., customers) on a regular basis in a way that is relatively painless.  With Internet use on the rise among virtually all demographics, the use of online surveys will continue to grow in the coming years.  It’s wise to know what’s available on the market so that your practice can leverage this important information in the management of your practice.

One of the key factors in a successful business is to know what your customers or clients are thinking – about your business, your products, your services. As a business owner, you’ll get feedback from your current customers just in the course of day-to-day business. But the results can be skewed by the interaction itself, and so most business owners find it useful to allow their customers to answer questions anonymously. And that’s where surveys come in.

Collecting on aging accounts is vital to the health of our business.  The collection process needs to be thorough and efficient in order to maximize cash flow.  But, having a methodical system does not mean that customer service is thrown out the window.  Peter Lucash offers some insight into maintaining great customer service while working these accounts.

Collecting fees, from co-payments to non-covered expenses, requires a degree of tact and compassion. Our goal is always to develop long relationships with our patients – they should never be viewed as one time transactions.

This is an interesting article on the growing trend toward consumerism in healthcare, whereby patients not only want to be made better, but they want to feel good while doing it.  Growing competition for healthcare dollars has lead to improvments in the delivery of the healthcare experience throughout the United States.

Today’s consumers expect more from their healthcare providers. They expect care that goes beyond the clinical experience and demand that it be fast, convenient and of high quality. We must continually seek ways to improve the customer experience along the entire patient continuum — from acquisition to service delivery to retention.

…”Consumers will be judging healthcare services as they would other retail transactions, expecting transparency in price and quality. And with those variables becoming easier to discern, customer service will become the key differentiator in healthcare choice,” according to a white paper from The Beryl Institute.