Happy patients = happy hospitals

Hospitals and clinics will have to embrace good customer care practices if they want to compete in the brave new world of patient-orientated healthcare. Jo Hartley explores the benefits of enhancing the patient experience.
Happy patients = happy hospitals
By Jo Hartley
Wed 03 Sep 2008 04:00 AM

Hospitals and clinics will have to embrace good customer care practices if they want to compete in the brave new world of patient-orientated healthcare. Jo Hartley explores the benefits of enhancing the patient experience.

Customer care is the latest buzz word ricocheting around the corridors of hospitals and clinics across the United Arab Emirates, thanks to health service reforms by two of the country's health authorities to drive competition between the public and private sectors.

Moves to introduce insurance-based healthcare schemes by the governments of Abu Dhabi and Dubai mean that patients traditionally treated by the government sector will now be able to choose where to go for treatment - a decision they will base not only on where they can receive the best clinical care, but the best customer care too.

You’ve probably heard many times that happy employees make happy customers. While there’s a lot of validity to that, I like to flip it on its head. Happy patients certainly make the job of caregiver much easier too.

The idea that customer care is as important in hospitals as it is in hotels is nothing new. It is already a routine part of practice in more developed countries, especially the USA, where moves to improve the patient experience have been shown to have financial benefits for healthcare providers too.

Increased revenues

Dusty Deringer, one of the USA's leading gurus on customer care, tells Medical Times that good service encourages patient loyalty, boosts word-of-mouth recommendations and can dramatically improve a hospital or clinic's bottom line.

In his own experience, revenue from a single patient encouraging their family and friends to sign up with a provider after a good experience can be boosted more than eight fold. "When people are happy they come back to your organisation and tell their friends and family about their experience," Deringer says.

At a hospital I've worked with, we calculated the total worth of a patient over a lifetime at just under US$348,000. When a patient tells their friends and family, the number quickly blossoms to nearly $3,000,000."

Ask your patients

Boosting income is a good incentive for providers to get on board. So what do local facilities have to do to reap such handsome rewards? The first thing, Deringer reveals, is to listen to what your patients want.

"You begin improving customer care by listenng to those you serve. Too many times we, as caregivers, forget that our patients don't understand our medical jargon," he says. "Your customers will tell you exactly what it is they want. You then set forth in delivering that."

Patient satisfaction surveys and focus groups are some of the best and easiest ways to gather information on what patients value in a healthcare episode.

These are one of the key initiatives the US-based Cleveland Clinic implemented when it took over the running of Sheikh Khalifa Hospital in Abu Dhabi a year ago.

The company carried out patient satisfaction surveys of the local population in association with Abu Dhabi Health Services Company, to gauge opinion on the hospital's services. Now, the hospital randomly surveys individual patients on a routine basis, according to medical director and acting CEO Dr Scott Strong.

"We have those [initial] results and we continually survey patients that are in the hospital following discharge, those visiting the emergency departments and outpatients," he explains. "We...identify areas for improvement, and have set up a task force to address the concerns.

Dissatisfaction with customer care can span a wide range of issues; from the unfriendliness or lack of professionalism of staff, to long waiting times and poor facilities, including insufficient parking, dirty waiting areas, inedible food and having to wait five minutes for a cup of coffee. And patients see each complaint as being as important as the other.

Another effective way of assessing patient experience is by mapping the journey clients take though your hospital or clinic. By drawing out the route, you can uncover the barriers patients encounter to good customer care, suggests Dr Ottmar Schmidt, director of marketing and public relations at Welcare World, Dubai.

"You try to be the patient because the patient knows best. If you are in pain or have a problem the last thing you want is to be waiting for long periods," he says. "So we have to find out what the process is and when you do a map you find out where the bottlenecks appear."

Mystery shoppers

The concept of ‘mystery shoppers', first used in the retail industry to secretly detect failings in customer service, can give important insights into the workings of a healthcare facility, adds Dr Strong.

All telephones at Sheikh Khalifa Hospital now have scripts attached to them, directing staff on how to proceed with the call, how to direct patients and what information to give. A dedicated public affairs office then makes ‘mystery calls' to different care areas to test the telephone etiquette of staff.

"They pose as English speaking patients, and Arabic and Urdu speaking ones," Dr Strong reveals. "That experience is taken back to the department staff and we look at how their phone manner was."

The mystery shopper method is used even more aggressively at Tawam Hospital in Al Ain, which has been run by the consultancy arm of US hospital John Hopkins for the past two years.

Brian De Francesca, chief operating officer at the hospital, reveals it has trained a team of volunteer patients to act as customer care spies. They are told to ask specific questions and look out for customer care dos and don'ts, as part of their routine visits. They are then asked to report what they find back to hospital management.

"We started it before we told staff about it and we discovered rude nurses, stuck doors, bad food - lots of things," De Francesca says. "And then a miracle happens. For the moment you make everyone aware of mystery shoppers, everyone is on their toes."

Just the thought that a patient could be secretly recording their healthcare experience is enough to encourage staff to perform well, he concludes.

Train to retain

Unearthing poor performance and failures in the system, however, is only one side of the coin. Alongside these schemes, training for all staff on key aspects of customer care is essential.

From those at the reception desk who give the first impression of the organisation when patients and visitors arrive, through to the consultants, education is key to ensure a streamlined service. Effective communication and quick service recovery are an integral part of any policy.

Such an approach is not only good for patients but good for staff too, according to service expert Dusty Deringer.

"You've probably heard many times that happy employees make happy customers. While there's a lot of validity to that, I like to flip it on its head. Happy patients certainly make the job of caregiver much easier too."

Furthermore, positive attitudes on the part of the patient have a knock-on effect on their clinical care too. If a patient likes the healthcare professional who is caring for them, reveals Deringer, they are more likely to buy into what they say. This, in turn, leads to increased patient compliance and better clinical outcomes.

System failures

Up-to-the-minute software systems are extremely valuable in speeding up waiting times and ironing out hitches in the processing of patient data, which ultimately reduces patient frustrations. Integrated IT systems that link up hospitals and referring clinics can also be a big advantage.

They mean patient information can be accessed whenever and wherever the person presents, improving their long-term experience. "In the case of an emergency the doctor, without losing time, can see the patient's records online," Dr Schmidt stresses.

But he warns that the job of scanning and inputting paper medical records into an electronic system can be extremely time-consuming. "It's a huge task to scan all documents, especially when hundreds of thousands of patients have been seen in the last few years," he says.

Complaints culture

With all the will in the world, however, things will still go wrong. A core part of a good customer service policy is an integrated complaints system where patients can voice their concerns, and be confident they will be acted on. All complaints should be used to improve the patient experience in the future.

"What I would say to people is to deal with patient complaints, because they escalate," warns Dr Strong. "If a patient has a complaint you want to learn about that, and the intent is to listen to the complaint and take aspects of the complaint to provide improvements."

Receiving few formal complaints, however, doesn't mean that everything is perfect, adds De Francesca. Some patients have complained so much for so long that they have simply accepted a substandard service, he warns.

"If someone has been complaining about parking for 20 years they stop complaining. If they are complaining about waiting times or the bad food and no-one does anything, they shut up. You need to actively ask people," he says, referring back to the need for focus groups and patient satisfaction surveys .

Customer care is a never-ending cycle of problems and solutions, with two-way communication at its core. It is not possible to get a 100% patient satisfaction score, laughs Dr Strong, whose hospital has recently achieved an 80% high.

"You get to a level and it's hard to improve when things are as you would expect as a customer. The patient has choices and they get quality care delivered in a compassionate and friendly manner.

THE FACTS: Improving customer care• Ask patients what they think of your services.

• Listen to them and act on their comments.

• Set up a mystery shopper scheme.

• Train staff in basic customer care skills.

• Utilise IT healthcare support systems.

• Set up a formal complaints procedure.

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