In the medical practice, patient satisfaction scores offer valuable insights to the perception of the patient experience. The person having the most significant impact on the organization is the provider. Practice workflows should focus on optimizing access, decreasing wait time between the scheduled request and the date of the appointment, ensuring providers have the tools they need when they enter the room, spending adequate time with the patient and understanding concerns and providing treatment options. Below are some options to pilot in the office:
Templating – Consider the provider’s template. Does it have an adequate number of new, established follow-up and same day appointment slots to support the size of the patient panel? Is the actual cycle time of these appointments reasonable and easily met? Would the practice benefit from adding advanced practice clinicians (nurse practitioners or physician assistants) to boost and extend the work of the physician? Does the practice have enough dedicated staff to ensure the patient flow is fluid?
Wait Time – Two critical elements of patient wait time is the time between the appointment request to appointment and wait time the day of the visit. Some patients may perceive it as a long wait, even if it is not. Studies have suggested that too long of a wait time to the appointment can contribute to an increase in no show rates. Assess your check-in process. Do you provide a verbal update to the patient regarding wait time? Do you have a patient access center to smooth the pre-visit process to streamline check-in and billing? Do you have visual management tools for your staff tracking front-end preventable errors? Do you have an automated call reminder in place? Do you have scripting for your staff to ensure they present the delay in a positive light? Be frank with patients when emergent situations arise and unexpected delays occur.
Feasibility – Do you have a good staff training program to help the provider be more efficient? Ensure your medical assistant or nurse can take a full history and prepare the room working to the top of their license. Can staff load pre-visit forms into the EHR? Can they set up the room/note for the anticipated service (i.e., open the radiology films, push the labs into the note, update the chief complaint and prior history, medications and allergies)? Does your practice use standing orders in the office to allow staff to complete “Point of Care” testing? This allows the provider to have a full discussion about the findings.
Explaining the Options and Follow-up Plan – The next area to review is the patient and physician decision-making component. Do you have a system to ensure medication changes are reviewed and the benefits and risks clearly explained? Do you have printed content available? Software such as “Up to date” can also provide credit for Meaningful Use to providers. Do you have scripting on laying out the options? Train the providers to say “Mrs. Jones, based on the testing results we have three options.” Encourage the provider to state “the first option is… the second option is …..the third and last option is …..Etc.”
Follow-up Plans and Testing Results – Is your process clear in terms of the next steps? There is nothing more frustrating to a patient than having to call the office to clarify the treatment plan, timeline and/or next steps. Do you provide a phone number and address for recommended preventative care such as mammography and colonoscopy or specialist? Do you have a clear process to deliver test results? Train your staff to avoid saying things such as “if you don’t hear from us everything is fine.” Best practice is to provide a written summary of the visit which can be reviewed at check-out.
Provider and staff engagement in the process is essential to success. Break the steps down into small, distinct units, provide feedback and assess the improvement over time!