Patient Satisfaction by Stephen Colucciello, M.D.
Tuesday, October 27, 2009 
Stephen Colucciello, M.D.At times, it seems like patient satisfaction scores are more important than quality of care. These scores, along with length of stay, have become the alpha and omega of ED benchmarks. While this can be frustrating for the hard-working practitioner (“I’m trying to save lives dammit, not win a popularity contest”) they are an inescapable fact of life in the modern ED.
Despite our sometimes jaded attitudes, there is nothing wrong with happy patients. In fact, happy patients mean more than just high marks on a survey. Happy patients tend not to complain, and best of all, they tend not to sue. Plus, some wise old docs have learned, happy patients make a happy ED. Happy patients are almost as important as happy nurses, but I will leave that to a later blog.
How do we get happy patients? It’s not that hard. I have a few suggestions that come from 30 years of pissing people off – and if I can learn, anyone can.
The Beginning
An ED is a scary place (for us and for patients) so familiar things are comforting. Like introductions and manners….
Knock. Before I enter a patient’s room, I knock and ask, “Can I come in?” After all, it’s their room. If there is no door to knock on, I shake the curtain.
Introductions. Introduce yourself and always shake the hand of EVERY person in the room; the wife, the brother, the friend, the fourth cousin once-removed. Unless my right hand is griping a laryngoscope, it makes the rounds. Don’t forget to shake hands with the star of the show (the patient).
Smile. If you’re a grim kind of doc, just twitch the corner of your mouth (watch any Dirty Harry movie for exact technique). Try not to sneer.
Touch. Don’t be afraid to rest your hand on their shoulder for a moment or two (or even longer). Some people don’t need to be touched, while others don’t like to be touched; but you will recognize these people in an instant. However a scared patient often longs for a healer’s touch; don’t be afraid to make contact.
Sympathize. Apologize for an ungodly wait. In their mind, they have been waiting forever and have the direst emergency anyone could imagine. If they have stewed for 3 hours in the waiting room, tell them, “I’m sorry you had to wait; I was almost able to save those horribly injured newborn quintuplets; but never mind that, I’m here for you now.”
The Interview
Offer assistance. Start with “How can I help you today?” This is more natural and less stilted than the contemporary equivalent, “how can I provide you with EXCELLENT service today”?
Sit down. This means there needs to be enough chairs and stools in every room. When a doctor sits during the interview (instead of standing) patients perceive the time spent is twice as long as it actually is.
Stifle yourself! Don’t interrupt their opening lines. The average patient runs out of steam in less than 3 minutes; the average doctor interrupts after just 18 seconds. If the story does not seem very pertinent, still give them the three minutes. You can’t always be fascinated with an extended monologue regarding bowel patterns, but you can appear that you are.
Find out why they are really there. Many patients have secondary agendas, discover them! If they have an amputated finger in a Tupper Ware container that is a good clue to their hidden agenda. However, if they have had nausea for 3 years, something else triggered today’s visit.
Closing the Interview
Recap. “So if I’ve got this right, you’re here because…..”
Let them in on the plan. Tell them what you are going to do and how long it is going to take. Inflate your time estimate by 40% to 60% (you’ll be glad you did).
Tell them you will be back. Patients fear abandonment. If you are going to order tests, tell them you will return to discuss the results.
Treat pain. One of the best closing lines is, “Can I get you anything for pain?” It doesn’t have to be 12 mg of IV Dilaudid; it might be a Tylenol and an ice pack. Treating pain is one of the few things we could do well (but rarely do).
Special rule for pediatrics: Always tell moms that they have a beautiful baby (even if it looks like one of those fish left on shore by the Tsunami). If you choke on the compliment when confronted with an ugly baby, earnestly remark, “Maybe he’ll be smart”.
During the Wait
Fly Bys. If a patient is waiting a significant time for test results or therapies, drop in and set a spell. A “spell” may only last 10 seconds, but it is 10 seconds well spent. Tell them what they are waiting for and ask if you can do anything for them. Apologize for the wait, mention the horribly injured quintuplets.
Treat pain (see above)
The Big Finale
Any great show (and emergency medicine is 90% show business) needs a terrific opening number, a polished performance, and a big finish. Which brings us to the discharge process. Make sure that YOU have a discharge meeting with EVERY patient. Do not leave this to the nurse. The nurse can also give DC instructions, but this is your show.
Test Results. Tell them what the tests show and what you think this means. Use simple language.
Admitted patients. Tell them that you think they should be admitted (or at least consulted for admission) and why. If they are conscious, ask them if they agree to be admitted.
Discharged patients. Tell them what you think they have and how long they can expect to be ill. Inflate your time estimate by 40% to 60% (you’ll be glad you did).
Discharge Instructions. They must be; simple, clear, direct. Tell patients what you want to tell them. Then tell them what you just told them. Then have them tell you what you just told them. If this sounds redundant, that’s the point.
Encourage questions. This is your last chance to get things right.
The Final Analysis
You can try to make patients happy for many reasons. You may calculate that happy patients will let you reach some PRC benchmark and thereby keep your ED contract or keep your job. Or you may realize that the little effort this takes makes work more fun and leaves you less burnt out. Or it might just be good medicine. Or maybe all of the above………..
Reader Comments (2)
This is a great summary on how to "do it right." This is going to be shared with our whole group, to get us "pumped up" once again regarding patient satisfaction and customer service.
My wife is a Physician Assistant (PA) and I am a marketing researcher primarily focused on measuring customer satisfaction.
This post should be sent to nearly all customer service organizations! Fantastic!
Here are the Cliff notes that I take away and will discuss with my wife:
1. Slow down and connect on a human level
3. Recognize the fear (emotional) factor
4. Remember, it's about the PATIENT (customer) and NOT about the institution or doc!
Thanks for a great post!
Andy Perkins
The Satisfaction Questionnaire Blog