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Many reasons exist to strive for high patient satisfaction, including those related to maintaining certification requirements, risk management, reimbursement and simply having a competitive practice, but the most important one is that by achieving high patient satisfaction, you will find that your patients will be more motivated and more engaged in their individual care, says Elliot Rosenstein, MD, FACR, FACP, director, Institute for Rheumatic & Autoimmune Diseases at Overlook Medical Center, Summit, N.J. “When this occurs, it’s more probable that a patient will adhere to their treatment regimen and consequently achieve the desired health outcomes.”
Dr. Rosenstein
Along these lines, Jonathan Krant, MD, medical director, CreakyJoints, and section chief of rheumatology, Adirondack Health Systems, both in Saranac Lake, N.Y., says improving patient satisfaction should be paramount in the minds of treating clinicians, because clinical response to therapy depends upon patient compliance with recommendations.
“Numerous barriers to the exchange of information (i.e., language, culture, cost constraints, understanding disease mechanisms and reasonable timelines for clinical response) underlie every encounter. Patients must understand them in order to engage in the doctor–patient relationship,” he says. Patient satisfaction scores speak to a variety of concerns in this relationship, encompassing such areas as empathy, perceived competence, trust and a willingness to comply with recommendations.
Dr. Krant
Sheryl Mascarenhas, MD, assistant professor of rheumatology, The Ohio State University, Columbus, Ohio, has found that patient satisfaction scores help evaluate the delivery of care. “Patient ratings regarding clinic flow, including wait times for registration, rooming, time with the physician and wait times for laboratory and radiology results, are helpful to know,” she says. “Rating office staff’s interactions and how well patients understand their physicians may uncover problematic areas that were unrecognized otherwise.”
Obviously, high satisfaction scores are a win–win for all parties involved. Here, some rheumatologists provide specific ways to make improvements and, ultimately, increase patient satisfaction.
Patient Interaction—Outside the Office
Dr. Mascarenhas
Patient engagement begins with the reception they receive when first calling a practice. “If staff appear disorganized or disinterested, a patient may perceive that as a lack of commitment to care, which could make them wary of potential problems related to promptness and preparation,” Dr. Rosenstein says. “This can ultimately lead to patient frustration, misunderstanding and lack of compliance.”
Jonathan M. Greer, MD, FACR, FACP, president, Arthritis and Rheumatology Associates of Palm Beach, and affiliate clinical professor of medicine, Nova Southeastern University, Boynton Beach, Fla., says it’s important that all office staff are attentive, caring and treat patients with respect—as if they are the practice’s only patient. Because his practice is inundated by phone calls, callers often don’t speak with a live person—which is not ideal. However, patient calls are returned the same day.
Dr. Greer
Dr. Mascarenhas has found that having the same care team members involved with each patient case works well. “Think of this as closing the loop of communication with as few members as possible,” she says. For example, when a patient phones into the practice’s call center they will speak with one of seven people. If further communications are necessary after their initial call, ideally the original call center employee will handle it because she is already familiar with the patient’s issue. This limits the need for the patient to rehash their history multiple times with multiple staff.
Patient Interaction—Inside the Office
Inside a practice, it’s also important to create an environment of trust. To achieve this, Dr. Rosenstein says a physician must display empathy, competence and a willingness to discuss a patient’s concerns and expectations. This is especially important in the field of rheumatology, where treatments are often perceived as challenging or even threatening.
In fact, doctor–patient communication is a major component of the process of providing healthcare. It can be a source of education, motivation, reassurance and support. “Not only does the patient benefit from this interaction, but the physician is also more likely to have less frustration and greater job satisfaction,” Dr. Rosenstein says. “Practitioners and medical staff members who have good communication and interpersonal skills are more likely to detect problems earlier, prevent medical crises and unanticipated interventions, and provide better care and support to their patients.”
Taking this a step further, Dr. Mascarenhas advises explaining your thought process as to why you are recommending certain medications or tests and asking if a patient feels comfortable taking a medication. “Medicine has shifted from a paternalistic model; now patients are usually partners with their doctors regarding medical decision making,” she says.
Dr. Greer says offering a one-stop-shopping service, along with great customer service, appeals to many patients. “The fewer places a patient has to travel to get care, the better,” he says. His practice offers onsite imaging and laboratory services, along with an infusion center staffed with nurses who treat guests like royalty. The center features state-of-the-art reclining chairs, Wi-Fi and flatscreen TVs, and provides snacks and beverages.
Quality of Care
For Dr. Greer, quality of care boils down to how a provider interacts with a patient. “I make it a habit to greet each patient, shake their hand and then sit down,” he says. “I don’t stand, because that gives the impression that I’m in a hurry to go somewhere else.” He’s also careful to look a patient in the eye, ask them questions and then listen while they talk. “Actively listening lets a patient know that you’re paying attention to them and taking them seriously,” he says. A scribe types notes while he focuses on the patient.
Dr. Greer also makes it a point to physically examine every patient, which includes a full rheumatology and internal medicine exam. “This ensures that I will obtain the information I need, and also makes the patient feel that I am more involved in their care,” he says. An exception would be if they had an isolated condition, such as trigger finger. He believes this is important because most rheumatology patients have multiple conditions and co-morbidities. For example, rheumatoid arthritis patients may also have high blood pressure, obesity, diabetes or coronary artery or gastroesophageal reflux disease. “Don’t only focus on the one arthritic complaint, because other medical problems will interact with how you treat them.”
Dr. Mascarenhas has found that many patients link how well they understand their physician with the quality of care that is delivered. “It can be helpful to inform patients of your ultimate game plan, so they can see the big picture,” she says. For example, during a visit she might discuss her plan for stepwise testing. This way, there are fewer surprises if they receive a follow-up call advising further testing. She might also discuss long-term medication plans. In addition to discussions about typical side effects, it can be helpful to let a patient know how long it will take to see the full effects of a particular medication. Discuss an alternative plan in case the treatment regimen fails.
To improve wait times, Dr. Mascarenhas considered what medical assistants were asking patients in exam rooms & realized that some questions were unnecessary. ‘Reducing their duties to essential questions decreased the time spent rooming patients, which again improved our clinic flow,’ she says.
Promptness
Patients need to understand that their physician is attending to many other clinical challenges, not only their own. And physicians need to understand that patients lead an existence outside of their practice. “Mutual respect and understanding of the time constraints of both parties [are] essential,” Dr. Rosenstein says.
Dr. Mascarenhas says promptness involves staying on time with your schedule and, if you’re running behind, having staff inform patients of the wait time. But going beyond this, she has found that giving patients reasonable expectations about timeframes works well. “Some patients expect to get results back before they may even be available,” she says. “Other patients may expect paperwork, such as Family Medical Leave Act forms or prior authorizations, to be completed immediately, which may not be plausible in many practice models.”
Dr. Greer’s office gives patients access to a Web-based portal where they can view their electronic health records, and check laboratory and imaging results. They can email the doctor through the portal, and Dr. Greer will respond within 24 hours.
In an effort to be prompt, Dr. Mascarenhas has asked staff to schedule procedures or certain patients who are known to take a long time accordingly. For example, she might schedule a patient whom she expects to take a while in a new-patient time slot or at the end of the day.
In another initiative to improve wait times, Dr. Mascarenhas considered what medical assistants were asking patients in exam rooms and realized that some questions were unnecessary. “Reducing their duties to essential questions decreased the time spent rooming patients, which again improved our clinic flow,” she says.
Final Thoughts
Dr. Greer’s final piece of advice is to treat every patient’s complaints seriously, with respect and dignity. “Never belittle their conditions or speak badly of someone in public. Be careful what you say to colleagues and staff.”
The bottom line is that you won’t please everyone. “There will always be things beyond your control that will affect your survey performance,” Dr. Mascarenhas says. “View surveys as tools to improve your delivery of care.”
Karen Appold is a medical writer in Pennsylvania.
