Customer Service in the Ambulatory Setting

1. Customer Service in the Ambulatory Setting David W. Mountjoy, MHA, FACHE Executive Director-Ambulatory Care University of Missouri Health Care

2. University of Missouri Health Care Clinic System • 51 Outpatient Clinics-Primary Care and Specialty Care • 600,000 Clinic Visits Annually • 400+ Physicians-Mix of Full and Part Time Faculty • 585 Clinic Staff • Clinics Reviewable by Centers for Medicare and Medicaid Services (CMS) and The Joint Commission • Clinic Management Model Requires Collaboration between Hospitals, School of Medicine, and University Physicians Practice Plan

3. Clinic Organizational Chart

4. Customer Service in UMHC Clinics • History as a Teacher • Who Owns Customer Service? • Getting Organized • Buy-In • Voice of the Customer

5. Why Focus On Customer Service? • Competition • Revenue and Finance • CG-CAHPS • Reputation/Marketing • Most Important…”It’s the Right Thing to Do”

6. Core Components of Customer Service • Leadership • Service Goals and Expectations • Responsibility and Accountability • Communication • Education • Service Recovery • Reinforce Behaviors • Measure Satisfaction • Action Planning

7. Education and Training • Ritz Carleton Model • Patient and Family Centered Care (PFCC) • Clinic Front Desk Training • Interpret Survey Results • Action Planning-It Takes a Team

8. Measurement Tools • Clinic Free-For-All Surveys • Press Ganey Survey-Pluses and Minuses • NRC Picker • Clinic Pulse Surveys

9. Press Ganey • 28 Questions • Some Questions not Relevant • Low Response Rates • Timeliness of Results • User Friendly • CG-CAHPS

10. NRC Picker • Guaranteed Response Rate • Web-based • Timely Results • Custom Reports • Stoplight Reporting • Sample Action Steps for each Question • Shared Action Planning

11. Clinic Pulse Survey • Simple and Brief-2 Questions • Timely Results-ARC • High Response Rate • Rapid Action Planning • Inexpensive

12. The Good, The Bad, and The Ugly • Examples of Less Than Desirable Practices • Examples of “Works in Progress” • Examples of Great Successes

13. Patient Expectations in Clinics • The Visit Through the Eyes of the Patient • Greeting and Welcome • Wait Times-Waiting Room and Exam Room • Provider Encounter • Clinic Environment • Technology

14. Speaking of Technology… • Phones and Phone Management • Smart Phones • Email • Social Media • Telemedicine • EMR/HIE

15. Example of ACDReport

16. Patient Portals • Book Clinic Appointments 24/7 • View Previous Appointments • View Lab Results • View Medical Record • Communicate with Provider • Receive Appointment Reminders • Prescription Refill Requests • Patient Education Material

17. Strategies For Customer Service to Improve Patient Satisfaction • Communication with Patients • Staff Training and Engagement • Physician Training • Other Tools

18. Communication With Patients • Appointment Delays-Be Honest and Timely • Reminders • Cancellations/Rescheduling • Utilize Wait Time • No Surprises-Don’t “Blindside” Patients • Patients Care about their Care

19. Staff Training and Engagement • Patient Satisfaction-Incorporate into Performance Evals • Phone “Scripting” • Phone Etiquette-”Smile over the phone” • 5/10 Rule • Body Language • Manage Up • Appropriate Attire and Appearance • Partner with the Patient • Be a Resource

20. Physician Training • Review Clinic Schedules/Appointment Access • Distribute and Review Physician-Specific Patient Satisfaction Scores • PFCC for Physicians-Mandatory • Incorporate Patient Satisfaction into Incentive Plans

21. Other Tools • Communication Boards in Clinics • Share Best Practice in Clinic Staff Meetings • Do Follow-Up Phone Calls • Review Clinic Space for Best Workflow • Clinic Environment-Art, PCs, Clean, and Safe • Stand Behind Your “Brand” • Rounding For Outcomes • Innovate

22. Results • NRC Picker • Pulse Surveys

23. Patient Experience – Our Journey Made Goal 6 out of 6 times Made Goal 3 out of 9 times

24. Clinic Pulse Surveys • Question 1: Based on today’s visit, I would recommend this practice to family and friends. Options: Strongly Disagree, Disagree, Neutral, Agree, Strongly Agree • Question 2: What, if anything, could have been improved today? Options: No Problems, Scheduling Appt., Check In/Arrival Process, Care Provider, Lab/X-Ray/Other Service, Nurse, Wait Time, Comfort/Cleanliness, Check-out Process • Survey Period-11/05/12-11/09/12 (5 working days) • Response: 35% of all patients seen completed survey

25. Clinic Pulse Surveys • Mean Score for Q1 for 3517 responses: 4.4 (5=Strongly Agree) • Q2 Results: • No Problems=2946 • Scheduling=64 • Check In/Arrival=87 • Care Provider=36 • Lab/X-Ray/Other=23 • Nurse=22 • Wait Time=351 • Comfort/Cleanliness=52 • Check-out=36

26. Suggested Readings • Hardwiring Excellence-Purpose, Worthwhile Work, & Making a Difference. Quint Studer • Front Office Success-How to Satisfy Patients and Boost the Bottom Line. Elizabeth W. Woodcock • Mastering Patient Flow-Elizabeth W. Woodcock. Second Edition • If Disney Ran Your Hospital-9 ½ Things You Can Do Differently. Fred Lee. 2006 • Customer Service in Health Care-Optimizing Your Patient’s Experience. Karen A. Meek. • The Six Elements of Customer Service-Gail Scott • 8 Customer Service Ideas to Enhance Patient Satisfaction. MGMA Journal. March 2010