Ensuring patient satisfaction and establishing good practice

Introduction
Patients are the foundation of our
medical practice It is very obvious that they must be satisfied Do we always succeed?

Some experiences

Patients tell the truth

 Quality service? I dont ask for much

from my doctors. The woman, a business professional in her late 30s, seemed pleased to be asked. I dont want to wait endlessly, but I understand it if something comes up in the schedule to cause a delay just tell me about it! Im much more forgiving if someone keeps me informed.

 I like to feel that I have my doctors

attention during the visit. I dont expect a half hour of his time, just a sense of concern. My pediatrician is wonderful. He

always remembers something personal

about my child. When he talks to me, he

looks right at me not at his paper work

or forms or does not talk on phone

 His staff is friendly. They make me feel

welcome and not like an interruption in their day. He explains things so they make sense, and he gives me information that I can take home and read. Im not just a case to him.
Patients dont care how much you know

until they know how much you care - Sir William Osler

Dynamics of medical practice today Patient as a customer Doctor as a service provider

In the past
Doctor was God
Supreme authority

Medical practice as business activity

Health care as one of the largest service sector industry Huge capital investments- expected returns

Drivers: technology, health regulations, health insurance, CPA, standard of living, influence of media, internet
Customer service provider Customer is the king

Patient satisfaction pays

1. Greater profitability.
2. Improved patient retention and patient loyalty. 3. Increased patient referrals. 4. Improved compliance.

5. Improved productivity.
6. Better staff morale.

Patient satisfaction pays

The Quality Diamond Model of patient satisfaction.

QUALITY MEDICAL CARE

Customer

Continuity

QUALITY MEDICAL CARE

Commitment

Expectations

The Customers : types

Difficult to deal with : Demanding, annoying,

unrealistic, loud and objectionable.

Desirable: pleasant, easygoing, intelligent,

accommodating and knowledgeable

Others: timid, questioning, unprepared, lacking in knowledge and uncertain about what they want or need. Have to handle all

Commitment
Emotional and intellectual pledge to a course of action Your commitment to quality services must be 100%.

If you are interested in something, you do it when you have time. If you are committed to something, you make time to do it.

Guidelines to ensure commitment to quality

1. The physician needs to be a participative
leader with conviction. 2. Have a statement of mission and vision for quality services and share it with the staff. 3. Recruit a high performance staff 4. Build a team which is committed to quality services.

Ensure commitment
5. Empower the employees to achieve goals of quality services

6. Ensure staff satisfaction and motivation

by various means like good salary,

appreciation for good work and

imparting a feeling of importance

Ensure commitment
7. Do some medico-social activities in the
hospital premises or get involved with

similar activities done by other

organizations. 8. Have accreditation by some regulatory authority or agency (e.g. ISO).

Expectations
(1) Medical (Clinical) expectations: These relate to accurate diagnosis and treatment. This is dependent on the medical core competence.
(2) Non-Medical expectations: These relate to physical facilities and functional components of services.

1. To have clinical core competence. Cure rate does matter

Few general expectations

Luxurious physical facilities cant substitute

CME
Good clinical methods Exude confidence Rational therapy Evidence based practices

Few general expectations

2. Honor the appointments. Appointment system
should be accurate but flexible.

3. Communicate well with them in day to day

language. Medical jargon should be avoided.

4. To listen to their problems patiently and give

them enough time. Master the art of listening

5. Show personal concern for the patient.

Few general expectations

Body language ,greeting , a good first impression of a caring physician, make it visible that we are with them in their worst times too.
6. To explain everything about the illness and treatment.

A short detour through the illness - etiology, pathology, clinical features, diagnostic investigations, treatment and prevention

Few general expectations

7. Staff which shows care, concern, courtesy and empathy.
Patients spend more time with paramedical staff

Behaviour and attitude of the staff

Ask to go beyond the rules of duty to help Handle personal and telephonic conversations Promptness in all responses Emergency case, admissions

Few general expectations

8. Provide reasonably good physical facilities.
Both outdoor as well as indoor Approachable location with good parking facility

Child friendly environment, cleanliness, facilities for recreation (library, toys, music, TV etc.)
Proper place for eating

Enough space for various facilities.

9. Impart health education: handouts, video examples.

10 Proper documentation.

Few general expectations

Good legible prescriptions, a detailed discharge summary, certificates, prompt issue of papers for mediclaim Clear explanation for administration of medicine to ensure compliance.

11.To provide hospital information brochure and to have informative sign boards.

Few general expectations

12. To have transparency in financial matters.
One of the major causes for dissatisfaction Proper display of routine consultation and indoor charges Should be properly informed about the expected expenditure before any procedure or admission.

Few general expectations

13. To use modern technology. Computerization and adaptation to new technology for diagnostic and therapeutic purposes. 14. To have easy flow between various services.

Patient should not be wasting time to avail of various services.

Factors affecting expectations

1. Nature of medical illness.
2. Past experience in the same set up.

3. Experience at other set up.

4. Financial and social standing. 5. Level of education.

Measuring expectations
1. Direct approach: Simple but effective technique. Can be used by doctor as well as the staff.

2. Questionnaire: This can be designed according to the services provided.

3. Suggestion Box: Outdoor as well as indoor facilities This box should be periodically opened.

Measuring expectations
4. Listening to the staff: Patients often talk more freely with the paramedical staff. 5. Listening to the patient: Their past

experiences at other hospitals, a valuable insight

into causes of dissatisfaction 6. Analyzing a discharge against medical advise: An opportunity to analyze the short comings in the services and improving upon them.

Meeting expectations - few principles:

1. Have systems in place to meet general expectations. This involves hospital administration.

2. Be flexible because expectations keep changing.

3. May not be able to meet all expectations, but one must try to manage. Managing expectations means patient listening and then explaining as to why we can not meet those expectations.

Meeting expectations - few principles

4. Unrealistic expectations may be gently
managed through patient education.

5. Take a walk in your patient shoes. Look at the

whole set up from patients point of view and find out good and bad things about our set up. This helps us to delete the negatives and enhance the positives.

Meeting expectations - few principles

6.Delight the customer is the buzz word .Going
beyond the patients expectations. Anticipatory guidance or asking the nurse to supervise and train a mother for breast feeding in an OPD visit 7.Master the art of handling difficult patients.

Consider them as the people who are testing the

quality of your services.

Meeting expectations - few principles

8. Service Recovery (when things go wrong):
Apply the triple A action plan. The steps are Acknowledge, Apologize and Amend.

Accept that mistakes do occur, but should make all efforts to prevent them.
Analyze the factors leading to mistakes and try to correct them. Differentiate between the wrong act and the doer. Criticize the wrong act and not the doer.

Continuity
Loop-closer in the quality diamond model.
A method for ensuring continuous,

consistent, ever-improving and never

ending service quality. All the ways and means of measuring, evaluating and monitoring the progress.

Continuity
It ensures that services get better day after day. Can we do better? is the guiding question It is about accepting the fact that what you do today may not be appropriate or effective

tomorrow.
Things do change.

Continuity
Benchmarking.

Looking beyond to other setups for better services and customer satisfaction.
Opens windows of our mind and let in new ideas.

Setting standard of service for all aspects

Continuity also requires monitoring patient satisfaction. A formal comprehensive process for determining patient satisfaction, may be in form of questionnaire

Thanks