Lee A. Resnick, MD, FAAFP
It is well known, and exhaustively preached, that a satisfied customer will tell 2-3 people while a dissatisfied one will tell 8-10 (with some estimates as high as 20). Measuring and tracking patient satisfaction has become a focus of most every practice owner, much to the chagrin of their employees, who often view this as a way to publicly embarrass and unfairly harass the staff. And yet, whether we are owners or employees, we all make pledges to our patients with regard to things like quality, quickness, and caring.
Conflict often arises in the debate over how to measure what exactly constitutes successful delivery on these promises. At one extreme is the case of the physician who has determined that patients will be inherently dissatisfied with their care because it is based on “quality” and “best practice,” which often conflict with patient desires. While there are certainly examples of encounters that fit neatly into this paradigm (drug seekers and unnecessary antibiotics come to mind), this all-or-nothing position vastly oversimplifies and completely misses the opportunities inherent in the process of eliciting patient feedback. We’ll call this physician an “absolute dismisser.” Another involves the physician, or practice owner for that matter, who focuses attention on the positive comments and high scores and dismisses the negative comments and lower scores as “outliers,” defending each one with excuses and blame. We’ll call this one the “selective denier.” And finally, consider: The employee who self-flagellates over every negative encounter or comment, throwing up his or her arms in defeat, seeing no point in trying so hard to please. We’ll name this person the “masochistic capitulator.”
Overcoming these dismissive and negative interpretations is not easy, but it is critical to the success of any practice in an increasingly competitive environment. MGMA recently released their benchmarking report, which found that 80% of “better performing” practices use patient satisfaction surveys. One might expect that the historically “consumer focused” urgent care industry would be even higher. Two significant business drivers are at play here:
- Volume: Patient satisfaction drives “repeat visits” and “friends and family referrals,” two of the most important volume variables in the business.
- Reimbursement: Irrespective of the final details and “ruleset” of the Affordable Care Act, reimbursement models are changing, and quality measures are undoubtedly a part of the new paradigm.
So, given the strongly held and profoundly negative view of patient satisfaction surveys by providers and other employees, how do we “sell” the use of these tools in our practice?
- Adopt a “weakness orientation”: Looking at our “warts” is the only way we will identify gaps in performance and opportunity for improvement. This principle can be adopted as a core value of your urgent care practice, and as such, be communicated and “pledged to” at hire. A low score or dissatisfied patient can be viewed as a “gift” to the practice and to the employee that offers insight into collective performance and into the “needs” of patients as consumers of health care.
- Be a “myth-buster”: Identify the “selective deniers,” “absolute dismissers,” and “masochistic capitulators” in your practice and point-by-point, break down the myths they have built up to protect themselves from feeling vulnerable when presented with criticism. Expose the judgments, labels, and assumptions they are using and show them how these can create real obstacles to the quality patient care they so vehemently espouse. Identify the self-destructive and avoidant behaviors they are using. Reveal the opportunities they have to grow by listening more carefully to patients. And celebrate the long-term job satisfaction that comes with this approach.
All said, we are in a transformative time in health care, and “patient-centered” care has become a key benchmark for quality and business success. Developing a positive approach centered on a set of core values that everyone in the practice can agree to is the best way to take advantage of this incredibly valuable opportunity. This is our chance to turn “myths” into “gifts.”
