Fenway Patient Services Cust Svc Manual FINAL copy

Fenway Health Customer Service Manual: Patient Services November 5, 2013

1

Introduction: Joe Foxborough is Late Again
“Yes, Dr. Osley will see you this
afternoon at 3 pm. Please come to
the fourth floor of 1340 Boylston
Street and check in with me at the
front desk so we can fill out your
paperwork before you see the
doctor…you’re welcome.” Annie
Smithfield, a customer service
representative at Fenway Health
for four years, enjoyed making
same-day appointments with
patients; they were always happy
to learn they could see a provider
so quickly.
She was still smiling when she
turned from her telephone to the
young man in front of her. “How
can I help you?” she asked. “I’m
here for my appointment with Dr.
Osley,” he answered, in an agitated
voice. Annie recognized him as Joe
Foxborough, a frequent visitor to
the health center, who almost
always had a problem and who
often arrived late. Still, she asked
him for his name and date of birth.
He complied. So far, so good,
Annie thought.
But not for long. “Oh, and here’s
my new insurance card. My
employer switched plans since my
last visit,” Joe announced. Annie
spared Joe the lecture about how
much time he could have saved
everyone if he had just called
ahead with this news, particularly
because his new plan was issued
by the company with the most
time-consuming process for
verifying coverage of any provider
in the state. But as she was about
to dial the phone, she noticed the


2

time for Joe’s appointment on her
screen, and realized that she had a
bigger problem.
“I’m sorry, Joe, you’re more than
fifteen minutes late. I’ll need to
ask Dr. Osley if he can still see
you. If he can’t, we’ll need to
reschedule.” The patient didn’t
waste a second on his way to an
angry confronation. “What do you
mean, I’m late? You’re the one who
was on the phone making that nice
appointment for 3 o’clock this
afternoon. If you were doing your
job and paying more attention to
the people here in front of you,
you’d have talked to me when I
came in, and I’d be on time.”
Annie spared Joe a second lecture
about the warning he received for
being habitually late the last time
he had an appointment at Fenway.
He was clearly in the mood for a
fight, and if Dr. Osley would see
him, she’d still need her patience
for the phone call to his insurance
company. “Let me check with Dr.
Osley and we’ll see what we can
do,” she said. “Tell him it’s me, Joe
Foxborough. He’ll see me,” Joe
replied.
Annie found Julie Krause, Dr.
Osley’s medical assistant, and gave
her the news about their tardy
patient. “Joe Foxborough? Late? I’m
shocked,” she said, rolling her
eyes. “I warned him myself last
visit that he couldn’t be late again.
And besides, Dr. Osley’s already
with his next patient. We’re
booked solid except for 3 pm this
afternoon. Joe can either wait 3
hours or come back another day,”
Julie continued.
“Well…no…I just booked that 3 pm
slot a few minutes ago,” Annie


3

replied. “Then Joe’s just out of
luck. It’ll serve him right. And why
is he here? Wait, don’t tell me. It’s
‘personal,’ right?” asked Julie.
“Always late, and it’s always
‘personal.’” Julie was right on all
counts, and Annie couldn’t blame
her for being so cynical. “Okay, so
can you tell him he needs to
reschedule” Annie asked. “Oh, I
would love to give Joe the news up
close and personal,” Julie
answered. “But Lenny, the other
MA, is in with Dr. Osley now and
I’m covering for him. There are
three patients – on-time patients –
waiting for me right now. You’ll
just have to experience the fun of
telling Joe to go home all to
yourself.” Annie wasn’t sure it
would be as much fun for her as it
would be for Julie, but she knew it
was up to her to deal with Tardy
Joe. And she knew she needed to
be ready for a fight.
It was waiting for her. “What do
you mean, ‘come back next
week’?” shouted Joe. “I need to see
a doctor today!” Annie kept herself
calm. “Well, Joe, I understand and
want to do all I can to help you,
but it’s up to the providers to
decide if they’ll see a late patient,”
Annie answered, remembering to
stay calm. “I don’t care whose
decision it is, lady. I need to see a
doctor today! And besides, I wasn’t
late; it was your fault that you
didn’t see me on time because you
were busy talking on the phone
when I got here. I’m not leaving
until I see a doctor.” Annie was
scanning Dr. Osley’s schedule for
an opening when she noticed an
incoming telephone line ringing
with no one else able to answer it.
She picked up the phone while
scanning the schedule and was
about to answer it when Joe


4

blurted out, “This is incredible. I’m
going to get AIDS because Fenway
Health decides not to see me?!”
“Fenway Health. Can you please
hold?” Annie had never said these
words so quickly, and she hoped
the caller didn’t notice the stress
in her voice before she pressed the
“hold” button. “Excuse me, Joe, did
you say you came here today for
an NPEP?” Like Julie, Annie had just
assumed his “personal” reason for
the visit was Joe’s regular behavior
of keeping as much of his
information as private as possible.
“NPEP, two-step, I don’t care what
you call it. I think I’ve been
exposed to HIV and I want the
medication you have to prevent the
infection. I don’t have until next
week. You know the 72-hour time
frame for treatment as well as I
do.” Of course, this news changed
everything. “Of course. That
changes everything,” Annie
acknowledged. “Thank you for
telling me the reason you’re here,
Joe. I’ll go and talk to the doctor
right away.” Thankfully, Annie was
able to transfer the caller to
another patient services
representative, and she went back
to find Dr. Osley or Julie Krause.
“Oh, and thanks for making me
raise my voice about the reason
why I’m here so everyone in the
waiting room knows my business,”
Joe continued to shout.
“Julie. Joe Foxborough is here for
an NPEP. He just announced it to
the entire waiting room. Who do
you think is the best provider to
see him today?” Annie noticed she
was still talking quickly, and
worked to calm herself. Julie didn’t
hesitate. “Wow, Annie, let me ask
Dr. Stanesh if he can delay his
lunch break and see old Joe in a


5

half-hour. I’ll meet you back at the
front desk.” Annie went back and
found Joe still standing at the front
of the counter. “Joe, I’m waiting for
confirmation that someone can see
you at noon. And since you will be
seen today, let me start working
on your new insurance plan. Can
you give me your card, please?”
After all this, Annie thought, now
she would have the chance to
listen to recorded insurance
company music for minutes on
end. She dialed the number,
punched “1,” then “4,” then “1,”
again, and finally entered Joe’s
fifteen-digit account number. The
ensuing instrumental version of
“Living on a Prayer” was the worst
she had ever heard. Luckily, Julie
arrived with good news. Dr.
Stanesh, a resident with great
people skills, agreed to see Joe
before going to lunch.
While Bon Jovi’s song was being
hacked to pieces in her left ear –
Annie didn’t want to lose her place
in line – she called Joe to let him
know she had found a provider.
With all the manners he could
muster, Joe thanked Annie and
took a seat by the window, but not
before asking Annie to make sure
his new coverage wouldn’t change
his co-pay amount for an office
visit. “Living on a Prayer” gave way
to “American Pie,” and then, “Call
Me, Maybe.” Finally, someone at
the insurance company picked up.
Annie was in the process of
verifying everything for Joe when
he jumped up from his chair and
rushed up to her.
“Wait a minute. Did you say Dr.
Stanesh is a resident? I don’t want
to be seen by anyone still in
school. I pay good money for my
health insurance, and my


6

insurance says I get to see an MD. I
want a real doctor,” Joe told her.
Annie was in the middle of her
conversation with the insurance
company’s service representative,
and she didn’t want to hang up
and start over. She knew that Joe
needed to know his co-pay, and
Fenway’s finance office would want
to be sure his new plan covered his
visit before he went in to see a
provider. But Joe was in her face,
demanding his preferred standard
of care, in a waiting room that was
increasingly busy. He was
becoming a distraction to everyone
else. Annie managed a calm smile.
“Joe, I’m working for you now with
your insurance company. I want to
be sure to tell you your new co-
pay, and if I don’t finish this call, I
won’t be able to do that. Can you
give me a few more minutes,
please?”
She was counting on Joe
appreciating the attention she was
giving to him, and because he
knew she was working on his
behalf, he lowered his voice.
“Okay, but I still want a real doctor
when you’re done,” he said, and
went back to his seat. Annie
resumed her call with the world’s
worst insurance company, gave the
representative all of Joe’s
information, and – of course – was
asked to wait a few short minutes
for the representative to confirm
Joe’s coverage, co-pay, and
prescription medication plan.
Annie cringed, knowing what was
coming next. Sure enough, she
heard a muzak version of “Girl on
Fire.”
Even though Annie was waiting on
hold, she couldn’t really relax. She
scanned the waiting area and saw
several people who looked like


7

they were ready to ask for help.
And she knew that after her call
with the insurance company was
done and she got the information
the finance department and Joe
needed, she was still going to have
to deal with his demand for a “real”
doctor. Annie felt a tap on her
shoulder. It was Julie Krause. “Dr.
Stanesh wants to know how much
longer you’re going to be so he
can see Joe in time to finish up and
eat lunch before his afternoon
patients,” she said, and walked
away. After a few more seconds in
musak hell, Annie heard the
insurance representative come
back on the line to let her know
everything checked out. Joe was
covered for the visit, and his co-
pay for the office visit and
prescription drugs wouldn’t
change. Annie entered all the
information into her computer,
and steeled herself for her
conversation with Joe. She called
him back to the front desk. “You’re
all set with your new insurance.
Same $25 co-pay for an office
visit, and the same $15 or $30 for
prescriptions.”
“Big deal. What are you going to do
for me to make sure I’m not
pawned off on some medical
student?” Joe was done
appreciating Annie’s work. And
Julie was back asking if Annie
could hurry up and get him to see
Dr. Stanesh as soon as possible.
Annie took it all in, and decided to
sit quietly for a few seconds. Her
serene expression hid a silent
fantasy in which she violated every
customer service standard there
ever was. In her mind, she told Joe
to go away and never come back,
she let Julie know what Dr. Stanesh
could do with his sandwich, and
she called the insurance company


8

just to sing the worst songs she
could imagine to anyone who
answered the phone. It was a great
momentary vacation.
But reality beckoned, and Annie
had to think fast. She opted for
strength in numbers. “Julie, can
you come here to the front desk
for a minute?” Caught off guard in
front of everyone in the waiting
area, Julie had no choice but to
comply. “Joe, this is Julie Krause.
She’s the medical assistant for
both Dr. Osley and Dr. Stanesh.
You two may already know each
other. Julie’s been helping to
arrange an appointment for you
today and we want to encourage
you to take the appointment with
Dr. Stanesh.” Annie believed that
the longer she explained the
situation without giving Joe a
chance to interrupt, the better. She
also thought that Julie’s
appearance in scrubs would look
more official to a patient like Joe,
increasing the odds that he’d
accept the appointment. “Julie, Joe
knows we’re going to see him
today for his NPEP, but he’s
concerned that Dr. Stanesh might
not be right for him because he’s a
resident and not one of our staff
physicians. Can you help Joe talk
through some of his concerns?”
Julie had her cynical moments, but
she was a team player, and knew
what to say. “Of course, Annie.
And yes, Joe and I know each
other.” Turning to Joe, she
continued, “like all of our
residents, Dr. Stanesh is an MD, so
he’s a real doctor, I can assure you
of that. I’ve worked closely with
Dr. Stanesh for six months, and
he’s a very good doctor. He’s
completely qualified to handle
your reason for being here today,


9

and if for some reason he, or for
that matter, you, believe a
supervising doctor is needed, Dr.
Osley or one of our other staff
physicians will come into your
exam room to deal with any
problems or questions.”
Joe was quiet, maybe because of
Julie’s official medical appearance,
so Annie decided to add her
reasons for accepting the
appointment. “Joe, I understand
you were upset when you thought
we wouldn’t see you today for
treatment that’s obviously time-
sensitive, and we really want to
help you. Unless there’s more than
your need to get a prescription for
NPEP medication, Dr. Stanesh will
do exactly the same thing Dr.
Osley or any other physician would
in these circumstances. The most
important thing is for you to get
evaluated quickly, and we can start
that process right now if you agree
to see Dr. Stanesh. I can book you
another visit with Dr. Osley, in case
you need any follow-up.” Julie
added her agreement, and they
both waited for an answer from
Joe.
“Okay, I’ll see Dr. Stanesh. You did
stay with me by spending all that
time with my insurance company, I
saw that. And you know how much
I like Dr. Osley, so if you can at
least let him know I’m here and he
has a minute, maybe he can come
in and say hello. I’m pretty
concerned about being exposed to
HIV, but you’re right, starting the
treatment is the important part, so
let’s go,” Joe said. “Great, I’ll meet
you at the door to your left and
take you in,” Julie answered. Joe
went with her to see Dr. Stanesh,
and Annie resumed her work with


10

the next patients and telephone
calls.
Later that afternoon, after Joe had
left, Francine Fontaine, the fourth-
floor patient services supervisor,
called Annie aside to talk about the
incident with Joe Foxborough. “I
heard you had quite a time today
with our old friend Joe,” Francine
began. “I think we can all learn
something from it and would like
to brief Perry about what happened
before the end of the day.” Perry
Morea was Fenway’s Patient
Services Director, and it would be
her job to decide if the incident
was important enough to discuss
at the monthly departmental
meetings. “At the very least, we’ll
talk about it in tomorrow
morning’s fourth-floor huddle,”
Francine continued. “So, let’s start
at the beginning and talk about
what went right and what went
wrong.”
Annie was almost more upset now
that the whole affair was over. She
had managed to keep calm while
Joe was in the building, and
apparently it was quite an effort,
given how she felt while she was
talking with Francine. “Well, the
obvious things were that Joe was
pretty rude to me while I was
trying to help him, and of course
the fact that he’s always late and
always lists his reason for coming
as ‘personal.’ I think we’re all a
little guilty of not taking him
seriously because he’s always
misbehaving on some level. I have
to admit I didn’t see it coming
when he blurted out that he was
here for an NPEP.” Francine kept
listening, asking Annie to
remember other details she
thought were important.


11

Annie continued, “I almost lost it a
couple of times, mostly when I
thought we had solved Joe’s
problems and he jumped up to
complain about Dr. Stanesh being
a resident and not a real doctor.
That made me angry, particularly
because we really bent over
backwards for him. If I didn’t force
myself to stay calm by saying
nothing at all for a while, I really
would have snapped at him. And I
probably took a little advantage of
Julie Krause by bringing her into
the conversation with Joe about
why he should see Dr. Stanesh,
because I believed her scrubs
would help convince Joe in a way I
couldn’t with my regular
receptionist clothes. She was nice
enough to help, but I really was
kind of desperate and didn’t give
her a choice about whether to get
involved. And it didn’t help that I
had to contact his insurance
company in the middle of
everything because he had
changed plans and never told us in
advance.”
“Those are all good concerns,
Annie,” Francine agreed. “We can
check with Julie, but I’m sure she’s
fine. I’m interested in what the real
core of the problem was today.
There was a lot going on, from Joe
always being late and never giving
us a reason for coming in, and
then having to call the insurance
company, and finally finding out
that Joe only likes to be seen by a
staff physician. But what do you
think the central issue was?” Annie
thought a moment, and answered,
“Well, me multi-tasking is always
an issue when any single thing
gets complicated. I need to find
the time to pay attention to that
complication and sometimes feel


12

like I can’t ignore everything else.
But that happens every day. The
real problem was that this patient
got so emotional and
confrontational, and made it even
more difficult to solve his
problem.” Francine waited a
moment, and asked, “And so,
Annie, what do you think it was
that made him so upset?” The
answer was obvious to Annie now,
after things had calmed down.
Maybe it always was obvious. “Oh,
it was the fact that he had an NPEP
issue and had to be seen within 72
hours, and we were going to send
him away because we didn’t
know.” Francine let Annie know
that was exactly the core issue,
thanked her for a job well-done,
and for taking the time to talk with
her about the incident.
Francine went to Perry Morea next,
to let her know about the incident
and talk about how to maximize
its value as a learning opportunity
for other patient service
representatives. After talking with
Francine about Joe Foxborough’s
tough day on the fourth floor,
Perry shared a few of her thoughts
as a way of opening up a more
general conversation. “Well, it’s
clear that the central issue is the
patient’s reluctance to state his
real reason for coming, and our
staff’s general attitude that he’s
habitually late, and not a very
cooperative individual. I think our
staff did most things right,
although there are two things we
could have done better. First, we
can try to get past the ‘personal’
reason for a visit. Maybe we can
brainstorm ways to do this at our
next monthly meeting. Second, I
think we can work on better
collaboration with the medical
assistants in cases like this. We all


13

know how sometimes things are
too hectic to have a provider
involved in telling late patients the
bad news. But in this case, having
Julie Krause tell Joe about her
decision to have him come back,
instead of leaving it to our staff,
might have motivated Joe to tell us
the real reason for his visit then
and there, rather than having him
blurt out his concern that Fenway
was going to give him AIDS to a
crowded waiting room. Conversely,
Annie is right; she probably
shouldn’t have put Julie on the
spot later on when she needed
help convincing Joe to see Dr.
Stanesh. We need a little more
cross-department teamwork at
times.” Perry stopped to ask
Francine if she agreed with her
thinking. Francine did, adding that
there’s always the third issue of
patients or staff making
confidential information public in
the waiting area. “Joe obviously
wanted everyone in the waiting
area to hear his complaint, but it’s
never a good idea.”
Perry agreed with Francine’s
additional concern, and took a
step back. “These are all important
issues. The question for me is how
to address them in our system
with the best chance of solving
these problems. We could file an
incident report and bring in the
medical department to address the
need for more teamwork, or we
could take a more internal
approach and put it on our next
monthly staff meeting agenda, or
encourage use of our idea board
for possible solutions. My thinking
is to keep it internal. The need for
teamwork with the medical staff is
an ongoing concern and may
eventually be a reason for a
broader training approach. But


14

what happened today is something
for us to address as a department.
I’d like you to focus on it tomorrow
in your daily fourth-floor huddle,
and I’ll put it on the agenda for our
next monthly staff meeting. The
most important issue is still the
need for us to have found out the
real reason for the patient’s visit,
and that’s something we can
address with some brainstorming
and maybe our idea board.”
Francine agreed, and began
preparing for the next day’s
huddle.
She had four agenda items to
cover: first, the need to ask for a
patient’s reason for making an
appointment before making any
decisions about rescheduling;
second, working on better
teamwork with the medical staff in
dealing with problem patients;
third, trying to preserve
confidentiality in the waiting area
as much as possible; and fourth,
keeping a cool head in the face of
difficult individuals or when
someone was feeling
overwhelmed. Luckily, because
Annie had worked so effectively on
keeping her cool, and also because
the patient himself was
responsible for a lack of
information about why he had
made his appointment, there
would be no danger of finger-
pointing regarding this incident.
Francine was confident the
meeting would be a positive
discussion about problem-solving.
Sure enough, she was right. When
it came time to address the Joe
Foxborough incident, her staff
was more than ready to talk openly
about the common problems it
illustrated, along with possible
solutions. Everyone liked the idea


15

of working more closely with
medical assistants to verify any
unclear reason why a patient
wanted to be seen, and people
were generally optimistic that this
could be achieved, or at least
improved. “It doesn’t matter
whether a patient service
representative, or a medical
assistant, or even a provider asks
the question if there is no reason
for being seen in the file. The
answer will always help everyone,
no matter how we get it,” one staff
person said. Another volunteered,
“instead of talking about a general
need for improved teamwork with
other department staff, maybe it’s
better to identify specific problems
like ‘no reason for being seen,’
and solve these. Interdepartmental
team work will just happen
naturally if we take this approach.”
Francine thought it was interesting
that her first two agenda items
somehow managed to become a
single discussion topic during the
huddle.
The other two points the incident
raised – confidentiality in the
waiting area, and keeping a cool
head – were familiar topics for
everyone in the huddle, and led to
more general discussions than any
new solutions. “Sometimes it’s us,
and sometimes it’s the patient,”
was one comment. “Yesterday, Joe
shouted out his possible exposure
to HIV. But every once in a while,
when things get hectic, one of us
might talk too loudly about a
patient who’s here for an STD test,
or some other issue, and people in
the waiting area can hear us. We
just need to remember.” And as far
as keeping a cool head, everyone
had a comment. Some had more
than one. Francine let the
discussion go on for a while, and


16

then wrapped it up with a reminder
that losing your cool causes at
least two problems. First, it
escalates any confrontation with a
difficult individual instead of
solving the underlying problem.
And second, it gets in the way of
clear thinking. It’s easier said than
done sometimes, she admitted.
But that doesn’t excuse losing your
cool when solving customer
problems is part of your job.
Francine had a good way of
bringing issues to a close in an
encouraging way, and this
particular huddle was no
exception.
Two weeks later, Perry Morea
called the monthly Patient Services
Department staff meeting to order
in the 9th floor conference room at
1340 Boylston Street. By then,
much of the Joe Foxborough
incident had been forgotten,
replaced by other daily dramas or
customer service challenges. But
Perry raised it as one of the more
instructive incidents of the month,
pointing out the same issues
Francine Fontaine had brought to
her huddle the day after Joe came
in for his surprise NPEP
appointment. The importance of
knowing a patient’s reason for
being seen, the need for teamwork
with other departments, patient
confidentiality, and keeping a cool
head were all good opportunities
to discuss problem-solving and to
underscore every individual staff
person’s ability to contribute to
the organization and take the
initiative to provide quality
customer service. Perry’s points
were that any Fenway staff person
could have noticed a lack of a
reason for Joe Foxborough’s
appointment and taken steps to
find out. And collaboration with


17

another department is something
that any individual can initiate
instead of waiting for someone
else to take that first cooperative
step. Respecting patient
confidentiality has always been
one of Fenway’s core values, and
keeping a cool head might just be
the single most important thing to
remember on a daily basis in the
Patient Services Department.
Like she did at every monthly staff
meeting, Perry asked for any
comments or ideas near the end of
the gathering. One of her staff
raised his hand, and volunteered,
“you know, when we find a patient
who says the reason for a visit is
‘personal,’ instead of asking him
or her to state that reason out
loud, maybe we’d get a better
response if we handed him or her
a piece of paper and asked that it
be written down. That would show
respect for the patient’s obvious
need for privacy, and might even
be a good idea for maintaining
patient confidentiality in a more
general way.”
“That’s a great idea,” Perry
answered. “Maybe you should
develop it a little further and add it
to our department’s idea board.”
And on that note, the monthly
meeting adjourned.


18

A Brief History: Fenway Health
and the Fenway Patient Services
Department
The Joe Foxborough incident is a
fictional illustration of what can
happen at the front desk of any of
Fenway Health’s medical offices.
It’s designed to engage team
members’ creative problem-
solving skills for use in delivering
great customer service while
paying attention to Fenway’s core
values. While some of our
characters made minor mistakes
when confronted with difficult
individuals, the important thing is
that they all did their best. In this
story, or in the real day-to-day life
of Fenway’s Patient Services
Department, most mistakes occur
when something gets in the way of
calm, clear thinking. Because
customer service cannot be
delivered by following a standard
set of rules, and each challenge is
unique, the combination of keen
observation skills, sound thinking,
creativity, communication, and
clear “ownership” of the
responsibility for providing great
customer service is vital. No set of
rules can replace these skills and
our commitment to providing the
quality customer service Fenway’s
patients expect and deserve.
Fenway Health has a long history,
spanning over forty years.
Throughout this time, it has been a
leader in providing excellent care
for communities that rely on the
organization for affordable,
culturally-competent, and
innovative care. This has been true
from its days as a free clinic in the
1970s through the research-driven
treatment of HIV and AIDS
beginning in 1981, and including
Fenway’s well-known focus on
women’s health, designed and
delivered by women themselves.


19

The organization’s success in
delivering reliable care to
populations under-served by
traditional medical facilities is
based on quality care, unique
community-based research,
education programs for both
patients and providers throughout
the United States, and advocacy for
the provision of care to those
unable to obtain it. Fenway’s
patients come back for care year
after year because they trust us to
understand them, respect them,
and treat them well in every sense
of the word. “Customer service”
might not have been a term used
to describe Fenway’s health care
model in the 1970s or 1980s, but
the underlying values we call
customer service today have
always been here.
“Patient Services” might also not
have been the word used to
describe the individuals who
checked patients into Fenway
Community Health Center at 16
Haviland Street, or 7 Haviland
Street, for most of the
organization’s forty-year history.
Some of these people were even
volunteers, in Fenway’s early days.
Today, with the addition of dental
services, eye care, and outpatient
diagnostic services, Fenway Health
is truly capable of being a
“patient-centered medical home,”
a physician-directed medical
practice that provides patient-
centered care that is accessible,
continuous, comprehensive,
coordinated, and delivered in the
context of family and community.
In reality, this can be seen as a
description of the care Fenway has
always provided to its patients.
Patient Services representatives
may deal with the realities of a
much larger, more complex, and


20

more diversified organization.
They certainly can offer far more
services than the volunteers and
early staff people could many
years ago. But, as an integral part
of the Fenway Health team, Patient
Services staff maintain the same
standards of customer service and
quality care that have formed
strong bonds with the community.


21

How Does The Patient Services
Department Deliver Great
Customer Service?
As noted in the Joe Foxborough
case, customer service is a key
component of Fenway Health’s
operations, and is delivered most
effectively when it is provided in
the larger context of Fenway’s
mission, vision, and values. Our
fictional story includes examples
of what happens when one of
Fenway’s priorities conflicts with
another. In this case, delivering
culturally-competent care – more
specifically, allowing a patient to
keep his reason for being seen
confidential – collided with service
delivery – basing the scheduling of
a medical appointment on
information central to the
improvement and protection of a
patient’s health and well-being.
Situations like this are not unusual
at Fenway Health, and no set of
policies and procedures can
anticipate all the possible
combinations of customer service
demands that can arise at any
moment. Broad guidelines, like
Fenway’s four core values, are
useful resources for assessing
problems, and in creating
solutions on the spot. Instead of a
checklist of things to do, this “way
of thinking” approach can help
make sure the situation is properly
understood, and that our
commitment to the customer is
always communicated.
The four core values of Fenway
Health can be summarized in very
few words:
1. Safety
Preventing harm to patients and
employees; providing the right
care, to the right patient, at the
right time.
2. Quality
Providing the most value to our
customer and striving to provide
services to individuals that


22

increase the likelihood of
improving health outcomes.
3. Operational Effectiveness
Using the most efficient resources
to minimize waste.
4. Service Delivery
Improving customer interactions,
customer satisfaction and
customer loyalty by delivering
services in a manner that meets
their needs (for both internal and
external customers)
Understanding the meaning of
“safety” or “quality” or any of these
core values requires few additions
to these written definitions. It is
better to engage in discussions
with team members, or even to
think as an individual Fenway
Health team member, about how
these values are alike, and how
they might lead to different
decisions, in your day-to-day
dealings with Fenway’s customers.
In some cases, there are easy
answers. “Safety, first and always,”
is our highest priority at all times.
Sometimes, a stressful situation
may make other considerations
more tempting, but they are never
the right answer if safety is
compromised in any way. Another
example of an easy answer might
be the enforcement of standard
rules to treat all patients fairly, and
to maintain cost-effective
operations. What is more
important, good service or
operational (cost) effectiveness? If
a patient is habitually late, it may
make sense to enforce a policy
that requires rescheduling after a
fixed amount of time. On the other
hand, a patient’s health or safety
can never be compromised,
requiring the patient to be seen
even if he or she is habitually late.
This situation can be more
complex when other factors are
involved, such as additional
demands for being seen by
providers the patient prefers,


23

whether this preference is based
on perceived skill level, gender, or
another consideration. In any case,
if the patient’s health will be
endangered without being seen,
this must also be taken into
consideration.
At other times, the solutions are
not quite so clear. What should be
done after a patient is actually
harmed, either by being sent home
in error, or having been given the
wrong prescription for a diagnosed
condition? Solving the immediate
health crisis is still a critically
important and “easy” decision, but
afterward, how can situations like
this be resolved? When patient
confidentiality is compromised,
and as a result someone is subject
to the risk of physical harm from
intolerant work colleagues or
family members, what is Fenway
Health’s responsibility? Serious
problems like these deserve
solutions that no individual Patient
Services staff person can deliver,
and it is always a good idea to ask
for help when confronting them.
Another point to remember is that
how you think about a customer
when interacting with him or her is
usually clear to the customer, and
influences how the customer feels
about you. If you don’t like
someone, it comes across, trust
us. Always bring a positive attitude
and feelings of empathy in dealing
with everyone on the job. Further,
even when you have good
intentions, be sure your behavior
matches these intentions in
delivering quality customer
service.
The good news is that the vast
majority of customer service
challenges that arise on a daily


24

basis can be solved by taking a
moment to get past one’s
emotions, thinking clearly about
safety first, and then exploring the
other three core values of Fenway.
Engaging the customer is also
important, because many times he
or she can communicate a
preferred solution. If that solution
is reasonable, you can solve the
problem on the spot. Finding a
way to keep a problem from
getting worse, and then taking
reasonable steps to solving it, is a
skill that comes with time,
practice, and judgment. Your
managers will always be there to
help, and so will the other
members of the Patient Services
team.


25

Conclusion One: Customer
Service is a Way of Thinking
While there is no checklist for
handling every conceivable
customer service situation at
Fenway Health, is helpful to take a
general “creative problem-solving”
approach in solving whatever
challenge may arise. Whether you
use the following suggestions as a
step-by-step methodology, or rely
on them in a more abstract way,
these may help solve many simple
problems, and find ways to
simplify problems that might be
more complicated.
Ask Questions. Make sure you
have the information you need
before you act.
• Do I understand what the
customer wants?
• Do I know how to provide
what the customer needs?
• Is there a problem that
needs to be solved?
Identify the Problem. Once you
understand it, think of how it can
be solved.
• What is the customer telling
me about the problem?
• What else do I need to know
to solve it?
• If there is a problem, how
can I solve it now?
Act. If you can solve the problem,
do it.
• What is needed to solve the
problem, and where can I
get it?
• What steps are needed to
solve the problem, and how
long will this take?
Get Help. If you need help, identify
what you need and ask for it.
• Are there Fenway Health
organizational concerns to
consider?
o For example, policies
and procedures, or
regulatory
compliance
o Is this a “give ‘em the
pickle” situation or
something larger?
• If I need help, where do I
get it?
Engage the customer.
Communication instills confidence
and builds trust.
• Ask the customer what he
or she would like to solve
the problem.
• When you have decided
what to do, make sure the
customer agrees.
Learn. Remember what worked
and what didn’t work. Share with
your co-workers.
• Talk about incidents in daily
team huddles and informal
conversations.


26

Conclusion Two: Customer
Service is a Continuing Dialogue
Customer service is not a
challenge we can solve on our
own. It takes a team effort, and it
takes communication. It’s a
continuing dialogue, with
managers, with co-workers, and
with customers. In fact, a healthy
dialogue with a patient can go a
long way to solving many
customer service problems.
An ideal outline for a dialogue with
the patient in many customer
service situations might include
these basic elements:
• Describe the situation. Make
sure you and the customer
have a common
understanding of what is
happening.
• Ask, “What would you like
me to do for you?” Don’t
assume what the customer
wants. You may be
surprised to discover a
simple solution.
• List the possible options of
what can be done. Keep
your conversation focused
on what is possible, and
keep the dialogue going.
• Don’t let the conversation
move into a “dead end” (i.e.,
“I’m sorry, that’s not my
responsibility,” or, “You
need to go to another
department for that.”).
• Ask the customer to select
from these possibilities.
Keep the customer engaged
in solving the problem, and
look for an agreed-on plan
of action.
• Under-promise and over-
deliver. Don’t set yourself
up for failure.
• Implement the option the
customer selects. Solve the
problem as a team.
• Remember it’s all about the
customer. Put him/her first
in all cases.
Dialogues with managers and co-
workers are included in the case
study at the beginning of this
manual. Key points are the
importance of keeping emotions at
bay, thinking clearly, being honest,
and finding a balance between
solving problems on your own and
asking for help. Remember that


27

learning from experience is better
when those experiences are shared
with colleagues.
A final point about customer
service at Fenway Health is that the
organization has its own time-
tested standards, based on years
of experience. Some of these are
simply Fenway’s own policies and
procedures, while others are
regulatory requirements associated
with the many licenses and
government agency standards that
apply to community health centers
in the United States and the
Commonwealth of Massachusetts.
No written document can prepare
you for every possible encounter
with the many customers –
patients, co-workers at Fenway,
and colleagues from other
organizations – you will meet in
the course of your career. If this
manual is useful, it will serve as
the basis for the development of
your own internal standards of
customer service, developed from
direct experience, and ongoing
conversations with members of
your team. Customer service is a
way of thinking that balances
independent, creative problem-
solving with the shared values of a
team of caring health
professionals…and the customers
who depend on you.


28

Resources: Where Customer Service Information Can be Found
In addition to this manual, there are several other documents and materials, as
well as interactions with your colleagues at Fenway Health that include
valuable information about customer service and its importance to the success
of our health center. Some of these materials include:
• Staff orientation and training materials
• Your job description
• Work flow procedures and performance standards
• Space planning and physical environment design documents and
discussions
• Department meetings and daily “huddles”
• Conversations with co-workers
• Your everyday behavior
In short, information about customer service can be found everywhere.
The appendix of this manual includes additional reference documents that can
be useful in maintaining excellent customer service at Fenway Health. They
include:
• An Introduction to Lean Thinking
• Client Feedback Form
• Methods for Patients to Report a Formal Complaint
• Fenway Health Incident Reporting Procedures
• Patient Services Staff Training Manual
• Patient Services Code of Conduct
• Idea Board Summary
• Fenway Organization Chart
• Medical Teams
• Medical Assistant Assignments
• Patient Services Staff Assignments
• Sample Medical Calendar
• Directing Calls about Prescriptions
• Excerpts, Patient Satisfaction Survey
• Hot List
• Additional Documents Available on Fenway Health’s Shared Drive


29

Fenway Patient Services Cust Svc Manual FINAL copy

Recommended

Recommended

More Related Content

Viewers also liked

Viewers also liked (14)

More from Tom Martorelli

More from Tom Martorelli (6)

Fenway Patient Services Cust Svc Manual FINAL copy