Patient first Culture

PATIENT IS A CUSTOMER
A patient is the most important customer in our premises.
He is dependent on us, as well as we are dependent on him.
He is not an interruption in our work, but is the purpose of it.
He is not an outsider in our hospital , but a part of it.
We are not doing him a favor by treating / serving him, rather he is doing a favor by giving us an
opportunity to do so.
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INTRODUCTION
The practice and system of medicine has evolved over centuries. There are certain significant
developments which have taken place in the health systems in recent times.
The establishment of corporate hospitals equipped with the latest facilities
The advent of TPA’s (insurance companies, governments, companies, etc.)
Increasing awareness among patients
Availability of information through the internet, and higher expectations of patient care.
Increasing litigations (unsatisfying results.)
The traditional concept of a noble profession is no more in existence.
Challenges before the health care industry - service industry. 10

Indicators of dissatisfaction :
Poor communication with physicians.
Lack of empathy.
Chronicity of many of the disorders.
Younger patients are keen on quick solutions - more likely for dissatisfaction.
People aged between 35 and 49 years, (major part of the new consumer cohort)
have the lowest patient satisfaction scores compared with other age groups.
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Doctor - patient relationship
A patient is happy with a doctor's approach depends on different nonclinical factors
- listening to him or her,
- promptness of services,
- way of talking and gesture.
Upgrading our professional knowledge are not always relevant to the patient.
(attending CMEs, conferences, mastering new skills, and keeping pace with new technologies.)
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6 aims for a quality health care system patient safety:
1. Timely
2. Efficient
3. Patient centered
1. Safe
2. Equitable
3. Evidence based
These 3 factors
directly
influence patient
satisfaction
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Patient as a consumer or a customer
The present scenario is that the patients are addressed as “consumers”?
Latin word “consumere” which literally means one who acquires commodities or services.
Similarly, the patient can be addressed as a customer.
Which is defined as “a person who purchases goods or services.”
Today the patient sees himself as a buyer of health services.
We all need to accept this concept and need to recognise that every patient has all the rights for delivery of
quality health care by us.
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Patient Satisfaction - important tool for success: Corporate
1. Corporate hospitals, have begun to function like a service industry.
2. HR professionals and management graduates employment.
3. TPA’s too are regularly monitoring patient satisfaction levels among their customers
4. Physician bonuses are linked to patient evaluation of their doctor's personal interaction with
them.
5. Higher the patient satisfaction leads to benefits for the health industry in a number of ways.
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Benefits of Patient satisfaction
1.Leads to customer (patient) loyalty.
2.Improved patient retention -
if we satisfy 1 customer, the information reaches 4 others.
If we alienate 1 customer, it spreads to 10, or even more if the problem is serious. So, if we annoy 1 customer, we
will have to satisfy 3 others patients just to stay even.
3. Patient’s are less vulnerable to price wars.
Organisations with high customer loyalty can command a higher price without losing their profit or market share.
Approximately 70% of patients were willing to pay more money if they had to consult a quality physician of
their choice.
4.Consistent profitability –
Loss of a patient due to dissatisfaction, can result in the loss of over > 1 crore in income over the lifetime of
the practice.
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All focus on
quality service
issues

5.Increased staff morale with reduced staff turnover also leads to increased productivity
6.Reduced risk of malpractice suits –
an inverse correlation has been reported for patient satisfaction rates and medical malpractice suits.
7.Accreditation issues –
- universally accepted accreditation agencies like
International Organization for Standardization (ISO),
National Accreditation Board for Hospitals (NABH),
Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
8.Increased personal and professional satisfaction –
Better the care, happier the doctor, the happier will be the patients.
Benefits of Patient satisfaction All focus on
quality
service issues.
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A patient first mentality means more than doing the work we are required to do:
• with courtesy,
• consideration and
• respect.
We all say we put patients first, but do we really?
Most of us put ourselves first. We think about our priorities, pressures or the procedures we need to
carry out, and we put these before our patients.
This is natural- but it’s not patient focused.
Putting patients first means placing them at the centre of what we do.
Put patients at the centre of the universe and have everything else revolve around them.
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It is a shift of mind, we need to realise and preach the same.
It’s all about them, not us.
We should not treat patients with clinical detachment – as bundles of symptoms or hostages,
and soon forget them.
We have to treat patients as people – and make them feel listened to, understand and really
care for.
We have to also see them as customers, not captives and remind ourself constantly that :
“it’s all about them, not we – that’s why we are here”.
1.PUTTING PATIENTS FIRST
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Service excellence revolves around 3 factors:
1.Doctor
2.Patient
3.Organization.
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1. The Doctor Factor : Twin responsibility
1.Giving the best health care to the patient
2.Leading the team or the organization in attaining the goal of satisfying the patient.
31

Doctor factor: The House rules:
“House rules” are certain rules laid down to handle the patient so as to attain a satisfying and a non-
complaining patient:
1. Break the ice: make eye contact, smile, call people by name, express with words of
concern.
2. Show courtesy: Kind gestures and polite words make a patient very comfortable.
3. Listen and understand: encourage patients to tell their problem. Invite and answer their
questions.
4. Inform and explain: it promotes compliance. People are less anxious when they know
what's happening.
5. See the whole person: see beyond illness the whole person.
6. Share the responsibility: risks and uncertainty are facts of life in medical practice.
Acknowledging risks builds trust.
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7.Pay undivided attention: this reduces distractions and interruptions as much as possible.
8.Secure confidentiality and privacy: watch what you say, where you say, and to whom you say.
9.Preserve dignity: treat the patient with respect. Respect modesty.
10.Remember the patient's family: families feel protective, anxious, frightened, and insecure. Extend
yourself, reassure, and inform.
11.Respond quickly: Keep appointments, return calls, and apologize for delays.
House rules:
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2. Patient factors
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Patients expectations from their doctors:
Keep up the timings,
Behave cordially, and
Communicate in their language.
Expect care, concern, and courtesy
Good professional job.
A patient's liking the doctor has a lot to do with the patient getting better.
A patient's expectations of a good service depends on:
age,
gender,
nature of illness,
hour of the day,
his or her attitude toward the problem
circumstances.

Understanding a Patient.
Certain tips can help a doctor or a hospital to understand the patients better:
1. Patients expect a personal relationship (compassion and care)
2. Patient has got certain rights.(regulatory authorities and hospitals)
3. Draw a charter of rights for the patients.
4. Make sure he gets a good first impression of you and the hospital .
5. "Step into your patients′ shoes; see through their eyes and hear through their ears."
6. Minimise the patient's waiting time to the least possible.
7. Try to make your problem-solving system to be functional.
8. Always obtain feedback from your patients and correct shortcomings if any.
35

3.Hospital / Organisation Factor:
Problems with a competent doctor and a compliant patient, may arise or persist because of the
o policies,
o work culture, and
o attitude shown by the hospital.
Super specialization has led to more fragmentation, costly care, and less than ideal customer service.
We need to build and sustain a service-oriented organizational culture, which is important for the
success of any organisation.
Management strategies need to be more focussed on serving better and improving the service quality.
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Areas where min. requirements and standards have to be maintained.
1.Telephone service
Ensure that a smart, competent, and intelligent person is placed to handle the telephone for he or she
will be the voice of the practice.
Establish standards to ensure that the telephone is picked within a certain time, mode and tone of
speech are cordial, and a triage protocol to be followed.
Avoid unnecessary calls.
Periodically, a survey can be made to monitor these standards and see that they are followed.
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2. Office appearance
OPD consultation area with doctor’s chamber should be aesthetically designed, well-furnished, properly
spaced with good interiors, well equipped with lighting, water, furniture, etc.
OPD staff should be well-dressed, ever-smiling, and pleasant.
Patients may not remember what you said to them; patients may not remember what you did to them; but
they always remember how you made them feel.
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3. Waiting time
The amount of time the patient spends in the waiting area plays a very important role in
determining the outcome of patient satisfaction.
With so many choices available, few people will stick to a doctor who has no respect for their
time.
The waiting time depends on a lot on factors:
1. Doctor's style of working
2. Kind of patients he or she sees
3. Locality where he or she practices
4. Efficacy of the supportive staff.
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4. Doctor-patient interaction
Most important indicator to determine the patient satisfaction outcome.
Physician's interpersonal skills increases patient satisfaction, which directly have a positive effect on
treatment adherence and health outcomes.
Few patients have comorbid psychosocial issues, so more time has to be given to them.
Insufficient communication is recognized as a major cause of dissatisfaction with treatment.
Should frequently spend more time with the patient and should not end up prescribing more.
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5.Patient education
Present day's patients are more educated, computer savvy, and much richer.
Essential to clear all their rightly or wrongly earned doubts with much patience and compassion.
Criterias for selecting a doctor:
Willingness to explain things as the most important criterion.
Reasonable fees
Access over telephone / mobile
Friendly office
Convenient appointments and location.
Incomplete, improper, and poor communication may lead to unrealistic goals and expectations
which in turn can lead to dissatisfaction.
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How to educate the patient?
Successful education increases patient satisfaction and results in improved adherence to
treatment and thus to a better outcome.
1. verbal education,
2. written information (handouts, articles in popular magazines, etc.),
3. group-based learning,
4. audiotapes, videotapes,
5. computer-assisted education, and the internet can be used to educate the patient about
the disease.
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6.Problem solving
This is perhaps the most important among all the patient-related issues.
The hospital should have a good system for handling complaints.
A mechanism must exist for receiving complaints.
Patients must be informed of this mechanism and of their right to complain.
The organization must respond to significant complaints and take appropriate
actions; patients cannot be penalized for complaining.
.
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6.Problem solving
o All health care facility providers must document patient complaints and their responses to
them.
o So when there is a lapse in the service delivered, one should always try to accept and
acknowledge the mistake with grace.
o While acknowledging the lapse, one is expressing the regret only for the process.
o Apologizing doesn′t mean that one is accepting the guilt. Steps should be taken to ensure,
that such lapses do not recur

7.Feedback
o The feedback given by the patient helps to improve the work of the physician, place, and also
the system.
o Patient feedback can be obtained by patient questionnaires, follow-up phone calls, suggestion
box, referral physician's survey, etc.
o The data can be used to design effective strategies to improve efficiency of care given to the
patients.
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7 WAYS TO IMPROVE PATIENT SATISFACTION
When you are on a phone, always smile a long way with your patients.
Your smile can be contagious, therefore share it with patients as much as you can.
(The act of smiling activates your neural messaging centre, which benefits your health and
happiness.)
1.SMILE
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2. Go Digital:
In the age of internet, always connect and engage with the patient online.
Most of the patients in this age are Tech savvy.
(Hospitals using digital technology, to communicate with the patient, boosts patient
outcomes).
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3. Decrease Waiting times
There is nothing more frustrating than showing up on time for an appointment, only to
wait in the waiting room for 30 min. before you can be seen.
( 40% of patients would switch doctors for a shorter waiting time.)
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4. Communication
Make an effort to educate patients beyond verbal education during visits.
( 80% of serious medical errors involve miscommunication between care givers when
patients are transferred or handed off.)
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5. Set Expectations
Remove patient anxieties before their appointment by making sure that they come in
prepared.
Set clear expectations by sending forms, directions, instructions.
(This reduces patient anxiety & improves satisfaction levels.)
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6. Keep Staff Happy
Creates a happy & uplifting work environment for your staff can make for a better
overall patient experience.
Turn even the biggest forms upside down.
(A strong relationship/ bonding has to exist between staff satisfaction & patient
perceptions of the quality of their care).
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7. Ask them
The sureshot way to find out how satisfied your patient’s are , is to ask them.
You will be surprised by how many patients are eager to give their feedback.
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CONCLUSION
 Patient satisfaction is an attitude.
 Though it does not ensure that the patient will remain loyal to the doctor or the hospital, it is still a strong motivating
factor.
 It is the only indirect indicator of the quality of doctor or hospital performance.
 Delivery of patient-focussed care must be provided to each and every patient every time.
 Quality should not stand still or halt .
 It should be linear and always ascending.
 One should strive to provide better care and soar above each and every patient's expectations.
 “A satisfied patient is a practice builder”.
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PUTTING PATIENT FIRST
LETS
ADOPT
PROMISE
PRACTICE
PREACH

Patient first Culture

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