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Thursday, February 18, 2010

What is your practice's service philosophy?

This question is worth answering for your practice.  It should be a part of your vision and mission statements.  After all, each practice is essentially a business delivering services and sometimes products to customers.  Having – and practicing – a service philosophy is crucial to doing well.

We deliver quality, safety, and value very well in family medicine, so it is focusing on service that makes a practice special in patients' eyes. This focus comes naturally to many practices, I suppose. Physicians and staff who know their patients well and care about them will naturally tend to deliver personalized service. Other practices can probably use some work. We are a new practice, relatively speaking, with physician tenures being 10, 7, and 4 years.  The TransforMed National Demonstration Project taught us that this was an area we could work on some.

To deliver excellent service to patients, one first has to understand how the patients define excellent service.  This can be very difficult in a family medicine practice as there are so many different ages, genders, and types of patients. We ask our patients.  Nurses and physicians ask informally during visits and try to create a culture in which patients to be honest about what they think.  We survey patients.  Our favorite question on the survey is "what would make your experience better?"  We really want to know the answer to this question, because we believe we can always improve on service.  The best answers are sometimes deceptively simple, like when one patient told us the visit was great, but that we needed better magazine choices in the lobby.  That is simple to fix.  We thought more deeply about this answer, though: Were our patients waiting too long if they had time to think about our choice of magazines?

Experience as a physician and patient helped me to develop a service philosophy. Wait times are a huge dissatisfier to patients.  We focused on reducing our wait times by measuring cycle times. This can be done very easily by handing the patient a clipboard and asking him or her to record the start time for each part of the visit: check-in, nurse, physician, ancillary testing, physician return, check-out, etc.  Many practice management systems will do this automatically. Patients will keep us honest, though, as the timing probably matters most to them. Studying the results of such surveys can help identify bottlenecks to patient flow in the office. Efforts can then be focused on reducing bottlenecks.

For instance, we found that the cycle times for one physician were much longer than for the other two physicians in the practice. We began by having a frank discussion about what we were doing differently. We considered simply making the one physician's appointment times longer, but ultimately addressed the problem by pairing ourselves with nurses who would help with staying on time, streamlining and standardizing our check-in process.

Reading also helped me to develop a service philosophy. I highly recommend the book  If Disney Ran your Hospital: 9 1/2 Things You Would Do Differently, by Fred Lee. You might think that family medicine and Disney are an odd mix. We treat sick people, not people who are going on vacation. However, that is no reason not to try to give them the best experience possible. Consuming medical services is generally not a very satisfying experience for the average patient. But what if instead of making it less "unsatisfying," we worked to make it outstanding?  We can learn a lot from the way Disney does things to help us in medicine. I have my nurse ask each patient: "What is the goal of your visit today?" Answers range from serious to facetious. One patient with a cough may want to make sure it is not cancer, while another simply wants to be well enough to visit their grandchild this weekend.  Knowing the patient's goal helps us tailor the care and deliver that "outstanding" experience.

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About the Author

Melissa Gerdes, MD, is a family physician practicing at Methodist Family Health Center – South Arlington in Arlington, Texas, and former president of the Texas Academy of Family Physicians.

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