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  • Practice Perfect

    4 Ways to Boost Patient Satisfaction

    By Sara Burns Rapuano, MBA, OCS, Practice Management Consultant

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    Patient care is the major reason many people go into health care. But dramatic changes in the field over the past decade have added com­plexity to ophthalmic practices. Today, so much time is required to maintain electronic health records and comply with regulations that it’s difficult to prioritize the patient experience.

    In my 20-plus years as an ophthal­mic administrator, I have developed the following 4 principles for focusing on the patient care experience. Although these tips may seem basic, we often lose sight of the obvious in an attempt to get through busy days. In a health care en­vironment where patients are increas­ingly concerned about out-of-pocket expenses, the winners in the future will be those practices that maintain a laser focus on the patient.    

    1. Commit to a Practice Culture That Values Time Spent With Patients

    Many practices are adopting the lean management approach ( as an excellent way to increase pro­ductivity by reducing inefficiency and eliminating long wait times. The foundational principle of lean man­agement is designing practice processes with patients in mind and putting their experience at the core of what we do.

    First and foremost, management must value staff who take the extra time to help patients. If we say we value empathic care and then write up an employee for not working fast enough, we are sending mixed messages. We must all share the vision of exception­al patient service, and our employee feedback and rewards system must be consistent with that vision.

    I once had a tech supervisor who focused on benchmarking the average technician workup time. The highest-performing technician by this measure, however, was not fully reconciling med­ications or performing diagnostic tests as ordered. The supervisor’s focus on this single metric (workup time) meant that our physician often had to perform what should have been technician work. Ultimately, this was not good for patient satisfaction because patients took longer to complete the physician portion of the exam and could see that the team was not working as cohesively or efficiently as planned. We learned to use this metric of workup time in combination with patient and physi­cian feedback.

    Both administrative and physician leaders must agree on a vision and lead in a consistent manner. Here are a few guidelines:

    • When considering a process improvement, evaluate the possible im­pact on the patient care experience.  
    • When the practice has efficiency standards or benchmarks, always allow ranges of productivity to enable staff to add the extra level of service that you would want for yourself or your family member.  
    • Always evaluate the impact of any process change on the entire patient care team.

    2. Recruit the Right People and Hire Enough Staff

    Great support staff may not show up on the balance sheet, but they make a dramatic impact on the bottom line. They are the front line in creating a pa­tient-centric culture. One of the biggest barriers to achieving a consistent level of patient care is an understaffed office. Although practices want to reduce costs, there is a downside to chronic understaffing, which can be defined in terms of skill set and workload.   

    Skill set. Finding and hiring the right staff is the hardest part of a manager’s job. The right staff are those who have the emotional intelligence to handle interpersonal relationships judiciously and empathetically. You can teach hard skills, but soft skills—such as good listening and communication and a team-oriented work ethic—are aptitudes some individuals naturally excel at and enjoy. These are the core traits to target in new hires.

    Although many human resources screening tests assess emotional intel­ligence, I developed a simple observa­tional screening strategy for these soft skills and used it when interviewing applicants. I personally walked the candidate around the practice, explain­ing what happened in each area of the office, and I made sure to lead them through busy patient areas to see how they interacted with patients in the hallways and elevators. In particular, I took note of the following:

    • Did they hold the door for patients?
    • Did they make eye contact with patients?
    • Did they step aside when someone with a walker or a baby carriage passed?

    Many applicants naturally noticed the patients and interacted well, while others bumped into elderly patients and were unaware of their visual chal­lenges. Smart, empathetic staff, who are given the time and resources to provide excellent service, will bring new busi­ness and increase patient retention.    

    Workload. Be aware of the amount of work each employee has. In addition to hiring the right employees, we still need to monitor the workload in each area of the practice to ensure the team is the right size. Patients can readily discern when an employee is over­worked and the practice environment is stressed. Overworked employees have a compromised ability to listen to patients and take the necessary time and initiative to respond to their needs. Stress may also trigger mistakes in registration or patient triage.

    If your staff is too busy to help a visually challenged patient complete his or her paperwork, assist a confused patient with obtaining a necessary referral, or listen carefully to a patient with a potentially serious medical concern, then the office is understaffed. The staffing should be adequate to allow the team the opportunity to help patients and always provide excellent service. Supervisors and managers can model this behavior every day.

    Once we find good employees, we need to create an environment where they stay and thrive. Practices often add physicians and increase patient volume without increasing the support staff. It is critical that we do not burn out employees.

    3. Measure Patient Satisfaction Through Regular Surveys

    To provide an excellent patient expe­rience, we first need to measure how patients perceive our office. One of the best ways to gather this informa­tion is through a patient satisfaction survey. Although there are standardized surveys, such as Clinician and Group Consumer Assessment of Healthcare Providers (CG CAHPS), they tend to be more appropriate for a primary care setting. Ophthalmology practices may want to devise a customized pa­tient satisfaction survey. These can be developed either in-house or through a vendor. They can provide valuable insight about how patients see your environment—and sometimes survey results are different than expected.

    When I instituted a regular patient satisfaction survey in the Wills Eye resident clinics, I expected to hear about our lengthy wait times and chal­lenging parking situations. Although a few patients noted those problems, these comments did not impact overall patient satisfaction ratings. Many saw the lengthy appointments as thorough visits. When patients did complain about wait times, they focused on a lack of communication, such as not having been advised of the expected wait time.

    What I found most useful were the notes and patient stories in the com­ments area at the end of the survey. These often highlighted staff interac­tions. One patient took the time to say how helpful and compassionate the patient assistance coordinator was. This staff member handles both charity patients and VIP patients at Wills Eye, and she ensures that both groups get the same level of care. Knowing how valuable this employee was to 1 patient gave me insight I never would have had without the survey.

    This qualitative feedback was my favorite management tool. Sharing the positive feedback is as important as sharing the constructive criticism. I also used these stories when training new staff to help them understand the importance of communication skills.  

    4. Maintain Your Patient Service Goals

    The last element of my strategy to cre­ate an exceptional patient care experi­ence is to maintain the practice’s focus on the patient. Management does not just devise a plan, implement it, and move on. Strong leaders realize that this is an iterative process.

    We must use the feedback we receive from patients, referring doctors, and staff to identify areas for improvement. We must also follow through by taking corrective action with employees who do not focus on the patient, as well as reward the staff who consistently pro­vide the highest level of care. Rewards can take many forms. Some are mone­tary, and some are simply making sure that staff know they are valued every day. We demonstrate that we value our employees when we:

    • share positive comments about their performance from patients and providers;
    • provide ongoing education to ad­vance their knowledge base;
    • acknowledge their contribution to practice improvements;
    • ensure they get an adequate lunch break; and
    • ensure they are not asked to work late every day. 

    Managers and doctors must always hire, train, and retrain with patient service goals in mind. And managers and doctors must be reviewed on their ability to support their staff in these goals.   


    When practices take these 4 steps, they will find that patient online reviews improve and physician referrals and volume of return patients increase. In addition, employees will be more satis­fied with their jobs, potentially resulting in lower staff turnover.


    Ms. Burns Rapuano is a practice management consultant in Philadelphia who works with the AAOE. Financial disclosures: Avedro: C,L; Wills Eye Hospital: C,L.


    Adapted from “How Do You Achieve Patient Service Excellence in Today’s Ophthalmic Practice?” which was published Sept. 24, 2018, by the American Academy of Ophthalmic Executives (AAOE), the practice management arm of the Academy.

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