Letter from your President, Dr. Michelle Tarbox


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Influencing and Managing Patient Expectations

 

“Apprehension, uncertainty, waiting, expectation, fear of surprise, do a patient more harm than any exertion. “    - Florence Nightingale

Setting the stage:

According to multiple observational studies, the primary source of patient dissatisfaction is physician and staff communication and attitudes.  Every interaction that the patient has from the time they park their car to come into the physician’s office, to the time they leave the office and pick up their prescriptions at the pharmacy can impact their experience, their satisfaction, their compliance, and even their perception of their physician’s competence. Some of these factors lie outside of the physician’s control. Doctors typically can’t dictate the condition of their parking lot or the provision of service at the patient’s pharmacy. However, the physician can meaningfully impact the appearance and cleanliness of their office, the demeanor and communication style of the front office staff, nurses, and of course of themselves.

A clean, accessible, pleasant waiting room and office facilities help set the stage for success. Front desk staff members are often the first people to interact with the patient, and as such, their demeanor and general attitude can have a significant effect on the patient’s visit. Excellent communication skills, a friendly, helpful manner, and the habit of keeping the patient informed of any delays in their appointment are behaviors and traits that should be selected for, cultivated, and rewarded in the front office and nursing staff.  Having regular staff meetings with stakeholders in these vital realms can help reinforce the value and importance of the front desk staff member’s contribution to the patient care experience.  Recognition of excellent performance with staff appreciation awards, events, and potentially bonuses can help promote the further development of these vital skills.

The physician’s demeanor and personal presentation can also be meaningfully adjusted to maximize positive influence on the patient encounter.  Patients respond most favorably to a physician who is well groomed and professionally dressed demonstrating a friendly and engaging demeanor. It is helpful to show an energetic and engaged deportment without appearing rushed or harried. Simple postural and behavioral practices can affect patient’s perception of time spent with their physician, and this perception is more favorable if the physician sits down to talk with the patient. Sitting down, preferably at eye level with the patient with an open body position, slightly inclined forward has been shown to be the most favorably perceived posture. Active listening improves patient perception of physician competence and compassion. The best way to appear interested is to be interested. It is helpful to be empathetic and supportive and to be sensitive to both what the patient is saying and what they aren’t saying.

 

“Expectations were like fine pottery. The harder you held them, the more likely they were to crack.”

- Brandon Sanderson, The Way of Kings

The playing field:

Patients enter an office visit with expectations based off of prior experience, anecdote, or supposition. They may expect a particular treatment plan, outcome, or doctor-patient interaction based off of the experience of their friends or family, exposure to advertisements, even portrayal of medical care in consumer media.

Patient satisfaction occurs if their expectations are met or exceeded and conversely, unrealistic expectations are a major cause of patient dissatisfaction. Studies of patient satisfaction have shown that unrecognized or unfulfilled expectations may predict a patient’s dissatisfaction with their medical care more strongly than even the technical success of the treatment.  In our time-pressured, overscheduled clinical lives, it can be difficult to take the time to determine what your patient’s expectations are; however, these expectations play a vital role in forming the rapport between a patient and their doctor and may impact compliance and even health outcomes.

Texas Two Step:

I recommend the Texas Two Step approach to help optimize patient experience:

Step 1: Identify the patient’s expectations and assess how realistic they are.

Step 2: Work with the patient collaboratively to adjust expectations to an achievable goal.

It is important to identify patient expectations early on and assess how realistic and achievable they are. Some expectations are impracticable, and it may be necessary to work with the patient collaboratively to adjust expectations to an attainable goal. It may be useful to use phrases such as: ”this is a difficult problem,”  or “this is a condition we can treat, but unfortunately we can’t cure.” Establishing realistic expectations for patients allows for the possibility of success in meeting or exceeding patient expectations.

The Texas Two Step approach also applies to patient care quality. One dimension of patient care quality is product quality, meaning what you provide as a physician, such as an exam, diagnostic test, treatment plan, or medication. Product quality can be dictated the practice’s and the patient’s resources, the condition being treated, the expertise of the physician, and the realities of the healthcare system. To a certain extent, some elements of the product quality of our patient care lie outside of our control. The second dimension to patient care quality; however, service quality lies firmly within our dominion. Service quality is the manner in which care is provided to the patient. Is the care you provide given with kindness or brusqueness?  Is your office running peacefully and efficiently, or is there chaos? Are you portraying your concern genuinely to your patients or is there an air of insincerity. As physicians, we can control some aspects of product quality and most components of service quality, and maximizing our delivery of both of these dimensions of patient care quality can improve our overall patient outcomes and patient satisfaction.

 

What’s at stake?

Satisfied patients are more likely to follow treatment recommendations, follow referral recommendations, and remain loyal patients.  They demonstrate better health outcomes and are much less likely to file malpractice claims. Small adjustments to your practice can help optimize patient experiences, outcomes, and perceptions. 

References:

  1. Susan Keane Baker. Managing Patient Expectations: The Art of Finding and Keeping Loyal Patients
  2. On managing patients' expectations JAAD , Volume 56 , Issue 2 , AB102
  3. Haanstra TM, van den Berg T, Ostelo RW, et al. Systematic review: Do patient expectations influence treatment outcomes in total knee and total hip arthroplasty? Health and Quality of Life Outcomes. 2012;10:152.
  4. The Customer Driven Company, Richard C. Whiteley (1991)
  5. Improving quality in healthcare: What makes a satisfied patient?Rev Calid Asist. 2016 Feb 8.

 


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