One simple question can reveal the underlying culture in a physician’s office

by Burl Stamp

For the sixth time, I recently facilitated the annual Executive Dialogue of the Society for Healthcare Strategy & Market Development of the American Hospital Association. The unique format of the conference features presentations by three nationally-renowned speakers followed by facilitated dialogue with the audience of senior healthcare strategy executives.

Speaking to the program theme of “leading change,” Peter Fine, president & CEO of Phoenix-based Banner Health, talked not only about the organization-wide, big-picture, strategic opportunities for leading change, but also the very personal, day-to-day occasions health leaders have to change the way our patients experience care. He focused many of his remarks on the front-end of the care experience in physicians’ offices and other ambulatory settings, suggesting one straightforward question can provide the greatest insight into the culture of a practice and how patients perceive service:

Who do staff members see as their primary customer?

Immediately, there was a collective “aha” moment in the room. Personal experience and professional observation enabled everyone to immediately understand the power of Peter’s question.

So, how did we get here?

That fact that many physician office staff members do not consider the patient as their primary customer should not be a surprise. First, we know that traditionally patients often place physicians on a pedestal. Many might argue that this elevation is justified given the sacrifices individuals make on the road to becoming a physician. It does not take a significant leap to see how this attitude can be nurtured by staff members, as well. Few would question society’s respect and admiration for physicians. The problem is that when respect moves to subservience, no one is truly well served.

Secondly, staff members in a very real way see themselves as protectors of their physician leaders. This point became crystal clear to me in a recent conversation when I was looking for a new primary care physician. Because I travel almost every week, I asked each practice if they offered any weekend hours. I was taken aback when one office staff member answered, “No, sir, we don’t have Saturday hours. You know, our physicians deserve their time off, too.” And this was in a concierge practice.

Without sacrificing the respect and even protection staff members feel for their physician leaders, how do we help practices move to a place of more patient-centeredness? Here are four ideas.

Strong frontline managers must set standards and mentor performance

Historically, physician practice managers were logistics experts, making sure the trains ran on time and that necessary supplies were available. While these operational issues are still important, team leaders in today’s competitive environment must develop and coach staff members to provide safe, efficient, compassionate care as well. By modeling practices that put patients first, practice managers are taking the initial important step in establishing a patient-first culture.

Effective team communication benefits everyone

All major patient satisfaction research firms tell us that “how well staff worked together as a team” is one of the most highly correlated questions to overall satisfaction. Teamwork is critically important to evidence-based patient safety work, as well, and patients instinctively know when there is dysfunction in the team.

Teamwork should be easier in a smaller group, right? But distinct roles in a physician’s practice can create silos. How often do staff members actually see the physician interacting with patients? Does the morning start with a brief team huddle? Are monthly staff meetings held to share information and ideas, answer concerns and create a culture of continuous, patient-focused improvement? All of these strategies help improve communication across the team and ultimately with the patient.

Environment makes a difference

Even if the dreaded opaque sliding glass window has been eliminated in an office, opportunities still exist to make patients feel more welcome and assured when entering an office. A clipboard with the instructions, “Sign in here and we’ll be with you as soon as possible,” doesn’t exactly create that sense of welcome.

Most receptionists are sitting behind a counter or desk so that standing patients are essentially looking at the top of their heads. What if they were standing up so they could make eye contact, better assess the patient’s status and need for assistance, and let them know about how long they might be waiting that day? Further, names shouted out from a check-in window or pushed open inner-sanctum door does not honor patient privacy. Making note of each patient when they register and then using that information to approach them in the waiting area and help them to the exam room makes a huge impact.

It starts with what the physician values and models

All of these suggestions pale in comparison to the power of the physician leader clearly communicating that patients come first. In all organizations large or small, the leader plays an inordinately significant role in determining the culture of respect and service, both across the team and ultimately to the patients the practice serves.