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EDITOR: Surviving Your Staff | PART 4 of 4. True Stories and Practical Tips for Physician CEOs

“Concierge Medicine is about doing something different, not doing the same things you’ve always done. If you’re too busy [in your practice] to not exercise good judgment when it concerns your staff, you will catch the shrapnel of their bad decisions. To which we say ‘as they go, you go …’ “

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Editor/Author – CMT/The DPC Journal/CMT Canada/AJRM – Join Michael & Others in Atlanta, OCTOBER 27-28, 2017 and learn more about the business of private medicine. — Register Here …

By Michael Tetreault, Editor-in-Chief

Let’s pick up where we left and see how the story ends. (READ PART 1 HERE > | READ PART 2 HERE > | READ PART 3 HERE >)

Here are a few considerations provided by Physicians, Consultants and Real, Concierge Medicine Patients that you may want to think about:

  • Are your staff becoming better people because of your influence?
    • Actively listen to your patients who tell you what they heard in the office.
    • Actively listen to your patients on what they see and hear (e.g. Many Physician’s work in the back of the office most days. They don’t always hear staff conversations. However, the patients do!)
    • Stand by your patients before your staff.  Patients want only the best for their Doctor. They’re bringing something to your attention not to be a pest, but because they care about you and ultimately, the care they receive from you. Staff come and go, but Patients will stay forever [well, approx. 9 to 11 years on average — compared to traditional practice environments where it is common for patients to leave every five to six years | (C) Concierge Medicine Today, 2017] when their doctor listens to them.
    • There is a reason why many Concierge Medicine Physician’s make staff changes within the first 18-months of their entry into the new subscription-based business model.
  • Pay attention to the conversations you overhear in the office.
    • Don’t always think patients are complaining when expressing themselves about issues with staff. Patients observe, hear and see more than the Physician realizes. Think about a way you as the Physician, can learn from your patients. Actively listen.
  • Note the verbal tone and tenor of conversations they have with patients.
    • Pay attention to non-verbal communication displayed. E.g. eye rolls, laughter or comments from staff . Unfortunately as a Physician you may not always see this and staff may try to hide them from you. But, patients observe these things.
    • Stop the gossip. The gossip that takes place amongst staff about patients happens all the time. We’ve learned from patients that even snide remarks are made with patients sitting right in front of them. What are you doing to develop a culture in your practice to avoid this from happening?

TRUE PATIENT STORY

A young [college age] woman was in the office to see the doctor for a lab draw.  She noticed that a pharmaceutical rep came in after her and was sent to the back to visit with the Doctor right away. The young woman called her Mother and she suggested the young woman ask the receptionist how much longer and tell the staff that she has a class to go to very soon. The receptionist asked the Medical Assistant.  The Medical Assistant’s comment to the receptionist was “if she let me draw her labs, she would have been done and gone.” Well, the young woman’s appointment was with the doctor not the Medical Assistant. The young woman had previously been delayed in the medical office multiple times due to the Medical Assistant’s schedule and trusted her Doctor to find her vein with one stick, something the Medical Assistant was unable to do in previous, repeated visits and attempts.

Lesson Learned: It is the Patient’s choice on who they want to receive their treatment(s), draw their labs, take their vitals, administer medication, etc. In the Patient’s opinion, that comment was uncalled for from the Medical Assistant. The tone and tenor was unbecoming of a medical office. Do comments like this and the behavior displayed portray a professional medical opinion with a remark like that?

  • What are your staff saying and posting on social media?
    • Photos, as well as their “likes” will tell a lot about an employee you consider hiring, providing they participate in social media.
    • Social media can provide you with an enhanced background and potentially, professional or unprofessional behavior.
    • Do they use profanity in posts or comments?
    • Do what you can to always have secure, compliant and direct communication with your patient, whether it be email, text or a phone call.
    • Just because staff are allowed to relay messages to your Patient, does not mean they should hear this [e.g. medical results] and information from your staff. Patients want to talk with their Doctor. Particularly if they have follow-up questions about what was communicated to them. Let’s remember, Patients are afraid to ask for the Doctor to call them. The Doctor assumes it’s okay for their staff to contact patients with results. Concierge Medicine changes all that. Staff contacting Patients with results is rarely okay. Remember, Concierge Medicine is about doing something different, not doing the same things you’ve always done.
    • Physicians may not know how or are afraid to terminate employees. Many employees are simply given multiple warnings and yet, still remain employed at the office long, long after they should be. You as the Physician or owner of the medical practice should exercise good judgment. That may mean you first consult with your business advisors and if necessary, your own legal counsel to deal with challenging staff circumstances.
    • Physicians who have any type of retainer or subscription fee, reduction in patients, etc., will most likely also experience a reduction in staff, post-transition when entering or starting a Concierge Medicine practice or Direct Primary Care program. Many offices will keep staff small and intimate, averaging 2.5 employees according to Concierge Medicine Today (CMT) polling results received by these offices in the past decade.

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“Concierge Medicine Physicians who reduce the amount of Patients, should try for a month seeing and communicating with eight to maybe 10 patients in one day,” says Barb, a Concierge Medicine Patient and CMT Reader. “In between Patient’s, Physician’s can and should call Patient’s back, call specialist’s, etc. What about calling the specialist’s while the Patient is in the room with you? I’ll wait. It’s not a waste of time for me. I want to know my Doctor cares. Show me. Do you have any idea what kind of superstar you will be in your Patient’s eyes? That kind of personal attention is invaluable. You’ve just made your patient feel cared for and most importantly, that they matter to you … enough to call the specialist right there … even if it was only to leave a message. The Doctor can relay a better message to a specialist much better than a member of your staff can. It’s not personalized service if staff is involved. It’s only personalized when conversation is between Physician and Patient. Let’s start getting this right.”

Matt McCord Anesthesiologist at Anesthesia Associates of Ann Arbor, PLLC writes “The under-appreciated art of follow-up (and follow through) for our patients. Truly healthcare’s black-hole where transitions of care mattered little in fee-for-service healthcare. Not taking your medicines? No problem, come back in. Thankfully, this is changing.”

This is a lot to chew on. And, this is a topic that is always evolving. Concierge Medicine is in the people business and people are challenging, whether it is staff or a Patient. This important topic today is not meant to be unpacked all at one time or even resolved in one staff meeting. More than likely you won’t ever face a patient who had an experience like the one sent into us this summer. But, when it dawns on you that the trajectory of the practice is slightly awry or a course correction is needed, consider making some thoughtful changes with the right business advisors and possibly legal counsel involved.

Finally, Physicians need to have an open communication policy with patients. It is not simply enough to hear a Patient’s concerns and then never do anything to correct them. It may mean an apology. It may require a conversation with a staff member. It is important to broach the subject the next time you feel it is necessary to let the Patient know you listened and are concerned. It doesn’t mean letting your Patient’s run your business. It’s more about letting them know how much you care to listen. Let your Patient’s know you want to hear about the positive and negative things they see and hear.

“Slow and steady growth is ideal in this type of practice because it allows you to offer patients a personalized experience,” says Joel Bessmer, MD, FACP of Omaha, Nebraska’s Members.MD. “I’ve found that the word-of-mouth aspect (vs. a billboard advertising approach) has been the most consistent factor in building my practice. I consistently have patients recommending their family members and friends. Getting word of mouth referrals based on high quality care, staff service and patient satisfaction has been a much more effective tool than traditional marketing. And the slow and steady approach ensures that staff can keep up with new patients, as opposed to getting a rush of new caseloads that would be more difficult to manage all at once.”

When Concierge Medicine Doctors become committed to exceptional patient/customer service, you may stumble from time to time, but when you do, you’ll still be providing great patient/customer service. The added benefit to providing exceptional service is that when you or your staff do stumble, your patients will be much more likely to forgive you. In summary, it is natural to assume that what worked in the past will always work. But, of course, that way of thinking is lethal. And the longer it goes unchallenged, the more difficult it is to identify and eradicate. Every innovation has an expiration date.

(READ PART 1 HERE > | READ PART 2 HERE > | READ PART 3 HERE >)

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