At UNC Health Care in Chapel Hill, N.C., one patient’s husband is expected to be an inpatient for two months due to chemotherapy treatments. According to a News & Observer report, the 70-year-old patient will have to pay $8 per day, or $500 total during that time, to visit her husband. Conversely, when hospital expansion planners allow medical services to take precedence over parking, the result can include significantly increasing parking costs, wasting valuable land, aggravating surrounding communities and inconveniencing or endangering patients and staff. [*]
By Michael Tetreault, Editor-in-Chief, Concierge Medicine Today
Everything about your medical office communicates a message about you, your level of sophistication and background in medicine and even your care. It’s not something you always have control over and it might not even be fair that you don’t own the building and have a ‘say-so’ on landscape or paint color.
Good or bad, it all says something about you.
Moreover, it echoes throughout your community (big or small) in all kinds of ways. The parking lot informs us how quickly we can get out. The U-Turn to enter from the road tells us how complicated things might be for us the next time we visit.
You might be thinking, that’s absolute hog-wash.
Well, is it?
Am I dreaming?
You have control over these seemingly insignificant details early on. If you already chose these things, you may have not taken into consideration a lot of the same things new patients (and yes, they are new customers) just how important these details are to a Patient, both young and old, new or existing.
These all inform us good or bad, negatively or positively, there is no neutrality … just how good and caring of a Doctor you really are.
Sure, it’s not fair that the landlord isn’t cutting the shrubs and the sidewalk and paint color is an eyesore that people see every time they walk-in the office.
We hope they just ignore it, right?
All of the time, every single day, these little things add up to big things, particularly in the eyes of Patients/new customers that don’t know how likeable you are or how great of a Doctor you are to your community.
John Matthews, founder and president of Gray Cat Enterprises, Inc., a strategic planning, operations and marketing services firm that specializes in helping businesses grow in the restaurant, convenience and general retail industries wrote a story for Convenience Store Decisions (CSD), a trade magazine published by WTWH Media writes a Evaluating new retail sites for the multi-unit operator can be a daunting task … all of the components of the site – location, build-out costs, landlord terms, a financial Proforma, etc. [are needed] – in order to provide a complete assessment of the property. In summary, having consistency and structure around your site selection evaluation will streamline the process for all parties involved and enable an organization to move projects through the pipeline much faster (or eliminate potential sites more quickly). When an organization is trying to grow organically, it is prudent to have the necessary backup for each new site so that when a post-analysis is conducted in the future, you can refer to the pre-build, documented decision-making process for each and every location.[*]
How long did it take you to select the right site for your current medical office? How much pre-planning, outside customer consideration, community research, etc., did you conduct?
Let’s look at another example of structure and how the little things communicate big messages to Patients. Enter, the Reserved Parking Space!
The dreaded Reserved For Dr. Sign that is posted on it.
What is this communicating to our communities?
Like it or not, it says something to Patients, existing and new about you, the Doctor.
This is a touchy subject. Especially for most Hospitalists.
Believe we get it.
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Nothing is more important than putting you in front of your Patient as fast as possible. After all, if I were waiting on you for surgery … believe me, I’d want you there as fast as humanly possible, more so if I could.
But this story isn’t necessarily about hospital parking lots or even taking away someone’s space. Around here we believe Doctors are the unsung heroes often neglected and unappreciated. You have an impossible job. We’ll never fully understand as a Patient the enormous pressure on your shoulders every day. Furthermore, we also see there are millions of patients who are looking for a Doctor just like you. Why is it then that America’s Best Places To Work never include a doctors office? Let’s change that and this is what today’s story is all about.
Let me explain.
The idea of having to drive around a hospital parking lot looking for a space as a busy Physician irritates most Doctors. It would irritate Patients as well who are waiting on that Doctor to walk into the exam room, particularly if it was an urgent issue.
The passion surrounding parking lots among Physicians is interesting. Many Physicians are incredibly passionate about their space.
So why address such a topic? Why stir the pot?
This isn’t necessarily about hospital parking lots of those impossible jobs or urgent situational cases whereby Physicians must quickly gain access to the building. At hospitals, we understand the need for these reserved spaces. Are Physicians seen more often than not strolling in checking their phone than rushing into the ER? From birth emergencies to urgent surgeries, we see the benefit as Patients. After all, if ‘Do no harm …’ truly is “all about the Patient” then putting providing adequate space in opportune places around the hospital helps Patients and Doctors.
We agree wholeheartedly on the need for these hospital parking lots spaces.
However, when it comes to hospital-owned facilities or private practice spaces, we take a different approach.
Why does a Doctor have a reserved parking space when there’s no urgency?
We raise this white flag on behalf of Patients. Why? Because of how the non-essential parking lot space or statement of superiority when a Patient walks by makes them feel?
What a “poor, poor me” thing to say right?
Hear me out.
From a Patient perspective, we surveyed and asked Patients an important question that will help us unpack why the little things, like passing by a Reserved For sign impacts the willingness of the Patient to actually know, like and trust their Doctor.
We asked patients who are not members of Concierge Medicine practices this question. “If Your Doctor Went Out of Business, How Much/Little Would You Care?”
You might be surprised, or not, at how little most people in and around our communities actually feel like their Doctor cares.
You might also be saying, what gives you the right to tell us where to park?
I’m not saying that at all. Not in the least. What I do know is that I know what it’s like to sit on the other side of the exam room. I have great kids, a wife and we have our have to visit facilities quite frequently and walk by Reserved For Dr. signs all the time.
If you’re upset at the parking space issue, the emotion might just be misplaced.
At the end of the day, what we as Patients really want is … you!
Plain and simple.
If you haven’t figured it out by now, this story isn’t about taking away your parking spot.
Asking a staff member if everything’s okay [with Patients] once a week in a staff meeting and addressing the eroding morale of Patient Satisfaction isn’t good enough. Your patient/customer service expectations need to be exceptional, and you need to create not just satisfied Patients, but happy, healthy and loyal patients who revere and respect and of course, tell other people about how wonderful you and the entire experience were.
“Business is tough,” says Dr. Chris Ewin of 121MD in Fort Worth, TX. “If you are doing something just for the money, you are never going to enjoy it. You will be the hardest boss you have ever had. So, find something you love and pursue it. Follow this advice and you will set yourself up for an enjoyable future in medicine.”
So if you believe as most Doctors we talk to do that Word of Mouth advertising and Patient Referrals are your number one most popular mechanism of driving your business/practice forward, you’d be remiss to not see the larger picture and what is truly at stake.
“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.”
If you want to create a happier, more satisfied Patient and is remarking positively about your practice when they leave … give them a great experience. Give them something worth sharing and talking about with their friends. Change the narrative of the typecast Doctor that’s been placed upon every Physician in our society.
type·cast/ˈtīpˌkast/Learn to pronounce | verb: typecast; 3rd person present: typecasts; past tense: typecast; past participle: typecast; gerund or present participle: typecasting; verb: type-cast; 3rd person present: type-casts; past tense: type-cast; past participle: type-cast; gerund or present participle: type-casting; assign (an actor or actress) repeatedly to the same type of role, as a result of the appropriateness of their appearance or previous success in such roles.”he tends to be typecast as the caring, intelligent male”represent or regard (a person or their role) as a stereotype.”people are not as likely to be typecast by their accents as they once were”
However, to grow or your practice, your brand, yourself, sometimes that means doing something out of the ordinary. It is about finding a unique way both of you can communicate with each other, better.
“If you provide anything less than exceptional patient service for your Concierge Medicine patients, you’re wasting time, creating extra work for and frustrating your patients, staff, suppliers and yourself,” says one of Texas’ most well-known Concierge Physicians in a recent radio interview. “Smart businesses outside of healthcare have customers. So do we. We put in our time, our emotion and our mental strength into our customers and it’s about time we start operating like a business. We have every advantage now that we’re free from a lot of the administrative burdens most traditional medical practices have. There’s simply no reason why we cannot make the extra effort to serve our patients now.”
One Concierge Physician writes … “I had a real battleaxe in the front office. She worked with our team and for me for a very long time. But, our practice has changed. That’s not what we need anymore. We went ‘Concierge’ and like it or not, we needed a softer, gentler and friendlier person in that position now. In fact, the whole position was changed. It took a few months for me to realize this … but I’m glad I did. I just hope my patients will forgive me for taking so long.”
“Patients were skeptical and reluctant because of how accessible and convenient the service was. They expected to be kept waiting on hold. Some seemed puzzled by the fact that when they called I answered the phone and knew who they were. One patient even inquired as to how come they only had one form to fill out.” ~Raymond Zakhari, NP and CEO of Metro Medical Direct, New York
We understand and empathize as Patients, well, at least I do, I can’t speak for everyone out there … the relentless demands, pressures and constraints on you as a Physician. We’ll never, ever understand or fully be aware of the pressures you have. Our hats off to working in a tough, challenging and stressful place we somehow call ‘healthcare.’ We all as Patients owe our reverence and respect to you and you’ve certainly done more for our communities than we will ever know. You may never receive the thanks you deserve for all we as Patients have put you through, but you deserve more than we could ever do for you. So, thank you.
“Growing up in a small town, my doctor knew me personally,” said one Functional Concierge Medicine Physician in a recent interview with us. “And it was never a high volume practice. So I always felt like I had a great experience when I went. As I got older, that changed drastically. My doctor didn’t know who I was or anything about me. I also got shuffled off to specialists. So there was no personal connection. And by the time I got into practice, that was just how it was. Busy, hurried, and impersonal.”
With that said, we want more time with our Doctor. We value your input more than you will ever know, I know I do.
At this point, you might be thinking, ‘Pie in the Sky Idea’. This will never happen. That’s not what Patients want and we could never do that. Our practice is way too busy. And, for most reading this today, that is true. However, for the exception, not the rule, this is something they needed.
One Concierge Doctor in New Jersey said … “You either have a workload issue or a workforce issue? If you’re not committed to providing exceptional patient/customer service for your patients, your practice will never achieve its full potential.”
However, there are a lot of obstacles that are put in the way both intentionally and unintentionally, that slowly erode the trust and likability kept so sacred between the Patient and Physician. You and I can probably fill up a notebook of items that keep the Patient and Physician apart. Many of which aren’t your fault whatsoever. We understand that.
What we’re simply doing today is drawing attention from a patient perspective about a small obstacle that many leasing companies, Doctors and facilities might have in place that are slowly eroding the Patient-Physician relationship.
I can’t tell you the number of times I’ve been in a room with a Doctor only to hear “I’m so sorry I’m late.”
Often people get turned away not because of something their Doctor did or didn’t do, but because of a staff members bad attitude or expectation not being met. How often are you frustrated with the advice and recommendations you give to Patients time after time only to see the Patient not follow your advice? This is something we hear a lot from Doctors about why they exit traditional, plan reimbursed medical practice or hospital settings and enter into a concierge medicine model or cash practice.
Everyone Doctor we meet has a way they prefer to communicate to their Patients. If that communication strategy or and approach aren’t getting you and your Patients to the goal line, change it.
If you’re routinely late to exams I’m early for, you should be irritated. If you’re staff doesn’t smile or is dressed inappropriately, that reflects on the Doctor too. And if outside the window in the almost empty parking lot with six cars in it has a Reserved For Dr. sign that a Patient [new or existing] walks past every time we visit, we feel as a Patient that you’re putting yourself above others and that mental note whether you like it or not hits a note with Patients. It might not be the deal breaker of whether or not a Patient walks in the practice for treatment by any means … but it communicates something to the Patient.
Here’s a recent example. A Patient wrote to us and said … “Uniforms should be the same across the board and appropriate for the practice. Pediatric scrubs for Pediatric offices. Solid color for other offices. And, when it comes to Concierge Medicine offices who are more upscale, a dress code that is not wearing scrubs but uniformity is important. It communicates professionalism. Going to a Concierge Physician, is more laid back, casual and comfortable. That’s fine. But this isn’t summer vacation or a trip to Walmart. I want polished and respectful dress on staff. Who wouldn’t? Common sense. Make the effort. We’re [Patient’s] pay attention. I’d like to see a dress code at any Doctor’s office for that matter where the style of wearing dress pants and nice blouse (all uniformed) for staff is more professional, appropriate and appealing to Patients. If we’re going to refer our friends and Family to your Medical Office, impress them. Impress me. I matter. Patients are anxious when they go to the Doctor and scrubs usually are associated with unpleasant procedures such as lab draws or injections. Scrubs also give the impression that the people behind the scrubs are nurses who have a higher level of education and the reality of it is, these people are medical assistants not nurses.”
If you take anything from this article and commentary today, it’s this. The more time you can spend in planning for the Patient experience, the more personal it becomes.
People stop going to their Doctor because they disengage or uncouple themselves from you, not necessarily because they disagree with you. Sure, this could be argued in your business. But that’s missing the point. So let’s restate this another way. Only a few Patients will walk out your door because of disagreement. Most will leave because of disengagement.
We don’t hear enough input from Patient’s because they are telling us that they are afraid to speak up …. actions have consequences and believe it or not, we are frightened that the Doctor [or worse yet, staff] will somehow penalize us for it. You might not believe this happens in your practice, and it might not. But sadly, it does happen and this is the reality of our healthcare marketplace today.
So what action will a Patient take?
Answered simply, we’ll leave.
Again, it’s not because we disagree. It’s because we feel you’re disengaged, removed and not connecting with us at your Patient.
This is worth reminding us all … “Five words from a Doctor, mean more than fifty words about you.”
And if you don’t believe me, that’s fine.
“Gain some customer service experience– try a service industry job as these skills are not taught in med school. Moving into Concierge Medicine is not solely about providing excellent medical care without the restraints of insurance industry mandates. You have to also appreciate the lost art of customer service so long ago forgotten when visiting a healthcare institution. Many times my clients (notice I do not use the word “Patients”) have noted why they refer their friends to my practice. It is the attention to detail, always delivering exactly what is promised and then some, and keeping their unique needs positioned first with a flexibility to offer new programs or meet needs as quickly as they are identified. This is the cornerstone of customer service.” ~ Dr. Carrie Bordinko, Consolaré, Paradise Valley, AZ
Let further unpack a Patient survey we referenced earlier clarify the talking point.
We asked Patients, “If Your Doctor Went Out of Business, How Much/Little Would You Care?”
- 49% said “Not At All. Glad They’re Gone. I Wanted A New One Anyway.”
- 41% said “It Would Be Inconvenient But I Didn’t Have A Relationship/Care Either Way With Physician.”
- and only 10% said “Call The Mayor! Save This Business! They Would Absolutely Be Missed! Don’t Let This Medical Office Close! We Have To Save It!”
A Patients attention span is determined by the quality of the presenter. When you invited friends over to your house for an important conversation, do you not tidy up the place? Do you not remove every obstacle, seen or otherwise, that might impede or distract from what you have to say to them? Of course we do.
With all the talk about how many Patients are not following a Doctor’s orders, the diminished attention spans of people today, eliminating distractions both inside and outside the office should be a clarion call for all of us today to change the experience of going to a Doctor. If the next time you went out to eat and the table at the restaurant was dirty from the prior customer(s) and no one did anything about it but proceeded to serve you anyway and act like nothing is wrong … would you come back?
“If I’m paying any amount of a monthly [or annual] subscription to see my doctor, you better know my name when I arrive and I sure shouldn’t have to tap on the glass when I walk-in. And please, move the phone to the back of the office so I don’t have to hear your staff calling in prescriptions or making specialist referral calls.” ~M.C., True Story, Actual Patient, (C) Concierge Medicine Today, 2017
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!)
- If your staff aren’t careful about their health, they are not going to be careful with your patients health. Staff who are not concerned about their own reputation, are not going to be concerned about your reputation. Staff who are not concerned with their own finances [overspending when maybe they shouldn’t on a car, luxury item, etc.] won’t be careful with your office expenditures and your finances. Staff is a reflection on the doctor. If the doctor is a smart dresser, the staff needs to be dressed just as smart as the MD, fashion-wise.
- 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 envirionments 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.
- Answer this question for yourself “If photos of my practice showed up on Facebook, would I be proud of them?”
- 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?
- 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.
In summary, what we’re trying to say here is you can have any parking space you want. And if you’re reading between the lines here, this really isn’t even about parking spaces. We’re not even saying you have to give up your parking space. What we’re trying to draw your attention to as a great Physician in your community and a respected leader among your Patients and colleagues is that your environment, your parking lot, your door handles, your garbage cans and restrooms communicate something about you. That’s not fair, but it’s true. An unkempt restroom with an overflowing garbage can, food on the front desk, crumbs on the floor, or yes, even a silly Reserved For Dr. sign have the potential to derail your message of health, prevention and wellness before you even enter the exam room.
When Patients Arrive They First Pay Attention to Your People [eg Your Staff]. Second, Your Practice Environment and Design. They’ll internally ask themselves, ‘Is that chair free of germs?’ or ‘I hope the bathroom is clean.’ Finally, they’ll eventually pay attention [and hopefully listen] to you, their Doctor, Dead Last.
In what ways can you eliminate distractions to improve the overall Patient experience?
If you don’t see a problem, if you aren’t bothered by these things, maybe it’s time to make put someone around you who does see it and is bothered by it. A distracting environment can dissuade or prevent what important things you have to say to the Patient before the visit even begins. Therefore, the proper care and treatment of a Patient we believe in Concierge Medicine … begins in the parking lot.
For hospitals: a bottom-line benefit
Hospitals offering valet parking services stand out as different and patient-centered, generating positive word-of-mouth from patients to their friends and family.
For hospitals, the many tangible benefits of offering a friendly, well-trained valet parking service makes it more an investment than cost. Partnering with a healthcare-dedicated valet parking company can increase patient loyalty and the bottom line by improving:
On-time arrival rates, avoiding that dreaded domino effect where one late patient delays subsequent appointments
Clinical staff productivity and efficiencies, due to lower downtime while waiting for late patients
Adherence to appointments, by making it easier and enjoyable to arrive