Monday, July 19, 2010

Service after the Sale

This is a subject that comes and goes periodically. Usually it is when I hear a complaint from a patient whose expectations were not met.

When I have a new patient, I usually tell her that our process for patient communication of lab results is through the mail. Our system, with its Electronic Medical Record, allows us to generate a personalized letter regarding results of tests that we have ordered. Many women are surprised that I am not, nor my nurse personally call them for all their lab results. There is a new patient brochure that they receive that tells them all of this. I am sure they do not read that part.

It takes variable amounts of  time for the tests to return to the doctor, and a typical physician will have somewhere between 60-120 tests to respond to each day. Then there are the autofaxed prescription refill requests from the pharmacy. There are usually a dozen of those, and then the 15-30 patient phone calls that require a response. Since my patients also expect me to run on time, and spend time with them in the exam room, I need to squeeze all of this into my workday. Needless to say, lunch is a fairy tale my mother told me about.  Oh, and lest I forget, a ream of records sent from the old doctor for each new patient, to sort through to see if there is anything in there that is relevant. Did I mention I do ambulatory care, so I don't get the stream of hospital and Emergency Room phone calls?

I do not play golf, and I don't have a four day work week. The fat was rendered from medicine 20 years ago. Managed care and risk sharing saw to that. There is no army of medical secretaries to do this work. It now falls to the physician and nurse to manage the practice. The office staff generally makes appointments and takes the phone messages and forwards them to the clinical staff. The clincal staff (my nurse and me) then sorts through all of this, in between a busy work day of patient care, and responds to the tests, patient calls, and other demands such as " just phone in my prescription, so I don't have to make two trips to the pharmacy" " fax it to my mail order". Nice for you. Did you even bring in the address and phone number of the pharmacy? Find me something else that is cheaper. How do I know what is on your insurance plan's least cost list? It's like buying a car. Nobody pays the same thing for the same item. And I am going out of town so I need it right now.

The joys of dealing with the public.

Managing the expectations of the customer is a critical part of what we do. Much has been written about this subject in the business literature. It is a daily challenge, especially on the front lines of a large organization. The customer ( in this case the patient) has expectations from hearing the name Cleveland Clinic. It is a prestigious academic medical organization almost a century old. It has been in Florida over twenty years. Processes have been in place for years before I showed up. It is up to me, and each new hire to fit into the process and make it successful in his or her own way. Nobody teaches that to you. It is implied when you are hired, that you will become " a Cleveland Clinic" physician. So the trial and error process begins. I asked to help make the onboarding process easier for new physicians, that way they don't step in all of the holes that are out there, there is a map.

In a medical world where qualtity of care and service are determinants of the paycheck, service after the sale is becoming more important.


  1. And when something falls through the cracks on those 200+ tasks you are expected to do perfectly each day, it is always the fault of you, the individual physician for not being as perfect as you should be, not the fault of the system, which desperately needs fixing. It's a lose/lose game for all of us, patients and providers alike.

  2. In my work with the Baldrige National Quality Award ( sound familiar from PRES?) it is the system, the process that is usually at fault. Root cause analysis will show that more education does not really fix poor processes. Looking at the problem from a new point of view, the now famous culture of safety, instead of the blame game will help. This is a matter of time before things slowly shift from placing blame on individuals to examining systems and workflow. Even residency got some on duty time limits, miracles do happen!