A patient can get excellent clinical care and still leave a practice for good. The reason usually has nothing to do with the diagnosis. It is the scheduling call that left her guessing, a cold check-in, the end-of-visit instructions delivered in a rush, or the two portal messages that went three days each without a reply.

That was the key takeaway of a 2026 MGMA Summit session led by Jasmin Barber, MPH, LSSYB, CODC, Patient Experience Outreach Advisor at UT Physicians Patient Experience, and Chelsea Grear, Sr. Business Development Representative at UTHealth Houston Department of Orthopedic Surgery. Their argument: patients trust a practice when staff explain what is happening, what comes next and who owns follow-through. When communication is clear, the patient knows what is happening, what to expect, and where to turn next. When it breaks down, even strong care can feel disorganized or dismissive.

For administrators, it means communication breaks in predictable places, and managers can coach those moments. Barber and Grear mapped those points to five places in the care experience, then showed what good and bad look like at each.

The 5 touch points

Barber and Grear organized the experience around scheduling and access, check-in and arrival, the clinical interaction, visit wrap-up and checkout, and between-visit follow-up. At each point, a specific person has work to do: set expectations, confirm information, explain the plan or follow up.

Scheduling sets expectations before the patient arrives

Scheduling is the first impression, and it usually happens before the patient is in the building. Grear said she deliberately invests in her scheduling team because the role rarely feels glamorous and its impact is easy to underestimate. A clear scheduling call means the patient arrives prepared and the front desk and clinical team are not absorbing avoidable confusion. An incomplete one means patients show up with the wrong paperwork, the wrong expectations, or assumptions no one corrected.

Treat schedulers as part of the care team, not as back-office support. During a session Q&A, Barber described correcting a new hire in orientation who introduced herself as "just" someone who answers phones. Barber's response was to drop the word "just." For many patients, the scheduler or call-center representative is the first voice of the organization, and that voice sets the tone for everything after it.

Check-in is relational or transactional, and patients can tell

The arrival experience sets the tone for the visit in the room. Grear contrasted a transactional greeting, "Do you have an appointment?" or the familiar "ID and insurance, please," with a relational one: "Good morning. Welcome to UT Cardiology. My name is Chelsea. How may I help you today?" The wording difference is small. The patient hears the difference immediately.

Most check-in breakdowns are subtle and tied to workload rather than attitude: no eye contact because a staff member is focused on the screen, rushed speech because the medical assistant is waiting at the door, or instructions so clipped the patient does not know whether to head to imaging first. The patient does not experience the workload pressure. The patient experiences feeling like a record number.

Grear gave managers a simple coaching point for fast clinics. In a fast clinic, she tells patient access representatives to take the extra minute or two to get the check-in right rather than rushing to clear the line, and she absorbs the pressure herself: a provider who is mildly annoyed about a short delay will be far more annoyed by missing insurance information or paperwork that has to be chased down later. As Grear put it during the Q&A, it can take less time to do it right than to rush and then double back, triple back, and fix mistakes.

Clinical communication needs plain language and a confirmation step

Patients get the most information during the clinical visit, often while anxious, in pain or trying to remember instructions. Barber pointed to four recurring breakdowns: information overload, medical jargon, unclear instructions, and rapid speech.

Barber emphasized two practical fixes. The first is plain language. Barber's example: instead of telling a patient she has rhinorrhea and acute otitis media, say she has a runny nose and an ear infection. The second is the teach-back method, a short loop of share, confirm understanding, clarify or rephrase, and continue. The point is not to quiz the patient. It is to give the team a chance to catch a misunderstanding before the patient leaves with it.

A live demo in the session showed how natural this can be. After a provider explained a likely lateral meniscus tear, ordered an MRI, and suggested topical Voltaren gel, the patient summarized the plan back herself: get the MRI, use the topical, and return once results are in. The provider confirmed, and the visit moved on with both sides aligned. Teach-back can be initiated by anyone in the room, including the patient, and works across medical assistants, nurses, providers, and checkout staff. The goal is fewer of the callbacks, portal messages, and missed follow-ups that confusion generates.

The visit wrap-up is the wrong place to hurry

Visit wrap-up and checkout often happen when everyone is ready to be done, which is exactly what makes it risky. Grear stressed that the visit wrap-up is where staff should slow down: walk through the after-visit summary, highlight the items that matter most and why, point out how to reach the care team directly and confirm the patient knows the next step.

A second demo made the failure mode concrete. A medical assistant first gave a patient generic end-of-visit instructions — "we'll order imaging and medication and see you back in four weeks" — and the patient immediately had questions. Which imaging first? Where? What medication? Rather than send her off uncertain, the MA paused, went back to the provider, and returned with specifics: "the X-ray is done in-office today," "the MRI order goes to a named imaging center that calls within two to four business days," "the prescription is the topical gel and here is how to use it." The extra few minutes prevented a string of follow-up calls. Checkout is also a useful moment for service recovery before the patient leaves.

Between-visit silence is the touch point leaders forget

The fifth touch point is the easiest to overlook because the patient is no longer in front of anyone. Barber argued that is precisely why it is dangerous. A portal message that sits unanswered for three days, followed by another that also goes unanswered, tells the patient no one is paying attention. The patient does not see the staffing shortage or the routing problem behind the delay. The patient sees silence, and starts looking elsewhere, whether that is another provider, WebMD, or what Barber called "Google University."

Barber pointed out that even when staff cannot resolve a request right away, they can acknowledge it and set a response window. A reply as simple as, "Thank you for your message. Our team has received your request and is actively working on it. We will follow up with you in 24 to 48 hours," keeps the request from disappearing into a void.

For leaders, this is an operational standard worth writing down rather than leaving to individual habit. Practices should set a response time for portal messages, assign voicemail follow-up and define backup coverage when the owner is out. They also need a way to track unresolved requests so none go quiet for six days. Without answers, between-visit communication is only as reliable as whoever happens to be at the keyboard.

Service recovery should reach the patient before the complaint does

The session's service-recovery example started with a patient who had waited about an hour for an X-ray while others came and went. The point was to respond when concern first surfaces instead of waiting for a formal complaint. A manager stepped in, listened without interrupting, acknowledged the frustration, apologized, checked with the X-ray team, learned a software issue had caused the delay, and came back with a realistic update.

The wait still happened. What changed was the patient's experience of it: acknowledgment, an explanation, and a concrete expectation instead of being left to stew. That is often the line between a patient who leaves angry and one who leaves disappointed but still trusting the practice.

Managers should train the sequence: listen, acknowledge the frustration, apologize, investigate, explain the next step, follow through and thank the patient for raising the concern. Staff also need to know the escalation path: when to pull in a manager and whom to involve.

Patient experience runs on employee experience

Asked how staff can stay patient and respectful on hard days, Grear reminded attendees that a patient is only going to be as happy as the practice's most unhappy team member. A team that feels rushed, unheard, or undervalued will not reliably produce warm patient interactions, no matter what the script says.

The behaviors that keep a team steady are small and concrete. Both presenters described rounding through clinics, thanking staff by name, and speaking to staff with the same patience they expect staff to show patients. Grear pointed to one of her clinics where a provider walks the floor midday with a small bucket of chocolates as a quick reset, and to the value of a brief afternoon huddle after a rough morning. The point is not the candy. It is a manager visibly checking in, because a depleted team cannot manufacture patience for the next patient in line.

Several attendees described a low-tech patient-connection habit: logging non-clinical details about a patient, a recent trip, a child's name, a tennis injury, in the EHR's non-medical notes or even on a sticky note, so any team member can reconnect at the next visit. A patient who is remembered after six months feels known rather than processed. As Barber noted, the EHR makes it scalable, but a pen and paper work, too.

Make the behaviors repeatable

The most useful idea for administrators is that managers can turn patient trust into a set of coached behaviors. It does not require turning staff into performers or adding long conversations to packed schedules. It requires finding the moments where communication most often breaks and building reliable behavior around them.

A practical starting point: map the five touch points, then look at where patients actually get confused, frustrated, or silent. The evidence is already in complaint logs, portal-message backlogs, call volume, missed follow-ups and front-desk escalations. Pair each weak point with a standard. Start with the weak point: what patients miss before they arrive, what check-in fails to explain, where clinical instructions get lost, what discharge leaves unclear or which messages sit too long. Then attach each weak point to a standard: what patients must know before they arrive, how staff greet them at check-in, when staff use teach-back, how discharge confirms next steps and who acknowledges between-visit messages. Give every staff member permission to begin service recovery before a concern hardens into a complaint.

Barber and Grear's session left a modest message for administrators: patients trust practices that remember them — explain the next step and respond before silence turns into doubt. The goal is to make those behaviors repeatable on the days the clinic is busy, short-staffed and behind.