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    Owen J. Dahl, MBA, FACHE, LSSMBB
    Last year I had an experience that shed a great deal of light on today’s patient encounter and issues surrounding what we as managers need to consider as we look to improve patient care. (In the interest of full disclosure, I signed my own HIPAA form.)

    While on a Baltic cruise, I developed cobwebs and pepper spots in my right eye. The ship’s doctor suggested I see an ophthalmologist at the next port. Long story short, a provider in Tallin, Estonia, diagnosed me with posterior vitreous detachment (PVD) and suggested I see my ophthalmologist within three months of my return, which I did. She confirmed the diagnosis but indicated that 10% to 15% of the patients with PVD develop retinal issues and that she sees five to 10 PVD patients per day. She suggested a return appointment in two months, which I made.

    On Wednesday a couple weeks later following a return from New York City, I suddenly couldn’t see out of my right eye. I immediately called my ophthalmologist for an appointment, telling the receptionist that I couldn’t see. The doctor wasn’t available and out the following morning and had no appointment slots left for the week. I hung up not knowing what to do. I grew concerned that this might be an emergency, called back and said I would see anyone. No one was available that afternoon or the following day. The receptionist recorded my concerns and noted that the doctor’s staff would get back to me. Later I got a call back saying there had been a cancellation at 2:05 p.m. Friday, so I took that slot.

    On Thursday morning I learned I could see a neighbor’s retinal specialist. I called that doctor’s office and was told to come to see him at 1:15 p.m. that day. On the way into the retinal specialist’s office, my regular ophthalmologist’s staff called and asked about my symptoms. The retinal specialist saw me with all the appropriate diagnostic tools. Even before walking into the exam room, the doctor asked the staff to schedule my surgery at 7:30 a.m. Friday, then discussed my situation and ultimately scheduled a procedure for 11:30 a.m. Friday. The staff was very friendly and efficient, but the recovery process is no fun.

    What can we learn from this episode? Here is my list:
    • Does the receptionist and/or scheduling staff have a set of questions/protocols in place to screen patients who call with certain symptoms?
    • The phone tree led me to the receptionist.
    • I did not feel a welcoming attitude when speaking to the receptionist who answered.
    • If the doctor sees five to 10 patients per day with a diagnosis that may lead to a serious condition, what steps are taken to deal with those possible situations?
    • Predictive analytics would indicate that there would be two to five patients per week who could develop serious issues, which would warrant a plan to address them.
    • When choosing to review a diagnosis or patient type, staff should track calls related to the diagnosis or patient type to determine issues to assist in assessment.
    • The practice is very large with many offices and includes retinal specialists. By not asking questions, potential appointments and revenue were lost.
    • It is understandable that doctors have full schedules. What options are there for unscheduled or emergency patients?
    • Look at past data to determine how many late additions there are per week.
    • Once a pattern is determined, plan accordingly.
    • If the practice has multiple offices, consider the scheduling effect on each office and whether it is prudent to have providers in more than one office and maintain a presence in all offices.
    • This large ophthalmology practice recently began offering hearing aids and Botox for patients. As a patient looking to schedule an appointment, did the service additions take away from the specialty’s core mission? Is the focus on increasing revenue or offering patient service in the area of practice expertise?
    • Is a smaller, solo retinal specialist practice more responsive to individual patients than a larger one? The larger practice may have many more rules in place, which limit how patients are given access versus working anyone in who needs to be seen.

    I decided it would be beneficial to the practice if I called to express my concerns about the lack of response. I talked with the office manager and the doctor, and neither listened nor offered any concern.

    The office manager called and, after my brief review, said that she had many years of experience and that what I experienced was an exception caused by a staff shortage at the time of my calls. She assured me that she cared.

    She did not ask how I was doing. She did not listen, rather simply seemed to go through the motions of reaching out to a patient who complained. There was no indication that anything would be done to look into my concerns or that she would get back to me and let me know that things had improved.

    The doctor called at 6:30 p.m. and said she was always available, noting that she was calling from her cellphone. She also failed to ask how I was doing.

    As a patient I was left wondering: If the email notification system worked and she was available via her cellphone, why didn’t I get a call back on Wednesday evening?

    There is a different perspective when you are a patient. The decisions made and actions taken affect you personally. Meeting the patient’s expectation should be first and foremost in all interactions. It is not only the provider but also the process and the team that affects the care given to each patient.

    Written By

    Owen J. Dahl, MBA, FACHE, LSSMBB

    Owen Dahl, MBA, FACHE, CHBC, LSSMBB, is an independent consultant with more than 40 years of experience managing medical practices and providing healthcare consulting services. Owen has worked as a chief executive officer (CEO) for a physician practice-management company with combined revenues of more than $75 million and 18 groups under contract, as CEO for a merged hospital with a 300-bed facility, and as president of a physician practice-management and billing company. Owen has presented at several state and national MGMA meetings, as well as to audiences from the Association of Otolaryngology Administrators, Association of Dermatology Administrators/Managers, American College of Rheumatology, American Academy of Dermatology and others. He has also authored Think Business! Medical Practice Quality, Efficiency, Profits; The Medical Practice Disaster Planning Workbook; coauthored Lean Six Sigma for the Medical Practice: Improving Profitability by Improving Processes, and written several articles and provided interviews for numerous journals. Owen is an adjunct professor at the University of Houston, Clear Lake, and is conducting a distance learning program at the University of New Orleans. He has also taught at Our Lady of Holy Cross College and Loyola University.

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