Patient Communication Guide for BCDA Members

Transcription

1 Patient Communication Guide for BCDA Members

2 Your guide to better patient communication This guide outlines some simple strategies and tips for improving communication with your patients. Research from the Canadian Dental Association indicates that soft skills have a direct bearing on patient perceptions of the value of care provided, the degree of trust placed in the dentist and the success of treatment. Although you may be familiar with some of the patient communication strategies included in this guide, reviewing them may strengthen your communication with your patients and remind you to be as consistent as possible by engaging your staff in positive communication techniques. The British Columbia Dental Association (BCDA) acknowledges the work of the Alberta Dental Association and College for initiating production of this publication based on the research of the Canadian Dental Association s Branding Working Group. This guide has been edited from the original publication for BCDA members.

3 The goal of effective communication is simple: To empower your patients with the knowledge required to make an informed decision about their dental health. It is up to you and your staff team to communicate clearly in a way that your patient understands. In many cases, you are providing complex recommendations about a subject that your patient has no knowledge of and perhaps no acute symptoms. Good communication skills will ensure you and your patient can agree on the best treatment option for them.

4 Why good patient communication is important If you include your patients as fully informed partners in their care, they re more likely to be loyal. As an added bonus, you ll have the satisfaction of happier patients, and more satisfaction in your work, renewed motivation and increased productivity. Patients often care as much, or more, about how they are treated than by extremely well executed treatment skills that they don t understand or can t see. As the lead of the dental team, it is vital that the dentist adjusts his or her communication style to meet the needs of various patients, and that the patient experience with the whole team is consistent. When patients have a positive experience in your practice, not only will they be more inclined to accept recommended treatment and return for ongoing care, they will also refer friends and family. This will help build your reputation and practice as well as enhance the image of the profession overall Increased patient satisfaction Canadian Dental Association market research has demonstrated a positive association between a patient s satisfaction with the care they receive and their provider s ability and willingness to communicate and empathize with them. Reduced complaints Open dialogue with patients results in better patient retention and a reduction in complaints. It is estimated that up to 70% of the complaints received by the College of Dental Surgeons of BC may have been resolved or avoided through better communication between dentist (and their staff) and patient particularly around the issue of treatment cost, when the final cost of the procedure exceeded the amount the patient anticipated, or agreed to. Improved efficiency Improved communication with your patients will make your practice more efficient. For example, giving patients time to express their concerns doesn t take any longer but can significantly reduce the likelihood of late-arising concerns or missed opportunities to gather important information. 2 Why good patient communication is important

5 The dentist-patient relationship The first law of patient care is: Patient Satisfaction = Perception Expectations If your patient expects one level of care, and gets something less or different, they are likely going to be dissatisfied. Understanding and addressing your patient s perceptions and expectations are important factors to be considered to keep patients happy and loyal. Why good patient communication is important 4

6 Communicating with care In its most basic form, good patient care consists of listening, understanding and responding to your patients needs. While your oral health knowledge and clinical skills may be exceptional, dentists are not necessarily taught how to be good communicators. While there are a multitude of patient needs seven basic needs stand out in the Canadian Dental Association research findings: Friendliness Basic courtesy and politeness; being warm and caring. Empathy The patient needs to know that the dentist appreciates their wants and circumstances, providing personal attention. Efficiency and punctuality The patient wants to feel they are respected. Control The patient wants to feel that they are an important part of their own treatment plan. Options and alternatives The patient wants to know what treatment options are available; explain options thoroughly. Information In addition to the treatment recommendation, the patient wants and needs to know about the cost of their treatment and what services are included in that cost estimate. Don t leave this entirely to staff. Trust about treatment cost Patients need to know that you re providing them with the truth, with respect to what they really need to address their dental care issue(s) and that your price estimate is fair, and with no (unnecessary) surprises. Dentists are encouraged to be thoughtful of how they defend or explain their pricing to patients, whether they charge above or below the suggested fee guide. Many patients are aware of the fee guide rates, and the coverage levels in their plans. As all dentists set their own treatment pricing, being thoughtful and confident in how you communicate the value of your services will help address patient concerns or questions on why your prices may vary from other dentists in your area. 4 Communicating with care

7 Communicating with care The fundamentals of patient relations Patients want to be treated as individuals, not numbers. Here are a few rules of thumb for patient relations, which you and your staff may want to consider: Your patient is your practice. Everything else can wait. Even if you are delegating some work to a staff member, connecting with your patient at the start of their visit, through a simple How are you feeling today? will comfort your patient, and assure them you are the leader of the dental team. Consider how your office welcomes new patients. Leading with do you have insurance conveys that your office cares more about money than care; or that you provide different care to patients with dental coverage than those who have none. Again, these subtle communication styles lead to perceptions about your practice that may not be what you want to convey. Discuss treatment cost ranges and potential payment options (if required) as part of reviewing treatment options fully with your patient. Ensure that your agreed upon course of action is documented in your chart notes and that your treatment plan, including cost estimate, is signed off in writing by the patient especially if the treatment was not expected, or is complex. This step may seem onerous, but will save you hours of aggravation in the event that the treatment does not go smoothly, or the patient forgets what was agreed on. The fundamentals of patient relations 5

8 Portrait of a good dentist from the patient s perspective: Confident My dentist s calm assertive approach makes me confident in their ability. My dentist fixes my teeth without any lingering problems. Empathetic My dentist understands what I am feeling and experiencing. He/she is empathetic that it can be uncomfortable having dental work. Humane My dentist is caring, compassionate and kind. Personal My dentist is interested in me, interacts with me, and values me as his/her patient. When I see my dentist, I know that his/ her attention is on me, even if I m only there for a regular exam and cleaning. Honest My dentist explains his/her diagnosis to me in plain language. I feel like I get the real story of what I need. My dentist does not up sell me on treatment I don t need. Trust I trust my dentist because he/she also gives me the option of not doing anything. I feel like I am making the best decision for me, without being pressured into treatment I really don t believe I need. Respectful My dentist takes my input seriously and hears what I have to say. He/she doesn t just try to get me to agree to things I don t want. Thorough My dentist is conscientious and takes their time, without rushing through things. I feel I get good value for my money. 6 The fundamentals of patient relations

9 Touch points of patient communication There are five key moments of interaction with patients during their visit to your clinic. Each component can influence your patients overall experience and their level of satisfaction. 1 The initial contact The initial contact with your clinic sets the tone for all other interactions throughout the visit. It may also be your best opportunity to avoid future misunderstandings or mismatched expectations between you and your patient. Get the visit off to a good start. First impressions matter. Slow down and focus your attention on meeting your patient s needs. Be an active listener, not just a teller. Ideally, be the first to greet your patient in the operatory or before they start their hygiene appointment. Be the dental leader of the team. Introduce yourself as Dr... on the first visit. If you prefer a more informal rapport with your patients, then say, please call me by my first name... Explain what will happen during their visit and introduce them to staff members who will be providing care assure patient confidence in your staff by being respectful and complimentary. Smile and be friendly and relaxed, but professional. Call patients by name. Listen attentively to their concerns. Ask permission to examine the patient or let them know you will be starting their dental examination. Ask them if they want you to let them know what you re looking for during the exam, and what you re seeing. If they say yes, then follow through. If they say no, fine. Have the patient alert and sitting at eye level to you (i.e. upright in the chair) for any treatment planning discussions, including cost of treatment. Use lay terms to explain your diagnosis of any problems and treatment recommendations. Jargon can be seen as arrogance. Take the leadership role by guiding the patient through the appointment. Your staff team play key roles with your patients, but they are coming to see you. Touch points of patient communication 7

10 2 The dental examination the diagnosis makes you the doctor The dental examination is one of the most important and perhaps under-appreciated components of the dental visit. For dental professionals, this is a routine procedure, but for many patients it is perhaps the highlight of their visit and the only point at which they will have direct contact with their dentist, and learn about their dental health status. It is an opportunity to educate your patients as to what is involved in the examination process and provide your diagnosis. Most patients have no idea what the dentist does or what the dentist is looking for during the dental exam. By explaining what you re doing, your patient will understand the value of what you do and enhance the relationship you have with them. The British Columbia Dental Association recommends that dentists explain what they are doing during the exam. If however, your patient is not comfortable with that approach, or provides you with different feedback, then take your cue from your patient. Point out that you are checking things such as gum condition, overall health and function of the jaw, soft tissue condition, teeth spacing and bite, and so on. Explain what you are looking for, or the sounds the patient might hear from use of your handpiece as you proceed through the examination. Provide the patient with a summary of your findings and stated daignosis when you are finished even if everything is okay. Encourage patients to ask questions so that they feel they are an active partner in their dental health. 8 Touch points of patient communication

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13 3 Discussing treatment options In order for your patients to feel like true partners in their oral health care, they must be fully informed of the treatment options available to them. Be thorough in your explanation of treatment options so that the patient understands the pros and cons of each. This is an opportunity to demonstrate your clinical expertise and to build trust in your abilities and your motivations/intention in providing care. Use plain language to describe the recommended courses of treatment; avoid using jargon as much as possible: Lay out the options in a logical manner. For example, from the least complex (and costly) procedure to the most complex. Explain the reasons that account for each option. If doing nothing right now is reasonable, include it as an option. When possible, provide simple printed materials for the patient to take home. Avoid being judgmental about the patient s choice of treatment. Ensure that all instructions for any treatment are as detailed and specific as possible. Ask the patient to paraphrase what you ve said to ensure they understand. Ask the patient if they have any other questions and correct any misunderstandings as necessary. Chart the discussion and the agreed upon course of action. Informed Consent* Discussions to obtain informed consent should take place before starting treatment, when entering a new phase of treatment or when changing a course of treatment. Risks and benefits of different treatments should be explained to patients. Options for treatment, including no treatment or treatment that you are not willing or able to provide, should be discussed. Costs of treatment options should also be reviewed. Communicating and recording on an ongoing basis is one of your best means of demonstrating proper diagnosis and consent of treatment in the event of a patient complaint. *source: College of Dental Surgeons of BC Touch points of patient communication 11

14 4 Discussing treatment costs and insurance coverage Discussing the cost of treatment may be the most uncomfortable part of a patient visit for dentists. But if costs are dealt with honestly and openly, misunderstandings and conflicts can be avoided. Many patients are uneasy or intimidated with the idea of discussing costs with the dentist as the practice owner, but at the same time they want to have that conversation with the dentist, not support staff. It is therefore important for the dentist to take the lead and set the tone for the conversation. Dentists are not expected to know every code in the fee guide for every procedure. What we suggest is that the dentist knows the range of costs for most procedures and discusses this range with a focus on the value of the service provided to the overall health and well-being of the patient, and an explanation of potential consequences of deferring or refusing treatment delivered in a non-threatening tone. Dispelling misconceptions The British Columbia Dental Association fee guide is not a fee schedule. Dentists set their prices to reflect their total practice costs. As you know, insurance companies base their coverage on the fee guide, but it is not always based on the current year s suggested fees. Government plans do not pay at the fee guide rates. Many patients are aware of the fee guide, or get access to it from their local library. Some question the dentist or office staff if their interpretation of fees in the guide in not in line with the price they are being quoted. When patients get cost estimates from more than one dentist, they may not be comparing apples to apples. For example, if one estimate includes lab fees and the other does not, the difference in fees is not really comparable. Further if one estimate is from a GP and the other is from a specialist, the comparison may again not be truly comparable. Transparency in the numbers Dentists are encouraged to be thorough when explaining treatment costs to patients. Explain the lab fee component and include an explanation of the consequences of not proceeding so they understand and appreciate the underlying value of the oral health care services you and your staff provide. 12 Touch points of patient communication

15 Some elements to include in your discussion about costs: Use the term cost instead of fees. Some patients interpret fee to mean what you personally get paid for the procedure. Most patients have no idea what it costs to deliver dental care. Reassure the patient that these are the all in costs and there will not be any surprises. If they have insurance, let them know that their plan may help offset some of the costs, and that they will be responsible for any costs not covered such as the the co-payment. At this point, it is fine to have them review their coverage details with your office staff. When you re providing a general price range or estimate, it is better to err on the side of caution and estimate a slightly higher price and end up with a pleasant surprise of a lower price, than to underestimate and have an irate patient. When discussing more extensive or complex treatment, consider the following: 5 Include the amount of time that you and your CDA will spend on performing the procedure, or if there are multiple steps involved. Any new scientific or specialized knowledge that you have gained necessary to carry out the procedure. The cost of any specialized materials, equipment or appliances required. Cost of laboratory services. Remember that patients who see value in your expertise and service will not be as price sensitive as patients who do not value dental care (especially as compared to other health services and high ticket items they purchase). Helping your patient appreciate that keeping their dental health in good order will benefit them, will help diffuse their focus on how much they have to pay. Concluding the visit The last few minutes of the patient visit are just as important as the first. Ask your patient if they understand the treatment options discussed or have any questions. Look at your patient when speaking to them and avoid turning away while they are speaking to you. Conclude the conversation before you exit the operatory. Confirm your patient s treatment plan or follow-up. End the consultation by reinforcing that you are here to take good care of them (or their child, etc.). If possible, personally escort your patient to the reception area. Always use your patient s name (first or last with Mr., Mrs., Miss, Ms., Dr. as appropriate) in greeting them and when saying goodbye. Touch points of patient communication 13

16 Making time to listen You are the expert on clinical dentistry, but your patients are the experts on their own decisions and how these decisions may impact them. While you will always know more than your patients about dental diseases and problems, you actually don t know more about their priorities or circumstances. If you cross that boundary, you risk having your clinical opinion undermined. The road to understanding begins with genuine interest. Listening and learning come before telling and educating In many dental practices, the emphasis is on telling rather than on listening to the patient. Become interested and curious. Ask. Listen. Ask some more. Listen some more. Understand. Respect. Then, tell. This process puts significant emphasis on understanding your patients before the examination begins. Counselling techniques are invaluable in gaining an understanding of your patient and helping them adopt new behaviours that are important to promoting good oral health. By first trying to understand your patient s perspective you encourage him or her to develop a sense of competence and autonomy. Rather than telling patients what to do or what is right for them, you can help them find their own way to make needed changes or adopt new behaviours. Listen effectively What many of us don t realize is that the most critical and powerful aspect of communication is not speaking, but listening. Listening shapes speaking. Once we start listening effectively and really understand the thoughts and concerns of our patients, we generate a powerful and mutually beneficial relationship with them. If your patient feels that you have been an attentive listener he or she will be comforted, reassured, and more likely to leave with a positive impression. Active listening One tactic that can be used is active listening. This tactic utilizes paraphrasing to demonstrate that a concept or recommendation has been communicated correctly. Once you ve explained a course of treatment, have your patient paraphrase what you ve said. This is an easy way to see if you re both on the same page. This tactic is especially helpful when communicating with English as a Second Language patients, seniors, or other patients where communication may be a bit more challenging. 14 Making time to listen

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18 Communication skills checklist Most patients want to play an active role in their health care decisions. Learn to communicate effectively with your patients. Even if you are busy, it s possible to be an effective communicator communicate smarter by making better use of the time you have. Have an open mind, a receptive ear and an empathetic heart. Your skills are only perfected through practice, experience and feedback from patients, staff and colleagues. Some tips to follow: Listen. The first and foremost component of providing excellent patient care is to listen let patients talk so you can adequately take in and understand what they are saying. Resist the desire to get to the point quickly with some very direct questions up front. You ll get more information and build rapport and mutual respect by actively listening and guiding as opposed to directing the conversation. Ask only relevant questions. Get to the underlying issue so you can quickly get to a resolution, or at a minimum, a plan of action to get to a resolution. Be mindful of your tone and non-verbal cues with patients and your staff. The words you say are important, but just as important is the tone of your voice while you re saying them. Is your voice tone sincere and polite or impatient and rude? Voice tone and inflection can say more than your words. Although you may genuinely be sincere in your recommendations, your tone could reflect anger, rudeness or even disrespect. Be mindful of your body language, or non-verbal communication. If your arms are crossed, you re standing up looking down on the patient, or you re tapping your fingers or feet, you can come across as impatient and prescriptive. Being caring and attentive with your patients, and then abrupt or dismissive with your staff sends two messages. Patients are less likely to believe what you re saying to them, if they see two personalities at play in observing how you interact with your staff. Keep your bad day, or frustrations to yourself. We all carry life around with us throughout the day. Don t let a difficult personal circumstance or patient make the whole day a bad day for you, your staff or your patients. Be polite. Kindness and politeness are like sugar, sweetening even the worst situations. When a patient is anxious, angry or concerned, they are looking to you for help and reassurance. Remaining calm and caring will diffuse even the most difficult circumstances. Responding negatively, harshly or without concern will only worsen the situation and very likely cost you a patient or patients by negative word-of-mouth advertising. Greet patients with a smile and handshake (unless culturally inappropriate). Call the patient by name and sit down so you are both on the same level. Don t appear rushed, even if you are. Patients get irritated when their dentist appears hurried. Make each patient feel that they are the sole focus of your attention. 16 Communication skills checklist

19 Dealing with difficult patients Learn to see each problem as an opportunity for improvement. Here are some steps in dealing with difficult patients: Avoid downplaying the seriousness of the patient s complaint. Let the patient tell you their side of the story without interruption. Sometimes all they need is to be heard. Express empathy. Let patients know that you understand the problem and are concerned about their feelings. Patients need to hear that you are on their side and are willing to do whatever it takes to solve their problem. Do not go on the defensive. You are certain to worsen the situation, and potentially lose the patient, if you become confrontational. Take control of the situation. Once you have heard the patient s side of the story, take the appropriate action to resolve the problem. Ask the patient what they want. You may be surprised to find that the patient s solution to the problem is both fair and simple. Once you have established a plan of action, explain to your patient how the plan will solve the problem. Chart the discussion, the agreed course of action and the outcome. By following these simple steps, your most difficult patient can become your most valuable patient. Experience shows that a dissatisfied patient will share their story with more people than a satisfied patient will. Dealing with difficult patients 17

20 Adopting a team approach It s not enough to improve your own communication skills you must engage your staff as well. Remember that your team members are representatives of your practice they are the ones your patients turn to for information regarding appointments, referrals, billing and lab tests. Great teams are created. A true team works well together and does not come apart at the seams when the workday becomes challenging. Evaluate each staff member s individual commitment to effective communication with patients and other members of the team. Hold effective staff meetings: Every practice needs to create opportunities for team members to work together and exchange ideas. To successfully determine where your team stands, schedule a meeting where staff can respond thoughtfully to a number of questions. The answers will be the first step toward collaboration and improved communication within the office and with patients: Do you think the team communicates clearly? Consistently? Often enough? In what areas can the team improve communication? Are there practice/patient communication processes that could be improved? What would be the single most important step we as a team could take to improve communication with patients? These questions should be openly discussed as a team. If any questions elicit uncomfortable silences, then set aside time to meet with staff members individually. To be truly effective, this exercise should be open and candid. After this meeting, let team members know how their responses will be used to benefit everyone in the practice. How your team reacts to these queries will give you a feel for the practice s challenges and strengths. The team s answers will provide insight about what is working in your practice and what is not. In areas where there clearly are deficiencies, team education will be required. 18 Adopting a team approach

21 Set goals: Use the information you gathered to set goals for improvement. Share these goals with the team. They will appreciate that you listened to their feedback and, as a result, will be more accepting of the positive changes you wish to make. Implement systems: Goals without a plan to accomplish them are just ideas. It s time to take the goals that have been agreed on and create effective ways to accomplish them. With step-by-step systems in place, including ones for patient communication, your practice will easily build a strong team. From scheduling to tray setup, it is important for the team to know exactly what to do, what to say and how to say it. Train the team: Training and cross-training are important ingredients for ensuring all members of your team are communicating effectively. Training also establishes a level of accountability for communication when combined with job descriptions for each team position. The instruction of team members is not something that can be effectively accomplished in the time between patient appointments. To ensure that your team members fully understand their roles, time must be set aside away from patients, and maybe even outside the office, so that the proper focus can be achieved. Monthly meetings are also an opportunity for hands-on training, when your staff can work with guidelines and role-playing to help reinforce consistent communication approaches. The British Columbia Dental Association is developing short online learning tutorials for the whole dental team, to be downloaded from our dental office website through the new CE@SLC program. These short tutorials are intended to provide cost effective education for all members of the dental team in the area of patient communications and other topics relevant to all staff. Watch for the first tutorials online at the 2013 Pacific Dental Conference. Adopting a team approach 19

22 Measuring patient satisfaction Satisfied patients become loyal patients and are more likely to refer friends and family. Patient satisfaction surveys are an easy tool you can use to answer this question and they can help you identify ways of improving your practice which translates into better care, happy patients and happier staff. It s important to move beyond gut feel and systematically measure and monitor how your patients feel about their experiences so that you and your team receive honest feedback. This information can help boost morale, as well as engage the team on areas for continuous improvement. Monitoring patient satisfaction over time will enable your practice to celebrate improvements and nip unwanted trends in the bud. It s easy to carry out patient satisfaction surveys it can be as simple as asking your patients to fill out a short form. Most patients are happy to provide feedback after all, their input allows you to improve the service you offer them. Survey tools: You don t need to go to a consultant to create and conduct a survey in your office. You can conduct an informal verbal survey by asking each patient about their experience at the conclusion of their visit take a second to ask and take a minute to listen. Keep track of the issues and encourage your staff to do the same. Another technique involves the use of a simple form. Carefully craft five or six multiple choice questions, provide a consistent 1 to 5 rating scale (from poor to excellent) preprinted on a single piece of paper. Include at least one openended question with space for written comments. Patients can complete the form at the conclusion of their visit. You can also consider using an online survey tool. Keeping score: With the paper survey, the online survey, and even the informal verbal survey, tabulate the results and review what you find with your staff at least monthly. Take pride in areas of strength and work on areas for improvement over the following month. The measure of your efforts will include increased patient satisfaction, stronger patient retention and more patient referrals. For more information and to utilize our online patient communication self-assessment tools for members, please visit the BCDA member website: If you need personal assistance, please don t hesitate to contact the British Columbia Dental Association s Member Services team at or bcda@bcdental.org. 20 Measuring patient satisfaction

23 Accessible and inclusive learning for the whole dental team. Learning options* Online: live distance education on-demand full-length courses short tutorials On-site: in-person lectures hands-on training Study groups: in-person online from anywhere in BC Mentor-led: case presentations literature reviews demos of new techniques Accessible alternative to traditional study clubs. Inexpensive. Inclusive. Multiple topics. for... Component Societies; Dentists, CDAs, RDHs; and Front Office Staff Study Clubs; Industry; Consultants; and Trainers Dental Associations and Colleges to host courses or examinations BCDA Members * being developed throughout 2012 To book the Sirona Learning Centre for your training session, study club or hands-on course contact: Sirona Learning Centre P E CEatSLC@bcdental.org Check availability online at bcdental.org

24 West 8 Avenue Vancouver, BC V6J 5C6 T F E bcda@bcdental.org