Michelle Stewart Way Consultant & Patient Access Specialist Otani Consulting Group, Inc 1
Customer Service A Customer A customer is the most important person on our premises. He is not dependent on us. We are depended on him. He is not an interruption to our work. He is the purpose of it. He is not an outsider in our business. He is part of us. We are not doing him a favor by serving him. He is doing us a favor by giving us the opportunity to do so. -Mahatma Gandhi 2
Is Customer Service Important? Yes and here are a few reasons why It s just the RIGHT thing to do! Quality Customer Service is a vital ingredient in a company s ability to maintain profitability and continued success It raises the bar of competition It effects future reimbursement HCAPS Value Based Purchasing (VBP) 3
Innovation Definition: is the application of new solutions that meet new requirements, inarticulate needs, or existing market needs. This is accomplished through more effective products, processes, services, technologies, or ideas that are readily available to markets, governments and society. The term innovation can be defined as something original and new that "breaks in to" the market or into society. One usually associates to new phenomena that are important in some way. 4
Innovative Tools Owner s Manual Waitlist Queue Resolution kits Hospital gift cards or free meal tickets Patient Portal Ensure that it includes scheduling, pre registration, form requirements, bill payment, etc. E Signature Kiosk Smart Swipe Silent Pagers Technology, Technology, Technology 5
Facts: Can do Attitude Japan 327 people per kilometer USA 31 people per kilometer Problem: Japanese markets are small, there is no room for large melons, Japanese people want watermelon. 6
Can do Attitude Solution: Square Watermelons! How: Can do-attitude! 7
Is Customer Service Important? Yes It s just the RIGHT thing to do! "What's missing in the public discourse about health care is the fact that while medicine has the power to cure, it's humanity that holds the power to heal," said Lloyd H. Dean, President/CEO of Dignity Health SAN FRANCISCO, CA (Marketwired Jul 15, 2013) Dignity Health, one of the five largest hospital networks in the country, today kicked off a major national effort to engage and inspire people to promote acts of humankindness within the health care industry and beyond. 8
Empathy Staff must have Empathy Yahoo! Answers: Empathy is important for our society because it is what facilitates our interactions and our connections to the other people around us. Empathy is a foundation for building a thriving and supportive community. Why is it important for individuals to feel empathy? Because with out that sense of connection, with out that ability to consider other peoples views or feelings (or place ourselves in other peoples situations)... we'd all essentially have anti social personality disorder 9
Empathy: The Human Connection to Patient Care YouTube *Cleveland Clinic http://www.youtube.com/watch?v=cddwvj_q o8 10
5 Ways to Improve the Customer Experience Listen to Your Customers Polite Make Promises that you will Keep Make an Extra Effort Build an Efficient Customer Service Team 11
5 Ways to Improve the Customer Experience Listen to Your Customers Listening skills are a vital component of good customer service practices. Having empathy and listening to your customers includes, listening to their requirements, to their expectations and to their complaints. Listen to them with concern and believe in what they say. Know what they say. Underestimating the words of your patients will lead the facility nowhere, as, distrust in the customers shall leave them dissatisfied and no facility can consistently retain dissatisfied customers. 12
5 Ways to Improve the Customer Experience Polite It is important for any business (healthcare or non) to remember that its customers are its valuable assets. Hurting the customers, being rude to them or disrespecting their opinions can lead to failure in business. Disney, Nordstrom, Apple 13
5 Ways to Improve the Customer Experience Make Promises that you will Keep Making many promises and keeping only a few of them is not a good customer service. Set realistic expectations. To build trust in the minds of your patients, you need to meet the expectations that you set. Moreover, make only those promises that can be kept. Wait times Forwarding results or paperwork 14
5 Ways to Improve the Customer Experience Make an Extra Effort The approach to only register or collect information while turning a deaf ear to your patients can prove dangerous. Taking a step or two forward in caring for your customers is bound to build comfort and trust in their minds. Clinical vs. Clerical 15
5 Ways to Improve the Customer Experience Build an Efficient Customer Service Team Know what your staff is doing! For Patient Access success you have build and maintain an effective customer care training program Make Customer Service the first topic on your agenda for every meeting Train staff to be polite and courteous with the customers (it s not always a given) 16
Results Measure Monitor Reward Share satisfaction survey results Act on results Celebrate the positive & Address the negative Listen and observe your staff Hardwire* Develop tools Suggested dialog / Scripting 17
Scripting Caution with scripting, why? Facilities force their employees without the least bit of sincerity to make the same statements over and over and over again to the customer. Did I deliver great service today?" I hope I provided excellent customer service. I hope you received 5 star service today. Customers can sense sincerity and insincerity, communications they trust and mistrust 18
Scripting cont d It IS beneficial to have a little bit of scripting and training and education with staff that relates to surveys is when the terminology you use to describe the attribute they re evaluating is not obvious. Maybe you ask on the surveys about registration process, but when you talk to the patient in the hospital, you never referenced the phrase registration process. It is beneficial to have a little bit of scripting when asking patients questions using terminology that they may not understand. 19
Role Play It s critical that employees practice scripts or suggested dialog in a safe environment. You want to provide scenarios and examples. When obtaining race and ethnicity an employee may ask What is your race? What is your ethnicity?. Implement that they ask with a reason statement, California law requires that we obtain information regarding race and ethnicity for census reporting. Would you like to provide your race? Is that of any Hispanic decent? When unable to answer a questions an employee may say I don t know, ask at the department. Suggest a statement like, That s a good question! I don t know the answer, but I ll be glad to make a phone call. 20
Facility Campaign Know your facility campaign and ensure it s actively implemented in your department Example of some facility campaigns: Dignity Health Hello Human Kindness Hoag Hospital OWN It! St. Joseph Health System Fostering Sacred Encounters *Every encounter will be experienced as a sacred encounter SHARP HealthCare AIDET: Five Steps to Achieving Satisfaction & 12 Behavior Standards 21
Case Study of ABC Hospital 22
Goal World Class Breast Care Center Dramatically improve patient experience Current Status Successful Clinical Services Improvement Needed Patient Flow and Process 23
Actual Patient Comments Have already recommended the breast center highly *** is the best hospital, I d recommend it to anyone that will listen Only negative would be waiting in the registration line Not informed of estimated wait times I will return because of my doctor, but I d prefer another facility because of the cumbersome registration process and the wait Registration was very time consuming and bottleneck Why pre register if you have to wait in line and register 24
Scope of Impact Assessment Onsite visits at the following locations: ABC Hospital Scheduling, Pre Registration ABC Hospital Patient Access ABC Breast Center Areas and Processes Reviewed Scheduling Pre registration Financial Clearance Registration Breast Center Breast Surgical Center Technology 25
Assessment Process Met with management and documented their expectations and requirements for staff Observed employees in all areas (non clinical and clinical)related to the Breast Center patients. *Included meeting with the volunteers at this facility Documented every piece of information gathered at each customer touch point Documented technical applications and information required for each application Shadowed patients Conducted a time study for each step in the process Reviewed all forms and printed material related to Breast Center Conducted Secret Shopper calls 26
Keeping us from our goal Incomplete pre registration process. Complete is defined by: establishing an account, collecting all required data, insurance benefits verified, and financial counseling (if needed). Delays caused by multiple step intake process in Patient Access and Breast Center Duplicated work efforts Physical layout location & size Segregation of like work duties by different departments Physician orders (incomplete, inaccurate, missing) Multiple systems (not always integrated) MagView* Technology 27
Current Patient Interactions Scheduling & Pre Reg Average of 5 Encounters and 21 Minutes Breast Center Registration Patient Exam Completed Authorization * Patient Access Registration Volunteer 28
Collaboration There is strength through collaboration which will transform the patient experience 29
Solution Implement a Hybrid Model Collaboration = The Breast Center Registrar combine position of Patient Access Rep & Breast Center Front Desk. This position would assume the responsibility for registering the patient, processing orders and arriving patient in radiology system. 30
Imperatives for Improvement and Goal Achievement Patient Experience Concierge Desk Optimize Patient Flow and Experience Communication Integration with Breast Center Integrate Staff from Patient Access and Breast Center Seamless information handoffs Facility Imperatives Stake Holder Buy in* Approval from Administration Improve customer service with patients Improve customer service with physicians Decrease patient wait Obtain all required patient information & forms Compliance Eliminate redundant process of rework Operate within budget constraints 31
World Class Service Map Patient self schedules or requests an appointment via a patient portal (offer email or text communication) Decrease the number of employee to patient interactions Check in all expedited patients and bypass registration or registration completion Kiosk/tablet includes complete any missing information e Forms, MagView questions During scheduling use a script: Do you have xx minutes to pre register your account or would you like to go on line to the portal? (for all depts., call center and clinical) Top 20 Breast Center Referring Physicians to use HIE for electronic orders or an equivalent Facility communicate appointment reminders and instructions with patients via email/text Contact for liability or missing items, if cleared, explain check in process Facility have a concierge desk in lobby to assist visitors and guest Patient Portal with ability for patients to complete Medical Health Screening form electronically prior to arrival as well as account updates and payment processing 32
Solution I of 2 Phases One Stop Registration and Arrival Phase 1 Mirror the Concierge functions from the South Entrance at the Women s Pavilion Entrance A proposal for this had been submitted and is pending approval and funding. Staffing has to be addressed by facility 33
Solution I of 2 Phases One Stop Registration and Arrival Phase 1 Occupy the volunteer counter space in the Women s Center Pavilion entrance Due to the high visibility of this space and patient convince this space is best suited for patient related services. 34
Breast Center Registration 35
Work / Process Flow Implement a modified scheduling/pre registration process for this patient population Include required information during the scheduling process (i.e. race/ethnicity) Develop New Patient pre registration requirements (obtain complete demographics) Morning BC Registrar assembles charts for expected patients for the day and identifies patients in two categories: Fast Track and Expedite These functions can also be performed prior to the date of service inbetween patients as time permits Account activation to be performed in Affinity prior to patients arrival End of day all no shows would be identified and accounts noted in Affinity No Show patients would be contacted and encouraged to reschedule 36
Work / Process Flow cont d Patient presents to concierge desk Pts identified as Fast Track are directed to BC directly Call backs & Re checks (patients with no orders & do not require MagView) Pts identified as Expedite are directed to BC Registration Limited info obtained on expedite patients (demographic, orders, cards, sigs) BC Rep pushes label print to BC Front Desk to notify them of patient arrival MagView provided to patient Patient escorted to BC Lobby Patient hands in or employee gathers MagView* As time permits BC Registrar would escort patients to BC Lobby and collect MagViews Both areas would collaborate efforts to collect MagView and return to BC Registration Services are provided 37
Solution 2 Phase One Stop Registration and Arrival Phase 2 Renovate front office space of Breast Center to allow for additional employees (dependant on funding and construction) Move current counter forward and push the lobby area back and utilize overflow lobby if/when needed Utilize silent pagers if necessary 38
Phase 2 Concept Rendering 39
Next Steps Obtain approval to occupy real estate of workspace in the lobby Concierge Desk approval and time line Determine FTE s required Obtain approval for staffing changes Determine reporting structure Manager & Human Resources Job Description & Wages Develop new training program for Breast Center Registrars and Scheduling Staff Identify employees Train employees in both Scheduling and Breast Center Registration area 40
Next Steps cont d Install work stations and equipment Work with Business Development on Marketing and Physician Order Education Conduct ongoing weekly meeting occur between patient access, breast center, pre registration, and business office services Monitor patient experience surveys, quality audits, regulatory requirements, and AR 41
Regulatory Agency CMS Tool used is Hospital Consumer Assessment of Health Plans Survey (HCAPS) Survey asks discharged patients 27 questions about their recent hospital stay. This data is submitted to CMS. Value Based Purchasing (VBP) Medicare reimbursement will be adjusted for their core measures and patient satisfaction www.hospitalcompare.hhs.gov Finalized rules for implementation for FY 2014, 2015, 2016 In the market today there are agencies that assist facilities with avoiding VBP penalties and turning HCAPS into a revenue generator (ex: Press Ganey, Cipher Health, Sound Physicians) 42
Questions? How to contact me: Michele Stewart Way 714 269 1040 Michele.way@loconsultingin.com 43