Physician practices, large and small, pay little attention to the culture of the organization. Large practices often adopt “sloganistic” positions: We’re Patient Centered, We Care or some other phrase that few can really explain. What does patient centered mean? Do patients dictate the schedule – after all, scheduling is about the only area of a physician visit that patients can really affect. The rest is clinical. Back when I managed medical practices and physicians within my corporation provided my own care, I would tell the staff to call me ten minutes before they were ready to room me for a visit. It took me five minutes to get to my physicians office – he was located one floor below my own office, and I allowed a five-minute window for them to be wrong. Usually, I’d walk around the office for another 10 or 15 minutes waiting for my appointment. Eventually, I just said, call me when my room is open, and I still never kept my physician waiting. I considered that a patient-centered activity.
The average patient can’t do what I did. How would your staff respond to a patient who requested to be called at some interval before their visit time to minimize their wait? Not to beat a dead horse…
The issue is culture and the point is it isn’t a slogan. Your practice has a “culture” and you either actively contribute to what it is or it just happens.
The point of this paper is to briefly discuss how to make it happen and happen in a way that will make you, your staff and your patients’ happy. I’m an advocate of what I’ve termed the Physician Centered Practice (another paper available on this site). The essence of the Physician Centered Practice is that as the leader, owner, etc… of your practice you should have the loudest voice in defining your corporate culture. Consider this, Nordstrom’s has a corporate culture that says the customer is always right. Business books have been filled with examples of crazy and unreasonable demands made by Nordstrom customers that were nevertheless cheerfully and graciously fulfilled to the extent that they have become urban business legend – difficult to separate the fact from the fantasy. Nevertheless, if you haven’t read those volumes, one often cited example is of a Nordstrom customer who demanded to return a set of automobile tires. The legend or fact goes that the clerk graciously provided a refund after checking on the retail value of the tires – Nordstrom’s doesn’t sell tires.
No sales person at Nordstrom’s independently decided we’ll accept tires for a refund. Nor did any corporate vice president make that decision. However, years ago, Nordstrom’s founders simply said, the customer is always right, and we’ll do everything in our power to meet their expectations. So if a customer believes he/she bought tires at Nordstrom’s and wants to return them, it’s our culture to meet this customer’s expectation.
Your practice culture needs to revolve around you. How do you like to work, how do you want staff to interact with one another – with patients, how do you want patients to respond to you and your staff? This internal discussion won’t result in a slogan, but it can result in a method of working and communicating. Your culture may be a very high touch empathetic approach or a very brusque efficient way of working. It doesn’t matter as long as it is truly your way, they way you want to work and the way you want others to treat you. I’ll quote my sainted grandmother who always preached the “golden rule” which is more about consistency than goodness. First, determine how you expect, or demand, to be treated, and then treat everyone else the same way.
The next step is to enumerate that treatment. It’s one thing to say I want everyone treated with courtesy and respect. It’s quite another to define courtesy and respect by your parameters. Some things you can script, such as how patients are greeted, what’s said in reminder calls, how payment is requested. Other issues arise on the fly. For example, is everyone courteous and respectful until a chart is misplaced and then it’s finger pointing time? How do you respond to the patient that consistently misses appointments? Courtesy and respect is a two way street, but the police don’t shoot someone for traveling the wrong way on a one-way street.
Finally, keep enumerating but with stories rather than rules. Stories become the lifeblood of corporate culture. If the Nordstrom tire story is true – and at this point it really doesn’t matter because it’s legend, then the power of the story became that it reinforced the larger corporate commitment to customer satisfaction and the flexibility expected of staff in meeting that commitment.
I once was vice president of a hospital in Decatur, Illinois – Decatur Memorial Hospital. It had a long history that emanated from two civic leader founders and was carried forward by one of my early mentors, a wonderful gentleman and healthcare leader, Anthony J. Perry. In 1958 his predecessor, Leon Pullen, commissioned the writing of the hospital’s history. That book, “Two Miles North,” was a story book, that is, a book of stories of the people who had made the hospital from its conception to those days in the late 50’s. In the mid-1980’s Mr. Perry commissioned a sequel to carry forward the story telling of this fine institution. While I’m not suggesting you write a book about your practice, telling stories of your practice will set the expectations for you, your staff and for your patients. Many physicians, particularly ob/gyns and pediatricians, do this today with picture walls of their patients (probably a HIPAA violation) that helps staff and other patients see the practice’s history. Such practices further focus staff and physician on the good they have done and how they did it. All these things: deciding your own “golden rules,” establishing sound policies and procedures, and telling your stories become the foundational elements of your culture.