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Patient_Satisfaction

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					     Ensuring patient
     satisfaction and
establishing good practice
             Introduction

• Patients are the foundation of our
 medical practice

• It is very obvious that they must be
 satisfied

• Do we always succeed?
 Some experiences



Patients tell the truth
• “Quality service? I don‟t ask for much
 from my doctors.” The woman, a business
 professional in her late 30s, seemed
 pleased to be asked. “I don‟t want to wait
 endlessly, but I understand it if
 something comes up in the schedule to
 cause a delay – just tell me about it! I‟m
 much more forgiving if someone keeps
 me informed”.
• “I like to feel that I have my doctor‟s
 attention during the visit. I don‟t expect
 a half hour of his time, just a sense of
 concern. My pediatrician is wonderful. He
 always remembers something personal
 about my child. When he talks to me, he
 looks right at me – not at his paper work
 or forms or does not talk on phone”
• “His staff is friendly. They make me feel
 welcome and not like an interruption in
 their day. He explains things so they
 make sense, and he gives me information
 that I can take home and read. I‟m not
 just a „case‟ to him.”
• “Patients don‟t care how much you know
 until they know how much you care” - Sir
 William Osler
Dynamics of medical practice
            today

   Patient as a customer

Doctor as a service provider
  In the past

• Doctor was God

• Supreme authority
         Medical practice as
          business activity
• Health care as one of the largest service
  sector industry
• Huge capital investments- expected returns
• Drivers: technology, health regulations, health
  insurance, CPA, standard of living, influence of
  media, internet
• Customer – service provider
• Customer is the king
Patient satisfaction pays
 1. Greater profitability.
 2. Improved patient retention and
    patient loyalty.
 3. Increased patient referrals.
 4. Improved compliance.
 5. Improved productivity.
 6. Better staff morale.
 •   Patient satisfaction pays
“The Quality Diamond”
   Model of patient
     satisfaction.


      QUALITY
      MEDICAL
       CARE
              Customer



              QUALITY
Continuity    MEDICAL       Commitment
               CARE




             Expectations
        The Customers : types
• Difficult to deal with : Demanding, annoying,
  unrealistic, loud and objectionable.
• Desirable: pleasant, easygoing, intelligent,
  accommodating and knowledgeable
• Others: timid, questioning, unprepared,
  lacking in knowledge and uncertain about what
  they want or need.
• Have to handle all
            Commitment
• Emotional and intellectual pledge to a
  course of action
• Your commitment to quality services
  must be 100%.

If you are interested in something, you
do it when you have time.
If you are committed to something, you
make time to do it.
          Guidelines to ensure
         commitment to quality
1.   The physician needs to be a participative
     leader with conviction.
2. Have a statement of mission and vision for
     quality services and share it with the staff.
3. Recruit a high performance staff
4. Build a team which is committed to quality
     services.
       Ensure commitment
5. Empower the employees to achieve goals
  of quality services

6. Ensure staff satisfaction and motivation
  by various means like good salary,
  appreciation for good work and
  imparting a feeling of importance
        Ensure commitment

7. Do some medico-social activities in the
   hospital premises or get involved with
   similar activities done by other
   organizations.
8. Have accreditation by some regulatory
   authority or agency (e.g. ISO).
             Expectations
(1) Medical (Clinical) expectations: These
  relate to accurate diagnosis and
  treatment. This is dependent on the
  medical core competence.
(2) Non-Medical expectations: These
  relate to physical facilities and functional
  components of services.
    Few general expectations
1. To have clinical core competence.

•   Cure rate does matter
•   Luxurious physical facilities can‟t substitute
•   CME
•   Good clinical methods
•   Exude confidence
•   Rational therapy
•   Evidence based practices
    Few general expectations
2. Honor the appointments. Appointment system
   should be accurate but flexible.

3. Communicate well with them in day to day
   language. Medical jargon should be avoided.

4. To listen to their problems patiently and give
   them enough time. Master the art of listening
     Few general expectations
5.Show personal concern for the patient.
   Body language ,greeting , a good first
  impression of a caring physician, make it visible
  that we are with them in their worst times too.
6.To explain everything about the illness and
  treatment.
   A short detour through the illness - etiology,
  pathology, clinical features, diagnostic
  investigations, treatment and prevention
     Few general expectations
7. Staff which shows care, concern, courtesy and
   empathy.
• Patients spend more time with paramedical staff
• Behaviour and attitude of the staff
• Ask to go beyond the rules of duty to help
• Handle personal and telephonic conversations
• Promptness in all responses
• Emergency case, admissions
    Few general expectations
8. Provide reasonably good physical facilities.
   – Both outdoor as well as indoor
   – Approachable location with good parking facility
   – Child friendly environment, cleanliness, facilities for
     recreation (library, toys, music, TV etc.)
   – Proper place for eating
   – Enough space for various facilities.


9. Impart health education: handouts, video examples.
   Few general expectations
10 Proper documentation.
  – Good legible prescriptions, a detailed
    discharge summary, certificates, prompt
    issue of papers for mediclaim
  – Clear explanation for administration of
    medicine to ensure compliance.
11.To provide hospital information brochure
  and to have informative sign boards.
   Few general expectations
12. To have transparency in financial matters.
  – One of the major causes for dissatisfaction
  – Proper display of routine consultation and
   indoor charges
  – Should be properly informed about the
   expected expenditure before any procedure
   or admission.
      Few general expectations
13.   To use modern technology.
  – Computerization and adaptation to new
    technology for diagnostic and therapeutic
    purposes.
14.   To have easy flow between various services.
  – Patient should not be wasting time to avail
   of various services.
       Factors affecting
         expectations
1. Nature of medical illness.
2. Past experience in the same set up.
3. Experience at other set up.
4. Financial and social standing.
5. Level of education.
         Measuring expectations
1.   Direct approach: Simple but effective
     technique. Can be used by doctor as well as the
     staff.
2. Questionnaire: This can be designed according
   to the services provided.
3. Suggestion Box:
     –   Outdoor as well as indoor facilities
     –   This box should be periodically opened.
      Measuring expectations
4. Listening to the staff: Patients often talk more
   freely with the paramedical staff.
5. Listening to the patient: Their past
   experiences at other hospitals, a valuable insight
   into causes of dissatisfaction
6. Analyzing a discharge against medical advise:
   An opportunity to analyze the short comings in
   the services and improving upon them.
    Meeting expectations - few principles:

1. Have systems in place to meet general
  expectations. This involves hospital
  administration.
2.Be flexible because expectations keep changing.
3. May not be able to meet all expectations, but
  one must try to manage. Managing expectations
  means patient listening and then explaining as to
  why we can not meet those expectations.
Meeting expectations - few principles

4. Unrealistic expectations may be gently
   managed through patient education.

5. Take a walk in your patient shoes. Look at the
   whole set up from patients‟ point of view and
   find out good and bad things about our set up.
   This helps us to delete the negatives and
   enhance the positives.
Meeting expectations - few principles
6.“Delight the customer” is the buzz word .Going
  beyond the patients‟ expectations. Anticipatory
  guidance or asking the nurse to supervise and
  train a mother for breast feeding in an OPD visit
7.Master the art of handling difficult patients.
  Consider them as the people who are testing the
  quality of your services.
Meeting expectations - few principles
8.Service Recovery (when things go wrong):
• Apply the triple A action plan. The steps are
  Acknowledge, Apologize and Amend.
• Accept that mistakes do occur, but should
  make all efforts to prevent them.
• Analyze the factors leading to mistakes and
  try to correct them.
• Differentiate between the wrong act and the
  doer. Criticize the wrong act and not the doer.
               Continuity

• Loop-closer in the quality diamond model.
• A method for ensuring continuous,
 consistent, ever-improving and never
 ending service quality.
• All the ways and means of measuring,
 evaluating and monitoring the progress.
                Continuity
• It ensures that services get better day after
  day.
• “Can we do better?” is the guiding question
• It is about accepting the fact that what you
  do today may not be appropriate or effective
  tomorrow.
• Things do change.
                  Continuity
• Benchmarking.
• Looking beyond to other setups for better
  services and customer satisfaction.
• Opens windows of our mind and let in new ideas.
• Setting standard of service for all aspects
• Continuity also requires monitoring patient
  satisfaction. A formal comprehensive process
  for determining patient satisfaction, may be in
  form of questionnaire
Thanks