While community clinics and health centers are dedicating resources to improving the patient experience, they may also find that despite their best efforts, a patient may have a poor experience during their visit or be unhappy about some aspect of it. One of the main causes of dissatisfaction is long wait times, whether in the waiting room, or in the exam room. This may be due to any number of factors –the complexity of the patient needs over the course of a day, a provider who called in sick, poor staff communication, not allowing enough time allocated for visits, or disorganization.
When things go wrong, what is the best way to respond? The most immediate action is to communicate with the patient, acknowledge their experience and show concern, and rectify the problem if at all possible. A staff member may attempt a service recovery, such as offering the patient a bottled water or snack, as a way of communicating concern for the patient’s well being. After addressing the immediate issue, the next step is to improve operations to prevent the problem from recurring. This is accomplished by engaging in a quality improvement process to solicit feedback from the patient and put systems into place to prevent the same thing from happening again to someone else. Each of these steps is described further below.
Communication: There are several approaches to acknowledging the client’s feelings and de-escalating the situation as much as possible. One is the C.A.R.E. approach (see Toolkit for more information):
- Connecting: saying the patients’ name, introducing yourself, shaking hands, making good eye contact;
- Appreciating: apologizing, acknowledging their feelings, appreciating that they let us know;
- Responding: giving choices to the patients, assuring them you will help, fixing what you can.
- Empathizing: Giving the tools out when you yourself, if you were in the patient’s shoes, would feel bad, ignored, disappointed, inconvenienced or irritable due to the clinic’s system.
Service recovery: Organizations can put systems into place to offer service recovery to patients who are clearly frustrated. For example, offering a patient a bottled water, a snack, or even a gift card to a local sandwich business or drug store, says to the patient, “You and your experience are important to us. We realize you are dissatisfied and we want to try to repair this relationship.” The success of this strategy depends on a culture in which individual employees, regardless of position, are supported in making their own decisions about repairing relationships with clients/patients.
Quality Improvement: An organization’s quality assurance/quality improvement (QA/QI) program is designed to review and address quality of care issues in order to assure a consistently high level of care. All federally funded health centers are required to have such a program as a condition of their grant. A QA/QI team will receive feedback about patient concerns through a formalized patient complaint process, or from patient satisfaction surveys – both of which are key components of any QA/QI program. An organization may use any number of processes to analyze and improve a situation that is causing patient concerns. Examples of quality improvement programs include a Plan-Do-Study-Act cycle, a root cause analysis, or a Lean process.
Check out the toolkit! There are several tools below on how to employ good communication, de-escalation, and service recovery skills when a patient or client shows signs of dissatisfaction. Also included are links to quality improvement tools and articles, as well as some standardized patient satisfaction tools.
Communication, De-Escalation and Service Recovery Tools
- Caring Communication Skill – Blameless Apologies (.doc)
- Blameless Apology Self-Check (.doc)
- Skill Builder – Acknowledging Feelings(.doc)
- Scripts for Difficult Situations (.doc)
- De-escalation Techniques (.doc)
- C-A-R-E information (.doc)
- Service Recovery Repair (.doc)
- Patient Grievance Flow Chart (.doc)
- Plan-Do-Study-Act: IHI Model for Improvement (website)
- Plan-Do-Study-Act Cycle Template (.pdf)
- Root Cause Analysis (.pdf) World Health Organization
- Implementation of Lean in a Community Health Center: A Case Study (website) American Institutes for Research for the California HealthCare Foundation, 2012.
- Applying Lean to Improve the Patient Visit Process at Three FQHCs (.pdf) Altarum Institute.
- Establish a Quality Assurance/Quality Improvement Program (.pdf) National Association of Community Health Centers, Health Center Program Governance Requirements, 2011.
Patient Satisfaction Surveys
- Sample patient satisfaction surveys (website) SAMHSA-HRSA Center for Integrated Health Solutions, Consumer Engagement section.
- Consumer Assessment of Healthcare Providers and Systems: Clinician and Group Survey (website) Agency for Healthcare Research and Quality. All CAHPS surveys are in the public domain so anyone can download and use these surveys to assess the patient experience. The clinician and group survey offers standardized questions plus supplemental item sets for various populations and settings.