Tearful breakdowns and loud outbursts—they happen with orthopedic patients even in the best of practices. And if you are an orthopedic surgeon who has rarely or never experienced a patient in emotional distress, just talk with your staff—they have no doubt experienced this many times.
There is something about orthopedic conditions—they carry with them an increased likelihood of emotional adverse effects for patients and their loved ones. Inhibited movement can lead to palpable frustration and depression. Time off from work may cause financial hardship and an identity crisis for a family breadwinner. Physical pain can cause the patient to become depressed, angry, or dependent on prescription medication. Medications can cause a change in disposition or outlook. These realities make orthopedic surgery practices particularly predisposed to patient relations risks and service recovery opportunities.
As a practice management consultant and former executive director of an orthopedic practice, I have observed and participated in patient relations and service recovery efforts at many levels. Particularly proud of the way our staff and physicians prevented and handled these and having spent many years traveling by air under the color-coded TSA (Transportation Security Administration) security level indicator system, I created the Patient Relations and Service Recovery Guide (Figure) to help practices gain perspective, have a vocabulary, and develop practical methods for mitigating patient relations risks and responding to incidents and complaints.
The Patient Relations and Service Recovery Guide
The Patient Relations and Service Recovery Guide shows the relationship between the practice as a whole and the patient as an individual.
Green and Red
Green describes the elements of service orientation that the practice must consistently demonstrate and convey to each individual from the point of access, through treatment, and, finally, during account settlement. If you think you have a systemic problem with anything under the Green heading, you probably need a practice management or service orientation consultant, not this article. Red shows the other end of the spectrum—a complete degeneration, worst-case scenario. As with problems in the Green category, this article will not help you in these Red situations, for which you need experienced legal counsel immediately.
We’ll now explore the stories, challenges, opportunities, and practical suggestions for the Blue, Yellow, and Orange categories. The Blue and Yellow categories in the Figure are shaded in grey as a depiction of the interactive, fluid nature of these situations. In addition, they are situations that have developed and can be resolved within and by the practice.
Blue
Patients are very comfortable complaining to the receptionist, x-ray technician, and medical assistant about any number of perceived shortcomings, but when you walk in the examination room, not a word. This is a reality I am sure you have heard about from your staff, and it puts them in a position to observe and determine if a patient’s frustration is escalating. Telephone and front desk receptions are first in line. Patients will say to a telephone receptionist, “I have called 3 times yesterday and twice today and the doctor/nurse still hasn’t called back.” Front desk receptionists will also observe dynamics in the seating area. Staff are your partners in patient relations and service recovery. Working together effectively will help you address issues in the Blue and Yellow areas.
Create an environment that prevents patient discontent and supports service orientation goals. A hospital-based practice that I once managed was a flagship for service excellence goals of a Fortune 150 corporation, had a large seating area, and was close to the airport in a city with multiple company properties; we frequently had executives showing up unannounced, and, because of company politics, it seemed like they were actively looking for instances of substandard service. More importantly, though, we had patients. We established “Waiting Stories” as a performance standard for the receptionists. That is, at any moment, the receptionist was able to recap the “story” of each person in the seating area. The “story” is the reason the person was there, the appointment time, and the cause of the delay, if the wait time was excessive. We all knew this was a performance standard for our practice, so if a receptionist called back to the clinic to find out the reason for a backup in throughput, everyone was respectful and responsive to the inquiry.
The receptionists quickly became effective in judging situations and mitigating or avoiding breakdowns in service and communication. We also implemented an easy and quick notification code for when they needed help handling a service recovery situation. The responses and support in those situations were unwavering, consistent, and blame-free. We would debrief after a significant situation was resolved to determine if there were systemic or response improvement opportunities.
