REV IEW

Cover Focus I—

The Secret to a
Satisfied Patient
Walter Bethke, Managing Editor

W ith technical skill ean-P aul S artre once w rote, Medical Group Management Asso­

seen as a given,

com m u nicatio n
J “Hell is other people,” and the ciation, so we have a large database
patients who fill out satisfaction of patient responses,” she says. “After
surveys would agree. Despite medi­doing a regression analysis of our sur­
cine’s cutting-edge technology and vey data, we identified the key driv­
excellent technical outcomes, time ers for both overall satisfaction with a
skills c o m e to the and again its the practice as well as
personal interac­ the likelihood of
forefront.
tion with doctors recommending a
an d sta ff— th e F e e lin g lis te n e d -
doctor to others.
o th er p eo p le— to c o r r e la te s h ig h ly The number-one
that patients fa cto r was th e
d e f i n e as t he w it h a w illin g n e s s .
provider listen­
deciding factor to r e c o m m e n d a £ ing to the patient.
influencing their S | j k e c' Patients feeling
satisfaction with p r a c tic e .” l l l i S listened-to cor­
their care. When relates especially
a staff member is highly with a will­
brusque, things ingness to recom­
aren’t explained properly or wait times mend a practice. The second-highest
seem long, patients take note. To find factor is ‘The doctor had respect for
out what surveys have identified as what the patient had to say.’ ” Mrs.
key factors influencing satisfaction, Luallin has distilled her learnings
and how some practices may be able about ways to improve the patient ex­
to improve satisfaction, read on. perience into the acronym CLEAR,
or Connect, Listen, Explain, Ask and
Communication Arts Reconnect. (Specific actions that fall
under the CLEAR subject areas ap­
Meryl Luallin, a partner at the Sul- pear in Table 1, pp. 22.)
livanLuallin Group, a firm that helps Jeff Machat, MD, an anterior seg­
practices improve the patient experi­ ment surgeon in Toronto, says listen­
ence, says that analyzing the 20 years ing to patients is key during an initial
of surveying has taught her some les­ consultation about LASIK. “People
sons. “We’re the preferred vendor who are nearsighted will tell you that
for patient satisfaction surveys for the they don’t have a problem with read-

20 | Review of Ophthalmology | December 201 + This article has no commercial sponsorship.

ing, just with distance, so ‘just fix that expense of looking someone in the eye
and don’t touch my reading ability,’ ” and making him feel important.”
he says. “Meanwhile, we all know that Dr. Lee conducted a study of pa­
when you get rid of nearsightedness, tient-centered care in ophdralmology,
they’ll then be presbyopic and miser­ widi a particular emphasis on patient
able. It’s important to understand how expectations . 1 Part of the paper in­
a patient imagines his life after sur­ volved patient focus groups that al­
gery, and what the procedure’s limita­ lowed individuals to identify die most
tions are, so the result you give him important things they expected and
will work for him. We need to have appreciated when they visited die oph­
long conversations with people so they thalmologist. “The top desire was for
really understand what we’re talking honesty,” Dr. Lee avers. “The second
about, too.” was information about their individual
The third highest influential fac­ Toronto’s Jeff Machat, MD, says good diagnosis and prognosis. Third was
tor in Mrs. Luallin’s database was the interpersonal communication is key. receiving an explanation in a clear lan­
helpfulness of the practice s staff, such guage. The fourth-ranked expectation
as the physician’s assistants and re­ uncommon; doctors will tune out all involved an issue of skill: The doctors
ceptionists. Paul Lee, MD, chair of other aspects of the patient interview reputation and experience. However,
ophthalmology at the University of and just focus on what they need for the fifth- and sixth-ranked expecta­
Michigan, says patient satisfaction or the diagnosis. It’s the practices who tions go back to communication and
dissatisfaction often begins with these have trained their staff to be caring relationships, specifically empathy and
individuals. “A big driver of satisfac­ and come across as personally inter­ how well die practice listened to, and
tion is the communication skill of the ested in the patients that score the addressed, their concerns. So, five of
entire team,” he says. “It’s not just the high ratings.” the top six key expectations involved
physician. In most practices, there is For physicians interested in anoth­ how well the physician and his staff
an integrated team that starts with the er reason to dislike electronic health relate to patients, rather than his or
person who greets the patient when records, they need look no further her skills.”
he comes in; it could be a clerk or than the cooling effect they have on Mrs. Luallin says her firm’s surveys
someone in a central lobby who helps doctor-patient interaction. It’s hard to have found an interesting effect of
people find their way. We view this as be warm and engaging while you’re expectations on satisfaction. “An anal­
a team priority, that everyone who has looking away from the patient and typ­ ysis of our database has found that
an interaction with the patient and/or ing data into a computer. Experts say first-time patients rate a physician ex­
his family plays a part in helping create there are some ways to counteract tins perience lower than existing patients
satisfied patients.” negative effect, though. “Look at the do,” she says. “We assume this is be­
As part of her job, Mrs. LuaDin will patient when you speak or ask a ques­ cause existing patients have learned
shadow doctors at their clinics, or tion,” says Mrs. Luallin. “Then, as you what to expect and have lowered their
sometimes play the role of a mystery type, reassure the patient by saying, expectations. As an aside, when we
patient, in order to advise them on ‘I’m entering your information into speak to practices and patients about
ways they can improve patient satis­ the record, but I’m listening.’ ” what causes many complaints, the
faction. One shadowing session stands Dr. Machat is aware of the effect of answer is often unmet expectations.
out in her memory. “At die beginning EHR on patient interaction, and takes We all experience this even outside of
of an exam, the middle-aged, female steps to help mitigate it. “I have both medicine, such as when we travel and
patient told the doctor she had a pain­ EHR and paper,” he says. “I actually have bad experiences with a hotel’s
ful lump in her breast,” Mrs. Luallin have a scribe in the room, which lets service tiiat didn’t meet expectations.
recalls. “ ‘When did tire pain start?’ the the patient know someone is taking The bottom line is, if patients have
doctor asked. ‘It was in March,’ the notes and also allows me to focus on an expectation and it’s unmet, such as
patient responded. ‘My mother had him. I always tiy to put myself at eye the expectation that the doctor would
died, and then in November my sister level with patients and look them in take some time with them but instead
died, and my best friend passed away, the eye so drey know tiiey have my full rushed in and out in five minutes, diey
too. Last year was a horrible year for attention. Then, once they leave, that’s could be a littie bit disappointed, and
me.’ ‘Wow,’ the doctor replied. ‘So, when I write my notes. So, EHR is tins will show up in the ratings.”
when did the pain start?’ This is not amazing and wonderful, but not at the Dr. Machat takes issues of trust

D ecember 2014 | Revoplith.com | 21

a Cover The Happy Practice
i Focus
and honesty, which ranked high in Dr.
Lees study, to heart when consulting
with a prospective LASIK patient. “We
don’t tell patients that anything is guar­
anteed and that they shouldn’t worry,”
he says. “I look them in the eye and
tell them that 99 percent of the time,
everything goes great, 1 percent of the
time we have a problem and one in
1,000 times we have a serious prob­
lem. These problems will affect the
sharpness, crispness and clarity of their
vision permanently. W hen patients
come to you for a surgery like LASIK,
they already know there are risks. If
you tell them there are no risks, that
reduces your credibility, and they want
to trust you.”

S u rg ic a l S a tis fa c tio n

Experts say the need for good com­

munication doesn’t stop at the exam
lane, but instead continues right to tire
operating room. “There’s a phrase that’s popular in rating care can be, Dr. Machat recalls
When Dr. Machat was with TLC patient satisfaction: Narrate the care,” one patient who traveled from New
Laser Eye Centers he says they con­ says Mrs. Luallin. “This involves tell­ York to Windsor, Ontario, in 1993 to
ducted many surveys and, once again, ing the patient what you’re going to have PRK. “She had a low prescrip­
communication was a key finding. “The do or are doing as you do it.” Dr. Ma­ tion,” he recalls, “and we performed
number-one factor was the patient not chat thinks this is key to managing a PRK. I told her during the case that if
getting the visual result he was looking patient’s trepidation during surgery. everything goes right, her vision will be
for,” Dr. Machat says. “He may have “When the surgical patient arrives at blurry immediately afterward. When
gotten 20/30 or 20/25 and felt he paid prep, I have an amazing staff who will the surgery was done, she sat up and
a lot of money and really wanted 20/20. calm him down dramatically,” he says. started to cry. I asked if everything
The number-two factor was having to “They distract him with conversations was OK and she blurted out, ‘I’m so
wait too long. Third was when he felt about his life, and inform him about happy—everything is blurry!’ So, it’s all
like just a number, like someone on a what to expect during tire procedure, how you speak to patients.”
conveyor belt. And then in spots four going through the steps, and telling Ultimately, Dr. Machat thinks one
through 10, it was all about human him the dos and don’ts. By the time of the keys to satisfied patients is to re­
interaction. Oftentimes, these com­ the patient sees me, he’s in great shape. member that this is all new to them. “I
plaints would be that they didn’t feel Then, during the procedure, I say tire tell doctors and staff that they have to
the surgeon gave them enough time, word ‘perfect’ 1,000 times as I describe put themselves in the patient’s shoes,”
understood them or listened to them. what I’m doing. ‘You’re going to feel he says. “You may have done thousands
They’d also complain that the surgeon some pressure now ... perfect.’ Then, of cases, but this is the patient’s one
didn’t talk them through the surgery. ‘Everything’s going to be dark ... per­ and only time he’s experiencing this. I
So, overall, nine out of 10 issues had fect.’ I say it so often that when patients want patients to feel comfortable, that
to do with interpersonal interactions. sit up and I ask how it was, they’ll say they can ask us anything, and to know
This led me to understand that, as a ‘perfect.’ I also have someone count that we’re empathetic to what they’re
staff member, if you’re having a bad down during every step so the patient going through.” REVIEW
day you still have to muster up a smile. knows how many seconds it will take
1. Dawn A, Lee P. Patient expectations for medical and surgical
That’s how a patient wants you to feel before that step is complete.” care: A review of the literature and applications to ophthalmology.
about their care.” As an example of how effective nar­ Surv Ophthalmol 2004;49:5:513-24.

22 | Review of Ophthalmology | December 2014

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