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How ‘the buck stops here’ can impact the bottom line


Controlling staff members’ attitudes may not seem important, but it is to patients who attend your practice. Make sure the overall atmosphere and experience for them is highly important or they will go elsewhere.


Take home

Controlling staff members’ attitudes may not seem important, but it is to patients who attend your practice. Make sure the overall atmosphere and experience for them is highly important or they will go elsewhere.


Putting It In View By Dianna E. Graves, COMT, BS Ed

President Harry Truman uttered this saying-“The buck stops here”-to define how all decisions and responsibilities during his administration fell directly under him. As the commander-in-chief, there was no way he could, or should, lay blame to someone else for his decisions or deeds. It fell squarely on his shoulders.

These are very powerful words. Managers worth their salt should pretty much agree with this concept. Yet, rarely are we solely responsible for all clinic and/or staff actions and deeds.

I can’t control that Kathy in Room 4 is having a really bad day after her car would not start, her ATM card was “eaten” at the gas station and she has no money for lunch, or that she has a parent-teacher conference at 5 p.m. regarding her son’s F in home economics. So when she snaps at Mrs. Tucker at 8:47 a.m., I wasn’t even in that clinic to be responsible!

But, ultimately, I am responsible for her actions, because I am her boss. The patient will call me. The clinic lead will call me, and the physician will call or e-mail me because Mrs. Tucker took his ear off. Guaranteed he will talk to me as if he were letting Kathy know his great displeasure in this event.

I can appreciate why they are all irritated with me-I don’t enjoy it, but I can appreciate it. As Kathy’s boss, most people don’t take it out on the person they are mad at. They tend to practice a kick-the-dog mentality and I am the commanding beagle within reach.


Taking responsibility

All of us are consumers buying a product, whether “buying” implies purchasing a product or agreeing with a concept (as in buying into an idea). As consumers, the service we receive is under constant scrutiny.

In the medical field, the rules are changing all the time-patients’ insurance, co-payment, pharmaceutical coverage, and non-coverage of given medication. We are used to these changes coming fast and furious, but the patients are not.

So when they come for their appointment, we seem to keep adding another change to the routine they have practiced for 20 years, and we expect them to keep up with these changes that we cannot even keep up with.

Because they are not used to it, they try to stay with the rules they have always known, and when we continue to push them to alter their behavior, they often push back.


Real-life situation

Here’s an example of this in a different venue:

I travel a lot for conferences and teaching. Recently, the angels above blessed me with a Transportation Security Administration (TSA) prescreen label on my airline tickets.

This means I can leave my shoes on and not have to strip down when I go through security. This made me ecstatic! No more hauling my computer out, forgetting the change in my pockets, or being swiped with the magic wand when my Minnesota Twins sweatshirt beeps ominously in the x-ray scanner.

All good things eventually come to an end, as I realized this was a promotion to get me to buy a prescreen status permanently.

Using this as a marketing tool-“This is what you could have if you enroll”-is a wonderful idea for frequent flyers but not for people who fly once or twice a year. They are used to the old way: remove your shoes and jackets, empty your pockets, and take the computers out of your bag.

Because these less-than-frequent flyers then try to comply with the old rules and bog down the system, they get in line and try to stick with the old ways-still trying to take off their shoes, belts, and jackets. They are trying to behave.


Unfortunately, instead of pre-advising people what a prescreen means for their ticket, it appears the most efficient way to educate the masses on a quick level is to yell directions at a group of 200 people as they are being corralled through the cattle gates of insanity (security checkpoint), again all trying to comply with the rules as they know them. Agents are constantly yelling directions at consumers to keep them moving, listen to the directions and move faster!

A recent experience at a large airport left me angry as well as commenting back a lot, which is not a smart move while trying to get on an airplane.

But it’s wrong to change the rules spur of the moment without helping you understand what those new rules mean. It’s not customer service; it’s chaos, confusing, and frustrating.

So, during this mass chaos, I wanted to yell at someone. Not at the agent yelling instructions at 82-year-old Stanley, who is still trying to take his sneakers and belt off. Not at the head of the TSA at the airport. Not at the head of Georgia Homeland Security.

I wanted to discuss this insanity loudly with the head of the Federal TSA. Oh, and then I would like 10 minutes with the president (their boss), even though I am quite positive that at 6 a.m., the president was nowhere in the building in Georgia.


Tying it all together

In the medical field, we are held to very high customer service standards. After every physician appointment, I receive no less than three surveys per visit asking me to comment on the service I received. It then gets published in the paper, Facebook, and websites. Don’t forget patients’ blogs.

As a consumer, I can hurt your practice by choosing to boycott poor customer service. I do this by seeing your competitor. Stopping the buck = no more money for you.

Good, quality service does not mean moving patients (or flyers through the airport) faster. Faster often means less personal interaction: no smile, no acknowledgement that you are even there. Just get through the system faster.

A technician or front desk person who can navigate patients through the system in a timely fashion while adding a personal touch-“Oh, it’s your birthday today. Happy Birthday!”-goes a long way. The patients are often thrilled, especially if the physician reads the sticky note taped to the chart and acknowledges their birthday as well.


Via patient surveys, we are now seeing patients stopping the buck by taking it to the top. They do this by responding negatively and sometimes even harshly to the treatment they received. They are complaining about:

  • No chair time with the physician.

  • Poor physician/staff bedside manner.

  • Feeling like cattle being herded as they registered.

  • The technician/physician staring at a computer without eye contact.

Because they won’t vent at the direct cause of their unhappiness (i.e., poor customer service), they have moved “the buck” from the employee they are mad at to the manager of the office to the administrator of the group to the head of the insurance groups of the state. They sometimes even take it all the way to the review board of the state!

They have also taken it to the public court.

So, while President Truman took full responsibility for all the projects under his administration by announcing “the buck stops here,” we now find it is not so easy to say the “buck stops with you.”

When the buck stops at your desk, it still has “miles to go before it sleeps," as Robert Frost said.

When you look at it, I’d rather just have the responsibility of the country on my shoulders than Kathy in a bad mood in Room 4.



Why customer service matters

1.              Increased complaints mean decreased patient visits.

2.              Decreased visits mean decreased dollars.

3.              Increased poor results on surveys mean increased publicity in the public court of review.

4.              This will also indirectly decrease your “buck”-ability with patients you don’t even know-yet.


Dianna E. Graves, COMT, BS Ed

E: dgraves@stpauleye.com

Dianna Graves is clinical services manager at St. Paul Eye Clinic PA, in Woodbury, MN. Graves is a graduate of the School of Ophthalmic Medical Technology, St. Paul, MN, and has been a member of its teaching faculty since 1983.


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