That's what you said last time!

June 1, 2008

Medical office staff has been taught that looking a patient in the eye and saying, "I'm sorry" can magically reverse whatever has made that patient upset. It was a great idea that has gone terribly awry. Your patients want decreased wait times. They want medication refills and questions turned around in a timely fashion. And they want to know that they are being heard when they ask, "Why?" No matter how much we smile and how sincere we teach our staff to be, hearing "I'm sorry" is no longer high on patients' priority lists.

It seems that corporate America has taken a great idea and turned it into a public relations nightmare. What was that great idea? The apology.

Whether you are talking about the pharmacy that refills your medicines, your local grocery, or your doctor's office, management has concentrated on training staff to say two of the hardest words ever spoken-"I'm sorry"-to help defray angry patients or customers.

Staff has been taught that any wrong can be righted, any angry person can be turned into a smiling customer, and any time delay can be magically reversed by a smiling staff member sincerely looking him or her in the eye and taking responsibility for whatever caused the upset. It was a great idea that has since gone terribly awry. Let's look at how this whole process became derailed.

Most days, our well-planned schedules became nothing more than disorganized chaos. Patients arrived when their transportation managed to get them there or they simply walked into our clinic unscheduled because an "illness" occurred overnight (that meant they had transportation for this day). Clearly, our clinics tended to run behind.

We also had a number of "outside" attending doctors that came from their busy clinics or from operating rooms to staff our specialty clinics. One clinic that springs to mind occurred every Monday afternoon.

Patients began to arrive for their appointments at 1:30 p.m. The techs and residents would work up the patients, and then wait for the attending to examine them. In most cases, the attending didn't arrive until 3:00. By this point, the patients, and the staff, were disturbed. Things usually went downhill from there.

Thinking we could decrease wait times, we changed the patient arrival times from 1:30 to 2:00. However, the attending just ended up coming even later. It became impossible on our end to schedule patients appropriately.

We had a broken system. To help manage our inevitably angry patients, we began to create "solutions." Half of the time they worked; the rest of the time we all ended up going home thanking our lucky stars that Monday afternoon occurred only once a week. It was a rough way to start the workweek.

Excuses versus solutions

With 20/20 hindsight, I now realize that what we created were excuses for our broken system, not solutions. We knew we had a problem and we even had the advantage of knowing what the problem was-but we didn't fix it. We bandaged it with excuses and apologies.

We would start with the "I-feel-your-pain" approach. Sooner or later during the day, a patient would begin worrying that he or she would miss the bus or pre-arranged transportation home. Our clinic treats a number of elderly patients with diabetes. Trying to talk a frantic patient out of leaving before he or she had been seen by the doctor has to be the hardest thing any manager can do. You know the patient needs the attention, but you also know the patient can't afford to pay for his or her own cab in the event of a missed ride. So, we promised the patient that if he or she stayed, we would pay for the cab fare home. There were nights when we didn't have any more hospital cab "chits," so the staff would pony up the $5.00 to get Stella home safe and sound. Noble, you say? Maybe, but the act created another set of problems: Stella liked taking a cab home after her appointments.