If you want to improve the patient experience — and your patient satisfaction and HCAHPS scores — here’s a good place to start: Reconsider how your hospital or practice thinks about time. And get to work swapping a patient-centered approach to time for your provider-centered viewpoint.
To see this in action, try a quick phone call to Cleveland Clinic. Here’s precisely what you’ll hear, after just a bit of voice jail navigation:
“Thank you for calling Cleveland Clinic. Would you like to be seen today?”
And they mean it. They do “about a million” same-day appointments a year, according to James Merlino, MD, Cleveland Clinic’s Chief Experience Officer (CXO).
Now, doing a good job in healthcare does take time. Scans take time to read properly. Cultures take time to grow. Thoughtful diagnoses and effective discharges absolutely take time.
The last thing I want to do is turn your hospital or practice into the healthcare equivalent of a fast food joint.
But some of the wait times your patients suffer through don’t add anything to successful clinical outcomes. And the reason you’re making patients wait? Probably it’s partly because you’ve always done things this way, and everyone else in healthcare is making patients wait as well.
Well, you can’t use that last rationalization anymore. Not if you’ve been watching what Cleveland Clinic has been doing on the timeliness front.
Let’s go back to listening to Cleveland Clinic, and that mind-blowing greeting:
“Thank you for calling Cleveland Clinic. Would you like to be seen today?” (After 4PM the greeting rolls over to”Would you like to be seen tomorrow?”)
This is for real. According to Dr. Merlino,
“Anybody calling [Cleveland Clinic] for an appointment for any specialty can be seen today.”
Getting people in to see a doctor the same day they call is an extreme and extraordinary move by Cleveland Clinic to take patient satisfaction to a new level.
Which is something that’s come a long way since the bad old days, when their incoming CEO, Toby Cosgrove, would joke, “Patients come to us for high quality care– but they don’t like us very much. ” (Which wasn’t much of a joke, really. When Cosgrove took the reins at Cleveland Clinic in 2004, patient satisfaction was in the lowest 10 percent of the nation.)
An eye on the millennial generation of patients
While nobody of any age likes to wait, this commitment to speed comes partly from Cleveland Clinic’s eyes being trained specifically on the incoming millennial generation of patients. (Millennials are a crucial generation of customers for any business—including healthcare—to consider. They are 80 million strong in the U.S., making them larger than the baby boom, and much larger than Generation X, the generation that immediately preceded them. And their expectations are quite different, being the first generation to take the internet, and smartphones, entirely for granted. A historical reality which changes their perception of time, convenience, and more.)
A million same-day appointments
They pull this off… how? Well, the same-day appointment commitment required Cleveland Clinic to get through some operational hurdles. Actually, Dr. Merlino corrects me on this: “‘operational hurdles’ is an understatement.” An extraordinary amount of work has had to be put into “managing the flow and ensuring we have the capacity.”
The same-day appointment promise is also dependent on a sophisticated triage process.
In other words: I can’t just call up and say
“I have a headache. I want to see a neurosurgeon.”
Well, actually, I can call in and say that—and they’ll be ready to deal with it. Here’s what happens: I’m taken through a series of questions on the phone; depending on how I answer those questions, the Cleveland Clinic telephone agent will be able to determine whom I should see, and will ensure I get that appointment today.
“So, Micah, [in the example above] you may not see a neurosurgeon for your headache, but you may see somebody who is a headache specialist or you may need to talk to a nurse who can better triage what you need. But we will get you to the right provider at the right time.
“If you call and say, ‘Look, I was in the emergency department last night with a headache and they did a CAT scan and they say I have a brain tumor. I need to be seen by a neurosurgeon today,’ you will see that neurosurgeon today. If you call in with a headache [and] you say certain things which are warning signs—answering yes to ‘is this the worst headache you ever have in your life?’ is one — you will immediately be transferred to a nurse who will do a more assessment and then guide you to an emergency department.
If it’s just a garden variety headache, as determined by the agent’s triage questions, they’ll still “get you an appointment with somebody today who can help you with the headache.”
Speak the patients’ language, use the patients’ channels
The same-day appointment commitment isn’t the only time-bending patient satisfaction change Cleveland Clinic has introduced. Another one that struck me is their understanding that patients these days, especially but not only millennial patients, want to communicate with their healthcare providers through the same communication channels they use to run their social lives. Which is a theme I am seeing in every arena of business. Appointments via mobile, information via mobile, chat online, doctors (after HIPAA waivers) corresponding with patients via email. Using telepresence for followup care with homebound patients. and more.
All of which, if you think about it, are ways to stretch, bend, mitigate the effect of time on the patient experience. Emails are asynchronous: they don’t have to be read at the time the doctor wrote them, a fact that can make things more convenient for both parties. Online chat is immediate when you need it to be immediate, again reducing wait. Information on mobile apps (Mayo is another leader in this) is another time — and potentially life— saver as well.
So what’s next on the speed front? Chief Experience Officer Merlino, who is also a practicing colorectal surgeon, jokes it might be, “Thank you for calling Cleveland Clinic. We’ve already solved your medical issue; is there anything else we can help with?”
Micah Solomon is a customer experience and patient satisfaction consultant, customer service keynote speaker, and author.