Best Practices – Customer Service

Colleen BarrettThose of us in private practice or other business endeavors, will do well to follow examples from larger businesses in other industries.  They say that success leaves hints. There is no question as to the hint this example provides.

In the September issue of The Costco Connection, there is an interview with Colleen Barrett, the President of Southwest Airlines. It is an excellent article, and I wanted to share three statements made that are applicable to any business of any size.

We’re in the customer-service business; we happen to offer air transportation.

I love this statement and feel that embracing its true meaning will set our business apart from other businesses. For any business, including our health care practices, we know how this can make a huge difference in our practice and the word of mouth referrals we receive.

For example, in my practice, I always ask people how they found us. More and more, I’m hearing Jane Doe told me to come here because you really listen to people and John Smith told me if I came here I wouldn’t have to wait for hours in the waiting room.

More often than not, the biggest complaint (unsolicited of course) I hear from patients about other practices is that they are herded through, they do not feel listened to and they have to wait for a long time to see someone for 5 minutes if they are lucky.  (Hint, when patients/clients complain about another business or practice, what can you do that is different and better?)

We consider our employees to be our number-one customer, our passengers our second and our shareholders our third. If we give great customer service to our employees as leaders, they will in turn provide it to their customers, who are the passengers. And the reward will be there for our shareholders.

If you have staff, you know they can make or break your practice. It is important to empower your staff to “own” their job if you will. While Southwest gives employees a percentage in the company (employees own 13-14% of company stock and share in profits), there are other ways to encourage staff “ownership” of their jobs.

Other things you can do is to listen to staff members and implement ideas they have that would work. For example, the person at your front desk is going to know more about the flow up there than you will. She/he will know where the breakdowns are, and how to best meet patient/client needs.  The same thing with your MA. While you are in the room seeing the patients, she/he is juggling what is happening in the back office, and may have some excellent idea how things might work a bit smoother.

At the very least, just like you listen to your patients, pay special attention and listen to your staff.

We’re very, very disciplined about hiring and we’re very, very disciplined about mentoring and coaching. We’re a very forgiving company in terms of good honest mistakes, but we’re not at all forgiving about attitude and behavior and demeanor.

This is so important. And soooo difficult. Hiring the right person is an art as much as it is a skill. It is important that we follow some best practices and bring on the person who we feel is best, and then work with them to become the best they can be. On the other hand, if you find they have an attitude or exhibit behavior that is not consistent with your office culture, then it is best they move on.

Southwest Airlines is known for being a very different kind of airline to fly with and to work for. These three key ideas shared by Ms. Barrett give us a glimpse into why. How can you take this information and use it in your business?

Feel free to share your thoughts with us below.

Barbara C. Phillips, NP

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  1. Excellent reminders, Barbara.

    My goal in my practice is to listen, to give personalized care, and to treat others as I would want to be treated. I have not had a lot of patients yet, but I go out of my way to call them back, and respond right away to their needs. The requirements to see a non urgent patient for Care Oregon was 30 days, my standard is 72 hrs, for urgent care it is 24 hrs, for me it is 2 hrs. I do not want people to wait, and I want to give affordable quality care, while at the same time providing a comfortable environment for them, that is non medical in appearance. I was happy to get 99% passing on my site visit, and thanks for your help. I think the provider relations inspector just loved the way the office felt to her, in her words “so cozy and quaint” and I actually had to remind her that she had forgotten things on her check list as she kept looking around!

    Your other good point is the staff. I have never had employees but I have certainly had years of being one. I feel that if the employees are happy,they will pass that on. But your other point is to make sure to hire someone with equal values, drive and ideas too. They need to care, and go out of their way to help. My ma actually left for 2 days vacation right before my site visit, so once again I was alone getting last minute things done! She is kind, but not sure she is the right person for the part time job I can offer now. I think I really need to get a marketing person to help me put together a well rounded package including gift bags, flyers, and talks so I can go present myself to groups. At the job I am temporarily working for 2 days a week, there was a luncheon put on by a nephrologist. He had these beautiful clear almost plexiglass thickness gift bags, filled with pens, business cards, pocket handbooks for the pcp on key points of when to refer to a nephrologist, and bags of candy all inside. He sprung for a gourmet chinese lunch. He was very soft spoken and came across as gracious, humble, and just informing us of his practice and when to refer to nephrology. He spoke with equal attention to each ma, np and md present, without preference. I loved him! He is someone I would refer to not only because of his introduction, but because I love being educated, and he took time out of his day to not only provide education, but also with a meal. I was so impressed. I may not need a marketing person, but as NPs we did not get the business or marketing training, and I am sure I could learn from a professional to spiff my image, being the new kid on the block. After that, I will make sure once they get inside the door, they will get the care they deserve. Carla

  2. Just an update on Healing Presence Family Practice. I opened in July of this year. I still have not been credentialed with Care Oregon (medicaid), although I am credentialed with Medicare, and all the other major insurers now. Care Oregon has a medical director who has submitted my file to a review committee for mid November, as I did have a gap in employement 2 1/2 yrs ago, for personal and family illness. So although I have some of these lower income patients wishing to see me, as there is no other provider in town, they are not able to unless I get credentialed.

    However, I am starting to get busier. My patients are coming from three main sources. The one pharmacy in town, is sending me about 50% of my new patients, and Blue Cross, Providence and Aetna I am now listed as a pcp accepting new patients. I am getting about 30% that way, and the other 20% have been some return patients. The first 3 months I was open, I saw a total of about 20 patients. This month, I have seen almost 20 patients already, and we still have 10 days left. It is incremental, but my patient volume has tripled. I also am continuing to advertise in the newspaper, in various venues. One was in a “Women in Business” section that comes out this week, and focuses on how I adopted the micro practice concept, and there is “no waiting” in the waiting room.. , and more personalized service. I also was interviewed by a reporter for a new on line news blog for the town of Wilsonville. An additional feature that I offer that is different is being the most affordable care in town for the uninsured. The reporter happens to be uninsured, and lives about a block from the office. She appreciates that concept.

    There is a group called the Wilsonville Community Sharing Org, and they are involved with the food bank, various volunteer services, and I am getting in touch to let the coordinator of services know about my medical services in town. Word of mouth is starting to spread, and that will be the best way to get referrals, and I continue to define to myself the philosophy and mission of my clinic, and how I wish to care for patients. This website continues to be a tremendous source of information and support for me. Carla

  3. Carla,

    I’m glad to hear that things are picking up. I’m still just speechless with the fact that you’ve not been able to get credentialed with Care Oregon.

    I’d love to hear from other NP’s in Oregon and see what kind of a problem others are having.


  4. Although I’m sympathetic to the financial squeeze that most practices are feeling, why is it so difficult to schedule patients so that they don’t spend outrageous amounts of time waiting to be seen.

    Its a simple procedure to determine the average time spent with a patient. Why the insistence on scheduling the time we wish to spend with them?

  5. I am pleased to hear others succeeding in their endeavors. I opened my clinic in August 06 with one patient, I have since grown to approx. 260 patients. I feel that is a great accomplishment thus far. I am in solo practice, the only NP in West Seattle that can say that, and it gives me great pleasure to hear positive feed back from my patients. When asked how they found out about the clinic, they often tell me it was from their insurance website or customer service. I have no M.A., it is only me and my office manager/biller and we are almost never there at the same time. My patients really like the fact that I answer the phones, call them back the same day (usually within 2 hours). I schedule appts and diagnostic tests. I call with lab results, get refills done the the same day and what ever else it takes to make my customers happy. I spend alot of time in the community working with women that have no insurance providing breast and cervical services on a mobile van. I offer greatly reduced fees to un-insured patients, boy is that appreciated. I take the time to really listen and include patients in on their health care decisions. I feel as if all these things are not only helpful for marketing but should not be a big stretch in any practice. Please keep posting and if I come up with a sure fire marketing tip, I will let you all in on it.


  6. Hi Chuck,

    One comment, I am not sure what you were referring to about scheduling? My patients do not wait. I actually call my reception room just that, not a waiting room. They always are seen the minute they walk in the door and the time spent is never an issue. I have never had a problem with that.

    For Grace, congratulations on your practice! I am in a very affluent area, so I am actually begging and calling the Oregon Medicaid to try and get the word out that I am so willing to see these patients that live within a mile of my clinic. There are about 3,000 apartments with lower income residents, in my area, even though the average income is 74,000. So most of my patients started with Aetna, or Blue Cross, and looked me up on line, or referrals from the local Rite aid. I opened 6 mos ago with zero patients, being new to the area, and have about 80 patients so far.

    But I am also signed up as a provider to provide free mammograms and paps with the BECCP program (Breast and Cervical Cancer Screening..) and have not had one patient so far.

    I also have called Care Oregon patients that they put on my panel in October of this year, and found they were way out of my zip code. So I am trying so hard to reach those near me, but whoever is matching up the patients with the new providers is not the best at it. I do have one contact at Care Oregon who is researching this as she finds this very puzzling, and of course it is detrimental to the mission of their organization. They did not get me in the 2008 Provider directory in time either, which is organized by zip code, and its like hey, there is a provider that wants to take care of the poor and they are not making it easy! Other clinics are turning them away or have 2 month waits and are farther away.. Oh well, in time, they will find out about me.

    Which mobile van are you with? Do you own it, or is it part of a public health grant, and are you able to refer back to your own practice from there? Carla Healing Presence, Oregon

  7. I posted to another reply of Grace’s. I see this post above was just two weeks ago, and now she is closing up shop. I would be interested to find out what influenced her decision.

    Barbara, I do think you have a wonderful site and have done a wonderful job, but I know you are changing the format, so it will be exciting to see how it comes out as sometimes it is hard to remember where people posted so I can see if there are any new responses. I have found that the forum style is easy to scroll down, and either add a new thread, or comment to existing ones..

    Anyway, in response to your comment up above, about how you would be interested to hear from other Oregon NPs, I am sure there are NPs in Oregon that read this site, (I have told them of this website) but I can give you a brief description of some of their practices, but nothing like coming from the owner of the clinic who truly knows. I also want an update, as it helps me to see how others are doing, I learn from that.

    One NP is in Vancouver, WA (sorry not Oregon). She has a cash only practice, and had to move her original location which was inside a building with other holistic practitioners that were not NPs. She now is near a Walmart, and so location location location has really helped her volume. She sees predominately spanish patients as that is her native language, and there is a lack of clinics of her type in which spanish speaking patients feel comfortable. I do know she still works part time at other jobs to supplement her income, and has been in business a little over a year. She uses paper charts and has no staff.

    Another NP is in SE Portland. She leases space in a Chiropractors office. She shares the receptionist, and her mother is her office manager. Her biller is a personal friend who does not charge her, who also helped her with credentialing. She is only open 3 days a week, so she can spend time with her 3 children. She had a full panel of patients at a physician office nearby for 5 years, when she opened, but she now sees about 15 patients per week. Her practice is a combination of traditional family practice and “natural or anthroposophical medicine”. Other than front office, no other staff. She uses paper charts.

    Another NP who has her own practice is in North Portland. She has a 1300 sf space that she gutted and renovated. It was a clinic before, so people in the community knew about it ahead of time. But it is remodeled and beautiful now. She sees predominately Care Oregon patients due to the neighborhood. She has had the practice a little over a year and is growing. She has evening and some Saturday hours, and a part time massage therapist. This office is doing very well. The NP uses an EMR (Soap) and has both front office, and back office help.

    And Barbara, an update on my practice. I see about 12 patients a week, but we are slowly growing. I still find it very very difficult to find the lower income patients, and I want to see them because they DO LIVE IN MY NEIGHBORHOOD. I have been open 6 months, and really did not start to see any patients until 3 months ago. October I saw 22 patients, November 45, and December I saw 50. Most are private insurance, and I have 3 Care Oregon families now. I have two Medicare patients. I do not have vaccine yet, and am still working on VFK (vaccine for kids) from Care Oregon, and Oregon Public health also has some that is earmarked for those that have other insurance or no insurance but are lower income, so I will have vaccine soon. I see a variety of patients, and find that many have a lot of internal medicine problems. One third of my patients have CAD or Endocrine or Lipid problems. I have two patients with chronic pain. I have 4 regular house call patients. I just bought a second computer that is being “built” and will be installed in front, and my lap top will go into the one large exam room which also will double as my office after the second computer comes in. I just hired one assistant for front and back office to work 20 hours a week. Ideally I would like my own building or a larger space with 2 exam rooms and a total of 1100 sf, but in Wilsonville, the lease costs are very expensive. This would cost me 1800 a month, and I cannot do this. I am still averaging about 3 patients per day, and need 6 per day, every day, before I would consider a move. But at the same time, a move is disrupting for patients, and you have to change your address with all the insurance companies, website etc, so at this point I think I am staying put. I will keep you posted with major updates or volume changes. I am going to put out a regular ad in my neighborhood paper weekly, as I have never done that, although I have had 2 feature articles, and also had an article in the Chamber of Commerce Newsletter that goes out to all the Chamber members.

    Hope you are Having a Happy New Year, Carla

  8. Carla,

    Happy New Year to you as well!

    Excellent news to see how you are growing! I have to agree, that even though I do have a “family practice”, the majority of my patients are really internal med – which is fine for me. We seem to be evolving into more of a diabetes clinic – I was actually surprised when people started coming in saying there were there just for diabetes (all word of mouth – I do lots of DM) – they do end of switching their primary care to us though.

    We are going to be evolving the site as you mentioned. It will include so much more for all of us and a forum is sorely needed. So keep your eyes posted.

    Thanks for the info on the other practices. All of us want to know what others are doing…a goal of mine for Phase II of NPBusiness.


  9. Carla, I did reply to your last response on another topic also. I am closing practice because all I do is work 7 days a week and I have no time more my children or me. I dont want to do it any more, there is also another major reason but that will have to wait awhile before I let you in on that. I work the King County BCHP program as you do in Oregon. I am suprised you have no one signed up from there yet. I sign up women at my clinic but provide my services at the community health fairs and have seen approx. 60 people this past year with 5 more scheduled this year. It really helps with income coming in for the clinic and helps build a reputation for your practice. But now I will use it as a pay check. Maybe we can meet one day when I am visiting Portland and I will tell you all about my decision to close.


  10. Grace,

    I would like to keep in touch more, and hear more about your decisions. Regarding the BCHP program, I just spoke with a new representative, on the phone, and hopefully we will start to see some referrals. Most of the patients that have come in the office, or called, have had insurance that covered their mammograms, etc, so it did not come up, but I have the brochures. When I worked as an employee at a community health clinic in California, the majority of the patients were medicaid, and also were on these special programs for women and children, so there was never any need to advertise. We saw 25 patients a day..My office practice where I now live is a big change. I really think the lower income people in the area, still have no idea there is someone a mile away like me that they can call, and that is the type of care that I love. In fact, all of the private insurance like BCBS, Aetna, etc, has so many ideosyncracies within each plan, regarding hsa’s, deductibles, co insurance, etc, and often patients are not aware, or choose not to be, so they get upset, when they have to pay any money, and we find out later..I have to call ahead of their appt now, and I do not like mixing talking about money, with their healthcare as the provider.. sometimes medicaid, with no co pay or co insurance or deductibles would be so much easier!

    I will work on attending some health fairs so I can promote this bchp, and medicaid area more. I have been open 5 months, and so I have not yet gotten to a health fair, things have been a bit overwhelming. But I think that is a great way of marketing. Carla

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