A Patient-First Practice H ow do patients view your practice and the care you deliver? It's difficult for the average patient to judge the quality of your "product" based upon direct evi-i dence. They can't try it on, and they can't return it if they don't like it. Patients must even undergo a process of education to understand it. When most people consider seeing a doctor, they unconsciously turn into detectives, looking for evidence of competence, caring, and integrity—processing what they can see and un-j> derstand to decipher what they cannot. Successful practices don't leave the nature of this evidence to chance. By carefully managing a set of visual and experiential clues, your practice can tell a compelling story about your service to your patients—that your practice places patients first. From the way you hire and train your employees, to the way your facility is designed, to the way you approach care, you must offer your patients and their families concrete and convincing evidence of your strengths and values. The result? Exceptionally positive word of mouth and abiding patient loyalty, which will enable you to establish your practice as a powerful brand in your marketplace. It's called "evidence management": an organized approach to presenting patients with honest evidence of your abilities. Evidence management is a lot like advertising, except that it turns your practice into a living, breathing advertisement for itself. Other organizations manage evidence well, too. Ritz Carlton, for example, very effectively communicates outstanding personal service. Employees at all levels take note of guest preferences and are empowered to solve problems on the spot, continually tailoring the experience to each person. Many businesses sell products that are intangible or technically complex—financial and legal services, software, and auto repair are just a few—and their customers naturally look for clues that can help explain what they don't understand or see. These businesses offer a lesson that practicing chiropractors would do well to heed. Understand the story you want to tell, and then make sure your people and your practice provide evidence of that story to your patients, day in and day out. Patients seen in practices that master "patient-first" evidence, consistently describe their care as being organized around their needs rather than the doctor's schedule or any other factor related to the practice's internal operations. The actions of staff members also clearly signal a patient-first focus. Here are some representative remarks: "After my first visit, my doctor phoned me at home to check on how I was doing." "Insurance paperwork is so confusing—they handle it all for me." "My chiropractor is the kindest person I have ever met. I was more than my problem to him. He related to me as a person." This type of praise isn't limited to doctors. Patients are "amazed" when the receptionist handles their requests without appearing bothered or put-off. Your employees must communicate a strong, consistent patient-first message to your patients. This process begins by hiring only employees who explicitly embrace your practice's values and then by emphasizing these values through ongoing training and reinforcement. Don't hire employees based upon their intellect or technical skills alone. Task competence is essential; however your hiring process should include behavioral interview techniques that elicit an applicant's values. For example, ask candidates to describe the proudest moment in their past work experience or even the moment they found most frustrating. A candidate who identifies making a difference in someone's life as his or her proudest moment may be more in tune with your practice's values than one who focuses on a career milestone. You will find that those employees who make the cut are those who were drawn to your practice in the first place. These individuals take pride in putting patients first. This feeling of pride and the alignment of employee's attitudes with your practice's values also contribute to lower staff turnover. This continuity of personnel, in turn, helps boost the quality of the care you deliver. Once hired, all new employees should go through an orientation process specifically designed to reinforce your patient-first mentality. The orientation process for non-physician employees—whether therapists, receptionists, or janitors— should be designed to help them appreciate how their job affects patient care. If your janitorial staff fails to maintain cleanliness, a patient may perceive sloppiness on the part of the caregivers. Give storytelling a central role in your orientation process. Through stories, emphasize how employees have used your practice's patient-first values to provide excellent patient care. An example of such a story follows: A patient who was hurt on the job was rushed directly from the workplace to the practice for care. The injury occurred just before the patient finished work and was to drive to pick up her daughter at the end of the school day. The distressed woman expressed concern that, as a single mother, there was no one else she could rely on to meet her child. The practice's receptionist telephoned the school and arranged for one of the practice's staff members to pick the little girl up. The staff member had a child close to the same age as the patient's daughter and so she arranged for her sitter to watch both children until the woman was able to pick her child up later that evening. When asked what prompted her to do this, the staff member replied, "At our practice the patient's needs come first." Patient-first storytelling should continue beyond orientation, in the daily operations of the practice. Once people are away from the classroom, the idea of putting the patient first can seem distant and sometimes even unrealistic, given the stress and unpredictability of day-to-day work. In healthcare, the visual clues about your practice's core values and the quality of care are particularly difficult to separate from the actual service you provide because patients spend significant time in your facility. Some are under active care for weeks or months. The design of your practice's physical environment is connected to positive outcomes for your patients. The potential of office design to promote healing has been documented in dozens of studies. For these reasons, make an effort to create welcoming spaces with soft natural light, colors, artwork and soothing music. Design your practice explicitly to relieve stress, offer a place of refuge, create positive distractions, convey a message of caring and respect, symbolize competence, and accommodate families. A well-designed physical environment has a positive impact on your employees, as well, by reducing physical and emotional stress. This has value, not only to your employees, but also to your patients, too be- cause visible employee stress sends negative signals. Don't limit your visual clue management only to I public spaces. After all, the scary stuff in a doctor's of- fice happens elsewhere—in the ^ treatment, examination, and diagnostic imaging rooms. Be particularly sensitive to overhead lighting when patients must lie in the supine position. The addition of live plants to the X-ray room conveys a sense of vitality. Be sure to provide adequate seating for the patient and family members in the report of findings room. The way your employees present themselves also sends signals to patients. Doctors shouldn't wear casual attire or white coats. Instead, they should wear business attire to convey their professionalism and expertise. Clinic doctors, just like service workers in many other industries, should work in a professional uniform. It's another visible clue that communicates respect to patients and their families. Your attention to visual clues must extend to the most minute detail. One particular enlightening story comes to mind. A staff member worked in the insurance claims processing department, a job that required her to wear the white uniform and white shoes worn by all staff members. One particularly hectic morning, after getting her children off to school, she arrived at work to find the Office Manager staring at her shoes. The Office Manager noticed that the laces were dirty where they threaded through the eyelets of the shoes and asked the staff member to clean them. Offended, the staff member replied that she worked in claims pro- cessing and not with patients, so why should it matter? Her supervisor replied that she had contact with patients in ways she didn't recognize—going out on the street wearing her I name tag, or passing patients I and their families as she ' walked through the hall—and that she couldn't represent the practice with dirty shoelaces. The example of the shoelaces story sets a standard for the service level that all patient-first employees should aspire to. A dirty shoelace might seem pretty minor, giving the impor- tant work of delivering care to patients in need. However, a shoelace is something that a patient can see, whereas your expertise and technical ability are not. It's a piece of evidence, a small but integral part of the story you tell to your patients. Create a patient-first practice by clearly and consistently reinforcing this simple message and then by managing the evidence. The design of your office, your approach to care, and even your shoelaces will support your message, day-in and day-out.| Dr Mark Sanaa is the CEO of Breakthrough Coaching. LLC, the leading resource for personal coaching to chiropractic and inultidisciplinary practices throughout the coun-tiy. He can be reached at Breakthrough Coaching. LLC. by calling I-800-7-ADV1CE. TAC's MISSION: We arc dedicated to the continuing education & advancement of the chiropractic professional—YOU!
