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The Three-Legged Stool of Patient Experience

Updated: Oct 11, 2020

I recently had to credential at a new hospital and got to experience the patient side of healthcare. The hospital required a urine drug screen test, so I scheduled an appointment at a local lab. Pee in a cup and hand over the specimen—I thought it would be relatively quick and painless. I walk into the lab and see a woman sitting at a desk behind a thick glass partition. She doesn’t make eye contact. I say “Hello” and she points to a sign that explains the sign-in procedure. I walk to the kiosk that was parked off to the side and not in the immediate line of sight. I enter information, scan my driver’s license, and take a seat.

I notice that there are three other people ahead of me, but assume that it shouldn’t take too long. Patients are simply getting their blood drawn or urine collected. While I wait, I notice another man receive the same “no eye contact” greeting and finger-pointing instructions that I did. At least they are equal opportunity on their lack of customer service. After about 45 minutes, I hear my name called, but when I look up, I don’t see anyone standing at the doorway to the treatment area. I decide to go in anyway and find another woman sitting at a desk with her head down. I mention that I heard my name called and, barely looking up, she tells me to go to Room 3, where I wait another 15 minutes until the lab tech walks in. She mumbles into the papers she places on the desk and tells me to go into the bathroom across the hall and pee in a cup.


If you’ve never experienced a urine drug screen test, the water to the sink is turned off so that you can’t dilute your urine with water. The toilet has blue dye in the bowl and doesn’t flush. I bring back my specimen, place it on the counter, and then wash my hands, at which point I was sternly told, “You aren’t allowed to wash your hands! You must sign here first!” I thought about explaining that she might want me to wash my hands before I took HER pen and signed with my unwashed hands, but thought it would be pointless. Once I signed, I handed her back her pen. I was told that I was done as she walked out of the room.


This experience reminds me of what I call the “three-legged stool” of patient satisfaction. Without all three legs, a stool will tip over, as will the patient experience.


What Is Quality?


The first leg is perceived quality. If patients perceive that the quality of the care they received was poor, they will be dissatisfied. I say “perceived” because patients often can’t tell if their care was good or bad. For example, my stepfather loved his primary care physician, to whom he went annually for a physical. It was only years later when he was diagnosed with rectal cancer that he discovered that his primary care physician should have been performing routine rectal exams, which would have diagnosed his cancer much earlier.


Once the quality perception is breached, it’s impossible to recover. Amputate the wrong limb, leave an instrument behind during surgery, or misdiagnose cancer and you’ve lost. But other perceptions of poor quality are more subtle. Does this sound familiar? “I went to the ER for my abdominal pain last week and was there for hours. They did all this blood work and CT scans and couldn’t find out what was wrong. What a waste of time. They were idiots! I’m still having pain.” I wonder if anyone explained to the patient that she was checked for appendicitis, gallbladder disease, kidney stones, pancreatitis, hepatitis, and ectopic pregnancy. And that other diagnoses such as irritable bowel syndrome, acid reflux disease, and peptic ulcer disease are not easily diagnosed in the emergency department and often require evaluation by a gastroenterologist. It’s always important to explain to patients what you’ve done for them and why. Without an explanation of the services provided, they have no ability to assess the quality of care you provided.


Providing Timely Care


The second leg is the timeliness of care. Nobody likes to wait, and once our wait threshold is crossed, our dissatisfaction rises. Because I work in an emergency department, I’m generally a bit more forgiving about wait times. But after waiting for 45 minutes in the waiting area and another 15 in the treatment bay for my drug screen, my patience began to wear a little thin. If someone had explained the testing process—and the reason for the wait—perhaps I could overlook the gruff treatment.


Treat ‘Em with Kindness


The last leg of the stool, but perhaps the most important, is compassionate communication. Making eye contact and greeting the patient with a smile can go a long way toward patient satisfaction. I was furious after leaving the lab because of how impersonal and rude the staff was. I can understand that someone can have a bad day and I don’t expect everyone to be Mary Poppins cheerful, but three different people all had the same bad attitude! A little eye contact and a smile can go a long way. Quint Studer figured this out years ago when he was a hospital system CEO and later created the Studer Group, a consulting firm that made millions teaching hospital clients to be nice to patients and their families. Incredibly obvious advice, yet still not universally applied.


Tips for Enhancing the Patient Experience


We make patients wait for hours and while there may be many reasons for the wait—too many patients or not enough doctors, nurses, or beds, being rude and unfriendly never helps the situation. Smiling at the patient and saying, “I’m sorry that you had to wait. How can I help you today?” can help save the patient experience.


Sometimes patients are rude, angry, or hostile, and while no one should have to endure boorish behavior, striking back in kind only escalates the situation. So how should you deal with openly hostile patients? Think of the methods of Martin Luther King, Jr.: provide a nonviolent response to violence. When a patient becomes hostile, instead of raising your voice and stepping toward him or her, lower your voice and take a step back. Lowering your voice forces the hostile patient to listen. Explain your position: “No, I’m sorry that I can’t order an MRI for your chronic back pain today. It violates the hospital policy for MRI ordering.” Don’t try to win the argument. You won’t convince them that they’re wrong and you’re right. Simply state the facts and move on.


As healthcare professionals, one leg of the patient experience stool that we can control is communication. Happy patients are much more enjoyable to work with and will even thank you for taking care of them. Nothing feels better than getting a sincere “thank you” from a patient.


How we interact with patients has a dramatic impact on their experience—and ours as well.

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