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Managing Expectations and Perceptions

By Dr. David Edward Marcinko; MBA, CMP™

By Dr. Gary L. Bode; MSA, CPA, CMP™ (Hon)

Patient satisfaction occurs when patient perceptions exceed their expectations. They get an intangible “something extra” from the visit, above what they, or their TPA / health plan / Medicare / Medicaid plan, paid for. 

Managing Perceptions

We’ll concentrate on managing patient perceptions. Note that when patient expectations match their perceptions, mutual obligations are fulfilled, making both practitioner and patient “even”.

Clinical Outcomes

The clinical result, within a relevant range, is only part of the patient’s perceptions. Numerous unconscious impressions comprise the remainder.

We’ve all had patients love us despite a less than optimal result. And, we’ve all had patients angrily leave the practice over some non-clinical matter like a trivial billing dispute.

A patient’s perception of any health care service is colored by a vast array of prior experiences that set up current expectations. The patient is pleased to the extent that his current perceptions exceed his pre-existing expectations. This encompasses far more than the clinical result (within a relevant range), and includes such non-treatment issues as the demeanor of the staff, condition of the physical premises, psychological comfort during the visit, etc.

Patients Talk

Remember, all patients talk about you anyway.

A happy patient tells four others about what a nice doctor you are.

They are more likely to complete treatment and follow instructions, thus obtaining a better medical outcome, and, generating additional fees for the practice.

They pay quicker, cause less bad-debt and help create a pleasant environment for us to work in.

An unhappy patient vehemently tells nine others what a nasty rip off artist you are. Sad, but true!  They are not as likely to complete treatment, thus incurring a less than optimal result, and generate fewer fees. They pay slower, if at all, create a stressed environment and detrimentally affect the attitude of other patients in the office.

Soft Managerial Science

Try to eliminate problems that might cause negative perceptions (i.e., a filthy restroom) and implement controls that help assure positive perceptions.

Patient satisfaction is a soft managerial science. It is a numbers game. Most patients don’t pre-define what would be “acceptable” from this encounter, but have vaguely defined ranges of prior expectations anyway, gleaned from a lifetime of health care related experience. Any variance between these this “acceptable” range of expectations and each trivial encounter invokes some degree positive or negative feeling in the patient.

The total perception of the office experience is an aggregate of multiple trivial, often subliminal, observations. Patient satisfaction is an intangible and amorphous process complicated by: 

• Inter patient variables: Significant differences between patients in their “expectations”. 
• Intra patient variables: A single patient can perceive the same thing or situation differently at different times, depending on uncontrollable variables like mood, or, context of occurrence which may (sometimes and/or partially) be controllable by the practice.
• Luck of the draw” in physical variables: Does Sally or Mary escort the patient to the exam room?  Was it the blue or green exam room: Did the last patient to use the rest room, five minutes ago, leave a disgusting mess?
• Heterogeneous staff variables: Even with appropriate training, people are not machines and have their own quirks.

By proactively anticipating the entire visit, from the patient’s perspective, the medical practitioner can structure and arrange things so that most patients have, generally positive perceptions, most of the time. This can be done despite all the potential heterogeneity of the above factors. Patient satisfaction can be improved in any office, and can be done by anyone.

Assessment

Because patient satisfaction is a multi-faceted amorphous subject, there are multiple correct approaches to the subject and no “cook book” recipe on how to proceed. Try and get the big picture: 

• Identify the worst areas and fix them.
• Identify the best areas and reinforce them.
• Proceed slowly.

It can be done one facet at a time. Adapt things to your own managerial style and personality. Be completely open to new suggestions, innovation and change.

Conclusion

How do you mange patient expectations, as an increasingly vital concept for CDHCPs, concierge medicine, retail and onsite medical practices and clinics? Please comment.

Related Information Sources:

Medical Practice Management: http://www.springerpub.com/prod.aspx?prod_id=23759

Physician Financial Planning: http://www.jbpub.com/catalog/0763745790

Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Executive-Post – is available for seminar or speaking engagements. Contact him at: MarcinkoAdvisors@msn.com  or Bio: http://www.stpub.com/pubs/authors/MARCINKO.htm

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