Beyond surveys: Find out how to win patient loyalty
Beyond surveys: Find out how to win patient loyalty
Group focuses on better service, building bonds
Your patients don't need a survey to tell you how satisfied they are. They talk with their feet. Patients who become unhappy will simply go elsewhere. As Sharp Mission Park Medical Group in suburban San Diego found, you can create more loyal patients by improving customer service and showing that you care about them.
While that may sound simplistic, finding your weaknesses and correcting them is actually a complex project, says Lorraine Ybarra, MBA, marketing manager. "People do not like to tell you the real reasons why they leave," she says. "Health care is such a personal choice. And some people don't want to talk badly about their doctors even if they don't like them for some reason."
The doctor-patient relationship is central to the patient's decision to stay or leave. But other factors influence patients, such as whether they feel comfortable with the staff and how long they have to wait to get an appointment to see the doctors of their choice, says Ybarra.
To tackle the many issues that affect retention, Sharp Mission Park created a comprehensive customer service program called "Making Your Mark." Goals were set in four areas: access, arrival (or waiting time), overall satisfaction, and patient outreach and retention. (For other ideas from the program, see box, p. 96.)
The medical group achieved a 91% retention rate among older adults, its first target population. The group is now working on retention goals with the commercially insured population.
"You have to be very specific in any program like this and very realistic," says Ybarra. Once Sharp Mission Park met its goals after the first two years of the program, the group raised the bar and sought even better performance.
As competitive forces change in the health care market, you can never be too assured of your popularity with patients. In the late 1980s, Sharp Mission Park was among the first to accept managed care contracts, and its patient volume boomed. But by 1994, patient volume began to slip as other medical groups signed on with the same health plans and patients had more choices.
The medical group launched "Making Your Mark" with customer service teams made up of staff members at different levels. They used patient satisfaction survey information to develop five goals, including improving satisfaction with wait times and overall satisfaction. Staff and physicians also received training in communications skills and customer service.
The medical director and CEO executive team were "champions" of the process and stressed its importance, says Ybarra.
Why did they leave?
But Sharp Mission Park wanted to learn more about the patients who drifted off to another practice. They weren't a part of patient surveys. "We could not just look at how we were doing with our existing population, we had to find out why people were leaving," says Ybarra. It's an ongoing process and more difficult to research."
For example, older patients enrolled in Medicare can change as often as monthly - from one health plan to another or from a health plan to fee-for- service, notes Susan Girton, MBA, contracts manager and chairwoman of the retention goal team. "[Medicare] makes it real easy for them not to be loyal, she says. "We work on making it difficult for them not to be loyal because they love us so much."
Sharp Mission Park decided to focus first on the senior disenrollment because the retention problem was greater among that group than the commercially insured population. It also represents a sizeable number of patients; the group's biggest single health plan is the Secure Horizons plan for seniors.
For six months in 1997, customer service staff called disenrolled patients, reaching 431 of them. (See phone survey, above.) They discovered that 44% of the patients had died, moved away, or left for other unavoidable reasons.
Another 13% had actually remained with the group but may have changed plans, which could cause one plan to report that patients had left before the paperwork arrived from the new plan. Two percent never were patients. And 19% of the former patients didn't want to talk about why they had left.
The 22% who left and agreed to talk about it cited these three primary reasons:
· They had concerns about their primary care physician (personality, access, location, or other reasons).
· They had issues about specialists (such as choice and timeliness of specialty referrals).
· They reported that they heard something more favorable about another medical group.
While the research continued, the customer service training and team work were, in fact, making their mark. The departure of patients slowed, and the retention team exceeded its goal of 85%. (See chart on retention rates, above.) "We could see that we were climbing steadily," says Ybarra.
In addition to fixing any customer service lapses, the medical group focused on creating bonds with new patients. The group has a goal of initiating three contacts with patients within their first three months of enrollment.
"We get membership lists monthly from each of the HMOs we have contracts with," says Girton. "The next step is to decide how to contact these members who don't contact us. We want to form a bond with them, but we don't necessarily want them to come rushing in to see a primary care physician. If they're not sick or in need of a physical, they could clog up access."
The answer: New patients receive a welcome letter with a site map and medical record request form to send to their previous physician, a follow-up phone call, and a brochure with a guide to clinic services, health education classes, and managed care.
As the group turns its attention to commercially insured patients, the task becomes more difficult. The group, with 69 physicians at nine sites, has about 13,500 seniors and close to 40,200 commercially insured patients.
Ybarra says she plans to work with other medical groups in the Sharp Health Care system in a centralized effort to come up with a uniform way to research and improve retention.
Strong support is central to a successful customer service, she says. "Your whole culture, your leadership, has to own a project like this because it is so time-consuming and ongoing," she says.
Ybarra also takes every opportunity to celebrate accomplishments and build enthusiasm among staff. For example, she recently presented her results to a systemwide quality symposium attended by administrators, medical directors, and physicians. She also promotes the "Making Your Mark" program among staff. "Any little thing you can do to keep it alive or re-energized is important," she says.
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