Helpful Tips for Increasing Your Availability

Regence BlueCross BlueShield of Oregon shares the best practices of five Portland area physicians who received high honors for accessibility in an unbiased consumer survey.

Today's health care environment demands an ever-increasing amount of clinical expertise, but unless a physician or other provider also has a reputation for accessibility, it may be difficult to build and maintain a successful practice.

Patients who have a good relationship with their physician
are most likely to complywith treatment regimens,
leading to better clinical outcomes and reduced health care costs.

Studies show that patients who have a good relationship with their physician are most likely to comply with treatment regimens, leading to better clinical outcomes and lower health care costs. Moreover, practices that retain patients through quality service tend to save a substantial amount of effort and money compared to those practices that must attract new patients to replace the ones who leave.

Here is a collection of useful tips from five of Portland's most accessible - and well regarded - primary care physicians.

I. "Just Like Clockwork": A Proactive Guide to Setting Appointments

II. Improving Patient Perception of Your Availability: Tips for Office Staff

III. Improving Patient Perception of Your Availability: Tips for Physicians and Other Professional Providers

The first step in improving your reputation for availability is to schedule appointments in such a way that patients - especially those with acute symptoms-are more likely to be accommodated on short notice.

• Improve the way you screen callers. When patients call for an appointment, find out how many different ailments or concerns they would like to discuss during their visit. This will help you determine how much time to allot for the appointment. Also remember to allow sufficient time for new patients to complete the necessary paperwork.
  New employees, especially those without a clinical background, should inquire with nurses and physicians to develop additional telephone screening tactics. "Make sure you're tuned in to ask the appropriate questions," says Marian Newell, office manager for Dr. Kenneth Whittaker of Newberg.
• Anticipate callers with acute needs. Like many other primary care physicians, Dr. Mary Foster finds Monday to be the busiest day of the week, due to patients who become acutely ill over the weekend. To make room for sudden arrivals, avoid scheduling non-urgent visits on your busiest day. "We sometimes leave more slots open on Mondays, knowing they'll be filled as the day goes on," says the Newberg pediatrician.
• Limit the number of lengthy appointments in a single day. Certain conditions such as asthma and attention deficit disorder may require routine appointments that are an hour long. When you schedule too many of these visits for the same day, it may be harder to stay on schedule or accommodate acutely ill patients who need an immediate consultation.
• Take a preventive approach to latecomers. If you have certain patients who tend to be late for their appointments, "schedule them for the end of the day or just before lunchtime," says Yvette Molter, office coordinator for Tualatin family practitioner Dr. Gretchen Riss. That way, their tardiness is less likely to impact other patients.
• Tailor your strategy to the season. Once you develop a successful plan for scheduling appointments, evaluate it periodically to ensure that it continues to meet the needs of your office and your patients. Some offices, for example, schedule fewer routine physicals during the winter months so they can accommodate a greater number of patients with cold and flu symptoms.

II. Improving Patient Perception of Your Availability: Tips for Office Staff

When patients arrive at the office, there are several things you can do to minimize waiting time:

• Pay closer attention to the examination rooms. The sight of a reception area filled with people can be instantly demoralizing to patients who want be seen quickly. To keep their anxiety to a minimum, always monitor the examination rooms closely so that you know which ones are occupied and which ones are available. As soon as another room is ready, usher the next patient in.
   
• Be flexible in your role. Some of the most efficient offices are characterized by people who are willing to perform a wide range of functions. This is true not only of office managers and receptionists but of physicians as well. Quite simply, "cross-training is important for everyone," says Dr. Lawrence Tremaine. The West Linn family practitioner sets an example from time to time by obtaining blood and urine samples from his patients - a task normally performed by nurses.

  Dr. Whittaker escorts his patients from the reception area to the examination room when his nurse is unavailable. "If she's busy, I don't mind helping out," he says. Not only does this maintain the all-important flow of patient traffic - it makes a positive first impression on new patients.

  To make your daily operations run more efficiently, talk to the entire staff - even the physicians - and identify tasks that can be reassigned or shared.

• Be solicitous of your patient's needs. Comfortable furniture, magazines, and television will not satisfy everyone's need for distraction. In fact, among the physicians who were interviewed for this article, none of them had exceptionally large or well-appointed reception areas. What every physician did have in common was an efficiently managed schedule and courteous staff members.

  In the unlikely event that your patients must sit in the reception area for more than a few minutes, apologize profusely and, if the situation warrants, allow them the opportunity to wait elsewhere if they so desire.

  Given the invitation, some patients may be content just to step outside for fresh air. Others may prefer to run errands. When Dr. Tremaine gets called away to an emergency, office manager Linda Callas phones ahead to alert patients who will be affected, while those who have already arrived at the office are encouraged to pass the time at the shopping center across the street. It's an invitation they often accept, and the result is a perception of a more pleasant - if not shorter - wait.

  One word of caution: Don't add insult to injury by suggesting this to every patient. A person suffering from limited mobility or severe pain may find your offer to be insensitive, no matter how good your intentions are.

III. Improving Patient Perception of Your Availability: Tips for Physicians and Other Professional Providers

Whether an appointment is ten minutes or an hour, make the most of your patient's time by following these tips:

• Be conscious of your body language. "A common complaint I've heard from patients who have seen other doctors is that they don't listen," says Dr. Tremaine. "They'll stand there with their hand on the doorknob as if they'd rather leave."

  No amount of time you spend with your patients is enough if they perceive the quality of your attention to be substandard. Although you've developed an effective bedside manner as part of your training, it never hurts to double-check your persona on days when you're feeling harried. Do you make eye contact with your patients? Face them while speaking? Listen without interrupting?

• Keep abreast of consumer trends. Several years ago, when alternative medicine became a popular topic in the mainstream media, Dr. Foster noted a sharp increase in the number of people inquiring about medicinal herbs. She now keeps a copy of PDR® for Herbal Medicines in her office so she can answer those questions quickly and efficiently, saving time for everyone concerned.

• Appreciate the gift of gab. Certain patients will always require extra reassurance and will talk at length about their symptoms and fears. From a time management perspective, these patients may seem less desirable, but the fact remains that a communicative patient is always preferable to a patient who hesitates to report symptoms and concerns.

  Since elderly people comprise a significant number of Dr. Tremaine's patients, he has learned to use breaks in his schedule for the purpose of simply listening to them and building rapport.

  "I have my staff update me throughout the day, not just on new appointments but cancellations," he says. "Then when a patient wants to chat, I won't have to look at my watch and wonder if I have time. I can relax because I know I do."

  Having stated the importance of making time for patients, it is sometimes necessary to…

• Supplement your own efforts at patient education by referring people to other credible authorities. If many of your patients have non-urgent or hypothetical questions, consider making a small investment in patient education brochures. You might also develop a list of recommended books and Web sites that cover topics of interest to your patient population.

  As a pediatrician, Dr. Whittaker gets a variety of questions from anxious first-time parents. Not only will he personally address their concerns, he goes the extra mile by lending out copies of his favorite pediatric health books. He also distributes handouts - some of which he developed on his own - to satisfy frequently asked questions about insect bites, sunburn, head lice, etc.

  Although these solutions are no substitute for one-on-one dialogue, they can be helpful in providing closure to lengthy conversations. What's more, when you send your patients home with useful literature, you provide them with a value-added experience at little cost to your practice.

• Consider modifying your on-call strategy. Many physicians who scored highest on access and availability prefer to take all their own calls on weekends and evenings, relying on other physicians only when they go on vacation. Others, such as Tualatin pediatrician Dr. Stuart Lawrence, share a rotating schedule with several people and still manage to score well above the norm. Although this arrangement reduces the likelihood that your patients will get to speak to you personally after normal hours, your reputation for availability will not necessarily suffer, provided that you and your callshare partners are responsive to each patient's concerns.

  Because Dr. Lawrence shares his call duties with four other doctors, he has the luxury of four consecutive weeks off. However, when he goes on duty during the fifth week, he keeps his personal calendar as flexible as possible so that he can follow up meticulously with each of "the 35 to 40 calls that come in on a Saturday or Sunday."

  If you would like to include other physicians in your on-call team, consider the personal preferences of every physician and the call volume that would be generated for a team of your size. Not everyone, for instance, is willing to handle 80 calls in one weekend, even if that weekend should come less than once a month.

  Once you modify your on-call schedule, keep it fairly regular so that it's easier to manage your professional and social calendar well in advance.