1. There’s No Such Thing as Bad Feedback October 9, 2015
Hopefully, you’ve each gained something during this series on improving the customer experience.
I know I’ve learned some things during the process… some ways I need to improve myself.
Which leads me to our final topic; one that is probably viewed as the least fun but most critical to learning and
improvement…
Customer Feedback
“Thank your customer for complaining and mean it. Most will never bother to complain.
They’ll just walk away.” – Marilyn Suttle
Negative feedback can happen to the best provider. This example was shared by Daniel Castillo, M.D., M.B.A, Medical
Director of Healthcare Quality Evaluation with the Joint Commission.
“In the middle of a busy shift, my hospital administrator approached, saying apologetically, “Could you answer this
person’s letter, please?” If you practice long enough, eventually you must answer a complaint. One of my first grievance
letters came from a 45-year-old man I had seen several months earlier for back pain. He was approximately 245 pounds,
and other than being significantly overweight, he was generally
healthy. He was initially upset at having a 3-hour wait in the
waiting room, and then he had demanded an MRI and Norco,
despite the fact that he had no other concerning signs or
symptoms. I had ordered an X-ray (negative), given NSAIDs and a
PT referral and spoke to him about losing weight, core muscle
strengthening and stretching. I thought I had done a pretty good
job. Apparently, the patient disagreed. After I discharged him, he
went directly to another ER where he received an MRI that
showed a very minor disc bulge, and was discharged on Norco.”
He goes on to explain his rationale for his conservative treatment of the patient, but also expresses some of the “lessons
learned” from the negative feedback. At the time of the encounter, he felt that he was too busy to “sit down and have a
5-minute conversation” with the patient.
Spending those 5 minutes could have saved him 50 minutes later, addressing the complaint.
Spending those 5 minutes explaining why he felt this treatment plan was ultimately safer, listening to the
patients concerns and developing a collaborative plan would likely have led to a patient who was satisfied with
the encounter.
He provided “high quality, safe care” that left his patient completely unsatisfied.
Castillo then asks a question that all health care providers and leaders will need to continue to address…
“Who gave better care? This question is going to become more concerning as the Centers for Medicare & Medicaid
Services (CMS) continues to incorporate experience of care and patient reported outcomes not only into hospital
reimbursement schedules, but physician reimbursement as well. Basically, the patient’s perception of care is going to
directly affect your bottom line.”
“Even your most loyal customers always have a choice about where to take their business.” – Marilyn Suttle
Feedback in health care is sort of like publicity to a celebrity…
There’s No Such Thing as Bad Feedback
This statement is clearly open to debate, but, when taken in the spirit of constructive criticism, it can grow our practice
and improve our patient satisfaction levels.
Over the last few weeks we’ve talked about various aspects of customer service, and improving the customer experience
in health care.
Paying attention to the needs and fears of your patient and their loved ones.

2. Effectively communicating with our patients, so they are comfortable with all that is going on and ensuring they
feel heard and understood.
Our responsibility to care for our patients in a morally appropriate way to build trust and confidence.
Respecting others, their fears, concerns and situations, will allow you to develop a partnership that will improve
their health and satisfaction.
As we wrap up this series, we need to understand the best way to know your efforts are improving the customer
experience. We must actively and sincerely seek, listen to
and incorporate customer feedback.
The Value of Candid Feedback
Feedback is essential for measuring customer satisfaction.
Obtaining candid feedback can be invaluable; but you must
determine what you will do with the data you collect in
order to insure that you are gathering the most useful
information.
Providing Quality Care That Meets Patient Satisfaction
As we’ve worked with hospitals, implementing the tobacco treatment model, we frequently hear the concern about how
enforcing a tobacco-free protocol will affect patient satisfaction scores.
We all know that tobacco use and nicotine addiction can trigger intense reactions. However, providing the best quality
care requires that we address tobacco use. It’s difficult to treat the health problem without addressing the CAUSE of the
problem.
So we must find a satisfactory balance.
We can show patients they have the strength, ability and support to quit.
And (to learn from Dr. Castillo above) to address why it’s so important.
Decreased tobacco use will also have a positive influence on readmission rates (and potentially reimbursement rates).
Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS)
The CMS HIVBP program uses the HCAHPS survey to assess patient satisfaction in Medicare patients after an inpatient
hospitalization. This is the first national, standardized, and publicly reported survey looking at the patient’s perspective
of their care. Three of the questions in the survey address patient satisfaction with physician communication.
• How often did doctors treat you with courtesy and respect?
• How often did doctors listen carefully to you?
• How often did doctors explain things in a way you could understand?
Responses to the doctor communication domain of the HCAHPS survey contribute to the physician’s evaluation, the
overall patient satisfaction score, and ultimately, the hospital’s reimbursement.
Improving Patient Compliance
Part of feedback is being able to listen to our patients and really understand what they are saying (or not saying).
Listening to, learning from and growing from patient feedback will improve the physician-patient relationship, improving
patient satisfaction and enhancing patient compliance.
Furthermore, patient satisfaction is critical to how well patients do; research has identified a clear link between patient
outcomes and patient satisfaction scores.
Uncovering the Patients Actual Needs
There is no doubt that healthcare providers’ time is precious.
Staff are stretched thin with the ever increasing expectations and requirements.
It might be easy to rush through an encounter and only address the surface issue.
However, many cases of patient dissatisfaction can be traced to an inadequate discovery of the patient’s needs and
concerns. While it may be tempting (and easier) to draw the lab test, prescribe the medication and call it a day, that may
not always meet their needs.
“What brought you in today?” is a critical question to get you started.

3. However “Why is this concerning you?” will enhance trust, allow you to gain insight into goals and identify other areas
where your health systems services might be of use.
Again, by digging a little deeper, you can create the foundation for a stronger long-term physician-patient relationship.
But How????
There are various ways a practice, hospital or system can collect feedback on patient satisfaction.
The ‘Best Way’ for one system may not work for another.
The important part is to utilize an option that patients can see, access and get responses if necessary.
Email/Contact Forms
This is one of the most valuable ways to get candid customer feedback.
It is quick, easy, inexpensive and allows the customer/patient to give feedback without feeling “guilty” for being critical.
When using email to garner feedback, there are three things you need to keep in mind.
1. Assure the customers of a speedy response and follow through.
a. Forty-three percent of customers surveyed stated that they don’t complain or leave feedback because
they don’t think that the business cares.
b. Of those, 81% said they would leave feedback if they got a rapid response.
2. Create an organized customer feedback system.
a. There are various tools and services that can help with this, but the ultimate goal is to assure that no
good feedback slips through the cracks.
This is something that we are very interested in and are currently developing. (So stay tuned for more!!)
3. Provide candid follow-up emails
a. Sometimes the best way to get candid feedback is to simply ask.
Over the course of this Weekly Update, your feedback emails have been encouraging and educational. I truly
value them. Others can use that feedback as well.
Surveys
This is not an easy approach, but if done well, it can provide you with some insightful, useful information.
Just keep in mind that while there are numerous potential questions you could be asking, you’ll need to focus on what
information you need to be the most constructive.
Only ask questions that will fulfill your end goal.
You can have these mailed out to patients following their encounter, emailed with a link to a survey or distributed within
your system with comment boxes.
Social Media
In the age of social media and quick access to a “platform”, it is important to
keep an eye on what is being said about your practice, hospital or system.
While there are obviously some things you can’t prevent or avoid, you can
provide candid and sincere follow-up to social media comments or questions.
Engagement on social media sites should be handled with caution, but they
can be utilized successfully and get customers/patients sharing (and
educating).
Ultimately, you want to assure your patients that you value their feedback
and that it is utilized in a constructive way. Follow up with patients via phone
or email to see how things are going. Patients appreciate when their health
care providers are actively engaged in supporting them as they work toward
their goals.
Managing feedback and patient satisfaction can be difficult.
Particularly when you factor in issues such as tobacco treatment and nicotine withdrawal.

4. However, incorporating effective cessation counseling and
appropriate medication can create shared decision making and trust.
It can also increase a patient’s confidence in their ability to quit
tobacco. This increased confidence can also increase and improve
feedback.
At a time where physicians are increasingly measured on patient
treatment outcomes, it is imperative to incorporate effective
feedback systems.
Until next time,
Jennifer W. Roysdon, MS
Tobacco Treatment Systems Coordinator
Hospitals Helping Patients Quit: Advancing Tobacco Treatment Initiative
Oklahoma Hospital Association
“There is no clinical treatment available today that can reduce illness, prevent death, and increase quality of life more
than effective tobacco treatment interventions.”
-Treating Tobacco Use and Dependence, US Public Health Service, US Dept. of Health and Human Services