Improving Customer Service for Healthcare Professionals

Customer service in healthcare is sometimes overlooked amidst the hustle and bustle of the waiting and treatment areas in our medical facilities. We are all conscious that a smile and an “I’m sorry” or a” Thank you for choosing our facility” can soothe many difficult situations. Ideally, you may (but not always) be able to relieve the patient proactively. Most people coming to your facility are tired, sick, or hurt, and that’s just the part you can see. They may also be recently bereaved, homeless, frightened, or recently fired from their job. We cannot know what may be going on in their day. One thing we cannot do to improve our customer service style is to take their prickly presentation personally. Some things, such as a lack of trust or anger, can make caring for a patient much more difficult. A relieved, respected, and appreciative patient will be easier to work with and will have better results from your care. Better care from you equals free advertising by word of mouth and a return customer. It’s easy to think of the people accessing care at our facility as patients who need us rather than customers who can choose who they want to perform their care. Xiaoping et al. remind us that the number one hospital in the United States is the Mayo Clinic, which has its core value of “Patients come first” (2023).

Empathy: The ability to sense intellectually and emotionally the emotions, feelings, and reactions that another person is experiencing and effectively communicate that understanding to the person (Farlex, 2012a).

Holistic Medicine: An approach to medical care that emphasizes the study of all aspects of a person’s health, especially that a person should be considered as a unit, including psychological and economic influences on health status (Farlex. 2012b).

Customer service: The assistance and advice provided by a company to those people who buy or use its products or services (Oxford Languages online dictionary, n.d.).

We can do our jobs as well as possible. If the patient feels disrespected by our body language (including facial expressions), tone of voice, or speed and tenor of speech, they will ultimately decide how to complain. Will they resort to social media or be happy to share their perception with a department supervisor, their neighbor, and family? How we look is also judged instantaneously. We all perform several judgments within just a few seconds of dealing with someone. We look at clothing, body language, facial expressions, voice, and general neatness. We form a self-dialogue regarding service workers everywhere we go. This is entirely natural and probably a built-in survival instinct. First impressions are everything. What do you think you know about the two people below… and the one above?

How long did it take you to form an opinion? Our patients will also judge us the same way. People say you can tell when a medical person has a “calling.” How do they know? Because there is a caring attitude, no matter the circumstance. You know when that care provider isn’t just in the profession for the money.

Although none of us can afford to help people get and stay on the wellness continuum without being paid, most of us are not in it just for the paycheck. We must remember why we are in this profession. Most of us wanted to help people.

Maria is a 32-year-old female coming in to get a referral from her doctor for a urologist. When she made the appointment, she mentioned her level of discomfort and that she was coming in for a referral for bladder pain. On arriving at the primary care office, the person behind the window slid the door open, passed out a signup sheet and a pen, and then closed the window. She never spoke to Maria. The signup sheet asked when her appointment was, who she would be seeing, and her arrival time. She filled it in and knocked on the window to let the receptionist know she was finished. The receptionist took the book and, in a voice without expression, asked if her insurance had changed. Maria said," No". The receptionist closed the window without further ado. Maria turned from the window and looked at the waiting area, seeing a relatively neat room with many empty chairs. She sat down, thinking to herself, "No wonder there are so many empty chairs; I hope the doctor and nurses are nicer than she was." We laugh, but this is common, and our next moves will make the difference when she decides whether or not to see our primary provider again. Suppose that door opens and a stone-faced nurse or aid calls her name in a droning voice and mechanically goes through the weighing and rooming. In that case, they have lost an opportunity to shore up Maria's emotions about this facility and all the staff. If the doctor is running late and Maria is left in the little exam room long enough without explaining why her appointment was at 2:00 PM, and it's 2:45, she will add to her inner dialogue.

Points to consider:

• If Maria is smartphone savvy, she might go online to report her experiences.
• Word of mouth and social media make great bedfellows.
• How does she feel? How would you feel?
• What could help?

Perhaps an authentic apology for her continuing wait time, a short HIPPA-friendly report of the delay, and your honest estimate of when the provider can come in. Then, inform the provider how long Maria has been in the room before their arrival.

We now have an increased older patient population that requires special care. In many hospitals, primary care and urgent care facilities, electronic patient check-ins, new patient assessments, and even surveys to assess patient satisfaction are handled through a computer connection (Leonardsen et al., 2020). However, as many older people above 60 are not computer savvy, this may be irritating to them. Artificial Intelligence (AI) customer service exists in many industries, even hospitals. According to Lee and Yoon (2021), AI is not being used at the patient level for diagnostics and prescribing except for IBM Watson Oncology, which is used to help prescribe oncology medications. However, we are using chatbots in almost every sector of business.

Mrs. Stefanovich is helping her husband, who doesn't speak English fluently, at the doctor's office. Her husband is 80 years old and is coming to visit his new heart doctor. The young lady at the reception desk hands her a computer tablet and asks her to complete the information. Mrs. Stefanovich has never seen a computer tablet and looks at it blankly. The young lady taps the tablet, and it lights up. She comes out from behind the desk and offers to sit with the couple and help them navigate the check-in procedure. She gives lots of encouragement, allowing the patient's wife to hold and operate the tablet as much as possible. She explains that this is a time saver because all the information goes into the computer, saving a lot of time and effort in writing down the answers. The 80-year-old couple finished checking in after the receptionist returned to her desk. Deshpande et al.  report, "Interventions tailored for patients with low electronic health literacy eHL could ensure greater equity in healthcare delivery…(2023)".

Points to consider:

• How would you have handled Mrs. Stefanovich's blank stare?
• Do you feel that the increasing generation of elders is well served by electronic technology?
• What about Mr. Stefanovich? How can we make his visit more comfortable?

Approximately 68 million people in the United States speak a language other than English at home; of those, 8.2% speak English less than very well (HHS, 2023). Effective communication is critical in healthcare and an essential component of customer satisfaction. In 2023, the US Department of Health and Human Services updated the Language Access Plan to help ensure improved services to people with limited English proficiency. This plan outlines that healthcare agencies must ensure that qualified interpreters are available at no cost to help those with limited English proficiency (HHS, 2023). The medical terminology and discussion about Mr. Stefanovich’s condition may have been confusing to Mrs. Stefanovich, preventing her from accurately relaying information to her husband in his native language. Mrs. Stefanovich is not considered a “qualified” interpreter in this case. An interpreter trained in medical interpreting should have been offered, providing significant relief to the older couple. Studies clearly show that a professional interpreter results in greater satisfaction, the best patient communication, and positive outcomes (Heath, 2023).

Facial expressions: How often have you been downright offended by someone rolling their eyes at you? Or someone whose eyes aren’t smiling along with their mouth?

Voice characteristics: If someone is saying, “Hi, welcome to our hospital,” but isn’t making good eye contact or speaks very quickly, mumbling a rote phrase with a distracted expression, what is your inner dialogue going to be?

Body Language: Do you feel warm regards if someone smiles and holds their hands out to you, cupping your hand between theirs when welcoming you?

These are extreme examples; however, a vulnerable person seeking help from someone they hope they can trust to be knowledgeable may be very sensitive to your presentation. People also base their acceptance and appreciation on past experiences.

In each of these people’s photos, you can see an aspect of body language. Expressions, stance, and neatness. How each medical personnel presents presents will affect how a patient will ultimately judge their facility. Regular customer service training is necessary to help staff remember these basics in busy situations.

Aside from appearances, what other areas are involved in customer services? Costs, quality of care, timeliness, addressing expectations, patient education, aftercare, and billing are all customer service factors. Our corporate customer service style is expressed in the workflow, which decreases costs. Quality of care is more than taking vital signs and listening to their hearts. Patients equate emotional comfort with quality of care (Gualandi et al., 2021). Waiting times are paramount to emotional comfort. How long did they have to wait for an appointment to come in? Is the waiting area full of sick people? What about the exam room, with one poster of an ear to look at? Addressing patient expectations in advance can help with emotional comfort, such as how long they will have to wait to see the provider or when they can expect to feel better. When should they come back to see the doctor, and when should they call 911? Proactive future appointments are one method of increasing a patient’s feelings of trust. Patient education is more than handing the patient a folder of printed handouts as they leave. Some conversation about what is likely going on with their body and how they can help themselves is called for. What medicine have they been prescribed, and what are the side effects? We have become such a technological business that we must work hard to keep the personal aspect of care close at hand. After the patient leaves, how much care is given to the patient? Remember, patients who feel frightened and adrift will go to the emergency department or urgent care. If possible, a telephone call or text message to check on patients with new diagnoses, medications, or ability changes may help soothe their fears and show you care. What about billing? Primary care and hospitals hire someone to perform billing, but we can inform people immediately when something is included at no charge. This eases the fear of being billed more than expected on a fixed or tight income.

Points to consider:

• What is this patient's overall comfort level?
• Will she be allowed some dignity at some point?
• How difficult would it have been for the nurse to explain that the ECG is part of the first visit, will be done by Sam, a trained technician, and at no extra charge to her?
• How does the power imbalance between the patient and the medical staff play out where you work?
• Does Mrs. Jones have any cultural or religious beliefs that should have been considered before a male technician performs her ECG?  Should she have been given the choice of a female technician?

When a person is entrusting their health to you and your colleagues, trust is paramount to them. Giving every patient the attention they want and deserve is sometimes difficult. They are, after all, paying for your services. People who are feeling vulnerable, irritated, and angry may become a verbal or physical threat. They may go on to share their experiences from their point of view. They may complete a satisfaction survey to show their feelings (Gullandi et al., 2021). A good survey is short and has a question about the patient’s emotional state. So, how do you maintain great customer service when you must help eight different people in a limited time window? There are tricks you can use to help yourself remember to use empathy.

1. Pretend the patient is your beloved parent, aunt, sister, or brother.
2. Smile genuinely; there is scientific proof it will make you both feel better (Coles et al., 2022).
3. Take a minute or two to de-stress after a particularly difficult case before presenting yourself to the next person. Breathe deeply, smile, and pat yourself on the back for the great way you handled that issue.
4. Be alert to the time spent doing other things like chatting with your colleagues or chart surfing. Sometimes, personal time while working takes more time than we realize.
5. Never wait until the last minute to do anything in health care since we never know what may happen.

Look at your facility's reviews online. As there are many choices, our customers review these before choosing a doctor, don't you? Customer service complaints make up most of the complaints listed for every doctor who doesn't have five stars across the board. Sometimes, it's scheduling, wait times, and personal interactions; sometimes, it's more of a generalized complaint. However, the healthcare workers who made the client angry, feel disrespected, and dissatisfied are the ones they share about. This is not just an American question. Studies about patient satisfaction have been done worldwide. An interesting study in England by Gullandi et al. (2021) showed that measuring a patient's complete journey with the facility by offering short survey questions at the beginning and the end of the visit can give real-time information on improving your processes. The results note that providing customers with a quality experience is the key to customer satisfaction. This was measured in several areas, including the emotional state of the patient, time spent waiting on nurses or aids or doctors, comfort and cleanliness of the rooms, how clear and useful the information was given, and patient involvement in health care decisions. According to Gullandi et al. (2021) and Murray (2020), the patient’s emotional status is more important than we realize in customer satisfaction. Akob et al. (2021) and Phonthanukitithaworn et al. ( 2020) report that patient loyalty and overall satisfaction are tied to their emotions and service quality. Interestingly, they also say that service quality is when the patient gets what he expects to get. 

• Use greetings that convey welcome, kindness, and appreciation.
• Listen to what they are saying.
• Offer to help them get signed in and teach about the patient portal.
• Communicate what is next, and if there’s a patient cost, and explain why they are waiting.
• Inform and educate.
• Schedule future visits, letting them know who they will see.
• Survey patient satisfaction with your processes and treatment.
• Make changes based on your surveys.

So much has changed in the healthcare sector in the last few decades. People born before the 1980s have not been raised on computers; therefore, many in their 60s, 70s, and up are likelier to find electronic technology in the healthcare sector more daunting. Before the 1980s, doctors’ offices were rarely combined with other facilities, and these patients saw the same doctors or doctors all their lives. This was a paternalistic relationship with a power balance weighted to the General Practitioner side (National Academies, 2021). As we have modernized since the turn of the century, we have added staff such as Physician Assistants and Nurse Practitioners and technological innovations such as computerized check-ins and patient portals. We have become extremely medically specialized. The power balance for the patient is now almost gone. Their only power is to change doctors and answer customer satisfaction surveys. Their insurance may only allow certain providers and specialists. Patients have calendars full of specialist visits now. They also see primary physicians, cardiology and nephrology specialists, and podiatry and ophthalmology physicians. If they are very sick, they may have a host of other physicians to visit. One patient may have a visit or more every month of the year. Older people may take up the entire day for one appointment. Bathing, dressing, traveling, waiting, and then going to the pharmacy are exhausting. They may spend the rest of the day recovering from the energy expended. Patients don’t know who to trust, and how you make them feel may be the only thing they can judge by. A corporate entity may author the customer service environment, but the patient-facing staff and their customer service styles make it work for the patient.

“I've learned that people will forget what you said and did but never how you made them feel” Maya Angelou.

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