URGENT MESSAGE: American consumers have been conditioned to expect high levels of customer service in exchange for their hard-earned money, so when urgent care fails to deliver on patient expectations, the result can be devastating to a center’s reputation. Fortunately, negative experiences can be turned around by practical strategies for dealing with angry patients.
Alan A. Ayers, MBA, MAcc is Practice Management Editor of JUCM—The Journal of Urgent Care Medicine, a member of the Board of Directors of the Urgent Care Association of America, and Vice President of Strategic Initiatives for Practice Velocity.
In a demand-driven society in which consumers are presented with myriad choices in product and service providers, expectations regarding customer service run high. Consumers expect a user-friendly, no-hassle, value-added experience wherever they spend money. As one would imagine, these heightened expectations have transferred to healthcare as patients believe medical providers should approach their businesses using the same service philosophies as restaurants, airlines, and retail stores.
However, healthcare appears to have missed the mark on meeting these expectations, given its paltry rankings in customer satisfaction surveys. In fact, healthcare as a whole consistently ranks worse than cable television and internet/wireless providers.(1) Unfortunately, lagging behind in customer satisfaction is no longer an option in an urgent care marketplace and regulatory environment that emphasizes a strong patient experience as the catalyst for repeat visits, positive word-of-mouth—and now, higher reimbursement.
When you think of how the world’s most recognized consumer brands (eg, Apple, Google, Samsung, Amazon.com) have also grown significantly in revenue and market capitalization in recent years, the economic importance of a positive customer experience becomes quite clear. The fastest-growing companies are those with the greatest customer satisfaction.
While the financial implications of a lagging customer service strategy are obvious, recent government measures have increased emphasis on the patient experience to such an extent that that it’s no longer an ancillary consideration but a critical part of the overall healthcare mission. As part of its efforts to improve the quality of care and, by association, reduce costs, the government has wholeheartedly embraced the “patient is always right” model of care delivery. This model presupposes that increased customer satisfaction will improve medical outcomes and reduce total costs.
Thus, minding the various metrics attached to patient satisfaction not only makes sense from a business management perspective, but it will also, in light of the current regulations, influence reimbursement for services under value-based reimbursement schemes. In short, forming a strong customer relations strategy is no longer a choice that can be made at one’s leisure; it has become a necessity, given current market conditions and the regulatory environment.
For the urgent care market, which represents one of the most consumer-focused delivery channels for medical care, patient satisfaction should be considered an essential component of the business plan. However, one should not be fooled into thinking customer service models from the retail industry or other nonhealthcare-related services will translate smoothly into the urgent care setting.
Unlike a trip to a restaurant or retail store, which can be either an indulgence or necessity, few patients look forward to their healthcare visits. A trip to urgent care is more like a trip to the “penalty box”—pain or discomfort due to injury or illness, unanticipated expense, and time away from work and leisure. Thus, the unique “baggage” urgent care customers bring to the doorstep require a unique and skillful approach. The first step in constructing a solid customer service strategy rests in understanding the roots of patient dissatisfaction in healthcare.
The Root of Patient Dissatisfaction is Injustice
Healthcare consumers are not content with their experiences overall; however, this should not be taken to mean that the average healthcare consumer is a cynical curmudgeon who will never be happy. In fact, it is a bit more complicated. According to the global accounting firm of PricewaterhouseCoopers, “When it comes to their healthcare, consumers are both content and restless.”(2) The reason for this complexity: “In healthcare consumers have been conditioned to feel powerless and routinely dissatisfied, and have never really felt in control.”
However, the data show that consumers do feel some positivity toward healthcare providers; it is just that they feel as if they have no say in or control over the experience, unlike the traditional retail setting. This sentiment can be explained by the fact that consumers’ expectations for healthcare are very different from their expectations for nearly every other consumer-driven retail experience, whereby the consumer is in control.
While this may appear simply to chalk up consumer dissatisfaction with healthcare to a lack of control, it is not quite that simple. Perhaps, it is something a bit more nuanced and engrained in our psyche. The healthcare consumer’s discontent may speak to our innate need for justice. We expect fairness in the transactions we engage—meaning the value or benefit we receive should be equal or greater to the money we pay, along with our efforts in utilizing a particular service provider. Justice also means we expect that processes and technology are hassle-free, policies and procedures are flexible, and employees interact with us in a pleasant, professional manner.
When these attributes of justice are absent, we feel victimized on several fronts—the need that led us to seek the service in the first place continues to be unmet, we’re out the time and money invested with the service provider, and there’s also the lost opportunity to have had our needs met in a more efficient/effective/timely manner. When experiencing such injustice, often our only mechanism for “settling the score” is to warn others. Unfortunately, this can be problematic for a healthcare provider whose patient base may depend on favorable word-of-mouth and online reviewing platforms.
Word-of-Mouth: The World’s Oldest Marketing Tool
Word-of-mouth represents one of the oldest forms of marketing communication, in which trusted sources of information in our social circle provide us with guidance on purchasing decisions. Research shows word-of-mouth recommendations in the form of positive comments from satisfied customers can increase purchases, while negative comments from dissatisfied customers can decrease purchases.(3) Moreover, customers who are willing to offer positive word-of-mouth recommendations are more likely to become loyal customers themselves.(4)
When shared with friends and family, negative word-of-mouth is perhaps most damaging to urgent care because not only is a patient who has complained to friends and family unlikely to return to the center, but the credibility of his experience creates a form of peer pressure that deters others from using the provider. If this happens enough times, an urgent care center will be unable to find a sufficient number of prospective patients from the community who are unfamiliar with its bad reputation. Perhaps even more damaging is the fact that when people complain to others and not to the center itself, the center has no opportunity to learn or correct its shortcomings.
Online Patient Reviews: Word-of-Mouth Accelerated
We all have stories of bad customer service, and sharing those stories can seem like “sport” at times. One has likely witnessed friends, family, or coworkers attempting to one up each other’s bad service experiences. “Well listen to what happened to me….” In the past, the risk was dissatisfied patients would tell a few friends or family members, but today—using websites like Facebook and Yelp, whose comments get picked up by search engines like Google and Yahoo!—one dissatisfied patient could deter potential thousands from ever trying a provider.
Countless studies in consumer behavior indicate that business reviews from the perspective of other customers strongly influences purchasing behavior. This rule applies not just to retail products, but also in the context of healthcare. Up to 42% of patients admit to reading online reviews concerning healthcare providers, and 68% say they use the information in selecting a provider.(5,6)
Practical Strategies for Dealing with Angry Patients
Urgent care centers face patients in varying forms of distress; therefore, providers will begin the task of forging a strong customer service experience from a comparatively difficult position when compared with how retailers receive their patrons. Regardless of these differences, a number of strategies can benefit urgent care organizations in leveling the playing field when it comes to the customer experience.
Consider the patient’s point of view
The reality is that patients are often on your doorstep already in bad spirits; insult is often added to injury when a patient is faced with hassles that make an already untenable situation worse. On this point, the facility and staff should orient themselves to the patient’s point of view when designing everything from physical facilities to policies and procedures. Put yourself in the shoes of the patient and ask yourself whether this is something that would mitigate my distress, or bring me closer to relieving it. With this strategy, urgent care operators can turn otherwise negative impressions into positive word-of-mouth—but regardless of what you do, there will always be some angry patients.
Think like a problem solver
When an angry patient asks to “speak with the manager,” the urgent care operator is presented with a unique opportunity to become either a hero or an enemy. More often than not, the hero is the problem solver who approaches the disgruntled patient from the perspective of constructively resolving a concern rather than acting as a barrier to a solution. In this sense, many frontline staff are ill-equipped to deal with confrontation. It is quite common for staff to take criticism personally, assume a defensive posture, reinforce policies the patient does not care about, and otherwise shut down meaningful communication in resolving the patient’s issue.
Engage with a plan
Before confronting an angry patient, frontline staff should be prepared with a plan of action that includes:
- Examining the situation from the patient’s perspective. The patient’s perception of a situation is her reality, so put yourself in the patient’s shoes to determine why the patient is upset.
- Assess the true needs of the patient. Anger comes from feelings of injustice, so it is important for patients to be able to express their concerns uninterrupted. Staff should show empathy by rephrasing concerns back to the patient, and take a “let’s solve this together” approach that respects the patient’s dignity, but also protects the center’s financial interest.
- Exercise self-control. Regardless of how aggressive a patient may be, staff should never be baited into escalating an emotionally charged situation. Staff should remain calm, cool, and collected in all interactions and be thoughtful and deliberate in their words and actions.
- Acknowledge and respond promptly to patient complaints. Unaddressed anger festers and patients become further put off if the staff ignores their concerns or insults them by dismissing their concerns as “nonissues.” Even if there is no ready solution, assure patients their concerns have been heard and will be systematically addressed.
- Apologize when the center makes a mistake. This involves admitting the mistake was made, making appropriate reparation, and then taking steps to assure the error does not occur again. Even if there was no mistake made, a sincere apology that considers the patient’s perceptions should be provided—“I sincerely apologize for the frustration you’ve experienced today.”
- Build partnerships with patients. After apologizing to the patient, develop a follow-up plan on how the center and the patient will move forward. Such helps the patient understand his options and provides an opportunity for the center to perfect its operational processes, thus improving the perceptions of future patients.
Following these simple steps can help foster meaningful patient dialogue focused on improving the urgent care experience. The ultimate result should be happier patients, reduced stress on staff and providers, and positive word of mouth—all of which benefit the center’s bottom line.
References
- Furniss B. Three ways healthcare providers can revolutionize patient care. Salesforce Blog. https://www.salesforce.com/blog/2014/09/3-ways-healthcare-providers-revolutionize-patient-care-gp.html. Accessed April 6, 2016.
- Estupiñán J, Kaura A, Fengler K. The birth of the healthcare consumer: growing demands for choice, engagement, and experience. Strategy+Business. October 14, 2014. Available at: http://www.strategyand.pwc.com/global/home/what-we-think/reports-white-papers/article-display/birth-of-healthcare-consumer. Accessed April 6, 2016.
- Ennew CT, Banerjee AK, Li D. Managing word of mouth communication: empirical evidence from India. Int J Bank Marketing. 2000;18(2):75-83.
- Gremler DD, Brown SW. Service loyalty: its nature, importance, and implications. In: Edvardsson B, Brown SW, Johnston R, eds. Advancing Service Quality: A Global Perspective. Jamaica, NY: International Service Quality Association; 1996:171-180.
- Leslie J. Patient use of online reviews—2014. Software Advice. Available at: http://www.softwareadvice.com/resources/medical-online-reviews-report-2014/. Accessed April 6, 2016.
- PWC Health Research Institute. Consumer ratings becoming a matter of dollars and cents on healthcare’s bottom line, finds PwC’s Health Research Institute. Available at: http://www.pwc.com/us/en/press-releases/2013/consumer-ratings-becoming-a-matter-of-dollars.html. Accessed April 6, 2016.
