Top People in Radiology: Innovators in Patient Experience winner Steven Mendelsohn, MD.
Each year, Diagnostic Imaging honors radiologists for their contributions to the advancement of some aspect of the profession. This year, the focus is on improving patient experience.
Here, DI talks with Steven Mendelsohn, MD, chief executive officer of Zwanger-Pesiri Radiology in Lindenhurst, NY, about his attempts throughout his career to augment the experience each patient has in his practice.
DI: From your perspective, why is it important to concentrate on improving patient experience?
Mendelsohn: I’ve been focused on patient experience for probably about 20-25 years, realizing that it’s the patients who are our customers. They’re different in that they can decide where they want to go for service. They’re our marketers. They tell their family, friends, neighbors, and referring physicians about their experience. If it’s good, they’ll tell people, and if they have a bad one, they’ll tell 10 times as many. We need to convert every patient into our marketer. The only way to do it is to give them an overwhelmingly positive experience. Not just a good one, not an excellent one. An overwhelmingly positive one. They’ll remember that, talk about it, and they’ll tell people. Good is not good enough.
DI: What are the highlights of your patient experience improvement work?
Mendelsohn: For many areas of the patient experience, I think we can look at the hospitality, restaurant, hotel, retail, airline, and even electronic shopping industries. They focus on every aspect of the experience because different people appreciate different things. When you look at surveys about patient dissatisfaction, there are three things they are most dissatisfied about - waiting in the office for an exam or to see the doctor, waiting for an appointment, especially if it’s not a convenient time, and trying to find viable parking and getting into the office.
I’m impatient. I hate waiting, so when we have new employee orientation every two weeks, we look at this topic. Ten minutes of his or her time is as important as my 10 minutes is to me. Just because I’m a doctor doesn’t make my time more valuable. We have no right to steal their time. We see a lot of patients every day - sometimes more than 3,000 a day for MRIs, PET, mammography, ultrasound, etc. There will always be emergency cases that get added in, or patients that come in late, problems with insurance, authorization isn’t completed correctly, or old or difficult patients. And, with the number of patients we see daily, we’re used to that and have to anticipate it and build time for it into our schedule. We know it’s going to happen. We’ve decreased waiting time. The average norm nationwide for getting in to have an exam and see a doctor is 30-to-45 minutes, and people accept that. But, that’s terrible, and we never want people waiting in our waiting room for more than 10 minutes. Right now, we’re running at 7 minutes from time of arrival to being in the exam room. That’s the average. Sometimes it’s higher because things happen, but getting the average down to 7 minutes is pretty darn good.
The second thing is we make appointments when the patient wants them. Too often, a doctor’s office will give patient what’s next available for an ultrasound or CT scan. Patients don’t realize they have a choice. For some patients, if they call now, the next available appointment might be Friday next week at 2 PM. Patients will say okay, and now they have to figure out how to get a babysitter or take time off from work. Instead, we ask our patients which of our 23 offices they’d like to come to and what day and time they would like. Oftentimes, they don’t want to come in for the next available appointment. That might not be convenient for them. And, around 95%of the time, we can accommodate within 10-to-15 minutes of the date, time, and location they request. They’re in charge, and that’s much better than assigning appointments.
In another rule of thumb, we allow and enable our patients to come in right away. We don’t need a doctor to call us up and tell us your study is STAT or an emergency. It might be a psychological emergency - a woman might have found a lump in her breast, and she wants the exam done right now so she doesn’t have to worry over the weekend. Or, maybe the patient is leaving for Florida that afternoon, and he or she wants to come in and have their exam done before their trip. That’s not a problem. We leave enough room in our schedule to accommodate the urgent requests because the patient wants to have their exam completed. If we get them in, then we’ve started their overwhelmingly positive experience. It’s all about being able to say yes and not create difficulty for them by saying no. The patient experience starts with the moment the referring physicians says, “You need such and such a study.”
Before the patient is even in contact with our office, that experience has started. They need to be able to locate our office, find it online, and find a contact number. We need to be mobile-friendly. They need to be able to find the website, click on the phone number, and be able to reach a scheduler easily. Like other organizations, we do have electronic phone trees, but ours only kicks in if the phone isn’t answered within 30 seconds. We have human operators answer the phones as the first contact. Patients call to schedule an appointment, and they connect with a person. They don’t have to press 1, 2, or 3 to get in touch with someone. Some of the time, the patient just wants a fax of their report. The staff member can verify their identity, pull up their account from the RIS, and fax the report right then and there. It needs to be as simple as possible. Patients used to have to come and get films or CDs, and they don’t have to do that anymore. And, they can visit any doctor they want - referring or a specialist in another city. If they need access to imaging, the patient can email him or her a link to give the provider direct access to images. It’s a much easier process for patients than it was 20 years ago. It’s much easier for the patient.
Everything we do is done around the thought of how the patients interact with our office. In fact, the entire office is predicated on the patient experience. I tease people that I run the biggest escort service in the world because we have a huge number of coordinators of patient services - COPS - in all of our locations. With the patients, from the moment they arrive, they’re accompanied to the front desk. Many have already completed their paperwork online before they come in, and when they do, the COPS ask for their insurance cards, copy it, get any co-pays, and escort the patient from the front desk to a sub-waiting room. We don’t tell them to go down the hallway and take the third door on the right. They are escorted. They are brought to the changing room if they need a gown, and the techs know they’re waiting.
Even if you come in during peak times, the main waiting room is virtually empty because we move patients back to sub-waiting rooms quickly. It’s important for us to not keep patients waiting. It’s also very nice for the patients because the techs never call their name out in an open waiting room. It’s no one’s business if they’re in the office. After exams are complete, the techs walk the patient back to the front desk and hand the patient off in case there’s anything else that needs to be completed. We never just tell them to go back to the front desk. It’s expensive to have the personnel, but we’re giving our patients the Nordstrom experience. We make them feel attended to.
Radiologists just need to listen to the complaints of the patients and referring doctors. People can tell you you’re doing a wonderful job, but that’s just not helpful. What we want is to know what we could be doing better. We heard complaints from referring physicians that it was difficult to reach the radiologists. We solved that. Now, no matter where they are, our radiologists have a ubiquitous four-digit extension at the bottom of the report where they can be reached. Anyone can call it and get to any of us. And, if we’re not there, they can leave voicemail. Ninety-five percent of the time they’ll leave a voice message, and the radiologist can call them back when he or she has the time. For urgent needs, we can be reached by cell phone, too. But, we might only get one call a day from patients.
When we started this five years ago, my radiologists were concerned that patients would be calling them with all sorts of questions about the report and how they don’t understand. We’ve made the efforts to make the radiologists more accessible and available to talk directly to the patients. It’s really easy - you simply answer the phone when they call. You click on their account, and you talk with them about the report. It’s prompted my radiologists to create reports that have clearer language and explanations so there’s less of a need for the patient or the referring doctor to call for clarification. In fact, if they really need to, then we’ve failed. For example, one of my mammographers used to include “expressive cystic breast mass” in his reports. It means a simple benign cyst, but when you say that in the report, people think that it might be something worse. Then, they call about it.
We’ve also acted on some unsolicited advice from patients given to us in our surveys. The girls at our front desk are very busy, and they didn’t always look up and make eye contact with patients when they would come in. Last January, I was in Asia, and I experienced the Chinese custom where people behind the desk stand and greet you. It’s a show of respect to the customer approaching the desk. We imported it, and now our front desk staff stand up and acknowledge the patients. They don’t get it right 100% of the time - maybe 80% - but we’re still integrating it.
DI: What has been the impact and benefits of your work?
Mendelsohn: We’ve gotten tremendous positive feedback. Our patients are phenomenally loyal to us. We’re a private practice, so we depend on the patient to come to us. When physicians are bought out by hospitals, they are encouraged to send their patients to their hospital facility. But, they’re loyal to us because of the experiences they’ve had with us. Occasionally, they’ll go to the hospital and have negative experiences. They get angry at their doctor and won’t go back to that facility. So, they become an even more loyal customer to us. As long as we can set the highest benchmark, it’s hard for them to have as good an experience somewhere else. Patients drive medical care wherever they go, but only recently have they determined that they have a medical choice. Patients shouldn’t assume they can’t change their experience.
Too often, we see non-hospitality people making decisions. To truly understand the patient experience, you have to walk in his or her shoes. Just because someone is an academic and publishes a lot of articles on patient experience doesn’t mean they know. It’s the clinical officers who work with patients who know best. They hear about a patient’s challenges or issues. I have my office management, COPS, assistant managers, and techs give me weekly reports and summaries on what they see. I get hammered with emails that relay their perspective of different events related to patient experience. Reading and seeing their thoughts helps us continually improve. Our motto is if we’re still doing things the same way we were a few years ago, then we’re doing it wrong. We’re continually improving and getting better. Don’t assume you can’t improve. It can be done easily, and it’s not necessarily expensive. I encourage my staff to be nice. Our core mission, posted in the lunchroom, is to be kind. It starts with being kind to each other at work. If we’re kind to our co-workers, we’ll be nice to others. If anyone can’t be nice to others, we don’t want them. I don’t care how competent you are. If you’re not nice, you can go work somewhere else. Once you establish a culture of nice, then everything is wired that way. We try to treat every patient like they’re our favorite aunt or uncle. If they make a request, we don’t say “no,” we say, “Let me see how we can make that happen.” Right now, our biggest challenge is the insurance companies with pre-authorizations. They’re the obstacle. We can do imaging on the weekends, but the insurance companies aren’t open on the weekends. And, if someone doesn’t have pre-authorization, we have to shrug our shoulders because there’s nothing we can do.
DI: As a field, from your experience, what should - and can - radiology do to improve patient experience overall?
Mendelsohn: Everything I’ve described, everyone can do. It’s not a complicated formula. It’s not rocket science. It’s having nice people putting themselves in the patient’s shoes. Walk through it and experience things like the patient. See what you need to do to be nice. Dress in blue jeans and a flannel shirt and walk into an office and go through the whole patient process. See what they go through. See how they’re treated. Go incognito if you can. A lot of people won’t recognize you. Everyone can do it. For example, try to experience their waiting time. We have a large orthopedic practice here, and I know the owner very well. They’re good doctors and very capable. I brought one of my kids there for an 8 AM appointment. We arrived at 7:45, and the waiting room was already full. They had scheduled 12 patients for 8 AM for each of the surgeons. They scheduled 50 patients to be there at 8 AM. Why not schedule them when you can actually see them? Why not keep orthopedic surgeons going from exam room to exam room and have everyone scheduled on a predictive basis of when they’ll be able to see the patients? Schedule them to arrive only 10 minutes before the appointment time. And, if a patient doesn’t show, the provider can work on charts or move on to the next patient. The office refused to think about it a different way. The patients hate them. There’s no reason to have a negative experience in radiology. We can lead the way to a positive patient experience. A lot of the country doesn’t realize that radiologists are physicians. In our practice, the name brand loyalty is there. The patients know that we’re physicians and radiologists that are available to speak with them.
Practices should also make efforts to stay current with technology. Places fall behind when they don’t update their technology, and patients know it. Make sure your patients know you have the most recent technology.
It’s become easy to give patients good experiences with radiology. So many other places give them bad experiences and keep them waiting. It’s a great opportunity for radiologists to be leaders and provide the best turnaround times to get results to patients quickly. Our patients love having all of the results in the patient portal. We started using it about six years ago. It forced us to become better and clearer with our reports. The patients love to see them and are now engaged with the portal. Some referring doctors hate it because the patient gets the results before they do. But, patients care about the results. They want to know if the results are normal instead of waiting and worrying. You have to put yourself into the patient’s shoes or think about what you would want for your mom or dad. Don’t you want your results right away? Do you want to be greeted when you go into a facility? We try to give everyone the red-carpet treatment.