Customer Service in the Time of COVID
No matter what type of business you own and operate, customers (clients, patients, families) are always the lifeblood of your success. Arrogance might suggest that if you have a product or service that someone needs and you’re the only one around that provides it, you can afford to treat your customer with less-than-ideal respect and attention. But in the real world – the one where most of us live, work, and operate businesses – the choice to be rude or callous toward a customer or patient will typically result in that customer looking for another service provider.
Most healthcare practices spend a good portion of their revenue on advertising and marketing; the need to attract a constant source of potential patients is not only part of the operations of the business, but also an essential component for growth. But marketing is only one facet of the chain to patient acquisition.
Once you get the patient, how do you keep them coming back when they have another medical need?
Perhaps for some types of practices, this might seem less of an issue than it can be for urgent care centers or those specialties that cater to episodic illnesses, injuries, or complaints. A primary care/internal medicine practice can often maintain a steady stream of incoming patients (and resulting revenue) simply because the clientele they are seeing have ongoing/chronic medical concerns that require follow-up.
While that might seem like a slam-dunk for patient retention, the truth is that patient retention is MUCH MORE than relying on being the only practitioner around or being the provider that takes the patient’s insurance. Sure, some patients will tolerate poor care, poor customer service because your services are convenient or cheap, but after a while, most will not continue to tolerate poor healthcare service no matter what the other aspects of your practice might be.
So now, with so many medical practices faced with another round of COVID surge resulting in increased volumes, long waits, ill/frustrated/worried patients, the stress and fatigue level for many working in healthcare is at a breaking point. Where some practices are seeing a volume increase by 50%, many are experiencing 100-200% increases in volume as the Delta variant continues to rise. This increased volume has a downstream effect throughout the industry, not only on the immediate clinic personnel but also on the RCM vendors, coding and clearinghouse functions, and even the payors as they struggle to keep up with increased claims and traditional credentialing functions.
Added to the misery is the difficulty in hiring and maintaining staff. In the past, medical practices could adjust to meet seasonal increases, planning ahead to bring necessary staff on board to manage patient volumes without their customers seeing a noticeable change in service. But as many operators have experienced, COVID doesn’t and hasn’t followed the normal trends like regular seasonal influenza. Just ask some of the providers and staff that recently experienced some of the highest patient volumes in August than their practice has ever seen year over year.
So how do these trends affect patient attraction, retention, and overall satisfaction? First, there is the opportunity for business that COVID has presented. In the initial months of the pandemic, and when most regions around the country were abiding by strict lockdowns and advisories to refrain from public gatherings, many practices found themselves seeing canceled appointments or severely reduced patient volumes. Patients simply did not want to risk exposure or infection by going for non-emergency conditions. In fact, as we’re now learning, the impact on patient compliance and health screenings dropped severely leaving many conditions going undiagnosed or untreated/monitored.
Urgent care centers were one of the first practice types to adjust and implement COVID testing. With their ability to manage walk-in patients, these practices quickly realized that they could – with some workflow modification – manage patients seeking to find out if they were positive or negative for the virus. In fact, many of these centers were also the first and fastest to adjust their cleaning prevention techniques along with the implementation of managing patients via telemedicine. Like seasonal influenza, this adjustment of service offering and how those services were offered salvaged what might have been a financially devastating year in 2019-2020.
Although it was a slow transition, the assurance that these practices were taking steps to protect concerned patients accompanied with rapid testing, kept many of these operators in business. Patients who did not want to wait in the long lines of free testing sites were more than happy to receive testing from a known and trusted provider. COVID test results could be obtained on a convenient, walk-in basis and despite self-pay fees, many patients – especially those with insurance – quickly returned.
In fact, while many hospital ERs were buried under the onslaught, private practices, and urgent care centers became a viable resource to reach many. But providing that resource was not without ramifications.
As patient volumes increased, many centers found themselves struggling to keep enough and healthy staff. Practices battled lack of experienced staff members as many who were initially ‘laid-off’ when the pandemic hit, were now reluctant to return to work. Many, who were able, found it more attractive to remain at home and receive stimulus money or Covid relief funds. That particular issue is still affecting many practices even today- nearly two years later.
Augmented by staffing shortages, those who did come back to work or remained through the initial wave, quickly found themselves suffering from fatigue and burnout. Some have even contracted COVID themselves and had to battle the illness after continuing to care for the high volumes of patients. Now, even with the availability of the COVID vaccine and monoclonal antibody infusions, finding available staff is difficult at best.
One additional effect of the pandemic is the effect on customer service. While urgent care has always been based on convenience and on-demand availability, the lack of staff and changes to how essential workers are viewed combined with the sheer volume of patients has left many feeling that the patient care aspect has degraded. Truly, when faced with double and even triple the usual patient volume, it is difficult to expect any worker (physician, nurse, medical assistant, or receptionist) to either spend quality time or extend compassionate care.
The focus to get patients in and out – registered, tested, and discharged – means that there was less emphasis on patient satisfaction and more on efficiencies and numbers. Many operators have seen a sharp increase in patient complaints, negative reviews, and even blatant anger and abuse of staff by patients and families. While many patients are certainly understanding of the packed waiting rooms or long waits, a few have taken out their irritation in negative ways.
It should be also acknowledged that the patients aren’t totally at fault for their responses. In the effort to get their patients in and out, it is true that many staff members have not exhibited the usual tolerance or understanding for the patient or their condition- and often just their fears. Staff members have been reported as “cold,” “uncaring,” and even “rude” as they “shoved that swab up my nose.”
One patient comment left behind on a clinic website speaks to this profoundly. The responder wrote; “While this might have been the 100th swab the nurse did today… it was my first… she didn’t explain what was happening or even ask if I was okay. She sharply said- have a seat in the lobby and we’ll call you back when your results are done. I had to ask for a tissue as my eyes watered terribly. If this is how you treat patients, I won’t ever be back.”
Sure, that experience may have a lot of missing information and is subject to the patient’s point of view, but one can easily see how fatigue and under-staffing may have led to a callous or rude clinical member. The shame is that in their rush to move patients, the nurse perhaps did lack empathy or compassion for the patient.
Another patient wrote a review of his experience stating that “I now know how cattle feel when they are being herded into a pen…” Harsh, but not uncommon as customer service has taken a hit in nearly every industry.
So, what can be learned from the pandemic? What can practices do going into the upcoming influenza season and the uncertainly of what that will hold? The answers aren’t new and may be difficult to accomplish, but planning and focus can remedy some of the problems.
- The priority is hiring and/or retaining good staff. Don’t settle out of desperation for an employee who shows little regard for the performance of their position and especially if they aren’t able to provide good customer service. Increased, one-time, volumes that result in dissatisfaction just delay the poor financials for your practice.
- Invest in your staff for downtime. No one can continuously operate efficiently or with competency at a fever pitch. When every day is a crisis, the mind and body will eventually disengage or shut down. Be sure to do what you must to provide for your employee’s mental and physical health. Be understanding; it's your business, but the staff is facing stressed-out patients all day and are then going home to worried families or other personal situations. Consider closing early or even closing for a day for people to re-group, re-energize and re-engage.
- Promote patient satisfaction. Remind staff that patients are all facing the same pressures and uncertainty. Expenses on the rise, pay that doesn’t stretch as far, childcare due to school issues, or maybe a spouse that’s out of work, can all contribute to a less than tolerant customer. Examine your workflows to see if there is a way to move patients efficiently without ignoring their humanity.
- Take patient complaints seriously. Don’t ignore them or pass them off to volume increases or patient exaggeration. They are your customers, and they have expectations that if ignored may result in them assuming this is the norm for business at your practice. Consider implementing “perks” or rewards such as little freebies that show the patient you appreciate their business as well as their patience. Respond promptly to complaints without offering the same over-used explanation or excuses. COVID isn’t new anymore, nor are the issues associated with managing the volume. A complaining customer USUALLY just wants to be acknowledged, not placated.
There’s no denying that COVID is going to be with us for a while longer. Despite having available treatment and preventative options, the fear in the general public is still very prevalent. Urgent care and primary care will continue to be on the front lines for managing testing and minor-case treatment (monoclonal antibody infusion). Like previous threats to the health of the country (H1N1/ Swine flu, Zika, Ebola, and others to come), urgent care centers and many primary care centers are often the first to be impacted and the first to adapt and respond. It's what makes our industry so viable and resilient.
Planning for the next pandemic and the success of managing the next ‘bug’ that comes will be a direct result of lessons learned from this one. Choose to respond positively by looking for and implementing changes that benefit both staff and patients alike.