Who Has Your Back? Part II – The Plans You Make

You know who has your back and your team is solid. Now what?

You and your support staff make an impeccable team. You know your receptionist manages the gates with smooth grace and dignity; your biller has your finances under control and your office manager is directing the team with foresight and impeccable customer service.

You and your practice need to employ stable, professional help, people who care about you, who care about your clients and you have impeccable customer service skills.

Customer Service

How you and your crew manage patient care – and how smoothly it operates – can all tie back into one unbelievably undervalued skill: Customer Service. Customer Service is probably the most difficult job that exists:

1) The client is NOT always right. In fact, clients, customers and patients might flat out wrong, or even lying. This is not always intentional. Other times it is manipulative. Sometimes it is born of embarrassment, frustration, in withdraw or experiencing low self-worth or extremely high stress. Or maybe they are just a jerk.

2) Behavioral health – any healthcare – works with vulnerable populations. Sometimes this means poverty and the judgements that go with it. Sometimes that means insecurity, mental illness, illegal substances. Sometimes that just means people who have taken their difficult situation to a provider who broke their trust.

What makes these all so hard is that at least half the time, you are not sure what of the above you are dealing with. You may not even begin to grasp the reality of the situation until the groundwork for how the conversation will go has already been laid out.

Great customer/patient care takes instinct, training and practice, so this Is far too complex to review in one post, but you and your team should be on the same page about at least a couple of things.

Be Consistent. This means, if you have a No Show policy where missed appointments accrue a $100 fee, then your clients should know about it long before they miss the appointment. More importantly, whether the Office Manager or the Receptionist is talking to your patients about this, they need to be telling everyone the same information and sticking to it. When your patient mentions it to you, you should not be secretly wondering who they spoke to and what information they were given about it.

Communicate. Pretend you are going on vacation in July for 2 weeks to Belize (I’m jealous just pretending about it). You and your staff should be starting to notify your patients by the end of May, at every chance you get – if your biller is talking to Bob Ross about his balance, then their conversation should end with “And do not forget, Celine Dion will be on Vegas in July, so if you need anything from her, don’t forget to reach out before she leaves”. Notify, notify, notify. You are dealing with a vulnerable population and THEY WILL FORGET. Spare yourself the grief and accept it. Be ready for it. But if you communicate constantly about everything, all the time, you will hugely minimize that grief for everyone involved. If everyone knows what’s going on in the office, then they can in turn communicate with the patients, and with everyone on board the same ship, you can steer confidently.

Allow for Consequences. Train Your Patients. This sounds weird to say, but when I worked sales in manufacturing many years ago, I learned this lesson and these days it is my mantra. Through communication and consistency, you can train your patients. This benefits you and your staff, and it benefits your patients, too. If, for example, you expect to have weekends off, then for the love of Pete, neither you nor your staff should be answering patients on a Saturday! You told them your hours with their first visit; you have posted your hours online (and, hopefully, you have long ago given all patients crisis contacts, right?). So if Bob Ross calls on Saturday afternoon and is angry that no one is responding to him about canceling his follow up this week, then allow him to be angry. Resist the urge to reach out Sunday morning to smooth it over. He is upset and frustrated, but he is okay, and next time he will reach out during business hours, guaranteed. He will know what to expect.

On Monday, when your reception calls Bob back, they will do so with a pleasant apology, a gentle reminder of the rules and a promise to prioritize his request this morning. Which leads to the last note here:

Follow Through. This one is simple. If you say you will do something, DO IT. If you cannot do something, then say so. Imagine Bob calls and asks for a letter to excuse him from work. You say, “sure Bob no problem”, then DO IT in the next couple of hours. If you can’t do it right away then tell Bob so, “I will do that, Bob, but it will probably be tomorrow”. Give them a deadline. Do not leave patients in limbo; limbo is frustrating and will create anger.

Meanwhile, If a patient calls requesting help with disability paperwork but this is something you don’t generally provide, then TELL THEM SO. You and your staff all need to be following the same protocols here – do not agree to fill out companion animal paperwork for Jane, then decline to do it for Bob, and confuse your staff about whether they should or should not offer it to Chris. Confusion ensues. A patient might be irritated when they are turned down, but everyone involved will be able to get on with their day much quicker.

Besides, if people feel they are being jerked around, they will get far angrier.

Customer Service is the Success Foundation to everything your team does in relation to one another and in relation to patients.

Screening

No matter who has your back, there is a high probability that at some point they will either be talking to a potential new patient or referring someone your way. Everyone, therefore, needs to know what you do and what you do not do. Are you a therapist? Maybe you are not comfortable with eating disorders. Do not put yourself in a bad position and do not put your potential new patient in a bad position. Be honest with potential patients: “I heard you mention that you are on a few benzodiazepines, I’d like to advise you a head of time that we will generally not prescribe those to patients, are you comfortable with tapering if you were in our care?”

If any of you have ever had a provider that you did not like, did not trust, felt they did not listen to your or understand your concerns – that is an awful position to be in. Do not put someone there.

If any of you have had a patient that you felt you did not understand, who frustrated you, that you worried you were not really helping, that left you stressed out and on edge – that is an awful position to be in. Do not put yourself there.

A good match is felt both ways and a good provider can be a thousand times more effective for a patient than someone that either party doesn’t like, doesn’t trust or otherwise is unhappy with.

Scheduling

Scheduling is rough because the instinct of any provider I have ever worked with is to over-schedule. And then they stress, fall behind and burn out. It’s a huge issue.

Scheduling smart means that your scheduler is giving you time for paperwork at the time of the appointment- so if you schedule for 30 minutes to see the patient, then block another 15 minute window to wrap up notes. Or have 1 – 2 hours at the end of each day to close up for the appointments you had that day. Do not just count face-to-face time as an appointment.

A lot more goes into care than the minutes you spend looking your patient in the eye. On a side note: if you let your scheduler manage your schedule without micromanaging them in turn, then it does become easier to avoid over-booking.

Take Your Breaks – do not skip lunch; a blood sugar crash can cause mistakes, or worse. Step away for 15 minutes every 4 hours (minimum). Leave the building for each break so that you cannot “just finish this one thing real quick” instead of give your brain reprieve. Your staff can schedule your breaks in, and they can harass you when you are neglecting yourself, just as you can harass them for skipping their breaks (because it is the law).

Protect your time. You are an asset. You are here to provide exceptional care, aren’t you? That is different from just providing care because you are a warm body with the credentials.

Sharing The Load

That leads me to Sharing the Load. Refer, refer, refer – help your patients build a team around them. If you are a Psych NP who thinks Bob should have dedicated therapy in addition to his Zoloft, then have the referral source to set him up with. Or maybe he needs a sleep study, where should he go?

Not only does this take the intense pressure off of you, but it also gives the patient more resources. They have a wider support network.

Referrals are difficult, of course, so your staff and/or you should be constantly networking around you. Refer to places you trust with your patients. When one source closes to new patients, work on finding another. This can be the trickiest part of any clinic, but it is imperative to you, your team and the stress of all parties.

Plan Ahead

Planning ahead sounds simple, but I mean to plan waaaaay ahead. Like, on January 1 go through the whole year and schedule excessive time off. You will likely not take all of this time, but the fact is that it is easier to back out of scheduled time off than it is to put it in later. You may not go to Belize for the month of July like you wished you could last year… but you have the option. Or, at least, you can take one or two of those weeks and visit Taos. Or maybe your hope for a vacation coincides with one your receptionist was planning for. Maybe you can catch that your Office Manager is going to burnout because they aren’t planning a single thing this year.

Maybe you will close the clinic for the week of Christmas; last year, half the people canceled anyway and your staff caught up on backlog, then shopped online when what they really wanted was to go play with their kids at home on break.

Maybe you and the team with take 3 days for a HIPAA training you saw; or maybe it will turn out to be far too expensive once you see the brochures that came out.

Know how many appointments you must hold in a week to make payroll for the next six months. Analyze your quarterly taxes for the end of the year, not just the ones on your desk right now. Are you in a good place? Fiscally sound? If you didn’t see another patient again after today, how long would the money last before you had to close up shop? Be realistic and know what is coming.

Planning ahead just means that you are plotting for the craziest scenario and scaling down to reality. Knowing what lies ahead takes a lot of pressure out of the surprises.

The Uncomfortable Stuff

Lastly, when you are getting yourself and your team streamlined, talk about the uncomfortable stuff.

Look, no provider likes accepting payments – talking about copays, asking for credit cards and collecting open balances sucks. It’s really, really hard when you are a provider. No provider wants to sit down with a patient at their most vulnerable moment, hear them out, create a treatment plan – and then ask for a credit card. So what is the real plan? Can you accept payment before services? Or can one of your staff handle it and completely separate CARE PROVIDER from MONEY?

Whatever parts of patient care make you uncomfortable, talk about them with your staff. It may not make another person uneasy, in fact, maybe your biller has a knack for discussing the sensitive stuff with your vulnerable patients.

“Change is the essential process of all existence.”

— Spock

You and your staff are a team. You should be utilizing one another as support. They are here to help you run your practice, but they should also be rooting for your success. For that to happen, you need to all be helping one another manage the incredible stresses that can come into the many aspects of patient care. Find ways to take care of each other for the benefit of yourselves and for the benefit of your patients, too. Always be reviewing your processes, talking to your people and making small changes to improvise your experiences with your patients. This is ongoing.