Moving to External Five‑Star Service

Five-star service has always been important, but has become even more so now that national healthcare reform will affect the way healthcare is delivered in this country and how practices are reimbursed for the care provided.


The rubber hits the proverbial road with external five-star service. This is where the action is. This is looking at how your patients and their families are treated and feel; it’s about every point of contact that they have with your office, including:

  • How they are treated when they call to schedule an appointment;
  • What they see when they log on to your website;
  • How they access your patient portal and the interaction;
  • How they are treated when they call with an urgent health concern;
  • How they are greeted at the reception desk;
  • How they are called back (invited) to the exam room;
  • The interaction at the actual visit;
  • What happens when they have a complaint; and
  • How an adverse event is handled.

Not only is it every point of contact, but every member of your office team’s interactions with patients as well. Your patients’ perceptions of you are affected by how your nurse manages patient care and communication, how your billing personnel respond to patient billing questions, and how your receptionist answers the phone.

Traditionally, healthcare has focused on the physician‑patient relationship. Of course this is vital to successful outcomes and patient satisfaction; however, an area often neglected by the healthcare industry is the practice‑patient relationship. As a physician, you could have an excellent relationship with your patients, but if your office is not projecting the same five‑star service that you provide, the quality of your patient care and patient satisfaction will diminish.

Let’s be clear: Physicians certainly need to be champions and role models. However, excellent service does not stop there. Patients and family members can become frustrated with a practice, and even though they are happy with their doctor, they may not be able to tolerate the office staff and processes. We have heard them say, “I really like Dr. Smith; but I cannot stand his office staff.”

Yes, many of the patient frustrations stem from changes in healthcare delivery or about their illness or perhaps their health insurer, and you can suffer from the splash-effect. However, you can reduce that splash. Data suggest that patients can sort out who is responsible for what. You and your office can be a positive aspect of healthcare changes. We have seen it happen!

Events that detract from your relationship with the patient can happen and do happen. Realizing they can occur and being pro-active in those areas helps to reduce any potential harm. Let’s review a few:

▪▪ Inadvertent mistreatment of patients by office staff. Inadvertent because staff do not intend to show disrespect to patients. However, patients pick up on body language, and these days, patient expectations are at an all‑time high. Poor body language, an overheard comment taken out of context, lack of eye contact, or signs of being impatient can make a patient feel unwelcomed. Your staff must understand that patients are always listening, always alert to what’s going on. Reminding staff that they are always “on” can help to reduce this clearly inadvertent harm.

▪▪ Long wait times for appointments. Wait times are of course a long‑known patient complaint, that continues. Patients sit in waiting rooms and stew when no one acknowledges that their appointment time has come and gone and no explanation for it is provided to them. The entire situation sets a negative tone for the staff interaction with the patient and the doctor interaction with the patient. You can be proactive in understanding your patient wait times, and working to reduce wait times. Audit your patient wait time and use the data learned to put into place measures that will help lessen patient anxiety during waits—because you cannot prevent all extended wait times. Place a sign at the registration desk that sets patient expectations and lets them know that their time is valuable to you. For example, post a sign such as: “We are sorry if you are waiting longer than anticipated. We respect your time. If you are 15 minutes past your appointment time, please see the receptionist.” We have seen this strategy work effectively. Technology can also help physician practices with this common complaint. Smartphone and tablet apps are being created that will help practices keep patients informed of delays. Further, one new patient engagement app will provide greater efficiencies to practices by permitting patients to complete paper work and medical issue documentation in advance of the visit. Further, make sure that valuable educational materials are available in reception areas.

▪▪ Scheduling: Long wait times for physician appointments. Some patients prefer to see a physician rather than a PA, and are not happy when told that the doctor is not available for an appointment for another two weeks or more. With the increased number of insureds and the resultant increased demand on the physician practices, combined with the need to incorporate advanced healthcare practice professionals into the day-to-day patient care at physician practices, this is becoming more of a hot topic in the industry. Patients who want to see a physician, but simply cannot wait the length of time it would take to get an appointment with the physician, can become irritated and angry. Information in the next chapter can help physicians address this area, as patient engagement becomes a key concept in patient care and advanced practice professionals are recognized as part of the patient’s care team.

▪▪ Patients seeing or hearing staff or physicians arguing with each other. We underestimate how unsettling this is to patients. It is natural that professionals will disagree and there are settings where it is appropriate to do so (QA, peer review for example). However, when it takes place in a public setting, patients or their families can misinterpret what they are seeing or hearing. Did someone do something wrong? Why is the doctor so upset? Is he distracted? Angry words between doctors or staff are never viewed as a positive by a patient or family and they are never forgotten.

Five-star service has always been important, but has become even more so now that national healthcare reform will affect the way healthcare is delivered in this country and how practices are reimbursed for the care provided. Reimbursement is moving from volume‑based to value-based reimbursement. Measurement of value will include the patient experience ratings. So now, patient satisfaction is not just about maintaining a good physician‑patient relationship, it can also affect your finances.

More specifically, an Accountable Care Organization, in order to participate in shared savings, must meet quality standards for a given year, and 7 of the 33 standards are related to “patient care giver experience.” These 7 measures are captured from CAHPS surveys.1

The concept of the patient experience is one that began to take hold in the healthcare industry only recently. For example, the Cleveland Clinic created the Office of Patient Experience, designed to address every aspect of patient care, including emotional well‑being, comfort, and education. This includes healthcare giver interactions, patient and caregiver interactions, communication, cleanliness, healing initiatives, and noise levels during evening hours, just to name a few.2

External five-star service is critically important, particularly with the future transparency regarding patient satisfaction. However, these are all building blocks: having internal five-star service in place, having a plan, getting the training.



1. Patient Protection and Affordable Care Act of 2010, Pub. L. No. 111-148, sec 3022 124 (2010); Medicare Program; Medicare Shared Savings Program: Accountable Care Organizations, 76 FR 67801, Issue 212 (Nov. 2, 2011).

2. For more information, see:

Excerpted from Operation Five Star: Service Excellence in the Medical Practice—Cultural Competency, Post-Adverse Events, and Patient Engagement by James Saxton and Maggie Finkelstein




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