This show has implications for provider organizations of all stripes, especially those looking to succeed in value-based care or those who need patient trust and relationships for any other reason, including just patient volume.
This episode also is for provider organizations who are trying to prevent clinician burnout better.
It’s also for practices trying to get themselves into narrow networks where patient satisfaction is surveyed at some point in the process, and this includes Centers of Excellence networks.
For a full transcript of this episode, click here.
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You know what the rate critical is that I talk about on the show today with Jerry Durham that rarely, if ever, gets talked about in any of these contexts? It’s not some fancy data artificial intelligence thing or something else the doctor needs to be clicking on or nurses need to step up and handle. Nope. I’m talking about the front desk. What an overlooked secret to success or a clinician and clinical failure point!
Consider that what goes on on or about the front desk is either gonna set up the doctor or other provider for success or make it really really hard for them.
This is what I talk about today with Jerry Durham in this encore episode from a couple of years ago that is still so incredibly relevant because the insights that Jerry shares are so often overlooked and they impact both patients but also doctors and other clinicians in ways we don’t often think about but, in this era of staff shortages and burnout, I’d suggest maybe we should.
Here’s something I never really understood: how physicians and nurses more often than not get to be responsible for the entire patient journey, including, start to finish, patient satisfaction. But if you just take one look at any random poorly rated physician’s reviews, they’re usually littered with complaints about the front desk in the practice. Negative reviews, of course, are not limited to front desk diatribes; but there’s often a lot of front desk commentary in them.
It has always seemed to me to be a common and strange phenomenon in healthcare provider practices where the front desk is like a totally separate little fiefdom with a different mission statement and goals from the healthcare providers in the same exact office. Isn’t that odd when you think about it? I mean, first, the front desk is literally physically separated from everybody else. No matter which direction you approach from, there’s at a minimum a half-wall barrier surrounding them. Sometimes, in directions most likely to receive an attack, I suppose, there’s been added a big glass barrier.
Liliana Petrova pointed this out in episode 236 of the Relentless Health Value podcast, and it was really the first time that I had thought about it at all and also thought about the implicit message this sends not only to patients but also to clinicians. That whole physicality of the setup, it just screams, “We over here have nothing to do with the mission or vision of anyone else in this place. We have our own thing going on over here, and to do it, we need to be protected from you all and all of your chicanery and untoward goings-on, you doctors and nurses and patients!”
So, I was really inspired the first time I heard Jerry Durham from The Client Experience Company talking. His message, as I understood it, was that a practice really on board with helping patients achieve the best patient outcomes and, nothing for nothing, erode clinician burnout includes the front desk in their thinking. Jerry has said that there’s four phases in the patient life cycle, as he calls it, which is sort of a synonym for the patient journey:
1. Marketing
2. The moment that a patient/person engages with the clinic or office
3. Provider interactions
4. The post course of care
So, all of these phases—all four of them—are critical to both patient outcomes and experience but also, really, to business success. So, you kind of almost have to do well by doing good. The front desk is mostly responsible for that phase two: what happens when that person/patient engages with your office or clinic.
In this healthcare podcast, as mentioned, I’m talking with Jerry Durham. He’s a former physical therapist and practice owner who has worked with a whole lot of PT (physical therapy) practices and also other MSK (musculoskeletal) specialties among other clients. His message transcends the specialty, however.
In this healthcare podcast, we get into a lot of aspects in terms of how a front desk can work for or against patient experience and outcomes. One of them is how a front desk can help secure a patient’s relationship with a practice. Without a relationship and trust, patient outcomes are meh at best. But a lack of trust is a big hairy factor behind disparities in outcomes among different ethnic groups, for example, as one point to ponder.
Also mentioned in this episode are Liliana Petrova and Julie Rish, PhD.
You can learn more at clientexperiencecompany.com or by emailing Jerry at jerry@jerrydurhampt.com.
Jerry Durham is a healthcare consultant and physiotherapist with a singular passion for leveraging the entire healthcare practice team toward improved patient outcomes while increasing the practice bottom line. Jerry has 30+ years’ experience as a physiotherapist, including 20+ years of business ownership, including practice ownership, business consulting, and a virtual front desk sales solutions for healthcare practices. Jerry has spent a lot of time on the front line of physio practices answering calls and learning why patients think and act the way they do when interacting with the front desk team. He has learned how to leverage the information at first contact carried all the way through to a completed plan of care, and these are the systems that lead to greater patient outcomes and greater practice success. Jerry defines these systems as “the rules of client engagement.”
05:49 What is the patient life cycle?
06:48 What are the milestones of the patient life cycle? When does it start?
10:05 “This isn’t a business solution; this is a patient-driven solution.”
10:21 “What is best for the patient is best for business.”
13:25 “The takeaway there is that your team members are all driving toward the same goal.”
14:34 How does the front desk impact health outcomes?
16:41 What is the objective of a front desk to reduce provider burden?
20:03 EP236 with Liliana Petrova.
21:18 “There’s actually three roles at the front desk.”
30:37 EP228 with Julie Rish, PhD.
Recent past interviews:
Click a guest’s name for their latest RHV episode!
Kate Wolin, Dr Kenny Cole, Barbara Wachsman, Luke Slindee, Julie Selesnick, Rik Renard, AJ Loiacono (Encore! EP379), Nina Lathia, Marshall Allen, Stacey Richter (INBW39)
[00:00:00] On Core Episode, a driver of patient engagement and clinician team success that is almost always overlooked.
[00:00:10] Today I speak with Jerry Durham.
[00:00:30] This episode is for provider organizations who are trying to prevent clinician burnout better.
[00:00:52] It's also for practices trying to get themselves into narrow networks where patient satisfaction is surveyed at some point in the process and this includes centers of excellent networks.
[00:01:03] You know what the right critical is that I talk about on the show today with Jerry Durham that rarely if ever gets talked about in any of these contexts?
[00:01:12] It's not some fancy data artificial intelligence thing or something else the doctor needs to be clicking on or nurses need to step up and handle.
[00:01:20] Nope, I'm talking about the front desk.
[00:01:23] What an overlooked secret to success or a clinician and clinical failure point.
[00:01:29] Consider that what goes on on or about the front desk is either going to set up the doctor or other provider for success or make it really, really hard for them.
[00:01:40] This is what I talk about today with Jerry Durham in this on core episode from a couple of years ago that is still so incredibly relevant because the insights that Jerry shares are so often overlooked and they impact both patients, but also doctors and other clinicians in ways we don't often think about.
[00:01:57] But in this era of staff shortages and burnout, I'd suggest maybe we should hear something I never really understood how physicians and nurses more often than not get to be really well.
[00:02:09] Get to be responsible for the entire patient journey including start to finish patient satisfaction.
[00:02:16] But if you just take one look at any random poorly rated physicians reviews, they're usually littered with complaints about the front desk in the practice.
[00:02:26] Negative reviews of course are not limited to front desk diatribes but there's often a lot of front desk commentary in them.
[00:02:35] It always seems to me to be a common and strange phenomenon in healthcare provider practices where the front desk is like a totally separate little fiefdom with a different mission statement and goals from the healthcare providers in the same exact office.
[00:02:51] Isn't that odd when you think about it?
[00:02:54] First, the front desk is literally physically separated from everybody else.
[00:03:00] No matter which direction you approach from, there's at a minimum a half wall barrier surrounding them.
[00:03:06] Sometimes in directions most likely to receive an attack I suppose there's been added a big glass barrier.
[00:03:13] Liliana Petrova pointed this out in episode 236 of the Relentless Health Value Podcast and it was really the first time that I had thought about it at all.
[00:03:24] And also thought about the implicit message this sends not only to patients but also to clinicians.
[00:03:31] That whole physicality of the setup, it just screams we over here have nothing to do with the mission or vision of anyone else in this place.
[00:03:40] We have our own thing going on over here and to do it we need to be protected from you all in all of your shakaneery and untoward going on you doctors and nurses and patients.
[00:03:49] So I was really inspired the first time I heard Jerry Durham from the client experience company talking his message as I understood it was that a practice really on board with helping patients achieve the best patient outcomes and nothing for nothing erode clinician burnout includes the front desk in their thinking.
[00:04:10] Jerry has said that there's four phases and the patient lifecycle as he calls it which is sort of a synonym for the patient journey.
[00:04:17] This is the first phase is marketing the second one number two is the moment that a patient person engages with the clinic or office.
[00:04:27] Number three is the provider interactions and the number four is the post course of care.
[00:04:33] So all of these phases of four of them are critical to both patient outcomes and experience but also you know really to business success so you kind of almost have to do well by doing good.
[00:04:43] The front desk is mostly responsible for that phase two what happens when that person slash patient engages with your office or clinic so today as mentioned I'm talking with Jerry Durham he's a former physical therapist and practice owner who has worked with a whole lot of PT practices
[00:05:02] and also other MSK muscular skeletal specialties among other clients his message transcends the specialty however today we get into a lot of aspects in terms of how a front desk can work for or against patient experience and outcomes.
[00:05:18] One of them is how a front desk can help secure a patient's relationship with a practice without a relationship and trust patient outcomes are me at best.
[00:05:30] But you know a lack of trust is a big hairy factor behind disparities in outcomes amongst different ethnic groups for example as one point to ponder my name is the director this podcast is sponsored by a venture health group.
[00:05:43] Jerry Durham welcome to relentless health value thank you it's a pleasure to be here I really appreciate this invite Stacy so if we're talking about patient experience and we're talking about the front desk how they go roll does the front desk play in the
[00:05:59] overall patient experience we're going to take a step further back what I like to address first is what I call the patient life cycle and the patient life cycle is literally the physical interactions the interactions with you and your potential patient all the way through their time with your company so this could be a phone call this could be emails this could be your paper work.
[00:06:22] This could be your physical waiting room this could be the conversations they have so that's the patient life cycle when we actually understand and map out and it's not very difficult it's really not to map out this patient life cycle we can then build what we call the patient experience the patient experience is this emotional journey it's the story and the emotions that occur during the patient life cycle.
[00:06:47] Do you feel like that patient journey and it's accompanying patient experience begins when the patient first walks for example through the door of the clinic is that when things start or like what are roughly the milestones or major steps of this life cycle that you tend to focus on yeah I'll take it one step forward before I really figured this stuff out I didn't think they're experienced started to the provider created them until they were.
[00:07:17] In the provider room and what I realized was there was this whole world that existed outside of the provider room so then I started to think about what happens when they arrive wait a minute what happens before they arrive the welcome phone call the appointment reminder did we get them their insurance benefit.
[00:07:35] This patient life cycle this interaction actually starts even before you know they exist in my company in my world I've broken the patient life cycle down into four phases phase one is actually what I'm going to do.
[00:07:47] I call the attraction or marketing phase that's when actually the patient life cycle begins this is an interaction with you your company your brand then phase two which which I've spent my time money and energy in and learning and helping other people with is when they first contact your company whether that's an email a phone call a walk in could be a factory for all from a doctor.
[00:08:10] That begins phase two and that's where that front desk comes into play is typically it is your front desk team members or following up with this person who is now moved from phase one into phase two of the patient life cycle phase two is where I found we can really leverage the interactions to set our providers up for success.
[00:08:31] Let me just frame this because obviously we're in a certain time and place in the universe you know we have had a pandemic there's a lot of providers that are struggling especially the procedure oriented providers you know practice volumes were down precipitously so there's a sort of supply side need to make sure that a patient doesn't you know for example call the front desk I have a bad experience get the patient.
[00:09:01] I'm thrown into some voicemail that's incomprehensible and just be like you know what I'm going to call somebody else who has a online scheduling or whatever you know so losing patients in ways that people may have not even contemplated is important from a provider standpoint but then also from the patient standpoint you know there are it's not like chronic conditions have gone away in the middle of this pandemic.
[00:09:23] So we have patients who need the care and if it's too frustrating and annoying to get the care then maybe they don't complete maybe they don't even begin the course of therapy that they're supposed to be embarking upon let alone finish it but then also we have the advent of consumerism and we've got a lot of people at this juncture who are either uninsured under insured have huge deductibles these high deductible plans who you know now they're starting you know the term consumerism.
[00:09:53] And bandied about has reached new highs all this stuff is becoming I'm going to say hyper critical that you are talking about here's the key to this this isn't a business solution.
[00:10:08] This is a patient driven solution in my formula in all my work we drive from patient success patient success drives business success in healthcare what is best for the patient is best for business we could bring up anything at this point Stacy anything you know we could be talking about billing we could talk about scheduling we could talk about phone lines if you're not sitting back and going okay we can do it.
[00:10:38] So what is best for the person we're serving in this then you are doing it wrong every great business on the face of the earth answers business questions related to their client customer healthcare does not healthcare has been lacking in that immensely and you don't have to be in healthcare.
[00:10:58] You have to do is be someone who's ever used healthcare walk into a doctor's office the front desk person doesn't look up at you call a doctor's office goes to a jumbled phone tree of which your phone call never gets returned right you have back pain you have diabetes.
[00:11:14] You have a heart condition and you're trying to get some help in your treated how.
[00:11:19] One of the things that you spend a lot of time working on and thinking about has been folding in the front desk to the practice team you know like there's a lot of talk in the industry about coordinated care team based care and everyone I'm going to say agrees having team base care is a way to produce better patient outcomes but I don't know very many people who put the front.
[00:11:44] And when they do it's more in the you know they should do excellent customer service you know that that's kind of the quote so is it your thinking to train the front desk and excellent customer service I give people inquiring and calling me and asking me all the time if I can help them train their front desk and customer service.
[00:12:05] And I say yes I can if you can answer one question for me how will we measure success how will we know my training was successful for your front desk team members and there's always dead air because no one knows how to measure it it's another nebulous term it's like quality here's something important it's a whole team so it's the front desk team members it's the provider team members and it's the back office team members are all part of a team.
[00:12:35] The way i'm going to drive your front desk into being helping your patients and therefore your business be more successful is i'm going to get all team members including the front desk team behind one central goal so for getting it the front desk team members bought in to helping more people get better and having them understand how can we make them believe their part of a team.
[00:13:02] The metric i came up with is completed plans of care and i can show you and i can show a company how the front desk plays a role in patients getting better and that same completed course of therapy i mean it would be any kind of course of therapy like it wouldn't necessarily have to be some musculoskeletal.
[00:13:20] Yeah exactly same roles would apply i mean it's transferable in that way yeah so i think what's really important there they take away there is that your team members are all driving towards the same goal.
[00:13:31] A complete a plan of care just in case anybody's getting freaked out it doesn't mean people get better if you take care of people and you refer them out so just know that there's some variability in that it's not that everybody has to get better to be successful because that's an unachievable goal.
[00:13:47] It's basically that the practice has decided that i'm going to put this in not PC terms like you're done with the patient yeah it's not that you've set up that they should have three more visits and the patient is the one that's the best.
[00:14:01] It's deciding they're done with you.
[00:14:03] You are correct you haven't asked me this but this for all your listeners if you want to measure if you want a measure of your pay you say i don't know what my patient experience is we don't have it and i'm like you have a patient experience whether you're doing anything with it or not here's the number one major of your patient experience drop off go back and look at the number of people that arrived for an evaluation and how many of them disappeared.
[00:14:28] How many of them called to cancel and not schedule anymore right that one sided unfinished okay so we've got a endocrinologist let's just say you know or PT or GP or a you know cardiologist you know patients are supposed to see their doctor you know even if kind of like the completed the course of therapy as you visit once a year.
[00:14:49] How many patients visit once and then never come back again how many patients are supposed to be taking their medication on a daily basis and don't which is a huge number.
[00:15:01] How does the front desk impact that you know like i'm thinking if i'm thinking like a doctor i'm thinking that that's my that's me.
[00:15:09] That's me ego so i do come from the provider side i do get to claim this and i get to claim it openly and not accusing others that you know the ego because by the way all you have to do is walk into any health care practice and you immediately know what they understand about their clients customer patients journey when the front desk treat you poorly actually you know from the moment you call them let's not lie the product the service is the interaction with the provider.
[00:15:38] So the question is and this is where I really led off from unlike we have all this research on therapeutic alliance we have all this research on managing and setting expectations within the provider's office cool why don't we do this work earlier so if you take that same research as a provider and they're going what the hell can my friend desk do.
[00:16:00] I show them that therapeutic alliance and the expectations research and say if I can get expectations managed and set further upstream before they arrived if I can build a more trust before they arrive then that sets you Mr. Mrs. provider up for success if the front desk is operating at its optimal level that actually takes a lot of weight off of the provider correct.
[00:16:29] I'm not sure that that is really recognize that if the front desk is working optimally the provider has a lot less that they need to do in seven minutes say what should a front desk be doing that reduces the burden on the provider in the exam room.
[00:16:48] The objective right so I mentioned those four phases earlier every phase has objectives and a overarching goal and they all have owners phase two is owned by the front desk team members and just to interject the phase two there is the moment they engage with your clinic office.
[00:17:06] So correct so whether it's an email a walk in a fax or you call in to say I want to get scheduled that starts phase two that is owned by the front desk team members the three objectives of phase two number one is to start to build a relationship that will last throughout their entire that patient potential patients life cycle with your company.
[00:17:27] So think about this that life cycle me end at the end of that phone call so what was their experience like that life cycle may keep going on and on and on forever what was that experience like number two is be a problem solver I love this because in the physical therapy world every front desk person is told to get everybody scheduled.
[00:17:48] I'm like that's not helping anybody in any way shape or form so be a problem solver if you're going to be a problem solver that implies that you need to listen to what someone wants from you not just needs from you and the third objective is to set the provider up for success let's go to the doctor's office now physical therapist of 45 minutes to an hour with a patient doctors 10 minutes 15 minutes eight minutes so if
[00:18:17] I can collect expectations if I can collect wants and then I get a desired outcome a K a goal whether it's of that visit or of that course of care if I can get that information that provider even five minutes before the visit that provider is now better prepared and more prepared and work has been taken off of them to now ask those same exact questions.
[00:18:43] Those things I just gave you are the things in research that correlate with outcomes in the physical therapy world meeting expectations and alliance our trust bill is aligned with outcomes so if that provider walks in the room and says well Jerry I see here that you're looking to get back to cross fit and want to get rid of that morning pain i'm glad you found us that person sent across from you going oh that's great you guys communicate yeah we do.
[00:19:09] And if you have that information that's going to set the provider up for success one of the other things about phase two the more trust that is built before they arrive the more likely things will go well for them so that's how we take the work off the provider any clinic we talked about the end of crime the GP anybody could say look I want these three things before the patient arrives and so they can greet their patient hi Jerry I know you're here right they called the schedule for low back pain your friend has found out they actually want to get back to crime.
[00:19:39] Crossfit and get rid of morning pain your provider walks out and says hello Jerry my name is doctor John do I know you're here to get back to cross fit and get rid of that morning pain i'm glad you found us.
[00:19:50] And I can definitely help you out follow me back to the room here if we could stop them right there and take another outcome measure I guarantee you they're better they're already better this is a far cry from how most front desk operate you know very much so there was episode 238 with Luliana Petrova.
[00:20:07] And one of the things that she talked about is you know you think about the just the whole architecture of a waiting room you know of a front desk area which you never thought about you know you've got the front desk person who's sitting behind you got this big wall with a glass thing and so what you're saying now.
[00:20:25] Is a far cry from that you know it's the front desk person who's actually you know meeting the patient where they're at asking them questions like that I mean is it a very difficult journey to get.
[00:20:36] Those kind of front desk you know where they're primarily concerned about snagging insurance information to become a front desk that is actually part of the team that helps the patient get better you understand the front desk and I think probably most your listeners do to we've turned the front desk of our health care practices into the joint drawer of our businesses so we need this paper filled out well let's have the front desk give it to.
[00:21:05] So we need this other thing done oh the front desk can do that we pile all these tasks on to everybody so you got five people at the front desk they're all five responsible for the same tasks every day and what we don't realize is there's actually three roles at the front desk there's the sales person the person who is the first contact the person who responds to the emails answers the new patient calls takes all that stuff or calls the factory for rose back there's the sells portion so I call them the voice of the company.
[00:21:35] There is then the face of the company which someone else or a lot of people might call the customer service person but I call the face of the company the retention person then we have the back office people those are the people managing the insurance stuff the authorizations everybody's role is equally important if we understand the life cycle if we break the front desk up like that Stacy we can properly fill each of those roles and be successful in this.
[00:22:05] This example in this world it definitely seems like you've got current state where you read up the providers, Yelp reviews and I'm going to say 60% of them are about the front desk yeah there.
[00:22:18] And that's right anyway it's all the things outside of the care it's front desk and billing right all the things that kill the practice based on what you're saying it's the providers who could
[00:22:28] effectuate change and bring the front desk kind of into the care team are exactly the ones who are thinking that it's all about them it just it seems like a bit of a strange conclusion to draw if you just look at like three Yelp reviews.
[00:22:45] It's too easy for a healthcare provider to go out there and start a business with no business knowledge.
[00:22:51] One thing that you've said that I also find intriguing is that having a not optimal front desk actually leads to provider burnout do you want to talk about how that causation transpires.
[00:23:03] I did not do any of this work any of this front desk work any of my patient life cycle any of the patient experience work believing I was doing anything more than just helping patients understand did I call the right place am I in the right place can they help me and is this where I want to spend my money.
[00:23:20] At the same time that the business could figure out is this person the right fit for the company can they pay you know whether it's insurance or whatever beyond that I didn't think I'd done anything more till I started getting deeper and deeper into it and realizing that yes when you manage.
[00:23:37] The front desk properly and give them the work and distribute the work properly you're not only do your patient metrics change but your business metrics change and if I'm setting the providers up for success and I'm not putting cancels and drop off and complete a plan to care only on the providers and we distribute the work equally as it should be across the team members.
[00:24:02] Then that creates a better culture and in creating that culture I have now taken the load off of the provider to be the sole reason and the sole purpose for success or failure.
[00:24:14] I started this podcast out by talking if a patient gets better the front desk team members have played a role if they don't get better I'm going to go back and go did we have the right person on the schedule I don't go to my provider and say you mess this up first question is did we have the right.
[00:24:31] Did we have the right patient in front of the provider you know we always want to pretend like well yeah we schedule everybody I said this earlier schedule everybody and I'm like whenever I run across anybody saying yeah our front desk job is to give people scheduled my first responses a you're wasting the time money and energy of your providers and you're wasting the time money and energy of your patients if you get everybody scheduled.
[00:24:56] Part of the work in face to is for that front desk person members set the provider up for success well if this person is telling me their expectations are built around getting a lot of hands on care in this clinic doesn't do hands on care then it doesn't be who me nor the business nor the patient to put this person on the schedule yet most clinics will put them on the schedule.
[00:25:20] They then get in front of the provider who then is going to exit you know maybe a little hands on care but is really exercise driven and movement driven and the patient drops off after visit to why because expectations weren't meant why because your front desk didn't ask them what they expect.
[00:25:36] But when they drop off we yell at the provider for not delivering value that's where that culture that's where we did that burnout if all team members are doing their equal share then it's a better culture and
[00:25:49] it is not a culture of the provider is successful or the provider failed.
[00:25:54] As I've had many conversations about you know how to build a results oriented or patient oriented practice haven't had anybody extend the conversation to or beyond what the providers are doing in the exam room.
[00:26:11] One person did lowly on it did that's true so if you're looking for a little ampadrava as it's 236 she talks about the
[00:26:18] airline industry. She talks about that whole podcast I swear to God I wish someone would had a video of me because the grin never left my face she talks about the airline experience let's think about this for a second it fits perfectly in the logical world I got on the airplane on time and it got me to where I wanted to be on time who cares about everything else will you tell me who cares about everything else it carries over to healthcare perfectly well I got to say that I was going to have a lot of things to do with the
[00:26:46] healthcare perfectly well I got to see the expert right and let's say the expert saw me on time and got me out on time but it's that whole experience lily and
[00:26:56] whole talk she never wants talked about the airplane she talked about the check in process and she talked about the tell in process and this is a
[00:27:06] billion dollar industry we're talking about health care that's a trillion dollar industry I hate to tell everybody but whether you want to own it or not
[00:27:14] there's no difference with that consumer of products and services what is the experience like you know this is the other thing if we're going to change health care
[00:27:24] we have to look at the whole experience the value thing this is what's so interesting about value driven care and patience I love how patient centered care
[00:27:33] you know there's all those other terms they see but they're always about the freaking provider and the patient yet how about if someone stood out front again
[00:27:43] this is what the front desk is doing they're setting the provider up for success by doing what by making sure they understand
[00:27:51] what that person on the other end of the phone wants and what they will value because you could have this
[00:27:59] term center of excellence all you want but if someone arriving doesn't know what to expect and then gets there and doesn't get what they expect
[00:28:07] whether it was the best care on the face of the earth or not they're not coming back so let's let's move it up stream
[00:28:13] and if you want to get paid for value driven care you better make sure people arriving value how you're going to deliver that
[00:28:23] care and what you're going to deliver if you had that aligned I promise you we're going to have an easier time in health care
[00:28:30] you know the one other kind of sticking point that I could certainly see happen is that I've had conversations with any number of providers
[00:28:38] and it's almost like the org chart is two separate stacks the front desk person is not reporting to the clinician who's working next to them
[00:28:46] you know there's a whole different org chart and I've had several conversations with clinicians who felt really
[00:28:53] impudent to have any impact on what's going on in the front desk in fact I was talking to someone who worked at a front desk
[00:29:00] and this is her term she called it a fiefdom you know where there was one individual who had been there for 30 years
[00:29:09] who kind of ruled the roost and who created who was more interested in maintaining kind of a base of power
[00:29:16] than potentially dealing with the annoying patients on the other side of the glass wall
[00:29:21] and the clinicians are sort of powerless to necessarily do anything about it have you encountered that
[00:29:27] and how do you realistically if start to effectuate this culture change which is obviously necessary here?
[00:29:35] Yeah I've had multiple discussions around this definitely you know I mentioned about this misunderstanding of the front desk role
[00:29:43] which is number one right is that it's multiple roles and then we hire people in
[00:29:48] and we this front desk team is left to their own devices because it's all about the providers seem
[00:29:54] or the billing team in the back I've run into clinics I had someone come to me in a hospital based setting
[00:29:59] who wanted to do some work and I said great let's get the front desk team involved too
[00:30:03] and we can make this thing work and he said well they're not part of my team I said that's cool
[00:30:07] can we get them involved and you said no they're off site and I said well can we get the manager involved
[00:30:12] so we can coordinate all this he said I've never met the manager I've never met any of the front desk people
[00:30:18] and it just they do all the scheduling and everything and I went and I told him flat out
[00:30:23] I said I can't help you I cannot train your team members I can't train your providers
[00:30:29] regarding patient lifecycle and patient experience if we can't control what's delivered
[00:30:36] up so 228 looking at my notes the Cleveland Clinic that that was a great conversation too
[00:30:42] because they have connected parts that other people can't or sorry not can't have it
[00:30:47] or believe they can I think that's what I wanted to say and so listening to that episode
[00:30:52] I think is good for a lot of people to understand that this is realistic the Cleveland Clinic
[00:30:57] they're constantly going back to who the providers nope
[00:31:01] they're constantly surveying the patients that really came out of that podcast
[00:31:06] and that's what I really enjoyed they're not going to the employees insane how are you doing
[00:31:11] they're going to the consumer the user of the product of the service insane how was that experience
[00:31:18] I'd say two things and one of them is going back to the consumer the patient
[00:31:24] and asking how they're doing actually does have a large impact on providers
[00:31:28] because if the like Stephen Covey's the four boxes right it's like you can spend all day
[00:31:33] unless you do proactive things that are not urgent
[00:31:37] if you don't spend time doing that box of activity then what you end up doing is
[00:31:42] spending all day playing whack them all you know dealing with fire drills i.e. patients that are pissed off
[00:31:48] like I could actually see that if you improve the experience of patients and now you have happy appropriate patients
[00:31:55] that provider experience and clinician experience and physicians who are looking to do the right thing
[00:32:00] which most of them are that experience also goes up because now you're spending your day
[00:32:05] actually doing good things as opposed to you know yet another person who's furious
[00:32:10] because he had to wait for two hours in the waiting room and was treated poorly and felt disrespected
[00:32:16] is that all being said you know I think that the original question that I asked was about
[00:32:21] what do you do in a setting where you've got the two different organizational line
[00:32:28] and there's been a lot of people on this show you know hospital executives for example
[00:32:33] who have repeated repeatedly that how you have to deal with these things is that
[00:32:40] you have to keep going up the organizational ladder until you find you get to the place
[00:32:47] where those two org chart lines meet maybe that's in the C suite
[00:32:53] maybe it's in the decision suite like the D suite one level down from that
[00:32:57] but culture change cannot happen unless it is driven by somebody who's way up in the executive suite
[00:33:04] so I think some of the things that we're talking about here really do require senior leadership
[00:33:09] buy-in and sponsorship and oversight. Completely agree my goal is always to
[00:33:16] just to have someone from the highest level involved so like you just said
[00:33:20] who was in the room when the decisions are being made and again for all this
[00:33:25] who go one step further and the patient feedback having the user the consumer
[00:33:30] the actual potential patient or patient in the room with you for some of these decisions
[00:33:35] is going to be key before we even start training with the team
[00:33:39] we have to have some of the champions in the room to talk this stuff out
[00:33:43] and if anyone is interested in learning more about the work that you do
[00:33:47] at the client experience company where can they get a hold of you Jerry?
[00:33:50] The best thing to do is email me Jerry at Jerry Durham PT.com
[00:33:56] you can also go to client experience company dot com the website.
[00:34:01] Jerry Durham thank you so much for being on Relentless Health Value today.
[00:34:04] Thanks for doing this thanks for doing this podcast.
[00:34:06] Links to everything discussed on the program today can be found at RelentlessHealthValue.com
[00:34:14] if you visit the website RelentlessHealthValue.com
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