Patient and Employee Satisfaction

An employee satisfaction survey can help uncover the brutal facts about your business. Such a
survey assists in finding the true motivations and passions of the people who make up an
organization. By embarking on this bold journey of discovery, you can start to build a great
company.


Dear Arizona Pain Specialists,
I understand that keeping my patients and staff happy is important, but I’m not sure how to gauge
this. I am often running from the office to the surgery center and then to meetings, so I rarely
have enough time to stop and ask, “How is the patient experience?” or “Does my staff enjoy
working here?” How can I be certain?
—Successful MD With a Busy Schedule


Dear SMDWABS,

Now more than ever, patients have an abundance of choices in who provides their care. They
can easily find ratings and opinions of you and your practice online. Do not despair though—there
are proactive steps you can take to engage your patients and your staff to address negative
issues. By doing so, you’ll create an environment of healing for patients, and a sense of purpose
for your staff.

The answer to your question lies in the idea of confronting the “brutal facts.” In his book Good to
Great: Why Some Companies Make the Leap … and Others Don’t, Jim Collins explores this
concept and argues it is a cornerstone of running a successful business. More specifically, it is a
concept he refers to as “The Stockdale Paradox.” Collins defines the paradox as such: “You must
maintain unwavering faith you can and will prevail in the end, regardless of the difficulties, and at
the same time have the discipline to confront the most brutal facts of your current reality,
whatever they might be.”

Collins argues that the idea of facing an ugly, unhappy reality plagues organizations and prevents
transformation of businesses because leaders are simply too far removed from reality. In medical
practices, this can be exacerbated by two facts: 1) owners are kept extremely busy as practicing
physicians; and 2) owners are also strongly biased. This can create an environment where staff
members do not want to speak up when an opportunity for progress is recognized; worse, it can
promote a situation where staff buries important feedback (either from staff or patients, or both).

So how does the busy physician-owner solicit such brutal facts from his or her patients or staff?
How does a physician who was never made to take an organizational behavior class in medical
school create a culture of openness?

It is important to recognize that as a physician you were trained to save the day. When running a
business, physicians must learn to accept that they cannot do it all. They need someone they can
trust to make decisions when they are busy doing procedures, providing care to patients in the
office or building relationships in the community. They need to identify someone who believes in
their work; this trusted individual will help create an environment conducive both to quality patient care and meaningful work for employees.

Gauging Patient Satisfaction

When it comes to patient satisfaction, a practice must be prepared to be both proactive and
reactive. Physician rating sites like Vitals.com and RateMDs.com are constant, permanent
reminders of how easy it is for a patient to leave a clinic and complain. Such negativity can
broadcast that the wait time was excruciatingly long, or that the physician’s bedside manner
leaves something to be desired. These rating sites are only growing in popularity. The most the
physician can hope to do is participate in the conversation and focus on listening to the message,
even if the details aren’t exactly as the physician remembers them. By actively engaging patient
feedback online, the physician will not only mitigate the likelihood of lashing out, but it will force
him or her to “confront the brutal facts.” Physician responses should not be specific, lest they
violate HIPAA regulations. Rather, physicians look at making comments as an opportunity to state
their philosophy on patient care, and further, acknowledge that they are listening and taking steps
to improve the patient experience. Logistically, we recommend that physicians make it the
responsibility of one person in the practice to monitor all online posts about their practice. This
should take no more than 15 to 30 minutes per day, including a report back to the organization of
what was published about the practice online.

But why should physicians wait for patients to leave their office before telling them how much
they are appreciated and ask for their feedback? Proactive steps should be taken to engage
patients the moment they walk through the practice doors. We recommend two simple things: 1)
a five- to seven-item questionnaire on an index card; and 2) a medical assistant asking one
additional question: “Is there anything else we can do to make your visit better?” Our patient
feedback survey can be found at http://www.boostmedical.com/services/surveys-and-patientfeedback.

The task of collecting this information should be assigned to the office manager and he or she
should enter the data into a spreadsheet. This will allow the practitioner to generate satisfaction
scores for each item and help identify areas for improvement. Additionally, the same manager
should take any specific feedback and share both the positive and negative results with the entire
staff during a weekly meeting. Staff members should be publicly recognized when they exhibit
behaviors that help deliver a better experience for patients. This kind of behavioral reinforcement
will, with time, have a dramatic effect on the way a practice responds to patient feedback, and will
let patients know that their practitioner cares about their well-being.

Employee Satisfaction

Feelings of pride and self-worth are critical to our happiness as human beings. Because we
spend at least one-third of our lives working, being unsatisfied with our job or career can have a
major influence on our overall happiness. In a medical practice, it too often can be the case that
we focus on a successful outcome rather than the process. When a physician performs a
procedure or diagnoses a patient with a complicated condition, it can be easy to forget that there
were a lot of pieces to the puzzle that put that patient in the same time and place as you. When
we instituted our “Anonymous Feedback Form,” I received disconcerting feedback that one of our
employees did not feel that her work made a difference. Because I believe in the mission
statement and vision of our company, I thought, “If this employee knew how vital her role is to the
success of our business, she would be proud to work here.”

This began a journey diving to the core of what our employees think, feel and believe about our organization, and their individual contribution to the greater whole. I began to ask myself: “Is everyone on the same page?” “Does every person—from the physician to the person answering the phones—know and understand the vision of the company?” and “Do employees understand their unique role in the whole picture?”

As the CEO, I would have to face the brutal facts in discovering the employees’ honest opinions. I
knew that these answers would be essential in moving our organization to further success. I had
a theory: If any employee who has contact with a patient is unhappy with his or her job, the
patient will feel the effects. And thus, patient satisfaction would decrease. Patient satisfaction is
most likely directly related to employee satisfaction, so improving one would likely improve the
other.

One of the things that make our organization unique is our physicians’ strong interest in research.
We have a PhD on our staff who spends most of his time doing business research and clinical
trials for our company. He put together a survey asking pointed questions about employee
satisfaction. This included work environment, knowledge of the mission statement, whether or not
the employee feels rewarded, and most importantly, whether the employee would recommend our
facility to their own mom or dad.

I sent an email to the organization expressing some of my goals, which included making our
company a highly desirable place to work, for each person to realize the purpose we serve in the
community, and to understand the value we bring to patients. The vision was clear: Completing
the survey would help us improve. I emphasized the anonymity of the form (which I hoped would
help ensure honest feedback) and provided the link to the survey.

I committed to presenting the results to the company within two weeks. Transparency is a key to
maintaining a healthy approachability with the employees.

Our Findings

The results were in, and the feedback was indicative of a young organization experiencing a
tremendous amount of growth in a short period of time. Some 54.1% of the employees viewed
their employment as a job, whereas 45.9% viewed their employment as a career. What’s more,
70% of employees agreed or strongly agreed that our mission statement is clearly defined. This
was good news to me. However, I want 100% of our employees to understand our mission. Also,
some 87% of employees agreed or strongly agreed that their work makes a difference on a daily
basis.

Further statistical analysis showed employees who see their work as a career versus a job, are
more likely to believe the organization is a good company to work for, feel that their work makes
a difference and believe in the organization’s mission. Moreover, it revealed that the more the
employee believes in the company’s mission statement, the more motivated he or she is to do the
job, the more he or she believes hard work is rewarded, and the happier he or she is in the
position.

Happy employees beget happy patients. A survey like this can be beneficial on multiple levels if
the information is used by improving processes, communication and overall morale. However, it is
important to realize that it takes time to make significant changes. Even in a young organization
like ours, people are creatures of habit and patience is needed to achieve true transformation.
My task was clear: I needed to make sure every employee understood the mission statement of
our company. Together our executive staff and I toured each facility, presenting each employee
with a card to carry with our mission and purpose statements. I gave a speech charging them to
take pride in their work and reminding them that they are each an important part of the big
picture. I was astounded that many of our employees had never heard our inspiring story. Each
employee now carries the card behind their badge and understands what it means to work for our
company.

It’s key to any organization’s success to have a realistic perspective of employee satisfaction. A
leader must look at the product of such a survey with the intent to produce positive change and
the perseverance to ensure results. It takes courage to examine the brutal facts of an employee
survey, but it is a necessary endeavor if one wishes to maximize the potential success of one’s
practice. Creating a happy, positive work environment for employees is an integral part of any
successful practice; sometimes, achieving this requires a willingness on the part of its leaders to
look in the mirror and confront the brutal facts. It’s always easier to look through a window than it
is to look in the mirror, but sometimes it is necessary to look in the mirror and realize that change,
although difficult, is necessary to improve the culture and success of your business. The results
are well worth it.

—Joe Carlon, MBA, Tory McJunkin, MD, Paul Lynch, MD, and Ryan Tapscott, PhD

Dr. McJunkin and Dr. Lynch founded Arizona Pain Specialists, a comprehensive pain management practice with
three locations, seven pain physicians, 10 midlevel providers, three chiropractors, on-site research and behavioral
therapy. They teach nationally and are consultants for St. Jude Medical and Stryker Interventional Spine. Through
their partner company, Boost Medical, they provide practice management and consulting services to other pain
doctors throughout the country. Joe Carlon is CEO of Boost Medical. For more information, visit ArizonaPain.com
and BoostMedical.com.