3 things a restaurant taught me about patient satisfaction

A few weeks ago, my husband and I took my parents to dinner at one of my favorite restaurants. I was excited to go because the food is excellent and the customer service is top notch. In the past, I’d always had a great experience … until then.

That night, the restaurant was packed as they were offering half-priced desserts. My husband and I arrived first. I noticed when we ordered our appetizer that our waiter seemed to be in a hurry, but I didn’t think much of it. However, when he came back to take my parents’ order, they hesitated. As they took a moment to glance back at the menu, the waiter said, “Are you ready to order or not? I’ve got 4 other tables so I don’t have time to wait.” I was stunned. I remember thinking, “I can’t believe he just said that,” followed by, “He obviously doesn’t care if he gets a good tip.”

Fortunately, his attitude improved throughout the rest of our dinner. He did his job, and although I would never say he was friendly, he was competent. When it came time to pay the bill, my husband and I left an acceptable tip (he worked hard so we did not want to shortchange him.) However, it wasn’t the 20+% that we normally give. This got me thinking. What did this experience teach me about patient satisfaction, and what did I learn that I can share with you?

1. Patients come to us expecting to have a great experience. One reason providers distrust patient satisfaction is because they feel their patients are determined to find something to complain about. Although this may be true for a few patients, most patients enter our health care system expecting to have a great experience. They have had positive health care experiences in the past, so they see no reason why this interaction would be different. This is also how I felt. Based on my past experiences, I arrived at the restaurant expecting to have a great time.

Unfortunately, my waiter’s actions changed my perception. Instead of confirming what I felt was true, his attitude forced me to reevaluate my opinion of the restaurant. In this same way, our patients come to us believing that they will have a positive experience. Through our actions, we have the power to either confirm or destroy this belief.

2. We do have control over how our patients view us. Another reason providers distrust patient satisfaction is because they do not feel it is within their control. I have heard many providers express the belief that patients judge them based on preconceived notions that the provider is powerless to change. Again, this may be true for a few patients, but most patients are more open-minded than this.

In general, patients formulate their opinions of doctors in that moment, so we definitely have the ability to impact their views. When I walked into the restaurant, I fully expected to tip my waiter my usual amount of 20+%. However, my waiter’s negative attitude immediately changed my opinion of him. Prior to his comments, I had no problem with him. However, his words and attitude directly changed my opinion of him.  When it came time to pay the bill and evaluate his work, his tip was negatively affected.

3. Attitude is as important as competence. One final reason providers distrust patient satisfaction is because it asks us to concentrate on something besides clinical expertise. Patient satisfaction asks us to focus on how our patients feel and what they think. This is burdensome in the midst of a busy day. To be honest, I think that’s how my waiter felt. It was extremely busy and he was simply trying to make it through the day. Providing a pleasant customer experience was not his top priority. It was, however, one of mine. Don’t get me wrong … I definitely appreciate the fact that the restaurant was clean, my food was cooked properly, and that I never developed food poisoning.

However, when you think about it, those are basic expectations that every restaurant should meet. That’s how our patients feel about us. They expect all physicians to be knowledgeable and skilled, and they take this as a given. Instead, patients choose doctors based on things such as if we listen to them, spend enough time with them, and communicate in ways they can understand. These are all characteristics that patients care about. They are the fundamental principles of patient satisfaction.

In the end, I still love that restaurant and I would definitely go back again. However, if I end up having the same waiter, I hope he’s having a better day. If not, maybe I’ll slip him my card. I’m always happy to share a few customer service tips.

Trina E. Dorrah is an internal medicine physician and the author of Physician’s Guide to Surviving CGCAHPS & HCAHPS.

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  • http://thematthewreview.com Matthew Durham

    You are more forgiving and generous than I !

  • Trina

    Lol! Thanks. I think what helped more than anything is I’ve been there many times before and always had a great time. They’ve built up a lot of goodwill, so it takes more than one bad waiter to run me off. I think that’s the same for most patients. However, similar to patients who have repeated bad experiences, if I continue to have issues in the future, I’ll definitely find another favorite restaurant.

    Trina
    http://www.patientsatsolutions.com
    @drtrinadorrah

  • guest

    You know, I find it fascinating that at a time when workers, including doctors, nurses and restaurant servers are being expected to do more and more work, in less time, with fewer resources, that our administrators, like Dr. Dorrah, increasingly insist that we do so with 100% unfailing affability.

    Anyone in full-time clinical practice knows that the key to genuine patient satisfaction would be to give our patients what they really want: more time with us–their doctors and nurses. Of course, administrators don’t want to provide that, as it’s hard to maintain those sorts of staffing levels in a healthcare system like Baylor Scott and White’s, with 26 total “executive leadership” administrators all making salaries that are probably at a minimum $300,000.

    • Trina

      An interesting paradox: when doctors do not get involved in healthcare and leave it to non-clinicians, we become frustrated by the decisions non-clinicians make and lament the fact that physicians were not given a place at the decision-making table. However, when doctors step up and take on a leadership role on behalf of their colleagues, they are disparagingly labeled as “administrators”. For me, I’m actually both, but first and foremost, I am a practicing clinician. It’s impossible to improve your environment if you never work in it. However, I also gladly accept the responsibilities given to me to improve quality, safety, and the patient experience because I firmly believe doctors must have a say in this work. Passion is what drives me to do this, as I certainly have never seen a paycheck that comes close to the $300,000 you reference.

      To your point on our broken system, you are correct. There are many factors that have led to the point where we are now. However, one solution certainly isn’t to ignore what matters to our patients. As I repeatedly tell my co-workers, we are all patients. It’s not us against them. We are part of the them, as are our family, friends, and loved ones. Focusing on the patient experience does not mean that we stop working on improving our basic processes and systems. In fact, the two are interdependent. Broken systems lead to unhappy staff which leads to less satisfied patients.

      So I would encourage all doctors who have any interest in these issues to get involved in their hospitals and clinics to try to make a difference. The bottom line is, decisions are being made, but in my opinion, I’d rather know there are some doctors at the decision making table in addition to those administrators.

      Trina
      http://www.patientsatsolutions.com
      @drtrinadorrah

      • guest

        I absolutely concur that physicians need to take a seat at the healthcare table and become an active part of the administrative process, wherever they work. That’s why I am actively involved in both organized medicine as well as administrative work at my physician-led healthcare system.

        As such, I am very aware that administrators who focus primarily on RVUs and patient satisfaction surveys and make comparisons between our work and restaurant work (Cheesecake Factory, anyone?) are likely to be popular with non-physician administrators but unlikely to be seen as effective or inspiring leaders by those doing full-time clinical work.

  • http://www.CommunicatingWithPatients.com/ Edward Leigh, MA

    Hello Dr. Dorrah: Another outstanding article! Thanks for sharing. Your article reminds us that we could learn so much from restaurants, as well as hotels & other service-oriented businesses. On a related note, clinicians sometimes feel that we don’t have time for these niceties. How long does it take to be friendly?

    • azmd

      Actually I think what clinicians are objecting to is the idea that we should be substituting friendliness for high-quality, thoughtful care
      We are frequently not given enough time to do a thoughtful evaluation of the patient, and are even more freqently told that if we could only be affable enough throughout the encounter, we could charm the patient into not objecting to the fact that they weren’t getting a good evaluation.
      The trouble with this theory is that for many patients, no amount of friendliness will distract them from the fact that they know that they have just gotten a superficial assessment from a clinician who didn’t have the time to do a thoughtful one.

      • http://www.CommunicatingWithPatients.com/ Edward Leigh, MA

        Hello. I could not agree with you more! You are preaching to the choir. I work with hospitals & practices and understand the time constraints. Very challenging situation. In the 1980s, I started my healthcare work teaching medical students communication / interviewing skills. (Yikes, now I feel old!). I know we only have a limited amount of time with patients — I have been studying ways to maximize this time. Savvy interviewing skills and quickly engaging the patients are key elements. I also find coordination among the healthcare team is vital. For example, many medical settings I work in — multiple people ask the patient the sames questions (e.g., allergies, meds, etc). This is a very inefficient use of limited time. This is an area I study intensely and I could go on & on. Once again, I agree with you completely.

        • azmd

          All of that is true, but quite honestly speaking as a patient, not as a physician, I think that the bottom line is that a 12-15 minute visit is not long enough to accomplish anything of any substance, unless the patient’s problem is extremely uncomplicated (and of course some of them are).
          Could we wring more efficiencies out of the system? Probably. But until we do that, I think harassing physicians about their “patient satisfaction” levels and their “friendliness” seems to a lot of us to be a way that administrators have of taking focus off the things that they are really supposed to be accountable for, such as whether a healthcare system has processes in place that do allow for maximal efficiency.

      • http://www.CommunicatingWithPatients.com/ Edward Leigh, MA

        In working with healthcare professionals for 30 plus yrs on interviewing skills — I think the biggest time waster is not giving the patient sufficient time to fully explain their medical issue. Based on the vast research, the best approach is to ask a question and let the patient talk uninterrupted. Most patients tell their story within 90 seconds. The literature suggest saying “go on” instead of starting with rapid fire questions. Once the patient has fully present their story many of the questions are answered. Now it is time to fill in the missing pieces. Professionals who adopt this interviewing style report more time efficient patient meetings.

      • Suzi Q 38

        “……The trouble with this theory is that for many patients, no amount of friendliness will distract them from the fact that they know that they have just gotten a superficial assessment from a clinician who didn’t have the time to do a thoughtful one.”

        So true.

    • Trina

      Hi Edward,

      Thanks for your support. I agree that incorporating some basic principles of patient satisfaction doesn’t take much time. I used to feel otherwise until I shadowed one of my PCP coworkers who is one of our region’s highest producers in terms of RVUs, but also has some of our highest patient satisfaction scores. I was interested in his secret. In the end, it had nothing to do with giving into unreasonable demands or prescribing unnecessary medications/tests. Instead, it was the little things he did such as briefly asking them how their weekend was or taking a moment to acknowledge their suffering. He’s definitely efficient, but he still finds ways to incorporate things into his practice that matter for his patients’ experience. This is what I encourage providers to do when I work with them. There’s a long list of suggestions for things you can do to improve the patient experience. What each provider has to do is remember you cannot incorporate them all, so pick 1 or 2 that you feel you can consistently do that will make a difference to your patients and that won’t take up a lot of time.

      Here’s a quick example: while doing the physical exam, take a moment to tell patients what you find and learn from the exam. Saying something like, “You’re lungs sound great!” after your lung exam is quick and easy to do, and it helps the patient because it engages them. Think of it from the patient’s perspective…they often wonder what we hear as we examine them. Is everything okay? Did we hear something abnormal? This is just one example, but it shows how you can incorporate something into your workflow that improves the patient experience without adding a lot of extra time or effort for the doc.

      Trina
      http://www.patientsatsolutions.com
      @drtrinadorrah

  • Doug Capra

    Fine article — but I must disagree with your first point. I can’t claim to know the exact percentage breakdown (and I’m not sure anybody does) — but I would strongly suggest to you that a large number of patients, maybe the majority — do not come to clinics and hospitals expecting a great experience. Of course, much depends upon their condition and what kind of help they’re seeking. But too many patients have had negative experiences, some over many years — and this carries with them every time they enter a hospital or clinic. Those that have had positive experiences in the past, don’t always have a second or third positive experience. Many have had mixed experiences. But I like your basic point. I do think, however, medical professionals should not assume that most patients are expecting a great experience. At best, too many are frightened, confused, vulnerable, and just determined to tolerate whatever treatment they get. If you accept this, you’ll have a better chance turning their fears and concerns into a true positive experience.

    • Trina

      Hi Doug,

      Thanks for the response. I really like what you said about remembering that patients are frightened, confused, and vulnerable. This is something one of my colleagues personally challenged me to do more of, and it has certainly helped me as I interact with patients. You’re absolutely correct that when we keep this in mind and frame our interactions around this fact, you’re frequently able to provide an experience that patients perceive to be positive.

      Trina
      http://www.patientsatsolutions.com
      @drtrinadorrah

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