Collaborating with Staff to Improve Patient Safety, Adherence, and Satisfaction

Risk management focuses on preventing errors, misunderstandings, and dissatisfaction among patients and staff. Oral & Maxillofacial Surgeons (OMS) can reduce liability risks by engaging in preventive strategies, such as helping office staff understand the contributions they make to patient safety, adherence, and satisfaction. Educating staff about these issues improves the OMS’ ability to work effectively with team members and the patients they treat.

Below are sample scenarios that highlight opportunities for improving the ways in which staff interact with patients.

Complaints About Office Policy

Mrs. Green arrives for her first appointment with Dr. Rodriguez. Receptionist Sarah Adams greets her as she signs in. Once the sign-in process is completed, Sarah gives several other documents to Mrs. Green. They include a medical history, a practice policy statement, and a HIPAA policy form.

“Oh no,” Mrs. Green says. “Not another HIPAA form!” “Well, I’m sorry, but I do need your signature on it,” Sarah replies. “Oh, for heaven’s sake,” Mrs. Green laughs. “It’s getting so you can’t even buy a cheeseburger without having to sign a contract!” “I know how you feel,” Sarah commiserates. “I’m the one who has to file all this stuff!”

If Sarah had understood the importance of the HIPAA policy in the example above, she might have responded differently. Rather than reinforcing Mrs. Green’s negative opinion about HIPAA requirements, Sarah might have said, “Our HIPAA policy does take a few minutes to review and understand, but I will be glad to answer any questions you have about this government requirement, Mrs. Green. It is important that you understand your rights to have your health information kept private and secure.”

Responses should always focus on what is best for the patient and lead to better patient understanding. In addition, staff members should emphasize the importance the office places on complying with the law.

Refusal to Cooperate with the Standard of Care

Ellen Baker is Dr. Smith’s receptionist. She loves her job and gets along well with Dr. Smith’s patients. However, Ellen is somewhat intimidated by patients like Mrs. Hawkins. When Mrs. Hawkins makes appointments for her children, she “doesn’t intend to waste time or money on unnecessary pictures!” As a result, the Hawkins children have not had X-rays in years. Ellen is not comfortable confronting Mrs. Hawkins; instead, Ellen notes in the children’s records, “mother refuses X-rays.”

In this example, Mrs. Hawkins creates a difficult situation by making firm pronouncements about the treatment her children receive. Unfortunately, her refusal of X-rays might be harmful to her children’s oral health.

Creating an X-ray policy for patients and informing new patients about the policy are strategies for preventing future occurrences like the one noted in this example. Staff also should be trained to explain and reinforce the value of X-rays and other treatments as part of the OMS standard of care.

Additionally, office policies should clearly define the practice’s approach to other situations, such as missed appointments, failure to follow home treatment protocols, refusal to see consultants/specialists, and nonadherence to medication orders.

Staff also should be encouraged to discuss difficult patients with the OMS. Together, they can engage in a discussion with the patients, or with patients’ parents, about office policies and the patient’s specific issues. By informing patients about various policies and ensuring staff members all take the same approach, OMS can reinforce a consistent and quality approach to care.

Defusing the Waiting Room

The Stewart family has four children — all boys. Mrs. Stewart brings all of her children to appointments and has them wait in the waiting room. Office manager Patty Lowe fears that the boys are disruptive to other patients and that their behavior may lead to an injury. She wishes that Mrs. Stewart would keep a better eye on the boys.

“Every time they come into the office, one of those boys gets hurt. They’re a big risk to other patients, too. And they set a bad example for other kids.” Patty wants Dr. Chen to discharge the family from his practice. But so far he has not done so.

Every OMS practice should have a policy regarding unacceptable behaviors. One element that the policy should cover is waiting room safety. The policy should address employee and patient safety — from physical and verbal abuse to roughhousing behaviors.

In most cases, a simple sign reading, “Indoor voices and quiet play behavior are appreciated” will suffice. However, as in the example above, some parents may fail to address the disruptive tendencies of their children.

In such instances, staff will benefit from knowing scripted remarks to use with children and parents to curtail the children’s rowdy behavior. Scripted comments should focus on patient safety and not on embarrassing the parent or child. Staff can remind the children to use indoor voices and play quietly.

They might focus on an individual child — “Michael, I’ll bet you are the fastest boy at school. The other kids probably want to follow your example and be able to run really fast. But here in Dr. Chen’s office, I need for you to set an example of how children can play quietly and safely so that no one gets hurt.”

Inappropriate behavior should be addressed early. If a parent does not intervene at the first signs of a child’s disruptive behavior, the staff should step in. And, of course, corrected behavior should be commended — “Hey, Michael, thanks for your help today.”

Training and Discussion

Periodic office meetings should encourage discussion of any problematic office situations. Staff members play a key role in identifying: (a) incorrect assumptions; (b) misunderstandings; (c) unrealistic expectations; (d) refusal to acknowledge boundaries; and (e) clinical nonadherence. Staff meetings are a good time to share these observations and agree on methods for addressing them.

As a group, it is easier to ensure consistency in the way that specific challenges are met. Also, office meetings offer an opportunity to practice challenging conversations — for example, asking Mrs. Stewart if she will encourage her children to have quiet time.

Training programs related to customer satisfaction and clinical standards are available from many professional societies and companies that provide customer service products and education. OMS also can contact their professional liability insurance companies for guidance on specific patient relationship challenges.

Conclusion

Working out appropriate ways to address office issues will build more effective relationships among staff members and providers, and staff will acquire a better comfort level in their interactions with patients and their families.

Further, developing preventive strategies to meet office challenges can help support patient safety, compliance, and satisfaction. A final benefit is that these skills also may help OMS reduce liability risk.