Do you know what your staff is telling patients?

ByDavid M. Glaser, JD

I highly recommend you spend some time in the administrative section of your office, observing what is going on and talking with the employees. My next few blog entries will talk about ways in which this communication can help a clinic.

A few years ago, I took my son to a pediatric specialist. I dutifully paid the copayment, as the sign at the desk instructed. I later received a bill for the copayment. I was certain I had paid it, so I called and inquired about the bill. I was told, “Oh, this happens all the time. Our physicians are just visiting the clinic, so when you wrote the check it was cashed by that clinic. You will need to write us a check and call them and get your money back.” I was stunned.

Billing practices

I was on the phone with a good client of mine and their employee had just admitted that they, along with another client of mine, were regularly billing people for copayments they had already paid. Rather than apologizing and fixing the problem, they expected me to do the work. I had followed all of their instructions. My compliance would have resulted in a double charge had I not noticed. The clients had caught a break. But if the same statement had been made to a litigious person, reporter or someone who wanted to call attention to this behavior, then the clinics could have faced a major headache and possibly financial penalties.

Since the administrators at both clinics were friends as well as clients, I knew they would be shocked to discover this was happening. I called them both and related the story. The good news is they reacted as I expected. But the fact that these two competent administrators were completely unaware of a significant issue occurring in their clinic is highly instructive.

Employee behavior

The second story didn’t happen to me, but it happened to one of my clients. Imagine that a patient calls with a well-founded complaint and the person talking on the phone tells them “if you aren’t happy, go someplace else.” The client learned about it when a friend of the patient related the story to a physician at a party. The physician was shocked to learn about the staff member.

Further research led the physician to discover that the employee had a habit of “telling off” patients who the employee believed were unreasonable. The behavior was well known among the administrative staff, but no one wanted to “rat out” the employee. I had a similar personal experience. We hired a PCA who unbeknownst to us was regularly falling asleep on the job. Her colleagues all knew, but they only revealed this to us after we discovered it ourselves. It is important to understand how something that is widely known in the office can stay completely below your radar screen.

The problem can be particularly acute in larger clinics where administrative staff is geographically separate. The “secret shopper” idea that is so common in most service industries is not as easily implemented in the health care context. But taking the time to listen to interactions between your patients and staff is a valuable risk management tool.