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Patient Service: Standards and Practices for Excellence in the COVID-19 Era

Analysis  |  By PSQH  
   July 03, 2020

During the pandemic, patients are also likely to rate their ambulatory service experience based on how carefully you protect them from exposure to COVID-19, and how well you prepare them for the changes those protections create during their visits.

This article was originally published July 1, 2020 on PSQH by Alexa B. Kimball, MD, MPH

As we hear the phrase “the new normal” frequently and work to understand what exactly it will mean for patients, providers, and our healthcare system, one thing is clear: COVID-19 has changed healthcare. While some changes may be temporary and immediate in response to acute crises, many changes are here to stay: increased use of telehealth, for example, and improved infection prevention practices both during patient visits and at home.

One thing that has not changed is providers’ desire to provide excellent patient care and service, and patients’ need to feel comfortable and well cared-for in the ambulatory environment. It is also still true that patients often judge the overall quality of their care based on the service experience at the hospital or office, and that perception is based on a comparison between their pre-visit expectations and their actual experience during the visit. During the pandemic, patients are also likely to rate their ambulatory service experience based on how carefully you protect them from exposure to COVID-19, and how well you prepare them for the changes those protections create during their visits.

With this in mind, here are five ways that you can make sure your patients’ experience will meet—and exceed—their expectations.

Pre-visit: Expectations and preparation

While pre-visit registration via telephone had become routine well before COVID-19, it’s important to have your registration staff well trained to answer questions and provide information about how the patient visit will differ due to the pandemic. When your office or hospital calls to remind patients of their visit or to pre-register them, devote a portion of the message or call to COVID-19 changes. For example, tell patients that they will be greeted outside by a professional who will take their temperature and ask them questions to pre-screen them for COVID-19 symptoms. Explain what will happen if they or another patient has a temperature or shows signs of the virus. Your registration staff should ask if the patient has any questions or concerns, and should confidently assure patients that the hospital or office is taking proper safety precautions.

Arrival: Greeting

Properly training the “greeting” staff (who greet patients to take a survey of any symptoms they might be experiencing and take their temperature) is essential. These greeters should explain what is happening in a friendly and calm manner. Recent stories of patients having a thermometer stuck on their forehead with only a “Hi” make it clear that some of us need simple training in empathetic patient service—even if it may seem obvious. If possible, patients should be given a disposable mask to use during the visit only, and should be asked to sanitize their hands before entering. The greeter should also give a brief introduction to what has changed as a result of COVID-19 precautions. Carefully explaining this initial screening, sanitation, and other processes that may have changed will go a long way in helping patients feel comfortable and secure during their visit. This introduction should create a team environment, emphasizing that everyone helps protect the vulnerable by wearing a mask, washing their hands, practicing social distancing, and using hand sanitizer.

During the visit: A sanitized ‘chain of custody’

With legal evidence, such as a stolen credit card with fingerprints on it, the prosecutor must show that the police kept the evidence secure from collection through trial, such that no one could tamper with it or change it. Similarly, ambulatory facilities should take a “chain of custody” approach: Having medical staff wear masks and change gloves often is not helpful if the office staff takes and hands back a credit card without changing their gloves or wearing any gloves at all. Each step of the visit should be “secured”: from sanitizing the waiting areas and restrooms, to setting up properly distanced seating, to making sure all interactions occur with proper PPE and sanitation, to considering what articles may move from room to room (including pens and clipboards). Small errors in handling undermine both the integrity of the process and patients’ confidence in it. It’s a good idea to do a mock run-through with staff to check for small issues, and to see how staff is interacting with patients and handling sanitation and other aspects that may have changed due to COVID-19. Finally, letting patients see the change of gloves or other sanitization methods that might normally take place after they leave will provide both a sense of security and a real difference in potential for virus spread.

During the visit: Making the patient feel comfortable

As healthcare professionals, we were taught to use body language, facial expressions, eye contact, and good listening skills to put patients at ease. This not only improves the patient experience, it also makes patients more likely to share important information about their physical condition. But wearing masks and other PPE makes communication via facial expressions and smiling difficult and less effective. Consequently, it’s important to supplement those nonverbal cues with verbal ones, helping the patient feel at ease with words in addition to a smile. And do smile! Even with a mask on, patients can see your smile through your eyes or other visual cues.

The details

With heightened stress and challenges during COVID-19, it’s especially important to manage operational efficiency and precision, staying on top of seemingly small details that can make a difference in patient experience. Ensuring that wait times are kept to a minimum while not making patients feel rushed is especially important, and while wait times cannot always be helped, clear communication regarding the expected wait is essential, particularly when patients may be distancing by waiting in their cars or other areas outside of the office. An office’s thoughtfulness in regard to safety can be seen in how patients flow through the office for the visit, with appropriate distancing through floor markers (as seen in grocery stores) and processes that can be conducted in the patient room to reduce the risk of exposure to other patients. Making sure that everyone in the office wears a mask properly (covering both their nose and mouth) conveys caring, as does making sure that hand sanitizer dispensers are available in multiple locations and are filled and working properly.

Like so many practices put in place to improve patient service, changes due to COVID-19 have the goal of improved patient care, safety, and experience. And as always, the first step in caring for patients is showing them that you care. At this time, it is especially important to have your organization and providers use complete safety precautions, and have procedures in place to consistently execute those precautions, while helping patients to feel comfortable with what is new and different.

Alexa Kimball is the president of Physician Performance LLC (PPLLC), CEO of

Harvard Medical Faculty Physicians (HMFP) at Beth Israel Deaconess Medical Center (BIDMC), and a professor of dermatology at Harvard Medical School.

Patient Safety & Quality Healthcare’s mission is to provide news, science, research, and a forum for opinion for clinicians, healthcare professionals, and everyone interested in improving quality in healthcare. Learn more.

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