Before, During, and After


How to re-engineer the patient experience in your practice.

By Nitin Chhoda, PT, DPT

“It is not the strongest or the most intelligent who will survive, but those who can best manage change.” —Charles Darwin

Small changes to your patient experience, as opposed to sweeping, groundbreaking transformations can yield a significant benefit for your practice over time. In fact, the right patient experience begins even before the patient has stepped into your practice, and it continues well beyond discharge. The entire patient experience consists of three main components: before, during, and after (BDA). Collectively, these are the components that form the patient BDA continuum.

The “before” patient experience consists of the patient experience before they set foot in your practice for the first time. It includes the initial inquiry phone call, the scheduling process, the eligibility or insurance benefits verification process, the potential waiting room experience, the patient intake experience, call center phone conversations, and any experience the patient has before they see the clinician for the first time.

The “during” patient experience consists of the patient experience when they are in the practice. It includes the front desk experience (greeting, copay collection), the wait time and general experience immediately prior to the visit, the clinician and staff member conversation experience, the treatment, and the immediate benefit and improvement experienced while in the clinic.

The “after” patient experience consists of the patient experience between treatments and after discharge. It includes staff follow-up to ask about the during experience, home exercise programs and other remedies for added and ongoing benefit, appointment reminder experiences, billing inquiries and statements, and marketing and promotional interactions (newsletters, patient appreciation day invitations).

Improving on each component can be achieved fairly simply.

Transform the “before” patient experience

This is a crucial part of the process because it establishes the patient’s first impression of your clinic. A comfort level is determined within seconds of the initial call. During the first phone call, make sure that your front desk staff is supportive, helpful, and empathetic to the patient’s condition.

If the patient says, “I have low back pain,” you may not want to immediately ask, “What’s your insurance?”

Mock calls to your front desk and a random audit of your front office staff can help identify areas for improvement.

Scheduling appointments should be a simple, effortless experience for all patients. With the growing number of devices patients can use to access the Internet, more and more patients are looking for simple, convenient ways to schedule appointments without having to talk to anyone on the phone.

If patients are routed to representatives in a call center for scheduling purposes after business hours, the first impression begins with that phone call. Every person speaking on your behalf molds the patient’s perception of your practice.

Also, the eligibility and insurance verification process is confusing and intimidating for most patients. Make it easy for them by doing the hard work and tell them what their copay is, and if they are likely to see a bill from you. A simple explanation can put the patient’s mind at ease and significantly improve acceptance of treatment, as well as timely patient payments. An educated patient is a happy patient.

The ambiance of the waiting room creates a lasting impression. Is the waiting room neat and tidy? Is music playing in the background? Is it a comforting place? Are there pleasing fragrances in the air? Are staff members relaxed, attentive, and helpful? Are they checking their phones, messaging friends on Facebook, or chatting amongst themselves?

The patient intake, in general, takes a lot of time for patients and front desk staff. The objective is to gather specific details from the patient and verify the accuracy of the information. It is crucial that all details match with the patient record that exists in the database of the insurance company. Small, inadvertent mistakes can cause claim denials. These include, but are not limited to, errors in the date of birth, and misspelled names and addresses.

Transform the “during” patient experience

When the patient arrives at your clinic and receives care, they are in the middle of the patient experience. Is the patient greeted by the front desk and welcomed? Is the patient’s first visit a celebration and does it validate the patient’s decision to show up?

Think of your front desk as the barista at a coffee shop—welcoming customers to a unique and memorable experience. The front desk has to go out of their way to create a personalized and unexpected experience that goes above and beyond. Here is an example: “Hello, please be seated and we will let you know when the physical therapist is ready.” This greeting is not personalized, and it is exactly what patients expect.

A better example is: “Hi, Joanna, it is so great to see you! Was parking okay? While you wait, can I get you a cup of coffee or a magazine?” This greeting, on the other hand, is personalized and completely unexpected.

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Most patients expect to be seen at their scheduled time, or wait a few minutes. Long wait times can cause frustration and anxiety—and must be avoided. While the patient is waiting, do the staff members make eye contact with the patient at least once, and offer to assist in every way they can? Staff members are extremely busy helping other patients, taking phone calls, and managing the office, but it takes less than a minute to show the patient that help is available at any time.

The manner in which a patient complaint is handled is also important. An honest and prompt interaction with the patient gets the patient to know, like, and trust you. It demonstrates an acknowledgment of the problem and a reasonable effort to correct the problem while thanking the patient for the feedback. Here is an example:

“We understand that you are unhappy about __________. I am so sorry to hear this. To make sure corrective action is taken as quickly as possible, please tell us what we can do better for you next time. We value your feedback and are committed to improving your entire experience with us.”

The interaction with the clinician, and the experience of therapy is at the core of the “during” patient experience. This includes the evaluation, treatment, and home exercise program. It also includes the immediate benefit (pain relief, increase in range of motion, etc.) experienced by the patient in the clinic. They leave the clinic feeling much better. Understandably, this is the strongest part of the BDA continuum because it is the area that clinicians focus on the most. It is the time at which clinicians deliver and then monitor patient care.

As a side note, quick, compliant clinical documentation and streamlined billing is important for clinical productivity. The ability to transmit the claim to the billing software with one click is the foundation of streamlined billing processes. When a claim is sent to the insurance company quickly, the practice gets paid faster.

Transform the “after” patient experience

The moment the patient leaves your clinic or is discharged from your clinic, they are in the “after” patient experience. This is typically the weakest part of the chain in the entire continuum. Here are some ways to improve the “after” patient experience: If the patient is tired, in pain, or needs help, someone in the office should offer to walk the patient to his or her car—go the extra mile. In fact, offer to carry the patient’s bags or anything else they might have difficulty carrying. You can take this one step further: Have a staff member get the car keys from the patient and drive the patient’s car over to the entrance. Yes, I am talking about a valet service for your patients. Test it out with some of your senior patients, and you might be surprised by the immediate impact of the patient experience.

Every patient should get a phone call once a week after discharge for six to eight weeks. Again, this is a personalized and completely unexpected gesture. instance: “Joanna! I am just calling to check in to see how you are doing and to remind you to do your home exercise programs. You came to our clinic for ___________, and I wanted to see if you were feeling better. If there is anything we can do to help, please let me know. By the way, we are never too busy for your referrals. Please call me at ________ if there is anything we can do for you or ask your friends and family to visit our website at ________.”

Every patient should get a phone call once a month after discharge for three to four months with a referral reminder script: “Hi, Joanna! Just calling to let you know that we depend on word-of-mouth referrals from valued patients like you. We are never too busy for your referrals. So, if you believe you know someone who might benefit from our services, please let them know we are here.” A referral reminder script by email with a call to action is also beneficial. A sample script is: “Simply respond to this email with the name and contact information of someone you know who might benefit from our services, and we will take care of the rest. We will reach out to them and offer a no obligation consultation to help them improve their health and wellness.”

Another idea is sending a newsletter that reaches patients by email and regular mail twice a month. Also provide content that reinforces your authority as an expert, tells patients a little bit about you and your staff, and provides practical information on an ongoing basis.

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Other marketing or promotional interactions and special offers include inviting your patients to come back to your clinic with free trials of cash paying services, conduct regular “patient appreciation days,” and identify valid reasons to add value to patients. You will draw them back to your clinic in the process.

Do not forget to send appointment reminders by email, automated phone calls, and text messages. Also, handle patient inquires about billing; send patients simple, concise statements, and answer related questions to help patients understand their financial obligations.

For many practices, there are several weak links in the chain that can be improved quickly and with little effort. Compared to the ease with which these gaps can be plugged, the overall impact on the BDA continuum—and the increase in patient satisfaction rates—is exponential.

Small things can indeed go a long way. Strive to make minor changes to your practice every week and transform your BDA continuum in the rest of 2015 and all the coming years.

Nitin Chhoda, PT, DPT, is a private practice marketing consultant. He can be reached at nitin@referralignition.com.