DNA Appointments (did not attend)


 

We all know how scarce hospital and doctors appointments are and what is more frustrating is the number of DNA’s (did not attend) appointments that are wasted day in and day out – week in and week out – amounting to hundreds every year. 

What does your surgery or hospital do to try to keep on top of DNA’s? Do you do anything at all?

Some surgeries and hospitals display in the waiting room the number of DNA’s in the month – and this can be pretty horrifying when you see just how many appointments are wasted.  But it does get the message over to people if they do not want their appointment please cancel it and let someone else have the appointment. But of course the people who did not turn up for their appointments do not see these statistics.

Some hospitals will send out a text message a few days before your appointment to remind you and if you do not want the appointment they ask you to cancel it. A good reminder especially if the appointment was booked some time ago, but this only helpful for those with mobile phones, perhaps not so good for some of the elderly that do not use such technology. 

I have even heard some doctors confessing that they “do not mind” the DNA’s as this gives them time between patients to “catch up”.

One surgery that I worked in decided to be proactive and look at the amount of DNA’s every month – the partners were shocked to find that there were several hours wasted over the month through patients not turning up for their appointments.

So, they decided that if a patient DNA they would write them a polite letter pointing out that they missed an appointment, and would appreciate if the patient could not make a future appointment that they phone and cancel the appointment.

If the patient had a 2nd DNA the doctors would write again, this time telling the patient it was the 2nd time that they had done this, and if they DNA again for a 3rd with without good reason they “may” be asked to leave the practice list. The letter would go on to explain the amount of DNA’s the surgery was experiencing and the fact that patients were experiencing problems booking appointments and this was not being helped by the fact that so many appointments were being wasted by patients not attending.

This seemed to work well. Patients that received the first letter would phone to apologise, some would just ignore it and receive a 2nd letter – but no one actually got as far as getting a 3rd letter so hopefully the exercise did actually do some good.

All was going well until……………………..

I received a call from reception. There was a patient on the telephone wanting to make a complaint. This obviously concerned me as I prided myself on the very few complaints that we had at the surgery and I was obviously concerned.

The receptionists put the caller through.

The lady was pretty angry. She had received a letter from the surgery regarding her not attending an appointment the previous week.

She went on to say she actually took the time to cancel the appointment the day before the actual appointment, she said that she realised that someone else could have had the appointment.

I asked her what day and what time she called and she confirmed it was on the previous Tuesday at 8.30 (one of our busiest times). I asked her if she could remember who she spoke to (this is way why we get Receptionists to give their names) she confirmed the name of the Receptionists she had spoken to.

I apologised for our error and said that I would look into it for her.

I went down to Reception and checked the rota; it confirmed that the Receptionist in question was actually on duty that day and she was actually on the telephones that same morning, which pretty much confirmed that the patient was correct.

I spoke to the Receptionist and she confirmed that she was on the phones that morning, and that it had been a particularly busy morning reception.  She couldn’t remember the call but she also said that it could have very easily happened – someone could have come up to her and her attention was drawn to something else.

If this had happened before (and more than likely it had) the DNA would have just gone by unnoticed – the patient thinking they had cancelled her appointment, the surgery thinking we had yet another DNA.

We spoke about this at our next Receptionists meeting, and the girls all agreed that it could be something that could have got overlooked, something that they all felt that they might have done at some point.

This didn’t cause any problems UNTIL we started monitoring the DNA’s and sending letters out.

So, from then we make sure that any patient that cancelled an appointment that it was done immediately so as not to have a repeat complaint.

You cannot be sending out such letters to patients that had actually taken the time and trouble to phone in and cancel their appointment.

I wrote to the patient apologising and admitting the error was on our part, and ensuring her that we had looked at our procedures and were making every effort in the future that it would not happen again. 

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Patient Care – Empathy


I watch a short 4 minute clip from you tube called Empathy from the Cleveland Clinic and would like to share it with you all. It really is worth a look.

As a Receptionist working in a Doctors Surgery, a Healthcare Clinic or a Hospital it is a reminder that behind every person there is a story.

 

http://www.youtube.com/watch?v=cDDWvj_q-o8&sns=em

The people in this film could have at one point spoken to you as a Receptionist on the telephone or at the desk.

We do not always know what is going on in people’s lives.

So perhaps if someone is a bit short or angry or out of turn with you or appears to be upset in any way they could be that they couldn’t get an appointment with the Doctor that same day, or angry that you cannot discuss their loves ones because of patient confidentiality, when people are upset, distressed and in pain they often hit out at others. They could have been someone in this film.

Knowing how to deal with a difficult / upset person at the desk is so very important – and being able to turn a negative situation into a positive one.

If you could stand in someone else’s shoes…..hear what they hear…..see what they see…..feel what they feel would you treat them any differently?

Patient Care – Empathy


I watch a short 4 minute clip from you tube called Empathy from the Cleveland Clinic and would like to share it with you all. It really is worth a look. As a Receptionist working in a Doctors Surgery, a Healthcare Clinic or a Hospital it is a reminder that behind every person there is a story. http://www.youtube.com/watch?v=cDDWvj_q-o8&sns=em The people in this film could have at one point spoken to you as a Receptionist on the telephone or at the desk. We do not always know what is going on in people’s lives. So perhaps if someone is a bit short or angry or out of turn with you or appears to be upset in any way they could be that they couldn’t get an appointment with the Doctor that same day, or angry that you cannot discuss their loves ones because of patient confidentiality, when people are upset, distressed and in pain they often hit out at others. They could have been someone in this film. Knowing how to deal with a difficult / upset person at the desk is so very important – and being able to turn a negative situation into a positive one.

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The Fed Up Receptionist


I had a friend who is a Doctors Receptionist phone me last night – she had the day from hell at work yesterday morning. The usual covering staff that are on holiday and then someone phoned in sick – she quite understands that it happens and like us all support her fellow team members.

She is a great receptionist, hard-working and extremely good at her job.

Her role yesterday morning was answering the phones. All Surgeries have different systems, at my friend’s surgery they have 3 girls on for the first couple of hours each morning answering the telephone in the upstairs office, that leave the girl in reception to deal with the patient during the busy clinics.

Yesterday due to sickness and holidays it only left 2 of them upstairs answering the telephones. She told me it was unusually busy for a Thursday morning and what didn’t help was they were a doctor short due to illness and could not get a locum in time  to cover. Any doctor’s receptionist/manager will completely appreciate this situation. Another member of staff had to phone patients to cancel appointments or fit them in with the other doctors – appointments were very short. She said the phones did not stop ringing. They could not answer them quick enough.

My friend answered one of the many telephone calls to a very irate patient. He was fuming – complaining that he has been kept waiting – he complained that phone just ringing and ringing – he even had the cheek to ask her if she was off having a tea break. That did not go down well with her as she did not get a tea break that morning.

The patient then said that he needed an appointment for that morning – he had an insurance form that he wanted the Doctor to complete. My friend explained that they only had limited appointments and they were for emergencies only. The patient said that it was an emergency. My friend explained that the surgery policy was that insurance forms should be left at reception and be collected a few days later. She “tried” to explain to the patient that the Doctors have many forms to complete on a daily basis and not something that they would do within surgery time. The patient was not happy.

The patient started getting quite abusive, the phones were ringing and my friend was conscious that they needed to be answered. She said she tried to reason with the patient again and he continued to be rude – so she did something that she should not have done – she put the phone down on him.

When she spoke to me she told me she knew had done wrong, but she felt at the end of her tether – she admitted that she almost got her bag and gone home. She asked what I thought.

My reply to her was

As a receptionist she should never get herself into a situation like this again. Whilst I could understand why she felt so angry with the patient, and there was no excuse for his bad behaviour I could understand the patient’s frustration with the unanswered telephone.

I told her that it would be very possible that the patient might make a complaint against her. I asked her if she had spoken to her Practice Manager about the incident. She said she hadn’t. I suggested she should have spoken to her Practice Manager. I asked her if her surgery had an incident report form she could have completed. She had no idea what I meant. I explained to her the benefits of such a form – here is what the form is :

The Incident Report Form http://wp.me/p1zPRQ-6o

From a Managers point of view – if I had received a complaint from the patient – I would have been horrified to hear that one of my receptionists had put the phone down. I would have probably called the receptionist in and this would have caused bad feelings – because in my experience calling in a member of staff to tell them there has been a complaint made against them never gets off to a good start, and of course you only have one side of the story to go on. Often the receptionists feel that they are not supported when a complaint is being made against them.

As a receptionist is she had of spoken to her Manager it might have highlighted some of the problems they were having answering the phones that morning. I asked my friend what the set up in the office was.

She told me that they had 3 incoming lines into the office, one for each girl to answer, of course they had one sick that morning so therefore had 3 incoming lines but only two receptionists answering the calls.

This resulted in one line ringing until it was answered.

She told me that there surgery policy was that phones had to be answered within 3 rings – the reason someone might be calling with an emergency. So, WHY were the receptionists left with one phone that was not being answered?

I suggested to my friend that she should have spoken to her Practice Manager about the incident. That they should look at their procedures  in the event of sickness or shortage of staff.

I suggested that perhaps she spoke to her Practice Manager today, to explain what had happened, and perhaps suggest that when there are only two receptionists answering the telephones that the third line is busied until the calls calmed down somewhat. Or, that they get a third member of staff into the office to help take the calls.

Perhaps notices should go up in the practice advising patients that any forms that need completing by the Doctor will take so many days to complete. This could be also included on the surgery website and any practice newsletters / brochures that go out to patients.

As a manager it is important to know what is happening in each area of your practice – when there are staff holidays and sickness other staff are taking on extra responsibilities, and often stress levels rise.

You can’t tell your staff that phones have to be answered within 3 rings yet let a 3rd phone line go unanswered. From a patients point of view they think that no one is bothering to answer the phone – this causes bad feelings and possible anger from some. This does not help when your staff are busy trying their very best. It just leads to bad feelings all round.

If a patient is phoning in with something urgent (possible heart attack or similar) if they get a ringing tone they will hold on, and on – panic sets in – how long do they hold for.

But, if the patient phones in and gets the engaged tone they know the surgery is busy – and then hopefully they would take other action and phone 999 – don’t let your surgery come under criticism that there was an emergency and the phones were not answered.

My advise to my friend is not to leave it as something similar will happen again. To speak to her Practice Manager and hopefully find a solution to the problem.

“I want an appointment NOW”


Before I started working at the Surgery I thought a Doctor
was just a Doctor. If you were ill you would go and see one of the Doctors that had the nearest available appointment. I soon learned how wrong I was.

We had 6 GP in the Practice that I first started working in.
Each and everyone one of them was different in many ways. Some patients would get
along better with one Doctor more than the others – and the same with the
Doctors – some patients for whatever reasons just used annoy the Doctors– but given
the professionals that they were never showed that side to the patients.

In my first few weeks I used to wonder why some patients
would only see one pacific Doctor and would wait up to a week for an appointment
with them – and the patients would climb the walls if their Doctor was on
holiday or fully booked – you would have thought that the patients world had
almost come to an end – they would just refuse to see anyone else.

There was one occasion when a patient phone for an
appointment to see Dr Stafford – I explained that Dr Stafford was not in surgery that day and was fully booked for several days ahead and then he was on holiday the following week. I offered the patient the next available appointment with another Doctor in the practice. The patient was   not happy. I could sense his blood pressure going up and that was over the phone. He explained that he HAD to see Dr Stafford THAT day as it was URGENT. I explained again that Dr Stafford was not in surgery that day and I would put him in with the Doctor that was running the surgery for “urgent” appointments that day – he was having none of it. He then started shouting at me down the phone – accusing me of “refusing” him an appointment adding how he had found me rude and unhelpful. (I might add I was never rude at any time to him)

I had to make sure that the patient understood that I was
not refusing him an appointment – but just not able to give him one with the
Doctor of his choice. I calmly repeated that I could give him an appointment
that morning with Dr Paul but the patient continued to shout down the phone to
me. I politely asked the patient not to shout – and explained that I was trying
to help him – he was having none of it – and his parting words were “so that’s
it then – you have refused me an appointment – so it’s on your shoulders if I
die then” and slammed the phone down.

Unfortunately we did get some calls like that – but thankfully
they were very few and far between. The first couple of times that happened I
worried myself sick. But soon learnt that as long as I was clear in my words
and offered the patient an appointment to see a Doctor there was not a lot more
I could have done. It was the patient’s choice not to take the appointment
offered to him.

But what I would do was document the call – I would make a
brief record on the patient notes that he called for an appointment with Dr
Stafford, was offered another Doctor due to Dr Stafford being fully booked and
the patient refused. I always put the time the call was taken too. I learned
very quickly to always cover yourself in any such incidents. If in the event
that something had happened to the patient – and he had told someone that I had
refused him an appointment where could that have gone? So I always documented
anything that I felt could come back at a future date.

Then I slowly began to see why some patients preferred to
see some Doctors more than the others. Each Doctor had their own area of expertise.
We had one Doctor that was fantastic when it came to anyone that had a bad
back. Another was excellent in skin conditions another on sports injuries and
one that was excellent with children – he actually still did some work in the
local  pediatric hospital. A lot of GP’s actually do clinics in their areas of
expertise in local hospitals.

It then made sense to why certain patients would only want to see one Doctor – and I could see the logic behind it.

And there were also some patients that for whatever reason
did not see eye to eye with certain Doctors in the Practice and would point-blank
refuse to see them. Difficult when at times these Doctors would be the only one
with an available appointment. Just like my story above.

One piece of advice I would give new Receptionists over the
years was when someone did have a go either over the phone or at the front desk
to try to not take it personally – because the angry person was not actually
directing their anger at them personally it was directed at the “Receptionist”
and if any one of us was standing there they would have had exactly the same
complaint. I found that this helped me in the earlier days when I felt that
they were shouting at “me”.

And to remember – patients are not customers. Patients are
often in pain, worried about themselves or loved ones, frightened or at times might
have a mental problem – and all Receptionists should remember this at times
when patients show their anger – I am not saying it’s right  – but we do have to take it into
consideration.