Patient Access – Appointments


imagesCAUP3U1D“Improving patient access” is all something that we hear about on a daily basis. It constantly being discussed at all levels, Partner meetings, Reception Team Meetings and Multidisciplinary Meetings. There is no one working within the NHS who is not aware of this.

As Managers we all strive to make patient access the best we possibly can. Often systems are changed to try to accommodate patients, yet still we hear people complaining that they are unable to access appointments for days at a time.

Not having appointments can often cause frustration not only from the patients, but from the Receptionist Team too, they often feel that are unable to do their jobs and often having to deal with difficult situations because some patients can become aggressive.

I decided to be proactive and look at the amount of DNA’s we had at the surgeries I managed. We had over 30,000 patients and I was shocked when I realised just how many hours were being wasted on a daily / weekly / monthly basis by patients for whatever reason not attending their appointments.

Patients are often the cause of the lack of appointments. It is not acceptable to just “not turn up”.

But what can we do to improve DNA’s? What does your surgery do to try and keep on top the wasted appointments?

Some surgeries (and hospitals) display in the waiting room the number of DNA’s each month, and this can be pretty horrifying when you see just how many appointments are wasted in this way. But of course the people who did not turn up for their appointment do not see these statistics.

Some hospitals will send out a text message a few days before an appointment, thus giving the opportunity to cancel if the appointment is no longer needed (also a good reminder if the patient has forgotten) This system will only be helpful for those with mobile phones, perhaps not so good for some of the elderly that may not use mobiles.

Some hospitals are now sending out reminder letters a week before the appointment, again helpful when the initial appointment might have been made some months before.

Adding something to a Surgery website is another way to encourage patients to cancel unwanted appointments, you could also display the DNA’s for the previous month.

Practice Newsletters is also another way of encouraging people to cancel rather than just not turning up.

We did a trail at one of our surgeries. When a patient DNA their appointment a letter was sent to them pointing out that they missed their last appointment, and the practice would appreciate if they could not attend a future appointment could they please phoned and cancel the appointment. The letter would go on to explain the amount of DNA’s the surgery was experiencing and that patients were having problems booking appointments.

Another surgery I know of has a system in place, that they feel works extremely well and have been getting positive feedback from patients and the Receptionists. They have over 25,000 patients, and have their fair share of DNA’s. They found the amount of DNA’s they were experiencing each day was getting increasingly frustrating for the staff. The Reception Team Leader started getting the Reception Team on the late shift to phone the patients who had DNA that day to ask the reason why they had not attended their appointment. They make the call as friendly as possible; the call is not made with “all guns blazing” or “pointing a finger” at the patient for not attending. The Receptionist simply asks the patient did they realise they missed an appointment today, and would they require another appointment. They found that most patients were extremely sorry for missing their appointments, and some genuinely did forget, but more important it made the patients aware that the Surgery was monitoring the appointments. Since starting this system they have found that their DNA has fallen.

The most important thing when doing this is when a patient cancels an appointment that IT IS CANCELLED. Often for whatever reason if appointment stays on the screen, despite the patient cancelling the appointment it could result in a letter or a phones call going to the patient.

This unfortunately happened at our surgery, a patient was sent a letter when she had in fact cancelled her appointment, and understandably was quite upset when she received a letter. If this system was to work it is essential that every single Receptionist understand the importance of cancelling appointments on the screen – in not doing so could result in the surgery receiving a complaint.

By highlighting the amount of DNA’s in these ways it lets your patients know that you are monitoring your appointments system – especially for those patients that just have not “bothered” to cancel their appointment.

It could also flag up that patients are perhaps cancelling, but for whatever reason they are not being cancelled on the system – which could indicate a training need.

Are appointments being booked too far in advance (i.e 6 monthly BP checks, diabetics checks etc) if so how can you best deal with this? Could you use the texting system to remind patients a few days before their appointment?

I am always in favour of giving out appointment cards especially to the elderly. Always remember to put the day as well as the date on the card along with the time.

Monitoring DNA’s will flag up those that repeatedly fail to attend.

Always approach patients about DNA’s in a positive way. Explain that the Surgery is trying to look as the amount of DNA’s and at ways of decreasing these and feedback on why they DNA would help with the exercise.

Explain if patients cancel their unwanted appointments then this will free up more for other patients – which could be them.

And when a patient does take the time to call the surgery to cancel an appointment, the Receptionist should always thank them for taking the time to do so.

Patients have to be made aware that by not cancelling their appointments it just adds more pressure to the already busy system.

© 2011-2017 Reception Training all rights reserved

 

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A Patients Experience – Would you complain?


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A patients experience is such an important event be it an appointment at the Doctors Surgery, an outpatient’s appointment or a stay in hospital. Every patient should be treated with respect.

So why is it I hear of such horror stories – few I am pleased to say, but the few are few too many.

Every patient should be treated with respect. Lets face it everyone single one of us are “patients” at some time in our lives.

“Treat people as you would expect to be treated”

Sadly I heard of an experience that I certainly would not like to face let alone any member of my family. This happened to my friends mum recently in our local hospital.

My friend’s mum has recently had major surgery; she is in her 70’s and has a stoma bag as a result of her operation.

As you can imagine she is struggling in many ways to come to terms with this, getting over a major op, being away from her home and the environment that she has known for so many years and of course the fear of what lies ahead, the results from the op she is yet to be given. Her world at this moment in time has just been turned upside down.

This woman has only ever been in hospital to have her children, so operations, and hospital procedures, follow-up appointments, hospital staff and patient care is all very new to her.

My friend took her mum to outpatient’s appointments where a nurse attends to the stoma bag. They have always been treated with respect, and the care has always been good, as it should be – until the other day where they experience was far from “good”.

The nurse that dealt with my friends mum was far from gentle, hurting her as such took off the stoma bag, ignoring the patient as she winced in pain. My friend has to say something to the nurse.

My friend noticed that the nurse didn’t have any gloves on, she asked why she wasn’t wearing any and the nurse replied that she “didn’t like wearing them”

On taking off the stoma bag the nurse screwed up her face and made a comment about the smell – the patient was made to feel so embarrassed. My friend felt awful for her mum sharing her embarrassment.

The nurse stood there arching her back complaining that it was sore, and how she had been on her feet “all morning” – it was only 11.00 am.

The nurse then asked the patient what treatment she was having for her “cancer” – she looked at her daughter with panic on her face – the look asking, “have you not told me something”? The patient has not yet had the follow-up appointment with the consultant and as yet not had any results. She and her daughter are now convinced that the nurse seen something on her records.

My friend was far from happy about the treatment her mum received, but the fear of a complaint coming back at her mum while she is still receiving treatment has made her reluctant to speak to someone regarding this awful treatment.

She fears that if she complains about the attitude of this nurse that her mum might suffer because of it. She asked me what I felt she should do – I told her she had to do what she felt was right, I didn’t feel that I could put my hand on my heart and say by complaining that this wouldn’t come back on her mum – and how very sad is that.

It is important that people should have the freedom to share their concerns, and when they do that they are dealt with appropriately and in confidence and made to feel that they or their family will not be treated in any way different by doing so.

Each organisation should therefore have a good system put into place for such incidents. To have appropriate systems in place to deal with staff that have had a complaint made against them. To then follow the complaint through and if needed further training identified for member of staff concerned.

No one should ever be made to feel uneasy by speaking up – they should have the right to be heard.

 

© 2011-2017 Reception Training all rights reserved

A message about visiting A&E


I seen this and thought I would share with you all. Its funny, but also right to the point.

 

http://m.youtube.com/watch?v=ffT1orYXdcI&feature=youtu.be&desktop_uri=%2Fwatch%3Fv%3DffT1orYXdcI%26feature%3Dyoutu.be …

3. DNA and the Patient’s Experience


I have had several people contacting me regarding my posts on DNA’s.

The first blog I did was the impact DNA appointments have on Hospitals and Surgeries.

The second blog was in response to a comment made by a Reception Team Leader and how her surgery is proactive in dealing with this problem, which I might add I think is a great system.

This the 3rd blog on DNA’s is from a patients point of view.

Someone contacted my regarding DNA’s and how this impacts on the health service resulting in people having longer waiting times for appointments.

This lady had a hospital appointment a couple of weeks ago, she realised the week before that due to unforeseen circumstances she was unable to keep the appointment the following Monday afternoon, and working in the healthcare sector knew how important it was to cancel the appointment and give someone else the chance of the appointment.

On the Wednesday the week before her appointment she tried to call the consultants secretary to cancel the appointment.

She was greeted with a recorded message saying that the secretary was on holiday and the secretary actually said in the recorded message there was no facility to leave a message. She asked that people call back on her return in 10 days time.

Obviously this would be too late to cancel the appointment. So this lady phoned the hospital and asked for outpatients department, the switchboard put her through and it rang and rang and no one answered. So she had to phone the main switchboard back again. She explained that no one was answering in outpatients, but she was put through again anyway – and again no one answered. So, she had to phone back yet again, she explained about wanting to cancel her appointment, before she could say much more she found she was put through to the “secretary” again, and heard the message she originally heard – and the fact she couldn’t leave a message!

She gave up at this point and left it until the next day when she tried again. She said that she was put through to several different departments, no one wanting to take responsibility for the call she was even told to phone the secretary on her return in 10 days time. She explained that the appointment was in fact in 4 days time and wanted to cancel it and not have a DNA against her name.

She got nowhere – so tried again on the Friday – the same run around.

Monday morning the day of the appointment she phoned the hospital and finally got put through to someone – she explained that she was unable to attend her appointment that afternoon and could they cancel it and ask the secretary to send her out a new appointment.  After taking the woman’s name said she would.

Two weeks went by and this lady had heard nothing so she telephoned the consultants secretary who was not back from her holidays – and to no surprise she found that they appointment had NOT been cancelled, she in fact had a DNA against her name, and the secretary did not get the message about her wanting another appointment made.

To say she was fuming was an understatement.

So, in order to get the DNA rates reduced it takes time and effort from all involved.

Patients have to be more responsible for cancelling appointments and this needs to be dealt with in a delicate manner.

Surgeries and Hospitals need to ensure that if a patient does cancel their appointment that it is recorded and cancelled and the patients does not received a DNA against their name.

Hospitals and Surgeries cannot moan about the amount of DNA’s they have unless they have a policy in order that will actually deal with this when the patients requests to.

And systems have to be in place that these messages are getting through to the right people.

The lady involved felt that no one wanted to listen to her – the operator just didn’t listen to what she was saying which resulted in her being put through to departments that if she had been listened to could have been avoided.

I would suspect that most patients after the first 2 or 3 phone calls would have simply given up trying to cancel the appointment.

My Live BBC Radio Interview on Being A Doctors Receptionist


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Last Thursday I was approached from BBC Radio via my blog to do a live radio broadcast in response to a broadcast the previous evening. The previous evening there was a GP speaking about patients and the “stiff upper lip of the British” and that they should go and see their Doctor “sooner rather than later”.

The radio station received several replies from some “unhappy” listeners saying that they have often found it difficult to get appointments at their surgeries. They mentioned lack of appointments, and rude Receptionists.

I was asked along to talk about the role as a Receptionist. Whilst I didn’t have enough time to answer some of the emails sent to the radio station I would like to share a couple with you and what I feel would be a response I would have made.

LETTER FROM A MALE LISTENER

Sender’s message

“Stiff upper lip? Certainly not.

Over crowded surgeries, unapproachable doctors (and receptionists) creaking overloaded health service not working on a Saturday YES YES YES”

My response would be

I agree that surgery clinics can often be extremely busy. Practices do acknowledge this and will try all avenues to spread the various clinics over the day/week. As the healthcare service continues to expand into general practice unfortunately the surgeries get busier. Many Practices offer baby clinics, various Nurse Clinics, minor surgery clinics, Health Visitors Clinics and many more and are often scheduled to run outside normal Doctors appointment clinics. Most Surgeries these days do have extremely pleasant waiting areas. Patients often have TV’s or a radio in the waiting room, magazines to read, an area for children, water drinks dispenser and other items  hopefully making  any waiting time as pleasant as they can. Many also have free wifi. Unlike not so long ago when you just had a waiting room and nothing else.

A busy surgery is often one that is offering several different healthcare services under one roof meaning patients do not have to travel to their local hospital for treatment.

Just because you might “see” a busy or “crowded” surgery does not mean it is not being run efficiently.

It saddens me to read that the gentleman finds the doctors and receptionists unapproachable – to this I cannot comment as I don’t have pacific details , if I was dealing with this gentleman at my surgery I would be asking in what way he found them unapproachable and would deal with it from there. Of course he also has the choice to move to another surgery if he is very unhappy with his present practice.

And as for not working on a Saturday – many surgeries that I know of certainly do work on a Saturday morning. But, is this gentleman aware that there is always the out of hours service and they are there every evening and weekend after the surgeries have closed and therefore he has access to either speak or see a GP or healthcare professional 24/7. Many surgeries are now open to accommodate people who are working and often open from 07.00 through to 20.00 – 5 days a week. A pretty good service I think!

LETTER FROM A FEMALE LISTENER

Sender’s message

I phoned for an emergency appointment when I realised I was suffering from depression. I was so distressed that I blurted out that I had been having suicidal thoughts. The receptionists’ response was to repeat “sorry to hear that, you’ll have to phone back in the morning”.

My response would be

The patient I am sure was pretty distraught by this conversation. Only she knew just how bad she felt – the Receptionist had no way of knowing how bad she actually was – but she was saying she was having suicidal thoughts – bad enough in my opinion.

.My advice to her if she was refused an appointment was to ask if she could speak to a Doctor. In the event that there was no Doctor available to speak to her she should ask to speak to the Practice Manager or someone else in charge. As a patient if you feel that it is urgent enough that you need to see a Doctor that same day and the Receptionist cannot offer you an appointment ask to speak to someone about it or ask for a Doctor to call you back.

 As a manager I would be alarmed if this had been a Receptionist at my Practice but I feel very confident that this would not have happen. All of our Receptionists would have received training in dealing calls similar to this.

This should never have happened. What is to say that there would not have been an appointment the following day? Why ask her to phone back again only to be told there are still no appointments.  The patient requested an urgent appointment. That needed to be taken into consideration straight away. The Receptionist didn’t even have to ask why she needed the appointment, the patient explained why she needed the urgent appointment.

Someone suffering with depression and admitting that she was having suicidal thoughts should have had alarm bells ringing.

If the Receptionist really could not offer the patient an appointment that same day she should have tried her utmost to either speak to a Doctor or nurse and ask their advice. In the event she was going to get a Doctor to call the patient back the Receptionist should not have let the patient end the call without taking a contact number first. (Even if the patient has a number on her records always check – because it has happened many times that patients change their telephone number and do not notify the surgery)

If Surgery had finished and perhaps there was no doctor on the premises (lunchtime) then the Receptionist should have called the duty doctor for advice.

Receptionists are dealing with calls like this on a regular basis, especially for “emergency” and “same day” appointments, it is a difficult task for them as they only have so many appointments that they can offer to patients on a daily basis. A good Receptionist will often be able to give a helpful solution to the patient by either offering an alternative appointment/day or perhaps offering an appointment with another healthcare professional i.e. the nurse or getting someone to call the patient back.

But at the end of the day if the patient insists they need an urgent appointment and the Receptionist is unable to give them one then the Receptionist needs to speak to her Senior Receptionist or perhaps a Doctor for advice.

And then there was a letter from a listener that goes to show that there are many patients out there that are more than happy with the service that we give.

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LETTER FROM A MALE LISTENER

Sender’s message

Can I – as a patient – stand up for those receptionists who are anything but rude, especially those in our local surgery in Hillsborough, Co. Down who are simply exceptional. As a family with two young children we have all had our fair share of visits and always been treated with the utmost courtesy and care.

My response

Whilst we take on board the negative comments , and hopefully deal with them in the appropriate way, it is always nice to get positive feedback. You don’t know how much that means to staff to hear that they are appreciated and the job they are doing are doing it well. Everyone thrives on good feedback.

Thank you.

As a Receptionist and a Manager I am still always overwhelmed at the positive comments and feedback that we get on a regular basis from the patients. This is what makes the job so very special.

 

What To Say And What Not To Say To A Grieving Person


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As a receptionist you will deal with the death of patients. It is often very sad when say a young patient dies, a teenager that had their life in front of them taken away, a parent leaving a young family behind, or the elderly patient that used to come in with cakes every week for everyone – we all have our favourite patients and their death no matter what age can often be very sad and have a big impact on many staff within the practice.

As a Practice are you the Receptionists made aware of patient that has recently died? Are you informed of such or do you just find out by chance.

It is important that you are giving such information as you often will be the first person that the grieving person will be talking to. How you handle that telephone call or face to face conversation will made a big impact on the grieving person.

For a new receptionist this could be the first time that they are faced with such an incident. At your practice do you have policies for such a delicate issue? Family members of the deceased will be coming into the surgery to pick up death certificates, and to perhaps see the doctor.

As a Receptionist how would you deal with this?

I asked new Receptionists this very question and some felt comfortable that they could approach the person and give them words of comfort. Others would often say “I would not know what to say” and “I would be afraid of saying the wrong thing so therefore would not say anything at all”

As a Receptionist you could be the first avenue of comfort to the grieving person. No longer are the excuses “I don’t know what to say” or I’m afraid of saying the wrong thing” acceptable. Some people might say “Ignorance is bliss” but when it comes to consoling the bereaved, ignorance is certainly not “bliss”

In your role as a Receptionist would you say something to the grieving person or would you not feel confident enough to say anything at all?

Often people want to say something to the grieving person but are unsure of what to say so will actually not say anything at all in fear of upsetting the person.

Remember, grieving the loss of a loved one is the worst pain that someone can endure. Be respectful and polite. Don’t discount anyone’s feelings. Even if someone puts on a brave face and looks like they are handling it well, don’t assume that the person is.

Show that you care.

Here are some suggestions at things that you could say to someone who is grieving

  • I am so sorry to hear of your loss.

Making an acknowledgement that you are aware of their loss will mean such a lot to the person. This often is the simplest and most effective thing to say. It also shows respect

  • You and your family are in my thoughts

Especially if you know other members of the family.

  • I can’t imagine how painful this must be for you

You can’t begin to know how this person is feeling, even if you have lost someone yourself in your life, everyone deals with grief and loss in different ways.

  • She/he was so nice – she/he will be missed by so many people.

If the person that has died was special to you or any of your team in any way – share that with the person – tell them how special they were, share a story if you have one like they used to bring you cakes in each week, or they always had a smile on their face when they came to the surgery. This will be a comfort to the person listening.

Here are some things that you should not say to someone who is grieving

  • Do not say – “I know how you feel”

Its simple  – you have no idea how they are feeling. Losses cannot be compared.

  • Do not say – “You’ll get through it – just be strong”

At this moment in time the one thing they do not feel is strong.

  • Do not  say – “don’t feel bad”

Of course they feel bad and it’s totally normal to do so.

  • Do not say – “I understand”

You cannot possible understand how that specific individual is handling their loss.

  • Do not say – “Time will heal all wounds”

Because for the grieving individual, imagining life without their loved one is, well, at that point unimaginable.

  • Do not tell the person how you would feel in their place

They just don’t want to hear it – or need to hear it. It’s not about you!

  • Do not say – At least they didn’t suffer (in the event of a sudden death)

It certainly didn’t make it easy on the person standing there in front of you and at that moment in time it is no comfort to them. They are still grieving their loss.

  • Do not say – He/she is in a better place

What they person would pick up from that message is – better than here with me!

The common thread in the statements above (and many more like them) is that while most may be said in an attempt to comfort, absolutely none of these statements will console anyone.

As Receptionists I am sure that you are compassionate and you do deal with the bereaved in a professional manner. But it is important that when any new Receptionist starting at your Practice has appropriate training in this very delicate matter and that they get it right.

And most important if the grieving person does not want to share, then you should respect their wishes and give them some space. You have done your best to show your respect for their loss.

Other posts in this subject

Patients: The Good, The Bad and The Ugly.


The events described in my blog are based on my experiences as a Receptionist and  Manager. For obvious reasons of privacy and confidentiality I have made certain
changes, altered identifying features and fictionalised some aspects, but it remains an honest reflection of life as a Receptionist and Manager working within the Healthcare  sector.

             Patients come in all shapes and sizes – literary.

In all my years working in the NHS I would actually say that 90% of patients were always courteous, friendly and extremely grateful. There of course were the other 10% those that would complain and were always ready for an argument. Unfortunately these people can spoil any good organisation they come across.

One thing I learnt working within the healthcare sector is that you have to learn very quickly not to be judgemental.

I believe that you should always treat people as you would want to be treated.

I quickly found the best way forward was to gain the trust of the patients. Listen to their needs; get to know them as people – after all everyone is different. Let them get to know you as a person. The trust soon builds up – but it has to work two ways and when it does it works well. The patient won’t push their boundaries and they will trust you to do the best for them – and you do.         

On a daily basis receptionists will come across people from different backgrounds, cultures and beliefs. Receptionists will come across people who are often frightened, anxious, nervous, or just downright rude. That is the nature of the business that we are in.

The key to dealing with these people especially is the rude patients is to remember that there might be a reason why they are being rude – now don’t get me wrong rude is not acceptable – but in some cases these people might be in pain, be worried about what might be wrong with them or perhaps a loved one – maybe worried about the unknown or recently suffered a bereavement. You can’t always see on the outside what is going on in the inside.

But of course there are those patients who are just downright rude – and when I trained new staff the best possible advice I could give them was to try to not to take rudeness personally. Rude people are usually rude wherever they go – it’s not just the Doctors Surgery they keep their rudeness for.

The first rule I would advise a Receptionist when they were faced with a rude patient at the desk would not to answer back. Don’t get involved in a disagreement or argument. Don’t fuel an argument. But it is important to listen to what the patient is saying.

Sometimes a person just needs to let off steam – not right but it happens – and nothing more will fuel an angry person is another person arguing back. So, listen, apologise if the fault was on our part and after a while you will find that the rude/angry person starts to cool down – they have nothing to fuel their anger – and usually the Receptionist will find that the patient will actually end up apologising for their outburst or anger.

Another thing is to sit and think to yourself – this person is not directing this at me “Ann”
they are venting their anger at the “Receptionist” the person sitting in front of them and if someone else was sitting here behind the Reception desk they would be saying exactly the same to the that person. I always found this a good one to remember when someone was being rude to me at the desk.

But if this continues as sometimes it did 3 or 4 times in a morning or afternoon you can soon start to take it personally.  I always would advise a Receptionist if she ever found herself in a situation that she couldn’t handle then she should walk away from it and pass the patient over to someone else to deal with. We all have had to do that at sometime. We all came across situations they we felt was out of our control – but it was the way you dealt with it that was important.

At times we also had to face violent patients – I am pleased to say that our Surgery didn’t have many of these – but when we did it was unpleasant not only for staff but for other patients in the surgery too. In all my time there were only a couple of times we had to call the police – thankfully. But unfortunately there were Surgeries not so far from us that had that had violent patients to deal with on a daily basis.

Another thing I found in my journey from Receptionist to Manager is well-trained staff are confident staff. Often Receptionists are faced with a situation that they are unable to handle. Confident staff can usually defuse a situation before it starts getting out of hand.

I will be sharing some of my experiences and stories when dealing with patients throughout the years in future blogs.