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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What Was Your Most Memorable Interview?


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I applied for a position in a large GP Practice for the position of Reception Manager. Getting the position would mean a big step up in my career so I was obviously both nervous and excited when I got an invitation to attend an interview.

I did my research, prepared for the interview and arrived early and felt pretty calm. I felt the eyes of the Reception team boring into the back of my head as I sat in Reception. I imagined at that moment I was the topic of conversation behind the Reception desk.

The Practice Manager introduced herself and took me into the interview room. The Senior Partner introduced himself and the interview began.

I answered questions with confidence and asked many in return. I started to feel a bit more relaxed. The Practice Manager was lovely. She then gave an almighty yawn. She was mortified and apologised we laughed, we both looked over at the Senior Partner to see what his response was and to our amazement he was fast asleep in his chair arms crossed – with his mouth opened!

The look on the Practice Managers face was a picture, she coughed loudly, he slowly opened his eyes with that glazed look of “where am I” the room was silent. I wanted to laugh, mainly due to nerves, was I that boring?

He sat up, apologised and we continued with the interview.

I was told they would be in touch as they had other candidates to interview. I left thinking that for some reason I had blown my chances.

To my delight I received a call the following day asking me back for a 2nd interview. This time the Senior Partner kept awake and after a lengthy interview I was offered the job. I was delighted.

He was a great Senior Partner with a great sense of humour and we would often laugh at the time I impressed him so much he fell asleep.

© 2011-2017 Reception Training all rights reserved

 

Practice Makes Perfect


I was asked recently to help with some Receptionists Training at a GP Surgery.

The surgery was holding an away day for the whole Practice and they closed the surgery for the afternoon. Everyone was involved from the Partners, Business Manager Assistant Practice Manager, nursing staff and all the Receptionists and Administrators. It was really impressive to see so many staff there. There had been a lot of work put into the away day from the Partners and the Business Manager.

When I go into any surgery I never know what I am going to be met with or what I am going to witness in regards to the Receptionists and how well they understand their role especially new Receptionists that perhaps have never worked in this environment before.

Let me share with you my experience on the day…

I arrived at the Surgery at 8.30 – I was going to sit with the Reception team for the morning and see how they worked as a team – and if there was any input or support that I could give.

When I walked into the Reception area I was really impressed. The Surgery was very impressive and the waiting room bright spotless and very welcoming.

There were good signs for everyone to see and the Reception desk was most impressive.

I was met by the Business Manager who made me very welcome and was very friendly and extremely easy to chat to.

I was introduced to the team of Receptionists who were going about their tasks for the day.

I was impressed with what I seen, everything that I would expect from a good reception team. They were all polite to the patients both face to face and over the telephone, well-informed and very calm whilst doing their jobs. There were a few minor things that could be improved on but nothing that could not be rectified.

What did really impress me was the lovely working area that they staff had to work to work in – the reception desk was big and spacious as was the administration office just at the back of reception. They had good quality furniture and the office was love and bright. The team was really lucky to be working in such lovely conditions.

All phone calls were made in the back office, no telephone calls was taken at the front desk. The Receptionist was just dealing with patients.

Patient confidentiality was excellent and this was achieved by the Receptionists accessing patient information by Date of Birth – a much quicker way of accessing patients details.

The surgery closed at 1.00 and the calls were put through to the out of hours service.

The afternoon began with lunch for all the staff – everyone interacting with one another – it was obvious that this was a surgery that valued their staff.

The Partners started the session off with an ice breaking game – it brought a good laugh and really did start the afternoon off well. The feedback from the Reception team was really positive about the interaction from the Partners.

Everyone then broke away into 3 groups, The Partners, the Nursing Team and the Receptionists and Administrators and myself.

We went over Receptionist Skills, Telephone Skills, and Dealing with difficult people and patient confidentiality.

On the whole the staff were very well informed on most of these subjects. But what was really impressive was the way everyone chatted about his or her experiences, sharing good ideas and finding ways forward with different situations that could help them in the future. We all had something that we took away from the training.

It was good to go over, discuss and learn from them and perhaps remind ourselves why we have to do these things (ie patient confidentiality) and perhaps how we could improve on things we are doing.

The most important thing for me was that I could see how much their were valued as a team, and how supported they were from the Management and Partners.

Why? Because their Practice wanted to invest in them – to support them and to ensure that the patients get the best care possible.

The communication between Partners, Management and staff was excellent. 

This was achieved in their working surroundings and the fact that their practice was prepared to invest in their training needs and support them for future training.

Good trained staff are confident staff and confident staff are able to deal with every day events that they are faced with. This is vital for your organisation and for your patients.

I for one would not only be happy to be a part  of this team I would also feel extremely happy to be a patient there.

Can you say the same for your organisation?

 

© 2011-2017 Reception Training all rights reserved

Managers Training: The Other Side of the Desk


When managing staff it is always good to give them feedback. Yearly appraisals are a good opportunity for this but why leave it once a year?

Here is a little exercise I used to carry out on my Reception staff.

Sit in your Reception area at the busiest time of day. Observe what is happening in your Reception area – see how the receptionist deal with patients how they cope with the busiest time of day and how they copes with the pressure that the busy time can bring.

Put yourself in the place of a patient – see it from their eyes and ask yourself how do they see our Surgery?

Have a note-book with you and take notes – but the most important part of the exercise is not only to pick up on any negative issues but also highlight the positive issues too.

What should you be looking for:

  1.  Is patient confidentiality being broken? Can people in the waiting room hear conversations from the Reception Desk? Patient confidentiality it vital in any Practice – and more so at the front desk.
    People in the waiting room can often hear conversations at the front desk. Make
    sure you staff use as little personal information as possible. Make sure that
    all your staff has the appropriate training on Patient Confidentiality. (see
    blog on A Quick Confidentiality Checklist. http://t.co/S3E94mU8)
  2.  How does the Receptionist interact with the patients? Do they have good eye contact? Are they polite and always helpful? It is easy to be short with patients when you have a queue of people at the front desk. Training in dealing with such times is vital – train your staff in dealing with such times –
    how to move patients on quickly without being rude or appearing that they are
    not caring. A smile and a thank you go a long way.
  3. How does the Receptionist answer the phone? Is it answered quickly enough? Does the Receptionist deal with the call efficiently? Always make sure that your staff answers the phone with good morning/good afternoon – the name of the surgery and their own name. Staff than give their name takes ownership of the call more than those that do not give their name. Again, if they are in ear shot of the waiting room it is important that they remember Patient Confidentiality.
  4. What are the other staff doing whilst the busy time is happening – are they helping out?  Often in Surgeries you have Receptionists at the front desk and others doing other things such as admin, typing, prescriptions – have you got a contingency plan for such busy times – if someone is busy on the front desk or on the phone do you have someone who can come and help out for short periods of time.
  5. Can you hear conversations between Receptionists behind the desk? When the quieter times come Receptionists often will have a little chat – but they should be made aware to be careful on what they are chatting about – I had an incident where 3 Receptionists were discussing a TV programme that was on the night before. They were discussing the programme about Breast Cancer and about a lady having terminal Cancer – they talked in-depth about the programme – talking about people who had lost relative/friends to the horrible illness. What there were not aware of was a patient was sitting listening to them in the waiting room that had just recently been diagnosed with Breast Cancer – she found the conversation very upsetting. Whilst I was doing
    this exercise I also heard Receptionists discussing an issue that could have
    upset a patient in the waiting room.
  6. Is the Reception area being kept clean and tidy? It is important to
    keep your reception area clean and tidy. Not just for a good impression but for
    Health and Safety reasons too – magazines, children’s toys left lying around on
    the floor is dangerous – someone could easily slip and fall.
  7. Are the patients kept waiting for long periods of time (often a problem in surgeries) This unfortunately happens in every surgery. Observe how your patients feel about it – and how your Receptionists deal with the patients if they come back to the desk to complain/enquire about their appointment running late. Do you have a policy on Doctors/Nurses running late?Do you have a surgery policy about Doctors/Nurses running late?

After you have done your observation bring them to your next staff meeting.

I always find the best way to approach this is to tell your staff that it was not an exercise to “catch them out” but an exercise to find if and where improvements can be made.

Always start with the positive notes you have:

  •  How well you thought the receptionist dealt with a certain patient/incident.
  • How good their telephone manner is.
  • How lovely and tidy the reception areas looks.
  • How pleased you were to see others helping each other at the
    busiest time.
  • How good they are with dealing with confidentiality.

Then

If there are any (and I am sure there will be) go onto the negative things that you found – discuss them and ask your team to give their opinion. Ask if there is a better way it can be dealt with. Include them in any decision-making. Include them in your findings.

Staff do not like change so I always used to say – we can change it, try it and if it does not work we can look at it again.  This always used to work.

Make minutes of the meeting – ensure that you record any changes that are going to be made and ensure that everyone has a copy – including those that were unable to attend the meeting.

Turn those negative into positives.

 

© 2011-2017 Reception Training all rights reserved

Receptionists Training: How To Identify People that Have Difficulties Reading and Writing.


How would you identify and deal with a patient that might have problems with reading and writing – and not embarrass them?

I have seen many patients embarrassed by a receptionist insisting that the “complete” the form in front of them.

TAIL TALE SIGNS OF SOMEONE THAT MIGHT HAVE PROBLEMS READING OR WRITING

  • They will often become agitated or look uncomfortable when given a form to complete
  • They might go very red in the face with embarrassment
  • They will try to make an excuse ask if they can bring the form back at another time
  • They might say they can not wait and will fill it in next time (when they can bring
    someone back with them)

And the most often used excuse is:

They have left their glasses at home!

Many of the above could indicate that the person had problems completing the form. For
whatever reason do not embarrass the person by insisting they complete the form.

If the form can be taken away and completed and brought back all well and good, but as I
well know many of these forms never come back again. So I appreciate the importance of getting the forms completed there and then.

HOW DO YOU HANDLE IT?

If you have reason to believe that the person is having difficult completely the form you
should

  •  Be very discreet
  • Never ask the person if they have problems with reading and writing
  • Never snatch the form back and say “give it to me”
  • Offer to help complete the form
  • Try and put them at ease – if they say they do not have their glasses just tell them that it is ok and that lots of patients do the same and you are more than happy to
    help complete the form.
  • Put the patient at ease by saying that it might be quicker for you to do the form
    because you know what parts have to be filled in.

You will often find by showing kindness and not judging the person will in fact tell you
that they have problems in completing forms. If they do tell them its fine – and they we get many request for help with filling in forms.

Explain  to them that you would be more than happy to help again, and that they should ask for you or another member of staff to help complete the next necessary form.

Ask the person if you want them to make a note of it on their patient notes – so in future they are not asked to complete a form again at the desk. Many are happy for you to do this. It also helps other team members know of their disability in not being able to read or write.

Every patient should be treated with respect at all times.

Patients With Special Needs (Patients Special Needs Board)


How do you keep staff informed about patients that perhaps need special attention?

What do I mean by “special attention”? Well this could come in many forms but for me as a manager I felt that certain patients needed to be at times “highlighted” to the rest of the staff.

Who would these patients be?

I know a lot of people think that Receptionists ask too many questions – that they are “nosy” or perhaps a barrier to seeing the Doctor – but believe me this is not the case – Receptionists ask these questions on behalf of the Doctors and Nurses and try their very best to ensure than anyone that needs to see the Doctor sooner rather than later does – if everyone was give this priority then the system would be in quite a mess. Then where would that leave the people who are possible at risk and do need urgent medical attention.

For me it was important that these people did not slip through the system without being given any necessary follows ups that were needed.  These people at times needed urgent appointments, urgent prescriptions or just access to the doctors without having to go through the many questions that sometimes a Receptionist has to ask.

Most of your staff will be dealing with these patient and will know of such cases – but what about the staff that work part-time – or those that have been on holiday for 2 weeks – it is amazing what kind of changes can go on in a surgery in this short space of time.

How many times I have seen a Receptionist that has been away ask a patient how their husband/wife/mum/dad are only to be told that they had died. It will happen – but there are ways that you can keep staff updated these issues.

What sort of things would these patients or their families phoning or coming into the surgery about?

An urgent prescription might need to be generated for a terminally ill patient. This could be done almost immediately instead of the usual 48 hours.

An urgent Doctors Visit might be needed for a terminally ill patient.  The visit would be logged without question. And then when the Doctor does his visits he could prioritise this patient if needed.

A patient might need an appointment that day due to a bereavement, or a miscarriage. The patient might be too upset to discuss with the Receptionist and might need to be seen immediately.

A relative of a patient that has recently died might need to see a Doctor. They would not want to wait a few days for this – does your surgery have a policy on patients that have recently been bereaved.

Often if the Doctor is aware that a patient has died he or she will often phone the relatives of the patient – this can be very comforting at this very sad time.

All of the above would mean the patient would need to be dealt with quickly, without fuss or questions and with compassion.

To have their call / query dealt with efficiently without question will no doubly help they already stressful situation.

I decided in creating a “message board” a “specials needs board” or  “patient board” it could be called whatever you like but at the end of the day this is how it worked.

In reception we had a wipe clean board. We used a wipe clean board simply because it was easy to use and update quickly. This would have three sections headed with:

  • Terminally Ill
  • Ante Natal
  • R.I.P. (recently deceased)

At the start of any entry the date that the entry was made should be dated.  This is a way of knowing when the message was written.

TERMINALLY ILL

Any patients that were terminally ill either in hospital in a Nursing home or at home their name would be entered onto the board and the place that they were at.

ANTE NATAL

If we had an expectant mum that was having a difficult pregnancy, had recently had a miscarriage or a still-born their name would be entered onto the board.

R.I.P.

Any patient that had died their name and date that they died would be entered onto the board.

Beside each of their names we would have the patients Date of Birth. This is important to identify the correct patient.

The board would be kept in the Reception Area – but most important not in view to anyone other than staff. This is most important – remember patient confidentiality.

This board would be seen on a daily basis by all staff in the surgery. District Nurses used to come in each morning and have a look to see if any of their patients had died over night.  The health visitors would also check the board on a daily basis. The midwife would look before she started her clinic and the doctors would look before their started their morning and afternoon sessions.

By having the board in Reception it is there for all staff to see – and the good thing about this board is you don’t even think you are looking at it – but when you answer the telephone and one of the names on the board is mentioned you immediately are drawn to the board – the board is almost subliminal you see it without realising it.

You will need to ensure that the board is kept up to-date. You could allocate this job to one Receptionist.

The terminally ill will need to be there until they sadly die and then go onto the R.I.P. (This also highlights those terminally ill that have died)

Your surgery will have to agree on how long you keep the Ante Natal information on there – at our surgery we kept it up there for a month after the entry.

R.I.P – again you will need to agree how long you want to keep the information on there – again we kept it up there for one month.

Try this board system – it really does work and those patients that need special care can get it without having to go through lots of questions to get what they want.

Here is an example of how the board might look.

Terminally Ill

  • Mrs Jessie Jones    DOB 30.03.29   (ca breast)
  • Mr John Smith       DOB 25.06.57  (heart disease)

 Ante Natal

  • Annie White           DOB 26.09.80   (miscarriage)
  • Joan Brown            DOB 25.08.86   (stillborn)

 R.I.P. (recently deceased)

  • Mr Alex Swords       DOB  06.04.75   (died at home)
  • Mrs Susan Bird        DOB 12.12.45    (died in St Marys Nursing home)

You can of course make the board up in any way you think will fit in with your Surgery. But I must stress how important it is that this information is not seen by anyone other than staff.

How do you thank you staff at Christmas?


How do you or your Practice thank your staff? Do you tell them on a regular basis or keep it to once a year at Christmas?

In my experience you will get far more from people if they are shown thanks and appreciation and it doesn’t have to cost very much either.

Here is how I used to say “thank you” to my staff.

Daily Basis

  • When I was leaving the surgery of an evening I would always take time to go into Reception, ask if everything was ok before leaving and as I left always say “thank you for all your help today”.
  • If I needed to go to one of the other surgeries to see one of the Doctors or the Surgery Team Leader I would always make a point of showing my face in Reception – I always wanted to be approachable and let the Receptionists know that I was always there for them. Again when I left to go back to my own office I would always thank everyone as I left.
  • At the end of any Team Meetings I would always thank everyone for coming .

One off Basis

  • When someone did something that stood out and was beyond their job description I would speak to the Practice Manager and she was in agreement we would get the Staff Partner to say “thank you” in the form of a letter. This letter could then be put on their CV and used in their next appraisals (when again it could be brought up).  This was not something that I did very often – so when a member of staff did receive a letter it was obvious that they had been praised for their good work. If the incident was appropriate and with the permission of the Receptionist receiving the letter I would use the incident in the next staff training.
  • If a Receptionist was having a baby or getting married I would organise a baby shower and the Receptionists would get together over lunchtime and have a good laugh. This was great for team work as they would organise the lunch, the presents and work together on making sure it was a great shower.
  • If an older Receptionist became a grandmother I would always send them a congratulations card.
  • If a member of staff was off on long-term sick I would always send them a get well card and tell them how much they were being missed.

Yearly Basis

  • My Practice Manage would send each surgery a Christmas card – I would send one to each individual member of staff thanking them for all their hard work throughout the year. To me this was very important to let each member of staff know how much I appreciated their hard work that year.
  • I would also get a personal present for each of the Surgery Team Leaders at Christmas – just a small token but again to thank them for all their efforts over the year, and let’s face it I could not have done my job as well as I did without their support and hard work.
  • The Practice would give the staff a Christmas Party – usually in the form of a Dinner Dance – this really can keep moral going – and everyone was always on a high for a few days after – staff very much appreciated the Practice doing this for them.
  • The Practice would also give the staff gift vouchers every Christmas – again this was extremely kind of the Partners to do this and again the staff always really appreciated this.

So, it does not have to cost a fortune to say “thank you” but it can be worth its weight in gold.

How do you thank you staff?