Communication and Customer Service in the Healthcare Office: Module 5: Customer Service in Health Care

The typical personal space between close friends who belong to the dominant culture of the United States is about:

18 inches.

Group of gestures, facial expressions, postures

Clustering

Which is the correct way to punctuate the salutation in a business letter?

Dear Mrs. Chen:

utilization review (UR)

Evaluation of the necessity, appropriateness, and efficiency of the use of health care services, procedures, and facilities.

adverse drug events

Harm experienced by patients as a result of exposure to medications.

Under what circumstances should you defer to a supervisor?

In any situation where the patient becomes angry or agitated

Patient Care Partnership

New name for the American Hospital Association's Patient's Bill of Rights which contains 12 rights of hospitalized patients.

advocate

One who supports or promotes the interests of others.

quality improvement

Processes used to find ways to preserve or improve quality of care while decreasing costs.

Which of the following professional titles is written correctly?

Stephen Carruthers, O.D.

Partnership for Patients

The Partnership for Patients is a public-private partnership, under the umbrella of the CMS, working to improve the quality, safety, and affordability of health care for all Americans. Members consist of physicians, nurses, hospitals, employers, patients and their advocates, and federal and state governments. Specific goals include a 20% reduction in hospital-caused harm to patients and a 12% reduction in 30-day hospital readmissions.

Personal prejudices are difficult to recognize in ourselves because they become part of our belief system.

True

"That must be frustrating for you."

acknowledging feelings

An office manager sends out new office schedule and payment information.

announcement

Becoming skilled in professional interactions requires

caring about the client

Customer Service

When the term customer is used, it refers to both internal and external customers. Internal customers are those who work in the health care industry. For example, health care professionals from other offices, outside suppliers of medical and pharmaceutical supplies, and coworkers are internal customers who are affected by the behavior of those they work with on a day-to-day basis. External customers are those who come to the health care provider for services. They may be referred to as customers, patients, consumers, or clients. Patients come to health care providers for a variety of reasons. They may hope to have a specific problem cured and their prior level of health restored. The visit may involve a request for a routine evaluation to confirm the patient's level of health or to obtain information on preventive measures that will help to prevent future problems. Or a sudden illness or emergency situation may develop that requires immediate attention. Whatever the reason for patients' contact with the health care facility, there is always the expectation that high-quality professional service will be delivered. When a patient evaluates the service received, it is not just the outcome that is important, but the entire experience. For example, two patients can have the same diagnosis, receive the same treatment, and return to their prior level of health within the same time frame, but one may be satisfied and the other very upset with the care received. It is necessary to review more than simply the medical problem that was presented. All aspects of contact with the patient must be examined when checking for quality. Examples of questions to ask about patient service include the following: If the initial contact was made by telephone, how was the patient treated? Was he or she placed on hold? Disconnected? Was the health care professional courteous and did he or she express interest and concern? When the patient arrived for the appointment, was he or she greeted in a friendly, yet professional manner? How long did he or she wait before being seen by the health care professional? Was the patient kept informed of any delays? Was the patient required to wait for procedures and tests once they were scheduled? Was he or she given clear instructions and were all questions answered? Was the patient given information about how to have future questions answered? Were all procedures explained and consent obtained? Were all personnel courteous and compassionate when delivering care? Or was the care rough and abrupt and not considerate of the patient's needs? If the patient was in the hospital, what was the temperature and quality of the food? Was it quiet at night so he or she could sleep with a minimum of interruptions? Was he or she able to get prompt assistance when needed? This is not the time for the health care professional to share the exciting weekend trip or the fun date from the night before. Avoid engaging in social conversation with other health care professionals and ignoring the patients. They are there for service, and the focus must be concentrated on their needs. Social interactions with coworkers should be saved for breaks or after-work hours. At the same time, health care providers should not interpret being professional as working with a "stone face" without expressing friendliness or emotion. Giving warm and focused attention to a patient can make a positive difference. An actual example is the case of a patient who had eye surgery and had to lie on her stomach for several days. Most of the caregivers simply spoke to her back; however, one bent down so the patient could see her face. The patient reported later that she felt gratitude for this thoughtful gesture because it made her feel valued. Most people are surprised to learn that lawsuits brought by patients are more closely related to whether the patient does or does not like the health care professionals than to any other factor. It is a common belief that if a lawsuit is filed, there must be good cause. Someone must have made a mistake. This is not necessarily true. Lawsuits may be filed as a result of emotional responses to perceived wrongs. Or they may concern matters of little importance, known as frivolous lawsuits. Keep in mind, though, that any lawsuit filed, whether it seems legitimate or not, will cause a great deal of stress for everyone involved. The amount of time and money spent in addressing a lawsuit can be overwhelming. Many lawsuits can be avoided by working to ensure that all patients are satisfied customers.

The Gale Doc

You might be surprised to learn that 86 percent of Americans say they would likely take a survey from a healthcare provider, if asked. A West survey of 1,036 adults in the United States showed patients are more open to taking surveys than most providers realize. This is encouraging news for physicians who want to conduct patient satisfaction surveys, remote health monitoring surveys, health risk assessments, and other surveys. There's no question that healthcare surveys are valuable tools for improving healthcare and supporting health management. Providers believe it is useful to have patients complete satisfaction surveys (98 percent), health risk assessments (94 percent), remote monitoring surveys (91 percent), medication adherence surveys (94 percent), post-discharge surveys (91 percent), and gaps in care surveys (92 percent). West's research findings show patients value surveys nearly as much as providers. Patients are most interested in taking satisfaction surveys (86 percent), post-discharge surveys (85 percent), and health risk assessments (83 percent). Despite their interest, patients don't always participate in surveys, as healthcare teams know all too well. And nine in 10 healthcare providers say their organization does only a fair or poor job convincing patients to actually complete surveys. Patient feedback suggests healthcare teams can influence survey response rates and that there are steps providers can take to increase patient participation. But in order to drive higher survey response rates, healthcare teams need to understand the factors that impact patients' willingness to complete surveys. The following recommendations, based on those findings, show three key ways healthcare teams can grow response rates by focusing on factors patients say influence their decision to participate in surveys. 1. Make it convenient and easy for patients to respond. Convenience is a must when trying to convince patients to complete surveys. More than four in ten Americans (43 percent) say they would be more likely to take a survey from a healthcare provider if they could do it on their own time. This makes online surveys an attractive option for patients. Online surveys give patients the flexibility to respond when it is convenient for them, rather than receiving an unexpected call from a live person and being expected to stop what they are doing to answer survey questions. In addition, 33 percent of patients say having the ability to take surveys from any device makes them more likely to participate. Patients prefer the convenience of being able to respond to surveys on a mobile device, tablet, or desktop. The takeaway is fairly obvious: if surveys are easy to take, patients are more likely to participate. For most healthcare teams, inviting patients to complete online surveys means leveraging technology you might already be using. Teams can configure the same technology for sending reminders prior to appointments to deliver a satisfaction survey invitation to patients a few hours after their appointments. For most healthcare teams, inviting patients to complete online surveys means leveraging technology you might already be using. Teams can configure the same technology for sending reminders prior to appointments to deliver a satisfaction survey invitation to patients a few hours after their appointments. Interest in surveys rises among patients when they understand how surveys will benefit them. More than four in ten patients (42 percent) report they would be more likely to take a survey if they knew how it would help with their treatment. Also. 39 percent of patients with chronic health conditions say they would be more apt to participate in a survey if they felt doing so would enable them and their healthcare team to better monitor their conditions. Taking time to explain to patients why they are being asked to respond to surveys and how their responses will be used can increase survey participation. Remote health monitoring surveys give providers a way to check in with patients and track their progress between visits. These types of surveys are extremely useful for monitoring chronic conditions, and they allow healthcare teams to escalate cases or intervene before small issues turn into serious problems. Seventy-nine percent of patients say they are interested in health monitoring surveys. Healthcare providers can give patients a nudge to complete surveys by presenting them as a necessary part of their chronic care plan. During office visits, patients should receive an explanation of the survey process. Letting patients know, for example, that they will be sent a weekly survey invitation and that staff will closely track their responses and any progress or changes is a good way to reinforce the connection between monitoring surveys and health management support. Healthcare teams can also emphasize the connection between survey participation and support following hospitalizations. Providers can use post-discharge surveys to follow up with patients at key points in the 30 days after discharge. Communicating to patients how their healthcare team can use information they submit through surveys to detect issues and intervene to prevent readmissions is an effective way to increase survey participation. Forty percent of patients with chronic conditions say they would be more willing to take surveys if doing so would lessen their chances of being admitted or readmitted to the hospital. Healthcare teams that sell patients on this potential benefit of post-discharge surveys may be able to persuade more patients to participate. 3. Follow through on follow-up. Actions speak louder than words. Rather than just telling patients about the benefits or how surveys can help them, healthcare teams can go a step further and show patients with follow-up communication. Patients who spend time completing a survey want to hear from their healthcare team. Thirty-four percent of patients say they would be more likely to take a survey if they were contacted immediately afterward by a healthcare provider. In addition, patients say providers who follow up over the phone (37 percent) or via a text message or online chat (32 percent) would entice them to take surveys. While immediate follow-up is not necessary or appropriate in every situation, healthcare teams can make sure patients understand that they will be contacted promptly if follow-up is warranted. By acting on survey data, healthcare providers can show patients they are engaged and committed to improving patients' health. For instance, when patients complete a medication adherence survey and confess they are not taking their medication, providers can learn why-and maybe find solutions to previously unknown medication barriers. Outreach following a medication adherence survey demonstrates providers' commitment to keeping patients on track, and it can make patients even more responsive to future surveys. Healthcare providers and patients agree that surveys can be valuable healthcare tools. But surveys are only useful if patients take them. It's frustrating when patients don't respond to survey invitations, and it hinders providers' ability to deliver the between visit support patients say they want. Rather than accepting low survey response rates, healthcare teams can take action to achieve the changes they wish to see. They can drive more patient participation by taking patients' requests to heart and ensuring that surveys are convenient, have clear health benefits, and are followed with additional communication. Allison Hart is vice president of marketing at West, where she leads thought leadership efforts for West's TeleVox Solutions. Send your technology questions to [email protected]. 33% Percentage of patients say having the ability to take surveys any device makes them more likely to participate. Patients prefer the convenience of being able to respond to surveys on a mobile device, tablet, or desktop.

"When you say that do you mean...?"

clarifying and validating

logical and in order

cohesiveness

If a patient is upset and disruptive, you should

communicate in a quiet, calm manner

Which term is NOT one of the five Cs of communication?

competent

consistent with one another

congruency

A physician writes to a patient's employer, stating that he is fit for work following an injury.

explanation

Criticism should be communicated in written form if this is more comfortable than giving it in person.

false

Having a high fatality (death) rate among patients probably means that a facility is delivering poor-quality care.

false

The purpose of quality improvement is to:

false

Before the writer begins to write a report, an informal outline should be prepared:

if the writer finds this organizational technique helpful.

A medical assistant asks a vendor for information about new medical office management software.

inquiry

The best way to respond to a patient who jokes about being an "old cripple" due to injuries suffered in a car accident is to:

listen carefully to determine if there is a contradictory message.

One characteristic of empathy is that it ​

​identifies with the client and feels what he or she is feeling

Working with Unhappy Customers (Internal and External)

1. Identify the problem Listen to the complaint with an open mind. Try to completely understand the customer's side of the situation. Ask questions to clarify as needed, but do not interrupt needlessly. Do not display verbal or nonverbal defensiveness. Thank the customer for the information, because the goal is to always obtain customer satisfaction. 2. Seek resolution If the problem is with you personally, it is appropriate to apologize, thank the customer for the feedback, and assure him or her that you will do your best not to repeat the error. If you need more information before the problem can be resolved, let the customer know when you will get back to him or her. Provide information that the customer may be lacking. Make sure the customer is open to hearing what will be said and that it is phrased in a nondefensive manner. For example, if a customer complains about having had to pay for parking on the last visit, this could be addressed in a defensive or nondefensive manner. A defensive approach usually is an attempt to place blame on the customer, whereas a nondefensive approach does not. Consider these statements: Defensive—"Well, if you had just asked about it, we would have validated the ticket for you." Nondefensive—"I am sorry, we should have informed you that we validate parking tickets for patients. Do you have your ticket with you so we can validate it for you today?" If you do not have the authority to deal with the problem, refer the customer to the proper person or ask the person with the authority to contact the customer. 3. Verify satisfaction Does the customer feel the problem has been resolved satisfactorily?

Reducing Medical Errors

A critical aspect of quality improvement in health care is the effort to reduce medical errors. A study by Johns Hopkins' safety experts reported that as many as 250,000 patients die annually as a result of medical errors, making this the third leading cause of death in the United States. The report emphasizes that these deaths are not due to "bad doctors," but to systemic errors that include poorly coordinated care and fragmented insurance networks. Although some errors are the result of problems with the system—that is, at a higher level than that of the individual health care professional—there are actions the individual can take to help prevent errors that result in patient harm or death: Act with thought. An emphasis in this text has been on thinking like a health care professional: observing, reflecting, and drawing on prior knowledge. Take care when communicating patient information to others, as when leaving a shift and informing your replacement. Do not rely on your memory to retain important information. Take notes when there is much to remember. When making a decision regarding patient care, stop and ask yourself "Are you sure?" before proceeding. Report to your supervisor if your schedule (hours worked, amount of work expected) is causing you fatigue that affects your effectiveness at work. Report conditions that affect worker effectiveness, such as noise, poor lighting, heat, and clutter. Work on improving your communication skills to prevent misunderstandings between you and your patients, coworkers, and supervisor. Ask for assistance if you are unsure of how to perform a procedure, use equipment, or handle a patient situation. Listen to patients if they have doubts about the treatment they are receiving or the medication they are taking, and report these concerns to their physician or other provider.

why is it important to communicate effectively with patients?

All of the above effective communication can impact positively on patient's health, satisfaction with care, and improve an employee's job performance and thus, chances of promotion

which of the following techniques allows you to determine whether or not your communication was received?

All of the above: ask patient to repeat back in their own words, monitor patient's nonverbal cues for positive changes, and monitor patient's communication level for positive change

The Joint Commission (JCAHO)

An independent, not-for-profit organization that accredits and certifies health care organizations in the United States.

What is the best way for a health care professional to deal with a patient who has not followed the instructions given about postoperative care and who then complains about the negative consequences?

Apologize for possibly giving unclear instructions and explain them again.

constructive criticism

Appropriate feedback on the performance of others, based on the belief that it can be improved.

If faced with a patient situation that requires intervention at a higher level than you possess, when is the most appropriate time to get assistance from a supervisor?

As soon as you recognize the situation requires a supervisor's assistance

How to Give Constructive Criticism

Be concise and clear during conversations. If the other person does not understand exactly what you mean, it increases the chances of misunderstandings. Giving specific examples that illustrate the issue is a great way to increase clarity. Never use vague, general, or harsh terms. It is frustrating to hear that you are doing something wrong or not performing well and not understand exactly what can be done to correct the situation. Include positive comments of what the other person is doing well. Using positive and negative comments is sometimes referred to as the "sandwich technique." Start and end the conversation with positive feedback and then incorporate (sandwich in) the area(s) that need improvement. If the problem directly affects you, state how it makes you feel. For example, if a coworker is not completing his or her tasks before leaving the workplace, state that you feel taken advantage of and rushed by having to complete the extra tasks. Show a respectful attitude toward the other person. Always strive to preserve the other person's self-respect. Everyone makes mistakes or has areas that need improvement. Demonstrate a cooperative attitude. Give ample opportunity for the other person to ask questions and seek clarification about what is being stated. Offer positive suggestions for improvement. Be sensitive as this may be difficult for the other person to hear. No one likes to confront their faults. If the reaction is defensive, do not respond defensively in turn. Acknowledge the reaction and attempt to redirect to a more positive exchange. Provide time for face-to-face communication that is done in private. It is uncomfortable giving a criticism, but distancing oneself by using impersonal messages or memos creates greater discomfort and prevents the opportunity for the other person to respond or seek clarification. Use empathy when communicating. Stay aware of the impact on the person of what you say and how you say it. Never complain to others about the performance of a coworker. Communicate directly with him or her privately and confidentially.

Taking Responsibility for Quality

Because this is an introduction to health care text, we have repeatedly emphasized the importance of reporting to, or checking with, your supervisor. This is important, but providing quality care involves more than this. You have a depth of responsibility that goes beyond just being a subordinate employee. Each individual health care professional should take his or her role very seriously. Everyone reports to a boss but that does not exempt them from maximizing their contribution to the organization. Even those who run large corporations that make widgets have an accountability. They report to the board of directors and frequently are accountable to shareholders if the corporation is listed on the stock exchange. In health care, it is more important than ever to assist in efforts to give quality care and decrease costs. Your job is not just making widgets; how you conduct yourself affects the well-being of another person. It is not enough to just turn the problem over to someone else or hope it goes away. You need to ask yourself, "Have I done everything I can to resolve this problem?" If you need to refer a problem to someone else, then you can ask, "Is there some way I can expedite this issue?" Sometimes it will be necessary to be an advocate (one who supports or promotes the interests of others) for the patient or draw attention to an ongoing problem that is not being addressed. Your supervisor may be busy or perhaps does not immediately see the issue that you do. In this case, it will be necessary to use your communication skills to get the proper attention the problem needs. Good quality health care means doing the right thing at the right time, in the right way, for the right person; and getting the best possible results.

Internal Monitoring

Each health care facility develops its own programs to evaluate the facility, identify areas for measurement, and perform reviews. These programs are designed by the health care facility to meet its internal needs. This approach is based on data and uses a scientific approach to collect and analyze information and processes. The focus is on long-term system improvements. Another process frequently used by health care facilities is called utilization review (UR) or utilization management (UM). This is an evaluation of the necessity, appropriateness, and efficiency of the use of health care services, procedures, and facilities. UR can be done by a peer review group or a public agency. It is a method of tracking, reviewing, and rendering opinions regarding care provided to patients. Usually UR involves the use of protocols, benchmarks, or data with which to compare specific cases to an aggregate set of cases. Managed care organizations sometimes refuse to reimburse or pay for services that do not meet their own sets of UR standards. UR involves the review of patient records and patient bills primarily, but may also include telephone conversations with providers. The practices of precertification, recertification, retrospective review, and concurrent review all describe UR methods. UR is one of the primary tools utilized by health plans to control overutilization, reduce costs, and manage care. The following real-life examples demonstrate how the quality of care can be improved while costs are decreased. Not prescribing broad-spectrum antibiotics: Past practice was to order a broad-spectrum antibiotic when prescribing antibiotics for a patient. The philosophy was that the broader acting drug would "get whatever was there." But as more was learned about the development of bacterial resistance when unnecessary antibiotics are prescribed, it was determined that performing a culture (a test to see what bacteria are present) and using a more specific antibiotic was the best treatment choice for the patient. This had the advantage of decreasing the risk of resistance developing and rendering the drug ineffective when it was really needed. The cost advantage in this case is that the more specific antibiotics are often less expensive than the broad-spectrum antibiotics. Ordering disposable bibs: Health care professionals in a hospital would often use a towel as a bib when feeding patients to prevent the gown from being soiled. The administration conducted a study that demonstrated that the cost of sending the towels to the laundry was more than that of purchasing disposable bibs. The disposable bibs were purchased, and much to the delight of the staff, were more effective for their intended purpose, as well as costing less.

Agency for Healthcare Research and Quality (AHRQ)

Federal agency with the goals of enhancing the quality, appropriateness, and effectiveness of health care services.

Quality of Care

Finding the balance between maintaining high-quality patient care and controlling costs is a major struggle for modern providers of health care. Although the United States spends more on health care than any other country, it ranks lower in life expectancy and patient satisfaction and higher in infant mortality than many other industrialized countries: Life expectancy is 26th among comparable countries Infant mortality is 30th out of 40 countries Patient satisfaction is 4th at 89.33% after Sweden, Finland, and Norway Discussions about improving the quality of care and raising patient satisfaction begin with two very difficult questions: What is quality of care? How can quality of care be measured? Quality can be defined as a measure of the degree to which delivered health services meet established professional standards and judgments of value to the consumer. Quality may also be seen as the degree to which actions taken or not taken maximize the probability of beneficial health outcomes and minimize risk and other negative outcomes. There are various methods of measuring for quality of care.

Which sentence is written correctly?

Flossing the teeth, for example, is an excellent way to prevent gingivitis.

Which is the most important professional goal for health care workers when interacting with patients?

Give care without making any errors.

which of the following phrases would be appropriate to express empathy to an upset patient

I'ts very frustrating to have to wait so long

When is it inappropriate to respond to a person by matching their communication level?

If a person is upset and agitated

American Hospital Association

In 1973, the American Hospital Association adopted the Patient's Bill of Rights which was recently renamed the Patient Care Partnership. The 12 rights, in abbreviated form, are as follows: Patients have the right to: Considerate and respectful care Obtain information concerning their diagnosis, treatment, and prognosis Make decisions about their care plan Have an advance directive Every consideration of privacy Confidentiality of their records Review their records A reasonable response from the hospital to his or her request for care and services Ask and be told the business relationships among the hospital and other businesses and organizations Consent or decline to participate in medical research studies Expect reasonable continuity of care Be informed of hospital policies and practices that relate to their care

what is the rationale for responding to a person by matching their communication level?

In most instances, matching a person's communication level ensures communication will be received and understood.

Quality Improvement

In the past, the belief was that if more was done, the result would be an increase in quality of care. It is now believed that the focus must be on improving quality of care and on cost containment. The processes used to find ways to preserve or improve quality of care while decreasing costs are called quality improvement. There are a number of agencies, both public and private, working to improve the quality of health care and patient safety.

Internal Customers

It is just as important to maintain good relationships with internal customers as with external ones. One of the common mistakes made when working with coworkers is to quickly point out errors but not take the time to stress what they do well. Praising coworkers for a job well done, a courtesy extended, or a quick response to a situation can build trusting and mutually satisfying working relationships. Everyone wants to do well on the job, to contribute to the effectiveness of the office or facility, and to have a sense of self-satisfaction with their contributions. When people take pride in their work, they will work harder and more cooperatively than they will if they feel that others are being overly critical. Good relationships also require that criticism be given when appropriate. Constructive criticism is based on optimism. The intended message is that setbacks or failures are due to circumstances that can be changed for the better. It holds out the hope of improvement and suggests the beginning of a plan for doing so. (See Figure 23-4.) On the other hand, destructive criticism has the effect of creating helplessness, anger, and rebellion. The person is immediately put on the defensive and may no longer be receptive to suggestions for improvement. When individuals are led to believe that their failures are due to personal faults that cannot be changed, they lose hope and stop trying. For example, a medical assistant is just starting a new job. In her haste to try to manage too many duties in order to make a good first impression, she inadvertently forgets to log two patient appointments. The result is that three patients are scheduled for the same time with the same nurse practitioner. The medical assistant's supervisor addresses the situation: Constructively: "While I know how overwhelming all the duties you have to accomplish are, it is important that you accurately accomplish each duty. Until you feel more comfortable with all your duties, try to concentrate on one duty at a time (e.g., answer one phone call; finish the scheduling of a patient's appointment prior to answering another phone). Destructively: "You messed up! The nurse practitioner will not have a chance for a break, and the whole day's schedule is behind." Positive relationships with coworkers provide the foundation for making efforts as an organization to offer high-quality service to all customers. Employee satisfaction leads to customer satisfaction.

Responding to Destructive Criticism

Look for the "kernel of truth" in the statement. Be aware of your emotional response and set it aside in an effort to benefit from the exchange. Do not attack the other person. You may feel that you have information about his or her own performance, attitude, or practices, but now is not the time to share these thoughts. If the situation becomes too emotional, ask to take a break and negotiate a time to resume the conversation later. This gives you an opportunity to put things in perspective. Even if you do not agree with what is being said, be open to trying to understand it from the other person's point of view. If the feedback is valid, take responsibility and initiate the needed changes in behavior. Look at the experience as an opportunity to develop stronger team relationships with coworkers and to improve communications. Work with the person giving the criticism to solve the perceived problem. Ask for specific examples if you are unclear about what is being said. Ask for suggestions about how you might improve.

Medication Errors

Medication errors can occur anywhere between a prescription and when the patient receives the medication. Many, although not all errors result in adverse drug events (ADEs), defined as "harm experienced by a patient as a result of exposure to a medication." According to the AHRQ, each year ADEs account for almost 700,000 emergency department visits and 100,000 hospitalizations. Medication errors can be due to numerical misidentification, as discussed in Chapter 4, but there are many other reasons why they occur: Improper dosing of drugs, especially dangerous with certain high-risk drugs such as intravenous heparin (decreases blood's clotting ability). The proper amount of this drug relies on careful measurement of the patient's weight and frequent monitoring of the blood's clotting ability to prevent severe bleeding. Taking too much or too little of a medication. It is important that dosage is clear in prescriptions and on drug container labels so the health care professional knows how much to administer. Patients may not understand about proper dosages to take at home. Studies have shown that caregivers, such as parents, as well as patients, make many drug administration errors Confusing medications with similar names. Drugs may have difficult spellings and similar names, making them easy to confuse. A couple of examples are oxycodone and oxycontin and sulfadiazine and sulfasalazine. Problems tracking drug use. The opioid epidemic and resulting deaths discussed in Chapter 2 has resulted in part from patients being able to get multiple prescriptions from different providers. Failing to understand how and when to take drugs. This is particularly problematic with those elderly patients who have difficulty remembering events of the day, such as when they last took their medications. Negative interactions of drugs. This can occur when patients use different providers to get prescriptions and a variety of pharmacies for the dispensing of drugs. The prevalence of polypharmacy, meaning taking more drugs than medically necessary. The AHRQ states that this is likely the strongest risk factor for ADEs. The preference of many Americans is to take a pill rather than make lifestyle changes and they pressure their providers who are often willing to write a prescriptions. Most ADEs are caused by commonly used drugs. In fact, four medications—account for more than 50% of emergency department visits: antidiabetic agents, such as insulin; anticoagulants, such as warfarin; antiplatelet agents, such as aspirin; and opioid pain medications. Health care professionals who participate in administering medications should be aware of the "Five Rights" of medication safety: Administer the Right Medication, in the Right Dose, at the Right Time, by the Right Route, to the Right Patient.

Three Primary Areas to Examine When Evaluating a Health Care Facility for Quality Improvement

Organizational structure: How is the facility structured? What is the management style? How is communication encouraged? What changes would increase efficiency and accessibility? Health care professionals: How do the health care professionals function as a team? What processes could be changed to increase efficiency and employee satisfaction? Patient outcomes: Is the patient satisfied with the care? Was the outcome of his or her health care problem resolved in an efficient and appropriate manner with minimal suffering and confusion? Was the care provided in a coordinated manner to decrease duplication of services and minimize confusion?

Approaches to Measuring Quality of Care

Patient satisfaction: If this criterion is used, then we need to look at what patients want and would rate the highest. Patients are concerned with the following: Easily accessible and available services Timely and safe delivery of care Coordination between services and continuity of care Effectiveness of services—that is, the delivery and outcome of care Unfortunately, if these concerns were addressed without regard to costs, they would lead to prohibitive health care costs. Lowest costs: Using this criterion, the health care facilities that spent the least would be measured as the most effective. This is obviously an inadequate tool because it means that those providing the least care are rated as the best. Patient outcomes: This criterion is based on how well patients recover or manage their ailments. This may seem an obvious choice for measuring the success of a health care experience. Did the patient recover to the prior state of health? This method also has limitations though, because it ignores the value of the time spent in the health care system and only focuses on the end result. For example, if a patient received no education about an upcoming surgery prior to the procedure but recovered and returned to an active and normal life, is this really quality of care? Perhaps the patient stayed in the hospital a few days longer because he or she was not being prepared for the care requirements needed to return home earlier. Could this be classified as a positive outcome? In health care, the goal is 100% correct care with no errors, because anything less can have serious consequences for both patients and health care professionals. This may seem unrealistic, but when viewed from a personal perspective, it becomes real. For example, how would you feel if you were among those who had the wrong surgical procedure performed on them? Or what would be the consequences to you and your family if you contract hepatitis B from a needle stick? Everyone must continually strive to provide competent, conscientious, and appropriate care.

external customers

People who come to the health care provider for services; they may be referred to as customers, patients, or clients.

internal customers

People who work within the health care industry—in other words, other health care professionals.

In which sentence is the apostrophe used correctly?

Please tell the medical assistants that it's about time for the meeting.

Services Sought by Patients through the Health Care System

Prevention Education: Examples include nutrition and exercise, prevention of heart disease, smoking-cessation programs, how to manage diabetes Routine physical exams Screening tests: Examples include mammogram, sigmoidoscopy/colonoscopy, Pap smear, blood pressure check, PSA (screening test for prostatic cancer), fecal blood, cholesterol and lipids blood tests Emergency and Urgent Care Services Illnesses and injuries that need immediate attention Inpatient Services Surgery Illnesses and injuries requiring continuous acute care Specialized treatments Rehabilitation Long-Term Care Nursing homes Assisted living In-Home Care Nursing Therapy Homemaking Psychological/Psychiatric Services Counseling Medication Dental Services Preventive care Treatment and restoration Pharmaceuticals and Medical Supplies and Equipment Medications and other items needed to restore or maintain health

Utilization Review Example

Problems are identified by the health care facility (e.g., a seemingly high rate of urinary infections in patients with a Foley catheter). These problems are called key indicators of quality care and are quantified (e.g., a chart review is done to determine how many patients with a Foley catheter have developed a urinary infection during a specified care time frame). The result is compared to industry standards to see if it exceeds the expected rate of such problems. If it is determined to be a problem area, education or other interventions are done to correct the identified problem. Then the study is repeated for subsequent periods (usually on a quarterly basis) to determine whether or not improvements have occurred as a result of the intervention. The results are used as measurements to determine if the quality of care is improving or declining. The focus is on individual performance, deviation from standards, and problem solving.

Customer Satisfaction

The "3 to 11 rule" of customer satisfaction states that for every good thing that happens to us we tell three people. For every bad thing that happens we tell 11 people. One approach that many health care businesses use to determine how satisfied their customers are is to conduct customer surveys. These can be done in two ways: Mailing out questions that customers answer and return by mail Calling customers and asking them to respond to questions over the telephone Some health care facilities maintain a log listing all complaints, what was done to address the complaint, and if the resolution was satisfactory. If the results are made available to staff, it is worth the health care professional's time to review the comments. The areas of concern may be very different from what is expected and can lead to changes in performance that will create greater customer satisfaction. Remember that each health care professional is responsible for patient satisfaction. The cost of an unhappy patient is much more than the loss of that one patient because he or she will probably tell family, friends, and coworkers. It is also important to recognize that satisfaction is a subjective perception. Therefore, a health care professional must listen carefully and constantly to determine if the patient has any concerns. The patient may have a positive outcome to his or her medical treatment but may be unhappy with the experience due to a cold food tray, a delay in answering a call light, waiting for tests, delayed treatments, an unemptied bedpan, delayed pain medications, or an unfriendly or curt caregiver. Patients can be dissatisfied if they perceive that their problems are not seen as important.

Agency for Healthcare Research and Quality

The Agency for Healthcare Research and Quality (AHRQ) is an agency within the United States Department of Health and Human Services. (The current federal administration has proposed that it be merged with the National Institutes of Health, so this may have occurred by the time this textbook is published.) The goals of AHRQ are to enhance the quality, appropriateness, and effectiveness of health care services and access to care by Conducting and supporting research, demonstration projects, and evaluations Developing guidelines Disseminating information on health care services and delivery systems Research results and tools are available to assist facilities and professionals evaluate their quality of care. For example, the Child Care Quality Tool Box contains definitions of, and methods for, measuring child care quality (https://www.ahrq.gov/professionals/quality-patient-safety/quality-resources/tools/chtoolbx/understand/index.html#useda). And the Nursing Home Survey on Patient Safety Culture was developed to solicit staff opinions about safety and health care quality in their nursing homes (https://www.ahrq.gov/sops/quality-patient-safety/patientsafetyculture/nursing-home/index.html).

Centers for Medicare and Medicaid Services (CMS)

The Centers for Medicare and Medicaid Services (CMS) is a federal agency within the U.S. Department of Health and Human Services (DHHS). Programs for which CMS is responsible include Medicare, Medicaid, the Children's Health Insurance Program (CHIP), the Health Insurance Portability and Accountability Act of 1996 (HIPAA), and the Clinical Laboratory Improvement Amendments (CLIA). The CMS promoted the development of internal monitoring (within health care organizations) and evaluation processes. These were designed to identify the changes needed to decrease costs while still maintaining quality. The CMS requires all health care facilities to establish a quality assessment and performance improvement (QAPI) program that is committed to ensuring high-quality and cost-effective care. Medicare contractors are required to prepare and submit a QAPI report to the CMS in order to receive reimbursement for any of the CMS programs. This report has many components. Being a Medicare contractor is vital to the functioning of any health care facility, not just those that care for patients aged 65 and older. This is because most private insurance companies, and also certifying agencies, require that a health care facility be a Medicare contractor.

The Joint Commission

The Joint Commission is an independent, not-for-profit organization that accredits and certifies health care organizations in the United States. Its mission is to improve patient safety and each year it sets goals to achieve this mission. Its hospital safety goals for 2018 include the following: Identify patients correctly Improve the effectiveness of communication among caregivers Improve the safety of using medications Reduce the risk of health care-associated infections Prevent patients from falling The Joint Commission certification is recognized as a symbol of quality and currently applies to 21,000 organizations. All health care professionals should be aware of these goals and strive to contribute to meeting them in their work.

An administrative assistant asks a patient to pay an overdue bill.

collection

At the end of a clause that introduces a list

colon

To separate the words in a series

comma

does not include unnecessary information

conciseness

In order to have positive self-acceptance, we must have

congruency among our three selves

A physician requests that a physical therapist see a patient.

consultation

The Patient Care Partnership developed by the American Hospital Association gives patients the right to all of the following EXCEPT:

demand free hospital

Good communication skills are required to provide effective patient ____________________ that teaches patients about promoting their own wellness.

education

Reviewing records of patient complaints is not a good idea because it can discourage the health care worker who is trying to maintain a positive attitude.

false

Verify perceptions

feedback

A physician informs a patient about the results of diagnostic tests.

follow-up

Which of the following is an appropriate response to give an upset patient.

getting the patient to agree that he or she is overreacting

________________is the set of rules that determines how a given language is organized.

grammar

The primary sensory skill involved in verbal communication is

listening

When assessing the needs of patients, it is disrespectful for the health care professional to:

make assumptions about their cultural backgrounds.

content of the communication

messages

After most abbreviations

period

The MOST important reason for health care professionals to develop excellent phone skills is to:

project a positive image of their facility.

The goals of effective listening include all of the following EXCEPT

providing a response that offers a solution

around titles of magazine articles

quotation marks

A medical receptionist reminds a patient to call and schedule her annual physical exam.

recall

​Decodes

receiver

"So you think milk and cheese cause gas for you?"

reflecting and paraphrasing

Which nonverbal behavior would likely indicate that a patient is angry or frustrated?

rolling of eyes

Between independent clauses that are not joined by a connecting word

semicolon

encodes

sender

"Your hands are shaking."

sharing observation

Therapeutic communication involves both professional and ___________ skills.

technical

Which of the following is NOT considered a barrier to multicultural therapeutic communication?

the Internet

Personal space refers to

the distance at which we are comfortable with others

Medication errors cause hundreds of thousands of hospitalizations each year.

true

Most lawsuits brought by patients are the result of poor interpersonal relationships with health care workers.

true

​A PCP might use social media to remind everyone to get a flu shot.

true

The main characteristic of traditional Western medicine as practiced by the majority of physicians in the United States is the:

use of scientific methods.

A low-context communication style refers to one that

utilizes few environmental idioms