By Gordon G. Massey, MBA and David G. Hunter, MD, PhD
Think back to the last time you went to a retailer’s service counter while shopping. Did you notice that when you approached the counter, you felt as if the retailer needed you more than you needed the retailer? Retailers carefully craft your experience as a customer, and part of the reason you feel so special is that the first person to greet you is often standing at a counter and not sitting at a desk. Standing is widely believed to convey availability, courtesy and respect, and that is what you see at most retail outlets.
In healthcare, the situation is very different and often to the detriment of the patient experience. Consider for a moment any healthcare institution you have visited recently and what happened when you approached the check-in desk. Most likely the first person you saw was sitting down, looking at some paperwork or typing away at a computer. As you approached, perhaps you were greeted with nothing more than a raised index finger indicating, “I’m busy but I’ll be with you when I finish this important thing that I am doing” – that is, if you received acknowledgment at all. You might have even felt guilty for interrupting the person, forgetting that the most important thing he or she had to do that day should have been to take care of you, the patient.
These staff members do not intend to be rude or inattentive. They are all certainly nice people and surely busy with work, preparing charts and handling required paperwork or insurance-related matters. But the very structure of their seating arrangement makes it nearly impossible for them to consistently contribute to making an approaching patient feel welcome.
Writing on the patient experience in healthcare, James Merlino, MD, past chief experience officer at Cleveland Clinic, says, “Patients too often are made to feel they don’t deserve a superior experience because healthcare is a necessity rather than a luxury.”
While brainstorming how we could improve the customer experience for families visiting the Department of Ophthalmology outpatient clinic at Boston Children’s Hospital, we decided to focus on our own check-in process. A key suburban location was due for a complete renovation, and since the walls had to be gutted, we saw an opportunity to act. We proposed modifying the check-in desks so that our staff could be standing while working and ready to greet all who approach at eye level, with one lower desk to accommodate wheelchairs.
But this seemingly simple idea was only the beginning of a long process that was necessary to implement such a profound cultural change in this large, established institution. We needed approvals from multiple parties, including human resources, the legal office, facilities management, occupational health, project managers, architects and, of course, senior management at the hospital. Each asked why we wanted to make this change. Once we explained the customer service value that aimed at enhancing the experience, they were ready to work with us.
First, you should consider the impact this would have on staff. There are worries that long workdays spent standing without a break could lead to health issues. But there is also evidence that remaining active during the day and spending less time sitting down has real health benefits.1 We proffered that if there were ever a situation where families should receive four-star service, it should be during the sometimes emotionally stressful healthcare visit. That is, it was not only a good thing to do for our patients, it was also the right thing for them.
Once we had the approvals, there was a lot more work to do. We needed to ensure that our front-line check-in staff felt comfortable with and understood the rationale for the stand-up experience. Because this was a newly expanded location, many employees would be new hires. During the hiring process we explicitly conveyed that they would be standing up to greet patients, so that they could decide before accepting the offer whether standing up was going to be a problem for them.
We then developed a training protocol for our check-in staff. We also developed a policy allowing for breaks or for tall stools to be used, so staff members could rest their feet on occasion when patients were not within sight of the front desk. But we held firm to the vision that no employee would be seated when interacting with a patient at the front desk.
We have certainly had to deal with some employees sitting down when the boss wasn’t around. In these cases, we reinforced the reasons they needed to be standing up, always focusing on what the patients and families deserved during their visit. These discussions and immediate feedback have kept the culture and vision alive and let people know that we are serious about it.
Since implementing the stand-up check-in, we have discovered the subtle but unmistakable difference in the atmosphere experienced when approaching the front desk. There’s an energy and clear tone of readiness that make the experience more positive.
We have received many comments from others about the hospitable environment at our check-in desk. Visitors have said they sensed the difference without understanding why the environment was better. Once we pointed out the stand-up check-in, they understood right away. Colleagues or those interested in service innovation are often detoured to our clinic to observe how customer experience has been made a priority with the check-in staff.
But implementing this model is challenging, even at our own institution. Despite our advocacy and six years of successful implementation at one site, we haven’t yet been able to institute stand-up check-in at our other clinic sites, where employees from different departments work nearly side by side.
The prevailing seated check-in setup at ambulatory healthcare clinics nationwide provides patients with a simple message: “You can wait for us because you need us more than we need you.” But a conceptually simple posture change (albeit a difficult culture change) will reverse that message. With stand-up check-in, we tell our patients, “Welcome! We are glad to see you, and you are the reason we are here.”
1. Katzmarzyk PT, Church TS, Craig CL, Bouchard C. “Sitting time and mortality from all causes, cardiovascular disease, and cancer.” Med Sci Sports Exercise, Issue 41, No. 5:998-1005. doi: 10.1249/MSS.0b013e3181930355.
October 2016 MGMA Connection Magazine