Providing a Positive Patient Experience in a High Stress Environment

Written by on February 27, 2015 in Features - No comments

NurseSmilingWEBMuch has been written about what makes great customer service. The definition usually includes responsiveness to the customer, the ability to resolve issues, timeliness and friendliness. Most of us have experienced great customer service at some time in our lives; an instance where we feel acknowledged, responded to and cared for. A great patient experience has those same elements. In healthcare, having the patient feel acknowledged, responded to and cared for is essential because many patients find themselves in a vulnerable position coming into a healthcare setting. Sometimes it is just routine healthcare services but other times the patient can feel anxious, uncertain and, depending on the reason for his or her appointment, afraid.

To give the patient that needed attention and care right from the beginning is very important but  can be challenging to the office staff who may be feeling stress of their own from high patient volumes, scheduling mishaps, demands from the physicians, and understaffing.

Work stress is significant in many occupations including healthcare. A nationwide poll by the American Psychological Association (APA) showed that approximately 75% of Americans experienced substantial work stress and half noted that their productivity had decreased because of stress(1). The cost of stress in the workplace is high and is seen in terms of absenteeism, “presenteeism” (defined as an employee being present at work but not engaged or focused), employee turnover and negative physical and psychological symptoms (2). Chronic stress often times can lead to burnout, a syndrome commonly seen in helping professions of all types, and very evident in healthcare. In the early 1980’s, social psychologist Christina Maslach began researching the concept of burnout in high stress work environments. She saw burnout as the result of chronic stress that developed from a variety of environmental causes that included such risk factors as work overload or excessively high work volume, lack of control or the feeling of powerlessness to effect change and make decisions to improve the situation, and insufficient reward or the lack of acknowledgement of one’s individual contributions (3).

Today’s healthcare setting has many, if not all, of the environmental risk factors that Dr. Maslach identified. A case in point is medical center receptionists. Receptionists are on the front lines of health care. One study reveals that over two-thirds of receptionists surveyed reported being verbally abused by patients. 60% reported telephone abuse and 55% reported face to face abuse (4). The same study showed that most receptionist feel that physicians fail to respect the complexity of their work. These are just a couple of the reported stressors added to issues for all office personnel such as insufficient staff, decreasing resources and increased patient volumes. A 2013 survey of healthcare employees found that 60% of healthcare workers say that, because of their working conditions, they are feeling burned out by the demands of their jobs with 21% percent saying they always or often feel burned out. Of those who say they always or often feel burned out, 67% plan to look for a new job (5).

Physician dissatisfaction and staff dissatisfaction tend to feed off one another. An overly stressed doctor can be angry and critical and abusive. Studies have shown that in the last few years there has been a notable increase in physician stress and burnout and the situation is only getting worse.

The 2015 study clearly showed not only is physician stress and burnout prevalent, but it is increasing. Almost 66% of the over 2000 respondents indicated more stress and burnout than in the 2011 study, 88% of all respondents identified themselves as moderately to severely stressed and 46% specified severe stress and burnout. Common sense and a wealth of evidence tells us that an unhappy stressed out work environment makes for a poor patient experience.

StressChart1WEB

By the same token, a staff member who is stressed and moving toward burn out will be more prone to mistakes, be more disorganized or just stop caring about the quality of his or her work. This adds more stress on an already overextended physician. For more information on this topic and the most recent data regarding physician burnout please visit www.VITALWorkLife.com/survey/Stress.

Symptoms often seen in high stressed healthcare settings are:

  • Poor communication or miscommunication. In a stressful office environment information is sometimes thought to be communicated when in fact it has only been partially communicated, if at all. Often the poor communication stems from the assumption, “She/he should know”
  • Unclear Expectations. Staff are not sure of the office manager’s or the physician’s expectations. They may feel pulled in different directions because they are getting mixed messages. Often times you hear, “they think we can read their minds and get angry when we can’t”.
  • Unclear roles and responsibilities. Tension and frustration can build when there is a lack of clarity regarding roles and responsibilities. Instead of accomplishing the task at hand, team members are likely to waste energy negotiating rules and protecting turf. In an office where there are “multiple bosses” (physicians) these issues can be magnified.
  • Disrespectful Interactions. If staff and physicians have difficulty managing conflict or difference of opinion, it can result in frustration overload that can lead to angry outbursts or chilly silences. Both of these responses can increase the tension in an already stressed environment.

Taking steps to improve communication and decrease stress.

The best way to develop an accurate assessment of the stress level in a high demand environment is to regularly gather observations from the staff about their work environment and experiences. This can be accomplished by:

Office Manager Rounding

On a regular basis the office manager can check in with each staff person by asking a few key questions to see how the employees are doing and if they have any suggestions for improvement. This brief inquiry can help you stay on top of any developing problems and concerns and allows you to proactively solve issues.

Anonymous Staff Surveys

This can take the form of a brief 8-10 question Survey Monkey questionnaire or a full employee engagement survey administered by the institution. Any format that allows you to query your staff and get honest feedback about what is working well, what needs improvement and what are suggestions for improvement is valuable. One caveat is that if you do a survey, review the information and report back to your staff about what you discovered and what steps will be taken to respond to the feedback. Nothing is more frustrating to employees than to be asked to take time to fill out multiple surveys with no action taken on the feedback.

Once information has been gathered it can be examined for themes and reoccurring issues. When these themes have been identified, getting input and ideas for solutions from the staff and the physicians is essential. One way this can be accomplished is by implementing Inter-professional work groups – these are small groups of identified staff and physicians committed to meet on a regular basis to review the information gathered by the surveys, identify priorities and present solutions for change. These solutions and action steps are then presented to the leadership for review and implementation.

In order to increase communication and provide clarity regarding expectations as well as de-stressing the office environment, a helpful solution is BID Huddles – 3 minute stand up meeting that takes place twice a day that brings together the physician and any staff involved with patient flow. It serves as a staff and physician check in that improves communication and also a proactive tool to trouble-shoot patient or office concerns. For more information about this method click on this link http://www.thehappymd.com/blog/bid/289959/Physician-Leadership-Patient-Flow-and-Team-Huddle-POWER-Training

In order to help members of the office staff feel their contributions are valuable it is important to acknowledge the good work being done. A good way to do this is using Recognition tools – There are many ways to reward and recognize performance.  Examples include words of appreciation when you see that person in the hallway, a hand written thank you note, or a team recognition event held regularly to acknowledge work above and beyond. These efforts can be driven by an office manager or a Reward and Recognition Team who implement recognition events. However you do it, it is important to acknowledge and celebrate the wins.

Engaged employees are the primary drivers for delivering an exceptional patient experience.  Paying attention to the sources of stress in a medical office, actively engaging in dialogue with staff and physicians on ways to improve the workplace environment and then taking action to make it better benefits the staff, the physicians and most importantly the patients.

  1. American Psychological Association. Overwhelmed by Workplace Stress? You Are Not Alone.https://www2.kumc.edu/PDFATraining/Admin/documents/Long%206.11.09%20Handouts.pdf
  2. McKee, MG, Ashton K. Stresses in Daily Life. Lang R, Hensrud DD (eds). Clinical Preventative Medicine. 3rd ed. Chicago, IL: AMA press, 2004. 81-89.
  3. Maslach C. Burnout: The Cost of Caring. Cambridge, MA: Malor Books; 2003
  4. Dixon CAJ, Tompkins CNE, Allgar VL, Wright NMJ. Abusive behavior experienced by primary care receptionist: a cross sectional survey. Family Practice 2004;21(2):137-139
  5. Career Builder press release, April 30, 2013. More than one third of health care workers plan to look for new jobs this year. http://www.careerbuilder.com/share/aboutus/pressreleases.aspx
  6. 2015 Stress and Burnout Survey, VITAL WorkLife and Cejka Search, February 2015,

By Maureen Dorgan Clemens, MS, LCPC, CADC, CPDC                      

Maureen has 23 years of experience in working collaboratively and effectively with health care leaders and physicians. She has consulted, trained and coached many physicians, executives, healthcare leaders and supervisors regarding the topics of leadership, effective communication, collaboration, effective team work and conflict resolution. Maureen has helped those she has coached to further develop their strengths in order to navigate the demanding healthcare environment.

Maureen is a Certified Physician Development Coach and one of her areas of practice is coaching individuals with disruptive or unprofessional behavior. Her coaching program is designed to help participants increase self-awareness, develop more productive communication skills and identify effective strategies to deal with stress. She provides services to physicians at all levels of the organization including those in leadership positions as well as residents and fellows. Maureen has facilitated and participated in behavioral interventions with physicians and residents and also helped design a Physician Peer Mentor Program based on the Vanderbilt University Medical Center model that trains volunteer physician mentors to intervene with colleagues in the early stages of problematic behavior.

In addition to her Masters in Clinical Psychology and Licensed Clinical Professional Counselor (LCPC) credential, she holds a certificate in Human Resources Consulting, is a Certified Addictions Counselor as well as a Certified Physician Development Coach.

Ms. Clemens is a physician consultant and member of the Advisory Team for VITAL WorkLife™, a national behavioral consulting company with providers in every major city and wide-ranging expertise in every aspect of behavioral health. VITAL WorkLife is the only company today providing healthcare organizations and practitioner’s easy access to the help they need. Dedicated teams of experienced medical and behavioral health practitioners understand the unique needs of doctors and their families, and deliver the services needed to help overcome work and life challenges.

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