Setting Expectations: The New Frontier For Patient Experience

By Tobi Elkin

While healthcare delivery models continue to change and evolve, attracting new patients and retaining existing ones remain key to revenue growth. Patient satisfaction will always be a critical part of growing a healthy practice. Managing expectations with respect to delays, wait times, and the components of a visit, along with communicating the costs associated with various services, can directly impact patient satisfaction and your bottom line.

“Customer experience” is a frequently used phrase that refers to the various ways in which consumers interact with a brand’s products and services. In healthcare, you only need to swap “customer” for “patient,” and “patient experience” refers to each of the touchpoints that connect patients, i.e., consumers of healthcare, to a doctor’s office.

These critical touchpoints include everything from the first call patients place to schedule an appointment (or email), to the online or on-site completion of forms, office check-in, wait-time, the taking of routine vitals, the exam itself, and checkout. Each touchpoint plays a role in a patient’s feeling properly taken care of and his or her confidence in the practice. A practice that fails in even one touchpoint in the continuum of care may see a drop in office visits and new patients and weak ratings or reviews. And taken together, these can begin to impact revenue growth if they’re not addressed.

The patient experience is closely linked to patient satisfaction, which most practices measure on a periodic basis through surveys. “Patient satisfaction is the business we are in,” said Chrystal Schanewolf, Director, Clinic Operations for OrthoCarolina, a North Carolina–based orthopedic practice with more than 30 locations. “We review patient satisfaction on a monthly basis to identify what we can do better,” she said. A key tool for OrthoCarolina is an online patient survey, the results of which reveal areas for improvement.

One of the biggest issues that impact the patient experience is time spent sitting in the waiting room and exam rooms. “Delays in the office are operationally difficult to define and are often a point of frustration throughout healthcare. For example, some patients feel their appointment starts at their arrival [time] while others see it as their scheduled appointment time. Perspectives also change based on where someone is during the visit, such as the waiting room vs. the exam room,” Schanewolf explained. “The goal with this improvement opportunity is not to eliminate wait times but to manage expectations on the front-end and the experience during the time the patient spends in our office.”


“The goal with this improvement opportunity is not to eliminate wait times but to manage expectations on the front-end and the experience during the time the patient spends in our office.”

OrthoCarolina conducts monthly patient satisfaction surveys and tracks the percentage of patients who felt they were adequately informed of delays. It determined a need to focus on improving the patient experience around delays and wait times.

Testing Workflows To Reduce Patient Wait Time

To understand how it could reduce wait times, the practice launched a pilot program in late 2013 through its Patient Family Centered Care Committee and created a workflow that aimed to improve communications during patient visits. The group, which consisted of staff, managers, and providers, identified steps to improve all aspects of the patient’s appointment. The pilot tested workflows at two different office locations and compared the performance against the company average; it tracked patient satisfaction rates on a monthly basis and tweaked processes along the way.

Prior to the pilot, the two offices logged patient satisfaction rates of 33 percent and 42 percent. Those rates represented the percentage of patients who felt they were kept informed of any delays at the time of their visit. After the first month of data tracking, one of the two offices in the pilot saw a 54 percent satisfaction rate after implementation of a new workflow. And while the rate dipped slightly the following month, a year and nine months into the program, satisfaction hit a high of 64 percent. The other office reached a high of 61 percent satisfaction just three months into the pilot program.


“After the first month of data tracking, one of the two offices in the pilot saw a 54 percent satisfaction rate after implementation of a new workflow.”

“Overall both offices [in the pilot] were far above the average satisfaction rate of the company. Research shows it takes a good year for a process to sustain itself, and it definitely was a lesson learned in holding accountability to communication and process implementation,” Schanewolf said. Apart from the specific question of whether patients felt properly informed of delays, OrthoCarolina’s overall patient satisfaction hovers around 80 percent annually and improves year-over-year as it targets areas of improvement such as this project.

The findings have helped inform changes. “We were able to use our patients’ feedback on how they felt delays were communicated and use this to make changes within the organization for better patient satisfaction,” Schanewolf said. OrthoCarolina, like other practices, is using technology and a patient flow system to optimize and manage its patients’ time and experience. OrthoCarolina will continue to focus on delays in the office as the demand for appointments is very high, and physicians have expressed a desire to spend more time with patients. To that end, the practice has begun rolling out a new screen-based system to track a patient’s time in various areas of the office. Digital screens are mounted outside of exam rooms to track where the patient is in the appointment process and how long they’ve been waiting in each area.

Technology Identifies Bottlenecks

Schanewolf said that by using the technology, the practices hope to identify bottlenecks in its workflow so it can see in real time when a patient is sitting stagnant in any part of their visit. The system will alert the staff when a patient is waiting too long. She said the system has been implemented in three locations and will be integrated in all new locations.

When patients arrive, they sign in to a kiosk, which captures the exact time they came in. Then they’re moved to the next step in the visit and assigned to a different staffer who “owns” the patient for the next segment in the appointment. The tablet screen alerts the staffer after 10 minutes with a red exclamation point, which signals the patient has waited too long. The screen is visible to everyone on staff, and the patient is then updated.


The tablet screen alerts the staffer after 10 minutes with a red exclamation point, which signals the patient has waited too long. The screen is visible to everyone on staff, and the patient is then updated.

While a year’s worth of data on the new system isn’t available as of this writing, Schanewolf said OrthoCarolina has noticed that a patient’s visit is a lot longer than they expect it to be. “It’s not necessarily because they’re sitting waiting in one spot for 30 minutes, but because there are a lot of checkpoints to go through in one visit, especially in orthopedic practices.” There are electronic forms and X-rays to complete, and then a visit with the physician and more.

“We have to do a better job of setting expectations with our patients when they make appointments.” Streamlining the process is a challenge since OrthoCarolina has physicians with a lot of subspecialties, all of whom have different needs. “We need to eliminate bottlenecks, make adjustments in our physicians’ templates, spread out new patient slots, and cluster-in quicker visits and follow-ups,” she said.

By extension, the practice could also give each patient a tablet that they keep throughout the course of their visit. The tablet would be used to check in, check out, pay co-pays, and view educational videos on various topics like knee pain and shoulder issues in order to make the most of their time. OrthoCarolina is also considering offering “live” patient satisfaction surveys using the same questions as the email survey, but patients would rate their experience on the tablet, in-person.

Web App Cuts Patient Wait for Appointments with Specialists

Dr. Paula Muto, a Boston-based vascular and general surgeon, believes technology, coupled with a human touch, can help improve the patient experience. She created UberDoc in 2016, a web application designed to make it easier for patients to land appointments by offering them direct access to a specialist for an accelerated appointment date. “Going to a doctor’s office can be like going through airport security, especially if you need a referral,” Muto joked.

As a specialist based in Lawrence, Mass., and one who works with an economically disadvantaged population, she was tired of seeing patients having to go through “10 hoops” to see her due to insurance rules. “There are so many steps in the process and a wait to see a specialist in Massachusetts,” she said. Doctors who use UberDoc set aside a couple of appointment slots per week to speed patients through the process. For the first appointment, patients pay $300 via credit card or health savings account, which includes $50 to make the appointment and $250 once they’ve been seen. After the first appointment, insurance is used.

The app also enables her and the other physicians who use it to communicate with patients at any hour, on demand: “It’s like a walk-in model for specialists,” she explained.

In addition, Muto has built other efficiencies into her practice. For example, during office hours, patient calls are routed to an answering service, which makes the appointments, freeing up her staff to focus exclusively on patients who are in the office. “I want attention on my patients. I don’t like people on the phone in the office booking appointments and talking to insurance companies. I want staff to focus the time on the patient at the window,” Muto said.

Her personal touch is also part of improving the patient experience in a healthcare system dominated by online portals, EMR (electronic medical record) systems, diagnostic codes, and scuffles with insurance providers that offer conflicting answers to patients’ questions about benefits and referrals. “When it comes to a pathology report, I pick up the phone and talk to my patients; it’s low-tech and much more efficient.”

Muto would like to see UberDoc offered as a subscription model for doctors and for it to appear in the office “window” alongside of Visa, Mastercard, and American Express. “Any service where a patient can skip cumbersome administrative steps and get right to the doctor is inherently valuable and offers relief in those times of stress when a delay is no longer tolerable,” Muto said. “We need more innovative ideas that increase access and decrease cost and simplify things. We need to give patients an affordable choice and allow doctors to provide it.”


“We need more innovative ideas that increase access and decrease cost and simplify things. We need to give patients an affordable choice and allow doctors to provide it.”

“Price Estimator” Helps Set Patients’ Expectations

Elective plastic surgery procedures can feel a bit like looking at a Chinese menu—a bewildering buffet of options but without pricing. Jonathan Kaplan, a San Francisco–based board-certified plastic surgeon, does his bit to improve the patient experience by reducing sticker shock for patients and prospective patients of his practice, Pacific Heights Plastic Surgery.

“So many medically necessary services and cosmetic services are paid out of pocket now because of high-deductible health plans or because they’re not covered by insurance, so we offer a Price Estimator,” Kaplan explained. The Price Estimator appears on Kaplan’s website and is also an app that patients who come in for a consultation can use in the waiting room. The tool offers instant gratification in terms of determining out-of-pocket costs and can be used repeatedly to calculate potential costs well before an appointment is made. When prospective patients use the Price Estimator, Kaplan’s practice obtains contact information, and the prospective patient becomes a “lead” that his practice can remain in contact with.

Consumers can scroll through different procedures using the Price Estimator and add procedures to a wishlist. After they submit the list with their contact information, they receive an email with a breakdown of pricing. “It helps them have a better idea of what they’re responsible for. The benefit is they get accurate pricing information, and we get leads,” Kaplan said.

Kaplan analyzed data that looked at 412 wish lists from 208 unique individuals over the course of a year. He found that of those 208 people, 17.8 percent came in for a consultation, and the others checked pricing information using the tool. The upshot is that he didn’t waste time on consults that went nowhere, but his practice did get contact information, and those prospects eventually came into the office. Of the 17.8 percent of the people with wish lists who came in for consultations, 62 percent of them booked a procedure. “People who knew the pricing ahead of time were 41 percent more likely to book a procedure because they were prepared. It’s a great way for patients and doctors to not waste their time, which improves the patient experience,” Kaplan added.


“People who knew the pricing ahead of time were 41 percent more likely to book a procedure because they were prepared. It’s a great way for patients and doctors to not waste their time, which improves the patient experience.”

Befitting a plastic surgeon’s spa-like facility, Kaplan offers water, tea, coffee, and healthy snacks. A bonus: Netflix is available in the CoolSculpting room.

Reducing Wait Times, Eliminating Unnecessary Steps

John Snow, Inc. (JSI), a public health research and consulting firm, offers physicians’ practices and publicly funded clinics recommendations on how to improve the patient experience. It has found that the most common complaint among patients is wait time. “There are lots of ways to approach it through staffing models, appointment scheduling adjustments, and basic clinic flow,” said Jennifer Kawatu, senior consultant at JSI, and a technical assistance provider who does patient experience work with publicly funded organizations.

“We encourage eliminating unnecessary steps to eliminate waste and improve workflow. You can put the patient in one room and have the services provided in that one room; you don’t move them around, everyone comes to them,” she said. Keys to improving the patient experience are eliminating services that aren’t of value to the patient and focusing on the specific reason for the visit.

Kawatu said that while a lot of time and energy is spent on doing quantitative surveys of practices, there is often little variation in the findings, and they can net a false sense of satisfaction. Across the board, she said, most patients in the practices she works with uncover the most useful information by asking qualitative, open-ended questions, like “What could we have done to make your visit better today?” These types of questions reveal specific complaints.

Publicly funded clinics receive subsidies to provide services and agree to accept Medicaid patients. However, they still bill for services, and it’s a way for them to see more patients. When these clinics start billing and become more sustainable practices, they might be able to attract more private-pay patients who are able to pay more. “In providing a better experience, they can attract private pay patients, those who have employer-sponsored health plans,” Kawatu said. If the family planning clinics she works with that provide same-day services can reduce wait times, they can compete with private practices.


If the family planning clinics she works with that provide same-day services can reduce wait times, they can compete with private practices.

Customized Visits, No Wait Time

Dr. Napoleon Maminta is an internist who launched his own practice, Naptown Priority Health, in 2016 after decades in corporatized healthcare settings. He grew frustrated with patient quotas and short appointment times that didn’t enable him to engage deeply with patients. In his new practice, each visit is 45 minutes long, and he sees about nine patients a day. Wait times are rarely more than five minutes.

His Noblesville, Indiana, practice is referred to as a “Direct Primary Care” model because Maminta has cut the insurance middleman out. He charges $100 a month per adult for unlimited visits and does telemedicine and home visits, which contribute to overall patient satisfaction—and his own.

Maminta offers his patients an iPad to complete a survey after their visits. While he has a waiting room stocked with a library of books, comfortable chairs, and a flat-screen TV, there’s hardly any wait time. “It’s two minutes, at most,” he said. In fact, his post-visit survey probably takes a bit longer than a patient’s wait time.

No matter how healthcare delivery and economic models evolve in the future, communicating with patients and setting expectations about their visits will always be critical to the health of your practice.


Tobi Elkin is a veteran content creator and consultant who enjoys crafting compelling narratives for diverse audiences. Based in New York City, her writing has appeared in newspapers, magazines, and on websites including Advertising Age, AOL, the Associated Press, CMO.com, Narratively, Robb Report, The Huffington Post, and many others. She has consulted on thought leadership, marketing, and content strategy for technology firms, consumer brands, and non-profit organizations.