What’s Next? Managing Client Expectations

Years ago, I worked with the staff at a large primary care practice teaching them some basic customer service-type skills to help them better manage their patients and, frankly, improve their own job satisfaction, too. Nurses, receptionists, the referral and billing groups – clinical and non-clinical staff attended. We made lists of patient complaints, then worked together to develop some simple and no-cost approaches they could use to reduce complaints.

I then asked them to begin implementing some of those ideas, to assess what tactics did or did not work for them.

Then, after a few weeks of practice, we came back together to debrief.

Now, I’ll admit… I was a little nervous. I had no idea what to expect. Had it worked? Did they actually implement some of our ideas? And if they did, what was their assessment of success?

Turns out…. They loved it! Many of the ideas worked very well. They were pleased, patients were pleased…

Today I am sharing with you two of the tactics we developed. Their specific details may not be useful to you because you do not work in a doctor’s office. But their approach will illustrate how to develop simple tactics that will keep the working relationships you have with your clients running smoothly.

The Waiting Room

Situation: You walk into a crowded restaurant, look around you, see that there are many people waiting… So what’s the first thing you ask the host? The answer, of course, is “How long is the wait?”

But patients rarely do that. They walk into a crowded doctor’s waiting room, check in, and sit down. They don’t ask how long the wait is – until they get upset if it’s “too long” – which each of them defines differently. That’s a major source of friction (which no doubt raises blood pressures, too) – and it’s mostly unnecessary.

waiting room

A two-pronged approach can satisfy most (not all) of those frustrations. The first is my mantra “manage their expectations.” The doctor’s receptionist doesn’t have to tell them exactly how long the wait will be, but s/he can give a relative estimate: “Dr. Smith is running behind – it may delay her a half-hour or more.” If it takes Dr. Smith a half-hour – then the patient will understand because she was told it would take that long. But if the patient had to wait only 25 minutes – then she was thrilled because she got called “early.” Granted, the delay may be very difficult to estimate, but some indication is better than no indication at all. The key is to let them know “what’s next.”

As an advocate, we can adjust this approach – in effect, use the flip side. During a visit to a doctor with your client, if the receptionist doesn’t give you some indication of the wait – then ask! You ask in a restaurant, so why not ask the doctor’s receptionist? Manage your patient-client’s expectations and he or she will be more satisfied with the doctor visit – and you, too.

The Referral Desk

Among those who worked in the doctor’s referral office (usually arranging for referrals by a primary to a specialist), the major frustration was that patients would constantly call them before the referrals were complete, upset that it was taking so long. Of course, fielding all those phone calls takes time – time they can’t spend working on completing the referrals. How annoying for everyone!

So I asked about their process. Turns out they make the first attempts at the referrals within 24 hours of receiving the referral from the doctor by phoning the patient’s payer for approval. After that, they mostly have to wait, and follow up, and follow up, and follow up again, and field calls from irate patients. Then, once they finally get the payer’s approval paperwork, they can call the referral doctor to make the appointment. It can take weeks or months to complete the process for some of their patients, depending on the patient’s insurer and the wait time to see that specialist.

sign - what's next?

My suggestion to them: Explain the process to the patient! Tell them what to expect. Manage their expectations. Tell them “what’s next”.

That can begin with the doctor, “Mrs. Rodriguez, I’m going to refer you to an orthopedist. Just so you know what to expect – depending on your insurance, this referral may take two weeks, or it may take a month. We’ll contact you as soon as we get the approval.” As the patient checks out from the appointment, a reminder can be provided, too.

Of course, the bugaboo for the referral team is those irate calls from patients. But if patients understand that it can take many weeks, and that it’s their own insurance that holds up the process, then the referral team won’t get so many of those calls. Patients are more understanding, and staff is happier. Win Win! And all because that question was answered, “what’s next?”

It’s a different way of thinking for many people. Letting everyone know what to expect, even if they don’t like it, at least affords them a platform of understanding in a different way. Plus it’s a sign of respect to communicate the process; a recognition that their time is valuable, too.

Advocates Can Answer “What’s Next”, Too

In the work you do as an independent advocate, situations might arise that are annoyances for both you and your clients. So why not bypass your client’s frustration by managing their expectations? Tell them exactly what to expect – what will happen next. Warn them of potential hiccups in any process so it won’t be a bad surprise. If things then go awry, they will have been warned. If the negative circumstance doesn’t come to pass, they will think you are a miracle worker!

Managing expectations, answering the question, “What’s Next?” is a powerful tool for running a successful, client-centered practice.


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