The mammography center website proudly states it is one of the top chains in the country, promising both physician quality and a compassionate, comfortable patient experience.
This is the tale of a “snake bit” patient and it can happen at any imaging facility—offering an opportunity to respond effectively to a complaint or heading rapidly to a one-star review. It is also a reminder that problem resolution is an important part of marketing.
Stephanie had previously been to Sunburst Mammography and did not anticipate this visit would be any different than last year. Since she had dense breasts, she also expected her mammogram to be painful but knew it would be over quickly.
The technologist introduced herself to Stephanie and noted it was her first week on the job. She was fresh out of training and a little nervous. The tech struggled with positioning and as she had her images checked for approval, informed Stephanie she would have to repeat the study. She repeated it several times and Stephanie said the level of pain increased with each attempt. She fought off tears but said she felt “mangled” before the lead technologist came into the exam room to assist. The lead tech got an acceptable image on the first try.
As Stephanie was leaving the clinic, there were “smiley face/frowny face” buttons on the wall. She hit the frowny face and continued home. That night she was unable to sleep due to pain in her breasts.
A week later, Stephanie received a satisfaction survey by e-mail. She completed the survey and mentioned her issues, while noting she recognized the technologist was new.
There were no other communications from the center but a few weeks later another survey arrived and she completed that one as well, providing additional detail of her experience in the “tell us about your visit” box.
The third survey arrived the following month and it provided more open text options. Stephanie unloaded, including asking the question about why she kept receiving satisfaction surveys if they weren’t going at least acknowledge the concerns she expressed. She also commented on their Facebook page and noted everyone from American Airlines to a local franchise location has responded to a negative Facebook post. Still nothing from Sunburst Mammography.
What did Stephanie expect? She thought she would at least get a call acknowledging her bad experience and offering an apology. She informed her primary care doctor to NEVER try to send her there again. She has also told a few dozen other women about her experience but said the ultimate insult occurred when she received a perky call the following year to schedule her mammogram. Just like nothing had happened.
The survey says...
Surveys can be valuable tools to validate what’s going well, identify operational issues and enabling a practice to address problems as they occur. Survey information can help define and refine business operations, but it needs to be acted upon.
Pulling off the accolades for social media posts is fine, but the expectation for someone completing a survey is that, since you asked for their opinions, you’re going to respond to them. The information provided sets up an excellent opportunity for meaningful communications and reinforcement for the “we care” statements often central to the marketing message.
The response may be one-on-one if the situation is isolated—saying “I’m sorry” to someone reporting a bad experience and meaning it, since the tone of your conversation will easily carry as much weight, if not more, than your words. Sometimes things just go badly and all you can do is apologize. Sometimes you can tell the person you will be changing some processes as a result of their input—or that you’ve disciplined a staff member involved. Offering goodies in response can be appropriate but it can also be viewed as a superficial copout, depending on the tone of related communications.
Operational Flaws Revealed
If survey results reveal an operational flaw reported by multiple people, your response can be to thank them for their input and let them know you’re taking steps to change processes so the problem is not repeated.
This means listening to referring physician offices as well as patients. For example, we discovered referring offices would only call during a limited period during the day—when they were sure April was out of the office for lunch. Then they could talk to Maria, who was courteous and helpful scheduling interventional procedures. But nobody wanted to talk to April, including some of the physicians in our own group. Did we do the ageless personnel shuffle, assigning April to another department where she could be surly only to her co-workers? No, that’s how she ended up scheduling special procedures so instead we shuffled April out of the company. Referring physician offices expressed their appreciation and Maria no longer had to shoulder most of the scheduling load herself.
Course of Action
Hoping a problem will just resolve itself if before the next survey is due? There are few “always/never” situations in life but it’s safe to say a bad situation never fixes itself with a little more neglect. If you don’t want to know the answer about what is or isn’t going well, don’t ask. If you know you won’t make any changes based on new information gathered, don’t ask.
On the other hand, if you use negative information to improve processes, communication and training, survey results should also improve as problems are corrected. There will still be occasional one-off situations you could never anticipate, but they will become rare and less disruptive. The first point is to thoroughly identify a problem and how/why it happened. Since virtually all radiology workflow—from patients scheduling to moving through the department for imaging studies to billing/collections—can be broken down into identifiable process steps, it is also possible to correct weak points as process failures occur.
Problems as Opportunities
I was on site consulting for an imaging center that went through a similar experience, although it involved CT contrast. The patient showed up for her appointment but failed to adhere to exam prep instructions and had to be rescheduled.
She appeared the following day and the technologist struggled inserting the needle for contrast administration, resulting in several failed attempts and an increasingly agitated patient. Things just weren’t going to go as smoothly as they usually did, everyone was stressed but the study was finally completed.
The center manager apologized profusely to the patient for the stress of the situation and offered a gift card to a local restaurant. The patient was still upset by the experience but did appreciate the gesture. The manager then called the physician who referred the study and filled him in on what had happened in the operationally “everything went wrong” scenario.
While ultimately he received the diagnostic information needed from the CT ordered, he was advised he would probably also have an unhappy patient relating the experience. He appreciated knowing he wouldn’t be blind-sided when again meeting his patient.
After Action Review
The staff discussed the situation at their regular Friday meeting, without blame and to examine how they might have handled things differently. This included a review of how exam prep information was communicated and they added a more detailed explanation of the “before your study” requirements to the call confirming the appointment time.
They met reality head on, did not dismiss the problem but examined it thoroughly, initiated uncomfortable conversations and turned it into a positive. The patient was soothed, the referring physician reassured that the center was concerned about their patient and the process failure addressed.
On the other hand, Stephanie is still talking about her frustration with Sunburst Mammography any time that door is opened, both in terms of her painful mammogram and the endless surveys she felt showed how little the center cared about their patients. The promise of best doctors? She still isn’t going back.
She worked as a consultant for radiology practices, billing companies, software developers, and hospital radiology departments for 20 years before joining MSN.
She is a regular contributor to the RBMA Bulletin and a frequent speaker on topics related to radiology practice management.
Pat can be reached at firstname.lastname@example.org