Medical Practice Customer Service

Customer Service Solutions in Private Medical Practice

David A. Wright, MD, MBA, MHSA

Sunday, February 21, 2016

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Defining The Dilemma

"A problem can result from new knowledge or thinking. When you know where you are and where you want to be, you have a problem to solve in getting to your destination. The solution can and should be fun and exciting as you think over the various possible solution paths you might choose. When you can identify the difference between what you have and what you want, you have defined your problem and can aim toward your goal." (Harris, 1998)

Mission Statement: To develop a solution that will bridge customer service gaps with patients (external customers) between private medical practice staff, personel, and professions.

Vision Statement: To use brainstorming and problem-solving techniques to identify and solve this dilemma.

Problem Statement: What tools can be employed to help bridge customer service gaps in the servicing of clients/patients in private medical practice?

Subsidiary Problem Statements: Is it reasonable to be able to close customer service gaps between the ways that professional and clerical staff members approach and treat patients in private medical practice?

Cause Statements: Why do many clerical staff members appears to be deficient in their treatment of patients in private medical practice?

Solution Statements: What advice can be provided to help us arrive at the best decision? Is there a single solution to this dilemma? Are there ways that other industry professionals can positively contribute to a solution?

Goals Statements: To suggest good advice to solve this customer service dilemma. To produce a solution that will negate the need for further major performance projects to improve customer service and patient satisfaction measures in private medical practice. To produce a solution that will help create a self-perpetuating system. To produce a solution that is not only short-term in nature; but has long-term power.

Approaching the Dilemma

According to Harris, there are a plethora of ways to detect, define, and resolve dilemmas and problems (Harris, 1998). Some of the basic steps that he suggests include the following: (1) Admitting that there is a problem (2) Defining the problem (3) Decide if it's truly a problem or dilemma or not. He also suggests that there are multiple ways to create a solution, including: (1) Prevent it (2) Eliminate it (3) Reduce It (4) Treat It (5) Tolerate It (6) Re-Direct It (Harris, 1998). Finally, Harris suggests the following about problems, in general: (1) Problems are opportunities for improvement and evolution (2) Problems are the remainder of the difference between the status quo and a desired future (3) A problem only exists if there is a recognition of a present dilemma and a belief in a future where the present dilemma has a lesser effect (Harris, 1998). The following graphic illustrates Harris' methodology to problem solving:


A management problem that is commonly encountered (or, rather, seen as a valid issue) in private medical practice is what might be described as a disconnect in the courtesy extended by the front desk staff members in private medical practices compared to the level and degree of courtesy extended by clinical personnel (physicians, nurses, medical assistants, etc.). The front desk staff can appear to be short and rude to patients that they view as a nuisance or with whom they experience difficulties. However, in my perception, clinical staff members are often times more accommodating, forgiving, reassuring, patient, and understanding of patient concerns, difficulties, dilemmas, and frustrations. It is my belief that the disconnect occurs for the following reasons: (1) Clinical staff expect problems and dilemmas; otherwise, there would be no patients in the first place (2) Clinical staff members are more adept at being empathetic and solving problems (3) Clinical staff members have a better grasp of the effects that clinical conditions can have on many different levels of human functioning (4) Clinical staff members, while observant of the business aspects of medicine, are primarily focused on helping patients—not accepting payments, scheduling, etc. (5) Clinical staff members have a more intimate relationship with patients, primarily due to the nature of the provision of medical care and services. These factors and variables, while not exclusionary, are primary reasons for the disconnect in the level of respect, courtesy, empathy, and patience extended to patients by the front desk staff members compared to clinical staff members.

6 Thinking Hats

This problem requires at least three hats: a black hat, a blue hat, and a green hat. The yellow hat is also implied because of the need for positivity and compassion. Furthermore, white hat efforts can help to provide data substantiating that the dilemma is a systemic one in private medical practices in the United States. According to the Debono Group, the black hat represents judgement and careful calculation while the blue hat and green hat represent thinking processes and creativity, respectively (Debono Group, 2016). The black hat would look at the responses of front desk staff members, the possible reasons for those responses, and would try to find practical, fair ways to address these issues. The blue hat would carefully consider the thinking processes of both clinical and non-clinical staff members, and would attempt to compare and contrast those differences in thinking processes—based on associated actions, verbalizations, and shared thoughts. Finally, the green hat would take the data elicited from the green and black hats (which could be place in the white, "informational" hat) and it would find creative ways to use that data to transfer or project empathy-associated thoughts, feelings, actions, characteristics, and behaviors from clinical staff members onto their less-empathetic non-clinical co-workers. Furthermore, the non-clinical staff members who display greater levels of empathy could be employed to help instill the changes. According to Debono Thinking systems, this type of activity would ultimately lead to better decisions and increased productivity (Debono Thinking Systems, 2015).

The Blue Hat

De Bono suggests that the single most important enemy of thinking (and, therefore, understanding) is complexity (de Bono, 1999). The reverse of that statement would be to assert that clarity and simplicity are the most vital elements of thought—and, therefore, understanding. Using that line of thinking as a foundation, we could infer that the blue hat is the most important one, because it represents, coolness, organization, and observation. According to the textbook, the blue hat most represents "control" and "monitoring." (de Bono, 1999). The only way that one can recognize simplicity vs. complexity is through the careful use of observation. Observation is the foundation of science, learning, thinking, understanding, knowledge, and wisdom.

White & Green Hats

Even though the white hat represents "neutrality & objectivity", and the black hat represents "carefulness & caution", only the blue hat allows for re-construction, evolution, change, re-structuing, re-orgnazing, re-assessment, and growth. While the green hat is associated with growth, creativity, and new ideas, those alone don't ensure evolution and growth. (de Bono, 1999)

Blue Hat Thinking: OBSERVATION

Among other things, the fundamental basis for every living system is observation and monitoring. In fact, all of our bodily functions (breathing, circulation, movement, reactions, reflexes, digestion, fight, flight, etc.) are based on observation. Our tissues and organs notice (observe) a stimulus, then they respond with a regulatory or reactionary one. Newborns and infants certainly develop by responding to observations elicited by their senses. Finally, projects start and end with observation. A new office project (i.e., increased levels of customer satisfaction) begins with the observation that the present level of customer satisfaction is deficient, and it ends with the observation that the new project illustrates an increase in customer satisfaction. Observation is both the beginning an the end—the genesis and the exodus of human thoughts and interaction.

Blue Hat Thinking: Top-Level Thinking

According to Test Stuff, the blue hat represents "top-level" thinking", and it is the "navigator" who knows the overall final destination. (Testuff, 2015). According to the Debono Group, the black hat represents judgement and careful calculation while the blue hat and green hat represent thinking processes and creativity, respectively (Debono Group, 2016). The blue hat represents "Thinking." According to Debono Thinking systems, thinking processes lead to better decisions and increased productivity (Debono Thinking Systems, 2015). BlueHat Marketing suggests that the blue hat is central to "trust." (BlueHat Marketing, 2015) Finally, Tipton asserts that the blue hat is about control, orchestration (action and execution), and "thinking about thinking." (Tipton, 2015). He asserts that the blue hat is central to development and growth.

Which Hat Trumps the Others?

One could probably provide multiple justifications for why any of the hats could take the leadership position. However, I would suggest that the blue hat is central because it represents "thinking about thinking." "Thinking about thinking" suggests observation, presence of mind, balance, perspective, and reflection. Our educational and philosophical systems are based on "thinking" about "acting", "thinking", "doing", and "reflecting." The go back to the "Greeks", who thought about "thinking." I can't think of a better justification for the proposition that the blue hat is the most important of them all. In this case, the observation is that clerical staff members within private medical practice don't extend the right degree of patient and courteousness to patients presenting for services. In this case, it is the blue hat that identified the dilemma in the first place.

One could also contend that all thought processes begin with observation. As such, observation is the foundation of learning, understanding, reflection, self-actualization, and self-determination. Beyond it's autonomic functions, an infant learns to navigate the world initially completely through observation. Other species of animals do the same.

According to Bogen, Aristotle's journey began with reasoning based on observation (Bogen, 2013). Kemerling suggests that Galileo's discoveries began with the practice of observation (Kemerling, 2011). The Weizmann Institute of Science asserts that the very acts of watching and observing change the reality of the observer (Weizmann Institute of Science, 1998). Finally, Rusbult, PhD, asserts that the scientific method begins with observation (Rusbult, 2004). Quite a few sources suggest that observation is the genesis of thought, learning, experience, growth, maturity, and evolution. The blue hat represents cool, calm, relaxed observation. In my opinion, these characteristics place it at the apex of the 6 hats.

Thinking Hat Switching

According to de Bono, one of the purposes of the Six Thinking Hats is to allow one to switch from one "Mode" to another—to switch from one reference point of thinking to an alternate one (de Bono, 1999). In a sense, this allows one person to brainstorm as if he (or she) were 6 different individuals—5 of whom have little relation to the one with whom you're primarily used to listening to. This allows for creativity, diversity of thinking, compromise, and evolution of thought. Creativity allows us to try to view process-level activities from the perspectives of both clerical and clinical staff members. It also suggests that the key is not who is right or wrong, but how we can learn from one another to improve patient outcomes and patient satisfaction scores.

Green Hat Thinking: Diversity of Thought

Folk-Williams suggests that diversity improves collaborative problem solving in a plethora of ways (Folk-Williams, 2010). According to him, diversity of thought can be subdivided into the following: (1) Cognitive Diversity (2) Identity Diversity (3) Preference Diversity. He summarizes that these all lead to collaborative leadership. In this case, diversity suggests that we travel outside of medicine to search for solutions. For instance, looking at the differences between the ways that bank executives and bank clerical staff members treat bank customers might help in our quest to find solutions.

Two ways that diversity might enhance the overall decision-making for an entire organization include the following: (1) the ability to think outside the box (2) consideration of perspectives outside of those traditionally considered. These 2 circumstances allow the leaders (managers, executives, directors, etc.) to consider variables that they might otherwise overlook. It should allow them to consider unforeseen circumstances, challenges, and dilemmas. It should also allow them greater degrees of empathy and compassion.

The Black Hat: Key to Caution, Trust, and Security

The black hat represents carefulness, caution, and prudence.  According to de Bono, it is the “most used, most important” of all hats--because, it’s the hat of “Survival.” (de Bono, 1999)  It is also said to represent “western thought” because it promotes critical thinking. The beauty of the decision matrix system is in its flexibility. For instance, if a new organization is seeking a low-cost solution, then the matrix can be designed (and, appropriately weighted) so that cost factors have greater weights and quality factors have lower weights (for instance, for a low-end product or solution). And, when the company is more financially solvent, then the same matrix can be adjusted to lower the weight of cost factors and increase the weights of quality. In this way, the matrix method is similar to methods used for creating and scoring psychological inventories. Different questions and items can be weighted in a way to increase or decrease both the sensitivity and specificity for certain variables and factors. This makes it more flexible, dynamic, and living.

The Decision Matrix Method

The decision matrix offers lots of possibilities as it pertains to decision making and solution finding. According to ASQ, the following considerations should be kept in mind when utilizing the decision matrix method for problem solving: (1) Its purpose is to shorten the list of options and possible solutions (2) The primary criteria include effectiveness, feasibility, capability, cost, time requirements, support, enthusiasm, and Return on Investment (ROI) (3) The Decision Matrix allows for the comparing of optimal, plausible solutions (4) Teams can be sub-divided to collect data and careful consider the most valuable criteria (5) Several criteria require some degree of guess work to arrive at an agreeable solution (6) The High End of the Criteria Scale should be closer to the ending of choice (7) Use the method to consider a single option or to consider the combining and incorporation of multiple items (8) Utilize Decision Teams to assign varied ratings to individual criteria (9) Use the results to simplify the reasoning for a solution, not to make it more complex. (American Society for Quality [ASQ], 2004)

These suggestions from the ASQ Website, coupled with the complete works of Tague from her book, The Quality Toolbox, provide resources for looking at problems and solutions from multiple vantage points. It could be likened to having the same person experience the same court trial as a defendant, a claimant, a prosecutor, a jury, and a judge. This would allow for a multi-faceted experience of both the facts and solutions available in the case. It is similar to the processes involved in putting on and taking off all of the different hats suggested by de Bono—each bringing a new perspective and alternate vantage point(s) (de Bono, 1999). Both the decision matrix method and the 6 hat system suggest that the best decisions require dissociation, compromise, and introspection. In this case, I would use the matrix method to create the strategy for identifying and mending customer service gaps. This, of course, includes finding the reason for why the gaps exist in the first place.

Project Dimension Mapping

In their 1997 article on "Mapping the Dimensions of Project Success", Drs. Aaron J. Shenhar, PhD, Dov Dvir, PhD, and Ofer Levy used 13 variables to measure "Project Success." They included the following: (1) Meets Operational Specifications (2) Meets Technical Specifications (3) Meets Temporal Goals (4) Meets Financial Goals and Constraints (5) Fulfills customer needs (6) Solves a major Operational Problem (7) Is actually utilized by customers (8) Satisfies Customer Satisfaction Goals (9) Demonstrates a Level of Commercial Success (10) Generates a Large Marketshare (11) Opens a New Market (12) Opens or Supports a New Line of Products or Services (12) Develops or Expands upon a New Technology. (Project Management Journal, 1997)


In conclusion, in many industries there are gaps in how different employees in different stations, positions, levels, and divisions treat customers, clients, and patients. These gaps exist for multiple reasons. Each hat in de Bono's system will help us to identify the problem, uncover why the dilemma exists, explore possible solutions, and refine the chosen solution after it has had an opportunity and time to solve the dilemma. In addition, we can employ the decision matrix model and dimension mapping to help develop the solution and refine the chosen solution; respectively. This will help to achieve success. The gaps that exist between how people treat one another, both personally and professionally, are as varied as the people involved. This is because we are all different. However, we can develop methods to develop and maintain an environment that supports a minimum level of customer service and customer service satisfaction. A plethora of tools is available to help achieve these goals.


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