Fenway Patient Services Cust Svc Manual FINAL copy

Fenway Health Customer Service Manual: Patient Services November 5, 2013

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Introduction: Joe Foxborough is Late Again “Yes, Dr. Osley will see you this

afternoon at 3 pm. Please come to

the fourth floor of 1340 Boylston

Street and check in with me at the

front desk so we can fill out your

paperwork before you see the

doctor…you’re welcome.” Annie

Smithfield, a customer service

representative at Fenway Health

for four years, enjoyed making

same-day appointments with

patients; they were always happy

to learn they could see a provider

so quickly.

She was still smiling when she

turned from her telephone to the

young man in front of her. “How

can I help you?” she asked. “I’m

here for my appointment with Dr.

Osley,” he answered, in an agitated

voice. Annie recognized him as Joe

Foxborough, a frequent visitor to

the health center, who almost

always had a problem and who

often arrived late. Still, she asked

him for his name and date of birth.

He complied. So far, so good,

Annie thought.

But not for long. “Oh, and here’s

my new insurance card. My

employer switched plans since my

last visit,” Joe announced. Annie

spared Joe the lecture about how

much time he could have saved

everyone if he had just called

ahead with this news, particularly

because his new plan was issued

by the company with the most

time-consuming process for

verifying coverage of any provider

in the state. But as she was about

to dial the phone, she noticed the


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time for Joe’s appointment on her

screen, and realized that she had a

bigger problem.

“I’m sorry, Joe, you’re more than

fifteen minutes late. I’ll need to

ask Dr. Osley if he can still see

you. If he can’t, we’ll need to

reschedule.” The patient didn’t

waste a second on his way to an

angry confronation. “What do you

mean, I’m late? You’re the one who

was on the phone making that nice

appointment for 3 o’clock this

afternoon. If you were doing your

job and paying more attention to

the people here in front of you,

you’d have talked to me when I

came in, and I’d be on time.”

Annie spared Joe a second lecture

about the warning he received for

being habitually late the last time

he had an appointment at Fenway.

He was clearly in the mood for a

fight, and if Dr. Osley would see

him, she’d still need her patience

for the phone call to his insurance

company. “Let me check with Dr.

Osley and we’ll see what we can

do,” she said. “Tell him it’s me, Joe

Foxborough. He’ll see me,” Joe

replied.

Annie found Julie Krause, Dr.

Osley’s medical assistant, and gave

her the news about their tardy

patient. “Joe Foxborough? Late? I’m

shocked,” she said, rolling her

eyes. “I warned him myself last

visit that he couldn’t be late again.

And besides, Dr. Osley’s already

with his next patient. We’re

booked solid except for 3 pm this

afternoon. Joe can either wait 3

hours or come back another day,”

Julie continued.

“Well…no…I just booked that 3 pm

slot a few minutes ago,” Annie


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replied. “Then Joe’s just out of

luck. It’ll serve him right. And why

is he here? Wait, don’t tell me. It’s

‘personal,’ right?” asked Julie.

“Always late, and it’s always

‘personal.’” Julie was right on all

counts, and Annie couldn’t blame

her for being so cynical. “Okay, so

can you tell him he needs to

reschedule” Annie asked. “Oh, I

would love to give Joe the news up

close and personal,” Julie

answered. “But Lenny, the other

MA, is in with Dr. Osley now and

I’m covering for him. There are

three patients – on-time patients –

waiting for me right now. You’ll

just have to experience the fun of

telling Joe to go home all to

yourself.” Annie wasn’t sure it

would be as much fun for her as it

would be for Julie, but she knew it

was up to her to deal with Tardy

Joe. And she knew she needed to

be ready for a fight.

It was waiting for her. “What do

you mean, ‘come back next

week’?” shouted Joe. “I need to see

a doctor today!” Annie kept herself

calm. “Well, Joe, I understand and

want to do all I can to help you,

but it’s up to the providers to

decide if they’ll see a late patient,”

Annie answered, remembering to

stay calm. “I don’t care whose

decision it is, lady. I need to see a

doctor today! And besides, I wasn’t

late; it was your fault that you

didn’t see me on time because you

were busy talking on the phone

when I got here. I’m not leaving

until I see a doctor.” Annie was

scanning Dr. Osley’s schedule for

an opening when she noticed an

incoming telephone line ringing

with no one else able to answer it.

She picked up the phone while

scanning the schedule and was

about to answer it when Joe


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blurted out, “This is incredible. I’m

going to get AIDS because Fenway

Health decides not to see me?!”

“Fenway Health. Can you please

hold?” Annie had never said these

words so quickly, and she hoped

the caller didn’t notice the stress

in her voice before she pressed the

“hold” button. “Excuse me, Joe, did

you say you came here today for

an NPEP?” Like Julie, Annie had just

assumed his “personal” reason for

the visit was Joe’s regular behavior

of keeping as much of his

information as private as possible.

“NPEP, two-step, I don’t care what

you call it. I think I’ve been

exposed to HIV and I want the

medication you have to prevent the

infection. I don’t have until next

week. You know the 72-hour time

frame for treatment as well as I

do.” Of course, this news changed

everything. “Of course. That

changes everything,” Annie

acknowledged. “Thank you for

telling me the reason you’re here,

Joe. I’ll go and talk to the doctor

right away.” Thankfully, Annie was

able to transfer the caller to

another patient services

representative, and she went back

to find Dr. Osley or Julie Krause.

“Oh, and thanks for making me

raise my voice about the reason

why I’m here so everyone in the

waiting room knows my business,”

Joe continued to shout.

“Julie. Joe Foxborough is here for

an NPEP. He just announced it to

the entire waiting room. Who do

you think is the best provider to

see him today?” Annie noticed she

was still talking quickly, and

worked to calm herself. Julie didn’t

hesitate. “Wow, Annie, let me ask

Dr. Stanesh if he can delay his

lunch break and see old Joe in a


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half-hour. I’ll meet you back at the

front desk.” Annie went back and

found Joe still standing at the front

of the counter. “Joe, I’m waiting for

confirmation that someone can see

you at noon. And since you will be

seen today, let me start working

on your new insurance plan. Can

you give me your card, please?”

After all this, Annie thought, now

she would have the chance to

listen to recorded insurance

company music for minutes on

end. She dialed the number,

punched “1,” then “4,” then “1,”

again, and finally entered Joe’s

fifteen-digit account number. The

ensuing instrumental version of

“Living on a Prayer” was the worst

she had ever heard. Luckily, Julie

arrived with good news. Dr.

Stanesh, a resident with great

people skills, agreed to see Joe

before going to lunch.

While Bon Jovi’s song was being

hacked to pieces in her left ear –

Annie didn’t want to lose her place

in line – she called Joe to let him

know she had found a provider.

With all the manners he could

muster, Joe thanked Annie and

took a seat by the window, but not

before asking Annie to make sure

his new coverage wouldn’t change

his co-pay amount for an office

visit. “Living on a Prayer” gave way

to “American Pie,” and then, “Call

Me, Maybe.” Finally, someone at

the insurance company picked up.

Annie was in the process of

verifying everything for Joe when

he jumped up from his chair and

rushed up to her.

“Wait a minute. Did you say Dr.

Stanesh is a resident? I don’t want

to be seen by anyone still in

school. I pay good money for my

health insurance, and my


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insurance says I get to see an MD. I

want a real doctor,” Joe told her.

Annie was in the middle of her

conversation with the insurance

company’s service representative,

and she didn’t want to hang up

and start over. She knew that Joe

needed to know his co-pay, and

Fenway’s finance office would want

to be sure his new plan covered his

visit before he went in to see a

provider. But Joe was in her face,

demanding his preferred standard

of care, in a waiting room that was

increasingly busy. He was

becoming a distraction to everyone

else. Annie managed a calm smile.

“Joe, I’m working for you now with

your insurance company. I want to

be sure to tell you your new co-

pay, and if I don’t finish this call, I

won’t be able to do that. Can you

give me a few more minutes,

please?”

She was counting on Joe

appreciating the attention she was

giving to him, and because he

knew she was working on his

behalf, he lowered his voice.

“Okay, but I still want a real doctor

when you’re done,” he said, and

went back to his seat. Annie

resumed her call with the world’s

worst insurance company, gave the

representative all of Joe’s

information, and – of course – was

asked to wait a few short minutes

for the representative to confirm

Joe’s coverage, co-pay, and

prescription medication plan.

Annie cringed, knowing what was

coming next. Sure enough, she

heard a muzak version of “Girl on

Fire.”

Even though Annie was waiting on

hold, she couldn’t really relax. She

scanned the waiting area and saw

several people who looked like


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they were ready to ask for help.

And she knew that after her call

with the insurance company was

done and she got the information

the finance department and Joe

needed, she was still going to have

to deal with his demand for a “real”

doctor. Annie felt a tap on her

shoulder. It was Julie Krause. “Dr.

Stanesh wants to know how much

longer you’re going to be so he

can see Joe in time to finish up and

eat lunch before his afternoon

patients,” she said, and walked

away. After a few more seconds in

musak hell, Annie heard the

insurance representative come

back on the line to let her know

everything checked out. Joe was

covered for the visit, and his co-

pay for the office visit and

prescription drugs wouldn’t

change. Annie entered all the

information into her computer,

and steeled herself for her

conversation with Joe. She called

him back to the front desk. “You’re

all set with your new insurance.

Same $25 co-pay for an office

visit, and the same $15 or $30 for

prescriptions.”

“Big deal. What are you going to do

for me to make sure I’m not

pawned off on some medical

student?” Joe was done

appreciating Annie’s work. And

Julie was back asking if Annie

could hurry up and get him to see

Dr. Stanesh as soon as possible.

Annie took it all in, and decided to

sit quietly for a few seconds. Her

serene expression hid a silent

fantasy in which she violated every

customer service standard there

ever was. In her mind, she told Joe

to go away and never come back,

she let Julie know what Dr. Stanesh

could do with his sandwich, and

she called the insurance company


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just to sing the worst songs she

could imagine to anyone who

answered the phone. It was a great

momentary vacation.

But reality beckoned, and Annie

had to think fast. She opted for

strength in numbers. “Julie, can

you come here to the front desk

for a minute?” Caught off guard in

front of everyone in the waiting

area, Julie had no choice but to

comply. “Joe, this is Julie Krause.

She’s the medical assistant for

both Dr. Osley and Dr. Stanesh.

You two may already know each

other. Julie’s been helping to

arrange an appointment for you

today and we want to encourage

you to take the appointment with

Dr. Stanesh.” Annie believed that

the longer she explained the

situation without giving Joe a

chance to interrupt, the better. She

also thought that Julie’s

appearance in scrubs would look

more official to a patient like Joe,

increasing the odds that he’d

accept the appointment. “Julie, Joe

knows we’re going to see him

today for his NPEP, but he’s

concerned that Dr. Stanesh might

not be right for him because he’s a

resident and not one of our staff

physicians. Can you help Joe talk

through some of his concerns?”

Julie had her cynical moments, but

she was a team player, and knew

what to say. “Of course, Annie.

And yes, Joe and I know each

other.” Turning to Joe, she

continued, “like all of our

residents, Dr. Stanesh is an MD, so

he’s a real doctor, I can assure you

of that. I’ve worked closely with

Dr. Stanesh for six months, and

he’s a very good doctor. He’s

completely qualified to handle

your reason for being here today,


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and if for some reason he, or for

that matter, you, believe a

supervising doctor is needed, Dr.

Osley or one of our other staff

physicians will come into your

exam room to deal with any

problems or questions.”

Joe was quiet, maybe because of

Julie’s official medical appearance,

so Annie decided to add her

reasons for accepting the

appointment. “Joe, I understand

you were upset when you thought

we wouldn’t see you today for

treatment that’s obviously time-

sensitive, and we really want to

help you. Unless there’s more than

your need to get a prescription for

NPEP medication, Dr. Stanesh will

do exactly the same thing Dr.

Osley or any other physician would

in these circumstances. The most

important thing is for you to get

evaluated quickly, and we can start

that process right now if you agree

to see Dr. Stanesh. I can book you

another visit with Dr. Osley, in case

you need any follow-up.” Julie

added her agreement, and they

both waited for an answer from

Joe.

“Okay, I’ll see Dr. Stanesh. You did

stay with me by spending all that

time with my insurance company, I

saw that. And you know how much

I like Dr. Osley, so if you can at

least let him know I’m here and he

has a minute, maybe he can come

in and say hello. I’m pretty

concerned about being exposed to

HIV, but you’re right, starting the

treatment is the important part, so

let’s go,” Joe said. “Great, I’ll meet

you at the door to your left and

take you in,” Julie answered. Joe

went with her to see Dr. Stanesh,

and Annie resumed her work with


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the next patients and telephone

calls.

Later that afternoon, after Joe had

left, Francine Fontaine, the fourth-

floor patient services supervisor,

called Annie aside to talk about the

incident with Joe Foxborough. “I

heard you had quite a time today

with our old friend Joe,” Francine

began. “I think we can all learn

something from it and would like

to brief Perry about what happened

before the end of the day.” Perry

Morea was Fenway’s Patient

Services Director, and it would be

her job to decide if the incident

was important enough to discuss

at the monthly departmental

meetings. “At the very least, we’ll

talk about it in tomorrow

morning’s fourth-floor huddle,”

Francine continued. “So, let’s start

at the beginning and talk about

what went right and what went

wrong.”

Annie was almost more upset now

that the whole affair was over. She

had managed to keep calm while

Joe was in the building, and

apparently it was quite an effort,

given how she felt while she was

talking with Francine. “Well, the

obvious things were that Joe was

pretty rude to me while I was

trying to help him, and of course

the fact that he’s always late and

always lists his reason for coming

as ‘personal.’ I think we’re all a

little guilty of not taking him

seriously because he’s always

misbehaving on some level. I have

to admit I didn’t see it coming

when he blurted out that he was

here for an NPEP.” Francine kept

listening, asking Annie to

remember other details she

thought were important.


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Annie continued, “I almost lost it a

couple of times, mostly when I

thought we had solved Joe’s

problems and he jumped up to

complain about Dr. Stanesh being

a resident and not a real doctor.

That made me angry, particularly

because we really bent over

backwards for him. If I didn’t force

myself to stay calm by saying

nothing at all for a while, I really

would have snapped at him. And I

probably took a little advantage of

Julie Krause by bringing her into

the conversation with Joe about

why he should see Dr. Stanesh,

because I believed her scrubs

would help convince Joe in a way I

couldn’t with my regular

receptionist clothes. She was nice

enough to help, but I really was

kind of desperate and didn’t give

her a choice about whether to get

involved. And it didn’t help that I

had to contact his insurance

company in the middle of

everything because he had

changed plans and never told us in

advance.”

“Those are all good concerns,

Annie,” Francine agreed. “We can

check with Julie, but I’m sure she’s

fine. I’m interested in what the real

core of the problem was today.

There was a lot going on, from Joe

always being late and never giving

us a reason for coming in, and

then having to call the insurance

company, and finally finding out

that Joe only likes to be seen by a

staff physician. But what do you

think the central issue was?” Annie

thought a moment, and answered,

“Well, me multi-tasking is always

an issue when any single thing

gets complicated. I need to find

the time to pay attention to that

complication and sometimes feel


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like I can’t ignore everything else.

But that happens every day. The

real problem was that this patient

got so emotional and

confrontational, and made it even

more difficult to solve his

problem.” Francine waited a

moment, and asked, “And so,

Annie, what do you think it was

that made him so upset?” The

answer was obvious to Annie now,

after things had calmed down.

Maybe it always was obvious. “Oh,

it was the fact that he had an NPEP

issue and had to be seen within 72

hours, and we were going to send

him away because we didn’t

know.” Francine let Annie know

that was exactly the core issue,

thanked her for a job well-done,

and for taking the time to talk with

her about the incident.

Francine went to Perry Morea next,

to let her know about the incident

and talk about how to maximize

its value as a learning opportunity

for other patient service

representatives. After talking with

Francine about Joe Foxborough’s

tough day on the fourth floor,

Perry shared a few of her thoughts

as a way of opening up a more

general conversation. “Well, it’s

clear that the central issue is the

patient’s reluctance to state his

real reason for coming, and our

staff’s general attitude that he’s

habitually late, and not a very

cooperative individual. I think our

staff did most things right,

although there are two things we

could have done better. First, we

can try to get past the ‘personal’

reason for a visit. Maybe we can

brainstorm ways to do this at our

next monthly meeting. Second, I

think we can work on better

collaboration with the medical

assistants in cases like this. We all


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know how sometimes things are

too hectic to have a provider

involved in telling late patients the

bad news. But in this case, having

Julie Krause tell Joe about her

decision to have him come back,

instead of leaving it to our staff,

might have motivated Joe to tell us

the real reason for his visit then

and there, rather than having him

blurt out his concern that Fenway

was going to give him AIDS to a

crowded waiting room. Conversely,

Annie is right; she probably

shouldn’t have put Julie on the

spot later on when she needed

help convincing Joe to see Dr.

Stanesh. We need a little more

cross-department teamwork at

times.” Perry stopped to ask

Francine if she agreed with her

thinking. Francine did, adding that

there’s always the third issue of

patients or staff making

confidential information public in

the waiting area. “Joe obviously

wanted everyone in the waiting

area to hear his complaint, but it’s

never a good idea.”

Perry agreed with Francine’s

additional concern, and took a

step back. “These are all important

issues. The question for me is how

to address them in our system

with the best chance of solving

these problems. We could file an

incident report and bring in the

medical department to address the

need for more teamwork, or we

could take a more internal

approach and put it on our next

monthly staff meeting agenda, or

encourage use of our idea board

for possible solutions. My thinking

is to keep it internal. The need for

teamwork with the medical staff is

an ongoing concern and may

eventually be a reason for a

broader training approach. But


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what happened today is something

for us to address as a department.

I’d like you to focus on it tomorrow

in your daily fourth-floor huddle,

and I’ll put it on the agenda for our

next monthly staff meeting. The

most important issue is still the

need for us to have found out the

real reason for the patient’s visit,

and that’s something we can

address with some brainstorming

and maybe our idea board.”

Francine agreed, and began

preparing for the next day’s

huddle.

She had four agenda items to

cover: first, the need to ask for a

patient’s reason for making an

appointment before making any

decisions about rescheduling;

second, working on better

teamwork with the medical staff in

dealing with problem patients;

third, trying to preserve

confidentiality in the waiting area

as much as possible; and fourth,

keeping a cool head in the face of

difficult individuals or when

someone was feeling

overwhelmed. Luckily, because

Annie had worked so effectively on

keeping her cool, and also because

the patient himself was

responsible for a lack of

information about why he had

made his appointment, there

would be no danger of finger-

pointing regarding this incident.

Francine was confident the

meeting would be a positive

discussion about problem-solving.

Sure enough, she was right. When

it came time to address the Joe

Foxborough incident, her staff

was more than ready to talk openly

about the common problems it

illustrated, along with possible

solutions. Everyone liked the idea


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of working more closely with

medical assistants to verify any

unclear reason why a patient

wanted to be seen, and people

were generally optimistic that this

could be achieved, or at least

improved. “It doesn’t matter

whether a patient service

representative, or a medical

assistant, or even a provider asks

the question if there is no reason

for being seen in the file. The

answer will always help everyone,

no matter how we get it,” one staff

person said. Another volunteered,

“instead of talking about a general

need for improved teamwork with

other department staff, maybe it’s

better to identify specific problems

like ‘no reason for being seen,’

and solve these. Interdepartmental

team work will just happen

naturally if we take this approach.”

Francine thought it was interesting

that her first two agenda items

somehow managed to become a

single discussion topic during the

huddle.

The other two points the incident

raised – confidentiality in the

waiting area, and keeping a cool

head – were familiar topics for

everyone in the huddle, and led to

more general discussions than any

new solutions. “Sometimes it’s us,

and sometimes it’s the patient,”

was one comment. “Yesterday, Joe

shouted out his possible exposure

to HIV. But every once in a while,

when things get hectic, one of us

might talk too loudly about a

patient who’s here for an STD test,

or some other issue, and people in

the waiting area can hear us. We

just need to remember.” And as far

as keeping a cool head, everyone

had a comment. Some had more

than one. Francine let the

discussion go on for a while, and


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then wrapped it up with a reminder

that losing your cool causes at

least two problems. First, it

escalates any confrontation with a

difficult individual instead of

solving the underlying problem.

And second, it gets in the way of

clear thinking. It’s easier said than

done sometimes, she admitted.

But that doesn’t excuse losing your

cool when solving customer

problems is part of your job.

Francine had a good way of

bringing issues to a close in an

encouraging way, and this

particular huddle was no

exception.

Two weeks later, Perry Morea

called the monthly Patient Services

Department staff meeting to order

in the 9th floor conference room at

1340 Boylston Street. By then,

much of the Joe Foxborough

incident had been forgotten,

replaced by other daily dramas or

customer service challenges. But

Perry raised it as one of the more

instructive incidents of the month,

pointing out the same issues

Francine Fontaine had brought to

her huddle the day after Joe came

in for his surprise NPEP

appointment. The importance of

knowing a patient’s reason for

being seen, the need for teamwork

with other departments, patient

confidentiality, and keeping a cool

head were all good opportunities

to discuss problem-solving and to

underscore every individual staff

person’s ability to contribute to

the organization and take the

initiative to provide quality

customer service. Perry’s points

were that any Fenway staff person

could have noticed a lack of a

reason for Joe Foxborough’s

appointment and taken steps to

find out. And collaboration with


17

another department is something

that any individual can initiate

instead of waiting for someone

else to take that first cooperative

step. Respecting patient

confidentiality has always been

one of Fenway’s core values, and

keeping a cool head might just be

the single most important thing to

remember on a daily basis in the

Patient Services Department.

Like she did at every monthly staff

meeting, Perry asked for any

comments or ideas near the end of

the gathering. One of her staff

raised his hand, and volunteered,

“you know, when we find a patient

who says the reason for a visit is

‘personal,’ instead of asking him

or her to state that reason out

loud, maybe we’d get a better

response if we handed him or her

a piece of paper and asked that it

be written down. That would show

respect for the patient’s obvious

need for privacy, and might even

be a good idea for maintaining

patient confidentiality in a more

general way.”

“That’s a great idea,” Perry

answered. “Maybe you should

develop it a little further and add it

to our department’s idea board.”

And on that note, the monthly

meeting adjourned.


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A Brief History: Fenway Health and the Fenway Patient Services Department The Joe Foxborough incident is a

fictional illustration of what can

happen at the front desk of any of

Fenway Health’s medical offices.

It’s designed to engage team

members’ creative problem-

solving skills for use in delivering

great customer service while

paying attention to Fenway’s core

values. While some of our

characters made minor mistakes

when confronted with difficult

individuals, the important thing is

that they all did their best. In this

story, or in the real day-to-day life

of Fenway’s Patient Services

Department, most mistakes occur

when something gets in the way of

calm, clear thinking. Because

customer service cannot be

delivered by following a standard

set of rules, and each challenge is

unique, the combination of keen

observation skills, sound thinking,

creativity, communication, and

clear “ownership” of the

responsibility for providing great

customer service is vital. No set of

rules can replace these skills and

our commitment to providing the

quality customer service Fenway’s

patients expect and deserve.

Fenway Health has a long history,

spanning over forty years.

Throughout this time, it has been a

leader in providing excellent care

for communities that rely on the

organization for affordable,

culturally-competent, and

innovative care. This has been true

from its days as a free clinic in the

1970s through the research-driven

treatment of HIV and AIDS

beginning in 1981, and including

Fenway’s well-known focus on

women’s health, designed and

delivered by women themselves.


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The organization’s success in

delivering reliable care to

populations under-served by

traditional medical facilities is

based on quality care, unique

community-based research,

education programs for both

patients and providers throughout

the United States, and advocacy for

the provision of care to those

unable to obtain it. Fenway’s

patients come back for care year

after year because they trust us to

understand them, respect them,

and treat them well in every sense

of the word. “Customer service”

might not have been a term used

to describe Fenway’s health care

model in the 1970s or 1980s, but

the underlying values we call

customer service today have

always been here.

“Patient Services” might also not

have been the word used to

describe the individuals who

checked patients into Fenway

Community Health Center at 16

Haviland Street, or 7 Haviland

Street, for most of the

organization’s forty-year history.

Some of these people were even

volunteers, in Fenway’s early days.

Today, with the addition of dental

services, eye care, and outpatient

diagnostic services, Fenway Health

is truly capable of being a

“patient-centered medical home,”

a physician-directed medical

practice that provides patient-

centered care that is accessible,

continuous, comprehensive,

coordinated, and delivered in the

context of family and community.

In reality, this can be seen as a

description of the care Fenway has

always provided to its patients.

Patient Services representatives

may deal with the realities of a

much larger, more complex, and


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more diversified organization.

They certainly can offer far more

services than the volunteers and

early staff people could many

years ago. But, as an integral part

of the Fenway Health team, Patient

Services staff maintain the same

standards of customer service and

quality care that have formed

strong bonds with the community.


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How Does The Patient Services Department Deliver Great Customer Service? As noted in the Joe Foxborough

case, customer service is a key

component of Fenway Health’s

operations, and is delivered most

effectively when it is provided in

the larger context of Fenway’s

mission, vision, and values. Our

fictional story includes examples

of what happens when one of

Fenway’s priorities conflicts with

another. In this case, delivering

culturally-competent care – more

specifically, allowing a patient to

keep his reason for being seen

confidential – collided with service

delivery – basing the scheduling of

a medical appointment on

information central to the

improvement and protection of a

patient’s health and well-being.

Situations like this are not unusual

at Fenway Health, and no set of

policies and procedures can

anticipate all the possible

combinations of customer service

demands that can arise at any

moment. Broad guidelines, like

Fenway’s four core values, are

useful resources for assessing

problems, and in creating

solutions on the spot. Instead of a

checklist of things to do, this “way

of thinking” approach can help

make sure the situation is properly

understood, and that our

commitment to the customer is

always communicated.

The four core values of Fenway

Health can be summarized in very

few words:

1. Safety

Preventing harm to patients and employees; providing the right care, to the right patient, at the right time.

2. Quality

Providing the most value to our customer and striving to provide services to individuals that


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increase the likelihood of improving health outcomes.

3. Operational Effectiveness

Using the most efficient resources to minimize waste. 4. Service Delivery

Improving customer interactions, customer satisfaction and customer loyalty by delivering services in a manner that meets their needs (for both internal and external customers)

Understanding the meaning of

“safety” or “quality” or any of these

core values requires few additions

to these written definitions. It is

better to engage in discussions

with team members, or even to

think as an individual Fenway

Health team member, about how

these values are alike, and how

they might lead to different

decisions, in your day-to-day

dealings with Fenway’s customers.

In some cases, there are easy

answers. “Safety, first and always,”

is our highest priority at all times.

Sometimes, a stressful situation

may make other considerations

more tempting, but they are never

the right answer if safety is

compromised in any way. Another

example of an easy answer might

be the enforcement of standard

rules to treat all patients fairly, and

to maintain cost-effective

operations. What is more

important, good service or

operational (cost) effectiveness? If

a patient is habitually late, it may

make sense to enforce a policy

that requires rescheduling after a

fixed amount of time. On the other

hand, a patient’s health or safety

can never be compromised,

requiring the patient to be seen

even if he or she is habitually late.

This situation can be more

complex when other factors are

involved, such as additional

demands for being seen by

providers the patient prefers,


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whether this preference is based

on perceived skill level, gender, or

another consideration. In any case,

if the patient’s health will be

endangered without being seen,

this must also be taken into

consideration.

At other times, the solutions are

not quite so clear. What should be

done after a patient is actually

harmed, either by being sent home

in error, or having been given the

wrong prescription for a diagnosed

condition? Solving the immediate

health crisis is still a critically

important and “easy” decision, but

afterward, how can situations like

this be resolved? When patient

confidentiality is compromised,

and as a result someone is subject

to the risk of physical harm from

intolerant work colleagues or

family members, what is Fenway

Health’s responsibility? Serious

problems like these deserve

solutions that no individual Patient

Services staff person can deliver,

and it is always a good idea to ask

for help when confronting them.

Another point to remember is that

how you think about a customer

when interacting with him or her is

usually clear to the customer, and

influences how the customer feels

about you. If you don’t like

someone, it comes across, trust

us. Always bring a positive attitude

and feelings of empathy in dealing

with everyone on the job. Further,

even when you have good

intentions, be sure your behavior

matches these intentions in

delivering quality customer

service.

The good news is that the vast

majority of customer service

challenges that arise on a daily


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basis can be solved by taking a

moment to get past one’s

emotions, thinking clearly about

safety first, and then exploring the

other three core values of Fenway.

Engaging the customer is also

important, because many times he

or she can communicate a

preferred solution. If that solution

is reasonable, you can solve the

problem on the spot. Finding a

way to keep a problem from

getting worse, and then taking

reasonable steps to solving it, is a

skill that comes with time,

practice, and judgment. Your

managers will always be there to

help, and so will the other

members of the Patient Services

team.


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Conclusion One: Customer Service is a Way of Thinking While there is no checklist for

handling every conceivable

customer service situation at

Fenway Health, is helpful to take a

general “creative problem-solving”

approach in solving whatever

challenge may arise. Whether you

use the following suggestions as a

step-by-step methodology, or rely

on them in a more abstract way,

these may help solve many simple

problems, and find ways to

simplify problems that might be

more complicated.

Ask Questions. Make sure you have the information you need before you act.

• Do I understand what the customer wants?

• Do I know how to provide what the customer needs?

• Is there a problem that needs to be solved?

Identify the Problem. Once you understand it, think of how it can be solved.

• What is the customer telling me about the problem?

• What else do I need to know to solve it?

• If there is a problem, how can I solve it now?

Act. If you can solve the problem, do it.

• What is needed to solve the problem, and where can I get it?

• What steps are needed to solve the problem, and how long will this take?

Get Help. If you need help, identify what you need and ask for it.

• Are there Fenway Health organizational concerns to consider?

o For example, policies and procedures, or regulatory compliance

o Is this a “give ‘em the pickle” situation or something larger?

• If I need help, where do I get it?

Engage the customer. Communication instills confidence and builds trust.

• Ask the customer what he or she would like to solve the problem.

• When you have decided what to do, make sure the customer agrees.

Learn. Remember what worked and what didn’t work. Share with your co-workers.

• Talk about incidents in daily team huddles and informal conversations.


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Conclusion Two: Customer Service is a Continuing Dialogue Customer service is not a

challenge we can solve on our

own. It takes a team effort, and it

takes communication. It’s a

continuing dialogue, with

managers, with co-workers, and

with customers. In fact, a healthy

dialogue with a patient can go a

long way to solving many

customer service problems.

An ideal outline for a dialogue with

the patient in many customer

service situations might include

these basic elements:

• Describe the situation. Make sure you and the customer have a common understanding of what is happening.

• Ask, “What would you like me to do for you?” Don’t assume what the customer wants. You may be surprised to discover a simple solution.

• List the possible options of

what can be done. Keep

your conversation focused on what is possible, and keep the dialogue going.

• Don’t let the conversation

move into a “dead end” (i.e., “I’m sorry, that’s not my responsibility,” or, “You need to go to another department for that.”).

• Ask the customer to select

from these possibilities. Keep the customer engaged in solving the problem, and look for an agreed-on plan of action.

• Under-promise and over-

deliver. Don’t set yourself up for failure.

• Implement the option the

customer selects. Solve the problem as a team.

• Remember it’s all about the

customer. Put him/her first in all cases.

Dialogues with managers and co-

workers are included in the case

study at the beginning of this

manual. Key points are the

importance of keeping emotions at

bay, thinking clearly, being honest,

and finding a balance between

solving problems on your own and

asking for help. Remember that


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learning from experience is better

when those experiences are shared

with colleagues.

A final point about customer

service at Fenway Health is that the

organization has its own time-

tested standards, based on years

of experience. Some of these are

simply Fenway’s own policies and

procedures, while others are

regulatory requirements associated

with the many licenses and

government agency standards that

apply to community health centers

in the United States and the

Commonwealth of Massachusetts.

No written document can prepare

you for every possible encounter

with the many customers –

patients, co-workers at Fenway,

and colleagues from other

organizations – you will meet in

the course of your career. If this

manual is useful, it will serve as

the basis for the development of

your own internal standards of

customer service, developed from

direct experience, and ongoing

conversations with members of

your team. Customer service is a

way of thinking that balances

independent, creative problem-

solving with the shared values of a

team of caring health

professionals…and the customers

who depend on you.


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Resources: Where Customer Service Information Can be Found

In addition to this manual, there are several other documents and materials, as

well as interactions with your colleagues at Fenway Health that include

valuable information about customer service and its importance to the success

of our health center. Some of these materials include:

• Staff orientation and training materials • Your job description • Work flow procedures and performance standards • Space planning and physical environment design documents and

discussions • Department meetings and daily “huddles” • Conversations with co-workers • Your everyday behavior

In short, information about customer service can be found everywhere.

The appendix of this manual includes additional reference documents that can

be useful in maintaining excellent customer service at Fenway Health. They

include:

• An Introduction to Lean Thinking • Client Feedback Form • Methods for Patients to Report a Formal Complaint • Fenway Health Incident Reporting Procedures • Patient Services Staff Training Manual • Patient Services Code of Conduct • Idea Board Summary • Fenway Organization Chart • Medical Teams • Medical Assistant Assignments • Patient Services Staff Assignments • Sample Medical Calendar • Directing Calls about Prescriptions • Excerpts, Patient Satisfaction Survey • Hot List• Additional Documents Available on Fenway Health’s Shared Drive


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Fenway Patient Services Cust Svc Manual FINAL copy

Documents

Transcript of Fenway Patient Services Cust Svc Manual FINAL copy