Ocular surgery can be an anxiety-inducing procedure for many patients. After all, according to a 2019 UK study by Enoch et al, more than three-quarters of respondents said they would rather have 4.6 years of perfect health instead of 10 years of life with total vision loss. Thus, providing every patient with top-quality care should be the foremost priority of every ophthalmic ambulatory surgery center (ASC) and the clinics that partner with them.
Successful completion of every procedure by highly skilled surgeons is a major factor in the equation, of course. But it’s not the only one. A welcoming environment and friendly staff; clear communication of expectations; careful listening of patient concerns and even “soft skills” such as kindness and empathy are equally key to delivering a premium, friction-free patient experience.
As Tonya Hawkins-Nealous, COE, CPC, CHAA, senior manager of surgical services at Thomas Eye Group in Atlanta, observes, “People will talk about a great experience at least once. They’ll talk about a terrible experience 50 times. We want them telling [everyone] about how well they were treated, how we care about them, and how satisfied they were with our services and their outcomes.”
Make a Great First Impression
Painting contractors have a saying: painting is 90% preparation, 10% painting. The same could be said of ocular surgery. Most of a patient’s preparation for ocular surgery takes place in the ophthalmology clinic. And make no mistake: Virtually every patient’s first encounter with the clinic starts with either a phone call or online query. This first step sets the tone for what patients can expect going forward, says Ben Seals, CEO of Thomas Eye Group. Mr. Seals participated in a webinar last September titled, “Delivering the Premium Patient Experience from the Practice to the ASC.”
“Looking at how your practice interacts with new patients as they schedule their first appointment…can help you understand what sort of tone you’re setting,” Mr. Seals said at the webinar, which was sponsored by the Outpatient Ophthalmic Surgery Society (OOSS). He recommended that ASC leaders review their appointment scheduling processes, which could lead them to switch to online scheduling, something growing numbers of patients are coming to expect of providers.
Beyond initial contact, he added, patients should be able to expect clear directions to the clinic. When they arrive, they should find convenient parking, clearly marked signage, and other measures to help them easily access the practice. And once they enter the clinic, they should be promptly greeted by friendly front-desk staff and offered a clean, comfortable waiting area.
“[Understanding] what that patient’s going to go through is reflective of the type of experience that you want your patients to have. If it’s cold and dark and damp like a dungeon, is that really going to encourage a patient to look for a premium service from your organization?” Mr. Seals asked rhetorically.
A PressGaney report, “Consumer Experience in Healthcare,” released this past February supports Mr. Seals’ argument. Based on 6.5 million patient encounters and a nationwide survey, the report found that almost half of consumers face pre-appointment roadblocks, such as scheduling errors, long wait times, and poor communication. “These ‘hassle factors’ can bias consumers from the start and erode confidence long before they step through the door,” the survey found.
Be Mindful of Your Patients’ Time
Owing to the number and duration of various tests, however, along with meeting with the doctor to discuss surgical treatment options, patient visits in ophthalmology can be lengthy. Regularly updating patients, as well as offering refreshments, can help alleviate frustration, says Carrie Jacobs, executive vice president of operations for Chu Vision Institute and an OOSS board director.
“We do whatever we can to make sure that they feel seen and not just like a number in the system,” Ms. Jacobs says, explaining that the importance of minimizing waiting time is even impressed upon the practice’s physicians and technicians.
The most important thing they can do when they walk in the room is to say, ‘Hey, Joe, I really appreciate your patience. I was with another patient that took longer than expected, but we see each patient and take as much time as they need.’ That really does matter,” she says.
Technology can also help. Key-Whitman Surgery Center in Dallas employs a system that alerts the front desk if a technician or doctor has not reached a patient within 15 minutes, says Nikki Hurley, director of surgical services at the ASC. “It lets them know the doctor’s running behind so that they can check in on the patient and keep them informed,” explains Ms. Hurley, also an OOSS board director.
Set Great—But Reasonable—Expectations
Managing patient expectations is a vital part of preparing patients for ocular surgery. This includes clearly communicating a roadmap of their journey and explaining the outcomes they can expect to receive from the procedure. Ms. Hurley, for example, says cataract patients receiving premium IOLs are informed that several postoperative visits will be required to optimize their vision.
“We let them know that, due to all the testing, it could take up to a couple of hours each time. But we also try to watch wait time because we want it to be as minimal as possible, especially to provide a premium patient experience with LALs [Light Adjustable Lenses, RxSight],” she says.
Patients should also be informed that their examination, the surgery itself, and services associated with the procedure, such as anesthesia, are all charged separately, says
Ms. Hawkins. It’s common for patients to think they’ve paid for everything when they’ve scheduled their surgery at the clinic.
“We try to handle that at least a week before they’re coming,” she says. “We let them know what their out-of-pocket is, and we try to keep them from having to deal with that on the day of surgery.”
The third, and perhaps most important and often challenging aspect of setting expectations relates to vision improvement. At Key-Whitman, patients are told that achieving their optimal vision is likely to take some time after surgery, Ms. Hurley explains.
“First thing post-op, if they don’t see 20/20, they’re very concerned, even though we’ve told them a million times, you are going to have some swelling, [and your vision] may not be perfect,” she says. “We tell them, ‘We’re going to check you, we’ve got you.’ But it doesn’t matter; if they can’t read that 20/20 line, they are very upset sometimes.”
This can be especially challenging with patients who think they know which monofocal, trifocal or premium lens they need based on their own online research.
“We may know that [the lens they want] is really not good for their case. But they’re adamant, so it’s hard to try to break that in a patient if they think they know exactly what they need,” she says, citing as an example a patient who insisted on a certain IOL despite the ophthalmologist’s recommendation. “They ended up having that lens cut out and the proper lens put in,” Ms. Hurley says, noting the physician was careful to document the patient’s insistence as part of the informed consent process.
Minimize Friction in the Transition
Continuity in transitioning the patient from the clinic to the ASC is critical to minimizing friction in the process.
Ms. Jacobs notes that, ideally, most of the documentation required by the ASC should be completed and immediately available well before the day of the procedure. In addition, to comply with HIPAA safety regulations, details of the case are confirmed with the patient “every step of the way” from their arrival, through pre-op, and inside the surgical suite. The value of this continuity goes beyond compliance with regulations.
“It helps patients feel at ease knowing that the ASC team is on the same team as the clinic, and we all are there to give them the best possible outcome,” Ms. Jacobs says.
A Personal Touch Goes a Long Way
The power of kindness and empathy to ease the patient’s concerns at both the clinic and the ASC cannot be overstated. “No one actually wants to have surgery on their eyes,” Ms. Jacobs observes. “There’s this fear that ‘if something goes wrong, I’m going to lose my most precious sense.’ Understanding that emotional component is an important piece in how you communicate and interact with patients.”
Ms. Hurley says Key-Whitman staff members will assist those with difficulty walking, as well as engage patients in light conversation to help ease nervousness. Ms. Hawkins reports the ASC staff at her facilities will even “let their loved one bunny suit up and go in the OR with them” to help put particularly anxious patients at ease.
Hurley, Jacobs and Hawkins all agree that communication should not stop abruptly once the patient leaves the ASC. At minimum, it’s important to follow up on the patient’s well-being the day after surgery. As with pre-surgical education, technology can be an invaluable asset in this regard.
Ms. Jacobs says each patient receives a text and video with post-care reminders recorded by their surgeon.
“They help offset the phone calls you get because of the anesthesia effect, and they don’t always remember everything or read their paperwork,” she says.
Key-Whitman takes a similar approach.“With some of the patients, it’s really funny. They’re older, and a lot of them think the doctor made it especially for them, so they thank the doctor,” Ms. Hurley says with a laugh. “They think it’s special, and it is, but they don’t know we’re sending out a mass text to everyone.”
A Premium Patient Experience Takes a Premium Effort
There’s little doubt that ocular surgery, no matter how routine, can be scary for many patients. The good news is that establishing a friendly, welcoming environment, managing patient expectations, and demonstrating kindness and empathy can go a long way in leaving patients with the sense of having received top-notch care.
“Patients have choices,” Ms. Haw-kins notes. “There’s competition out there, and patients can find out everything they want to know about you and your center and what people actually think about it.”
“Your team and the connectedness that the clinic and the ASC have are really your most important assets in the patient satisfaction journey,” adds Ms. Jacobs. “Everything comes down to the surgery, but beyond that…it’s really the team you have in place—humans taking care of humans.” OASC