Behavioral science is a growing field of science, rooted in economics as a means of understanding decision-making. People do not always make rational decisions that align with the beliefs of economists. Indeed, traditional economists had historically opined that all human determinations are made based on price and quality. Researchers are now challenging that notion.
At the most basic level, think about a pair of shoes that your child asks you to purchase; the shoes are $400(!). You think that the price is way too high, especially when you learn that the shoes will not even be worn. Your child is simply focused on the “coolness” factor that the shoes provide.
The field of behavioral science is centered on understanding seemingly irrational human behavior - and may have some important findings that can be translated into your medical practice.
Take the opportunity to consider these observations and tactics to benefit your practice:
Waiting feels like forever (literally). A recent meta-analysis concluded that, on average, a minute of waiting time feels like three minutes. Consider designing systems to keep your patients informed and perhaps even entertained. Train staff to fill in dead space during phone calls, or when they escort the patient down the hall. Talking about the weather is always a great default (and yes, many staff need training on how to make small talk). Message or call patients back at the end of the day to report that their message is in process, or their records are being reviewed. The uncertainty breeds insecurity, which often translates into more work (i.e., patients leaving a multitude of messages trying to get a response). If you cannot close the loop on messages every day, at a minimum, make it a priority on Friday afternoons. Give patients a tablet to gather information while they are waiting, ideally linked directly with your EHR system to reduce the staff’s burden of re-keying the information. The dead time in the exam room can be supported by a poster or LCD screen conveying patient education; soft, white noise; or coloring pages. Look for other ways to reduce waiting times – or the perception of them.
Recency bias is real. Not surprisingly, researchers have proven that the last information we hear is what we remember. Our brains cannot contain everything, so we take short cuts. Translate that into practice for staff meetings – always close with the key points verbally and bullet the takeaways on index cards; for patients – always repeat the key points of the plan to conclude an encounter; and reiterate the date and time of the follow-up appointment at the end (over the phone or in person).
The community exerts influence. During the pandemic, we were restricted from being with other people; new research has demonstrated the negative impact of loneliness. Consider group visits: 98961 and 98962, for example, provide a community setting for patients – and the opportunity to leverage your non-physician clinical support team’s time for billable services. Some commercial payers recommend using the standard office E/M codes – 99211-99215 for group visits, making denials unlikely. Another idea to leverage your community is to ask patients to be your “spokespeople” – reach out to a local high school or college and ask a teacher to sponsor a film project. Seek permission from patients who are willing to share their stories on film. Photographs can also be a compelling medium.
Use basic, non-verbal cues. In Japan, each train station stop has a unique “jingle” when the train pulls up to the stop. In healthcare, many children’s hospitals have embraced non-verbal design elements such as the “butterfly” elevator. But cues do not need to be limited to trains or children’s hospitals. Consider sound, light, colors, shapes, or symbols to promote a patient-centered design in your practice. Design elements may include a large red carpet in front of check-out, or a series of circles that lead a patient to the lab. Paint the exam room doors a different color for each pod, or use a theme for each (e.g., mountain, river). For a large facility, associate a color with each floor. If patients are registering at a central station on the ground floor, give the patient a green folder, clipboard, or form for the second floor, for example, and carry that theme through the clinic on that floor. Dimmer lighting has been proven to create a calm environment for patients; remove bright lights as the standard for your exam room, and instead rely on an exam lamp when needed.
Get a foot in the door. Every medical practice is challenged with staff recruitment and retention today; consider that behavioral science reveals the benefit of getting a foot in the door. This is why, for example, many companies offer free trials to get us hooked as customers. Instead of conducting phone interviews, therefore, consider bringing in top candidates who have compelling resumes to interview after an initial screening. Offer a mug, charger, or other small gift emblazoned with your logo, as a thank you for interviewing. If you like the candidate, shoot a text to a current employee during the interview to stop by the room to welcome the candidate. Send an email to the candidate thanking them for interviewing. A mug or a bit of kindness is not going to make up for a sizable salary difference, but if your candidate is deciding between two similar offers, your small gestures will certainly be a positive influence.
A multitude of ideas exists to harness human behavior to your practice’s benefit. Start with a few of these – and challenge yourself and your staff to come up with more ideas. Researchers in behavioral science are not only thought-provoking, but they are also inspiring – and some of their findings may have a big impact on your practice.
Elizabeth Woodcock is the founder and principal of Woodcock & Associates. She has focused on medical practice operations and revenue cycle management for more than 25 years. She has led educational sessions for a multitude of national professional associations and specialty societies, and consulted for clients as diverse as a solo orthopaedic surgeon in rural Georgia to the Mayo Clinic. She is author or co-author of 17 best-selling practice management books, to include Mastering Patient Flow and The Physician Billing Process: Avoiding Potholes in the Road to Getting Paid. Elizabeth is a Fellow in the American College of Medical Practice Executives and a Certified Professional Coder. In addition to a Bachelor of Arts from Duke University, she completed a Master of Business Administration in healthcare management from The Wharton School of Business of the University of Pennsylvania. She is currently a doctoral student at the Bloomberg School of Public Health of Johns Hopkins University.
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