Treating a Bad Patient Experience as a Sentinel Event
How Root Cause Analysis Can Transform Your Practice Culture
Note: This week’s newsletter is more dental/medical focused, but if you’re one of our library-oriented readers, take a look! You may be able to apply it to your own customer experience (CX) failures!
Treating a Bad Patient Experience as a Sentinel Event: How Root Cause Analysis Can Transform Your Practice Culture
It’s a busy day in the office. You’ve had a few dental emergencies come in, a crown took longer than expected, and an anxious patient had a huge meltdown and threw everything off. Just as you’re about to get to your lunch break, you get a call from your front desk. “Can you talk to Mrs. Jones? She’s been waiting three hours, hasn’t been taken back yet, and she’s FURIOUS. She says she’s never been to such a shoddily run practice in her life.” You try to get more details, but before you can make it out to the waiting area, you hear “Never mind. She just left. She said to remove her as a patient.”
It's a nightmare, and it happens in our practices sometimes. You can try to reach out to Mrs. Jones. You might succeed or fail. But no matter what, something went terribly wrong today. Mrs. Jones should never have experienced a three-hour wait, and it is up to you, and the leader of the practice, to ensure that this never happens again. You now have a “customer service sentinel event.”
What is a Sentinel Event?
The Joint Commission is a national accrediting body focused on improving patient safety and care at hospitals, nursing homes, urgent care clinics, surgical centers, and in-patient mental health facilities. The commission has developed the idea of a sentinel event – any event that results in patient death, severe harm, or potential for severe harm. After a sentinel event, an organization is required to conduct a study to determined why it happened, and develop policies and routines to prevent similar events in the future.
A sentinel event can’t be blamed on one bad employee. They represent failures of systems. Care teams are made of humans. There will be days when they are tired, cranky, overwhelmed, or distracted. A good system means that even on these days, a sentinel event is impossible.
How does this apply to a patient experience failure?
No one died when Mrs. Jones had to wait a long time. She was never in immediate danger. But the mistake that morning did cause lasting harm, to her and your practice. Mrs. Jones no longer trusts you and your team because you treated her badly. She may go find another dentist, who may or may not be as skilled as you are. Or, she may just stop getting dental care altogether and put her health at risk.
Meanwhile, your practice is also harmed. Mrs. Jones will tell anyone who will listen how badly she was treated and how badly run your office is. Even if you respond to her scathing online review and woo her back with attention, the damage is done to your practice and its reputation. Mrs. Jones’s long wait is a major problem, and you need to get to the root causes of the event.
Asking the Right Questions
When we’re hurt and scared and annoyed we’re very bad at finding the root causes of our problems. In fact, many practice leaders, when faced with a patient experience failure, ask all the wrong questions first:
· Who’s fault is this?
· Whose heads need to roll?
· Why didn’t the patient say something?
· Why should we care, we’re a great practice?
These are all emotional reactions. To get to the root causes, you’re going to need to take a deep breath, calm down, and focus on reason and systems. There are a few big principles to keep in mind as you conduct a root cause analysis of this failure:
· This is a failure of systems, not people
· You want information, not accusations
· To address the failure, you will have to change the processes
· Major errors are often the result of multiple failures setting up a chain reaction
Once you’re ready to begin, the process will have a few steps:
1. Form a team. You can’t find root causes like a lone detective or a grand inquisitor. You need at least 3 different viewpoints on the investigation team. Choose two team members who are dedicated to serving patients and understand why the failure to serve Mrs. Jones is a large problem.
2. Conduct interviews. You need a complete picture of what went wrong that day, and from multiple perspectives: Mrs. Jones, the receptionist, the hygienist who was supposed to take her back, etc. Anyone who interacted with the patient, or anyone who ought to have interacted with the patients, needs to be interviewed as soon as possible after the event. If you wait too long, memories will be fuzzy and the information from interviews will be less useful.
3. Collect objective evidence. This is information like computer records of the check-in and schedule, video footage if you have it, any recordings of calls, etc.
4. Use the interviews and objective evidence to create a detailed timeline for each person involved in the event. This timeline is going to be the tool that you use to find out what went wrong and how to fix it.
5. Start asking why. This is where you start finding out how your existing procedures failed, and what additional safeguards or tools you need to prevent similar failures in the future. Why didn’t the desk team notice Mrs. Jones was still waiting? Why didn’t the hygienist ever call her back? Why didn’t Mrs. Jones ask for help sooner? Why didn’t you, the dentist, notice the hole in your schedule? In most cases, each of these first whys will lead to another question .. and another. When you can’t ask any more questions, that’s when you know you’ve reached the root of the problem. (Engineers often say that it takes 5 whys to get to the root cause).
6. Brainstorm ways to address the problems. Was the front team too busy to notice Mrs. Jones waiting? You may need to delegate some duties to the back office, change the timing for scheduled tasks, or hire a new team member. There might have been a failure of training. Perhaps you need to revamp how you onboard new employees so that they know how to deal with long waits. Maybe a scheduling snafu meant that the hygienist never knew she was supposed to see Mrs. Jones. Then, you’ll need to address how dental emergencies get pushed onto the schedule.
7. Issue a report to the affected patient and your whole team. Once you’ve discovered the root cause and developed a way to prevent it in the future, you need to make sure to communicate that information, both verbally and in writing, to all the affected people. This includes the patient and the entire team, not just the people involved in the original incident. For most dental practice fails, a short one-page report will do, listing the date of the incident, what happened, what the root causes were, and how future events will be prevented.
Make sure your recommendations for preventing future problems are concrete. “We’ll improve training” will never happen. “All employees will learn and follow this procedure for checking in patients” is something that you can implement and you can track.
After such an involved process, such a simple report can seem anti-climactic. However, if you need more than a page or two to sum up your plans for improvement, you probably haven’t found the root cause.
8. Reward your team members who helped with the analysis. Root cause analysis is a lot of work and can be pretty stressful. In a small team, people worry about seeming like the bad guy, stepping on toes, or hurting feelings. Once the work of solving the problem is done, give the people who helped you solve it some sort of thank you gift. They’re now extra valuable to the practice because next time there’s a patient experience failure, they’ll be there to help.
Need help improving your patient, client, or patron experience?
Contact us! We’ll analyze your current systems and help you develop new processes to serve, surprise, and delight everyone who walks through your door.