In a stage production, there are areas known as the front-of-house and back-of-house (or backstage). What happens back-of-house is all the nitty-gritty necessary to produce the show or experience. Disney has this system down to a science. And as a result, their customer service standards are second to none. Now they train hospitals and health care organizations around the country on this concept. I was fortunate enough to attend a couple of Disney Institute trainings during my career. Their philosophy is: Keep the busy work behind the scenes so your patients only see the smooth, controlled customer service of the care provided.
It has been interesting watching this concept unfold in two different oncology clinics.
Oncology Clinic #1
The first oncology clinic was designed in such a way that the exam rooms had two entrances. One from the patient/family waiting area (front-of-house) and a second from the staff work area (back-of-house). The patient family waiting area was an oversized hallway with chairs through the middle and a wall of nothing but doors. The doors remained closed until the nurse or medical assistant opened one and ushered Mom, my sister and I through to see the medical oncologist. Because it was a consultation, the nurse explained how the appointment would go, checked a few health history facts and left us to wait for the oncologist. She left through the staff door and the physician entered through that same door a few minutes later.
When we were done with the appointment, we left through the same door we entered and the staff left through their door. As we were leaving the waiting area, another family was also leaving. One of them realized they had left something in their exam room, but the door had already clicked shut – and locked. The person could not get back in. Fortunately, a staff member was either in the room or in the hallway, noticed the need to get back in and opened the door. As I thought about that, I wondered – what if one of us had needed to step out of the exam room? We’d have been locked out. And if Mom had been alone for the appointment and left the exam room, she would not have been able to get back in. Being locked out is not a good patient experience.
Oncology Clinic #2
The second Cancer Center – and the one Mom is being treated at – has a very different layout, but still strives to keep the front and back-of-house separate. The waiting area is large, more like a traditional multi-practice waiting area. Patients who are there are waiting to see the medical oncologist as well as have their required labs drawn. The exam rooms are accessed through a door off the waiting area and then divided into two primary hallways. Mom’s appointments are always to the left of the primary entrance. There is a separate work room for the clinical staff, which is at the back hallway of the exam room space.
When we are called back to these exam rooms, the MA or nurse reviews Mom’s vitals, her med list, etc. then asks if we’d like the door open or closed before exiting to tell the oncologist Mom is ready for him. Mom prefers to have the door open. The room is nice, but chilly and the area is completely silent most days we are there, so silent it is unnerving. Unfortunately each time we’ve been in this clinic, our waits have been for 30 minutes or longer, which seems like an eternity. During one visit, I was getting so cold, I started sitting on the rolling stool in the doorway (the hallway is warmer). Another time, Mom had a question so I went in search of someone to ask and ended up back at the registration desk. Because I had toured this clinic when it opened in this location, I know where the staff work room is but felt I should seek help from the staff made accessible to patients and families.
Small changes can make a difference
Overall our experience in both of these clinics has been good. Because of my professional background, I notice these patient experience opportunities when others wouldn’t. Mom has commented on the silence and the wait times, and because it happens with each appointment (and we are now at visit three or four) it is becoming more of a frustration for her. And she didn’t notice the locking exam room doors at the first cancer center.
While keeping back-of-house work separate from the patient is an admirable goal, if it compromises the quality of patient experience, maybe it should be re-evaluated and tweaks made.
- Tell patients and their families that the exam room doors lock and what to do if they need to leave the room
- Pipe in some ambient sound to drown out the sound of silence and lessen the feeling of isolation
- Adjust the workflow so more people are walking through the halls
- Explain where to find assistance if it is needed
