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Dynamic Chiropractic – October 7, 2010, Vol. 28, Issue 21

Moving Beyond Patient Satisfaction: How to Build Trust and Partnership

By Shelley Simon, RN, DC, MPH, EdD

It's said that patient satisfaction is a significant predictor of continuity of care and positive health outcomes, but how many practices have objective evidence to back up this assertion? That you should make every effort to keep your patients happy is a given. Most chiropractors work toward this goal, and in large numbers report having "satisfied" patients.

But satisfaction, however important, can be transient. A patient may be satisfied with the care you provide and the results they experience today or this week, only to become dissatisfied during the next visit if they perceive a less positive outcome, feel that you are rushing through the visit, detect that policies are inconsistent, or for any number of other reasons.

Trust, on the other hand (once it's earned) tends to be more steadfast and may be an even better predictor of patient loyalty and good clinical outcomes than satisfaction. Patients who trust you at a deep level will, over time, gravitate to you as their first choice for many, if not most, of their health issues and wellness goals. They will also be more likely to adhere to treatment plans and experience better outcomes.

It's important to note that trust is relationship-specific. You may have a good overall reputation in your community, but authentic trust is established one person at a time. For this reason, patience is truly a virtue when it comes to building a practice based on trusting relationships. Here are seven points to consider, attitudes to adopt and behaviors to engage in that will help you have a successful, practice based on a model of trust and partnership.

1. Appreciate the Fact That Trusting Relationships Are Healing

There is increasing evidence that a positive doctor-patient relationship is therapeutic for the patient and promotes healing. As the doctor, you may assume the role of coach, teacher, expert, motivator, advisor or witness. Which role you take on will depend on the particular situation and what is in the patient's best interest at the moment. In any of these roles, it's important to understand the power of the relationship as a healing force.

Patients who successfully achieve new (and sometimes difficult) health goals do so in large part because they trust their doctor and feel like a partner in their care. The mind-body connection is real and powerful. When patients trust that you have their best interest at heart and feel that you have faith in their ability to heal, they are more likely to take steps to avoid disappointing both you and themselves. When patients feel hopeful about what they can do to improve their health (regular visits, daily exercise, taking supplements, etc.), their bodies rally to support that hope.

2. Be Aware That Patients Are Continually Choosing

The partnership model recognizes that at every point throughout the course of care (and even during each clinical encounter) patients recognize reasons to continue or discontinue care. When a patient has an experience that causes the scales to tilt in favor of discontinuing care, the doctor may or may not be aware of this developing reality. Even if you've "sold" a patient on participating in a long-term care plan, that individual makes a determination at each visit whether or not they are receiving value and getting the results they expect.

Chiropractors who work in true partnership with their patients never assume that "all is well" or that "no news is good news." These doctors are also less likely to be surprised when patients decide to leave the practice because they are continually checking in and having honest dialogues about whether expectations are being met.

3. Plan for an Ongoing Dialogue

Because partnerships develop over time, your conversations with each patient should deepen with each encounter. Don't expect a patient to reveal every fear, bias and concern they have during their first visit to your office. Some will, but most won't. But as the doctor-patient relationship evolves, so will the depth of the dialogue. Be aware of when you are engaging in social conversation versus therapeutic or healing conversation (and do more of the latter).

Educate patients based on what they need at each juncture of care. Don't push more information onto an individual than they are ready to absorb at any given moment. Take the time to explore beliefs held by the patient that may be getting in the way of them taking greater responsibility for their health and vitality. And above all, stay focused on the patient's agenda, goals, and what's in it for them.

4. Be Transparent

Patients have access to an incredible amount of information today. On the Internet they can find out where you went to school, if you've ever had trouble with the state licensing board, and even read reviews about your service and care written by other patients. Because of this, it behooves you to be transparent in all your dealings. The days of maintaining an air of mystery around the profession are over. Laying your cards on the table about fees, time frames for care, and the potential for clinical outcomes (whether they are excellent or poor) builds trust and partnership.

5. Become a More Effective Leader

Practices that adopt a partner paradigm are patient-centered, relationship-based and doctor-inspired. This last element, doctor-inspired, means that you are responsible for motivating, leading and inspiring your patients toward optimal health and wellness, and your employees toward working as a true team. The 21st century leader and motivator is collaborative (not authoritative); purpose-driven and mindfully present; exhibits optimism, flexibility, and superior interpersonal skills; establishes and maintains appropriate boundaries; and has the ability to empower others toward meaningful and realistic goals.

6. Engage Staff in the Partnership Model

If you are serious about having a practice based on partnership, your staff must be on board. Schedule time with your team to discuss what such a practice looks and feels like, what changes are needed, how each staff member could uniquely contribute to this change, and how everyone in the office can work together to achieve the goal of having patients who view you - and your entire team - as their collaborators for wellness and vitality.

7. Cultivate Advanced Interpersonal Skills

Chiropractors working in partnership with their patients consistently do the following: listen carefully; ask "agenda free" questions; let patients speak freely and honestly without interrupting; use time with patients effectively and mindfully; demonstrate genuine empathy; avoid using clinical jargon without explanation; demonstrate respect for patients; know that patients are always asking themselves, "What's in this for me?"; continually work on improving their own emotional intelligence; consider their patients' needs ahead of their own agenda; stay engaged and fully present, and meet patients where they are; and avoid being pushy or trying to "sell" patients more care than they're ready for.

Expect to Be Impacted

Cultivating partnership is a conscious decision that requires ongoing effort to fully engage in a mutual, transformational process of learning and growth. We are fortunate in that we reap satisfaction, joy and a sense of purpose when we participate meaningfully in patients' lives over time and witness the unfolding of health from within. When you help a patient solve a problem that has caused them suffering, the patient is changed; if you are in true partnership, you will also be impacted.

With every patient you care for, you learn and grow as a practitioner. Developing long-standing relationships based on trust and partnership are good for patients, good for you, and good for practice viability, sustainability and profitability. Think about what you can do to move beyond patient satisfaction. Doing so will serve you and your patients well.


Click here for previous articles by Shelley Simon, RN, DC, MPH, EdD.

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