A patient sits in an orthopedic clinic’s waiting area, checking her watch, scrolling through her phone, and looking around for someone who can explain the delay.
Staff members pass by.
Nobody stops.
And long before a clinician enters the room, the practice has communicated something unmistakable: We do not see you.
For Chelsea Grear, Patient Experience II, UTHealth Physicians, that scene is more than a hypothetical. She acted it out during an MGMA Summit presentation with patient experience expert Jasmin Barber, MPH, LSSYB, CODC. They were clear in their message: Communication failures happen in ordinary moments, and patients experience those failures before, during, and after the clinical encounter.
In a recent conversation with Daniel Williams, senior editor and host of the MGMA Insights Podcast, Grear and Barber explained how practices can recognize those moments, repair trust, and redesign work so that patient experience does not depend on one unusually attentive employee.
The patient does not do this every day
Grear entered healthcare after working in education. With a retired nurse for a mother, she cared about people, but one practical concern made the profession seem unlikely: “I couldn’t deal with people getting sick, like actually throwing up.”
An opportunity at an outpatient surgery center changed her path. As a patient experience coordinator, she became what she calls the “in-house fixer,” working directly with employees rather than directing them from behind a computer. She still carries that approach into clinics.
“If I’m in the building, I don’t care if you just need a piece of paper off of the fax machine, you want me to run a patient to X-ray, or get a question answered from a provider, use me up,” Grear said. “That way, they can see me live and in action.”
That proximity exposed one of the most common communication failures in healthcare: Staff know the process so well that they forget what it feels like to encounter it for the first time. In an orthopedic practice, a specialist might hear the same knee, spine, or lower-back complaint repeatedly. The patient has lived with it once.
“Our patients don’t do this every day,” Grear said. “Every time I go in for anything, small or big, it’s the first time. So please hear me out.”
Trust begins with the person waiting beside the patient
Barber’s commitment to patient experience began while she was in high school, when her mother and grandmother were hospitalized at the same time for the same condition, but in different hospitals. Barber had to move between them while trying to understand what was happening.
“It is about taking care of the patient, but it’s a whole other ball game when you’re also making sure that the family members, caregivers, friends, whoever is there with them, also feel cared for,” she said. “They’re just as scared as the patient themselves.”
The hospital teams cared for Barber while caring for her family. That experience originally pointed her toward medical school, but, as she puts it, “We didn’t click.” She moved into healthcare administration and public health instead, looking for ways to translate resources and knowledge into daily practice.
Her experience broadens the unit of care. A spouse trying to record instructions, an adult child waiting for test results, or a caregiver wondering whether one medication replaces another is part of the communication system. Ignoring that person can leave the patient without the support needed to follow the plan after discharge.
“Sometimes we may have the resources and the knowledge, but not really know how to put it into play,” Barber said. “Once you do it, it gets the ball rolling and produces better outcomes.”
Replace jargon with "teach-back," paper, and pictures
Medical terminology can create a false impression of efficiency. A clinician delivers technically accurate information quickly, but the patient leaves unable to answer the most basic question: Was that good news or bad news?
Grear recommends plain language, diagrams, and even quick drawings on exam-table paper. She also favors what's called teach-back, or asking patients to explain what they heard rather than ending the encounter with simply asking if the patient understood.
“I explained all this information,” she said. “You want to write anything down? I encourage writing things down.”
That exchange tests the communication, not the patient. If the explanation comes back incomplete, the clinical team has identified a defect before it becomes a medication error, an unnecessary phone call, or a missed follow-up.
Proactive communication pushes the process one step earlier. Barber recommends anticipating the questions patients are likely to have once they get home:
Is the new medication replacing the old one?
When should it start?
Which instructions matter most?
Who owns the next step?
“It’s being prepared and being ready in the moment versus having to get ready later,” Barber said.
Make handoffs visible to the patient
Repeated questions can make a patient feel that nobody listened. Yet some repetition is clinically necessary. The difference lies in whether the practice explains the reason and demonstrates that information has traveled with the patient.
Grear’s preferred handoff happens in front of the patient. For example: “I received this information from Ms. Jones. We’re seeing her for her lower back. She expressed that she’s having pain when she walks. She’s taking this medication.” The staff member then turns to the patient and asks whether anything was missed.
That sequence accomplishes three tasks. It confirms that the first employee listened, gives the next employee a usable starting point, and lets the patient correct the record without retelling the entire story.
When verification is necessary, Grear advises making that explicit: “This is why we’re having to ask you the same questions, because we want to ensure we have not missed anything.”
Practices can audit this workflow at five predictable points:
- Scheduling and access
- Check-in and arrival
- The clinical interaction
- Checkout
- Between-visit follow-up
Grear and Barber previously organized their MGMA Summit framework around those five touch points, assigning someone at each stage to set expectations, confirm information, explain the plan, or complete follow-through.
Read the waiting room before it becomes a complaint
A patient checking a watch, tapping a foot, huffing, or repeatedly looking toward the front desk is already providing feedback. The organization does not need to wait for a formal grievance. Grear sometimes sits beside patient access representatives and scans the lobby herself.
“I’m constantly reading the room,” she said. “Who’s been sitting for too long?”
Her recovery script begins with the appointment time, a sincere apology when the clinic is late, and an offer to investigate the delay. The intervention is small, but it prevents the patient from watching a staff member walk past twice and concluding that the delay is invisible.
Nonverbal observation also has a clinical dimension. A patient who has been waiting since an early breakfast may be experiencing low blood sugar. A child who managed an hour and a half in the clinic may have exhausted every book and lollipop available. A worried facial expression during an explanation may signal confusion the patient is reluctant to voice.
“I can tell the patient is either confused or they’re worried about what was being said just from either their body language or their facial expressions,” Barber said.
The next move doesn't need to be guesswork. Ask the patient directly: Is there something I said that caused concern, or something I can clarify?
Access pressure can make these moments more common. A 2025 MGMA Stat poll found that practice leaders’ leading patient-access priorities for 2026 were no-shows at 27%, online scheduling at 24%, phone access at 22%, and wait times at 21% — showing just how many potential breakdowns compete for attention at the front door across the MGMA community.
The pressure to move patients through the practice can make listening seem expensive. But Barber argues that the opposite is true: Loyalty, referrals, and return visits emerge from moments when a patient or caregiver feels like the most important person in front of the employee.
“If I’ve had a good experience, then of course I’m going to be like, yes, go here, go see Dr. So-and-so,” she said. “But not just them, their staff as well. It’s a team thing.”
Fix the workflow before blaming the employee
Not every damaged relationship can be recovered. Grear jokes that some patients “woke up like this,” borrowing a Beyoncé reference for the person no apology or intervention will satisfy. Even then, the practice should clarify the situation, offer available resources, and, where appropriate, help the patient find another source of care.
Other dissatisfied patients expose a correctable defect. If the same breakdown appears at check-in, imaging, or checkout, Grear sends the problem back to the workflow. One employee may complete a task in two clicks while a colleague in the next pod uses five.
“Sharing is caring,” she tells her teams. “If you have found a better process, your success is my success. Your failure is mine.”
That position changed the way Grear thought about patient experience. A relentless focus on cheerful service had ignored the conditions under which employees work. “Our patients are only going to be as happy as our most unhappy team member,” she said.
Sometimes the corrective action is a redesigned workflow. Sometimes it is listening to the employee. Occasionally, it is making sure that person has the pen that helps the day run smoothly.
Barber reduces service recovery to one decision: “It’s better to attempt and to try than not.”
Acknowledging the delay, asking about the worried expression, or carrying the patient’s story into the next room can keep a small communication crack from becoming, in her words, the break that sends “all the water flowing out super fast.”
Outside the clinic, Barber resets near Lake Michigan, journaling or listening to music by the water. Grear, a self-described “professional napper,” relies on Prince, her Shih Tzu-poodle mix, to get her outside after a long week. Both habits depend on noticing what is happening in the moment. Notably, their prescription for medical practices is much the same: Look up, read the room, and respond before the patient has to demand it.
Resources
- Connect with Chelsea Grear on LinkedIn
- Connect with Jasmin Barber on LinkedIn
- 5 everyday touch points that shape patient trust (MGMA Summit recap)
- Patient access priorities for 2026: Tackling wait times, phones, no-shows and more (MGMA Stat poll)
- Automatic for the people: AI moves for medical practices to boost the front office and access (MGMA Stat poll)
- MGMA Patient Experience Playbook
- MGMA Tools & Checklists - Patient Experience
- MGMA Insights Podcast Network
MGMA Members: Would like to appear on an episode? Email us at dwilliams@mgma.com. If you have a question about your practice that you would like us to answer, send an email to advisor@mgma.com. Don't forget to subscribe to our network wherever you get your podcasts!
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