Q: Our agency is struggling with patient satisfaction. Any words of advice?

I hadn't been practicing in the home care setting for very long before I had a very pointed awakening to the unique dynamics of treating patients in their homes. It was my first time seeing "Mrs. Smith." I followed another therapist who had seen her for a few visits. When I arrived, she immediately told me to sit down and listen. I could tell she was unhappy. Mrs. Smith proceeded to give me an account of her last therapy visit. Tired of sleeping in a recliner on the first floor, she wanted to try the steps to the second floor where her bedroom was located. The therapist insisted she wasn't ready. I could tell the conversation had bothered her. She paused, then finally said that the therapist had told her that he was not letting her try the steps, he was in charge and that was that. She leaned in close and said, "You tell that man that when he's in my house he is not in charge."

The first 12 years of my career as a physical therapist assistant were spent in private practice where patients came to my "home." When they came for therapy, they were the visitor on my turf-I clearly had home field advantage. Until my conversation with Mrs. Smith, it hadn't occurred to me that the roles are reversed in home care. I am now the visitor and the patient clearly has the home field advantage.

Since that initial interaction with Mrs. Smith, I have made it a practice to give patients the best experience possible. Here are 14 simple things we can all do to give our patients an outstanding experience.

* Show up on time or call the patient if you're going to be late. Our patients' schedules may not be as demanding as ours, but their time is valuable and should be respected. Furthermore, patients wait for us to come and when we are late they get concerned.

* Ask for permission to use anything or move anything in the home. It's their home and their possessions. Remember we are entering their world; we have rights to nothing. Don't assume it's okay to move furniture, remove throw rugs, even turn off the television. Ask permission first.

* Put your phone on vibrate and answer only if it's absolutely necessary. Many of our patients did not grow up with a cell phone attached to their hand. They see phones as intruders into their time and space. Be respectful and make sure the patient knows that they are your primary focus, not your phone.

* Only speak positively about other clinicians. Trust is important between a patient and all their visiting clinicians. Negative words spoken by you about another clinician can harm that trust. If the behavior of another clinician needs to be addressed, address it with them, not the patient. Keep your opinions of colleagues to yourself and . . . if you don't have anything nice to say, don't say anything at all.

* If the patient has a complaint, apologize and do what you can to address their concern. Assure them you will relay their concern to the right people. No matter how trivial the complaint may seem, to the patient it is important and should be treated as such. They need to know that you value them and take every concern seriously.

* Keep the information of other patients confidential. Don't talk about other patients other than in generic terms. If you talk about others, patients will assume you talk about them too. They need to know that their personal information is safe with you.

* Use humor when appropriate. Laughter is very good medicine. Appropriate humor breaks ice, lowers anxiety, and acts as a bonding agent between individuals. Much of what is happening in our patients' lives is not laughable, but laughter is usually a very welcome reprieve.

* Keep your language and humor clean. Some may be okay with colorful language or off-color humor, but others may find it offensive. Our goal is to not make anyone uncomfortable. The best policy is to keep language and humor on the professional level.

* Smile. Our patients need to know they are not an imposition. Let them know you are happy to see them and enjoy their company. This gives them a sense of worth and value.

* Be encouraging and positive. Don't complain about your job, boss, or co-workers. Don't complain about a doctor or hospital. Don't complain about your spouse or your children or your mother-in-law. Keep your words positive and encouraging. Celebrate with them when they accomplish a goal. Point out how they are improving (celebrate even the small victories!).

* Ask about them but don't probe; tell them a little about yourself but don't make it all about you. Ask questions about their life; it shows you are interested in them as a person and not just as a patient. Listen to their stories and tell some of your own. Sharing a bit of your own life shows vulnerability and serves well to tear down some of those natural walls we put up. But be careful not to dominate the conversation and don't burden them with your problems.

* Ask if they have any questions. Give them every opportunity to ask questions and give the best answer you can. Answer in layperson terms and give examples and word pictures when possible. Make sure they understand your answer and explanation. If you don't know the answer to a question, promise to find the answer and get back to them.

* Leave their home the way you found it. If you move furniture, ask them if they'd like you to replace it. If you borrow a pen, make sure to give it back. If you pulled the covers back on the bed to practice bed transfers, put them back. Respect for their living space.

* Close out your visit by thanking them and asking if they have any final requests, concerns, or questions. Make yourself available to assist them in getting a drink, refilling a water bottle, grabbing their mail, or any other small gesture that shows a willingness to "go the extra mile."

Ultimately, we work in healthcare because of the patients. Give every patient the experience they deserve.