Common Service Problems

Taking Corrective Action

Customer Service has become a popular catchphrase among healthcare providers and managed care programs, yet few administrators or physicians are trained in the fundamentals of delivering great service and developing a service-oriented organization. This deficiency is perhaps most glaring when things go wrong and the customer has a complaint about service, expectations or outcomes. But when complaints are successfully resolved, programs can gain market share through account retention, customer loyalty, and word-of-mouth
referrals.

The majority of customers—about 68%—stop doing business because they encounter an attitude of indifference, either on the part of the company or an individual. However, the wonderful thing about attitudes is that they can be changed, simply by educating physicians and staff about recognizing and resolving complaints promptly. In fact, most customers will continue to do business with you if you resolve a complaint immediately, and to their satisfaction.

Only about 4% of customers will ever voice their concerns. The majority simply begins using the competition, preferring to keep their negative experiences to themselves. Complainers, on the other hand, are more likely to continue doing business with you, assuming your approach to resolving their complaint is satisfactory. When a customer complains, they are really saying, "I value my relationship with you and the services I receive. I would like to work this out so I can continue using your
services."

Complaints are a rare glimpse into the experience of your customer and should be embraced with enthusiasm rather than disappointment or frustration. Receiving a complaint should be viewed as a critical opportunity to gather customer feedback, improve organizational performance, and solidify the relationship with that customer. For every customer who complains, there are also numerous other customers (26 on average) who have the same or a similar problem. If your fix is focused on a global organizational process rather than something specific to that one account, solving a problem for one customer often solves it for many.

Customers get upset for the same reasons anyone gets upset.

• They had to wait too long.

• Their expectations were not met.

• They feel helpless, unsure or scared.

• They were treated discourteously.

• Someone argued with them.

• They were having a bad day and the experience with your clinic was "the last straw."

[top]

Upset customers want to be heard and understood. They want you to empathize with them and respect them, making them feel important and appreciated for their business. They also want to be taken seriously and guaranteed immediate action. Often they want to be assured the problem will not happen again and, when appropriate, that they will be compensated.

In general, customers want to feel good about their choice to use you and comfortable about their relationship with you. When things go wrong, the fundamental foundation upon which your business relationship is predicated has been seriously jeopardized and must be restored. While this is true in any purchase situation, it is essential in healthcare where the consumer’s confidence in the provider’s reliability and quality of services is paramount.

All physicians and staff should be trained in a consistent approach to resolving complaints, such as the one outlined in the following steps:

1 Don’t Argue. Arguing never improves any situation and is unlikely to make you feel better in the long run. It only fuels the fires of discontent and sends a clear signal to the customer that he or she is wrong and you are right. This may allow you to win the battle but you ultimately lose the war and, in all probability, that client’s business.

2 Listen Carefully. It is the customer’s job to complain and your job to listen attentively. Let the customer vent and tell you everything that has occurred, from his or her perspective. This helps to validate the speaker’s concerns. Ask questions to clarify and collect the information you need, but let the customer do the talking.

3 Apologize and Restate the Problem. A focus on the prevention of healthcare malpractice claims has resulted in providers avoiding admission of guilt on any level. This has unintentionally prevented us from employing basic good manners. Apologizing for the customer’s frustration or perception of a problem does not have to be an admission of guilt. Apologies must be sincere and genuine, so make sure that the tone of your voice and facial expressions are consistent with your words.

4 Express Appreciation. Thank your customers for being willing to complain, acknowledging that it is a negative process for them. Let them know that you appreciate their business and will do everything you can to resolve the problem to keep them as a customer.

5 Solve the Problem. Offer a solution. Or, if you are unsure of a solution, ask the customer what would make him or her happy. Tell the customer exactly what you will do and approximately how long it will take to do it, particularly if it is a problem that is not amenable to a quick fix or requires further investigation on your part. Let them know when you will get back with them and how to reach you in the interim.

6 Do What You Promised. Then follow up with the customer as quickly as possible, preferably the same day, but in any event within the timeframe you originally gave the customer. Some situations may also necessitate additional follow-up weeks or months later to ensure on-going satisfaction.

7 Make Restitution. If the magnitude of the problem indicates that you should write something off, then do so. Remember, any amount you write-off is a pittance in comparison with the lifetime value of that account, its replacement and opportunity costs, and any negative word-of-mouth publicity this incident might cause.

8 Give Something Extra. Give the customer something they didn’t ask for as a gesture of gratitude, both for their business and for their willingness to complain. (Nothing works to delight a customer like an unanticipated pleasant surprise!) This demonstrates that you genuinely appreciate the fact that they gave you the opportunity to do better. It might also give you the best word-of-mouth publicity available.

9 Tracking and Trending. Log the complaint in your tracking system and identify whether it should be incorporated into your process improvement activities.

[top]

Successful complaint resolution begins long before a customer voices a problem or concern. As an administrator, you must first make a determination of how much latitude you are willing to give staff. What types of problems should they be solving, and what dollar amounts can they write-off without a manager’s approval? The Ritz-Carlton, which has a legendary service reputation, allows any staff member to write-off up to $2,000 of a guest’s hotel stay without a manager’s approval. Nordstrom, another famous service leader, simply states in its employee handbook, "Rule #1—Use your good judgment in all situations. There will be no additional rules."

The next step is training staff to feel comfortable with those boundaries and how to achieve successful complaint resolutions. Neither the Ritz Carlton nor Nordstrom base their success on simple service rules. Those rules are backed up with extensive and on-going service training for all staff. Your staff must know their limits and when it is appropriate to involve a physician or administrator. This is particularly important in healthcare when a problem involves clinical care or outcomes.

You should be working with physicians and staff to identify and minimize or eliminate your most common service delivery problems. You should also develop a Service Recovery Plan for when problems occur. For example, most occupational practices accept walk-in injuries in addition to scheduled appointments. This invariably creates times when the clinic is bottlenecked and service is delayed. Lunchtime is also a busy period that is frequently beset with problems. Besides analyzing data and the scheduling systems to identify opportunities for improvement, you should have a Service Recovery Plan that can be executed when problems resurface.

Examples of a Service Recovery Plan for busy periods include:

• calling in additional staff or moving staff from one clinic (that isn’t busy) to the clinic that is swamped;

• ordering food or beverages for waiting patients;

• facilitating the transfer of patients (who are willing to go to a sister location) by calling that clinic and getting that patient scheduled;

• having movies and popcorn on hand to create a more entertaining atmosphere.

Whatever your plan, it should be something that you and your staff map out before you need to use it. Then, after its execution, revisit the plan to discuss what worked and what didn’t, paying particular attention to customer feedback on what worked from their perspective.

An extension of these activities is creating a culture where anyone who encounters a problem owns it, and can achieve a prompt, successful resolution for the customer. This may seem a bit intimating at first for both you and your staff. But when staffs are given proper training in complaint resolution and instructed that the only mistake they can make is failing to act, eventually everyone will be not only comfortable with this process but proud that they managed it on their own. Customers will invariably be delighted, since this minimizes the number of people involved with the problem and resolves their complaints quickly. For managers, it means you will have fewer complaints to solve and more time to work on proactively managing the service experience rather than always reacting to it.

Resolving complaints is never fun, but reframing how you and your staff conceptualize and approach problems can make all the difference. With a new attitude—defining complaints as an opportunity to gather customer insight and information for process improvements—you and your staff can learn how to resolve complaints promptly and to the customer’s satisfaction. Then, by taking a longer view and developing Service Recovery Plans to deal with possible problems, you turn your organization into a true service leader.

Wait times
Expedited delivery of medical results
Average or inconsistent service
Problems with physician/provider coverage or client interactions
Billing, ER, or other support departments
Telephone coverage
Balancing walk-ins to appointments
Managing patient flow on busy days
Treating patients like customers
Incorrect or outdated client protocols

Use Process Improvement to minimize common service problems
Work with staff to standardize a Service
Recovery Plan for recurring problems
Train staff on successful complaint resolution techniques
Create a culture and support your staff in owning problems and resolving them on the spot and to the customer’s satisfaction
When necessary, write off reasonable amounts

 [top]

About the author:
KAREN SWEDERSKY, MHA
has assisted numerous organizations with administrative, operational, and strategic assessments and new program start-ups. She has authored two occupational policies and procedures manuals for Occupational Health Research and frequently lectures and writes on marketing and operational issues. Ms. Swedersky is a former editor of the Occupational Health Tracker. She may be reached via e-mail: karen.swedersky@chmcc.org.