Measuring Success

Perhaps nowhere in healthcare does service excellence become more compelling than in the occupational health setting. These providers have always been aware of the importance of keeping the customer happy, since there is such an obvious correlation between client satisfaction and the program’s bottom line. But understanding the importance of satisfying the customer is not enough. You must also know how to do it, and adequately train staff to ensure that it happens with every customer exchange.

There are many, many elements that create a truly customer-driven organization. Hallmarks of excellence are:

• Friendly and approachable physicians and staff.

• Superior orientation programs and on-going training for all physicians and staff in service excellence.

• Educational activities designed for the customer.

• Monitoring of customer satisfaction and use of information as part of routine process improvements.

• Using a network of feedback loops that keeps you close to the customer.

• Routine communication of findings or improvements to customers and employees.

• Process standardization that minimizes errors.

• Service goals, qualitative standards, and ongoing measurement of performance and improvements.

• A service recovery strategy for successful complaint resolution.

• Clean and pleasant facilities.

To move your organization forward and keep it moving, managers must understand the pivotal role they play in setting the priorities for program and staff on a daily basis. If service excellence is not your priority and passion, it won’t be anyone else’s either. You must also acknowledge that staff, often unknowingly, will imitate your behavior. Consequently, the foundation for developing a service-driven culture begins with you and the rest of your management team.

Service skills can be learned and mastered by anyone. These skills should be viewed as essential management (as well as staff) skills and something everyone is constantly working to learn or improve. You, along with your staff, will be a "work in progress" as you continually learn and relearn service skills. Consequently, it is also your responsibility to ensure adequate initial and ongoing education—of your physicians, staff, and customers. (Some problems can be solved or eliminated by better instruction of your customers.) You must ensure that the content is appropriate and sufficient, and that time and resources are available for adequate training.

As the labor pool tightens and filling staff vacancies becomes more difficult and critical, some managers make the mistake of cutting training short just to get positions filled. This solves a short-term problem only to create others: under-trained employees make more mistakes and are ill prepared to correct or avoid them. As mistakes inevitably arise, their confidence (and pride) in their performance diminishes, leading to more mistakes and more dissatisfied customers. High staff turnover leads to poor service quality and poor service quality leads to high turnover; people quit because they don’t want to feel incompetent or frustrated in their positions, leading to a potentially vicious cycle.

Perhaps more important than the training you provide is the interviewing and hiring you do. You must hire the right people. Poor attitudes and unpleasant personalities cannot be fixed later. You can train anyone on your service standards and policies and procedures but you cannot train them to have a new personality or a cheerful disposition. This includes physicians, your highest paid customer service team member. You will lose or win customers over your physician choice, so choose wisely, since these mistakes are not easily undone.

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Next on your list should be cultivating a service culture where problems are minimized. When they do occur, all staff should have sufficient training in complaint or problem resolution so that problems are fixed at their point of origin and to the customer’s satisfaction. Your goal should be to have as few problems as possible hitting your desk, understanding that as a manager, you are only really in charge when you can walk away and trust that everything will be handled as if you were there. Besides creating fewer headaches for you, the service literature indicates that 95% of customers will do business with you again if you resolve a complaint on the spot and to their satisfaction.

Organizations such as Nordstrom and The Ritz Carlton, with long standing reputations for superior service, embrace this philosophy and spend a lot of time training all levels of staff to resolve complaints without prior managerial approval. As part of this process, they also establish clear boundaries and dollar limits on what staff can and cannot solve on their own.

Another part of building a solid "Service Culture" is establishing service goals for your staff. These goals may be based on industry norms and/or client feedback, or tied back to your own Process Improvement (PI) measures. Some examples of service goals are:

• Anticipating the patient’s or customer’s needs and assisting them in any way possible.

• Apologizing when a customer’s expectations have not been met and resolving the problem as quickly as possible—and to the customer’s satisfaction—whenever possible.

• Taking a consistent and thorough approach to patient care.

• Remembering to smile and introduce yourself when greeting any customer, whether in person or on the phone.

• Monitoring patient service times and proactively dealing with any delays and keeping the patient informed about the delays and their options regarding rescheduling.

• Processing medical results and communicating those results to the employer the same day they are available.

Physicians and staff should also be evaluated on their service skills and adherence to your service standards. After all, people are the product in healthcare; their kindness, empathy, and civility can all be evaluated by the customer and used to create an extremely positive or negative impression. Evaluations at all levels in the organization should rate the employee on their ability to deliver excellent service as defined by your customers and organization.

A company’s service is only as strong as its weakest link. Where are your weak links? Have you fixed them?

Once you have begun to lay your foundation for service excellence, you will want to look at your most frequent customer complaints or operational problems. What can you do to minimize or eliminate them? For problems that cannot be eliminated, what is your Service Recovery Plan? You should have a strategy for recurring operational problems that staff can execute, hopefully to the delight, rather than dismay, of your customers.

Wendy’s and McDonald’s both have peak periods of business. During those times they typically open two or three drive-up windows and add staff to serve customers more quickly, rather then letting hordes of customers wait. Put yourself in the place of your customer. What would make the experience better for you? Better yet, ask your customers what would make the experience better for them.

Besides a Service Recovery Plan, you need to train your staff in the steps to consistent and successful complaint resolution. Service Recovery is best accomplished, however, through preventive strategies. Common operation problems should be worked on until they are eliminated or reduced to their lowest common denominator. If your Process Improvement activities are taken seriously and incorporated into daily operations, execution of Service Recovery Plans and resolution of complaints should gradually become infrequent, rather than common events.

At the end of the day or fiscal year, what will your customer-driven efforts produce? Initially, it is not uncommon to experience an increase in complaints, as customers become accustomed to your willingness to hear negative comments and suggestions for improvement. This phase should not last, and its duration will directly correlate to the laundry list of areas for improvement revealed by your first few customer benchmarking surveys. Over time, if you are truly customer-driven, complaints should decrease and satisfaction should increase for all surveyed groups (patients, employers, and employees).

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Eventually, you should have some improvements and success stories that you can brag about and use in marketing your program. You can also rest assured that your customers are giving you great lip service too. All of this should lead to improvement in account retention, financials, and market share, as well as an improved work environment for you and your employees. All customers benefit from the creation of a customer-driven organization that embraces service excellence.

It is also important to remember that improvements are usually incremental. Rare is the fix that will take your performance ratings from poor to outstanding overnight, so don’t lose heart if your progress isn’t as rapid as you or your staff would like. You should see consistent movement in your customers’ satisfaction level from just satisfied to very satisfied to delighted. Moving your customers from satisfied to delighted is critical, since the service literature indicates that customers who are just satisfied are six times more likely to defect than any of your other customers—including the ones who are dissatisfied! The goal is to have as many of your customers as possible rate your service as superior and their satisfaction level as delighted. While you will probably never reach 100% of this goal, that should be your objective and what you and your staff should be striving for every day.

Besides that innate sense that things are going better, how do you know if your efforts to improve the service experience of your customers have been worth it? Here are some organizational benchmarks you can check:

• Market Data: are you gaining market share or losing it? How many clients have you lost? Why? Is this number growing, shrinking, or staying about the same?

• Operating Results: how are you performing financially? Is the bottom line improving?

• Human Resources: what is your turnover rate for staff? The longer staff have been with you and the more satisfied they are should translate into better service for your customers.

• Customer Complaints: perhaps the most obvious bellwether of your efforts—are complaints going up or down? What trends can be ascertained by reviewing customer complaints from last year? How do they compare to prior years?

• Formal Survey Tools: another obvious bellwether: how do the results from your employer surveys compare to previous ones? Are you seeing improvement in areas where you have targeted your efforts?

• Service Goals and Degree of Attainment: you should have prioritized several specific goals that your staff knows you have targeted for improvement, based on customer feedback or complaints, e.g., turnaround time on medical results. How has your teamed performed?

There are few activities we can undertake as managers that have the power to transcend the organization and benefit not only our customers but also our community. Great service begins and ends with you. Only managers can infuse their staff with the commitment it takes to make an organization truly and consistently customer-driven. But remember, creating service excellence is only the first step; sustaining it distinguishes the real winners from those who have only embraced it as today’s latest healthcare trend. 

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