The Pulse

Customers don’t like rules – so one “turn on” is to avoid ever mentioning your business’s rules – in fact, avoid having any rules where customers are concerned.

Customers want whatever is in their best interest and if it can be done, they want you to do it.  And if it can’t be done, present the best possible alternative.  For instance, our family took a trip to Estes Park for spring break.   We got caught in a snowstorm so we ducked into a pizza place at about 1:30 in the afternoon.  There were about three people in the place.  We are shown to a table that is in line with the front door so every time it’s opened we get a blast of cold air.  I asked if we could sit at the larger table away from the door.  The waitress says no, that’s reserved for groups of eight.  I said, ‘Are you sure, there’s no one in here.”  She says, “Yea, if you don’t like it, take it up with the manager.”  Well, when it’s put that way you know the manager will support it, so we left.

The question is, what was the cost of turning customers away because of a rule?  In this case it was probably about $30. In your case it could thousands of dollars.  As Roger Staubach is credited with saying, “There are no traffic jams on the EXTRA MILE.”

Too many organizations assume their employees know how to achieve customer service excellence because when they hired them they told them what they wanted. However, only through direct observation can you really understand how your organization is perceived so that you can quickly address issues and make changes.

Direct observation is a two-fold process.  First, we can think of no better way to affect change than to insert trained observers into the employee-customer relationship.  That is why most of our programs involve healthcare mystery shopping.  The other important observation effort must be teaching managers to observe their employees and immediately coach them on what excellence looks like.

The Reasons Observation Efforts Succeed: Gaining customer’s perspective – Immediate recognition of problems – No place to hide and no excuses.

The Reasons They Fail: Managers stop observing because it is easier not to – Some managers are more comfortable with administrative tasks – Managers have decided that “employees get it now.”

“Customer service is just a day-in, day-out, ongoing, never-ending, unremitting, persevering, compassionate, type of activity.” Leon Gorman, L. L. Bean

Customer Service Building Block II: Hiring
Customer Service Building Block I: Commitment

A recent healthcare mystery shopping study of ours revealed that on 50% of the shops where staff friendliness was mentioned, staff failed to acknowledge mystery shoppers through eye contact, smiling or verbal recognition.  It says a great deal about a facility if staff is (un)willing to be courteous for the few seconds it takes to let consumers know their business is welcome and wanted – not to mention the implications it has for putting a loved one in the hands of seemingly (un)friendly people.

A healthcare mystery shopper wrote:

“She was not rude, but her general attitude was somewhat casual in the way that she kept pausing for long periods of time and checking information more than once.  It gave me the feeling of talking to someone who was either distracted or overworked and also left me hoping that she had gotten the information correct.”

How do you get employees to pay attention to consumers?  Quite simply, tell them it is okay to get off the phone, put the paperwork down, leave the computer, or break away from co-workers.  In fact, insist that they do.

“There was a woman behind the desk looking at some papers.  I wandered about intentionally to see if she would initiate contact with me.  She did not.  I walked toward the desk and stood there, waiting.  She got up from her seat with her papers and walked to the other end of the desk and began an activity that looked like filing to me. I waited for another 30 or 40 seconds, and there was no response from her.”

To effectively address the acknowledgment issue, our firm conducts role-playing by having one employee play the part of a consumer while the other participant plays the role of an employee.  The ‘employee’ must appear busy with seemingly insignificant tasks for 20 seconds before acknowledging the “customer” (the facilitator keeps track of the time).

We have found that it makes for better theater if the facilitator quietly encourages the employee to be as animated as possible. Typically, participants express surprise at how long 20 seconds really is.  Everyone is left with a new understanding of what it feels like to be in the “customer’s shoes.”

The second part of this exercise is to train employees on the “I’m ready when you are” service approach of preemptive acknowledgement.  If employees could embrace this one simple mantra when they enter into an encounter with a customer, they would prevent most of the occurrences that ultimately lead to negative outcomes.

This simple philosophy implies that the employee is immediately accessible to the customer.  Actually, it indicates even more.  It suggests that the employee is ready before the customer is.  This respect issue preempts animosity that can occur before anyone has even spoken.  Seconds off the clock can have a dramatic affect on a customer’s disposition.  If an employee is in full view and a customer is forced to wait even five seconds, they get frustrated; after 10 seconds they are angry; and after 20 seconds, they may want to hurt someone.  Every second that a customer has to wait jeopardizes the relationship.

To illustrate this concept, our firm does a customer service training exercise in which attendees demonstrate how it appears when an employee is looking at the customer before the customer is even ready.  The intent is to show how effortless an encounter can be when the employee is waiting on the customer rather than the other way around.

Any healthcare provider who takes a one-size-fits-all approach to patients, does so at their own peril because they are doomed to repeat the same satisfaction outcome over and over again. My feeling is that if you can recognize the type of patient you are working with, you have a much better chance of altering that outcome.
In the past, Brooke Billingsley and I have written and talked to healthcare organizations about “reading” patients based on our extensive healthcare mystery shopping experiences. This is the process of identifying the patient’s personality type and understanding what the patient needs from an emotional standpoint. But if the desired outcome is a positive patient satisfaction survey, reading patients is only part of the equation. The other part of the equation is addressing the issue of who will likely be filling out the survey based on the patient’s medical situation and the patient’s behavior.

I have created the following list of patient types (if you have others, please share), to illustrate that creating real change in your healthcare organization sometimes requires predicting how a particular patient might respond on a survey and then develop strategies to make the most of that prediction:

1. The hard to please patient – I am reminded of the nurse who said to me, “If patients would learn to be nice to me, I’d be nice to them.” Of course, it doesn’t work that way. Make sure staff appreciates the damage these patients can do with one survey. Then ask them to consider how many of these types of patients they encounter each week. The percentage should be low. Hopefully they will come to the conclusion that extra effort to be responsive and overly-attentive will pay dividends.

2. The passive patient who is silently disgruntled – Beware of the phrase, “Everything is fine” when the patient’s body language and facial expressions say otherwise. Don’t accept that answer if other things are telling you otherwise. Probe the patient for feedback. If you can’t get it from the patient, ask family and friends such as, “It seems Betty might be upset about something, is there something I should know?”

3. The submissive patient who has the family fight his/her battles – With this type, you are getting no clues of dissatisfaction from the patient but volumes from the family. Thinking with the end in mind, who is likely to have the most input on the survey? It is probably the family. Focus your attention on them to make sure they are satisfied by the time the patient is discharged. In doing so, make sure they are directly involved in the discharge discussion.

4. The happy patient who is uncomfortable commenting – These patients fall into the category of those who don’t bother completing the survey because everything was just fine. Don’t let them get away with it! For this type, put more effort into encouraging them to participate. They have to be convinced that it REALLY IS IMPORTANT that they do so. Please don’t use underhanded tactics like “begging for a five,” but tell them that the organization really appreciates as much detail as possible such as identifying staff people by name.

5. The demanding but appreciative patient – These patients keep asking and asking, but as long as their needs (or wants) are met, they are happy. You won’t know this unless you carefully assess their response to your actions. If you go above and beyond for them on a regular basis, you’ll have a friend for life.

6. The very ill patient – I include this type not because they are likely to respond to a survey, but because someone else might. Again, it is important to feel confident that the family is pleased with the care their loved one has received and that their needs were met.

A client said the other day, “Your phone ought to be ringing when hospitals realize they’re not going to get their VBP (see 8/1 post) check.”   Time will tell, but the primary reason anyone hires a healthcare mystery shopping company is to answer the question “Are we doing what we told staff we wanted done?”   What percentage of your employees go back to the same things they were doing immediately after being presented with another training initiative?  Without doing extensive research, but having been on the training side of this consideration, I would say the 80/20 rule is in effect.  That is to say 20% actually get fired up and try to implement some of what they heard.

Don’t get me wrong, I believe in customer service training as the only viable starting point. You need to create a level playing field. But what about after that? You’ve established the “this is what we want you to do” part, but how do you know if they are truly doing it? Can you afford to hope that everything you have put in place will bear fruit especially in light of the fact that you are using the same exhausted staff who has more on their plate than they know what to do with? It’s a lot to ask.

These days in healthcare it’s like the argument I heard on the radio the other day about the crumbling infrastructure in this country. If we don’t invest heavily now we will continue to fall behind other countries. The same can said for patient satisfaction. An investment into programs such as mystery shopping and employee perception deep dives will insure that there is a constant monitoring from the outside.