Phil C. Solomon
Vice President of Global Services MiraMed Global Services, Inc., Jackson, MI
With increased competition and declining margins, every healthcare provider must continue to find ways to stay fiscally viable. Providers must begin to un-think1 their concept of healthcare delivery— beyond how well they improve patient outcomes and cut costs—if they want to prosper in an industry undergoing a transformation.
A Shift of How Customer Service is Delivered in Healthcare
Healthcare providers are being forced to embrace the market reality that consumerism and pricing transparency are redefining healthcare delivery. Organizations that are succeeding are taking a radical approach to serving their patients as a means to foster loyalty. This stratagem has resulted in improved patient satisfaction and financial stability. Unthinking the way organizations approach the delivery of health services begins with treating a consumer more like a customer than a patient.
The importance of providing outstanding customer service has long been a focal point of business. Companies like Apple and Ritz Carlton Hotels have succeeded in highly competitive markets by delivering excellent customer service.
The former President of Ritz Carlton Hotels, Horst Schulze, built a successful six-star luxury hotel chain by following a simple premise: provide service that goes above and beyond the call of duty. He believes great customer service begins at the highest level with the leaders of his company. When asked about this he said, “Great leaders truly care. They care about people, and they care about excellence.”3
The late Steve Jobs, founder of Apple, understood customer service and how to provide it. He said, “Be a yardstick of quality. Some people aren’t used to an environment where excellence is expected.”4 Today, these philosophies are considered critical to every businesses’ success.
Unfortunately, the healthcare industry has been slower to adopt similar customer service strategies. James Merlino, MD, Chief Experience Officer at Cleveland Clinic and President and Founder of the Association for Patient Experience, believes that “It is especially unfortunate because hospital ‘customers’ are very different than those in any other industry for one important reason—they don’t want to be there. The experience is scary, confusing, and they often feel as though no one understands them. Yet often these same patients are made to feel that because healthcare is a necessity rather than a luxury; they aren’t entitled to a superior patient experience. And this is probably the biggest mistake our industry makes.”5
Dr. Merlino believes creating a great patient experience is not about making patients happy over quality. It’s about safe care first, high-quality care and then patient satisfaction.
Some healthcare organizations have taken the first step towards providing customer service that improves the entire patient experience. Walnut Hill Medical Centre (WHMC) in Dallas, Texas has created their own customer service model, W-E-C-A-R-E = Warm welcome, Empathize, Communicate and connect, Address concerns, Resolve and reassure, End with a fond farewell, to improve relations between patients and staff.7 WHMC believes that taking a few extra minutes to find something in common with a patient, to explain what is happening or to make sure the patient is comfortable goes a long way in creating a better patient experience.
The University of Toledo Medical Center (UTMC) recently launched an en-tire program based on patient satisfaction, iCARE University, which mandated patient satisfaction course work and training for every university student and employee. UTMC’s Service Excellence Officer, Ms. Ioan Duca, said, “I am really focused on creating a church-like environment here. We want a total cultural transformation. I want that Disney-like experience, the Ritz Carlton experience.”
The Patient Protection and Affordable Care Act (PPACA) and its Effect on Customer Service
Why is it now so important to treat a patient more like a customer? The health industry is preparing for the changing healthcare ecosystem driven by the Patient Protection and Affordable Care Act (PPACA), commonly called the Affordable Care Act (ACA) or Obamacare, signed into law by President Barack Obama on March 23, 2010.8
As a byproduct of the PPACA, Medicare is now requiring providers to perform a Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey asking patients about such things as:
- Communication with doctors and nurses;
- Responsiveness of hospital staff;
- Cleanliness of the hospital environment;
- Quietness of the hospital environment;
- Pain management and communication about medicines;
- Discharge information; and
- Overall rating and recommendation of the hospital.
The results of that survey have financial repercussions that are substantial: beginning in 2013, nearly $1 billion of Medicare reimbursements are at stake based upon the results of the survey, as well as other data sources on the quality of care available online.9
The HCAHPS reimbursements are not the only remuneration at stake for health providers. Unsatisfied patients can have a damaging effect on provider organization’s reputation and its financial sustainability.
Consumers making day-today purchases have experienced an improvement of customer service because they control who they buy from and are allowed to “vote” with their wallet. Sam Walton, founder of Walmart, once said, “There is only one boss, the customer. And he can fire everybody in the company from the chairman on down, simply by spending his money somewhere else.” However, purchasing healthcare services is different.
As the focus of consumerism and pricing transparency gain acceptance and healthcare becomes increasingly more competitive, the healthcare patient will be empowered to make similar purchasing decisions as a typical consumer and those decisions will affect a health provider’s bottom line. The “news of bad customer service reaches more than twice as many ears as praise for a good service experience” regardless of the industry.10 Since it takes 12 positive customer experiences to make up for one negative experience,11 health providers have a lot at stake and must change their culture to focus on improving customer service and the patient experience.
What is Good Customer Service and How Does it Improve the Patient Experience?
Customer service is the act of taking care of the customer’s needs by providing and delivering professional, helpful, high quality service and assistance before, during and after the customer’s requirements are met.12 In healthcare, it is defined as providing the best clinical care, safety and physical comfort, as well as meeting the patient’s educational, emotional and spiritual needs.
The tenants of delivering good customer service for healthcare begins with understanding what patients think is great service, recognizing what they want and knowing how to create loyalty. The following are examples of fundamental actions toward providing excellent customer service.
- Establishing rapport with the patient and their family;
- Creating personal relationships and being friendly;
- Being kind and empathic;
- Proactively providing information;
- Keeping the patient and their family informed of their treatment; and
- Listening to patients to determine their wants, needs and desires.
The organizations that survive and thrive in today’s evolving healthcare climate must provide excellent customer service to remain competitive. Providing good customer service just isn’t good enough anymore. It must be excellent.
Lessons Learned About Improving Customer Service From Steve Jobs and Apple
Healthcare leaders need to start thinking like business people, like Steve Jobs. When he returned to Apple, he decided to re-imagine the computer experience and he ended up re-inventing it. He blew up Apple’s old model of customer satisfaction and started all over again from scratch. His efforts resulted in Apple being rated as one of the “Top Companies with the Best Reputations” as reported by 24/7 Wall Street.13
There are eight important lessons health providers can learn from Steve Jobs and Apple to improve patient interactions and satisfaction, increase performance, productivity and loyalty. They are:
- Stop doing just your job. Take a lesson from Steve Jobs. When he first started Apple, instead of figuring out how to grow the company, he focused on improving his customers’ lives. Compare this philosophy to your organization’s vision and your own personal beliefs. Just doing your job isn’t enough to improve the patient experience. Don’t just do your job; enrich the lives of your patients, co-workers, clients and partners.
- Enrich lives. When you begin to think about enriching lives, magical things start to happen. For example, enriching lives led to the creation of Apple’s "Genius Bar,” where trained experts are focused on “rebuilding relationships” as much as fixing problems.
- Hire for smiles. The soul of any organization is its people. Consider when you hire, train and motivate your new employees and retrain existing employees, you teach them to create magical and memorable moments for the patients they serve. When a patient calls your facility, instill values in your employees to exude a magnetic personality as well as perform the tasks of their job.
- Celebrate diversity. Apple hires people who reflect the diversity of their customers, and healthcare providers should follow that premise. Providers must hire people based on how passionate they are instead of just focusing on previous experience.
- Unleash the inner genius. Employees need to be empowered to try things they never knew they could do before. They will make a patient’s experience delightful, instead of just good. Staff members need to think creatively and be rewarded for it.
- Empower employees. Empower your people to do what they believe is the right thing to do for your patients.
- Sell the benefit. Interactions with healthcare providers are typically not planned events. Always keep in mind a patient’s encounter could improve their life and the lives of their loved ones. The level of customer service given will stand out as a part of the overall benefit they gained from their treatment.
- Follow the steps of service. Leverage Apple’s five steps of service as they relate to healthcare:
- Approach your patient with a warm greeting;
- Probe politely to understand the patient’s needs;
- Provide an explanation or solution the patient can understand;
- Listen for and address all unresolved questions; and
- End with a farewell that leaves a lasting positive impression.
There are many ways a healthcare provider can deliver excellent customer service that supports a positive patient experience. Micah Solomon, a patient experience consultant, customer service consultant, speaker and bestselling author outlined seven ways “To Improve Patient Satisfaction, Experience, and Customer Service.”14 They are:
- Strive to deliver service on the schedule of your patient, not just a schedule that happens to be convenient for your institution.
- To improve HCAHPS scores, take a relatively broad approach. Being too selectively focused on the individual HCAHPS questions can actually backfire. Create an organization-wide halo effect that raises your scores as well as your actual rate of referral—not just the hypothetical “willingness to recommend.”
- Excellent customer service means systems as well as smiles. When Mayo Clinic overhauled their scheduling system, they employed industrial engineers using stopwatches to time wheelchairs between appointment locations in order to ensure that correct scheduling algorithms were created.
- Not-for-profit hospitals and institutions in healthcare can benefit by recognizing and embracing their inherent organizational advantage over for-profit institutions: It is easier for the employees to identify with the aims of an organization that doesn’t have profit at the center. If you’re not-for-profit, be aware of this advantage and make the most of it.
- Eliminate bullying and disrespect of employees by superiors. Working in an environment characterized by bullying increases turnover intentions of nurses and employees. They report high turnover intentions whether directly bullied or simply in a work unit with bullying.
- Every single employee needs to know how to handle customer complaints and concerns. Even if handling the concern means responding similar to “I’m finding you someone right now who can address this.” That response is far better than “I can’t help you, I’m the wrong person.”
- Much of what’s wrong in patient satisfaction and customer service is related to poor use of language, and to nonverbal language cues (such as hospital employees avoiding eye contact with civilians in the hospital, and acting like they are “other” from them).
- Creating a blame-free environment leads to improved transparency, improved systems and, ultimately, better results. Horst Schulze, founder of the Ritz-Carlton brand, frequently says, “If a mistake happens once it may be fault of employee. If it happens twice, it is most likely the fault of the system.15 So get to work fixing the system.”
One of the key factors driving positive changes in customer service and patient satisfaction in healthcare is the concept of patient-centered care.16 In this new approach, patients are involved at every level of care design and implementation. They are treated with dignity and their needs for privacy and individual expression respected. Also, patients are informed about their clinical status, progress and prognosis, and their test results and treatments are promptly and clearly explained.
Patients and their families are viewed as partners in decisions about treatment and care. They are offered options including access to complementary therapies and alternative healing practices.
Customer Service and Its Effect on The Eight Dimensions of Patient-Centered Care
The Picker Institute and Harvard Medical School created a structure or plan that providers can follow to improve the patient experience. The Eight Dimensions of Patient-Centered Care (EDPCC) was created through years of research by thousands of interviews and the experiences of caregivers and patients. Analysis of this research showed that there are certain things, certain behaviors that are instrumental to patients’ healing, feeling cared for and having a positive patient experience. From that research, the medical community better understands what’s most important to patients.17
Building on the legacy of Harvey Picker’s EDPCC, National Research Corporation has been helping hospitals and health systems develop patient-centered care strategies for over 30 years. They recognize how important customer service initiatives are as they relate to the EDPCC efforts. Delivering quality customer service touches every dimension of patient centered care and ultimately drives patient satisfaction.18
Research and analysis shows there are certain actions a provider can employ that are instrumental to patients’ healing, feeling cared for and having a positive patient experience. They are:
- Respect for patients’ values, preferences and expressed needs – Patients indicate a need to be recognized and treated as individuals by hospital staff. They are concerned with their illnesses and conditions and want to be kept informed.
- An atmosphere respectful of the individual patient should focus on quality of life;
- Involve the patient in medical decisions; and
- Provide the patient with dignity and respect a patient’s autonomy.
- Coordination and integration of care – Patients report feeling vulnerable and powerless in the face of illness. Proper coordination of care can ease those feelings. Patients identified three areas in which care coordination can reduce feelings of vulnerability:
- Coordination of clinical care;
- Coordination of ancillary and support services; and
- Coordination of front-line patient care.
- Information and education – Patients express fear that information is being withheld from them and staff is not being completely honest about their condition and prognosis. Based on patient interviews, healthcare organizations can focus on three communication items to reduce these fears:
- Information on clinical status, progress and prognosis;
- Information on processes of care; and
- Information to facilitate autonomy, self-care and health promotion.
- Physical comfort – The level of physical comfort patients report has a tremendous impact on their experience. Three areas were reported as particularly important to patients:
- Pain management;
- Assistance with activities and daily living needs; and
- Hospital surroundings and environment.
- Emotional support and alleviation of fear and anxiety – Fear and anxiety associated with illness can be as debilitating as the physical effects. Caregivers should pay particular attention to:
- Anxiety over physical status, treatment and prognosis;
- Anxiety over the impact of the illness on themselves and family; and
- Anxiety over the financial impact of illness.
- Involvement of family and friends – Patients continually address the role of family and friends in the patient experience, and often express concern about the impact illness has on family and friends. Family dimensions of patient-centered care were identified as follows:
- Providing accommodations for family and friends;
- Involving family and close friends in decision making;
- Supporting family members as caregivers; and
- Recognizing the needs of family and friends.
- Continuity and transition – Patients often express considerable anxiety about their ability to care for themselves after discharge. Meeting patient needs in this area requires staff to:
- Provide understandable, detailed information regarding medications, physical limitations, dietary needs, etc.;
- Coordinate and plan ongoing treatment and services after discharge; and
- Provide information regarding access to clinical, social, physical and financial support on a continuing basis.
- Access to care – Patients need to know they can access care when it is needed. Focusing mainly on ambulatory care, the following areas were of importance to the patient:
- Access to the location of hospitals, clinics and physician offices;
- Availability of transportation;
- Ease of scheduling appointments;
- Availability of appointments when needed;
- Accessibility to specialists or specialty services when a referral is made; and
- Clear instructions provided on when and how to get referrals.
The Risk For Not Providing Excellent Customer Care and a Positive Patient Experience
Geisinger Health System has made a commitment to their patients that they will deliver great customer service and a positive patient experience every time a patient interacts with the health system, and they guarantee it. They believe so strongly that they are going to do everything right every time, that they have put their money where their mouth is.
Once a medical treatment is completed, patients have access to an application on their smart phone that allows them to evaluate the treatment and customer service they received during their medical encounter. If they are unsatisfied with their experience, they can request a refund based on a sliding scale of the total cost of their care.
Geisinger Health System President and CEO Dr. David Feinberg calls the new application “Geisinger Proven Experience™.”19 Dr. Feinberg said, “We’re going to do everything right. That’s our job, that’s our promise to you.”
Something has to be done to change the healthcare system, Feinberg added. He compared the refund idea to getting a coffee at Starbucks. “If the barista makes it for you and you sip it and you don’t like it, Starbucks says we will make you a new coffee or give you your money back. I’ve never seen a Starbucks barista sip the coffee and say no, we made it right, you have to drink it.”
Feinberg envisions other big changes in the field as healthcare becomes more focused on the patient experience:
- Same day appointments upon request;
- Easy to understand bills;
- Automatic delivery and installation of supplies you may need upon returning home from surgery; and
- Office visits where you go directly to the exam room and the doctor is already there waiting for you, rather than you waiting for the doctor.
Offering a program like this has its risks, however “I don’t know if a money-back guarantee or warranty is the right way to do it,” Feinberg said, “but I do know if we don’t figure out how to do it, somebody else is going to do it.”
Today, every healthcare organization should have a customer service and patient satisfaction policy in place to show every employee what their organization expects of them and what is required by their patients.
The current healthcare consumer is better educated and informed than ever before. Healthcare organizations must address those aspects of service that consumers most readily appreciate: access to care; relationships between physicians, meaningful and understandable information; and participation in their own healthcare and treatment decision making processes.20
Providing excellent customer service in the healthcare industry needs to be a top priority for every provider. Improving patient satisfaction, customer service and the customer experience is critical to the long term stability and viability of a healthcare provider. Increased competition and the changes brought on by the Affordable Care Act have elevated the importance of delivering a consistent positive patient experience. Healthcare organizations that understand the implications of consumerism, pricing transparency, customer service and providing positive patient experiences will have a clear advantage over the competition in the future.
- Definition of un-think, http://www.merriam-webster.com/dictionary/unthink
- Definition of consumerism and pricing transparency in healthcare, http://www.healthcarefinancenews.com/news/consumersdriving-price-transparency
- CEO Perspective: Time with Horst Schulze, Jeremie Kubicek, http://jeremiekubicek.com/ceo-perspective-time-with-horstschulze-2/
- Steve Jobs, the CEO of Apple’s most memorable quotes on business and customer service, http://www.cheatsheet.com/technology/20-most-memorable-quotes-from-steve-jobs.html/?a=viewall
- James Merlino, MD, Chief Experience Officer at Cleveland Clinic and President and Founder of the Association for Patient Experience, http://finance.yahoo.com/blogs/the-exchange/why-customer-matters-healthcare-industry-214727535.html
- James Merlino, MD, President and Founder of the Association for Patient Experience, http://www.patient-experience.org/Home.aspx
- Walnut Hill Medical Centre, Dallas, Texas, Created a customer service model called (W-E-C-A-R-E), http://walnuthillmc.com/
- Patient Protection and Affordable Care Act, Wikipedia, the free encyclopedia https://en.wikipedia.org/wiki/Patient_Protection_and_Affordable_Care_Act
- Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey http://www.hcahpsonline.org/executive_insight/default.aspx
- Customer service statistics in business, White House Office of Consumer Affairs, https://books.google.com/books?id=A1mFAwAAQBAJ&pg=PT159&dq=%22White+House+Office+of+Consumer+Affairs%22&hl=en&sa=X&ved=0ahUKEwjhjsLq4JXKAhUM9WMKHfoQCHIQ6AEIOzAC#v=onepage&q=%22White%20House%20Office%20of%20Consumer%20Affairs%22&f=false
- 2012 Global Consumer Pulse research on customer service, Accenture, https://www.accenture.com/us-en/insight-accenture-global-consumer-pulse-research-study-2012-summary
- The definition of customer service, Study.com http://study.com/academy/lesson/what-is-customer-service-definition-types-role-in-marketing.html
- “Top Companies With the Best Reputations” reported by 24/7 Wall Street, http://247wallst.com/special-report/2015/05/06/companies-with-the-best-and-worst-reputations-3/2/
- Micah Solomon http://www.forbes.com/sites/micahsolomon/2013/11/02/quick-truths-for-improved-patient-satisfaction-and-customer-service-from-consulting-in-hospitals-and-healthcare/
- Horst Schulze, founder of the Ritz-Carlton brand quote about mistakes, http://www.forbes.com/sites/micahsolomon/2015/01/11/8-ways-to-improve-patient-satisfaction-and-patient-experience-and-by-the-way-improve-hcahps-scores/
- Patient Centered Care defined by Wikipedia https://en.wikipedia.org/wiki/Patient-centered_care
- The Eight Dimensions of Patient-Centered, the Picker Institute and Harvard Medical School, https://www.ncsbn.org/PCC-PickerPrinciple.pdf
- National Research Corporation, policy of implementing Patient-Centered Care, http://www.nationalresearch.com/products-and-solutions/patient-and-family-experience/eight-dimensions-of-patient-centered-care/
- Geisinger ProvenExperience™ money back guarantee program, http://www.geisinger.org/pages/newsroom/articles/ProvenExperience.html
- Customer Satisfaction and Health Care Delivery Systems: Commentary with Australian Bias, Internet Scientific Publications, http://ispub.com/IJH/3/1/4173