By Phil Dourado
The language and practice of ‘customer service’ doesn’t always transfer easily over into healthcare. Developing customer loyalty, for example, is a preoccupation among firms in the private sector lately. But, it isn’t something we really want to encourage among patients: We want them to get well and not come back, rather than bringing them back for more. That aside, if we carefully pick around some of the customer service ‘best practice’ that has been written up in journals and handbooks over the past few years, we can find a few ideas for overworked, over-stretched ward staff to make your life – and the lives of your patients while in your care – more satisfying. So here goes, starting with an icebreaker on how to make staff, and ‘customers’, happier…
1. Induce happiness
Happy staff lead to happy customers, according to the People-Service-Profit Chain, a framework developed at Harvard Business School in the late 1990s that focuses on improving customer satisfaction by improving staff satisfaction. If you and your colleagues are constantly stressed and unfulfilled at work, that mood will transmit itself to your ‘customers’ in all kinds of ways. Here’s a tongue-in-cheek (or pen-in-teeth) idea for reminding you and your colleagues not to scowl at patients or each other unless you absolutely have to. It’s from Stanford Professor Bob Sutton. Try it for a couple of minutes on your way into work:
‘Saying the phonemes e and ah, which activate smiling muscles, puts people in a better mood than saying the German ü, which activates muscles associated with negative emotions (Zajonc, Murphy & Inglehart, 1989). Simply activating one of the smiling muscles by holding a pen in the teeth (rather than with the lips, which activates a frowning muscle) is enough to make cartoons seem more amusing (Strack, Martin & Stepper, 1988).’
2. Listen to the grumpy people
Having said ‘induce happiness’, it’s common for management to frown on staff who are always complaining. Don’t. Encourage grumpy people to complain, rather than silencing them with disapproval, because they are usually your best source of improvement ideas. At Intel they teach all employees ‘constructive confrontation’. Encouraging people to express themselves honestly this way prevents suck-up attitudes where honesty is suppressed in favour of not rocking the boat. For that kind of honesty you need to recruit a few grumpy people, says Professor Sutton of Stanford University again. Keep most of your people upbeat and persistent and ‘can do’. But use grumpy people to bash existing practices and new ideas to test how customer-friendly they are. Grumpiness can be catching, however, and you don’t want too much of it, so keep them locked in a cupboard to avoid contagion. Just wheel them out occasionally.
3. Think ‘external customer control’
…instead of internal hierarchical control. In other words, acknowledge when designing or re-designing your ward’s working practices that the customer needs to be in control, which means decision-making moves down to the frontline, away from management. It’s hard for many managers to acknowledge that their role is not to accumulate power anymore, but to support frontline people in exercising their own decision making. Allowing front-line people to design processes and even their job roles is based on the ‘lean production’ processes pioneered by Toyota. When this ‘customer pull’ as opposed to ‘supplier push’ model is applied to service organisations, it is known as ‘lean service’, because it strips out bureaucracy and unnecessary practices. Lean service consultants even have their own ‘lean service’ joke, which they like to tell corporate clients to break the ice before they present their not-so-lean bills. It goes like this:
Sign seen outside an Australian gym ‘Fat and ugly? Why not just be ugly?’
Involving customers in designing their own service or products is something carmakers and others are experimenting with lately. So, maybe get your ward members together to design their ideal ward or, more realistically, to come up with a list of improvements that they – and the staff – jointly put into practice. See below, point 4, for how galvanising it can be to give people more control over their own lives in this way.
4. Connect people around a common cause
What’s the most powerful force in the Universe? The need to have some control and direction over our own lives; exactly the thing that is largely taken away by group living in a ward. So, create opportunities for people to ‘do’ rather than just be done to. Creating a customer community that allows patients to connect and to act around a ‘mission’ of some kind is one route. One example of connecting people around a common cause that they find fulfilling can be seen in www.join-me.co.uk, set up by a redundant TV producer who recruited thousands of people to join him and then had to come up with a mission for them. He decided their mission would be random acts of kindness, which members had to report to the website, with an accompanying evidence to prove the kindness committed. Could you adapt this idea to get some of your patients united and active around a common cause – maybe educating people outside about what it means to be mentally well and unwell through a joint video project or writing a booklet together?
5. Be a consumer
Train station tannoy announcements: how come they are nearly always impossible to understand? Because the person broadcasting it isn’t hearing what the customers down on the platform are hearing. So, it’s often at the wrong volume setting. The obvious lesson? Be where your customers are. Spend a day a month or so in your patients’ shoes. Be admitted. Go through, on the receiving end, whatever induction or settling in programme you have for new patients (what do you mean ‘What induction programme?’). Yes, you are busy. Yes, your staff resources are stretched. Yes, this may seem like role play for which you have no time. But, it reconnects you with what in the private sector and, increasingly, the NHS, they refer to as ‘the customer experience’. By going through what your patients go through, you will spot an endless number of opportunities to improve the experience for patients.
6. Small things make a big difference
In a relationship, it’s often the small things that drive you up the wall – the top constantly off the toothpaste, the dishes always in the sink. Similarly, for your patients, it’s often the small, easily fixed things that diminish the quality of life. So, if a root and branch overhaul of your ward practices is too much for you (and them), try one improvement a week or even every two weeks. Maybe get people in the ward to vote on which procedure or practice or rule they find most infuriating and work on that for a week or two before moving onto the next one. Carmakers have been using this continuous improvement method – feeding customer complaints back to the factory to fix irritating problems at source – for years.
7. Do you like your customers?
The lateral thinker Edward De Bono summed it up best. He was doing some consultancy work with the Board of a major bank, trying to get to the bottom of why customers seemed to hate them. One of the Board arrived at a ‘Eureka’ moment: ‘Our customers hate us because we act as if we hate them! No matter how we try to hide it or dress it up, they realise that we treat their money as if it’s our money and see them as a nuisance. It kind of seeps through’, reported De Bono.
Of course you don’t hate patients (er, if you do, time to get out quick) but to what extent do your ward practices treat your patients as a bit of a nuisance, as getting in the way of work rather than being the reason you are all there? And to what extent do you take refuge in paperwork and other bureaucratic ‘back office’ work to get away from the sometimes intensive and perhaps tiring ‘face time’ spent one-to-one (or, more often than not, one-to-many) with your ‘customers’?
8. Ditch the jargon
Deloitte Consulting created a computer programme it calls The Bullfighter. It sifts the ‘bull’ from company reports. Deloitte says The Bullfighter has discovered a direct link between jargon and business failure. When Deloitte applied The Bullfighter to a survey of America’s top 30 companies, they found a recurring pattern: jargon and goobledegook increases as profits shrink.
The mental health profession – like all professions – is full of bureaucratic jargon which distances you from patients. In fact, that’s the very reason jargon develops; to create a secret language the uninitiated are kept out of or have to learn if they are to understand you. So, seek out and destroy jargon wherever you find it. We are all overpowered by the volume of information pumped at us today. Jargon just makes it worse.
9. Try something new: live a life less ordinary
‘Never be afraid to try something new. Remember that amateurs built the ark. Professionals built the Titanic.’ Dave Barry
Some degree of repetition is inevitable in any job at any level. That’s what experience is: ‘I’ve done this before. I know how to do it.’ But, experience can lock you into ways of working that quickly become outmoded or just plain run of the mill. Yes, many of your patients will value routine and find change unsettling. But, that doesn’t mean you have to bore them to death.
We need to leaven the repetitive stuff by regularly, deliberately doing something different, to maintain freshness. That doesn’t mean changing your entire job; just ensuring you, and your people, have the freedom to try new things on a regular basis. It’s about creating a life less ordinary at work.
10. And, finally…encourage patients to tell you off!
‘A complaint is a gift’, the sunny optimists on the other side of the Atlantic say. They’re right on this occasion. Here’s a story from a hospital in Singapore that shows how useful it is to let patients tell you off regularly: Alexandra Hospital had one lousy service reputation: long waits, unkempt facilities, unpleasant surroundings, surly staff…and an unpleasant association with suffering in Singapore’s history. The complaints were long and tempers often ran short.
A few years ago, a new management team took on the challenge of transforming this one-star hospital into a five-star service showcase. It took discipline, imagination and hard work. Today, Alexandra Hospital is developing a strong service culture and world-class patient care.
One of the culture-building tools used by the new management is ‘Scolding Sessions’. These unusual sessions were described by hospital CEO Liak Teng Lit, to service consultant Ron Kaufman, who wrote it up in his e-newsletter as follows:
‘We receive 1,000+ feedback forms from patients and their families each month. Most feedback is positive. About 5% is negative or gives suggestions for improvement. We contact this group and invite them to our patient focal group discussion. Typically 10 will come back.
‘Held over lunch on a Saturday, the sessions last about 90 minutes. We seat the patients in front in a circle. I chair the discussion. In my absence, the Chairman of the Medical Board or the Chief Operating Officer chairs. ‘While attendance at these discussions is not compulsory, members of our management, clinical leadership team, nursing officers and supervisors are usually present. They sit behind to listen.
‘We tell the participants that we are providing lunch for them to scold us. Bad news tell us, good news tell others because criticism helps us improve while praise makes us complacent. I also ‘threaten’ to charge them for the lunch if they do not point out our weaknesses.
‘While the participants are making comments we do not attempt to give any response. I merely take notes and urge them to elaborate further. Usually the participants will bring out 40-50 upsetting points over an hour. When they are done, I apologise for our failures and briefly explain what we intend to do to correct our mistakes and weaknesses. Where we are unable to respond positively, I explain why we cannot. ‘Feedback obtained is tabled for discussion and action at our Quality Steering Committee meeting and other hospital and departmental meetings. We have been doing this every month for the past five years. The original intent was for our customers to help us identify our failures and also to obtain their suggestions. But we realised that we achieved much more.
‘Our staff, especially the senior doctors, got to listen directly from patients how they felt about our care and services. The emotions communicated through their words, tone of voice, body language and facial expressions could only be expressed in a face to face meeting like this. These sessions make us feel the pain of our patients and force us to be honest with ourselves. ‘Scolding Sessions’ have played a significant role in changing the culture of the organisation.’
This article was first published in ‘Star Wards, First Addition’ 2006