Creating a positive community image through customer service.

It's a basic. It's also often overlooked.

One of the many challenges facing long-term care providers is today's new way of consumer thinking. Consumers are learning to make better-informed decisions, they have more alternatives, and are very selective about their choices in health care. In the nursing home industry, we often think of the customer as the resident, but in reality the customer is anyone who comes into contact with the facility. How these customers are treated is just as important as the actual care that is provided.

Most providers rely upon traditional forms of marketing, such as advertising, to enhance their community image. However, reputations are in fact created, not bought through advertising. And it is the actions and attitudes of every employee that have the greatest impact on how a facility is perceived by the public. Today's customers have heightened service expectations, and are more likely to be dissatisfied with poor service, as compared to consumers of previous generations. They also have difficulty measuring a provider's quality of care. Nevertheless, every facility touts quality care, making it less than unique as a key selling point. As a paying customer, one would expect that quality is a fundamental of health care delivery, and an assumed standard of operations. Yet operators expound upon quality of care, kind staff, home-like environments, and nutritious meals as though consumers have never before heard of these things and would be mightily impressed.

With so many operators selling the same product, customers rely upon very specific messages or cues to assess an operator's statement of quality. Their judgement of quality is based upon what they see and what they hear. When contacting a health center, what if the telephone rings six to ten times before it is answered, or the customer is cut off or put on hold? The customer responds by thinking, "if you're too busy to answer the phone, how can you have time to take care of my mother?" What if a customer sees cluttered work stations, unanswered call lights, or unprofessional hand-lettered signs taped to the walls of the facility? What if the staff are not in proper and professional dress, or do not warmly acknowledge a customer's presence? Each of these examples carries a powerful and memorable message, one that speaks volumes about "quality."

Quality customer service is the power of communicating and demonstrating a facility's quality of care. It is the sum total of how everything looks and how everyone acts. It means building an image of an institution that takes pride in a job well done, that cares about the customer, and knows how to show it.

To ensure successful customer service provision, it is essential to have written policies and staff training on both procedural and personal aspects of service delivery. Procedural quality consists of defined tasks and systems, such as how the telephone is answered. Personal qualities are the attributes of the individual providing the service, such as the voice inflection used when the telephone is answered, and the appearance of that individual. Procedural and personal service standards should be defined for three areas that create a powerful first impression: telephone techniques, the appearance of the physical plant, and the appearance and attitude of the staff.

When individuals contact a health center by phone, they expect to speak with someone who is friendly, yet shows compassion and listens. Their first and lasting impressions are profoundly influenced by how promptly and professionally their needs are met by the individual who helps them over the phone. Written procedures and training should cover a variety of phone scenarios and scripted information presentations. Specific focus should be devoted to telephone coverage for after hours and weekends when full-time receptionist staff are typically not available.

A first impression situation that is more difficult to control occurs when the customer comes into the facility to conduct business, visit a family member or obtain information for a possible admission. Here the customer is forming opinions about quality based upon the appearance of the facility and of the staff, and the actions and attitudes of the staff.

Most nursing facilities are clean and have good housekeeping standards, but it is important to pay attention to the details that can take away from a facility's overall appearance. The facility must be seen from the customer's point of view, and all staff should be alert to avoid or remove customer-perceived blemishes. They should: Police the parking lot often for litter and cigarette butts. Make sure the entry doors are spotless and without signs. Keep all work stations neat and clean, and avoid putting hand-lettered signs on the walls. They should remember that the housekeeping staff is not solely responsible for keeping the facility clean; all staff should contribute.

Research has shown that a customer's opinion about the quality of a particular service is also based upon the appearance of the person providing the service. If employees don't look as though they can take care of themselves, how can a customer be convinced that they can be entrusted with the care of someone else? Most facilities have policies concerning appropriate dress, and it is important for management to ensure that employees comply. All employees should wear name tags, be neat and clean in their appearance, and well-groomed. For employees who don't wear uniforms, there should be written standards concerning appropriate street attire.

As is obvious by now, developing a quality customer service program translates into staff training and making customer service part of everybody's job. Nevertheless, successful customer service begins at the top. Management must establish the basic tenets of customer service and set a strong example for others to follow. Customer service must be a continuing focus in strategic planning and in day-to-day operations.

Employees should be informed at the time of hire that their role is to provide quality care and quality customer service. Job descriptions should include language on employees' role as customer service providers, and performance reviews should take this role into consideration. Orientation and in-service training for both new and tenured employees should be conducted on an ongoing basis to introduce and reinforce customer service principles.

Specifically, training programs should address:

* The role of staff as providers of quality care and quality service;

* How to identify a facility's strengths and weaknesses in customer service performance;

* How to recognize and respond to customer needs;

* Specific telephone and personal communication techniques to create a positive impression and reputation with customers; and,

* Techniques for communicating quality through the appearance of the facility and the staff, and through the attitudes and actions of the staff.

An enhanced reputation will be only one benefit the facility will enjoy. A customer-focused organization experiences enhanced quality of care, less staff turnover, increased census, fewer customer complaints, and a staff empowered with trust and teamwork. In an industry where rapid change has often obscured a heritage of caring, it is vitally important that operators look to the future by going back to the basics: the principles of quality customer service.

Phyllis M. Thornton is President of Signum Marketing Services and a principal of Ethos, Inc., Louisville, KY, firms that specialize in marketing and customer service programs designed for the long-term care and retirement housing industries. This is the first of a series of articles by Ms. Thornton on marketing principles applied to specific long-term care situations.