Customer dissatisfaction: eight sure ways to enrage residents and families; You can't go wrong if you do the opposite.

As a long-term care professional, you have endured customer-satisfaction and quality-care seminars. You've received tips, advice, and prescribed steps to "quick fixes" for managing difficult residents and families. It seems as though you are doing all the right things and sticking to the plan.

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But think about it. Does it seem as though you still spend far too much time putting out fires or calming irritated families? Do you and your staff find yourselves purposefully avoiding certain residents and families? What's wrong with this picture?

We are professionals who have evaluated and treated residents in many different facilities that provide varying levels of care. In addition, one of us has had personal experience with family members in assisted living, Alzheimer's care facilities, and nursing homes. As such, we have been on the outside looking in and have observed certain self-destructive attitudes displayed over and over in facilities. Please keep this in mind as you take in our tongue-in-cheek look at customer service--or, in this case, disservice. The insights you gain will apply to every staff member, from housekeeping to the executive team.

What follows is our list of surefire tips on how to displease customers--or what not to do if you're interested in customer satisfaction. We then follow with some italicized recommendations.

Number One

When you get a complaint, look serious and say, "We're doing the best we can." This makes the complainer think you are working hard on the problem already but, unfortunately, there is some outside limitation to your efforts. Few people will respond, "Well, that's just not good enough." But although family members or residents might seem to accept your earnest reply, that does not mean that they will not tell everyone they know about their bad experience. They might even decide to tell the state board or a plaintiff's attorney about their complaints.

When someone complains, it is essential that you offer a solution. A better response than simply, "We're doing our best" would be, "We're doing our best, but we might not have thought of all the possible solutions. Do you have any suggestions we could incorporate into a solution?" Of course, it goes without saying that you must follow through with your promises.

Number Two

Immediately blame someone. And, importantly, make sure that the person you blame is inaccessible to the complainer, either because the person works at inconvenient hours or is not on site at the moment. This makes you look as though you know exactly what's going on with everyone at all times. It also signals that you will deal with the culprit when you see him/her, effectively weakening the complainer's sense of empowerment.

Instead of pushing the customer into this trap, accept the complaint, tell the person you understand the issue, and assure them confidently that it will be resolved. Don't mention who is at fault. Most of the time, the system itself is largely to blame. No system is perfect, and creating a scapegoat merely impedes the important process of continually improving your operations. If you really think about it, the complainer is doing you a favor by calling attention to your facility's particular weaknesses.

Number Three

Call the family liars. Of course, you may not want to use that exact term, but you can hint at it by indicating that their eyewitness account of inappropriate care could not be correct because your (second- or third-hand) information is always more accurate. This tactic is particularly effective if you avoid documenting anything not specifically required by law. The standard legal advice is, "If it's not documented, it didn't happen." That way, it's their word against yours. Also, be sure to appear as though you feel hurt that anyone would dare to imply that your staff's work is inadequate.

Remember, an outsider may actually be doing you a favor by bringing something to your attention rather than immediately going to higher authorities. Likewise, documentation is more than a meaningless chore; it is the primary way for staff and families to communicate the details of care throughout the day. It is also the best way to detect patterns that may herald serious problems. Documentation is the single most important tool you have to engage in truly meaningful collaborative dialogue with families about their loved one's ongoing condition. Respect it and stick with it.

Number Four

Be sure to stand your ground and never accept a family's suggestion for improvement as a good one. If you allow them to believe for one minute that they have a good idea, families will barrage you with all sorts of new plans for your facility and staff. You must never change the way you do things. Aside from any other inconvenience, you will have to do that in-service training all over again.

Families want you to successfully take care of their loved ones, and often their suggestions are the result of their own trials and errors. If you fail to respond, it could mean to them that they've failed in their choice of facility. Accept their hints and suggestions for at least serious consideration. You and everyone else involved may be better off for it.

Number Five

When a request is made or a suggestion is offered, simply look the family or resident in the eye and flatly respond, "We can't do that." After all, you are the professional, and you know your business. (See Number Six below if they ask, "Why not?")

There is no better way to create outrage than this. It's one thing to offer an excuse, but to flatly say that any suggestion is impossible makes it clear that you're not even trying, nor do you even care about trying. If there are legal reasons you can't do something, you need to say that up front. But you must open a dialogue to find ways to achieve the family's goal that will work within the legal constraints that pertain to your facility. Likewise, the common response "corporate won't let us do that" is infuriating to a consumer. We all know that if there is a will, there is almost always a way to address an issue. That someone who is willing to help must be you.

Number Six

If the family or resident persists with the suggestion, (i.e., asking "Why not?"), you can always say that there are no funds in the budget for it. Make sure you look really disappointed and frustrated. Don't forget to mention that you often have discussions with your colleagues about these issues, and they echo your dismay over the lack of funds for remediation. Do not mention, of course, that the facility's monthly care fee is increasing; the administrator will take care of that later in a letter.

One thing families and residents really do not understand is how you can "poor-mouth" your facility for its lack of funding and at the same time send them monthly bills that seem exorbitant. You are being paid to do what is necessary to take care of your residents. Sit down with people and talk about their suggestions, write them down, and bump them up to a level of authority that can do something about them. Engage everyone in brainstorming and planning, and keep them apprised of the progress you have made.

Number Seven

Look busy, but never make eye contact with or speak directly to anyone, particularly to those residents who are being too demanding at the front desk. This way, you appear as if you have lots to do besides listening to their gripes, and they may decide not to bother you.

Families and residents want to believe that you are busy with important caregiving tasks, and they don't want to waste your time. No question, if you look busy, they will delay talking with you--and, as time passes, they will become increasingly resentful. In contrast, a simple greeting or just stopping to talk socially is an excellent way to convey your ongoing involvement and interest in them as individuals. Yes, you are busy--but are you too busy to find time to spend with them when they aren't complaining? Many families have told us that they would not have complained to nurses and administrators so frequently or so vehemently "if they had only stopped and listened to me in the first place."

Number Eight

Act as though you have no idea what's going on or who is in charge--in short, look dumb. A blank look can serve many purposes. Confronted by this expression, it is up to the complainer to carefully explain the whole situation to you, giving you time to stall and come up with one of the other seven unsatisfying responses noted above.

The blank look is one of the most frustrating experiences for any consumer. It only creates an even greater sense of urgency and anger. If you really don't know what to do, at least look thoughtful and say, "I'm thinking about how I can help you on that. Tell me a little more so I'll know how I can take care of it." After all, if you are such a poor problem solver and yet the facility seems to have trusted you enough to hire you, does the family really want to entrust their loved one's care to you or your facility?

The most important three-word message to take from this article is: Don't be defensive. Accept suggestions, requests, complaints and, yes, compliments in the same spirit. Remember, you can't possibly know everything, and you can always learn something new. Families (and residents) want you to succeed, because they want to feel that they have made the right choice in allowing you to care for their loved ones. If the families and residents are talking to you about problems, consider it a good sign that they believe you can help them. It's when they don't talk to you that you should start worrying.

Katherine E. Goethe, PhD, and Martha E. Leatherman, MD, are partners in the consulting firm Dignity First, based in San Antonio, Texas, and focused on improving long-term caregiver skills. Dr. Goethe is a licensed psychologist specializing in the neuropsychology of aging, and Dr. Leatherman is a geriatric psychiatrist who cares for elders in various long-term care settings and serves as an expert examiner for the Texas State Board of Medical Examiners. For further information, phone [phone] or visit www.dignityfirst.net. To send your comments to the authors and editors, please e-mail [e-mail]. To order reprints in quantities of 100 or more, call [phone].

BY KATHERINE E. GOETHE, PHD, AND MARTHA E. LEATHERMAN, MD