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Achieving the customer-oriented laboratory.

Clinical laboratories have always been the health care profession's leading proponents of the "Q" words--quality control (QC), quality assurance (QA), and, most recently, total quality management (TQM).

Customer satisfaction is a key ingredient of TQM. One of the best definitions of quality service is "to meet or exceed the needs and wants of all people serve." TQM demands consideration of customers in every policy, procedure, schedule, and meeting. It is manifested at all contacts between clients and lab representatives.

Four key questions to ask: Who are the customers and the providers? What do the customers want? Are we satisfying these wishes? If not, what should we do about it?

* Who are customers? These can be categorized as external and internal. Among the external customers are attending physicians, who enjoy preferred status. Patients and participants in wellness programs also merit VIP treatment. Other external customers are blood donors, physicians' office laboratories, surgical centers and other freestanding medical facilities, and patients' families and visitors. Bill payers, research grantors, and other outsiders who provide the monetary wherewithal certainly count as customers.

Internal customers include such recipients of educational and training programs as students, trainees, and individuals undergoing orientation; nurses, often a major source of complaints to the laboratory; administrators; interfacing departments, including human resources and finance; special staff members, including safety and quality assurance coordinators; and committees that request data or services from the laboratory.

* Who are the providers? Unseen work done in the heart of an enterprise is as important to customer satisfaction as direct contact. [1] In other words, every employee is involved in customer service. It is often hard to make laboratory employees understand this. Efforts to assure them of their importance to customer satisfaction--a campaign known as internal marketing--deserve the same attention as the external marketing directed at outside customers. [2]

* What do customers want? Patients want a pleasant environment; good medical outcomes; a caring, competent staff; and--especially when they pay part or all of their bills--reasonable charges. Bernard E. Statland, M.D., Ph.D., summarized what physicians want in a previous MLO article (Figure I). [3]

Quality consists of far more than prompt turnaround time, accurate reports, smiles, and politeness. It is defined in terms of expectations. As customers, we expect more personalized service in an expensive restaurant than in a fast-food eatery. When our perception of service rendered exceeds our expectations, we are pleased. When service fails to meet our expectations, we complain. In the lab, adequate service may be perceived as unsatisfactory if we promise more than we deliver. The solution is to underpromise and overdeliver.

* Are we satisfactory? Ask yourself: Does our laboratory pay as much attention to what our customers want as to the demands of accrediting agencies? Do we spend as much time upgrading customer service as preparing for a CAP inspection? If either answer is a negative, take a second look at your customer service. That starts with feedback on a large scale.

The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) now recognizes the need for direct consumer input. Its 1992 standards require a process for patient feedback and response. [4]

A customer feedback strategy should answer these three questions: Are we overlooking any customer category? Should we be offering any additional services? How good is our service?

Establish active, ongoing, well-publicized channels for inviting comments, complaints, and suggestions. Solicit input from all categories of clients and from employees, especially front-line forces. Consider the techniques for obtaining customer feedback in Figure II.

Always be prepared to ask, "Were you satisfied with our service?" View complaints as opportunities. In fact, encourage them. [5] Proactive managers identify and correct situations that might lead to unsatisfactory service before complaints arrive.

* Improving service. If your lab is found wanting in satisfying customers' needs, your remedial actions will depend on what the feedback discloses. You may have to modify the infrastructure, rework hiring and staffing protocols, rethink administrative actions, delegate more authority to think and to act, provide more inservice education, or any combination of the above.

* Infrastructure. The greatest cost of producing better service involves modifying the infrastructure. To enhance the physical setting, you might relocate an outpatient phlebotomy room or designate a special parking area for blood donors. You may have to update your computer system or buy a new chemistry analyzer.

* Hiring and staffing. Altering organizational culture takes time, patience, and persistence. Focus on customer expectations in choosing and orienting employees. Ask prospective employees (and the former employers they offer as references) to describe their attitudes and experiences toward service. Spell out customer-related qualifications in all job descriptions.

Selecting employees carefully is the first step in retaining personnel. Among many reasons to keep turnover low is that it represents a major roadblock to effective client service. When the pool of candidates is small, we must rely even more on orientation, training, and counseling to achieve the behavioral results we desire. Consider client satisfaction when developing performance standards, making appraisals, and setting compensation.

Base staffing and scheduling on what is best for your clients, not what is most convenient for your staff. The common error of assigning the least qualified technologists to late shifts violates this principle.

* Administrative actions. Do your lab's policies suggest any procedural changes, such as expanding the hours of a phlebotomy station? Send your staff to health fairs to teach the use of pregnancy tests and other self-diagnostic kits. Dispatch phlebotomists to collect specimens from homebound patients. Make sure your employees know how customer complaints and incident reports are processed and filed.

* Authority. Empower your front-line forces. Give staff members the authority, responsibility, and incentives they need to serve their customers better. Employees should feel an obligation to act, not merely to accept blame, when complaints arise. Managers must learn to regard errors in judgment as learning experiences.

Every lab employee must be a customer advocate. Don't rely exclusively on a quality assurance coordinator or customer service representative to improve your services. From the staff's standpoint, this intermediary is merely another clipboard carrier who prevents them from getting their work done.

The use of quality circles is an effective way to generate suggestions for improving customer service and solving problems. Employee participating groups might debate such topics as Stats, scheduling, lab utilization, specimen collection, cost and inventory control, handling of test request and report forms, processing of complaints and errors, working with blood donors and physicians' office labs, or intergrating new or improved services. Discussions of confidentiality and other matters of ethics can improve service.

* Education and follow-up. Give your staff a broad spectrum of technical and professional training. If your employees lack the knowledge and skills to perform competently, your customer service program is no more than window dressing.

Everyone needs to understand customer identification and expectations, team building, and interdepartmental collaboration. All staff members should have a thorough knowledge of organizational culture, philosophy, mission, and goals.

For those who interact most directly with customers--receptionists, phlebotomists, supervisors, blood bankers, and laboratorians who make and receive telephone calls to physicians and other clients--provide programs on appearance, interpersonal communication, telephone courtesy, customer feedback, answering questions, handling complaints, and coping with difficult people.

Be a role model. Supervisors reinforce or erode what employees learn at training sessions. All employees are boss watchers. How their supervisors respond to client expectations will affect their behavior more powerfully than anything you can say about customer service.

The most effective interactive training is informal, whether in groups or one on one. When employees are cross-trained and managers spend some time with extra-hour shifts, customer service improve.

* Leadership. Developing a consumer-oriented culture is more difficult than achieving leadership in technology, cost containment, or quality control. Because people resist change, lab managers must be change specialists able to overcome human and organizational barriers.

All service processes generate variations that adversely affect service. Introducing open heart surgery, neonatal intensive care, or specialization in trauma care to a medical institution requires adjustments by their laboratories. [6]

* Rules of conduct. In the customer-oriented laboratory, client satisfaction is everyone's business. Service providers must be aware of who their clients are and use feedback systems to monitor customer satisfaction. Tenets to remembers:

* The importance of continuous training and education cannot be overemphasized.

* Hiring should focus on identifying candidates with a customer-oriented attitude.

* Client orientation is reinforced through job descriptions, performance standards and reviews, and reward systems.

* Those who interact with customers must be empowered to act on their behalf.

* Laboratory leaders who extoll customer satisfaction must demonstrate exemplary behavior in that regard. What you do is more important than what you say.

[1] Albrecht, K., and Zemke, R. "Service America," chap. 7. Homewood, Ill., Dow Jones-Irwin, 1985.

[2] Reardon, K.K., and Enis, B. Establishing a companywide customer orientation through persuasive internal marketing. Management Communication Quarterly 3(3);376-387, 1990.

[3] Statland, B.E. Quality Management: Watchword for the '90s. MLO 21(7):33-49, July 1989.

[4] Joint Commission on Accrediation of Healthcare Organizations. "Accrediation Manual for Hospitals, 1992," p. 103. Oakbrook Terrace, Ill., JCAHO, 1992.

[5] Plymire, J. Transforming complaints into opportunities. Supervisory Management 35(6):11-12, June 1990.

[6] Greenwood, F., and Kobu, B. Management modifications. SAM Advanced Management J. 55(1):30-33, winter 1990.

William O. Umiker, M.D. is professor of pathology at the Milton S. Hershey Medical Center, Pennsylvania State University, Hershey, Pa. This article was adapted from his latest book, "The Customer-Oriented Laboratory," published recently by ASCP Press.
COPYRIGHT 1991 Nelson Publishing
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 1991 Gale, Cengage Learning. All rights reserved.

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Author:Umiker, William O.
Publication:Medical Laboratory Observer
Date:Dec 1, 1991
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