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Getting a second chance to make a first impression.

Installing a service recovery program can help your lab make fewer service mistakes and minimize damage resulting from those that slip through the cracks. DO ANY OF THESE incidents sound familiar?

* A physician calls for a hematology result and is spoken to rudely by an overworked technologist.

* Patients in an outpatient clinic are kept waiting over 2 hours because of a poorly trained phlebotomist.

* A woman is chastised by a medical technologist because she has not properly fasted for her glucose tolerance test.

All of these, unfortunately, are everyday occurrences in medical laboratories--and all represent service delivery breakdowns. How would your organization respond to such problems?

* Lip service for customer service. Despite all of the rhetoric about the importance of customer service, many organizations do only a fair job of delivering consistent, high-quality service; most do a poor job of recovering after service snafus.|1~

Some organizations acquiesce to what they see as inevitable service errors, or build into their operation an expectation for a "reasonable number" of such errors. After all, they rationalize, to err is human.

Fortunately, true service-oriented organizations know better.|2~ They realize that the costs associated with winning back disgruntled customers and gaining new ones is just too high.|3~

In the highly competitive health care environment of the '90s, dissatisfied customers, even those who do not make their displeasure known to the offending organization, have a nasty habit of taking themselves and their business elsewhere. They also become a hidden network, spreading negative messages about the quality of your services.

* Poor service is insidious. Findings from a series of studies done by the Technical Assistance Research Program (TARP) for the White House Office of Consumer Affairs|4~ dramatizes the importance of excellent customer service and of service recovery initiatives:

* Customers pay more attention to an organization's performance when something goes wrong than when everything goes smoothly.

* The average business never hears from 96% of its dissatisfied customers. For every complaint received, the organization has another 26 customers with problems, six of which can be classified as "serious."

* Of those customers who are unhappy, 90% will not enter into an "exchange relationship" with the organization again.

* The average customer who has had a problem with an organization tells nine other people about it; 13% of customers who have had a problem discuss it with more than 20 others.

* Wait, there's hope. The study also showed that the complaint itself is not the most damaging problem; rather, it is how the complaint is subsequently handled. Of the customers who register a complaint, between 54% and 74% will do business with the organization again if their complaint is resolved to their satisfaction. This figure goes up to 90% if the customer feels the complaint was handled expeditiously. What's more, satisfied customers tell an average of five people about the good service they received in the end.

In health care organizations, the value of recapturing a dissatisfied customer, in terms of future business over the lifetime of the customer, has been estimated at $6,000 to $8,000 per patient.|5~ Although such estimates are difficult to quantify with any certainty, it is clear that the benefits of a service recovery program are significant.

* Total commitment necessary. Well-designed and properly executed service recovery programs can significantly influence customer perceptions of your laboratory. These programs are usually aimed at external customers--patients and their families--but should also be designed for the organization's internal customers--other allied health professionals as well as senior administration and other employee groups.

Many health care organizations, even those that pride themselves on quality services, often fail miserably in their efforts at service recovery when things go wrong. Sometimes their commitment is only verbal. ("They sure don't walk their talk.") Sometimes the organization inadvertently seals itself off from its customers. ("You can never get in touch with them when you really need them.") Sometimes the organization just doesn't care enough to make amends. ("When you call in angry, the only person you get to speak to is some junior assistant who can't change anything.") And sometimes the organization just can't get it right. ("Will these people ever learn?")

Many employees who make a service delivery mistake think that the proper response is to ignore it, conceal it, rationalize it away, or quietly smooth it over. Many who make a service error are openly defensive about recognizing their involvement; the risks are just too great.

* Punish processes, not people. Well-run service organizations, however, don't punish the person who made the error without first considering the context in which that person is operating. They abide by the principle of fixing the system that made the error, not fixing blame on the person who committed it.

While organizations that generally provide excellent service hate making service delivery errors and do everything possible to prevent such occurrences, they recognize that a mistake in delivering service represents a golden opportunity to improve a flawed process. They believe that each service recovery situation offers a unique opportunity for communicating commitment to customers while strengthening customers' loyalty.

The key to long-term success is for your organization to develop a capacity to learn from its mistakes so as to prevent further service delivery breakdowns. This can only occur when employees are comfortable with openly searching for and rooting out faulty services.

* Methods of response. All service recovery initiatives must incorporate mechanisms designed to assuage customer concerns while creating and strengthening their loyalty to your organization. Service recovery programs should, therefore, be designed to provide psychological and tangible responses to dissatisfied customers.|6~

Psychological responses are the most cost-effective because they are intangible and usually easy to implement. An example of a psychological recovery response is to apologize to a customer for poor service and explain why the error occurred.

Tangible responses, on the other hand, involve compensation for damages incurred, such as giving cinema passes to patients who are kept waiting longer than 45 minutes in the outpatient clinic. Most effective service recovery programs include both psychological and tangible responses.

In addition to choosing service recovery responses, you must determine the desired timing of the response. Service responses can be preventive (made before any dissatisfaction occurs), such as guaranteeing a certain result; concurrent (made at the time the dissatisfaction occurs) as with, for example, an immediate apology; or post hoc (made after the dissatisfaction has occurred), such as sending chocolates to a dissatisfied customer.

Organizations with effective service recovery programs take strong preventive measures to minimize the possibility of service failures. Unfortunately, service errors can still occur, even when service processes are well designed. * What to do. Before undertaking any service recovery program, here are some suggestions to consider:

Commit to zero defects. Quality management expert Philip Crosby|7~ has coined the term "zero defects" to describe a quality standard of error-free product manufacture and service delivery. Zero defects means that it is an unsatisfactory standard to permit even a fixed percentage of errors or mistakes to occur, no matter how small.

Lab organizations committed to service delivery excellence and recovery believe there is no substitute for flawless service delivery. It is much more cost-effective and easier to prevent service errors from occurring in the first place than to fix them after they've happened.

Enlist support from the top. Unless there is unwavering involvement and commitment to service excellence from those at the top of the organization, a service recovery program will have little chance of success. An organization's leadership is responsible for the modeling of behaviors and attitudes that speak of the critical importance of service delivery excellence.

Management should also provide resources to monitor and track customer responses to various aspects of service delivery as well as to fix and improve the service delivery system. In addition, management must assure maintenance of ongoing training programs in service delivery and support a system of reward and recognition to reinforce positive service delivery results. Obtain legal input. Legal input should be sought in the design and implementation of any service recovery program. Everyone must understand the boundaries and constraints of any program so that it does not hamper risk management efforts and strategies.

Establish listening posts. Well-run laboratories strive to discover problems associated with their service delivery by casting a wide net to capture customer grievances. To minimize the chances of service problems slipping through unnoticed, these organizations have established effective "listening posts" for monitoring customer complaints and for conducting customer research. For instance, a lab wishing to understand the satisfaction level of its external and internal customers can use any number of mechanisms, including satisfaction surveys that measure general levels of customer satisfaction; focus group interviews with customers to assess their ongoing satisfaction and needs; hot lines that allow customers to grieve poor service over the phone; and researchers who pose as customers to experience and evaluate services provided. Well-run labs are now going beyond merely satisfying the needs of their existing customer base to securing ever-increasing levels of customer loyalty and delight. They conduct formal research on customers' service problems and create effective systems for capturing complaints by actively encouraging customers to voice their grievances.

Monitor processes. Anticipating service problems requires constant monitoring of general service processes. One monitoring approach is to use a type of flow chart, called a service blueprint.|8~ It exposes the anatomy of the service and helps identify fail points where service is vulnerable to breakdowns. Service blueprints depict the chronology of tasks associated with rendering a particular service and assist in identifying those crucial points where the "activity" is handed off from one work group to another. Once a work process is thoroughly understood and potential fail points have been identified, response strategies must be devised for dealing effectively with breakdowns when they occur.

Designing a response strategy. Management and staff might decide, for example, to develop a list of potential responses and actions from which employees are free to choose the most desirable response. Some organizations appoint a contact person who is on call to advise staff members in determining an appropriate response when dealing with a dissatisfied customer.

Train employees. Responses by employees to service problems should not be left to chance. Although many employees are naturally empathetic when dealing with customers experiencing problems, some are not. Even those who respond well in routine situations may become unnerved in situations requiring immediate or novel responses to customer-oriented problems.

Proper training to make service personnel perform equally effectively in routine and recovery roles is critical to success. Employees, through training, must be prepared and encouraged to excel at resolving service problems. Empower employees. Those who are on the front lines and are dealing on a daily basis with customers must be empowered to manage the service recovery effort. There is nothing that takes the wind out of the sails of a service recovery program faster than an employee who must get approval from a supervisor before instituting a service recovery initiative.

Giving employees the authority to satisfy customers on the spot also means that employees have been given sufficient resources to do so. For example, phlebotomists at one medical clinic were permitted to award any patient, after having suffered through several failed attempts at drawing blood, a small gift of sample perfume or cologne as recompense for their discomfort.

Reward employees. Rewards are essential for achieving and reinforcing strong recovery efforts. By rewarding exemplary service efforts, management is aptly demonstrating its commitment to the service recovery program.

In order for rewards to be effective, they should be visible, meaningful, and valuable to those who are being recognized. Rewards don't have to cost very much. A letter of commendation from the hospital president or a write-up in the company newsletter are simple yet effective ways of recognizing specific service recovery achievements. It is also a good idea to publicize widely and display prominently the specific accomplishments of award winners so as to inspire other employees.

Learn from mistakes. Problem resolution situations are more than just opportunities to fix flawed services and strengthen relationships with customers. They are also a valuable source of diagnostic information for tracking and thus improving customer service. Service failures experienced by customers (both external and internal) are often symptoms of more serious problems with the service system.

Although proper steps must be taken to appease customers and compensate them for service breakdowns, in order for a service recovery program to yield full benefit it must facilitate the identification and elimination of the root causes of service failures. For instance, a recurring pattern of complaints by emergency room physicians about slow laboratory turnaround times necessitates closer analysis of Stat laboratory processes so as to identify possible areas for improvement. Merely apologizing for slow times, providing recompense, or threatening staff to make them work faster or smarter is unlikely to fix the underlying problem.

* The bottom line. The rationale for any service recovery program is that it makes good business sense. When users of your services are treated with respect and dignity, they are much more likely to comply with requests and to become more active participants in the care that they receive. When management is truly committed to delivering high-quality services and when front-line staff are trained, empowered, and rewarded for doing so, the result has an immediate and sustained impact on the quality and cost of care delivered. References

1. Berry LL, Parasuraman A. Marketing Services: Competing Through Quality. New York, NY: The Free Press; 1991.

2. Heskett JL, Sasser Jr WE, Hart CWL. Service Breakthroughs: Changing the Rules of the Game. New York, NY: The Free Press; 1990.

3. Hart CW, Heskett JL, Sasser WE. The profitable art of service recovery. Harvard Bus Rev. 1990; 68(4): July/August: 148-156.

4. Band WA. Creating Value for Customers. New York, NY: John Wiley & Son; 1991. 5. Strasser S, Davis RP. Measuring Patient Satisfaction for Improved Patient Service. Ann Arbor, Mich: Health Administration Press; 1991.

6. Schweikhart SB, Strasser S, Kennedy MR. Service recovery in health services organizations. Hosp & Health Services Admin. 1993; 38(1): Spring: 3-21.

7. Crosby P. Quality Is Free: The Art of Making Quality Certain. New York, NY: McGraw-Hill; 1979.

8. Leebov W, Ersoz CJ. The Health Care Manager's Guide to Continuous Quality Improvement. Chicago, Ill: American Hospital Publishing; 1991.

Kent V. Rondeau, M.A., M.B.A., RT(CSLT)is an assistant professor at the School of Health Services Administration, Dalhousie University, Halifax, Nova Scotia.
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Title Annotation:service recovery programs for laboratories
Author:Rondeau, Kent V.
Publication:Medical Laboratory Observer
Article Type:Cover Story
Date:Jan 1, 1994
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