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Improving lab business via a client satisfaction survey.

Improving lab business via a client satisfaction survey

Any laboratory that performs tests for outside accounts may discover that its client base is currently more vulnerable to competition from both independent and hospital-based rivals. A prudent manager will ask: How can the lab strengthen its hold on clients and build even more business?

The answer is all around us. Successful organizations in most fields make frequent checks of their customers' expectations and satisfaction.

Our consulting firm has found a client satisfaction survey invaluable in assessing the best course for laboratory survival and growth. We will explain how to measure performance through client ratings of key service attributes and how to determine if a low-rated attribute urgently needs improvement.

The questionnaire we use (Figure I) covers leading service indicators for reference testing, whether by independent or hospital laboratories. Among the areas we probe are accuracy and speed of results, convenience of test request and reporting formats, fee levels, billing procedures, and various support services offered to clients.

Our form can be adopted by any management wishing to perform its own periodic surveys without outside assistance. Of course, additional questions may be germane in a particular situation, and some of our questions might have to be modified.

Incidentally, a hospital laboratory can also employ this technique to gauge clinicians' satisfaction with inpatient work. Service ratings are just as useful to a lab with no outside accounts.

Questions should focus on aspects of service that are relevant to good performance and on which clients are capable of making a judgment. Avoid vague phrasing open to multiple interpretations. "Specimen pickup/report delivery' leads to uncertainty over what is being rated--courier service or total turnaround time. Umbrella statements like "quality of service' embrace too many possible attributes to be meaningful.

Clients are asked not only to grade aspects of laboratory performance as excellent, good, fair, or poor, but also the importance of each aspect (very important, important, somewhat important, not important). Results are tabulated on a scale of 1 for the lowest rating to 4 for the highest.

Some aspects of service may receive poor marks, but if clients don't place high importance on them, laboratory improvement is not a top priority. On the other hand, poor marks in an area deemed vital by clients point to a need for immediate action.

Leave room for comments and suggestions alongside each attribute. Narrative observations shed light on checked-off ratings. It's also wise to include an open-ended question: "How may we serve you better?'

Two final questions ask what percentage of a client's send-outs go to the surveying laboratory and what type of test is referred to other labs.

Many of our satisfaction surveys yield response rates of 45 to 70 per cent. One reason for this high level of participation is a personal touch--the client's name handwritten in the top right-hand corner of the questionnaire. This sends the message that the laboratory considers each form, and each client, important.

A helpful added identifier is a tabulation code composed of an alphabetical character and one or more numbers. The letter may signify the client's geographic location, market segment (physician's office, nursing home, new account, etc.), of some other desired classification. If the laboratory recently took on several new accounts, for example, it might want to summarize their responses separately from the rest. The letter A could be used to identify these accounts.

The numerical part of the code consists of all but the last two digits of the lab's monthly revenue from a client. Thus, a questionnaire coded A 12 would indicate a new client worth $1,200 in business per month. When an account generates less than $100 a month, we use the letter L for low.

Mail the questionnaire to all active clients. A cover letter, signed by the most prominent member of laboratory management, should succinctly emphasize the value of the client's opinion about laboratory services and urge cooperation. Here's how the letter might be worded, under the greeting, "To our valued account':

"May we please have your help? Your opinion about our service is vitally important to us. By promptly completing and returning the enclosed questionnaire, you will help us learn how we can better serve your needs and those of your medical colleagues. Thank you for your cooperation and support.'

We send out our questionnaire in a 9 12 envelope. This avoids fold creases, allows room for a self-addressed, postage-paid return envelope, and stands out in the client's batch of daily mail.

A week after returns have tapered off, telephone the non-responders and remind them how important the survey is to the laboratory. Follow-up increases participation by 10 to 15 per cent, we have found.

Now it's time to add up the 1- to 4-point scores and calculate the averages for each service attribute. A set of mean ratings is shown in Figure II. What do they tell us? Consider the first item, speed of reporting. With a mean importance rating of 3.83 and a mean performance rating of only 2.63, you can conclude that clients deem timely results crucial-- and that the laboratory isn't doing very well on that count.

So a prime rule is to watch for gaps between clients' expectations and laboratory delivery. The relationship between the two sets of scores is the key to gauging the relative success of laboratory performance.

An average performance score of 3 for accuracy of test results isn't anything to be proud of; accuracy is an attribute that clients consistently hold of high importance. But a performance score of 3 on the laboratory's newsletter is quite acceptable, since clients aren't as demanding about such information.

The significance of survey data is clearly brought out by graphic analysis. Figure III places each service attribute in one of four quadrants. Its exact location is determined by the importance and performance ratings it received. Along the horizontal axis, performance improves from left to right. Along the vertical axis, importance increases from bottom to top.

Quadrant A contains important service attributes (1, 2, and 9 from the list in Figure II) that don't meet client expectations. This is where the laboratory should concentrate efforts to improve. The seven attributes in Quadrant B also rank high in importance, but the lab is performing them well.

Quadrant C items earn poor or fair marks for performance, but they are also of minor importance to clients, and so may not require urgent attention. Quadrant D pinpoints four areas of possible laboratory overkill: relatively unimportant services that the lab performs well. Here management may be able to cut or reallocate expenditures or personnel.

Another analysis, the performance rank summary, may provide additional insight. List all attributes in order of highest to lowest mean performance ratings. For each one, summarize clients' relevant comments and suggestions.

Then calculate the "problem percentage': the proportion of performance ratings that are fair or poor. If a service attribute has a middling performance ranking, it's essential to learn how many clients ranked it fair or poor. You might discover that even though many clients are satisfied, a sizable minority encounter major problems.

Tabulations by client code, described earlier, can shed further light on the source of a low performance rating. Through the alphabetical part of the code, the laboratory can determine whether the bad score or problem correlates with a particular grographic area, market segment, or group (such as a particular medical specialty). Similarly, tabulating by the sales volume code numbers can reveal a snag limited to accounts of a certain size. These approaches eliminate laboratory guesswork and bias about the reasons for problems.

Management of one laboratory, for example, was sure that only new clients were responsible for some of its negative survey feedback. Analysis by account size revealed that the true source of discontent was large accounts, both new and old. As frequent users of the lab's services, they were the ones most likely to experience certain weaknesses.

The two closing questions in the survey provide the basis for a strategy to attract new or lost business: "Our laboratory now receives what proportion of your referred lab work?' and "What type of testing is referred to other laboratories?'

The average response to the first question can be projected to the entire client base for a percentage estimate of available business received by the laboratory. Conversely, the lab will know what percentage of work its clients refer to competing facilities. Since the lab also knows how much revenue it takes in, it can calculate how much revenue it is missing out on.

Not all of this revenue can be captured, though, since the competition may offer tests that are not on the laboratory's menu.

That brings us to the final survey question, about specific tests sent elsewhere. Wherever it performs the same tests, the lab should find out why it is not getting the business.

As you can see, a client satisfaction survey is a strong marketing tool. You just have to know how to wield it.

Table: Figure I The client satisfaction questionnaire

Table: Figure II Summary of client ratings

The ratings are based on 4-point scales, from 1 for not important to 4 for very important, and from 1 for poor performance to 4 for excellent performance.

Table: Figure III Plotting the ratings of lab service

Each numbered service attribute from Figure II is placed in one of these quadrants. The position marks the importance clients attach to the attribute (vertical axis) and how well they rate lab performance of the attribute (horizontal axis). The lab should concentrate on doing a better job among attributes in quadrant A, since they are important to clients but low in performance. Quadrant B attributes are important and the lab performs them well--no improvement is needed. Quadrant C attributes are not very important, so the lab doesn't have to give immediate attention to its low performance ratings there. In quadrant D, where attributes are also unimportant, the lab may be performing too well and might consider trimming its efforts.
COPYRIGHT 1986 Nelson Publishing
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Copyright 1986 Gale, Cengage Learning. All rights reserved.

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Author:Root, James M.
Publication:Medical Laboratory Observer
Date:Mar 1, 1986
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