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Quality Matters

Quality Matters: Make It Right: Service Recovery Programs in the ED

Welch, Shari J. MD

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Emergency Medicine News: June 2012 - Volume 34 - Issue 6 - p 4
doi: 10.1097/01.EEM.0000415452.87886.79
    The service recovery boxes at Paoli Hospital include easy-to-use instructions, left, and boosted Press Ganey Scores above the 90th percentile and ED visits by 10 percent in one year
    The service recovery boxes at Paoli Hospital include easy-to-use instructions, left, and boosted Press Ganey Scores above the 90th percentile and ED visits by 10 percent in one year:
    The service recovery boxes at Paoli Hospital include easy-to-use instructions, left, and boosted Press Ganey Scores above the 90th percentile and ED visits by 10 percent in one year.

    Advertising is aimed at the masses, and it will bring a patient to you once. Service recovery is another matter, aimed at the individual, and it's the patient experience that brings him back.

    The new focus on the patient experience and its increasing role in reimbursement schemes has health care leaders and executives obsessing over the patient experience. That encounter must include service recovery, even in the emergency department, because every health care organization, no matter how excellent their products or employees, occasionally makes a service mistake or, worse, a medical error. Last month I explored the impact a poor service encounter has on the reputation of the facility and future use by patients.

    The goal is to maximize positive service encounters, and EDs must embrace the premise that service recovery should not be an ad hoc or one-dimensional process. The most effective model is a carefully designed program engaging staff at all levels with clearly articulated strategies. Most emergency departments do not have such programs in place, and most ED providers have no idea where to start, but service recovery should follow any mistake.

    The process begins with an apology and taking responsibility for the error or the inconvenience. The patient must be given something of value as compensation, something that says, “We value you, and want you to continue to use us for your health care.” A hotel can upgrade a disgruntled guest to a suite. A restaurant can offer a free appetizer. A cell phone company can offer 500 free minutes. What product or service can you give that will cost you little or nothing but that has value to the patient?

    Service recovery programs can have a positive effect on patients and staff alike. They can prevent patient defection, which will increase your census and the bottom line. It is sometimes difficult to convince ED staff that they want more patients, but talk to anyone whose ED has closed, and you will be reminded of why you want your department and your hospital to be fiscally sound.

    These programs also prevent employee defection. Press Ganey has shown that staff are satisfied when patients are. As patient satisfaction goes up, staff turnover goes down. (Patient Satisfaction, 2nd Ed. Chicago: Health Administration Press; 2006.) When employees are trained in customer service and empowered to make decisions that satisfy their patients, they are happier in their jobs.

    What separates leaders in service excellence from the rest of the pack is how they respond to mistakes. Leaders will do whatever it takes to solve a patient or family member's problem. They understand the importance of service recovery to their bottom line. Service leaders like Amazon, Dell, Southwest Airlines, General Electric, Commerce Bank, and Lands' End have mastered the critical elements that drive a service-focused business and customer service excellence strategically. That means everyone from the CEO on down walks the walk and reinforces the importance of customer service. They make sure their policies, procedures, and systems are customer-friendly. They hire good people and treat them well, investing time and money to train them in the art of customer service. They empower their employees, giving them the authority to bend and break the rules to take care of the customer.

    Empowerment is a difficult concept for many health care managers to introduce. They would rather institute policies and procedures that eliminate the need for employees to make decisions about how to serve the customer. What they don't realize is that those policies and procedures prevent employees from doing their jobs well. Service recovery involves three important interventions at the front lines:

    • Apology and accountability: Staff can be taught to listen patiently to a patient or family member's complaint and to respond with an apology and statement of accountability through scripting, such as: “I am very sorry that we did not meet your expectations, and I accept the blame for this problem.”
    • Make it right: Probe and explore how to make it up to the customer. This will take training and allowing the staff to come up with creative solutions. A tourist is in the ED for so long that he misses his flight. Can the hospital put him up in hospital housing until he can catch the next flight out?
    • The wow factor: This type of intervention should exceed the customer's expectations and be a significant gesture at providing compensation and value to the customer. “I am so sorry there was a delay with the lab, and here is a gift certificate for the gift shop.”

    The ED at Paoli Hospital in Paoli, PA, has 34,000 visits a year, and opened a new pavilion in 2009. This was another Pebble Project with evidence-based design features like the one I wrote about last year at the University of Kentucky. (EMN 2011;33[8]:22.) Paoli Hospital simultaneously launched a service recovery project throughout the system by first assembling a multidisciplinary team that included staff from food service, housekeeping, medicine, nursing, administration, case management, quality improvement, and ancillary services.

    The group developed and approved “tokens” to be given to patients as part of service recovery. Hospital staff at all levels were educated and empowered to recognize service failures and attempt to remedy them.

    Service recovery boxes with simple instructions were placed conveniently around the hospital for staff to use. Each unit and department kept a log of when the service recovery box was used so that trending could done. The Paoli hospital staff was rewarded for service recovery interventions, and the information gleaned from the service recovery logs provided ideas for customer service initiatives.

    The fruits of all these labors could be seen almost immediately. Paoli's Press Ganey scores, which were already high, moved to above the 90th percentile and ED visits grew by 10 percent in one year! (Stanowski A, Winn C, Presentation at ACHE Congress, March 2011, Chicago.)

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