Make the most of service recovery

Simple things can help

One mother came into the emergency department at Greater Baltimore Medical Center frantic and upset because her small child was very ill. She was visibly frustrated with the registration process, until the patient access representative performing the registration expressed concern.

"She offered comforting words and asked if there was anything the patient's mother needed or anything she could do to put her mind at ease," says Jeanne Day, RHIA, CHAM, director of medical records and patient access.

This made such an impression that the mother of the patient sent in a thank-you card recognizing this employee for her concern. "In many situations, a simple expression of compassion and sympathy are all that are required to ease the patient's mind," says Day.

Five steps followed

Patient access staff at Greater Baltimore Medical Center follow the L.E.A.R.N method for service recovery. Here are the five steps in this process:

Step 1: Listen. Staff give the patient or visitor undivided attention, including maintaining good eye contact. This includes keeping an "open" body position without crossing arms, nodding head to acknowledge what the person is saying, and taking care not to appear rushed when listening.

Step 2: Empathize. This entails showing that staff understand how the patient or visitor feels, thanking him or her for communicating the problem. Staff are instructed to repeat their understanding of the problem to ensure that the issue has been properly identified, and acknowledge the emotions of the other person.

Step 3: Apologize. Staff are told to provide a "blameless" apology by making statements such as "I am sorry that you experienced this problem. Please know we are doing all that we can to correct the situation." Staff also are cautioned to avoid providing unnecessary information that may escalate the situation.

Step 4: Respond. This involves thanking the person for sharing his or her problem or concern. Staff fix what they can and forward what they can't fix to the appropriate department or person.

Step 5: Notify. Staff inform others who need to know about the problem. They follow up about what is being done to correct the situation and prevent it from happening again.

All patient access representatives are given additional training in service recovery, in addition to the customer service training they receive during orientation. "I think the most difficult customer service situations are the ones that we have no control over," says Day.

For example, an emergency department patient may be upset about waiting to be seen, but patient access representatives do not control wait times. This doesn't mean that there is nothing that patient access staff can do, however. "We alert the nurse if the patient starts feeling worse. We do everything possible to make the patient's wait more comfortable," says Day. This might mean getting the patient a blanket or pillow, but at times, something extra is needed.

"All of our patient access representatives are given tools, such as parking and meal vouchers, to assist with diffusing situations," says Day. "Any situation where something has gone wrong and/or the patient is unhappy is an opportunity for service recovery. We hope to 'recover' situations before the patient makes a complaint."

If patient access representatives feel they need additional support to resolve a situation, however, they contact their team lead or supervisor for assistance. They also can call the appropriate charge nurse or administrative coordinator for assistance, or refer patients to the hospital's patient relations representative.

"Any situation where the patient access representative feels they need additional support to assist with service recovery warrants involving a member of the management team," says Day. "While we empower our patient access representatives to resolve issues, sometimes patients demand to speak with a member of the management team."

[For more information, contact:

Jeanne Day, RHIA, CHAM, Director of Medical Records & Patient Access, Greater Baltimore Medical Center, 6701 North Charles Street, Baltimore, MD 21204. Phone: (443) 849-3554. Fax: (443) 849-8776. E-mail:]