Expert says follow hospitality’s lead
By Polly Gerber Zimmermann
RN, MS, MBA, CEN
Occupational health nurse, author, and lecturer
Customer (or patient) satisfaction is gaining more attention in health care. In one recent survey, 54% of people were not satisfied with their health care.1 Why? Health care clients judge the providers’ competence from their customer service skills (not clinical skills) approximately 85% of the time.2
One emergency department (ED) was able to decrease their patient complaints by 70%, increase their patient compliments 100%, and significantly improve the patient’s ratings of staff competencies by using these hospitality industry-proven techniques:3,4
Initial contact: As the old saying goes, you never get a second chance to make a first impression, which is why staff are told to:
• Look up and say "Hello!" when someone enters. Then, they won’t feel ignored.
• Beam a smile. In the book, How to make People Like You in 90 Seconds,5 the author emphasizes the need for eye contact, keeping the heart’s physical area open (e.g., no crossed arms), and leaning slightly forward. It signals you are interested and welcoming.
• Use a warm voice tone. One study found that the physician’s tone of voice, particularly if it demonstrated hostility or lack of concern, directly correlated with malpractice claims.6
During the wait: Waiting is a universal irritant. The key is to manage the waiting area, just like any other treatment room. You can do so by:
• Renaming the waiting room. Consider calling it the lobby or process area. That subconsciously projects a different impression.
• Providing pleasant amenities. Make the waiting room attractive and comfortable. The presence of nature, such as plants, a fish tank, or a small waterfall, has a calming effect. A television, if possible, is great but at least have reading material. (Staff can donate their used magazines, with name and address removed.) One office starts a jigsaw puzzle on a side table.
• Eliminating the clock. While it seems drastic, remove the room’s wall clock. Offices that do this report receiving fewer time-related complaints.
• Avoiding triggers. Staff eating, laughing, or just standing around commonly irks people. People who witness this may perceive that staff are doing nothing, even though there honestly can be periods of time where staff must wait to proceed. Always do these types of activities out of client earshot and eyesight.
During the interview: At the beginning of the interview, the client explains the reason for the visit. This is what is most significant to them. Avoid multitasking, pay full attention, and do the following:
• Sit down physically close to clients. The client will perceive that the interaction lasted two to three times longer if you do. A frequent misperception is that the nurse is hurried or abrupt if he/she stands by the doorway.
• Initially repeat their complaints (concerns) in their own words. Then the person feels that you’ve understood. The tendency is to translate. The client states, "My arm is sore." The nurse states while assessing, "You’ve bruised your arm," while charting "5 x 7 ecchymotic region s/p blunt trauma to the left forearm." Then, however, the client doesn’t feel heard because to him or her, his complaint of soreness does not equate to a bruise.
• Always praise what was done right. Every-one is hypersensitive to criticism. Start on a positive note. Even if the client should have come in for treatment earlier, state that you are glad he or she came in today. Though the patient can’t recall the name of the antihypertension medication, tell that person you are glad he or she is aware to take it daily.
• Use scripted phrases. It is hard to think of new, creative, therapeutic statements all day long, especially when rushed or distracted. It is easy to forget to express nurturing or compassion for something routine to the clinic. Develop a few statements that work well for your personality and use them regularly. Possibilities include, "I’m sorry this happened to you," "That looks sore," and "Sure, I can help you with that!" Now the client feels that you’ve shown empathy.
Handling a complaint: Inevitably, things do go wrong sometimes. People remain satisfied, though, if they feel their complaints are properly handled in a timely manner.
• Broken record. If someone vents, acknowledge those feelings and then repeat in a calm voice the information. "I understand you’ve been waiting for a long time, and it will be about another 20 minutes until the physician can see you." The key is to keep repeating the same information matter-of-factly without irritation, no matter how
the client repeats the complaint. Once you become angry, the focus becomes the emotion rather than the information. The temptation is to keep trying to give a better explanation that the person will finally accept, but the variety only fuels the process. The complainant then has reason to hope you will eventually change the answer to what he or she wants to hear.
• The blameless apology. When someone lodges a complaint, indicate you are sorry he or she had a problem. Note that responsibility is not assigned or accepted by anyone. You are simply acknowledging there was been a difficulty. "I’m sorry this paperwork has been a burden for you to complete."
• Listen and offer self. Initially, do not debate; do not defend; or do not interrupt the complaining person. Trying to correct him or her only enhances feelings of being misunderstood or mistreated. As the saying goes, silence is one of the hardest things to refute.
After the client is done, ask, "What would you like to do now?" Most of the time the person will say he or she just wanted "someone to know."
It is more rewarding personally and professionally when clients are able to appreciate the effort and quality of the nursing care. Present your interaction in a way that allows clients to perceive your concerning care and its value for their well-being.
[For more information, contact:
• Polly Gerber Zimmermann, RN, MS, MBA, CEN, 4200 N. Francisco Ave., Chicago, IL 60618.Telephone: (773) 539-1048. E-mail: polly@email@example.com.]
1. Employee Benefit Research Institute. "American Satisfaction with Health Care Rises, but Pessimism about Future Remains." (Press release.) Washington, DC: Employee Benefit Research Institute. In Coile, RC. Futurescan 2002: A Forecast of Healthcare Trends 2002-2006. Chicago: Health Administration Press; 2001.
2. Herzlinger R. Market-Driven Health Care. New York City: The Free Press; 1997.
3. Mayer TA, Cates RJ, Masorovich MJ, et al. Emergency department patient satisfaction: Customer service training improves patient satisfaction and rating in physician and nurse skill. J Healthcare Management 1998; 43:427-41.
4. Mayer TA, Zimmermann PG. ED customer satisfaction survival skills: One hospital’s experience. J Emerg Nurs 1999; 25(3):187-191.
5. Boothman N. How to Make People Like You in 90 Seconds or Less. New York City: Workman; 2000.
6. Ambady N. Surgeons’ tone of voice: A clue to malpractice history. Surgery 2002; 132:5-9.