The Quality-Cost Connection (Part 1 of 2): Using customer concerns to improve quality

By Patrice Spath, RHIT
Brown-Spath & Associates
Forest Grove, OR

Service quality is a high priority for most health care organizations. Unfortunately, failures in service and, therefore, concerns are inevitable due to the number of variables and perceptions involved in health care delivery. Feedback and learning from concerns is a key ingredient for achieving service excellence. If concerns can be transformed into knowledge about customer expectations, they can become valuable learning opportunities. To exploit this information source, health care organizations must have a systematic concern management system that is integrated with other performance improvement activities.

Research suggests that relatively few dissatisfied patients and family members bother to report a concern. As a result, every concern received by the health care organization can provide insights into what might be a much larger problem. By evaluating the causes of concerns, the organization can reduce the number of concerns as well as improve satisfaction with services. Implementation of a formal concern management system requires some additional expenditures on the front end. However, in the long run, such a system can reduce everyone’s workload. By effectively dealing with individual concerns, systemic or recurring problems can be eliminated with a resulting decrease in future concerns. So even organizations with limited resources should have a systematic process for handling concerns. Using a system to manage concerns is more effective than providing ad hoc responses, which can lead to more serious concerns. A concern management system also allows you to feed information into the continuous improvement process, so that the organization can prevent similar future concerns.

An effective concern management system helps to develop an organizational culture of continual improvement as well as improving the organization’s reputation, credibility, and image. When concerns are handled in a timely and professional manner, the organization will enjoy greater trust and satisfaction from patients and families. In addition, the information derived from concerns is a first-rate source for identifying customer needs.

Many health care organizations have a process for managing a serious grievance, but often the "minor" concerns get lost in the system. Thus, valuable information about customer satisfaction is not available to the organization. A good way to determine the types of concerns that should be managed is to ask, "Does this expression of dissatisfaction require that we take some sort of action to resolve the matter, other than providing routine services, information, or explanations?" A positive answer indicates that the concern represents a learning opportunity for the organization.

An effective concern management system involves five steps:

  1. Document the concerns.
  2. Organize the information for analysis.
  3. Translate concerns into customer needs and expectations.
  4. Analyze and determine a resolution.
  5. Make use of the information.

The first step is to capture details about the concern. Freeport (IL) Health Network (FHN) has a well-defined, organizationwide process for handling patient, family, and visitor concerns. At FHN, a concern is defined as "any situation in which the employees or facility services did not meet or exceed the customer’s expectation."

The concern may be a verbal or written expression of dissatisfaction, a dissatisfied comment, or a strongly suggested improvement.

When a patient or family member expresses a concern to an FHN employee, that staff member is expected to take steps to resolve the concern. Resolution begins with listening carefully to what the patient/family is saying and extending an apology for not meeting expectations. The concern process at FHN includes a service recovery component. The goal of service recovery is to address patient/family concerns to their satisfaction. Research has shown that customers who have had a service failure resolved quickly and properly are more loyal to a company than are customers who have never had a service failure. Service recovery means that FHN staff members are expected to take responsive actions to "recover" lost or dissatisfied customers and convert them into satisfied customers.

When a need for service recovery is identified, the staff member is encouraged to use the most effective and appropriate method possible. For example, if the concern is related to a delay in care, the patient or family may be offered a meal pass or small gift. Staff members can make billing adjustments for concerns related to billing errors, if appropriate. In some circumstances, the concern involves another facility or department. In these situations, the employee explains that the issue will be forwarded to the facility or department director within 24 hours for action and provides contact information to the patient/family. All efforts are made to resolve a concern at the lowest level possible. If necessary, the staff member may consult with the FHN customer service/patient safety officer. All concerns are expected to be resolved within seven days. The patient/family is notified of what was done to ensure customer expectations will be met in the future.

A patient concern form is completed for each concern. (See form.) They are available to all employees in electronic or paper form. After the concern is resolved and actions implemented for preventing future problems, the form is forwarded to the customer service/patient safety officer. This person reviews all concerns and actions taken and uses the information to prepare summary reports for the network’s quality coordinating council and the customer and market focus group. Concern patterns or trends also are communicated to the entire organization to raise awareness and improve care and services.

When patients or their families have a negative encounter with a health care provider, they are less likely to use that provider again, more likely to talk negatively about the provider, and more likely to switch to another provider. One way an organization can ensure repeat business is by developing a strong customer service program that includes service recovery and concern management as essential components. The first step of an effective concern management program, document concerns, is described in this column. The remaining four steps will be detailed in next month’s Quality/Co$t Connection column.