Teach staff and managers to put the focus on customers

Inservice should cover more than smile therapy’

After all of the home care changes in the last couple of years, an inservice on customer service might be the very last thing your staff, who consider themselves survivors, want to hear about. Still, it might be the most important inservice you could hold this year.

Now more than ever, all home care customers, and this label also applies to staff, need the best service a home care agency can provide.

"The overriding concern of home care agencies in the last year or so has been the interim payment system [IPS]," says Kevin Loso, associate director for development for the Rutland (VT) Area Visiting Nurse Association (VNA).

"So a lot of our response to IPS has to be explained to our patients and customers," Loso says.

The Rutland Area VNA conducted an in-depth customer service program to give staff pointers on how to better communicate and meet patients’ needs while simultaneously providing care with greater efficiency.

"In response to IPS, we came up with a communications plan that focuses on our staff, our patients, other providers, other stakeholders, and the community at large," Loso says. "There was a strategy for each of those key audiences."

Home care agencies need to emphasize a philosophy of instilling a customer service consciousness, says Karen Carney, president of Carney Communications in Andover, MA. Carney Communications is a marketing and training company that specializes in home care. Carney spoke as part of the Rutland Area VNA’s customer service program.

"It should be a problem-solving approach, and it should not be smile therapy or a mandate for behavior change," Carney says. "Ninety-nine percent of employees truly want to give great service."

Customer service also includes finding out what’s important to an agency’s referral sources and then giving them what they need, says Carleton Townsend, vice president for quality measurement with Fazzi Associates in Northampton, MA. Fazzi Associates is a management consultation firm that does research training presentations focused in home health care.

"Providing referral sources with good customer service is the key to agencies really distinguishing themselves from the pack," Townsend says.

Carney and Loso offer these guidelines to setting up a comprehensive customer service program:

1. Commit time and energy to the project.

Rutland Area VNA embarked on a customer service training program with a full commitment from management, Loso says.

"I did some education up front on why it’s important and why it’s necessary to bring in a consultant to address this issue," he explains. "We coordinated the education plan around IPS in general."

Loso, with help from a senior management team, developed a communications plan that focused on internal and external communications.

Then the agency sponsored a workshop on customer service and developed a customer service action plan along with quarterly action plans. The agency also has incorporated the customer service philosophy into its orientation process.

"We started out with a planning retreat for our management team, and we followed up with three-hour sessions and had a total of six of them to cover the entire agency," Loso says. "Subsequently we’ve broken down into a customer service focus group that takes information generated in those sessions and identifies key objectives."

2. Involve everyone in the process.

Home care agencies should include customer service training for all employees or else they may compromise their ability to foster a customer service environment. (See story on customer focus, p. 36.)

"Sometimes they just want people to come in and fix their staff, so to speak, and that really doesn’t work," Carney says. "It needs to be a companywide and customerwide effort."

This also means that home care agencies need to consider their employees as their customers, as well. Any workshops on customer service also should include training managers to handle staff better.

Managers should be taught how to create great opportunities for service to happen, a process Carney calls jump-start consciousness.

Carney gives an example of one of the quick-fix approaches that is unlikely to work: A home care agency trains staff to smile and be nice to patients and customers at all times. The reason this doesn’t work is twofold: one, the staff are tired of hearing that they have to be nice in every type of situation; two, customers are not satisfied with care from providers who smile but are unable to give them what they want.

"You have to give your staff the skills to be able to handle different situations," Carney explains. "It has to go beyond smile therapy because that’s not an effective tool for what they face in the field or on the phone."

Even the agency’s chief executive officer has to buy in to the customer focus or it won’t work. This may mean the CEO has to change how he or she interacts with the staff, Carney adds.

A customer focus also means that home care staff may have to learn new ways of defining quality care.

"An organization can provide superb clinical care and not necessarily provide good customer service," Loso says. "The quality of care being provided is a given, so that’s not where you add value."

Instead, all home care staff should go the extra mile, Loso suggests. "If you’re going to be 20 minutes late, it’s important to get on the phone and tell the patient that this is what’s happening today."

Home care employees also need to remember that patients must be involved in the decision-making process and that their role includes empowering the family, he adds.

"It’s the whole philosophy of you can’t do everything for everyone, and you can’t be all things to all people, but you can make it a win-win situation rather than a win-lose," he says.

3. Teach that change is constant.

Home care employees must be ready to adapt to a wide variety of difficult situations, which change constantly.

For example, Carney once heard of a home health aide who arrived at a home to provide bathing and personal care to a patient. The problem was that the only bathtub in the house had a dead bear in it because the family was draining its blood so they could eat it that winter.

"It was hard to give the patient a bath at that point," Carney says. "So home care employees need to think about what they have under their control, and they have to have an attitude of being able to face anything."

Employees often react negatively to changes and insist that either managers or regulators, are trying to make things more difficult for them. They may not have a lot of control over new company rules or government regulations, but they can control their attitude about those changes.

"Your attitude can set the tone for how you deal with a situation," Carney says. "How you act and your attitude can make a big difference in how people interact with you."

Carney suggests people try this exercise, just to see how important attitude is: Go to a favorite grocery store, gas station, or shop, and watch to see how many employees make eye contact with you. Then the next 10 times you go to the store, make an extra effort to smile and engage the cash register clerk in conversation. For instance, you could say to the teenage bagger, "I don’t know how you do it that fast," or "Aren’t you cold with the door swinging open like that?"

"My guess is that long before that 10th visit you will have changed that person’s attitude, and they’ll start to say Hi" to you and engage you by name," Carney says.

4. Emphasize problem-solving approach.

"The problem-solving approach is the whole philosophy of instilling a customer service consciousness," Carney says.

It’s a way of helping employees find solutions without giving them absolute mandates for certain behaviors. For example, some agencies might have rules that telephones must be answered on the third ring. While this may sound like a good idea, it could work against customer service at times. "What if you’re on the phone with a hospice client, and this person is emotionally distraught? Can you really put the person on hold and pick up the other phone?"

One size does not fit all

Instead, agencies should teach staff how to make important decisions about which behavior is the most appropriate. In the aforementioned case the employee would not pick up the phone on the third ring, and someone else might pick it up on the fourth or fifth ring. But that might be better than putting a distraught client on hold.

Carney suggests it’s better to offer employees certain behavioral guidelines that allow some leeway so they can decide how best to handle a particular situation.

"The problem is in the beginning of a focus on customer service, the attention is on what they’re doing wrong," Carney says. "Sure they’re doing things wrong, but they’ll figure that out for themselves.

Instead, home care managers should tell employees what they’re doing right, and then ask if employees would mind also focusing on a few more details.

This positive approach to changing staff behavior will work better than any mandates or a punishment-oriented environment, especially in today’s difficult home care environment, Carney says.

"It’s so easy for home care employees to feel that things are out of their control," she adds. "They can get burned out, downtrodden, emotionally zapped by all that is happening."

By helping employees shift their focus from the negative and what’s wrong to the positive and what they can do to make things better, everyone will benefit.