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The talk, the walk begin at top
In these days of virtually no unemployment, it’s more important than ever that home care managers know how to make their employees happy. Keeping your staff happy will help retain valuable employees and reduce the costs associated with training new staff. Better yet, happier employees also keep patients more satisfied.
Education managers may want to hold a customer service inservice that is directed toward managers and supervisors. "There’s an infinite number of little acts of heroism every day that the staff rightly feels they should get credit for but nobody knows about them," says Karen Carney, president of Carney Communications in Andover, MA.
That’s why employees become so angry and self-righteous when managers start to point out how staff can improve service. "Employees say the suits’ don’t know what we do in the field on a day-to-day basis," Carney explains.
Carney offers these four guidelines to help managers and supervisors improve satisfaction among staff and patients:
1. Give staff direction.
Managers need to tell staff what they want to happen. They can’t assume employees will know what they want. That means giving employees clear, reasonable directions. "Managers will say they want productivity up, so they want you to go through your visits as quickly as possible," Carney says. "But they also want you to spend enough time with patients, and sometimes that can be a challenging balancing act."
Employees who appear to be having a problem with productivity might really be having a problem with that balancing act. They need to be shown how they can draw the line between seeing more patients and spending enough time to take care of the ones they have. "These are issues management needs to talk about with their staff," Carney says. "When you say good customer service,’ what do you mean?"
Also, agencies will have to decide how they will handle those tricky situations that challenge an agency’s rules regarding payer sources and patient care. For example, suppose an agency has a rule that staff must obtain prior authorization for all home care visits to patients who have managed care insurance. If such a patient is referred to the agency late on a Friday afternoon, and the insurance company’s case managers have left for the weekend, obtaining authorization will be impossible. The patient needs to be seen twice a day all weekend. Does the agency accept the referral and see the patient without the authorization?
"Give your staff directions on how to handle this type of situation," Carney says. "They need to know where your agency is headed and how you define superior service." If superior service means the patient always comes first, for instance, what limitations are placed on this policy?
2. Involve staff in the process.
Management can’t come up with changes and a plan for implementing them in a back-room meeting and then toss them out to employees. Employees should be included in the planning process from the start. Carney suggests home care agencies begin by focusing on how employees may contribute to any change, and managers should ask themselves if they know what employees already are doing well. "Management needs to acknowledge that these are tough times, and the staff already is torn and challenged. They feel like they’re giving it all they’ve got, so they don’t want to be told they need to do any more."
Managers can start by asking themselves these questions:
• What are the barriers our employees face?
• What do employees feel gets in the way of their doing a good job?
• What do our employees like least about working for us?
Also, managers should focus on the needs of all employees and try to find solutions to conflicts among the needs of different departments. For example, the billing office might want to make sure all the boxes on certain forms are checked, but clinical employees may want to focus solely on seeing patients, and they may view documentation as just busy work.
Besides involving staff in decision making, home care managers should get involved in the frontline process. "How many CEOs and senior managers really regularly go out on frontline visits?" Carney says. "They should go because they’ll develop rapport with their staff and gain insight."
She suggests top managers make the visits at least quarterly and spend time in the office with the billing staff. "The approach to take is, I hear from you what’s going on, and now I want to see your experience. Share with me your experience.’"
Staff will begin to think differently about managers, and they might begin to have more respect for their decisions.
3. "Walk the talk."
"This is the toughest part for managers because you always have a couple of rabble-rousers in every organization," Carney says. "People will take shots at you, and they’ll say, Management doesn’t really [follow through]. They talk a good game, but they don’t do it.’"
Managers should take this criticism without getting defensive. "You need to say, I wish I could solve this, but I’m not a superwoman, and I can’t,’" she suggests. "What we need to do is set priorities and tackle the ones we can, and can you help me do this?"
Then they must follow through. If employees give managers feedback but it’s not acted upon, staff will think their managers don’t value their input. Also, remember that employees are constantly watching managers to see if they are practicing what they preach. Just as it does little good for a cigarette-smoking parent to tell a child not to smoke, it does little good for managers to call for actions they don’t take themselves.
Managers should consider the following questions, she says:
• Do I go above and beyond to get employees the tools and resources they need to satisfy their customers?
• Am I willing to jump in and roll up my sleeves to help out when things get rough?
• Do I consistently reward and promote staff who are the most deserving and capable?
Staff view the answer to that last question, especially, as a measure of whether a manager is serious about customer service, Carney says. "Employees are smart. They see exactly what you see, and it’s tough to fool them. So if you’re not sincere, they’ll know it." For example, one home care agency had a business office manager who had great results on paper. "She was fiscally sound and brought in the bottom line every month, but her staff was miserable."
The manager would not let staff talk to one another or with other departments. All communication had to go through her. Business office staff were great workers, and they wanted to provide good customer service, but they were miserable and ready to quit because of the manager, Carney says. "Manage ment didn’t want to hear her staff’s complaints because she got great results."
The agency could have handled the situation in a variety of ways. If the agency was serious about improving customer service, it could have coached the manager about how to handle staff better. If she still wouldn’t change her approach, they could have reconsidered keeping her in that position. Leaving such an ineffective manager unchanged in her position can seriously undermine staff efforts to improve both customer service and their own morale.
4. Increase support and decrease barriers.
Managers need to find out what resources staff need to become more effective. Those resources might include a simple policy or management change, such as giving employees permission to act on behalf of the customer.
"Or, if an employee brings a problem to management’s attention, do they get in trouble for doing it, a kill-the-messenger’ mentality?" Carney asks.
Also, make sure employees are trained in all necessary areas. Managers should never assume employees know how to do everything that may come with their jobs. For example, perhaps they could be taught how to deal with difficult patients or how to work with physicians. These training sessions could be as simple as bringing up the topic for five minutes at a staff meeting. "You raise their consciousness and give clues on how other people can handle it," Carney says.
Managers should recognize staff at every opportunity. "People constantly need pats on the back," she says. "Even though the world around you might be chaotic, you can create order in your own little world and be the person who everyone comes to when they want to get things done."
Agencies also can put positive stories in company newsletters about employees who did something extraordinary for patients. They can hold occasional inservices on skills building. And they can allow new employees to mentor with the pros who provide good customer service.
"Some organizations have set up welcome programs for new employees, where right from the start the new employees are made to feel like VIPs," Carney says.
Employees should be rewarded regularly, and it doesn’t hurt to remind them they can recognize and reward their managers. Managers also need pats on the back.
• Karen Carney, President, Carney Communications, 12 Burnham Road, Andover, MA 01810-3104. Phone: (978) 475-2096. Fax: (978) 475-8476. E-mail: email@example.com.
• Carleton Townsend, Vice President for Quality Measurement, Fazzi Associates Inc., 243 King St., Suite 46, Northampton, MA 01060. Phone: (413) 584-5300. Fax: (413) 584-0220.