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Techniques to improve client satisfaction

January 28, 2013
by Gerald Shulman
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Providing customer service

Research has demonstrated that the longer clients are in a treatment system, the better the outcomes, and good customer service results in better patient retention. Once the client calls, try to schedule the assessment within 24 hours, and consider walk-in assessments.

Have trained and motivated professionals as first-contact specialists. If the client has to wait, design activities that will reduce anxiety. Provide incentives for coming to intake/assessment and the first treatment session (food, shelter, transportation, cash, gift cards, etc.).

Look critically at the waiting room. What does it “feel” like? Is it welcoming? Provide comfortable seating. Provide snacks, coffee or other liquid refreshments, reading materials (including those appropriate to the cultural profile of your typical clients), and a recovery video if it will be a long wait. Most importantly, keep the client current with wait time (do you remember the last time you were on a plane that was delayed and how you felt when you could not get any information?).

Do research on clients who do not come back and on who was the most helpful staff person. Develop an engagement ratio to determine the percentage of patients who complete the intake process (and, if outpatient, the percentage who return for the first scheduled appointment, enter treatment and continue in outpatient treatment). Profile high-risk dropouts to identify them upon admission.

During the intake we do a great job of explaining everything to the new, usually anxious or angry patient who still may be in withdrawal: the rules, regulations, policies, schedules, staff and patient expectations, consents for treatment and releases of information, and we expect the client to understand and remember it all. At least the admissions staff person has a packet of forms to help him or her remember! Delete irrelevancies in the paperwork and combine forms. If you don’t use the information, don’t collect it.

Make certain that the focus of the first visit or admission is on engagement, not paperwork. If necessary, shift some of the paperwork to a later time. Short of consents for treatment, what absolutely has to be done at admission?

During treatment, use real-time assessments of engagement and therapeutic alliance. Use motivational interviewing with a non-judgmental attitude. Track no-shows and dropouts both by clinician and patient demographic and clinical variables, type of reimbursement, admission dates and times/shifts, etc.

The walk-through

The walk-through proposed here is different from a “mystery shopper” sort of challenge. That is usually done by an incognito outsider with a checklist of individual items, the goal of which is to find flaws. By contrast, a walk-through is more comprehensive and thorough, usually done by someone familiar with the service or program, and its goal is to “feel” the experience, to see the program/facility through the client’s eyes.

Select two detail-oriented people committed to enhancing customer service, and have one play the patient and the other the family member. Make the walk-through as realistic as possible, at different times playing different types of customers (e.g., a patient who doesn’t want to be there, a typical client, one with special needs, or one who is likely to leave treatment prematurely). Walk-through clients should be instructed to think and feel as a client would think and feel.

Let the admissions staff know what you are doing so they don’t feel tricked, and ask them to treat walk-through clients as they would anyone else. Remind the walk-through client and family member that the admissions staff will be on their best behavior.

Besides detail-oriented people committed to enhancing customer service, also consider choosing a variety of individuals to do the walk-through at different times, including the executive director, a counselor or nurse, or someone from maintenance or housekeeping. The reality is that each of these people does the walk-through with their own unique “lens.” Repeat the exercise over time in order to see if any recommendations that were made were implemented—because staff and procedures change, and organizations experience “drift.”

The staff customer

Staff are program customers! I recall the staff person who wanted to be reminded of how lucky he was to be working at the facility because he kept forgetting it. Or there is this analogy: “Doing a good job here is like wetting your pants in a dark suit; you get a warm feeling but no one else notices.”

Some of the ways we can provide customer service to our staff include:

• Valuing staff and what they do and letting them know that;

• Treating staff fairly and equitably;

• Creating a process that encourages staff to identify problems proactively and make suggestions;

• Seeking input and making staff part of the change process (and particularly not asking for input and then ignoring it);

• Setting up a system of communication so that all staff understand what is happening with the program or facility, both good and bad; and

• Admitting mistakes.

One major reason to provide good customer service to staff is that nationally, there is up to a 50% turnover rate among clinical staff.3,4,5 Turnover creates financial, training and quality costs to the program. It is also harder for unhappy staff to deliver good customer service to patients and to establish therapeutic alliances with them.

Customer service and healthcare reform