Give hospital employees the skills and confidence to tackle tough challenges.
By LesleyAnn Carlson, M.S.N., RN, NE-BC, CPN
Karen Ross* always parks at the same privately-owned parking lot at the airport when she travels. While on a trip this summer, she decided to try the car detailing services available at the parking lot. She returned from her trip, excited to hop into her clean car and head home, only to find the seats weren't touched, the windows were smudged and it smelled like someone had used dirty rags to wipe it down—her car was in worse shape than when she left it.
When Karen got to the checkout, she told the employee what was wrong, and he immediately grabbed his manager. The manager inspected her car and agreed it was a terrible job. They exchanged contact information, and he told her she'd have a full refund the next day. When she checked her bank account, the money was already refunded, and the manager had also included a refund for three days of parking. When Karen traveled again three months later, she received a personal email from the manager asking how her recent experience was. He apologized again and wanted to make sure everything went smoothly.
Customer service industries such as travel, retail and hospitality have a long history of providing service recovery training—strategies for employees to offer a prompt, effective response when a customer has had a negative experience—so they can resolve dissatisfaction with services or products quickly.
Following the lead of these industries, hospitals recognize there are elements of service recovery that are applicable to health care environments and can improve patient family satisfaction, patient outcomes and help employees overcome challenging customer service issues.
In health care, fiscal reimbursements, market share for competitive edge, Magnet status, and securing a positive reputation while enhancing recruitment have driven initiatives to enhance customer service, do the right thing for patients and families and improve patient experience.
But traditionally, efforts to improve patient experience scores in most hospitals have focused on activities that improve the overall experience. Positive interventions to enhance the hospitalization experience range from offering free internet services to in-room food delivery or family sleeping spaces.
These efforts can produce desirable outcomes for patients and families during hospitalization. But providing staff members with the tools they need to employ strong actions to recover from negative interactions and experiences is a critical factor in improving service scores, the patient family experience and patient outcomes. At Rady Children's Hospital-San Diego, a strategy to empower staff members became an important initiative for improving service.
Identify ineffective methods of customer service
Rady Children's was not achieving its goals for patient experience scores in several units, and it was also not achieving its organizational goal of consistently exceeding the 50th percentile. Despite the usual positive experience promotions, like posters and screen savers proclaiming excellence, a teddy bear on the bed of every new admission, and pagers in the waiting rooms, the organization was lagging behind its desired goals.
Taking a closer look at survey data and examining missed opportunities for service satisfaction, the hospital discovered an abundance of situations that could've benefited from empowered employees leveraging a service recovery program.
Although service recovery steps appear simple for staff members to engage in, Rady Children's found no focused or comprehensive deployment of these steps. A review of current culture and the process staff members used when addressing unachieved service expectations for patients and families revealed several ineffective strategies were in use for confronting challenging issues. Instead of the evidenced-based steps of service recovery, staff members were:
- Avoiding. The "stay out of that room" action.
- Ignoring patient and family concerns. The "wish it away" action.
- Passive acceptance. The "oh well" approach.
- Assigning the patient family to others. The "dump on the traveler, new grad or float" action.
- Escalating to others, such as the charge nurse, social worker or unit leadership. The "cover my butt" action.
Transitioning from ineffective and potentially detrimental actions became the hospital's goal and focus with staff members. A coordinated approach in all departments toward promoting a new culture of service recovery began with providing awareness, training and tools for all employees and providers.
Address employee fears
As work got underway, unit leaders discovered overwhelming hesitancy and fears from staff members when addressing service concerns—they felt ill-equipped to be effective at achieving resolutions to challenging issues. Staff members expressed limited awareness of what constituted service recovery and a lack of training or tools that would ensure consistency in their approaches.
Based on these factors, the patient experience nursing executive designed and presented a 30-minute service recovery training program to each nursing and ancillary department during staff meetings over a three-month period. This training was inclusive of the evidence-based "Five-Step Service Recovery Strategy."
Specific tools, actions and comments that could be employed in various situations were tailored and reviewed for the specifics of each individual care area. Staff members shared examples of challenging service situations specific to their environment as a component of the presentation. Although the steps initially appear straightforward and simple, it was clear employees had hesitancy and some doubt.
Tailoring the training to specific challenges hospital-wide, as well as individualized or unit-specific circumstances, presented employees with real opportunities for successful service recovery. For example, in the emergency department (ED), teams applied service recovery strategies to wait times, and in the medical unit, teams applied training to situations when there was a lack of a private room. It was crucial the training allowed for staff members to exchange dialogue and share their personal experiences with challenges they encountered.
Barriers to implementing new service standards
Train for results
Over a three-month period, every area received service recovery training. As a result, patient family perception of quality of care led to four areas achieving measurable changes in overall quality of care scores.
During training, staff members identified some barriers to full implementation of the five steps. Some employees perceived an apology as an admittance of wrongdoing or that they did something they shouldn't have when they were actually following policy or procedures. Staff members in the ED expressed difficulty saying "I'm sorry" or apologizing for the extended wait when they did not feel accountable to the wait because of high utilization.
Staff on the medical and surgical units also had difficulty saying "I'm sorry" to complaints from families about placement in semi-private rooms versus private rooms when there were no other options. Helping staff depersonalize the apology and identify it instead as powerful words to acknowledge the patient family concerns and feelings was an important discussion and framing process.
Using responses such as, "I'm sorry to hear that," "I'm sorry that happened," and, "I'm sorry you have been disappointed," gave hospital employees support for this process.
The biggest barrier to listening and empathizing was related to the concept of time. Staff members felt they didn't have time to sit and listen to every complaint. During training, relating the value of being heard and accurately identifying the issue by fully listening to the complaint helped employees see that less time was invested if the right issue was addressed.
During training, the concept of fixing the problem initially seemed the easiest to convey and achieve. Staff members, however, focused on when they could not fix the problem. For example, day shift nurses felt they could not fix the problem of noise during the night shift or a problem that occurred with a nurse several days ago. ED nurses felt they couldn't fix the problem of long wait times, and medical/surgical nurses identified the inability to fix semi-private room accommodations.
Presenting scripts and strategies to help staff members specifically demonstrate their desire to fix a problem was ultimately the goal. Comments such as, "I will review/remind/investigate this with staff," or, "What would you like me to do to make this right for you?" and, "I will take care of it right now," can convey to patient families a strong commitment to addressing their concerns and needs regardless of the specific solution.
Finally, the barrier to offering atonements was the unawareness of what constituted an atonement and then empowering staff members to use them. Items such as extra pillows, blankets, toys and coffee were easy to associate with this step once they understood the concept.
However, questions came up about how to obtain parking vouchers for free parking, how to charge for comped meals or drinks sent to families or obtaining specific comfort items. Providing menus of atonement activities for staff members to choose from was essential to ensure this aspect of service recovery is active. Once employees were empowered to access resources and understood how they would be charged, staff members were enthusiastic about this step and felt it was an important tool for enabling them in service recovery.
Sustain service success
Including service recovery as annual training and competency for staff members ensures they are confident and aware of the concepts, and it promotes consistency in how employees use the skills and tools. This aspect of patient family satisfaction and engagement is essential to optimizing positive satisfaction scores and improving patient outcomes. Relating service recovery episodes from industries outside of health care helped personalize the concepts and experiences for staff members and illustrated how principles they have encountered in other venues can be effective in a health care setting.
To sustain the organization's service recovery practices, ongoing refresher training with unit-specific success stories generates continued engagement. Additionally, communication classes for enhancing employees' skills with difficult conversations and building confidence with highly charged situations helped in promoting customer engagement overall.
LesleyAnn Carlson, M.S.N., RN, NE-BC, CPN, is associate chief nursing officer at Rady Children's Hospital-San Diego.
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