What About Service?


HomeCare, Apr 1, 2003


Perhaps more than ever before, home medical equipment providers face issues that present direct challenges to their business success. Competitive bidding, inherent reasonableness, unprecedented paper work requirements and the Health Insurance Port ability and Accountability Act, to name a few, are forcing providers to reassess their businesses to determine how they can prosper in these uncertain times.

Yet, during all the evaluations and audits, how many providers have looked for ways to provide superb customer service in this heavily competitive environment?

Companies that choose to place customer service on a pedestal and make it a true priority will succeed, according to experts.

“There are absolutely wonderful and talented providers throughout the home care industry who are dedicated to providing superior care and products to patients at home.

It is interesting, because you can see the superior customer service oozing from every pore of the business,” says Jonathan Sadock of Wayne, Pa., a partner with Paragon Ventures, a health care business merger and acquisition advisory firm with locations in Philadelphia and Charleston, S.C.

“You see it in the way the warehouse is organized and in the attention to detail, both in terms of the order and the associated paperwork,” he continues. “You see superior customer service in the attitude and in the smiles on the faces of the employees throughout the organization, from the guy sweeping the floor to the person answering the phone. It quickly is evident when a company provides superior customer service.”

Gary Schwantz, director of educational services for The MED Group in Lubbock, Texas, says providers who regard customer service as a priority make an active choice to do so. “I've seen some companies that do a great job with it, but it's not so much technique as strategy,” Schwantz says. “It's just their heart … they just have a great heart for their patients and a great heart for what they do. They're convinced that they make a difference in people's lives, so customer service is alive and well.”

Yet, even if a company wants to go the extra mile and win over its customers with top-notch service and attention, certain barriers exist.

Barriers to Customer Service

In HME, knowing who your customer is can be confusing. Is it the patient? Is it the caregiver? Is it the referral source? Is it the payer? The answer is, they all are, and understanding their needs is the basis of all customer service programs.

“Providers not only need to determine who their customers are, but they need to better identify what is important to the customer,” says Louis Feuer, president of Dynamic Seminars & Consulting in Pembroke, Fla. Feuer, who has taught customer service to health care professionals for more than 25 years, says this is where it gets dicey. Because of the reimbursement structure, the person who uses the equipment most likely did not order it or pay for it. Likewise, the one who ordered the equipment will not use it or pay for it. So, the system's design is primed for communication barriers and unmet expectations.

Communication breakdowns are commonplace but can be corrected, experts say. “Probably the most common problem — and easiest to correct — in a business' customer service policy is communication,” Sadock says. “The perception of poor customer service often occurs [when a company is] not listening to the customer's needs, creating an unfulfilled expectation or not communicating with the customer.”

Poor communication with customers can send a message of neglect and disinterest, experts note. For example, if a customer's call is not returned promptly, his immediate reaction may be that you neglected him. He does not know you had an emergency in the warehouse, or that you had to call seven other customers first, or that you had to solve an immediate personnel issue. All the customer knows is that he was not called back, and he makes the presumption that you do not care. The result is that he finds someone who does care, making communication a financial issue.

“Communicating well with your patients can be one of the least expensive and [most] highly effective means to give a customer the perception of superior customer service,” Sadock says. “Like many things with customer service, the customer's perception is reality.”

It can be hard to determine the customers' perception if you do not look to them regularly for answers. Feuer says that if companies would interview their customers regularly, companies would find that customers either like them or don't like them, based on a personal interaction with an employee. “No one takes business away from you,” he says. “Once you neglect your customer, someone will be happy to pick up the pieces.”

Being proactive is essential. Miriam Lieber, president of Sherman Oaks, Calif.-based Lieber Consulting, suggests making what she calls a “care call.” A care call involves calling patients randomly to ask about compliance, usage problems and customer satisfaction. “The cost you incur is minimal compared to the wealth of information you can receive,” she says.

Feuer says this type of call also can be used to determine if the equipment is beneficial, or as part of a quality assurance program. Additionally, you can learn a lot from customers who are upset but not willing to initiate a complaint, he says. “Some providers think that if they don't hear from a customer, there were no complaints,” he explains. “That is not necessarily the case.”

Feuer also promotes the use of written surveys, but he stresses that nothing can replace talking directly with a customer.

Making a Commitment to Improve Service

The good news for HME providers is that any company can establish or improve a customer service policy, as long as the company is committed, is willing to make changes through education and training, and has employees who are eager to go the distance to win and retain customers. One caveat: It must start at the top.

From there, Sadock says, the customer service policy must be ingrained in each employee. “Ultimately, it is the responsibility of the entire team to communicate with the customer and provide those extra touches that give [customers] the perception of superior customer service,” he says.

Tom Inman, president of Virginia Home Medical in Williamsburg, Va., has a customer service philosophy that flows through his company. “I want the community, our referral sources and our physicians to think of our organization as a resource for the community,” he says. “If you build your customer service model based on that [goal], whether you end up serving the customer or not doesn't become the focal point; you become a resource for [the customers]. Good customer service cannot help but come out of that kind of philosophy.”

Management's message must emphasize that the company cares about customer service issues in addition to the bottom line, because without customers, the bottom line disappears, says Kim Brummett, director of reimbursement for Advanced Home Care in Greensboro, N.C.

Echoing Brummett's thoughts, Joyce Shelton, office manager for Virginia Home Medical, puts it this way: It's a cutthroat industry, so you have to offer superior customer service. If you don't, there are a “hundred HME companies waiting for you to mess up,” she says.

Schwantz says pleasing a customer can take more time, but small gestures can go a long way. For example, he says if a customer wants a particular piece of equipment, rather than just telling him where he can find it, call the company directly to expedite the process.

At Virginia Home Medical, that is standard procedure. “We try to figure out a way for people to get what they need, even though sometimes it may not be from us,” Shelton says. “[The product] might be from somebody else, but our goal is to get [customers] what they need.”

The Right People for the Job

So, once you are committed, how do you begin the process of providing service that exceeds your customers' expectations? First, the experts say, you hire the right people for your team. Then you provide them with ongoing training that enables them to wow your customers with attention, solutions and service.

The quest for customer-focused employees begins in the interview process. Schwantz recommends role-playing to discover how a potential employee would field questions from a customer who is upset or dissatisfied.

Intuition also plays a large role. If you hire smart people with “heart,” you can teach them the business. “If you hire people and look for that customer service focus, then the rest of it comes on its own,” Brummett says. “If you are smart, I can teach you regulations, I can teach you Medicare law, and I can teach you about our software. But I can't teach you how to provide customer service if you are not customer-focused.”

Although customer service issues are present in every department, the customer service department is one area that must have the right people in place. According to Lieber, customer service representatives have to like two things: multi-tasking and chaos.

This is a difficult area, Inman acknowledges. “From an owner's standpoint, the most challenging task is finding the right people,” he says. “Because if you're talking about a CSR — your front-end person on the phone who takes orders and handles the customer contacts — it is a very stressful position and it can make or break you.”

Inman says the right person is one who has empathy and is a good listener. Knowing when to ask for assistance is also key. “A good CSR is one who knows his or her own limits and realizes that there are going to be some situations that will require a manager's help,” he adds.

After hiring people who seem eager to follow a strong customer service philosophy, the next step is to provide them with adequate training. “Once you bring someone into your organization, you need to make a commitment to developing a program that reminds them that the customer is the focus of the business,” Feuer says. “It needs to be a full-time program that permeates all of the actions of all the employees.”

In addition to formal training classes with consultants or at national trade shows such as Medtrade, Feuer suggests a monthly meeting that concentrates on the things employees can do to improve customer service and on the types of complaints the company is receiving. This will help keep employees and management focused on customer service.

Training, Lieber says, is critical and something that should be continuous. Revisiting critical service issues is also necessary.

Advanced Home Care requires employees to attend eight to 10 classes during the first three months to a year of employment. To prevent employees from losing focus, the company decided to add an in-depth customer service class that is required not only for new hires, but also for long-term employees. Even though the information is basic, the classes encourage employees to do a better job of improving customer satisfaction, Brummett says.

Virginia Home Medical provides training to employees through many venues. Most recently it has benefited from the teleconferences offered by Feuer's company, Shelton says. This brings up an interesting question. Do you have to hire a consultant to jumpstart your customer service program?

Not necessarily, but doing so can provide expert advice and send a powerful message to employees and customers. Hiring a consultant can provide an organization with two things, Inman says. “One, you get definite feedback from [the consultants] about what they're seeing in your organization, compared to what they see in others, and that is invaluable,” he says. “The other is that people understand you're committed to good customer service, and that you'll spend resources and time and the organization's efforts to improve what it is already doing.”

Inman adds that the process is continuous. “The organization that sits out there and reads [its] customer comment cards that come back all glossy and shiny and then thinks it doesn't have any customer service issues is a little nearsighted,” he says. “It's a dynamic that never goes away and always can be improved on.”

Feuer likens training to booster cables. “Don't buy the booster cables if you are not going to keep the car running,” he says. If all you do is take one course, buy a book or hold one teleconference for your employees, “you probably shouldn't bother — it's not enough,” he says.

The Cost of Satisfaction

Even though customer service training programs, seminars, and educational literature can be costly, losing customers is even more so, experts say. Despite continuous reimbursement cuts, there is no better place in your company to spend money than on customer service.

“If you don't have good service, you won't have to worry about competitive bidding, and you won't have to worry about a cut in reimbursement, because you're going to cut your profits yourself,” Feuer says. “You can't withstand both bad service and damaging legislative issues.”

Sadock says customer service can affect the value of a business in several ways. “From the perspective of customer retention and profitability, the value of customer service should not be ignored,” he advises. “What does it cost you to obtain each new patient or referral source? The old adage — that it costs far less to keep a customer than to find a new one — is very true.”

Superior customer service, in tandem with other operational efficiencies, will result in increased profits, he adds. On the other hand, poor customer service will have the opposite effect. “Provide poor customer service and your patient will be angry. You are at great risk that the referral source will hear about it, and even if you do everything else right, your business and its profitability could be in jeopardy,” he says.

Customer service also can affect a company's market value. “Where a patient will see an individual event as a litmus of customer service, a buyer/acquirer will evaluate customer service in terms of profitability, employee turnover, reputation, and diversity of referral sources, contracts and payers,” Sadock says.

When It Goes Wrong (And Often It Will)

Even in the best of circumstances, customer service disasters can occur. How you recover, and the steps you take to right the wrong, will determine your future relationship with the customer, experts say.

It sounds simple, but saying you are sorry is always the first thing you should do when a customer is unhappy. When you think you are right and you try to prove it, it becomes a losing situation. “Any time you have a disagreement with a customer, you are always on the losing end, and even though you may fix it, you have to realize you are going to lose some points,” Feuer says. “When a customer complains, you need to do whatever you can to fix it as quickly as possible, because there is no winning in winning.”

After acknowledging the problem and apologizing, it is time to repair the damage. “Your object now is not to win anything. The object is to keep the business and keep the customer happy,” Feuer says. “If you neglect [the customer], that is when the business goes out the window. When that happens, it's not necessarily because you did something wrong, it's because you neglected to follow through and keep on a path of getting to the solution.”

It is crucial, at this point, to keep the customer involved in the solution by sharing your plan, which is one of the steps Schwantz recommends for handling complaints. In his “Five A Approach,” Schwantz, who wrote a dissertation on customer service, advises providers to:

  1. Attend: Listen, without interruption or defensiveness.
  2. Apologize: Don't be afraid to apologize to a customer, even if you have done nothing to create the problem.
  3. Acknowledge: Think about the customer's feelings and simply say, “I understand you must be angry, frustrated or disappointed.” Once the customer is finished speaking, say back to him or her exactly what the problem seems to be. Avoid, if possible, the use of the word “you,” as in “What you don't understand…” or “Who you'll need to speak to is…”
  4. Act: Offer to help and create a solution. Speak in positive, action-oriented terms, such as “I will” or “I can.” Keep the customer informed.
  5. Appreciate: Never forget to thank the customer. They offered you the opportunity to solve a problem.

Whether the problem is with the product or in the delivery of the item, successful providers should be willing to offer a solution, says Cy Corgan, national sales manager for retail mobility for Pride Mobility Products in Exeter, Pa. “Providers need to work with the customer and come up with a solution that best suits the individual's needs,” he says. “Something may go wrong during the process of recommending a product for a particular customer, but providers need to work with the individual to correct the situation.”

Keeping Your Focus

Anyone who chooses to work in health care realizes that it is an industry built mostly of products and services that no one wants to buy. In this industry, many customers are sick, fatigued and confused, and this makes exceptional service even more important.

Inman tells his employees to remember one important thing: Never be “anything but extra polite to our customers.”

He also encourages them to ask themselves one question: Would I trade places? “If the answer is no, then you can't understand why they feel the way they do. So, count your blessings,” he says.

So, do you want to thrill your customers, as Schwantz encourages providers to do, by making a positive difference in people's lives? It may take time and it may take an effort, but if your heart is there, it will not be difficult. “I think it comes down to one question, which is: Do you love what you do?” Schwantz says. If the answer is yes, the rest will come.

Internal Customer Service

Internal customer service is the primary path to exceptional customer service, many experts say. How employees treat each other is critical in the overall message the company presents to patients, referral sources and payers. When departments cannot work together well, the customer suffers because of poor follow-up, neglect and inaccurate instructions.

The first step to excelling in this area is employee buy-in, says Miriam Lieber, president of Sherman Oaks, Calif.-based Lieber Consulting. “You have to promote the fact that employees are on the same team and that they are all in it to succeed,” she says.

Kirk Miller and Associates, a Scottsdale, Ga.-based training company that creates custom workshops, offers these tips for improving internal customer service:

  • Begin with your own perspective. Regard fellow employees and other departments as your customers. Understand that helping your colleagues do their jobs more successfully helps your organization and you.
  • View interruptions not as nuisances but as opportunities to serve your internal customers. Take pride in helping your colleagues. In most cases, your willingness to help others get their jobs done will lead others to assist you readily when you need it.
  • Exceed your internal customers' expectations. Think what you can accomplish in your organization by exceeding the expectations of fellow employees.
  • Say “thank you,” even when it is a person's job to provide information or a product to you.

A department's tone can set the standard for customer service, experts say. Negative interaction between departments and employees can have a far-reaching effect that results in unsatisfied customers and unhappy employees. On the other hand, positive internal customer service can improve employees' morale, job satisfaction and interaction with customers.


Ensuring Superior Service

There are specific strategies companies can use to improve customer service. Jonathan M. Sadock of Wayne, Pa., a partner with Paragon Ventures, a health care business merger and advisory firm with locations in Philadelphia and Charleston, S.C., offers these tips to enhance your customer service program:

  • Develop and maintain a mission dedicated to providing superior customer service.
  • Teach customer service to all new and existing employees.
  • Reward employees who provide superior service.
  • Develop and implement policies to deliver superior customer service, such as keeping appointment times, calling the patients routinely to inform them of any delays, and calling again within 24 hours after the delivery, to gauge customer satisfaction.
  • Develop and implement systems to monitor customer service. For example, attach a postage-paid reply card that customers may return to the president or owner of the business. When a customer takes the time to complete the card, reply personally.
  • Tout your successes. Let the community know how you are doing in your advertising literature, message-on-hold feature and community sponsorships.
  • Ask your patients to refer their friends.
Creating Norms

One of the goals Greensboro, N.C.-based Advanced Home Care set when it began to improve its customer service process was to create customer service norms. Kim Brummett, director of reimbursement, says creating norms is a continuous process, but some examples include:

  • Avoid blind phone transfers. Stay on the line until someone else picks up the phone.
  • Talk about what you can do for the customer rather than what you can't. Even if you have to say no, offer the customer options.
  • Instead of saying, “I don't know what happened,” say “I need a moment to check with another department.”
  • Be conscious of your tone of voice and inflections. Even if you are saying the right words, your tone of voice can send the wrong message.
  • Avoid giving too much information. The customer does not need to hear about internal problems.