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The following article appeared in the June 1996 issue (Vol. 6, No. 2, pp. 12-15) of the Division 11

peer-reviewed publication Perspectives on Admistration and Supervision. To learn more about Division

11, contact the ASHA Action Center at 1-800-498-2071 or visit the divisions Web page on the ASHA

Web site (www.asha.org/about/Membership-Certification/divs/div_11.htm).

Customer Satisfaction in Health CareMarni ReisbergAdvanced Rehab. Systems, Inc.

Everyone is a customer. Each person involved in a

work process is at one time a customer of someone anda supplier to someone else. For example, when conduct-ing videofluoroscopy to complete a swallowing study,you are a customer of the equipment manufacturer andthe radiologic technologist, and a supplier to the pa-tient/family and the patients physician. Customer sat-isfaction, then, is achieved by managing these sequen-tial relationships while providing high quality care.

Efforts to deliver customer-oriented service aretransparent. Customers know the characteristics; theygrab their attention. Our own professional behaviorshould make it clear that we are working in the best

interest of customers. Our intent is to battle for consum-ers, not against them. The purposes of this article are tooutline customers basic needs, identify roadblocks tocustomer service, define customer, pose a series ofquestions designed to determine whether we are meet-ing customer requirements, suggest three steps to cus-tomer-oriented service, and chart a hierarchy of cus-tomer values that can be factored into our routine prac-tices.

Basi c Needs of Cust omers

Research in the field of clinical psychology has

identified 10 basic needs that motivate customers andinfluence their actions:

1. Customers need to feel in control.

2. Customers need to feel that their actions aredirected towards their goals.

3. Customers like to feel good about themselves andwant to interact with those who can help themaccomplish this.

4. Customers want to be treated fairly and appro-

priately.5. Customers want their suppliers to be friendly

and warm, which engenders trust and confi-dence.

6. Customers want to know what is happening andwhy.

7. Customers want to feel safe and secure.

8. Customers like the approval of others.

9. Customers want to feel important, recognized,and appreciated.

10. Customers need a sense of belonging; they like toidentify with organizations.

These basic needs help us to understand the psy-chodynamics of behavior. Thus, their acknowledgmentforms the foundation of customer service.

Roadbl ocks t o Customer Serv i ce

Roadblocks to customer service can dismantle evenour best efforts to meet basic needs. Thus, they should

be anticipated to prevent them from occurring or tomanage them despite their occurrence. Roadblocks in-

clude poor quality products, which often result in cus-tomer complaints, and flawed systems and procedures,which often lead to poor quality services. When systemsare inefficient and policies are rigid, we need to deter-mine their interference with customer service, and workto modify them accordingly. Inadequate equipment andsupplies may restrict the provision of quality care. Otherroadblocks include feelings of being overworked as aresult of understaffing. This situation poses a particularchallenge to employee morale, which can directly affecthow customers are treated. It can lead to a work culture

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that reflects low standards or mediocrity, thus making itdifficult to deliver consistently high-quality services.

Cust omer Defi ned

Health care is changing rapidly. Customers areeducated and are demanding that we meet their needs.In the ideal service environment, we do not want to justmeet the customers needs, we want to delight thecustomer. It is important, then, to identify all of ourcustomers.

The customer is defined as anyone who receives theresults of our work and makes a value judgment aboutservices provided. Customers take two forms: externaland internal. External customers are those end users ofour services and are outside the organization. Internalcustomers are those individuals or departments withinthe organization to whom we provide a service. Internalcustomers may or may not be end users of our service,

but are nonetheless a part of our work process. Thereason for the distinction, according to Marszalek-Gaucher and Coffey (1990), is the degree to which wecan influence or negotiate customers requirements.With external customers, we may not have the ability tonegotiate requirements. With internal customers, we usu-ally are able to negotiate requirements if we consider themunrealistic.

Internal customers include coworkers and super-visors within our facility, and other members of therehabilitation team (e.g., physicians, nurses, socialworkers, dietitians, physical therapists, occupational

therapists, administrators). External customers includepatients and their families, third party payers (includ-ing managed care organizations), state and federalregulatory agencies, professional organizations, andreferring facilities (including hospital discharge plan-ners and case managers). Once we understand who ourcustomers are, both internal and external, it is only thenthat we are positioned to serve them.

A re We Meet i ng Cust omer

Requirements?

The following series of questions is helpful to en-sure that we are meeting our customers requirements:

Who are our customers? What do they need? How do we know? How are they doing? How do we know?

If we can answer these questions, we are communi-cating with our customers. We also should be able toanswer these questions:

What do we do?

Who do we do it for? What do the recipients of our services want and

why? How can we improve their satisfaction? What is the strategy and process for creating a

customer-focused environment?

Once these are answered, we have established acustomer-oriented approach to service that is both mean-ingful and enduring.

Three St eps to Cust omer-O ri ent ed

Service

If we truly are customer-oriented, we need to regardeach customer contact as an opportunity to provide a

better-than-expected experience. It involves three stepsand related techniques:

Step One: Get off to a good start. Greet your customers promptly. Talk to them with your eyes. Break the ice. Get customers involved. Enjoy people and their diversity. Watch your personal appearance. Check the appearance of your work area. Use good telephone technique. Call people by name. Say please and thank you. Smile.

Step Two: Build on a good start. Listen with more than your ears. Anticipate customer needs. Reach out. Compliment freely and sincerely.

Step Three: Build on the relationship. Encourage feedback, both positive and

negative. Explain how things work. Reassure the customers decision to do business

with you.

Under-promise; over-deliver. Make customers feel special. Exceed customers expectations.

A H i erarchy of Cust omer Val ues

When providing a service, developing a program,or training staff, we should look at the cycle of service(the complete range of events a customer experienceswhen seeking or receiving services) and factor in ahierarchy of customer values. Thus, we can transformthese values (often expressed in customers own ac-

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tions and words if we watch and listen) to key aspectsof our service. Any set of customer values can be orga-nized into four hierarchical levels:

1. Basic: The essential attributes of the experience,either tangible or intangible. Without basic at-tributes, there is no point in doing business.

2. Expected: The associated attributes of the expe-rience that the customer has come to take forgranted as part of general business practice.

3. Desired: Attributes that the customer does notnecessarily expect, but appreciates if the experi-ence includes them.

4. Unexpected: Surprise attributes that add valuebeyond the customers typical desires or expec-tations.

This hierarchy can transform services to ones de-signed to meet each of the four levels. An example of this

concept is offered:

Work process: Registering for an outpatientspeech-language evaluation.

Basic: There is a designated registration area inthe facility.

Expected: The designated registration area isclose to the speech-language pathology depart-ment.

Desired: Waiting time and completion of regis-tration take no more than 10 minutes.

Unexpected: When someone calls to make anappointment, preregistration is completed im-mediately over the telephone. The person thencomes directly to the department at the time of theappointment instead of having to wait at theregistration area.

If we are committed to customer service, we will dowhatever is necessary to improve our services and meetour customers needs. Handling complaints tactfully isan important part of the service cycle. We must be goodlisteners and remain open-minded to hear everythingthe customer is saying. We cannot become defensive.

Sometimes, customers just need to vent. Often, theircomplaints have little to do with us; they are just angryat the system. Customers become especially disheart-ened when service providers adopt an unconcerned,its not my problem attitude. Conversely, they feelgood when we can relate to their problem. We canrespond by empathizing and emphasize that we willwork with the customer to try and solve the problem,discuss alternatives, or refer the customer to someonewho can solve the problem.

The two most important components of resolv-ing conflicts are: (1) identifying a course of action

and (2) acting on it promptly. We should never makea promise that we cannot keep. And, we must alwaysfollow up with the customer to determine whethereverything has been resolved to his or her satisfac-tion.

ConclusionIn his book, Keep the Customer, Desatnick (1987)

states that service is the new standard by which custom-ers are measuring an organizations performance.Davidow and Uttal (1990) believe that satisfaction, orthe lack thereof, is the difference between how custom-ers expect to be treated and how they perceive beingtreated. Finally, according to Sanders (1995), believethat you are in business to serve customers, act on that

belief, and customers will respond. The key to Sandersadvice is that it guarantees customized service. If wetreat our customers with the respect and caring they

deserve and respond accordingly, we will always pro-vide service that optimizes our efforts and exceeds theirexpectations.

Some basic principles and techniques for customerservice in health care have been described. While theymay seem either obvious or superfluous to some, theirabsence can, in essence, put us out of business in todayscompetitive, cost-conscious, and customer-orientedenvironment.

References

Albrecht, K., & Bradford, L .J. (1990). The service advantage:

How to identify and fulfil l customer needs. Homewood,IL: Dow Jones-Irwin.

Davidow, W. H., & Uttal, B. (1990). Total customer service: Theultimate weapon. New York: Harper Collins Publishers.

Desatnick, R. L. (1987). Keep the customer: Making customerservice your competitive edge. Boston: Houghton MifflinCompany.

Leebov, W. (1988). Service excellence: The customer rela-tions strategy for health care . American Hospital Pub-lishing.

Marszalek-Gaucher, E., & Coffey, R. (1990). Transforminghealthcare organizations: Achieving and sustaining or-

ganizational excell ence . San Francisco: Jossey-Bass.

Sanders, B. (1995). Fabled service: Ordinary acts, extraordinaryoutcomes. San Diego: Pfeiffer and Company.

Printed in the USA 1996 ASHA