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Irving Stackpole is one of the international care industry's most prominent experts. Based in Boston, Irving is well known across the US not just for being expert in up-to-the-minute best practice, but for his controversial views on all aspects of the care home industry.
There has been much written about trust in the professional workspace. Trust has been used as a measure of cultural health within organizations and as the focus of training. The research data says that if you don't trust your supervisors and leaders, you are less likely to stay on with your employer, you are less likely to commit the 'extra effort' that results in a job really well done, and further, you say more negative things about your job and your employer to family and friends. And this same dynamic affects customers and consumers as well. If the local authorities and commissioners don't trust the provision of care, if families don't have confidence that mum will get the attention she needs (remember the neglected woman in the wheelchair from the last blog posting?) what impact will that have? Everyone begins to disbelieve or distrust that what should happen, will happen, and the opposite of trust creeps into everyone’s consciousnesses. Trust is the confidence that what is expected will be done, and trust is built one decision after another over time. The Rule of Trust requires vigilance. If given the choice of attending to a non-verbal elderly woman in a wheelchair, or getting to a meeting on time, which rule would you follow? Maybe the woman in the wheelchair will never raise her voice about the indignity, and your boss will certainly raise hers over your being late. Does your supervisor, indeed do all your colleagues, trust you and each other enough to share the latitude to make such choices? My colleagues and I examine these dynamics through surveys and other research methods continually. What we find is that when employees report that they have confidence in their supervisors, families report that they trust the leadership of the organization, and residents are more satisfied. Do you think these are related? We know they are. The Rule of Trust beats the Tyranny of the Urgent in the long run, every time. Irving Stackpole can be reached at istackpole@stackpoleassociates.com.
I was in a nursing home here in the US this week (as I am most weeks on either side of the pond), walking to a meeting down the hall from the main entrance. This meant that I had to walk through an area of resident rooms. It was a busy morning, with bustling clinicians with clip boards and over stuffed lab coat pockets and residents in wheelchairs on their way to and from various therapies and appointments. One very elderly woman resident, in a wheelchair stopped in the hallway, had her hand partially extended in a palsied attempt to get someone's attention. Her staff escort had turned away to talk with a colleague. So I started to count (that's what market researchers do) and 12 professional staff walked past her without looking down at her or otherwise noticing her. Then her escort turned back to her and resumed their hallway pilgrimage. Interestingly, I was on my way to talk with the director of nursing about the satisfaction survey results from the prior month, which showed that 'response to call lights' was an important driver of dissatisfaction among residents and families. Surprise? As my young daughter says: 'Hel-lo!' And in this busy morning hallway, there were more than just employees. Visitors, vendors and an ambulance driver saw this vignette, and at some level, perhaps not consciously, will remember it. I call this the Tyranny of the Urgent, and believe that it wages war continuously with the Rule of Trust. We are distracted from what we know is important – caring for those who have placed their trust in us (the Rule of Trust) – by the 'deadline' the 'opportunity' or the 'intrusion.' We need to remind ourselves about the order of priorities, and we need to help each other in this mission. Because we are sometimes not able to see our way clear of the distractions, we need colleagues family, friends and other prompts to help us shed this yoke of tyranny, and stay focused on the Rule of Trust.
In the customer service experience, few things are more annoying than feeling rushed. Waiters who don't look at us as they dash from kitchen to table, sales clerks who brush our question aside because they're busy with another task or the person on the other end of the phone who announces (in one hurried breath), "ABCD Company, please hold", and "Click", we're listening to a 1990's cover of a Wayne Newton tune. In our care homes and other types of care services, are we adding to this list? My experience is that many of us are, and we aren't doing so deliberately. But the solution is availbale and effective. First, sensitize staff to the importance of not sharing staffing shortages or concerns with residents, consumes or families. This is particularly challenging, because we all like to garner sympathy or at least empathy, and it's an easy way out of guilt and an apology by explaining that the reason Mum's hair isn't brushed (again) is that so-and-so called in sick and we're short staffed. (And we wonder how our families come to think we're chronically under-staffed?) Through direct coaching, close monitoring and reinforcement – both positive and corrective – staff must be taught to apologize, explain (not excuse), act and follow through. So let's run through an example. Mary is behind on her morning routine. There should be three carers on a weekday morning, but there is only two this morning. Mrs. Smith's daughter, Barbara, arrives to take mum to her dentist appointment, to find Mrs. Smith unprepared. Mary is at the supply closet, collecting linens when Barbara appears, demanding help preparing her mother. What should Mary say? First: Mary should take a deep breath and apologize. "I am sorry for the delay, Barbara. Second: Mary explains, "We routinely have the morning care completed by this time, and I understand that you need to leave soon." Third: Mary acts, and in this case give Barbara the step by step. "Barbara, if you would tell your mum to choose her blouse, I will drop off these linens and be there to help in just a few minutes." There are exceptions, of course, where such a prompt response isn't possible, but it is never acceptable to make excuses; there are explanations, but never excuses. If the person Mary is caring far has had an accident or is in urgent need of attending, perhaps Mary can recruit help from another member of staff, and perhaps when Barbara understands the nature of the delay, she'll accept the situation with an offer to help with her mother herself. What's your least favorite excuse? What are some of the customer care excuses you've heard that make you most upset or angry? By looking at our own experiences, we can find the focus and determination to change the perceptions in our care home! Irving Stackpole can be reached at istackpole@stackpoleassociates.com
In the last few posts I talked about the importance of effective recovery, and the steps involved. If you are not regularly dealing with mistakes or processing complaints, you have probably lulled yourself into the dangerously false security of the "How Bad Could It Be?" mindset. If you are not hearing about errors, or receiving complaints, either your customers have given up, or you are just not listening - or both! No service provider is that good. But effective recovery can only occur if supervisors, managers and operators learn of, or hear about errors and complaints. Too often mistakes and sometimes even complaints are ignored, swept under the rug or dismissed as, "She's just having a bad hair day!" To develop an ethos in which care givers and others are encouraged to point out mistakes and respond effectively to them, requires serious effort in most situations. Here are the steps: - The highest level managers must routinely ask carers, residents / consumers and families. In person, by surveys – as many ways as possible
- When a mistake is relayed or a complaint heard, every manager and supervisor must practice saying, "Thank you for brining this to my attention." Remember that 70% of communication is non-verbal, so practice saying this in front of the mirror (I am serious) until your non-verbal body language, facial expression and tone of voice all convey that you really are grateful
- When dealing with staff, ask: "What do you think is the best recovery here?" Effective recovery may involve correcting a procedure, or replacing a lost or damaged item (for the correct response to various service errors, see the prior posts) and the staff will never learn unless this becomes part of the routine dialogue within the organization.
- Celebrate those who point out mistakes or receive complaints. Most expectations in any work group or team are established and reinforced by peers.
If others see that Sally is getting kudos for pointing out a service error, they will be emboldened to try the same thing, and when they do, the response will be: "Thank you for bringing this to my attention!"
Last week I made the claim that care providers can gain higher levels of customer loyalty by screwing up and recovering effectively, than by providing error-free service. We all have plenty of opportunities to recover, (i.e., we all make service errors) so what is "effective recovery"? Effective recovery describes the best response of the staff to the realization that an error has been made. Effective recovery has three (3) characteristics: 1. prompt 2. authoritative and 3. responsive Prompt means that you respond right away, there's no lag between the error and the response.
Authoritative means that there's no equivocating about what will be done. Whoever recognizes the error, or hears the complaint is enabled to respond, and he / she doesn't need to seek approval for the response.
Responsive means that the person who accepts responsibility for the complaint follows through and assures that what was said would be done is actually done. There are two types or errors, and the exact steps to effective recovery are based on the type of error. First, there are the errors of 'loss'. This is when you lose the eyeglasses, crush the dentures, burn the nightgown in the laundry (again?) or give the diabetic resident the apple pie (the yummy one – with the sugar). Second, there are 'process' errors. These are the marginally rude or offensive behaviors, such as when a resident is left waiting while the carer finishes her conversation about the latest soap opera with her buddy, or when the dinner is unceremoniously dropped onto the table with a "thud" without any comment or courtesy. For loss errors, effective recovery is: 1st Apologize So many errors and issues would be immediately dissolved with a sincere apology. And an apology has a simple structure. 'I am so sorry that you had this experience.' There's no need to excuse or in any way defend what was done. Just apologize! 2nd Explain An explanation is not an excuse. 'We do our best with the laundry, but sometimes there are mistakes. We handle these errors as best we can, and this situation will be sorted right away.' 3rd Compensate Replace the item(s) or compensate – no questions or quibbling! 4th Demonstrate / Remind Show the resident and his or her family that you have replaced the lost or damaged item, and that the change has made a positive impact. Take a picture of the resident reading with her new glasses, or smiling with her new dentures, and send it to the son or daughter. Also show the changes that have been made to the procedures as a result of the complaint. This demonstrates that you as the care provider have integrated the change and that other care recipients will benefit from the experience of one person and his / her family. The easiest way to do this is by email, so make sure you are capturing family members' email addresses. For process errors, the procedure is only slightly different: 1st Apologize Once again, many errors and issues would be immediately dissolved with a sincere apology.
2nd Explain An explanation is not an excuse. 'We do our best to train our staff, but sometimes there are mistakes. We handle these errors as best we can, and this situation will be sorted right away' 3rd Demonstrate/Remind Show the resident and his or her family that you have changed the procedure, and this has had a positive impact. This demonstrates that you as the care provider have integrated the change and that other care recipients will benefit from the experience of one person and his/her family. Notice that in process errors, there is no need to offer compensation, and further, that in none of the recovery scenarios must we make the situation entirely to the aggrieved customer's satisfaction! We shall revisit these situations in detail, but for now, enjoy your complaints! To reach Irving directly: istackpole@stackpoleassociates.com
None of us, with the possible exception of barristers, enjoys hearing about problems. In our daily operations, problems are too frequently glossed over, swept under the rug and/or ‘tolerated’ as we say to ourselves, “We can’t do anything about it anyhow!” In a previous posting, I brought your attention to the definition of Quality by W. Edwards Demming; 'Quality is the degree to which products or services are free of controllable defects.' To the extent that a 'problem' is a 'controllable defect' in the service provided, then there is something that can be done about it. Sweeping it under the rug or glossing over it is not healthy for the organization, its staff, or its customers. But don’t take my word for it, let’s look at the data. The largest database of customer behavior is the Profit Impact of Market Strategy (PIMS) database which is maintained by the Strategic Planning Institute. Relative to customers and consumers of services such as health and social care: Only 1 out of 4 persons who have a legitimate reason to complain actually do so. When service is poor, however, consumers are willing to tell an average of 11 people about their negative experiences.
What this means is that, by the time we hear a complaint from a resident, patient, family member or anyone else, as many as 44 others have also heard about the same problem, concern or issue. We all know the importance of 'word-of-mouth marketing.' This is how reputations are built or destroyed. If, however, we treat complaints and/or problems as opportunities to improve our service, we can transform complaints and problems into assets. Once again, the data:
If we provide 'defect free' service, we can achieve 45% to 55% customer loyalty. If a service error occurs, and we recover effectively, we will achieve over 70% customer loyalty! If you simply review your own experience as a customer and consumer, you will see that this data is true. We are far more loyal to service providers who, when an error occurs, recover effectively from errors. What is effective recovery? We’ll review that next week.
Meanwhile, have you found that making the effort over customer complaints has paid off? Let me know!
Irving can be reached directly at istackpole@stackpoleandassociates.com
We were in a conference call last week with three care home managers and their executive, reviewing the results of an annual satisfaction survey of residents. Two of the operations had done very well, improving in many important areas over the prior year, for example food & dining, personal care and housekeeping, while the results for the third home were not as positive. The managers of the two progressing homes dug right into the survey results - asking questions about interpreting the data, the meaning of certain residents' comments and how to impact resident satisfaction. They also reflected on whether this program or that had been responsible for improvements in certain ratings. The conversation was brisk, and lively, until the manager of the third home, the one that hadn't done well, said, "Are you sure that the comment on page eight is correct?" While my colleagues and I were puzzling over this, she added, "I don't think the response rate is calculated correctly..." We told her that we would check the results again and get back to the team. My research director and I reflected on this later and realized the "leaders" had looked at what could be changed for the better, while the one struggling "manager" shifted focus from the results and what could be done, to the survey process and how to invalidate the results which she saw as negative or critical. There is a very high positive correlation between perceived leadership and satisfaction. Leaders embrace hard truths and use them. Satisfaction is not something leaders hope for, but they embrace errors and recover effectively. We can all congratulate ourselves on what has been done well – as we should. But only by embracing what we aren't doing well can we change, and improve the quality of the services being offered. You can contact irving direct at irving@stackpoleassociates.com
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