PART 1
Service
Recovery
Service
recovery is an important and effective customer retention tool. One way an
organization can ensure repeat business is by developing a strong customer
service program that includes service recovery as an essential component. The
concept of service recovery involves the service provider taking responsive action
to “recover” lost or dissatisfied customers and convert them into satisfied
customers.20 Service recovery has proven to be cost-effective in other service industries.
A good recovery can turn angry, frustrated customers into loyal ones, result in
higher satisfaction, and even create more goodwill than if things had gone
smoothly in the first place.21–23
Service
recovery cannot take place if the provider is unaware of dissatisfied
customers. Unfortunately, when customers are dissatisfied, they are more likely
to complain to friends and family than to complain to the provider.20 In the
health care industry, only 5% to 10% of unhappy patients actually complain
following a dissatisfying experience.24 Instead, many leave silently with the
intention of never returning. 14, 25 If consumers do not complain, the
organization loses the opportunity to remedy the problem and retain a
customer.26 Because the potential impact of service failures on return behavior
and negative word of mouth is so great, effective recovery strategies are
essential to a comprehensive customer retention approach.27 Background: Patient satisfaction and
retention can be influenced by the development of an effective service recovery
program that can identify complaints and remedy failure points in the service
system. Patient complaints provide organizations with an opportunity to resolve
unsatisfactory situations and to track complaint data for quality improvement
purposes.
Service
recovery: Service
recovery is an important and effective customer retention tool. One way an organization
can ensure repeat business is by developing a strong customer service program
that includes service recovery as an essential component. The concept of
service recovery involves the service provider taking responsive action to
“recover” lost or dissatisfied customers and convert them into satisfied
customers. Service recovery has proven to be cost-effective in other service
industries.
The
complaint management process: The complaint management process involves six steps
that organizations can use to influence effective service recovery: (1)
encourage complaints as a quality improvement tool; (2) establish a team of
representatives to handle complaints; (3) resolve customer problems quickly and
effectively; (4) develop a complaint database; (5) commit to identifying
failure points in the service system; and (6) track trends and use information to
improve service processes.
Summary and
conclusions: Customer retention is enhanced when an organization can reclaim
disgruntled patients through the development of effective service recovery
programs. Health care organizations can become more customer oriented by taking
advantage of the information provided by patient complaints, increasing patient
satisfaction and retention in the process.
PART 2
Given the
important influence of service recovery on patient satisfaction and loyalty,
health care organizations should welcome and encourage patient complaints. An
effective complaint management process can be an important QI tool that allows
organizations to obtain customer feedback that is useful in making process
improvements that increase customer satisfaction, loyalty, and profits.28–30
Understanding
Complaints
Customer
loyalty can be increased by encouraging consumers to complain.31 Complaints
provide organizations with an opportunity to recover from their mistakes, retain
dissatisfied consumers, and influence consumers’ future attitudes and
behavior.32–33 Moreover, complaints allow the organization to identify common
failure points in the service that in turn enable the organization to improve
the quality of health care delivery. Consumers in the health care industry are
reluctant to complain because they fear that they may receive lower service
quality if and when the need for future care arises.24 This is unfortunate,
since complaints are important to health care providers. The majority of
customers who do complain to the provider about some aspect of service actually
will use the service provider again if they perceive the complaint as being
resolved.11–12,34 In best-practice organizations outside health care, customer
complaints are viewed as opportunities for improvement.28 However, in health
care organizations, complaint data have only recently been recognized as a
management tool.35 Service recovery cannot occur without a complaint, and resolution
of complaints can build customer confidence in the organization. 16,20
There may be
situations in which the organization realizes that the customer is not always
right and customer retention may not be the appropriate goal. A customer who
complains frequently or is never satisfied with recovery efforts may need to be
labeled as the “wrong customer.”24 Because of the stress these customers place
on the organization and its employees, some organizations may choose to avoid
relationships with these customers, since they do not represent valuable long-term
relationships.27 However, in instances when dissatisfied customers must return
because of insurance requirements, the organization should attempt to make the
customers feel that they have been heard and treated fairly but inform them
that it is not possible to meet their request.16 If no compromise can be
achieved, the organization should maintain a record of these specific customers
so that employees will be aware of their disposition and approach the situation
with caution when these customers return for future services. During the past
several years, most hospitals have developed a formal complaint handling
process to meet accreditation standards set by the Joint Commission on
Accreditation of Healthcare Organizations
(Oakbrook Terrace, Ill). These standards require that
1. A mechanism
exist for receiving complaints;
2. Patients be
informed of this mechanism and their right to file a complaint;
3. Each complaint
be analyzed and appropriate action be taken, if warranted;
4. Each patient
or family making a significant complaint receive from the organization a
response that substantively addresses the complaint; and
5. Filing a
complaint will not compromise the patient’s future access to care.36
Although many
hospitals have instituted procedures for handling patient complaints in
response to accreditation requirements, some still do not track complaints for
improvement purposes and/or do not formally capture any complaints except those
accompanying the patient satisfaction survey.35,37 Complaints offer valuable
insight into areas of the organization that are in need of improvement, and an
organization that does not respond to customer complaints risks gaining a
negative image in the eyes of the consumers who complained.17
The Complaint
Management Process
Figure 1 (p
281) depicts a model that incorporates the role of complaint management in the
service recovery process. Recommended actions for each step are summarized in
Table 1 (p 282). The model contains six steps in the complaint management process
that influence effective service recovery and in turn influence patient
satisfaction and loyalty and ultimately customer retention and hospital
revenues.
The six steps of the complaint management process are as
follows:
1. Encourage
complaints as a QI tool;
2. Establish
a team of representatives to handle complaints;
3. Resolve
customer problems quickly and effectively;
4. Develop a
complaint database;
5. Commit to
identifying failure points in the service system; and
6. Track
trends and use information to improve service processes.
These six
steps, and recommended actions to take during each step, are now described.
Encourage
Complaints as a QI Tool
It is
important for the hospital to institute a formal policy throughout the
organization to provide a mechanism for patient complaints. The hospital should
view complaints as a QI tool and make it easy for customers to complain.16
Inform patients and their families of the complaint process on admission to the
hospital and reinforce the organization’s commitment to service excellence and
the importance of complaints to both patients and staff by posting visual
materials throughout hospital. Require staff to record all complaints on a
formal log sheet for documentation purposes and make them aware that complaints
are encouraged for quality, rather than disciplinary, purposes.29 Provide
monetary and nonmonetary incentives to employees who support the complaint management
process. Reward and recognize employees who comply with procedures to record patient
complaints, and deny rewards and recognition to those who do not. A combination
of individual and team-based compensation, rewards, and recognition will reinforce
and illustrate the value of complaint management to all employees.28
There are
several ways for a health care organization to encourage complaints. Patients
and families can be informed of the complaint resolution process as part of the
admission process. Patient handbooks can provide information on the complaint
management process, with a contact number to call if conflict arises. Patients
can be provided with an information flyer in their rooms that communicates the
hospital’s commitment to service excellence and includes a customer service
hotline number. Posters can be placed in the hallways that encourage patients
to express complaints and concerns, with a contact telephone number listed.
Finally, complaints can be solicited from patient satisfaction surveys that are
mailed to patients after discharge.
Resolution,
demonstrate the effectiveness of the complaint management program and reinforce
the organization’s ongoing commitment to encouraging complaints. Fewer than
half of the patients who have a negative experience with a hospital respond
actively to change the dissatisfactory situation, which suggests that written
complaints are just the tip of the iceberg. 12 Many times customers lodge
complaints with the nearest employee they can find. Although it is certainly a
challenge to ensure that complaints delivered in this manner are communicated
back to the organization, it is vital for an accurate assessment of
organizational performance.24 Hospitals should pay attention to oral complaints
made to hospital personnel because they are an accurate reflection of the level
of dissatisfaction with hospital services.12
Field reports
from one hospital involve a standardized systematic approach to complaint
management39; to capture the complaint as soon as possible, a physician or
staff member who receives a complaint immediately refers the patient to
management personnel. If a manager is not available, the complaint is recorded
on a standard patient complaint form. The information recorded on the complaint
form must accurately report the allegation as well as the patient’s suggestion
for correcting the situation. The complaint form is then forwarded to the
appropriate manager for further investigation.
To gain employee buy-in for the complaint management process, it is important
to make it easy for employees to track complaints. The hospital can provide employees
with simple complaint forms that serve as internal documentation used to record
service failures.24 It can also hire or designate certain employees to respond
immediately to complaints that require prompt attention, such as complaints
regarding quality or medical issues. For complaints that do not require
immediate resolution, employees can log the complaint by using coded data or
flagging the patient’s record until the appropriate manager can attend to the complaint.
The process can be further simplified by appointing a complaint coordinator
whose primary responsibility is tracking and compiling complaints soon after
they are registered. Employees for whom the workload does not permit an
immediate filing of the complaint could direct the patient to address the complaint
to the appropriate personnel.
Summary and
Conclusions
The growing
importance of customer service has prompted many organizations to make customer
retention a primary goal of their patient satisfaction programs. Customer
retention is enhanced when an organization can reclaim disgruntled patients
through the development of effective service recovery programs.
Health care
organizations can become more customer oriented by taking advantage of the
information provided by patient complaints, increasing patient satisfaction and
retention in the process. Satisfied patients serve as referrals for a health
care organization by encouraging others to use the service provider, whereas
dissatisfied patients can damage