The Seven Elements of Client Service

Programs designed to improve service to clients have been around since the early 1990s, but most veterinary practices have taken a renewed and more serious interest in these “client-centered” efforts in the past few years when client visits started to drop off.  This is partly due to the 2008-2010 recession, recent studies and industry reports, but it is also because practice leaders understand that when the client believes the service they receive was excellent, it is easier for staff and primary providers to their jobs.  Client satisfaction is a proven win-win, especially when you understand that the best veterinary practices have over 50% of their new clients coming from word-of-mouth referrals from satisfied clients.

That said, achieving excellence and sustaining measurable gains is not easy.  And, because many early client service initiatives were not successful, there has been skepticism among practice owners . . . so what went wrong?

Some past programs were “eye-wash” gestures, assigned to the practice’s front team, with minimal training.  Others were shallow attempts at “guest relations” or “charm school” techniques focusing on the front-line team, with little commitment from the primary providers or practice leadership; these were just “band-aid efforts” and had little sustainability.  In some other cases, people were not held accountable for expectations, with few, if any, consequences for noncompliance.  In many cases, leaders were not given the education or tools needed to successfully improve service in their respective spheres of influence.  Finally, and most importantly, early efforts, and even some successful, well-received initiatives, did not last; there were no metrics geared to supporting the new initiatives, so recognition and replication had no foundation.  In order to have a spirit for client-centered service in any organization, you need a culture of client-centered patient advocacy, and many practices just did not have the necessary infrastructure in place to promote, replicate, or export things that seemed to initially work.

“Client-centered patient advocacy, to extend and enhance, the quality and duration of an animal’s life” is not just lip service or some “cool jargon” from some consultant. It is the philosophy that is embedded in all my consults!

Systems can be established to address those pitfalls of the past, and create a culture of client-centered patient advocacy IF, and ONLY IF, the healthcare delivery leadership pays special attention to the following seven areas:

1. WRITTEN STANDARDS OF CARE

A strong client-centered patient advocacy practice culture starts with the consistency and compliance of the providers to an established Standards of Care (SOC), especially in the well care programs.  This establishes not only the right mind-set within the practice team, it also reduces the fear of “saying the wrong thing at the wrong time” to clients.  The SOC must be written to the current State-of-the-Art in veterinary medicine, it captures the WHAT of the delivery programs. The WHY is established as the SOCs are shared with the team members.  The WHO and HOW are established by the zone teams and brought back to the practice group for integration and assimilation.  The WHEN is by joint discussion before the program is initiated, so the milestones, and measurements of success, are known by all and not changed at the whim of an owner or passing provider.

As a matter of practicality, we start practices with the outpatient well care programs, since that is not only 70% of the front door swing rate, but also the easiest to get consensus by providers.  As time progresses, the SOCs begin to embrace the routine elective procedures and inpatient procedures.  Program protocols FOLLOW the SOCs, they are part of the WHO and HOW, not the WHAT – protocols belong to the team, and cannot be changed arbitrarily by a primary provider, unless documented in the medical record.

2. RAISE AWARENESS

A strong client-centered service orientation culture starts by having the right mind-set, and there are a variety of things leaders have done to set the stage, often by answering a few critical questions, such as:

• Why is the practice focused on speaking for the animal’s needs?
• Why do we want to focus on improving our client-centered approach?
• What are the real objectives of the initiative?
• What will be different or changed as a result of these efforts?
• What are the behavior and competency expectations for staff members?
• What will the primary providers and practice leadership do to support this?
• What is in this for the staff to get on board?

Leaders should think through answers to questions like those shared above and design ways to share important messages with staff members.  Speaking for the NEED of the patient, since seldom do our patients get to speak to their owners, usually rings true to our staff; they joined this profession as a calling and want to do right by the animal.  Using the action word “need” instead of confusing the client with words like “recommend” or “you should consider sometime”, is part of this clarity of purpose to the SOC format.

A common question is often. “Aren’t we already doing this?”  One way to find out is to shadow clients to discover what is working, as well as opportunities for improvement (see Shadowing-Data Collector Tool on the next page, used for assisting in tracking client reactions to services offered and/or received).  Computer tracking of specific procedures per 100 transactions supports the shadowing process.

If you involve the skeptics in these shadowing exercises designed to get closer to client perceptions, it reinforces the importance of focusing on client-centered patient advocacy, as well as assisting in the break-down of some of the resistance to change common to veterinary healthcare staff.  These activities must be ongoing, so every staff meeting provides a staff member the opportunity to share client perceptions about what the practice has been doing as patient advocates and with SOC compliance.

3. SET SERVICE EXPECTATIONS & STANDARDS OF BEHAVIOR

Talk is cheap, and clear standards of behavior must be set and reinforced, by example as well as by interactive review.  Unfortunately, history has shown us this is where many veterinary practices often fall short.  The owner or primary providers have been making personal exceptions for so long, they believe it is their right and privilege.  Some practices have written protocols, but then failed to ensure they were followed 24/7, 365, by every provider in the practice; owners are the biggest offenders, since they have the largest network of “good old mates” accessing the practice. Service expectations became “wish lists” rather than the example of “this is how we do business here”.

Begin by creating ideal client-centered service oriented behavior expectations so the staff and other providers not only know the behavior expectations, but see it being practiced every day in every way, 24/7, 365, by the owner, tenured providers, and managers.  These expectations are included in every hiring and orientation process of each and every new employee, even new associates!

Once established, work on improving only 3 or four of the behavior expectations (or maybe five or six interrelated behaviors) at a time, for at least a quarter at a time.  During that period, teams can be expected to create zone-specific standards that mirror the practice’s overall expectations, and monitor, measure, and provide feedback to reinforce the standards in everyday operations. It is impossible to watch all service behaviors at one time, so the “thematic” approach creates a consistency and awareness which sends the message, “We do mean business when we say it is a behavior expectation!”

4. IDENTIFY & ELIMINATE BARRIERS AND OBSTACLES

Early service excellence efforts suffer when the emphasis in a practice is only placed on behaviors and people issues.  This is because policies that do not make sense, procedures that get in the way, and rules, norms, and protocols that make satisfied client a difficult target, all need to be addressed.  All so often, a practice policy is just a scar from a previous bad encounter; when challenged, the explanation is something like, “Susie was the only one that did it, so we set a policy, but Susie is gone, yet we kept the policy to be safe!”

Exceptionally led practices spend time, money, and resources streamlining systems and processes to make them more user friendly, and try to change things in a Continuous Quality Improvement (CQI) environment so that clients, providers, or staff members do not feel frustrated or helpless when trying to improve the client service systems.  The challenge is identifying the “right” issues as a system for the team assessment(s).  Based on the one-at-a-time approach for behaviors, start with the “chosen” behavior group and ask clients and staff, “What is in the way?”  Next, place the issues and challenges into four categories:

• EXCUSES: Get over it, move on!
• EASY TO FIX: Just do it, get on with it!
• HARD TO FIX: Prioritize and make a case for change.
• CAN’T BE FIXED: Redefine the setting, learn to live with the challenge.

Practices can prioritize and oversee hard to fix issues (see the DIG BOARD concept, Appendix A, Building the Successful Veterinary Practice: Innovation & Creativity (Volume 3), Blackwell/Wiley & Sons publishers) and install a system of 30-day improvement initiatives in every group for the easy-to-fix options. If you are already doing “all of the above”, be very proud, you have developed an organizational behavior culture that is continually innovating and improving service.  These techniques will not solve all challenges, but it will send a clear message that you and your team will do what it takes to succeed.  Clients will notice the difference; pride will be perceived as quality, and clients are willing to pay extra for the peace of mind that comes with a confidence in quality care for their four-footed, furry, family members.

5. LISTEN TO YOUR CLIENTS

This actually leads us to a critical strategy of al change actions: measurement and feedback.  You cannot celebrate without a scorecard, and what gets measured, gets done!  Feedback can promote improve – if it is about course correction and NOT about what someone is doing wrong.

For feedback to be effective, however, it must be tied to specific targets and objectives for action, and it needs to be front-line driven.  Staff members should be able to identify who to talk to about what issues, discover ways to collect and share information (processed data), and most importantly, determine how to use the feedback being collected to celebrate and cause course correction.

FOR INSTANCE – learn to help teams celebrate successes by asking zone leaders to brainstorm a list of recent improvements (don’t be surprised by the length of the lists – when excitement is high, the lists are endless).  Then ask them to choose a few it believes other teams may not have on their lists. To finish the process, ask for a staff meeting presentation of the high points, then post the list(s) so everyone can see what has been accomplished.  Everyone works hard to make things better for clients; not sharing the changes, improvements, and successes is a missed opportunity, and feeds the skeptics who say, “Nothing ever changes here!”

The goal is to understand the client’s experience so we can respond appropriately to challenges as they occur.  Making amends after the fact may be too late (but continue to strive for addressing the client’s concern within 24 hours as a matter of policy).  If mistakes are seen as an opportunity to learn and grow, a practice must stop thinking of service recovery as damage control and instead view it as an opportunity to improve performance!  We support this shift in thinking in many ways, including 1) quarterly council of clients (focus groups), 2) asking targeted exit interview questions of departing clients, 3) using simple, targeted, 30-second survey cards, 4) watching/shadowing clients as they go through the outpatient system, and 5) soliciting staff opinions on client perceptions. These techniques can provide valuable information.

Practice staff can learn ways to respond to client complaints and concerns, and be empowered to right a wrong.  This is a departure from the traditional approach, which relies on the practice owner or primary provider to handle client perceived problems.  Having to wait until a busy clinician has the time to handle a client concern can be frustrating to clients and wastes a wonderful opportunity to involve and engage staff in acting like owners of the practice programs.

6. REINFORCE AND SUPPORT CONTINUOUS IMPROVEMENT

The real challenge with client-centered patient advocacy initiatives, and the subsequent client satisfaction levels, is keeping the energy, learning, and improving alive and ongoing. Savvy leaders realize that every meeting is an opportunity to share their passion for and strategy related to improving service. They also seek ways to help zone teams celebrate success, learn from experience, and build team spirit.  If managers and zone coordinators see the practice owners and primary providers model service excellence behaviors, as well as own the process, they are much more likely to mirror these behaviors in their sphere of influence.

So in meetings, ask people to share service stories and examples, and think of people they personally can thank for making their jobs easier.  They can read letters from clients, or inversely, send personal thank you notes to help people feel good about their contributions.

Developing a strong foundation for client-centered service takes time and dedication, as well as an exemplary organizational behavior practice culture (Signature Series monograph on Organizational Behavior, with an electronic tool kit, is available from the VIN Bookstore).  It is not simple, and it is not about doing one thing, but actually doing many things with a single objective: Client-centered patient advocacy to extend and enhance the quality and duration of an animal’s life.

Is it worth it?  Will it produce results?  I believe that paying attention to these seven strategies for improving client service will help any practice make a difference not just in the short term, but also over the long haul!