What hospital failure can teach us about customer service

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Data from the UK’s Department of Health shows a fifth of hospital trusts in England may be covering up mistakes.

The review said this may be a sign of a “poor” safety culture. Safety is something that all industries should take seriously, not least the healthcare sector. Yet, if we consider safety improvement alongside service improvement, some much wider lessons emerge.

Ask any customer service team leader what they look for in an ideal employee and it is likely that they will describe some or all of the following characteristics:

  • Gets on and sorts a problem without making a fuss
  • Works as part of a team and compensates for the strengths and weaknesses of others
  • Rarely, if ever, makes mistakes
  • Acts as an ambassador for the way we do things around here

Essentially, we all seem to want employees who solve problems for customers with the minimum of fuss.  However, it may be that this type of behaviour is exactly what you don’t want if you desire a leading edge service improvement culture.

That’s the finding from an in-depth study of system failure on the front line of care delivery in nine US hospitals including intensive care units, maternity and oncology wards (Source: California Management Review ‘Why Hospitals Don’t Learn from Failures:  Organizational and Psychological Dynamics that Inhibit System Change’ 2003)

The study made important distinctions between problems (e.g. waiting for equipment, missing information, work overload) and errors (e.g. failure to give correct medication, patients incorrectly transferred between wards)

The first thing to accept is that errors and problems happen.  No matter how successful your service organization, failures will occur.  What is key are the behaviours that front line teams display in solving these problems. The classic customer service characteristics described above will typically only solve the issue in hand.  Whether it’s a returned item that was found to be faulty, or a missing application form for a new service, the ‘no-fuss’ approach will only ever mollify the current customer.  The ‘no-fuss’ approach won’t address the underlying cause.

For example, nurses were encouraged to take personal responsibility to solve problems, yet counter-intuitively, this drove a behaviour to fix their problem rather than the underlying cause. Their compassion understandably encouraged them to deal with the immediate needs of the patient, yet their scoping of the problem usually ignored tackling the root cause as well.

The nurses were measured on the quality of their patient care, not overall system improvement. Their empowerment to solve problems was also introduced alongside a reduction in manager support, whose role was seen to be more broad in perspective, rather than ‘hands-on’. The net result was fewer managers around to receive feedback and identify systemic failure.

It may be that something similar is occurring in the NHS in England – that the majority of employees are trying to fix the problem in front of them, rather than supporting a systemic change in safety improvement.

Meanwhile, for those of us trying to design and deliver ideal customer service, we may need to change what we’re looking for in an employee. The new rules are to find someone who:

  • makes a fuss when problems happen
  • points out when colleagues have made an error for the sake of learning
  • admits to making mistakes and learns from them
  • challenges the status quo and looks for better ways of doing things

Such a shift may be a difficult cultural adjustment, but a necessary one if we are serious about improving the quality of service (and care) our organisations can offer.

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