What is five-star service? We know it when we experience it.
Consider the hospitality industry, where the five-star concept has its roots. You recognize what a five-star restaurant is when you dine there, and you know a five-star hotel when you stay there. Where it gets interesting is that many of us have received five-star service at a hotel that’s been rated three stars, and we’ve endured two-star service at a hotel that’s touted as five-star.
Why? Because true “service” goes beyond a good meal or a well-appointed hotel room. The rating encompasses the entire experience.
A five-star rating in a medical practice designates a high level of service, but one that is thoughtful as well. Five-star focuses on quality and service at every phase of your patients’ experiences and interactions with your practice, whether it be in person or by telephone. Simply put, five-star designates a pervasive culture that is consistently applied internally to staff and externally to colleagues and, of course, patients and their families.
True five-star customer service in healthcare is rare, which creates a real opportunity for medical practices to move up the five-star continuum and differentiate themselves.
Five-star customer service may seem to be common sense to those first introduced to the concept; however, in reality, providing five-star customer service on a consistent basis can be extraordinarily difficult, particularly when the individual health professional or practice is under stress. Why? Because true five-star service addresses behaviors, actions, and reactions.
Further, it is far easier to provide five-star service when the EMR is working, everyone shows up for work, it’s sunny and 75°, and you don’t have a medical malpractice lawsuit looming over your head!
Unfortunately, this rosy scenario is not always the case. How an organization operates under stress is critical to the success of the organization; this is when the five-star culture kicks in.
We often hear comments like:
“Our scores are already in the top 20%; we are very good in the satisfaction area.”
“The doctors in our practice have not been sued much, so clearly we are doing something right!”
“We just do not have the time to establish five-star service right now. We are going to focus on taking care of patients.”
“Most everyone in the practice understands this . . . well, not Dr. Smith. That’s just the way he is. But he’s a great doc.”
Although each statement sounds reasonable, every one misses the point to some degree. Do not be satisfied being in the top 20%, particularly under the present scoring system. It is great that you have not been sued, but that is not your only goal. Focusing on taking care of patients is critical, and five-star service can be a component of providing high-quality care. Today’s “great” doctor or today’s “rock star” will excel at five-star service! This culture can propel your practice to the top.
Barriers To Five-Star Service
It would seem that this concept of high-quality customer service is yesterday’s news, yet, five-star has not permeated most organizations. That’s in part because of perceived barriers to attaining a five-star practice. So, one of your goals should be to identify the barriers and work to overcome them. In conducting hundreds of five-star practice evaluations over the years, we have identified some common barriers to success, including:
Belief that being in the top 20% is good enough.
Lack of true buy-in from leadership.
Lack of an objective understanding of where a practice is on the five-star baseline.
Belief but without a real plan for implementation.
Lack of follow-through after the rallying “kick-off.”
Lack of consistent training on the basics.
Failure to focus on what truly matters to patients.
Practices that keep the naysayers for too long.
Lack of ongoing measurement.
Lack of a true “service recovery” process.
Frustration by champions, who finally give up.
Disregard of stressors.
Failure to incorporate into employee interviews/evaluations/compensation metrics.
Let’s review some of these in greater detail.
Contentment with Current Scores. We have heard from hospitals and practices that they rate in the top 20%, so their work is complete. This is a false sense of security. First, many scoring systems are flawed; they are not specialty-specific, are overly generic, or should be considered only as a baseline. Many practices, after specialty-specific testing, find significant opportunities for improvement. The fifth star is elusive. You have to keep chasing it.
Lack of Buy-In from Leadership. Leaders — both physicians and non-physicians — play a critical role in promoting five-star service as a cultural phenomenon. Five-star service is about what you do, not what you say you are going to do. Others will watch the leaders and learn from them. If you are a leader, this is your chance.
Lack of a True Objective Baseline. If you do not know where your practice is on the specialty-specific five-star baseline, you will not be able to deploy your resources effectively. Every practice should undergo an objective five-star evaluation and use the results to identify the areas of opportunity and formulate the practice’s short-term and long-term goals.
At the end of the day, most practices are not where they thought they were on the five-star scale. Gathering the data to find out where you are is a good and necessary first step.
No Real Plan for Implementation. If there is no plan, then there will be no real forward movement to affect the five-star culture. Everyone will simply continue with the day-to-day routine they know. A plan should be created that includes immediate, short-term, and long-term goals, as well as timetables, responsibilities, and accountability.
We recommend establishing a five-star committee that meets quarterly, with an agenda that assures the five-star concept is front and center. To get something done, someone must be responsible for the five-star committee being successful.
Lack of a Cultural Infrastructure. Many practices embark on a five-star initiative, only to fail because the cultural infrastructure critical to nurturing the five-star concept was not fully developed. The basic culture must be in place first; otherwise, it is an uphill battle that will not take hold for the long term.
This infrastructure can be established by leadership buy-in; through educational programs such as “Developing Your Five-Star Service Culture” or “How to be Part of Your Practice’s Five-Star Service Culture” or “Maintaining and Enhancing Your Five-Star Service Culture”; and by making it part of the operations of your practice. This could include describing the culture on your website, including training in your orientation programs, and making it part of your evaluations and your compensation system.
Lack of Training on the Basics. Staff cannot simply be told, “Next Monday, we are starting a five-star program . . . get ready!” They need education on the basics of the five-star concept: what, why, and how. This basic information can evolve to more advanced education about topics such as defusing anger, dealing with the frustrated patient, improving body language, and showing empathy.
These educational processes can take place with adult online learning, web-based programs, in-service programs, or a combination. Eventually, great educational topics will come out of your own patient experience data.
Failure to Focus on What Truly Matters to Patients. Most healthcare professionals do what they do because they want to provide quality care to others. Clearly, clinical care is paramount, but interpersonal relationships are key as well. Research tells us that what patients and families want most from their physicians is to provide confidence, empathy, humaneness, personalized care, respect, thoroughness, and directness.(1)
Patients want their healthcare providers to make them feel valued and cared about. The five-star concept supports the conveyance of this feeling to patients throughout the practice.
The most powerful tool to better understand what your specific patients believe is important is to survey them. To really understand what they want, you need to know what they want from you as their physician and what they expect from your practice as a whole.
The patient experience is more than your brief 10-minute examination; it includes the check-in procedure, the receptionist, the waiting room, the décor, the cleanliness of your facility, the nursing staff, and so on. Finding out how patients feel about these topics through scientifically crafted questions is a critical success factor today.
Keeping the Naysayers for Too Long. Even practices that take five-star service seriously put up with the naysayers for seemingly reasonable reasons; however, the naysayers can be like a virus that infiltrates your practice, infecting one person after another until the five-star service culture deteriorates and is no longer pervasive or habitual.
Naysayers come in more than one flavor. Some are complete eye rollers, and that’s an easy case. Others say the right things on occasion, but neither buy in nor contribute to your five-star culture. In fact, they seem to look for opportunities to complain or point out why it’s not working. These are more subtle but just as important to address.
When you tolerate these people, you are sending a message that their behavior is acceptable. Of course, you should first try to help them, counsel them, and provide them with additional training. However, if their negativity persists, they need to move on.
Be sure to follow your internal employment policies and procedures and relevant laws as you go down the path of potential discipline and, ultimately, dismissal. Believe us, when one individual is let go for not participating in the practice culture, it is a message heard loud and clear throughout the entire practice!
Lack of a True Service Recovery Process or Lack of Use of an Existing Process. No five-star culture can exist without a true service recovery process. By “service recovery,” we mean management of any service breakdown, such as late appointments, missed lab notifications or orders. These may seem like little things to the practice, but they are big things to the patient!
Often practices do not incorporate a service recovery program, believing that it would be too time-consuming; however, the opposite is true. When done right, a service recovery process can save time for the entire healthcare team. If you address it correctly, you can get right back in the game. If you ignore it, it can put a bull’s eye on your back. Have a service recovery policy and procedure in place that includes responsibilities for managing these matters. In the long-term, this will create greater efficiencies.
Champions Get Frustrated and Give Up. Without the cultural infrastructure, investment in training, and ongoing support, and with the other barriers discussed, the true champions of the five-star movement can become frustrated and give up. If what they are doing is not appreciated by the practice, they decide it’s no longer worth the effort. Support your champions. Celebrate the change. It takes time and support.
Stressors Are Unrecognized or Are Not Addressed. Oftentimes, stressors go unnoticed or, worse yet, are noticed but not addressed. Stressors cannot always be eliminated, but they often can be acknowledged and tension reduced. Change produces stress, and significant changes occurring in the healthcare environment become everyday stressors, including:
Increased volume of patients requires more staffing.
Greater emphasis on physician collaboration across specialties, often without a platform.
Introduction of the Accountable Care Organizations and unfamiliar changes in reimbursement methods.
Broadened scope of practice for medical professionals.
New mandated preventive care requirements along with the systems necessary to accomplish and track.
New payment methodologies that change the focus of reimbursement from volume to value.
Emphasis on electronic medical records and related communication strategies.
Increased required data collection resources.
Introduction of the patient portal and its implications.
Changes in the work/life desires of physicians.
Continuation of a difficult litigation environment.
One or a few of these challenges may have been a stressor, but several of these occurring simultaneously makes five-star service all the more important. Again, the key is to acknowledge and manage the stressors and concurrently build your culture.
Conclusion
Five-star is the pervasive (excellence even under pressure) and consistent (by every individual in the organization) effort to focus on what is important to the patient and the family. It can be simple: Be empathetic and smile when appropriate. It can be challenging: same-day scheduling. Regardless, the payoff is immense.
Congratulations to those of you who have high scores in customer satisfaction. You clearly are champions and are well-poised to take your practice/your hospital to the next level. Do not slow down. Continue to ramp up and challenge yourself to discover, per specific specialty, what makes a difference to your patients and how they can be better engaged. This is an area in which we all have a lot of room to grow.
Reference
Bendapudi NM, Berry LL, Frey KA, Parish JT, Rayburn WL. “Patients’ Perspectives on Ideal Physician Behaviors.” Mayo Clin. Proc. 2006 Mar;81(3):338–344.