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A Culture of Customer Service
Marshall M. Baker, MS, FACMPE
Physician Advisory Services, Inc., Boise, ID
Customer service is a frequently heard buzz word, the “culture” many ad- vocate, and, in the final analysis, the true demonstration of “walking the talk”.
Some will differ on whom they identify as their “customer” – for some anesthesia providers the response is often “the surgeon,” while most acknowl- edge their customer base includes a variety of individuals and organizations – patients, surgeons and proceduralists, hospital and health system administra- tors, surgery center directors, vendors, and members of the payor community. I submit that all of those listed and any others you interact with are “your cus- tomers” – they are whom you serve.
The key is whether these customers view your practice as customer friendly?
To better understand how your customers would rate your group’s customer service begins with a baseline assessment as to whether you and your colleagues are viewed as demonstrating a high level of customer service.
What is the level of satisfaction your customers have with your services?
Satisfaction surveying is encouraged and, while approaches vary, the goal is to better understand how you and your group are viewed (and rated).
Surveying techniques include telephone, focus group, written questionnaires, and the disciplined recording of “feedback” as it is received.
Some types of “satisfaction surveying” include:
• Patient Satisfaction (with the experience with their anesthesia provider)
• Surgeon/Proceduralist Satisfaction (with your service, responsiveness)
• Staff Satisfaction (both anesthesia group and delivery site (hospital, ASC, Endoscopy Center, birthing center, etc.) – about their experiences working with you (as clinical support or administrative support staff for you)
• Payors (what’s the “temperature of the water” when you or your staff interact with payors and their staff?)
Assessment is one tool that will produce information to either reenforce that a high level of satisfaction exists, or alert you to areas (and individuals) where there are opportunities for improvement. Examples of surgeon and patient satisfaction surveys appear on pages 7 and 8.
In addition to “after the experience” satisfaction surveying, customer service initiatives should be proactive. Here there are a variety of actions or initiatives the group might consider to build a loyal and supportive following. Two that I found produced positive results:
1. The anesthesiology group I was associated with instituted a “thank you card” program – our anesthesia providers would leave a card at the patient’s bedside when making post-op/post-procedure rounds. The card read:
   
   THANK YOU for allowing us to be of service to you. We are committed to a healthy community. If you have questions about the care we provided – call: XXX-XXXX If you have questions about payment of our charges – call: YYY-YYYY Anesthesia Consultants, PC

   The key here was two-fold, to genuinely thank the patient and to reinforce that we had been involved in their care – patients always remember their surgeon/proceduralist; but seldom recall the name of their anesthesia provider or the group that provided the anesthesia. In fact, many challenge the charges when received and it’s not uncommon to receive a call with the patient stating, “I never saw that doctor”. The card (with the anesthesia provider’s business card enclosed) can minimize those types of calls.

2. Another proactive approach we took was the recognition of every surgeon’s birthday – sending a card and a small gift (e.g. – one year it was a mag-lite flashlight, another a small tool kit, with our logo emblazoned on the item).
   

   First, the surgeons were impressed—one remarking, “My mother doesn’t even remember my birthday”.

   But the really positive result was when we were battling with insurance companies for payment for post-op pain management and consultation, and the payors threatened to reduce the surgeon’s allowable charge to pay for pain management.

   The surgeons rose to our defense (a new behavior in our community where relationships between anesthesiologists and surgeons often disrespect). Because of our positive relationship building activities (only one of which was the birthday gift), they advised the payors that requesting a “pain specialist” for their patient was no different than requesting a consult from any other sub-specialist, and such consultation and service was NOT a part of the surgical or procedural event.
Beyond surveying, cards, or gifts the theme you want to communicate to your customers is the way you and your colleagues treat people.
When there is an inappropriate behavior, how does your practice address it?
Like all communication, it is how the individual interprets your words or actions; and whether such disruptive and inappropriate behavior is viewed as such by you as well as by the customer.
Paramount to such a disruptive or inappropriate behavior is how your group responds. Is such behavior allowed to continue without intervention?
I would suggest a NO tolerance policy for outbursts, “scream-fests”, or deliberate disregard for “driving outside the lines” of established group culture and behavior. The development of a disruptive behavior protocol will be important to assure there is no misunderstanding about what is expected.
When an event occurs, there must be immediate action, and a process to coach the individual toward a change in behavior, with understanding of the consequences if there is no demonstrated change and improvement. To ignore these types of misbehaviors can result in a potential loss of business, damage to the group’s reputation, or worse, litigation.
Customer service should be a hallmark for your practice, and taking the time to craft a customer service program and instill a culture that is readily recognized as “customer friendly” for your organization will be a cornerstone to the long term success of your practice.


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Mr. Baker is an experienced healthcare executive, administrator, educator, and consultant. His practice focuses on strategic positioning; compensation design; practice structure/formation; and management and governance structure. He is a Past President of Ohio MGMA, New Mexico MGMA, the American College of Medical Practice Executives, Ambulatory Surgery Center Assembly (MGMA), and the New Mexico Heart Institute. He may be reached at 208-577-8869 or mbaker@physervinc.com.

The Customer, First and Foremost

Tony Mira
President & CEO, ABC

Most of us are aware of the supremacy of customer service in our professional lives. The subject doesn’t seem very technical or complex and it has not always been offered or seen as part of a professional education. Yet there is a considerable knowledge base on how to provide, measure and improve customer service. In this issue of the Communiqué, we bring you a variety of experience-based perspectives and tools:

• Marshall Baker, a widely respected consultant, describes the different types of customers served by an anesthesiology practice and offers several sample survey questionnaires.
• Marie Walton, president-elect of the Medical Group Management Association-Anesthesia Administration Assembly (MGMA-AAA), gives a highly practical explanation of how the employees of an anesthesiology group can foster patient satisfaction, to which Mr. Baker’s model “Customer Service Code of Conduct” is a valuable complement.
• Mark Weiss has generously given us yet another thought piece, in which he makes the point that the satisfaction surveys have an important role, but that anesthesiologists should try to study themselves as parties to working relationships first. Mr. Weiss uses the term “experience monopoly” to encompass all that goes into offering service “of such a high quality that your customers would not consider obtaining it from any other source.”
• In Bill Kingsley’s description of how he, as a tax partner with the international accounting firm of Grant Thornton, works to earn the loyalty of corporate customers, you are sure to find ideas that don’t appear routinely in articles on medical practice customer satisfaction yet can be adapted to anesthesiology to make your practice stand out. Note in particular Mr. Kingsley’s insight that “Usually, it takes a team to create a superior service experience. Teamwork means close coordination and collaboration by everyone—from the receptionist to the lead supervisor—to get the job done. Clients expect the left hand to know what the right hand is doing—if they perceive silos in how you operate their confidence declines and their risk of dissatisfaction increases.”
• In a team effort, five senior members of the staff at Anesthesia Business Consultants have chosen elements of customer service on which to offer some personal insight: effective listening, managing expectations, client-friendly use of technology and honesty with tact.

As vital as customer service is, there are other subjects that merit anesthesiologists’ and their administrators’ attention, starting, perhaps, with the very current question of whether to convert one’s IRA to a Roth IRA. Scott Thompson and Jon Koteski of Oakmont Capital Management, LLC in Oakmont, PA, explain this opportunity in their article “Traditional IRA: Shall I Convert?”



Legal issues, too, are always with us. Members of the Health Law Firm in Southfield, Michigan discuss (1) a recent criminal conviction of an Ohio anesthesiologist for prescribing pain medications in improbable quantities and taking just a minute or two to evaluate a patient and perform a pain injection; (2) the final regulations on mandatory notification of breaches of protected health information and (3) the Stark law exception for “in-office ancillary services” and its significance for pain practices.

Client satisfaction is one of our highest priorities at Anesthesia Business Consultants, just as it is for you. We would hope that our clients would grade us well above the 95th percentile and that you will let us know if we fail to meet your expectations. We also hope that this issue of the Communiqué will provide you with useful information.

Tony Mira
President and CEO
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Customer Service Makes the World Go ’Round
Marie Walton, CMPE
Vice-President, Client Services iMed Group, Houston, TX
Well, even if it does not necessarily make the world go ’round, good customer service certainly makes the journey less bumpy. We can all easily identify poor customer service—just think back to the last bad experience in a store or restaurant. Defining what comprises good customer service is a much more difficult task. Most agree that customer service is an organization’s ability to meet their customers’ wants and needs. However, many believe that good customer service is an organization’s ability to constantly and consistently exceed the needs of their customers.
Though our customers’ expectations and needs may differ according to our fields of service, the general rules of good customer service pertain to all of us. As I was preparing to write this article, I asked personnel in different areas of our office two questions: “Who do you consider to be your customers?” and “What do you do to provide them with good customer service?” I then analyzed their answers, incorporated them into my current research and arrived at the following common elements of good customer service:
• Be available–This element covers everything from answering your phone to returning emails. Customers want to be heard. Customers desire to reach a human being when they are trying to make contact with your organization. If at all possible, phone messages and emails should be returned within 24 hours – even if it is just to let the customer know that their message was received.
• Listen–Focus on what the customer is saying to you, be attentive, and show that you are listening to them by responding appropriately. Ask questions in order to understand their wishes and carefully listen to their answers to make sure you are meeting their needs.
• Keep your promises–Before you make any promises or commitments to a customer, make sure you can fulfill them. Keep appointments and meet deadlines. Being reliable is a key element to excellent customer service.
• Manage expectations–Many times what is perceived as poor customer service is simply a disappointed customer whose expectations were not met. This can be avoided by managing the customer’s expectations in order to have them match what you are able to deliver. Reiterate what you understand to be your commitment prior to completing the encounter with your customer. Your goal should be to exceed your customer’s expectations.
• Make customers feel important and appreciated–Customers are very sensitive and can sense whether you really care about them. Use their name (though not excessively) and take every opportunity to thank them for their confidence in you and for the opportunity to serve them.
• Be honest and sincere–Do not take advantage of your customers. Be truthful and keep what is in the best interest of the customer as your goal. People value honesty, integrity and sincerity and these traits engender confidence in you. Customers like dealing with people they can trust.
• Address complaints quickly–Nothing can ruin a positive customer service experience more than a complaint that is perceived to be ignored. Acknowledge a complaint as soon as possible and let the customer know that it is being addressed. If the customer is upset or angry, calm them with words and actions that show you take their complaint seriously. Once the customer is satisfied that their complaint is being addressed, make sure you thank them for bringing the problem to your attention. Let the customer know what you have done to resolve their complaint. Complaints should be viewed as opportunities to improve processes, policies and procedures.
• The customer is always right–While they may not technically be right, the customer believes that they are right. It is important to remember this when communicating with them and to avoid implying that they are wrong.
• Know how to apologize–When something goes wrong, apologize. Customers appreciate it, it is a simple thing to do, and it can defuse a potentially damaging situation.
• Be helpful–Assisting someone, even if it is not your job or will not reap you immediate benefits, can be a sure way of keeping existing or acquiring new customers. Help your customers understand terms and processes inherent to your organization.
• Go the extra mile–If you want to provide excellent customer service, make that extra effort. Do not just tell the customer who can help them, offer to contact them on the customer’s behalf. Customers notice when people make the extra effort.
• Use the power of “yes”–Always look for opportunities to accede to a request. Even when the answer is “no,” find a way to not have to say so directly. If possible, let the “no” decision be made by an entity other than your organization. Even if you already know that the answer to the customer’s request will be “no,” offer to inquire on their behalf and then let the customer know that the other party has denied their request. After all, there is always the possibility that something has changed and the answer will be “yes.”
• Train your staff often–Many people think customer service is instinctive but good customer service needs to be taught. Talk about what good customer service is and go over examples of both good and bad customer service and point out the differences. Use complaints you have received as teaching opportunities. Have your staff demonstrate good and bad customer service through scenarios or skits. Provide your staff with sufficient information and empower them to be able to make decisions that lead to excellent customer service. Your staff needs to be as concerned about your customers as you are. The final element of good customer service does not directly relate to customers but it is an integral part of an organization’s success in exceeding the customer’s wants and needs.
• Treat your employees well–Employees are your internal customers and need to be appreciated. Treat them with respect, thank them, let them know how important they are to you and they will treat your customers in a similar manner. Regardless of what responsibilities you have within your organization, you can apply these elements of customer service to improve your customers’ experiences. First, determine who your customer is, and then determine the process by which your organization can deliver its services or products in a way that allows the customer to access them in the most efficient, fair, cost effective, and humanly satisfying and pleasurable manner possible. Thus, you will be providing excellent customer service.
Additional training tools and information on this subject may be found in the Medical Group Management Association (MGMA) website at www.mgma.com by entering “customer service” in the search box.
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Marie Walton, CMPE is Vice-President for Client Services of iMed Group, a medical practice management company where she has worked for almost 10 years. Currently, she serves as President- Elect of the Medical Group Management Association Anesthesia Administration Assembly (MGMA-AAA). She has made many anesthesia business presentations for MGMA-AAA and Anesthesia Administrators of Texas (AAT). Ms. Walton may be contacted at mwalton@imedgroup.com.
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Customer Satisfaction: A Necessary Element For Group Success
Mark F. Weiss, J.D.
Advisory Law Group, Inc., Los Angeles, CA
Saturday afternoon. The store’s crowded and you’re in a rush. You’ve found two pairs of pants. You head to the counter to complete the purchase, only to find two sales clerks talking to one another about their evening plans. Five, ten seconds pass, they don’t make eye contact with you. Fifteen seconds, twenty seconds...
If you’re like me, you would have waited about five seconds before abruptly interrupting their conversation. If that didn’t work, you would have walked out. But that’s the entire point. No matter how wonderful the store’s selection and no matter how high its quality and reasonable its prices, it’s often the “details” like inattentive service that make or break the experience.
But you run an anesthesia group, not a store, so the lesson is not 100% transferable to your world — just 99%. If you were running a store, it would be obvious, should you take the time to watch, what your employees are doing. You could see them on the floor and observe their interactions, or non- interactions, with customers.
Granted, it’s a bit harder to watch your fellow partners or shareholders and your employed and subcontracted physicians and other staff members. But it is possible. And, what they are doing might just be destroying the future of your practice.
Multiple Problems + Few Direct Complaints = Big Problem For You
It’s no secret that disgruntled customers tell stories of their poor experiences and that this results in loss of business. In fact, a study conducted in 2006 by the Wharton School of Business and the Verde Group provides proof of this long-held general belief.
According to the study, which looked at retail customers, only 6% of disgruntled customers made a direct complaint. But 31% of disgruntled customers told their friends, family or colleagues what happened. And then those other people repeated the story, multiplying its effect. Altogether, the “Retail Customer Satisfaction Study 2006” found that for every 100 customers with a bad experience, a company stands to lose 32 to 36 current or potential customers.
Multiple Customers and Multiple Points of Contact
In the retail world it’s easy to identify your customer. It’s a bit more complicated in yours.
Anesthesia group “customer” interactions involve multiple interested third parties and multiple points of contact. There’s the patient and sometimes the family and other influencers. There are the surgeons, nursing and other technical personnel, hospital administration, the medical staff, and third party payors. As to each of the customers, the number of points of contact vary from the single instance to the continual stream.
And, to complicate things, in some cases the expectations of one customer group negatively impact upon another. Take, for instance, the example of case turnover time. Surgeons don’t want to “waste time” between their consecutive cases, but pressuring anesthesiologists to pick up the pace might adversely affect immediate post-surgical patient care (a key customer service factor if there ever was one) as well as the pre-surgical interaction between the anesthesiologist and the subsequent patient.
Setting the Stage for the Customer’s Great Experience And for your Great future
The first step in the solution may be the hardest: Stop kidding yourself that the delivery of expert, even world- class, medical care is sufficient to guarantee your group’s future. An “A” in anesthesiology does not automatically equate to even a “C” in customer service. Expertise from an anesthesiologist is simply expected; it’s just the down payment on your future. Expertise must consistently be supported with extraordinary customer service in order to guarantee that you will thrive.
Of course, this begs the question of what great customer service is.
On one level customer expectations are simple to discern: Customers want to be treated with respect, they want you to be courteous, they want you to listen to them (really listen to them) and to respond fully to their questions and concerns. They want you to be friendly, they want you to smile, they want you to say please and thank you, they want you to show up on time and they want you to follow through with what you say you will do.
In addition to those common expectations (which are often forgotten in terms of delivery) you must identify the specifics of ideal customer service at your institution, not through your eyes, but through the eyes of your customers. As the study discussed above reveals, you can’t do this simply by relying on complaints that have been brought to your attention, as only a small percentage of disgruntled customers will have ever informed you of the problems.
Certainly, you can conduct formal or informal surveys of your patients, surgeons and other customer service touch points. In fact, as your group begins to excel in customer service, surveys, especially those that reveal high patient satisfaction levels, have the benefit of not only spurring you on to even higher levels of performance, they become an important tool for leverage in the larger context of group/hospital relations.
But to begin, I suggest that you take a more practical, “down and dirty” approach: draw on your own knowledge base — not only as physicians in terms of how you value the interactions your colleagues have with you, but also with respect to the interactions you have had with your physicians when you have been a patient as well as your interactions with retail and wholesale establishments, both in regards to products and services. Ideally, you are aiming at creating what I term an “experience monopoly” for your customers: an experience of such a high quality that your customers would not consider obtaining it from any other source.
Don’t attempt to “benchmark” to other physician groups; instead, if you must benchmark at all, aim to compete with the Four Seasons or the Ritz-Carlton in terms of the experience that they provide.
To illustrate, let me provide you with two examples related to the anesthesia world, one directly, and the other tangentially, that describe this concept of experience monopoly:
In the late 1980s, I had minor outpatient surgery at a world-class hospital. More than 20 years later I recall the experience clearly. From a technical standpoint, the anesthesiologist must have been an expert: I felt no pain, had no complications and was back at work the next day.
But, shortly after the physician introduced himself to me in the pre-op area he walked a few feet away to make a phone call: several minutes of screaming at his divorce lawyer about his soon-to-be ex-wife, whom he did not describe in particularly endearing terms. He was so visibly upset that I wondered about his ability to concentrate on my care. Despite the fact that everything went smoothly, I would never consider having another procedure performed at that facility.
Contrast that with the following experience:
A few years ago, immediately after checking out of the Hilton Tapatio Cliffs Resort following speaking at the ASA’s Conference on Practice Management, I met Chester Haymore, the bellman.
Chester greeted me warmly, just as he did each and every person who passed him. He asked each person waiting at the hotel’s entrance if he could help them. He offered chilled bottles of water and suggested that people wait in the shade.
He quickly summoned cabs or town cars and arranged for valet parked cars. He loaded luggage into trunks and helped people into cars. He told a particularly tall man that he would adjust the seat in his rental car. When he overheard a man comment that he had cut his finger, Chester asked if he needed a band-aid!
Chester isn’t just a bellman, he is a one-man customer service king with a mission. He elevated the entire experience of the hotel, which otherwise was a slightly aging, unmemorable place.
Once you’ve examined your knowledge base of customer service experiences, my advice is that you look at each possible interaction between the members of your group and your customers and devise a set of expectations. I’m not talking about setting hard and fast rules for all conduct, as we’re talking about professionals and, in any event, you do not want to institute robot-like performance. However, there should be minimum expectations and those minimums should not simply be aimed at meeting minimum levels of customer satisfaction, but, rather, at hitting high levels of service that will delight the customer.
Next, you need to document your group’s customer service expectations and train your group, both physicians and other staff, in exceeding them. Importantly, you need to incentivize, both financially and socially, your group to take customer satisfaction expectations seriously. This means that your group’s compensation plan must take into account customer service factors in determining total compensation. It also means adopting a plan for the recognition of service excellence.
In order to accomplish these goals, you must coordinate your customer service plan with, and into, the provisions of your group’s organizational documents, subcontracts, employment agreements, and compensation plans.
For example, if your partnership agreement and employment agreement simply reward production, providing no incentive for better customer service, then you have abandoned the legitimate right to claim to be shocked when your group’s physicians rush for volume, even with an eye to patient care standards, but ignore the quality of customer interaction, only to have complaints, reported or unreported, destroy the foundation of your practice.
Addressing this issue as far as your physicians go is only a part of the process. You must take similar steps with any support and office personnel who come into contact with any identified customers. This extends to the employees of your billing service provider – one cranky interaction can destroy the improvement that your group, internally, has worked to achieve. Your contracts with, and policies adopted in respect of, these entities and individuals must support those requirements and provide for penalties in the event of breach.
Why Care?
Why do you need to care about customer service when your group has the exclusive contract at the hospital? After all, your customers can’t go anyplace else. Because customer service is directly related to customer satisfaction which is directly related to support from the medical staff and from administration. That support is essential in respect of renewing your exclusive contract and in obtaining necessary financial support from the hospital.
Sure, you may be the only game in town, but if you don’t pay attention to customer service, someone else will be the next only game in town.
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Mark F. Weiss, J.D. is an attorney who specializes in the business and legal issues affecting anesthesia and other physician groups. He holds an appointment as clinical assistant professor of anesthesiology at USC’s Keck School of Medicine and practices nationally with the Advisory Law Group, a firm with offices in Los Angeles and Santa Barbara, Calif. Mr. Weiss provides complimentary educational materials to our readers. He can be reached by email at markweiss@advisorylawgroup.com.
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Customer Service in Anesthesia Care
Jody Locke, CPC
Vice-President of Anesthesia and Pain Management Services, ABC
In the current economic environment it is not enough that anesthesia practices have consistently good outcomes from the care their practitioners provide. It is a given that today’s anesthesia providers can successfully manage any surgical patient safely, no matter how complicated the circumstances or medical history, through surgery and post-operative recovery. This is the basic service that anesthesia groups sell and that hospitals and surgi-centers buy. What matters is not just how well the anesthesia practice manages the patients’ surgical experience, but, rather how well the practice manages the broader expectations of its various customers. Anesthesia has become a critical cog in a much larger system. As such, the success or failure of the relationship depends not only on its ability to anticipate the needs of individual patients, but also on its ability to anticipate the needs of the system as a whole. This is why customer service has become one of the most important anesthesia practice management issues of the day.
Anesthesia training programs do an excellent job of preparing anesthesia providers for the exigencies of surgical and obstetric anesthesia. Most anesthetics take the provider through a familiar routine of preparation, induction, maintenance, emergence and recovery. Rare is the clinical situation that the provider has not already worked through at least a few times or where the fundamental physiological and pharmacological issues are not familiar. The operating room and the delivery suite are environments in which expectations and requirements are, for the most part, well understood and readily attainable. There is ample evidence of most providers’ ability to artfully manage the needs of patient and surgeon. Consistently reliable feedback of an array of monitors allows for timely and tactical decision-making. With experience comes confidence. Real challenge occurs when these same clinicians step outside the operating room into an environment in which they have neither the same type of reliable feedback nor the experience to consistently juggle a seemingly inconsistent and conflicting set of expectations and requirements.
Marketing consultants love to ask who is your customer and what does your customer want? Not only are these tough questions to answer in anesthesia, but no two sets of answers will be the same. Too often the default answer is “it depends,” which does not really allow for effective decision-making. If customer requirements cannot be clarified and quantified, service delivery strategies cannot be formulated and refined. While the same basic assessment and decision-making skills that make clinicians so effective in the operating room will actually serve them well in the Board room, the application of the concept is not always clear in an unfamiliar context. Anesthesia providers are trained to accept and rely on digital arrays that indicate how the patient is responding to anesthetic agents administered during the case, while the absence of such reliable monitoring tools and feedback outside the operating room makes for confusion and distrust. It may take some training, but anesthesia providers must learn to be able to read their customers like their monitors. There is no doubt that this is often more art than science, but it is not less important a skill.
Herein lies both the greatest single opportunity and quintessential test for the anesthesia provider. Anesthesia’s value to the system is that anesthesia providers do more to determine the overall quality of the patient’s surgical or obstetric experience than any other provider involved in the surgical experience. Because customer service is about perception, though, if I do not understand or appreciate how you are going to anticipate my every need and guide me safely and artfully through the potential trauma and stress of my surgery, then all your training and skill is for naught.
Surveys have shown that two areas of greatest concern to hospital administrators with regard to their anesthesia providers have to do with outlier providers and pre-operative communications. Too many groups suffer the consequences of their own inability to monitor and manage their problem providers. It is a curious phenomenon. So much is at stake and yet when it comes to monitoring how different members of the department or group interface with patients and other members of the medical staff there is an unfortunate and, sometimes, fatal tendency to turn a blind eye. There is a fine line between the competence of a clinician who can listen to and evaluate the situation of a patient effectively and in a way that the patient is left with a sense that he or she is in good and competent hands, and the arrogance of the scientist who does not appear to need or want the input of the patient. In other words, today’s patients want what they get in the salon; they want to be cared for and not just taken care of.
We all know good customer service when we experience it. Some intangible quality bonds us to certain service providers, even though we may know they are not the best providers or the cheapest option. Research suggests it is not the relationships where nothing goes wrong that are the strongest, but the ones where the commitment of the provider to find solutions and keep the relationship are evident. If your mechanic does not fix a problem with your car the first time, you may be upset but you will give him the chance to solve the problem. If the problem is resolved then your stock in him goes up but if he does not demonstrate an attitude of caring, compassion and contrition you will not go back.
The reality of today’s increasingly complicated reliance on technology is that not all solutions are evident or easily identifiable. This is especially true of medicine. A hospital is a forum for collaborative problem-solving where teams of providers and administrators work in partnership to achieve two related goals: higher quality care and stronger balance sheets. It is normally assumed that if they accomplish the first, the second will follow. Given the vagaries of the market, however, there is not always a clear connection between the two and sometimes the latter supersedes the former.
Each of the following five stakeholder’s perspectives on the surgical experience is defined by his or her own requirements, expectations and history. It is not unlike the parable of the blind men and the elephant. Each one sees the relationship only from his or her perspective. Typically, none of the participants is willing to look at the relationship through any other lens. It is easy to see why anesthesia providers become so exasperated with their interactions in the operating room suite; no one else sees what they see.
• Patients want amnesia and the confidence that they will be pain-free and safe.
• Surgeons want availability so that they can get their cases done in a manner that allows them to be productive.
• Hospital administrators want affordability because they are always struggling with the bottom line.
• The Operating Room staff and the nurses, by contrast, want affability because they have to deal with a variety of personalities and complex clinical situations.
• Meanwhile the members of the anesthesia department or group want acknowledgement for their hard work and tireless service.
It would be easy to say that what is needed is for all the stakeholders to take a step back so they can see the whole elephant, but this is easier said than done; they are too busy trying to satisfy their own interests. It is also unlikely and unrealistic to assume that the paradigm will change from without, although occasionally hospitals do take dramatic and draconian steps to shake things up.
It would be equally naïve to assume that any of the stakeholders is willing to acknowledge the potentially pernicious impact of his or her pursuit of self-interest. No commuter leaving home at 8:30 in the morning is willing to take responsibility for the traffic jam that results when hundreds of thousands of people do the same thing so they can get to work and provide for their families. This is the nature of system problems. Our roles and responsibilities are all defined by a system over which we have little influence and no control.
Specific vulnerability of the anesthesia practice is defined by its replaceability. Contrary to popular belief, the anesthesia practice is the most readily replaceable of the five stakeholders listed above. There is no more compelling evidence of this fact than the growth of staffing companies such as Sheridan Health Care, NAPA, Sonos, Premier, etc. Many of the nation’s largest anesthesia practices have also become active players in responding to Requests for Proposal (RFPs) and in accepting contract agreements for the provision of services outside their primary catchment area.
This explains why customer service has become both a challenge and an opportunity to the typical anesthesia group practice. The challenge is survival, but the opportunity is security. Both are defined by clear evidence of and a compelling commitment to customer service. What makes so many group practices vulnerable is the perception on the part of the O.R. staff and administration that they “don’t get it about customer service.”
No service relationship is perfect and it is unrealistic to think that there will not be some disagreements or miscommunciations in the relationship between an anesthesia group and the management of the operating room. The strength of the relationship can best be measured in three areas. The first is the consistency of care provided and the perception of the medical staff. Contrary to popular opinion, superior clinical care is an essential pre-requisite. The second is the way the organization deals with its shortcomings and problems; a perception that a practice is willing to accept its shortcomings and a pro- active approach in addressing them is essential. It is never a good sign when the hospital administrator has a list of “problem” providers. The third and final factor is the management of the practice; practices that have strong leadership and which speak with one voice are always preferred over those that function as loose confederations of independent providers. A lot can be learned from the hospital administrator. Practices that do not have regular interactions with administration are generally more vulnerable than those that do.
It is these same three qualities that define the practices with the best and most secure relationships with their hospitals. A commitment to excellence in execution is essential and best practices are continually striving to anticipate clinical needs of the institution. The second quality that creates and engenders confidence is strong internal monitoring and peer review. Best practices not only do various forms of continuous quality improvement but will identify opportunities to have additional staff improve their skills or learn new techniques. There is obviously no one right way to run a hospital or its operating room suite. Because the anesthesia department inevitably has more and better data about what actually happens day to day there is an expectation that anesthesia can be a strong contributor to the ongoing improvement of operating room operations. But by far what distinguishes the strongest relationships is the way administrations interact. If leadership of the anesthesia practice has a good rapport with administration that allows for collaborative problem-solving and strategic planning, then almost nothing else matters. There is no clearer evidence of this that the level of participation in hospital committees. The practices with the tightest relationships to their hospitals are those that are willing to share data and ideas and which make it a point to offer solutions rather than to complain about problems.
It is a sad reality that those practices afraid of losing their franchise probably will. Unfortunately, there are many others that don’t even realize just how vulnerable they are. Not a week passes but that some anesthesia group president is surprised to learn that his hospital administrator has decided to send out an RFP. The lesson here is that those groups that fail to take the feedback they are getting from administration seriously are doomed to be victims of their own ignorance. Every organization can be improved and every relationship can be made stronger through communication. The fact is that those organizations that are confident they are providing the best possible care and creating value for the institution and have evidence to prove it will likely enjoy long and profitable relationships. Customer service in the world of anesthesia is all about partnership; the more you commit, the more you benefit; but it is an all or nothing proposition You either get it about customer service or you don’t.
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Jody Locke, CPC, Vice Presient of Anesthesia and Pain Management Services for ABc, is responsible for the scope and focus of services pro-vided to ABC’s largest clients. He is also re-sponsible for oversight and management of the company’s pain management billing team. He will be a key executive contact for the group should it enter into a contract for services with ABC. He may be reached at Jody.Locke@anesthesiallc.com.
 
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