Geriatrics, Bedpans, and the Customer Experience

The Millennium Fangel Retirement Community is set on a beautifully landscaped 35-acre campus and marketed as offering the very latest in residential styled living and assisted living apartments. At its core is a state-of-the-art special care unit for elderly individuals with life-changing conditions and illnesses – what many would term a ‘geriatric hospital’.

Being only a year old the geriatric unit is scheduled for an interim inspection by government agencies on its care practices, and quality of patient care. At stake is a continuance of its operating license. The audit will include interviews with staff, patients, and patient family members to determine levels of proficiency and satisfaction.

The entire campus is very high-tech and serviced by the Millennium Fangel IT organization centered in Atlanta Georgia. The senior nursing staff was eagerly awaiting the arrival of their local field technician – Fred. They are under extreme pressure to prepare copies of reports and printouts required by management and the audit inspection team, and a vital high-speed laser printer has broken down.

Fred arrives at the scheduled time and is led to the printer by Susan the senior staff nurse on duty. She seemed very rushed and stressed. It doesn’t take Fred long to resolve the issue, which involved the replacement of the maintenance kit and a cleaning of the entire printer internals. “Anything else I can help you with while I’m here?” asked Fred innocently. Susan was quick to respond, “Oh yes! We have a major issue with the inventory system and the availability of bedpans”.

The Bedpan Issue

Susan went on to demonstrate and explain the procedure she and her staff had to follow to request the use of a bedpan through interaction with the inventory management system. With some frustration Susan said, “… and after all that, more often than not, we find no bedpans in the cupboard store!”

She continued, “This is huge issue for me and my team, and of course the patients. Any delay in responding to a patient’s need for a bedpan, results in extremely embarrassed and unhappy staffers and patient, not to mention family members who likely hear about the debacle afterward.” Although Fred was not an expert in the systems involved, and it was way beyond his normal jurisdiction, he recognized Susan’s desperation and immediately checked with the IT support center.

Susan could overhear Fred as he first confirmed the printer was now working and then discussed her bedpan issue with the support center. “No record whatsoever of the issue, hmm…”

As Fred ended the call Susan was interrupted by the panic button being pressed by Mrs. Hitchcock in bed 13. Fred noticed staff ignore the inventory system, checking the bedpan store first – it was empty. Over the next ten minutes the worst-case scenario played out as staff failed to locate a bedpan, and helped the patient as best they could, to the embarrassment of all involved.

Observing the Natural Habitat

Contrary to policies and Fred’s jurisdiction, he extended his stay and took careful notes, adding comments from other staffers. He noted this happens 2-3 times a day and took two staff up to an hour to put everything back to normal. As he left, Fred promised Susan he would present this to the support team and get her the help she clearly needed.

Shortly after meeting with the Support team, Fred’s notes were translated into a formal support request, an ‘incident’. The degree of impact to the nursing staff and patients, and especially on the possible outcome of the audit, caused the problem investigation team to take special note, and engage. They visited with Susan and her staff and interviewed them, as well as some patients, to define the full extent of the situation. At the heart of the investigation was their need to understand and document its true impact, and the overall experience of all concerned.

A Management Imperative

Where they had first chuckled, management now designated the resulting problem statement as serious. They stressed it was imperative the situation was resolved fully and immediately due to the active inspection. Within a week an improvement was designed and implemented involving adjustments to the inventory system, nursing staff procedures, management policies surrounding the management of customer assets (such as bedpans manufactured out of expensive surgical steel), and support practices. Even the inventory clerk Jose was to receive printouts using his natural language and terms he could read and understand more easily.

Co-Designing the Experience

There was no shortage of underlying causes contributing to the problem and finding them was surprisingly easy. With management attention on the inspection acting as suitable ‘cattle prod’, the focus of the problem team quickly turned to addressing each cause as part of an overall solution.

It was at this point the problem team decided to break with tradition and involve the nursing staff directly on how best to resolve some of the causes, especially those involving local procedures, and the role of previously unseen inventory management staff. It was also clear the interaction between the hospital staff and was vital in setting and managing satisfaction levels.

The problem team ‘walked in the customer shoes’ and with the help of staff across the retirement home, traced the path of the

Service Management and the ‘DNA Rule’

So what has this to do with service management? Well, as an increasing number of service management providers are now (re)discovering, customer satisfaction is key to success. It leads to customer loyalty and advocacy, and lower costs by focusing efforts, especially those of the service provider, where they have most effect.

Outside-in thinking puts the interest of the customer first and explains customer satisfaction is the result of an acceptable experience using services to perform activities in pursuit of successful, desired outcomes – results. Results are viewed from many perspectives and subject to the ‘DNA’ rule – do not assume, abuse, annoy, or argue – ask!

Customer experience is an aggregate of customer interactions with the service organization and its products and services. Service provider organizations and the support they offer must incorporate outside-in thinking to succeed.

In this case, Fred’s willingness to adapt and take a moment to think outside-in resulted in an opportunity for the IT organization to do likewise, and to eliminate a problematic situation that directly impacted a number of parties, and could have resulted in a huge business impact, with the license being revoked.

They can all take pride in the fact they were likely a big reason the hospital passed its inspection. Despite the previous issues, patients and family members offered a positive view when asked by auditors about the quality of care.

Conclusions

All this was possible because Fred, the field technician, took a moment to ask, and follow through on an issue that clearly impacted his customer, and the customers of his customer – the patient. He had to be prepared to temporarily pause his inside-out thinking (technology, process, policies and procedures), and replace it in its entirety with outside-in thinking, the customer perspective.

Everything was recorded from a customer perspective, with the provider’s added after. The singular focus and driving force behind Fred’s decision was the customer situation, and by placing himself in the customer shoes and walking a while he ensured customer satisfaction. There was no need to wholesale commit to a reengineering of processes. But if there had been , the reason would have been clear and powerfully stated.

Needless to say, should I ever find myself in a retirement home fumbling for the panic button, I hope the staffers are served by a similarly accommodating and outside-in thinking organization.