Sunday, April 19, 2009

On the Stage

What does the world's greatest Shakespearian actor have in common with a doctors Receptionist?

They are both on the stage.

I am doing loads of training nowadays on something called Exceptional Customer Care. Most of the participants are receptionists who work on the front line of healthcare. These folks are giving the first impression either on the telephone or face to face to the patient attending the surgery.

I am always impressed with their modesty about their crucial role in the grand scheme of things in a doctors surgery.

I tell them that the customer’s experience of the visit to the surgery will probably be influenced as much by the interaction with the receptionist as it will be by the consultation with the doctor or the nurse.

I tell them they are, in my opinion, not ‘Receptionists’ – I tell them they are Customer Service Professionals.

I tell them they are like actors on the stage – always under the spotlight – there is nowhere to hide.

The great Shakespearian actors who play the lead role for many years have to turn up night after night and deliver their performance as if it were their first. The actor may be delivering the role for the 500th time. For most of the audience it will be their first experience of this particular actor, in this particular role, in this particular play.

Receptionists have the same responsibility in my opinion. They have to deal with each customer as if it were their first.

Patients who may have emotionally struggled to pick up the telephone and make that call because they may be worried or stressed about the health problem they have.

A receptionist may have had to deal with 50 or more different customers each day and the 51st person may be coming to see a doctor for the first time in their life - they may be worried sick. The receptionist is in a key place to reassure the customer.

Once more on my Blog I am delighted to thank all the brilliant receptionists doing such a terrific job as customer service professionals. I am proud to work with you.

Your audience awaits on Monday morning …….


Dan Gunter said...


I'll bet you knew I'd have to comment to this one, too. Bravo, by the way, for your words. Very well put.

I'll share with you a quote from Andy Andrews (a speaker from Orange Beach, AL here in the U.S. that I mentioned to you earlier this evening.) As Andy puts it "This isn't JUST the lady answering the telephone. She's the DIRECTOR OF FIRST IMPRESSIONS for the whole company!" I agree without exception. As he goes on to say, the CEO or President could go on vacation for a couple of weeks and nobody will even notice he's gone. But let the receptionist take the afternoon off and the whole company might as well shut down.

In the course of my filmmaking work, I produce a lot of advertising videos for AT&T. The AT&T sales rep sells the ad to a business customer, then they contact another company. That company in turn contacts me. Then I contact AT&T's client, confirm the shoot and go out to that client's place of business film it, then go back and edit it. Everybody is a client to somebody else. And I always try to keep in mind that when I call AT&T's client, although I don't even work for them, the end client who's buying the ad "perceives" me as representing AT&T as much as I represent my own individual production firm. If I go out on a shoot and make a horse's rear end out of myself, the impact is felt quickly by me, AT&T, the AT&T sales rep, the intermediate contracting company... the list is virtually endless. On the other hand, if I go out and do things well, everybody ends up being a hero.

I guess my point is that I have to keep in mind that the whole operation and everyone involved is being judged (whether it's fair or not) based on my individual actions, just as that registration clerk, receptionist, or whoever makes an impression for the whole medical team.

Just as importantly, he or she sets an important tone for the rest of the patient care encounter. Allow me to elaborate.

When I worked in CQI/Risk Management in healthcare, one of my responsibilities was to do part of the orientation for new hospital staff. I shared with them the following:

When a patient enters our facility, they are obviously already not having one of their better days. Their senses are heightened. By this, I especially mean that if you treat them with indifference or disrespect, it will be noticed even more. Even worse, the patient (and family) will EXPECT you to screw something up. From that point on, if you so much as walk into the room with a shoelace untied, you should expect to be sued for it.

On the other hand, if you treat the patient with GENUINE -- no pretending -- respect, caring, and courtesy, you could make a relatively serious mistake and they would still like you.

As I told my orientees, this might be SLIGHTLY overstated. But it's a fact that most medical malpractice suits did not ultimately result from a doctor or someone making a serious mistake. If you dig deep enough, you'll discover that the whole patient care encounter went sour somewhere along the line in terms of attitude toward the patient.

Doctors, nurses, techs, staff... they are all human. Mistakes will happen so long as human beings are providing the care. Most of them can be addressed and corrected with little or no patient harm. But if a lousy attitude toward the patient is thrown into the mix... well, get ready to write a fat check for the settlement, because there is no satisfying the patient that you did your best.

I've had people tell me 15 years after telling them these words that they thought about it seriously and remembered it later.

I do not claim to be a healthcare "guru." But I can tell you this much: apparently I and the team did SOMETHING right, because we stayed completely out of court for the duration of my tenure in CQI/Risk Management. The team listened and we loved our patients. I wouldn't have kept anyone on the team who didn't.

Trevor Gay said...

I kind of expected you comment Dan :-) – I looked forward to it in fact and you didn’t disappoint!

I love the DIRECTOR OF FIRST IMPRESSION and give you notice that I intend to steal that title and use it in all future workshops!

I spent 2 years as a complaints manager in my 35 year healthcare career and I concur with your impression of complaints. I estimate at least 90% of the complaints I dealt with were nothing whatsoever to do with the technical competence of doctors, nurses or other clinicians. It was usually to do with communication and the way a patient or their family felt ‘slighted’

One of my favourite quotes - George Bernard Shaw famously said ‘The problem with communication is the illusion that it has been accomplished”

We have to work at communication – it doesn’t just happen. Ask anyone who has teenage children – I had three and we always had to work hard at it to understand each other.

Dan Gunter said...

Interesting that you quote George Bernard Shaw. I am a "possibilities person" in every sense and to the Nth degree. At one time, I made it a point to spend the extra money to have something printed on the reverse side of my business cards. It was the following:

"Some men see things as they are and ask 'Why?' As for me, I dream dreams that never were and ask 'Why NOT?'"

-- George Bernard Shaw --

I even toyed with the idea of replacing my "official" title on my hospital business cards with my much preferred, unofficial one: "Chief Guru or WHY NOT?" I actually DID make a sign with this title and hang it on my office door when they gave me the entire lower half of a building for my offices and training area. I still sometimes refer to myself by this title occasionally (although I seriously question the validity of using the term "guru.")

Dan Gunter said...


Just "by the way," you might already recommend this to hospital admin people, but it's a good idea to make sure that all clerks, receptionists, etc. actually have their own business cards. It's a tiny investment, but it has profound, far-reaching rewards.

Proven fact: if you want to create changes in how well someone does their job, the first ("FIRST" -- underscored, highlighted, bold, italicized) step should be to change how they perceive their job. Once they truly come to appreciate their job and the potential impact they have on day-to-day operations (patient encounters included) you have opened the door to learning and greater appreciation of the "technical" AND "soft, touchy-feely" stuff that makes a difference.

I actually employed this method as an ad-hoc experiment of sorts with great results once. We were tracking numerous quality indicators (as we all do in health care.) One of them that we were having a bit of a problem with was the registration process. More specifically, there were two registration clerks that were getting lower than average satisfaction feedback. One MUCH lower than the average. Experiment time: I invested around $80 to buy every registration clerk a box of business cards.

I called a meeting with all of them which lasted about 20 minutes tops. No lectures. No scoldings. I did not even mention the satisfaction survey results. All I did was tell all of them how much we appreciated the work they do and how important they are to the patients. I thanked them for their hard work and said "You are professionals in every sense of the word and I am thankful to have you on our team. Our patients speak highly of all of you but sometimes, due to the inherent and understandable stress people go through emotionally in a hospital, they forget your names. You all deserve better than that, so here..." and I presented them with their cards and asked them to give one to every patient.

Within two or three weeks, the results were starting to show us that satisfaction scores SHOT up (if memory serves me correctly, it went from just above 2.7 to something like 4.2 on a 0-5 scale. What stood out most, however, was that the clerk who had previously gotten the lowest scores was now running a very close race for top scores (and on occasions did, in fact, score the highest.)

We could have invested thousands of dollars in customer service training, off-sites, plaques, etc. But $80, 20 minutes, and most of all a sincere "Thank you... what you do is very important" worked magic.

Sometimes effective solutions ain't so expensive or complicated. As it has been said, though: "Fish discover water last."

hucknjim said...

Trevor and Dan,

I'm sure you both know this already, but let me spell it out for the general public who may be reading. As a unit secretary on a very busy surgical floor, not only do I have to answer phones (sometimes 3 or 4 ringing at the same time) and call lights. At the same time I also have to decipher doctors' handwriting which at times borders on the indecipherable. I then have to enter the orders in the computer while the phones continue to ring and the call lights go off. On particularly busy days all this happens while we continue to get admission after admission. That is just a hint of how stressful the job can be. Oh, and I forgot to mention patients and visitors coming to the nurses' station with questions and/or complaints; and docs demanding this or that test result or wanting to talk to the nurse. So add some more elements. I often joke that I can do five things at once, but when it gets up to six or seven I get a little stressed.

Having said all that I appreciate that I am often the first impression of my hospital that our various visitors perceive. As such, I do my absolute best to make a good impression. I don't always succeed, but I find that a SINCERE apology and the offer to make it right most often smooths things over. To paraphrase my dad, who was only slightly more of a perfectionist than my mom: If you make a mistake, make it right. Just my two cents, or judging by the length of the reply, my ten bucks.


Trevor Gay said...

GBS must have been an inspiration to work with! I have come across that quote too Dan it is very powerful –I have always been a half glass full person and can relate to his words. And by the way I love the title - ‘Chief Guru of Why Not?’

The business card story resonates too Dan – we all want to fee valued in practical ways as well as through words. Poor management will say they ‘value’ workers but only on their terms and when they want something. Good management ensures the culture all the time is of valuing people in practical and measurable ways.

Trevor Gay said...

John – you are very much at the front line and you tell us things as they really are. In my experience as a complaints manager I reckon that almost very complaint could have been dealt with by someone in the early stages of a compliant apologising so you are a role model. In the words of a famous Elton John ‘sorry seems to be the hardest word.’

Dan Gunter said...

Regarding my above post: if you read all the way through it, I hope you got something out of it. I'd hate to think you endured its length without at least receiving something in terms of "take home value," no matter how relatively small.

Trevor, you are forgiven for your part in getting me so revved up again. LOL.

Warmest regards to all,
Dan Gunter

Trevor Gay said...

Dan - Fabulous comments and yes of course there are many take home points. You write with the passion I love to see from anyone working in healthcare. There are too few people with your passion.

One of the things I always get irritated about is when managers talk about "MY” employees. I always use the terminology of working “with” rather than “for” and I love "We" rather than "I"

The best teams always use the language of "us" rather than "me"

As someone smarter than me once said “there is no “I” in team”

Dan Gunter said...


Please delete my earlier post which is identical to the following with the exception of correction of one typo that I just discovered that significantly changed the meaning of something. Apologies extended.


Again your words and points are excellent. While in nursing school, I took on two jobs with a local hospital: Unit Clerk on the weekends; nursing assistant on weekday evenings. I basically hated both, not because of the "work" itself, but because of the "working conditions." There was so much political B.S. and fighting about "pecking order" that it frequently became disruptive to patient care, and most certainly to the quality thereof.

Flashback to the years prior to that time...

I was a Paremedic/Firefighter. I was accustomed to dealing with situations regularly that had no room for politics, disagreements, etc. The stakes were too high. We worked through our differences back at the station (not always admittedly easy) and when we rolled-out on a call, those differences were totally put aside. I am not saying any of this for effect. When you are crawling around inside a burning structure, feeling your way around because you can't see six inches from you, your fate is as much in the hands of the man crawling beside you, holding onto a firehose that in an instant can become your lifeline. You don't get inside and start wondering "Does he know what he's doing? Can I trust him?" If you do, you're in big trouble already and should not have entered the structure in the first place.

Now, flash forward to BEYOND the Unit Clerk/nursing assistant days...

When I received my R.N. license, it was a proud day. I was immediately recruited to work in the Emergency Department and Intensive Care Unit. Not a very common thing for someone fresh out of nursing school. But I was known for already having medical experience (both in crisis situations and teaching) and known to be able to perform well when things were at their worst. I was not "born" that way. I had made the conscious decision from the outset that I wanted to (1) "know my stuff" and (2) be able to do it to the best of my ability under extreme pressure.

So, there I was, now THE R.N. actually in charge of the E.R. or the I.C.U. Within weeks of taking on that role, a couple of friends and upper level hospital staff began telling me that some of the Unit Clerks, Nursing Assistants, L.P.N.'s, etc. were specifically requesting to be scheduled to work with me. When I got curious enough to inquire "Why?" I was told that it was because I treated them differently than other R.N.'s did. When working with me, they felt like they were not "grunts" or "gophers." They liked the fact I asked them questions, sought their opinions, listened to what they were telling me about patients, and basically treated them like they were part of a team.

I vividly recall looking at one person and replying "What? 'Like' you are part of the team? There's no 'like' to it. You ARE part of the team. Just as important as I am. Every one of us has the potential to make a patient's life better -- or worse. If we aren't working as a team, then we aren't working at all."

A few years and a few ulcers later, this philosophy and way of doing things resulted in my being asked to take on the responsibility of Risk Management and CQI for the hospital.

Yes, I tried very hard to master all the "tools" of the trade, from Shewhart cycles, Pareto charts, Ishikawa diagrams, statistics, standard deviations, how to identify whether a "process" or "measure" was in or out of statistical control, all the legal aspects of the health care field... the list is endless. But these are things anyone with intelligence above the level of a chimpanzee can most likely learn. They are also just the beginning of the REAL CHALLENGE.

Suppose you see that a process is out of control? What are the implications? The actual underlying causes? The numbers only take you so far.

If you keep digging, you invariably find out that the problems BEGIN with, END with, and EFFECT real, live HUMAN BEINGS.

You can say "Well, that surgery went bad because such and such piece of equipment malfunctioned." Yeah? Well WHY did it malfunction? Most likely the "malfunction" that SEEMED to be the cause was actually the result of lack of (or improper) maintenance. Got our cause now, right? Nope.

Why was proper P.M. not performed? "Because the Surgical Unit Manager is so swamped he didn't have time to schedule it." Oh, so that's our REAL cause, right? Wrong again.

Why is the Surgical Unit Manager so short on time? "Because he doesn't have anyone to help with the scheduling, O.R. setup, stocking supplies, prepping patients for surgery, getting consent forms signed..." Wow! Now we've gotten to the root cause, haven't we? Nope.

Why is the Surgical Manager doing all this instead of having someone to help?... this (and I) could go on forever.

My point is this: if you EVER ASSUME that you've really found the "root cause" of a problem and simply stop there, you're robbing yourself of the chance to REALLY keep the same problem from occurring again. Sure, you can have the item that malfunctioned repaired -- an afterthought that's not much comfort to the family of a patient that just died (NOT the way to find out you HAVE A PROBLEM.) But what keeps it from malfunctioning again? If you say "P.M." I dare to say you're wrong. There were multiple issues at hand. Leave any one of them unaddressed and you're on your way to the same problem again.

The definition of foolishness: doing the same thing and expecting different results.

My apologies to anyone who saw fit (or was bored enough) to read this epistle. But I hope you turn away from your computer monitor right this very moment and at least FOR a moment ponder what Einstein said:

"The significant problems we face can not be solved by the same level of thinking we were at when we created them."

Emphasis on "WE." To lob another analogy across the net: computers don't "make errors." The errors result from faults in either the system or program. Who creates those? They don't create themselves. People do.

Treat team members AS team members. With dignity and respect.

Put personal issues aside and focus on what you (supposedly) all agreed to come together and do.

Approach problems with a hell-bent and determined attitude to really understand the depth and scope of the problem and solve it effectively (not "efficiently," I mean "EFFECTIVELY.")

Most of all, genuinely appreciate your fellow human beings and you'll have the fuel to get you started on the three ideas prior to this statement.

Trevor Gay said...

Deleted earlier comment Dan - thanks :-)

hucknjim said...


I'll have to reread your epistle a couple more times to fully digest it, but just a few comments on the topic of respect. In my long experience in health care I can count on less than two hands those nurses that I truly admired and respected. Most of them remain my fast friends to this day even if they've moved away, one to another state. That was because they returned my initial respect for them with the same because they saw that I was good at my job. They are the ones who "get it" that respect begets respect. Then there are those who initially look down on me because I'm "only" a tech and a unit secretary. The respect from them is much more hard earned. I have to assert myself to show that I know my stuff as you say. Their assumption is that that I am somehow beneath them, and the process has at times been long and arduous. In that case, I may respect their nursing skills although sometimes not, and I will
not in most cases come to consider them friends. Hope this makes sense. It was one of those long and stressful days.


Trevor Gay said...

"Then there are those who initially look down on me because I'm "only" a tech and a unit secretary."

Ignore those people John - you are just as important to the team as any surgeon, nurse or therapist. I simply cannot understand anyone looking 'down' on anyone else in any team. Its beyond my comprehension. Frankly its not a team if that culture exists.

Your comments are always valuable here and very welcome. Have no fear about respect on Simplicity Blog - everyone is respected - its called good manners and common decency :-)

Hope today is less stressful for you.

Dan Gunter said...


Sadly, the sort of interpersonal issues and conditions you describe are closer to the norm than are respect and courtesy, especially in the historically hierarchical world of health care. It can change, but for most of the people involved (as in life) such a change process starts with a "crisis." Just like a lot of patients I cared for over the years, it often takes being in tremendous pain or "on death's doorstep" to reach the point of genuine help-seeking and change. But sometimes -- too often, in fact -- that is too late.

Teams, like patients, can reach the point where palliative, "comfort care" is about all the benefit that can be gained. My sincere hope and prayer is that more and more people (and teams) will change their thinking by some other means (Trevor's work and his blogs are a good example) and start what would SEEM (superficially) to be a process of "prevention." But a lot of experience has taught me that the difference between "prevention," "cure," "life saving," and "life sustaining" is not the technicalities of the treatment as much as it is "timing."

Start early. Stick to it. Stay strong. Sustain hope. Do these and the prognosis can be altered dramatically. Whether we're talking about our health, our jobs, our relationships... it's universal.

I share my friend Trevor's sentiments in wishing you a much better day.

hucknjim said...

Trevor and Dan,

Thank you for the kind words. I know I'm respected here. Otherwise I wouldn't be posting. Unfortunately, it was another of those days; and this was just the third day of a six day stretch. The good side is that I have a long awaited 4 day weekend coming up. I can hardly wait.


Trevor Gay said...

Keep smiling John - I'm running a receptionist course (half day) today for 20 front line receptionists – it is the first of five half day sessions. I love working with these folks - they are the foundations of all excellent healthcare.

They are as important as any other member of the healthcare team.

Enjoy your long weekend and keep in touch.



John O'Leary said...

Trevor, you can't get more "front line" than the person who greets the customers. He/she sets the tone and models what kind of enterprise the customer/vendor is dealing with. If the greeter/receptionist/customer service professional exudes life/warmth/joy/humor I'm already thinking well of their company.

Hey, good luck in the big jaunt!

Trevor Gay said...

Hi John - good to hear from you again.

'You don't get a second chance for first impressions' as someone once said.

We are well prepared for the marathon on Sunday - now we just have to actually do the deed - thanks for your thoughts my friend.