[The story you are about to hear is true. The names have been changed to protect the guilty. ]

From the Files of SOS: The Case of… “The Three Ring Circus”
(on Customer Service)

By Lynn Homisak, PRT

This article was reprinted with permission from Podiatry Management Magazine

This is the city…Bridgeport, Connecticut. Located on the Long Island Sound, this fifth largest city in New England is also the most populous in Connecticut and considered part of the NY Metropolitan/Tri-State area. Actors Robert Mitchum, Brian Dennehy, Bob Crane and comedians John Ratzenberger, Kevin Nealon and Richard Belzer all hail from Bridgeport, but perhaps it’s most famous past resident (and Mayor in 1875) was the one and only Phineas Taylor (better known as “P.T.”) Barnum – part of the very famous Ringling Brothers and Barnum and Bailey Circus. In fact today in downtown Bridgeport, there stands the Barnum Museum, a Bridgeport architectural treasure to celebrate his life and works. Barnum, an icon of American spirit and ingenuity, will not soon be forgotten.

Also not forgotten are my cherished childhood memories of having attended the Ringling Bros B&B circus; probably one of my all-time favorite adventures. Each year, when the circus came to town, my grandmother would take us across the Hudson River into Manhattan to see the “Greatest Show on Earth.” The spectacles that took place on that three-ring circus floor were unforgettable and they undeniably touched all my senses. Leave it to P.T. Barnum to create a “feel good, happy” experience that left all his audiences wantingmore from the MOMENT they stepped foot in his oversized tent…until the moment they left.

It was not odd that thoughts of my past circus experiences resurfaced during my phone communication with Dr. Ellie Fante as I listened to her lament about diminished customer service in her practice. My assignment was two-fold: one, examine potential areas of patient neglect and two, assure that ladies and gentlemen and children of all ages who stepped in to Dr. Fante’s “Step-Right-Up Footcare Center” would leave with an experience unlike any other! We’re SOS. We carry a computer…so let the show begin.

As my partner and I walked from the train station to Dr. Fante’s office to begin our investigation, we discussed how to best approach the staff. We thought it might prove interesting to present ourselves as patients, but I was apprehensive since our goal of successful change implementation did not mean trying to catch staff red-handed. I’ve always found that getting the staff to understand and buy into the change and have them work cooperatively with me to achieve our outcome was the more productive formula. That all changed the moment we entered the office and were ignored for 45 long silent seconds, which was exactly 45 long, silent, uncomfortable seconds too long! (45 seconds is less than a typical TV commercial and we know how annoying that is)  It was then that we both decided to go under-cover, something we never do, to see what other major customer service crimes were being committed. We didn’t realize what we were in for!

A friendly wave to get the attention of the “greeter” (and I use that term loosely) receptionist who was on the phone resulted in a stiff pointed index finger reply indicating that we needed to “WAIT!” Did that mean wait at the desk? Have a seat and wait? Another staff person who was tapping on a computer could have stepped in, but she seemed determined not to look up from her work. Call me crazy, but the first thing on my menu of expectations (as a potential new patient) is a friendly greeting of some sort ...“Hello! Welcome to our office…can I help you?” And if that greeting could also come with a smile, color me happy…you had me at hello! A third staffer opened the door from the clinic to the reception room to summon a patient and without even giving us a nod, escorted him through, letting the door close behind her. My partner and I looked at each other. If we were patients, we just got a colossal dose of “badfirstimpressionitis” and it didn’t sit well. We had to play this out.

“Good morning,” my partner said, “We’re Jim and Emma and we’re here to…” but before he could finish his sentence, she responded …“WHO?” “Bond, Jim Bond,” he repeated. “And this is Ms. Peel.” She turned and called back to her co-worker at the computer with a somewhat irritated tone. “Jen, did you make an appointment for a Mr. Bond and a Ms. Peel and forget to enter it in the schedule?  I don’t see them on for today!” “No!” responded Jen. She then turned back toward us and said without taking a breath, “Well, you must be here on the wrong day…I don’t see your names anywhere! Did anyone call you to confirm? I don’t know when we’ll be able to see you – today is just crazy, but if you want to wait, have a seat and fill out this paperwork” and with that, she slapped a clipboard on the counter and went about her business. We took the clipboard and sat down.

The reception room looked ransacked; magazines scattered, furniture askew. Describing it as cluttered would be kind. It made the children’s play corner look good, although toys were strewn just waiting to sprain an unsuspecting ankle. The lone plant looked about as neglected as we felt sitting there, but not as much as the aquarium… I’m pretty sure fish aren’t supposed to float. The only three real patients were mumbling that this was the last time they were going to wait so long for their appointment and after comparing times and questioning how they were all scheduled for the same 10am appointment, one walked out. The attitude temperature of the room was rising quickly.

The more the phones kept ringing, the more abrupt the staff was getting. It was obvious they couldn’t handle the stress. We saw and heard enough. My partner walked up to the front desk window, which was now slid closed to the reception room and gently knocked. No one came. He knocked again and explained that we were here to see Dr. Fante, not as patients, but as consultants to observe their customer service skills. The receptionist nearly tripped over herself trying to undo all the damage she’d done, but it was too late. We had already formed our first impression and it was similar to a three-ring circus… the informal definition: circus - group of people whose behavior is wild, disorganized, or unintentionally comic.

The patients that were scheduled through the rest of the day were seen as we continued to observe from the sidelines. It was clear that this staff’s priority was not outstanding patient care. At the end of the day, we gathered the Fante team together to share the outcome of our investigation.  First, we asked the staff what they thought excellent customer service meant to them... “ Treating patients nice,” was their response but realizing that we were about to discuss the pachyderm in the room regarding their unacceptable behavior, the receptionist spoke up in defense of her behavior. “We realize we made some crucial mistakes when you came into our office today,” she admitted, “but you don’t understand! Right before you walked in, Mrs. Tornado stormed out and she had us all twisted up! We can never seem to please her…you just caught us at a bad time!”

Well, we both agreed on one thing. Excellent customer service IS about treating patients nice. “However,” we told them…“ it goes well beyond that. It is criminal to allow one patient ruin the entire day for all patients. The minute customer service is compromised so is your reputation. Every patient that walks through your door should feel like they are your only one; like you came to work just to make them feel special.” From a marketing perspective, the repercussions of poor customer service are incalculable – increased complaints, reputation, negative work environment, decreased patient visits and associated loss in revenue are just the beginning. One dissatisfied patient will tell two others about their experience and they’ll tell two more and they’ll tell two more and, etc., etc. It can be devastating on a practice.

Something had to be done and quick! The team at “Step Right Up Footcare Center” agreed to pull together, put their best foot forward and climb to the top. We played Ringmaster, took center stage and threw five tips out there to get the ball rolling:

• Offer “Grandstand” Service – A patient’s very first impression starts the minute the phone rings. How many times does it ring before someone finally answers it? Shouldn’t be more than three. And remember that customer service may start with the phone but that’s not where it ends. Anything you can do from that point forward to impress your patients is golden. Instead of answering the phone with a drone “Doctors Office” greeting that I hear far too often, we suggest using the telephonic communication tool as an opportunity to introduce the office (and yourself). “Good afternoon, you’ve reached Step Right Up Footcare Center, this is Annie, how can I help you?” is always a more sincere welcome. It’s ok to engage in a little friendly chit-chat, but don’t waste valuable time. Be considerate…you have other jobs to do and spending unnecessary time on the phone only offloads your work onto your co-workers. Have scripts handy to ensure that the call stays focused on the patients’ needs and that they are receiving the correct information. Be friendly, polite and use common courtesies. Apologize if you’ve upset them and don’t forget to thank them for calling. Finally, get in the habit of placing them on hold only if you get their permission to do so and never ever hang up the phone before they do.
  
• Send in the Clowns? – Maybe that works under the Big Top, but not in your office. You never want to come across to your patients as entertainers, amateurs or anything BUT skilled and competent professionals. Just because a patient’s perception of `medical professionals’ is based on their own critique, don’t forget that perception is reality. It is therefore important that you dress, speak, walk and act the role at all times because you will always be judged. Professionalism should ooze out of your every pore as a representative of the practice. Clean shoes are mandatory; so are clean and unwrinkled scrubs. Matching scrubs are even better as they send a message of office unity. Name badges are helpful. It should be an office as well as a personal policy to leave your troubles outside the office. Remember, you are a professional.
  
• All the World’s a Stage – or so they say. It was time to take everyone on a private trip through the office and see for themselves what was lurking in their own arena. We had them sit in their reception room and their treatment room – and even walked them through their restroom where we found overflowing garbage pails, no hand towels or toilet paper. We posed this question… if everything that patients see is a reflection of this office, what exactly does a dead plant or dirty carpet convey? Keeping a clean office is very important and so is tidying up during the day. Have you considered replacing those posted negative billing demands with more positive signage – e.g., “Welcome to Our Office” or your framed mission statement? Isn’t it about time you repaired that torn treatment room chair or wiped down the base? Dust the wall hangings and introduce a flat screen educational video that your patients can watch if they must wait. Put in-office dispensing products in a glass cabinet to give them more visibility.  Straighten magazines, tidy up the kid’s corner and remove cups, candy wrappers and garbage left behind by patients throughout the day. Use a portion of your marketing budget to spruce up your reception room. It’s an investment in your patients and your practice. Remember, “Without promotion something terrible happens… nothing ” - P.T. Barnum
  
• Juggling Your Schedule is a Balancing Act - How many different ways can this be said? Patients don’t like to wait! Dr. Fante continuously ran behind schedule to the point where a patient left the office. How many other patients do that and go unacknowledged? Take control of your schedule…not every condition you treat takes 15 minutes, so it’s unrealistic to schedule every single patient for the same block of time. If you can’t determine where your back ups start, perform a time and motion study to pinpoint your weak spots. Finally, if you are determined to treat every condition your patients present with (even though they are not initially given the appropriate amount of time), think again. In order to please one patient you need to rob time from the others. Is creating ONE satisfied patient worth a room full of DIS -satisfied ones?! More importantly, is it fair to repeatedly test the patience of your patients?
  
• Go the Extra Mile…with the Greatest of Ease – Have you ever thought how far you really need to go to make a difference in your practice? Not very. People notice the little things. I recall my visit to the surgi-center to have a small procedure done…their simple gesture to warm up the linens, slippers and robe made a world of difference to me!  Maybe elderly patients could use a little help with their shoes and socks or have a pillow placed behind their back. How about calling patients to inform them when you are running very late and offer them a chance to re-schedule? There is a dentist in our town who knows what going the extra mile means and it serves him extremely well. He not only provides outstanding dental service, but his patients also get to view a private TV monitor with earphones during their dental care. They are given a paraffin wax hand treatment AND he hires someone to massage their feet!! Do you want to know how many people recommend this dentist in our community? Plenty! People like getting MORE than they expect! Have you ever taken the time to ask your patients what they want? It’s easier than you think. Distribute a patient satisfaction survey; then listen and learn from what they tell you!

In the end, we could have blamed the staff completely for what we saw, but it wouldn’t be totally fair. The fact that Dr. Ellie Fante didn’t realize half the things that were happening in her practice until it was almost too late makes both her AND her staff guilty of this offense.  P.T Barnum believed that if you keep your customers interested and satisfied, it not only brings them back, but it attracts new ones as well. History has quoted him as saying, “there’s a sucker born every minute,” but based on his people oriented business philosophy, recent references argue that he really said, “ there’s a customer born every minute.” Barnum knew that you never got a second chance to make a good first impression and true to his philosophy, he billed his events as the Greatest Show on Earth promising customer satisfaction and a memorable experience. Today, “Step Right Up Footcare Center” has made his philosophy their philosophy; and a tradition that was born in Bridgeport Connecticut, thankfully lives on.

“Politeness and civility are the best capital ever invested in business. Large stores, gilt signs, flaming advertisements, will all prove unavailing if you or your employees treat your patrons abruptly.” Well said, P.T. Barnum…well said!