Beryl is approaching its 25th anniversary. We have a lot to be proud of--connecting millions of people to healthcare, building long-term client relationships, and creating a great place to work. Over the next few months, I'll be sharing anecdotes and lessons learned from 25 years in business. Let's begin with how it all started.

My brothers and I always wanted to do something together.  We decided to go into business providing medical alert systems for people with medical conditions and the elderly. Being a 24/7 business from day one, we traded shifts, slept on a cot and made sure we were available when people needed us.

I’ve learned since then that good values and hard work lead to good results. I also learned early that listening to customers is what makes our business grow.

In 1986, one of our hospital customers asked us to pick up the phone for something they called "physician referral." I had no idea what that was!  But when they told me they would pay us $3,000 per month, I made a deal on the spot. 

Little did I know that every hospital did it and that we would start an industry providing outsourced referral and information services for hospitals.

In 2008, Pete Blackshaw authored a book titled, Satisfied Customers Tell Three Friends, Angry Customers Tell 3,000. You don't have to be a math whiz to see that having angry customers doesn't help your business agenda.

It's important for any business to be alert to changing customer needs and to be as proactive as possible in anticipating them. It's also imperative for businesses to handle negative situations with alacrity if and when they do arise. Even a single unhappy customer can do real damage to your reputation. Here are a few ways to keep relationships on track and increase customer satisfaction:

Watch for warning signs
If clients ask for a copy of their contract, chances are they are not happy. If they stop communicating or are not engaged, problems could be lurking.

Don't let tough times catch you off guard. My company implements a strategy we call the "web of influence." Once a contract is signed, we establish a team to work on building relationships with the customer at multiple levels in addition to primary contacts. This strategy helps us identify potential issues and address them before they become problems.

Survey says: Be accountable
One tool many companies use to gain insight into customer attitudes is customer satisfaction surveys. It's laudable to conduct the survey, but it's laughable that many companies don't follow through and implement an action plan to address issues uncovered by the survey. At Beryl, we match annual surveys with a robust, disciplined follow-up process to make sure that we respond to and resolve any issues that arise. When you create your customer satisfaction survey, it's important to put a consistent system in place to build accountability for follow-up and problem resolution.

Build relationships
My philosophy for staying ahead of problems is to worry less about the terms of the contracts and more about building relationships. By reaching out to customers throughout your partnership, you can learn what they want. If you deliver consistently, you'll build a relationship of trust that extends beyond the contract.

This can pay dividends in tough times. If you've earned your customers' loyalty, they will be more forgiving of your errors, especially if you bring them to their attention with a plan to course correct.

Be responsive
It's easy to be responsive when things are moving according to plan. The challenge, however, is how you respond when things get tough. Your employees have to be empowered to resolve issues and address client concerns. Customers who feel they have your team's full support will work with you--not against you--and will be more receptive to your solutions.

Prove your value
When customers don't properly gauge the value you are providing, they will seek to find an appropriate level of value somewhere else. The only way to ensure that you retain your customers is to prove your value on an ongoing basis and be true to how you differentiate your brand from the competition.

My company differentiates itself on superior customer service, not a low price, which means our business is always at risk, given that customers are tempted to respond to price appeals by our competitors. The only way we can combat that appeal is to prove that our customer service levels are worth every penny.

Four Rules to Remember

Want to ensure that your customers are truly satisfied? Here are four steps to make it happen:

1. Develop a true partnership. Establish an open dialogue with clients. Engaging in an open dialogue promotes teamwork and collaboration and ensures everyone is working to help accomplish the customer's goals.
2. Establish a web of influence. Develop multiple relationships throughout your customers' organizations.
3. Listen and respond. Stop talking and really listen to your customers. When a situation arises, respond quickly and be thorough.
4. Be accountable. Put a process in place to address issues and ensure accountability for the resolution.

We can all agree on the importance of customer service. Yet, even with a great product or service, we can't assume customers are happy. Make it your responsibility to beat their expectations--be proactive instead of reactive. If you don't, another company will, and your customers will become their customers.

Connect With Your Customers: Keep Them Happy--or Someone Else Will Make Sure They Are:
http://www.entrepreneur.com/management/columnistpaulspiegelman/article204690.html
Reprinted with permission of Entrepreneur Media, Inc.
Copyright 2010 by Entrepreneur Media, Inc.
All rights reserved.

Being stranded on the side of the road with an automobile emergency is one of life’s least popular little interruptions...and there’s very little that can change that perception.   However, a friend told me about his recent experience with a flat tire during rush hour that may have changed my mind, a little.  

He used the roadside assistance service linked to his cell phone plan and called for help.  Within the hour, a patient and skilled auto assistant came to his rescue.   In a short time, he was on his way again.   Several very striking things occurred during the hour or so my friend was stranded.  I related his experience to where health care needs to go. 

Within a few minutes of placing the call for help and getting confirmation that help would be sent, he got a return call updating him on the status of the roadside rescue driver.   A few minutes after that, he received another call inquiring about his ongoing safety.  Shortly after the tire was replaced and the roadside technician had left the scene, he received another call asking if he would take an automated survey on the dispatch center service and roadside technician service, with the option of speaking to a real person following completion of the survey if he wanted to provide additional feedback or had any questions.  

While my friend probably should have noted that his tire was worn and done a better job with car maintenance before starting out on the road, the roadside service did its best to get my friend up and running again, while keeping him informed and providing a conduit for additional communications.   The only thing the service didn’t do was put my friend in touch with the closest car mechanic for a more thorough examination of his car.  Maybe that’s a thought I should a pass along to the cell phone company.

In the not too distant future, I believe health care providers and/or insurance companies will need to develop this kind of intensive connection program with patients under their care.   This translates into communications before the inpatient visit and after discharge.  For non-urgent care, early connection with the patient could ensure that he or she gets more comprehensive treatment during the pending patient visit.   For example, while a patient may request an appointment regarding an arthritic shoulder, a quick over-the-phone health quiz might also uncover the need for an annual cholesterol check or colonoscopy, allowing the provider to make those arrangements during the upcoming visit.   In addition, contact after discharge is a key step to reducing hospital readmissions.

Every consumer is basically like my friend with the car….cruising down life’s highway, and perhaps not taking good care of themselves.  When an emergency occurs, they want to call someone who can help solve the immediate problem, but also help manage the situation.   If a cell phone auto rescue plan can provide that attention for $9.99 per month, shouldn’t hospitals and insurance companies look to model this type of customer service?  What are you doing to be only a phone call away?

The term offshoring is now commonplace in American business. It's unclear how many jobs have moved abroad, but Bureau of Economic Analysis figures cited by USA Today estimate that "from 2000 to 2005, U.S. multinationals eliminated as many as 2.1 million jobs, while adding 784,000 abroad."

Offshoring's lure of cheap labor may be good for some businesses, but it's never been a fit for mine--a 400-seat call center dedicated to the U.S. health-care industry. Seventy-five percent of our costs is labor. Could we reduce work force and infrastructure expenses to increase profit? Maybe. But it goes against everything our company stands for. We put employees first, not profit, and that philosophy has helped lead us to profitability that's five to six times that of our competitors, even those that offshore.

Here are a few things a company should bear in mind before making the decision to offshore:

Your business may need to compete on quality, not price. When my brothers and I started our company, we decided we were not going to compete as a "commodity" company--a company that competes by setting low prices and tends to have equally low morale and margins. Instead we concentrated on our customers' chief goal, quality in service, and created an employee-focused culture that bred that level of service.

Today, our customers know we don't offer the lowest price. In fact, we charge much more than "commodity competitors," but we still maintain a 95 percent customer retention rate and a No. 1 industry ranking. So which do your customers want--a quality product or a low price?

Offshoring promises big savings but doesn't always deliver. As more companies' offshoring stories come in, many are not finding the savings they expected. Factors such as rising crude prices are affecting the cost to ship manufactured goods back to the U.S., and rising labor costs are mitigating work force savings.

A study by the AT Kearny consultancy shed light on this. It found that 34 percent of the companies it surveyed with operations offshore didn't earn the savings they expected. It also found that companies that moved operations overseas purely for savings fared worse than companies whose key motivation was improving performance. Even then, 60 percent of companies didn't reach their operational performance targets.

One surefire way to save money is high employee retention. When you consider that the American Management Association estimates that each employee turnover can cost a company as much as 200 percent of an employee's salary, savings from employee loyalty can rival what offshoring offers.

Customers value companies that value their employees. With the country's unemployment at record levels, the public's distaste for offshoring is becoming more pronounced, and many companies have pulled back from offshoring simply for their reputations' sake. But what do customers really say?

A 2007 survey found that the top two factors American consumers consider in defining a company's corporate social responsibility are its commitment to its employees and its community.  Another survey found that nearly 70 percent of consumers consider it important to buy goods or services from companies that share their values.

The takeaway: When a business is loyal to its employees and community, customers often are, too.

I have no doubt that offshoring will continue to grow in certain industries. But if you've built your business for something more and you are committed to a level of quality that can only be delivered by controlling culture and value, keep those jobs right here, with people who are committed to helping you grow and prosper.

Is Offshoring Really the Best Option?:
http://www.entrepreneur.com/management/columnistpaulspiegelman/article204098.html
Reprinted with permission of Entrepreneur Media, Inc.
Copyright 2009 by Entrepreneur Media, Inc.
All rights reserved.

Imagine a health care system where doctors have a financial incentive to limit unnecessary tests and ensure that patients take better care of themselves.  This system would actually aim to keep patients out of the hospital. 

This is the goal behind Accountable Care Organizations, or ACOs, the latest health care delivery model being touted by D.C. policy wonks and health care gurus.  The current version of the health care reform bill in the U.S. House of Representatives calls for a Medicare pilot project to see if ACOs can lower costs and improve care. 

What exactly is an ACO?  There is no exact answer, but they must include three components: primary care physicians, specialists, and at least one hospital, and the size of the hospital doesn’t matter. These three groups would share responsibility for the quality of care and the cost of care received by the ACO's patients. If the ACO achieves both quality and cost targets, it could receive a bonus; if it fails, its members could face lower Medicare payments. The incentive is to deliver coordinated, efficient care. 

Each ACO would be operated by a group of doctors and hospitals that would be paid by Medicare to care for all the health needs of at least 5,000 elderly or disabled people.

Under the existing fee-for-service system used by Medicare and most private insurers, doctors get paid more by providing more services, and hospitals make more by increasing admissions. With ACOs, doctors and hospitals would get paid based on their ability to hold down overall costs and meet quality standards. In effect, their pay would be based on improving care, not generating more of it.

If the ACOs fail to meet certain quality and cost savings targets, the providers in the ACO would receive lower payments from Medicare.  Conversely, the ACOs would also be rewarded for keeping patients happy and meeting national quality standards, such as making sure men get annual prostate exams and women get their annual mammograms.

In effect, ACOs are an attempt to build relationships between doctors and patients that mimic the closeness that many small town doctors enjoy with their patients.  It’s also an attempt to build integrated health systems like the Mayo Clinic where none exist. But Mayo took several decades to build.  The pilot ACO studies will attempt to see if one can be formed in a year or two.

Creating ACOs requires hospitals and doctors to work closely together and to share financial risk, as well as potential profits.  This means ACOs must break down some pretty serious political and cultural boundaries between hospitals and doctors.  Many doctors prize their independence and don’t want to be bossed around or be treated as employees.

Not all ACOs have to be the same. This could be especially true in rural areas.   The end result, though, is the same: creating an integrated health care organization that is responsible for cost and quality.

If hospitals and doctors are going to live up to this objective, they’re going to have to manage patient health in a more proactive manner.  This means becoming slightly more intrusive.  Imagine a time when the doctor or hospital representative becomes as intrusive as the telemarketer.  The only difference is that the telemarketing call probably raises your blood pressure, whereas the weekly ACO caller is interested in helping you lower it.    How many hospitals are set up to maintain this sort of contact level?  The ones that aren’t may not be ready for the ACO agenda.  Tell me what you are doing to proactively manage your patients’ health.

Hiring people who complement my company’s corporate culture has helped us push our employee satisfaction numbers to a five-year high and earned us the highest client retention rates in our industry. In fact, a few candidates have had as many as 18 interviews before coming on board. In most cases, our recruiting and assessment system works well. However, I recently had to end two senior-level relationships that were off-target from the start, forcing me to reflect on what had gone wrong.

After hiring both senior-level team members, I felt confident that I had a team that could go the distance and help grow the company. My mentor, however, warned me it wouldn't be long before my thinking would shift. "One is always weeding the garden," he said.

Weeding the garden, ideally, means creating an environment where people with great potential can bloom into peak performers. If you’ve weeded your garden expertly, you should never have to fire a peak performer.

The words were ringing in my ears when the mismatches became apparent. One of the new senior level team members--who we’ll call Jeff--was insistent on firing a member of his team he was struggling to manage. I explained that his team member needed to be made aware of the issues and given a chance to mend his ways. After all, we don’t automatically send people out the door saying, “Thanks for your seven years of service.”

When the problem employee came to me to discuss his challenges, Jeff couldn’t believe he had the right to do so. Like a lot of managers, Jeff found transparency threatening. My response was that employees at all levels can talk to the CEO if they have a beef with a supervisor; there's no retribution because things usually get better once a dialogue is started. This was all too much for Jeff and he left the company.

The other new hire, a director in a key department, began implementing great ideas, but at a pace that made people feel threatened and uncomfortable. She was receptive to coaching, but was never able to strike a fit for our environment. The culture mismatch was felt by the whole team and decreased morale.

Tips for Weeding the Garden

1. Take time to hire for fit
   It's tricky to strike a balance between skills and fit, but I'd say that more than 50 percent of your decision to hire should be based on fit. Even when your business is experiencing rapid growth, don’t let the pressure to hire quickly push you to employ the wrong person. You could end up paying the price in employee morale and ultimately customer service.
2. Make your interview process dynamic
   Screen for a fit at multiple levels using behavioral-based questions, social get-togethers (e.g., a friendly lunch), and personality assessments to gain insight into how a candidate will handle a variety of professional situations.
3. Respond quickly to a bad hiring decision
   Don’t postpone a discussion with problem employees. Give them a chance to make necessary changes, or be more proactive and hold coaching sessions to work through an issue. Address this early and often before negative effects possibly start to ripple through your business.
4. Keep the lines of communication open 
   If you're too impatient to notice incompatibility, workers in transparent organizations will let you know if things have gone wrong. You should also go out of your way to let employees know it's okay if they wake up one morning and decide they're not on board with what you're doing.

My mentor called the other day and asked about my weeding. Humbled by recent events, I responded with his second favorite catchphrase: "The task is never done."

Weeding the Employee Garden: http://www.entrepreneur.com/management/columnistpaulspiegelman/article203786.html
Reprinted with permission of Entrepreneur Media, Inc.
Copyright 2009 by Entrepreneur Media, Inc.
All rights reserved.

As a student of corporate culture, I've been following the country's job loss news with a mix of horror and detachment. Obviously, when nobody is buying your products, you can't keep your entire team intact. But what does cutting surviving employees' salaries and 401ks really have to do with a company's long-term viability? As counter-intuitive as it sounds, you need to invest in fun instead.

Fun is a signature element of people-centric management; an approach that puts people ahead of the bottom line. A recent American Management Association study found that this type of workplace culture is less vulnerable to market cycles.

We’re always looking for ways to lighten up the environment in our office. For instance, everybody wore their favorite team jerseys on the Friday before the Super Bowl, winners of our version of “The Amazing Race” had a great time on a four-day trip to New York and I'll be emceeing our annual Gong Show (our "lack-of" talent show).

Making things fun is important because our financials prove we can't provide a premium service--and charge accordingly--without a happy, motivated workforce.

Here's how they do it.

1. People-centric businesses know they can't satisfy customers with freaked out workers. In today's economy, stressed out customers won't tolerate service issues. While everybody else was cutting back, our management team gave 70 percent of our staff a salary bump. We cut into profits, but a 3 to 5 percent raise makes a huge difference to a single mom with two kids and the cost will pay for itself many times over in loyalty and quality service.
2. People-centric businesses know managers are the most effective leaders in tough times. It's easier to open your books than your heart, but keeping an open dialogue with employees is a great way of rallying a spooked team. Internal forums like town halls are a chance to say, "We can't make any guarantees, but we're doing everything we can to protect you. What else can we do to get through this together?" Workers feel safer and more motivated. When layoffs are inevitable, your employees know you really did do everything you could to protect them.
3. People-centric businesses are ahead of the communication curve. Progressive companies laid the foundation for the current downturn years ago by creating an open dialog and trusting relationship with employees about the company's goals. Employees who were plugged into their company's financials have been helping whittle down excesses long before the market soured.
4. People-centric businesses don't cut back on training in a crunch. We just finished an exercise to make sure everybody understands our brand. It took time and consulting fees weren't cheap, but everyone's connecting our strategy to their daily routines, with an eye to enhanced performance and client retention.

So, even if your revenues are hammered, now is as good a time as any to engage your employees, improve your culture, and be better prepared for the next crunch. Whatever you do, heed this advice from the AMA: "Don't let the market dictate your culture."

Put People Before Profits: http://entrepreneur.com/management/columnistpaulspiegelman/article203074.html
Reprinted with permission of Entrepreneur Media, Inc.
Copyright 2009 by Entrepreneur Media, Inc.
All rights reserved.

2010 is here; a new decade with new challenges. During the past decade, all sorts of new technology entered our lives. As your children played with the latest Wii, Xbox or PlayStation, and you downloaded the latest best seller to your Kindle, did you take the time to think about the implication of the latest technologies for your hospital?

How will patients, accustomed to using their phones for instant access to everything, change the customer service demands for healthcare providers? Will they expect to use text messages to get their room cleaned? Will they want a special app for food on demand?

A new report, Trends in Patient Service Strategies: Improving Customer Satisfaction with Technology, explores how healthcare organizations can leverage technology advancements to improve customer service.  While most hospitals already use relationship management systems and web-based scheduling and are dabbling with personal health records, patients are looking for e-mail and chat as well as registration kiosks and patient portals. This report details how technology can support and improve patient satisfaction.

I believe that in this new decade we will increasingly rely on technology to support our customer service initiatives. The emergence of new technology and the increasingly high expectations of patients will make support for technology a strategic necessity. While there may be challenges to adoption, I am convinced that hospitals who leverage technology will increase customer satisfaction.

How are you integrating technology into your customer service strategies? I'm anxious to hear from you. So text me, email me, tweet me or use whatever technology you prefer. I want to hear from you...my phone works pretty well too.

You can follow Paul on Facebook (facebook.com/paulspiegelman) and Twitter (@paulspiegelman).

A sweet grandmother called St. Joseph's Hospital and timidly asked, "Is it possible to speak to someone who can tell me how a patient is doing?"

The operator said, "I'll be glad to help, dear. What's the name and room number of the patient?"

The grandmother said in her weak, tremulous voice, “Norma Findlay, Room 302."

The operator replied, "Let me put you on hold while I check with the nurse's station for that room."

After a few minutes, the operator returned to the phone and said, "I have good news. Her nurse just told me that Norma is doing well. Her blood pressure is fine, her blood work just came back normal, and her physician, Dr. Cohen, has scheduled her to be discharged tomorrow."

The grandmother said, "Thank you. That's wonderful. I was so worried. God bless you for the good news."

The operator replied, "You're more than welcome. Is Norma your daughter?"

The grandmother said, "No, I'm Norma Findlay in Room 302. No one tells me anything."

--------------------------------------------------------------
Many of us can identify with Norma to some degree. Perhaps we’ve felt out of the loop and uninformed at some point in our own healthcare experiences. Perhaps it was a situation where we didn't feel like our doctor explained a condition in more detail, or when a nurse came to run tests we didn’t fully understand, or when the physician’s office location changed without telling us. 

As healthcare providers, it’s easy to get caught up in the behind-the-scenes work and our many daily tasks. We may not realize how our interactions or inactions might affect the patient experience.

I did spot one good thing in this story though. It sounds like the hospital was doing a good job making information available to family members, giving the organization the benefit of the doubt when it comes to HIPAA violation.

With patient satisfaction so important, stepping back and assessing how well all levels in your organization are doing with respect to communicating to patients is critical. As a healthcare organization committed to delivering the best patient experience, what steps are you taking to ensure that your patients are kept in the loop and do not feel like Norma?