Conference Reviews

Service Recovery: When sorry is not enough

Reviewed by Mary Hegenbarth, MD

We’ve all been there—things didn’t go as well as they should have, and the family is upset. Lisa Robertson of Florida Children’s Hospital and Kay Leaming-Van Zandt, MD of Texas Children’s Hospital discussed concepts and techniques regarding service quality and service recovery.

Dr. Leaming-Van Zandt stated that increasingly patient experience will be considered the "true north” of quality. There are two components of service quality; technical (delivered by teams, involve planning, objective, easily measured outcomes) vs. service (delivered by individuals, spontaneous, subjective, and difficult to measure). There is debate about whether people seeking care are “patients” or “customers”, but in fact they are always both. Although patients have access to ever increasing amounts of information online and through social media, the interpersonal relationship with a physician who is seen as warm and caring remains paramount. Communication skills are key, as shown in a study of parent satisfaction in the setting of expectations regarding antibiotic prescribing (Mangione-Smith, Pediatrics 1999)—how well the physician communicated was much more predictive of satisfaction than whether antibiotics were prescribed.

It is best to reframe “difficult patients/families” as “difficult encounters”. Multi-disciplinary preparation is key. A point person (usually the physician/team leader) is identified, and should be skilled in communication, conflict resolution and modeling professional behavior. Before attempting to resolve conflict, both external preparation (figuring out what happened) and internal preparation (self-reflection, mindfulness) are needed. Internal preparation helps de-escalate the provider’s natural response to a stressful situation. The patient/parent should be allowed to vent, with the provider remaining quiet, open-minded and avoiding the impulse to become defensive or fix things right away. One of the best tools is reflective listening, which involves active listening then reflecting your understanding back. Empathic validation involves acknowledging and being able to understand some aspect of the parent’s emotions or experiences, most of which are logical. These skills should be practiced in all encounters so they are readily available in more stressful situations.  An empathic and focused apology helps regain patient trust and acknowledges that the team/system have learned from the conflict. Negotiation should focus on realistic expectations/goals; at times a third party mediator may be needed.

Ms. Robertson talked about service recovery, or how to make things right after something has gone wrong. Empathy is critically important; patients respond most strongly to a sense of fairness. Service recovery should be a planned process, addressing predictable problems and working on solutions/implementation. Successful recovery must be immediate, simplistic, respectful and empathetic. Find out what the real problem is, listen with open ears and heart, and don’t make excuses.  Thank the family for bringing up the problem, empathize, apologize, and provide a solution/plan.  While saying you are sorry is not enough, it’s a start. If you have trouble apologizing, practice. Leave the family with a kind gesture such as shaking hands, a hug etc.

Finally, complaint management was discussed. There should be skilled staff and an effective system for receiving and quickly resolving complaints and grievances. Complaints should be tracked to identify trends and improvement opportunities. Service recovery is everyone’s responsibility!

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