Pre Services – The Gateway to Healthcare Consumerism?
By: Mischa Dick
Recently we have engaged with several healthcare provider organizations wanting to fundamentally redesign their existing pre-service operations. While some of the initial motivation is linked to better capture the patient financial liabilities, the leading organizations are rethinking this process from a much broader perspective. These organizations seek to:
- Enable the organization to be the provider of choice in an increasingly consumerist market
- Use Pre Services as the gateway to consumerism
- Leverage non-clinical customer service as a competitive advantage
Healthcare service quality is difficult to evaluate in advance, which makes it difficult for consumers to choose the best option, but they will form an opinion nonetheless. The perception of quality is directly linked to the quality of non-clinical processes, in some ways superseding the quality of the clinical processes for the patient experience. Getting it right really matters as consumers will exit if they perceive to have better alternatives. Pre-services are the first touch point, therefore the first opportunity to disappoint or wow the customer.
Pricing also increasingly matters in the decision process, and many healthcare providers still struggle to create pricing transparency and accuracy to satisfy the demands of the consumer. However, the mere fact that consumers are seeking pricing information opens the door to an initial dialog that can be of value to both the consumer and the provider organization.
One avenue to explore is a redesign of the pre-service processes in such a way that they operate as true customer service delivery processes, rather than administrative processes perceived more as hurdles than a help by consumers.
To start this journey, it is worthwhile to define customer service in a simple, practical and constructive way. The Ritz Carlton hotel group has been working on creating an exceptional customer service model for decades, and we took the liberty of loosely borrowing one of the more practical explanations of customer service as the anchor for this discussion:
Customer Service is taking care of the customer the way they want to be taken care of
Executing to this definition of customer service to create a positive experience, and ultimately customer loyalty, is a complex endeavor, however, it is one that can be accomplished in stages. A few key areas need to be addressed by the solution:
- A culture of true customer service is established and nurtured. Existing cultures often see pre-services just as an administrative and transactional function, so the starting point is to transform that culture to one where serving the customer is the primary objective.
- Processes, tools and policies are built to enable associates to focus on customer service. This means processes have to be well defined and reliable. Tools should make the mechanical parts of the job easy so minimal energy is spent on repetitive and unnecessary tasks. Lastly, policies and guidelines need to allow for associates to address individual concerns and obstacles for customers without fear of being reprimanded by ‘coloring outside the lines’ while ensuring compliance and professionalism in all interactions.
- Technology is built to enable the ‘way they want to be taken care of’ part of customer service. Most consumer facing technology from providers to customers are antiquated and not representative of today’s service environment. The capabilities expected of customer service processes are simply not available through the EMR portfolio and thus need to be created. Most pre-service interactions today are still heavily reliant on telephonic interactions, a method that while a slice of the population values, many do not; they prefer self-service technology over waiting for return phone calls or waiting in phone queues.
Venturing on this journey of redesigning pre-services can be accomplished in phases, which allows progress today while establishing the comprehensive process over a reasonable amount of time. We have found the 5 step process outlined below to work well in creating and implementing fundamental process change:
Phase 1 – Design the new process
Using a team of associates, leadership and process design experts, the new, comprehensive process is designed in detail. This includes the process flow, workflow and work management methods, metrics, service level and staffing models, technology requirements (regarding existing and new technology), organizational structure, etc. Next, all elements that can be implemented in the here and now (typically those elements that do not require significant changes to technology) are identified and two documents are created: 1. The intermediate process documentation, the implementation plan, and the budget/financial justification 2. The final process documentation and implementation plan. This very method of designing the process and involving the operational staff is a crucial step in creating a culture of customer service excellence. We will argue that a pure implementation of “best practice” process will fail to deliver this crucial element, as working through the detailed elements of process purpose and process design creates the very comprehension that changes culture.
Phase 2 – Implement the ‘here and now’ pieces
Typically following the process design phase, the process tools, policy revisions and training programs are completed. Next the intermediate process is implemented and put into operation, including the implementation of a root cause corrective action system to quickly identify issues and correct them. Building the environment, via tools, policy, training etc. that allows associates to be successful is key to making the overall project successful. All too often the administrative component of doing the job at hand is so cumbersome and complex, that customer service takes a back seat to tactical operations. It is simply not enough to push a mantra of customer services if the basic operations are too complex and demanding, leaving the staff expending their energy on mechanical tasks.
Phase 3 – Build the elements to enable the full process
In phase 3, the elements, typically technology changes and technology builds, are completed. In the case of pre-service processes, this includes the creation of consumer facing technologies, such as apps for patient self-scheduling and appointment requests, pre-service checklists, patient itinerary communication and SMS reminders. The technology infrastructure gap for consumer facing technology in healthcare is large, but given today’s development platforms and the development mentality of minimum viable product can give visionary providers a fast leg up in the race for customer service.
Phase 4 – Implement the full process
Once the pre-requisite elements are completed and tested, the process is once more revisited and implemented fully in accordance with the previously designed plan. This phase usually includes extended presence of process engineering to fully resolve any issues preventing the process from delivering to outstanding customer service.
Phase 5 – Continually Improve the process
Lastly, the operations team is introduced and trained on management methods that allow for continual improvement of the operation. This key element ensures that the process in operation today remains agile as learning occurs and as demands change.
In summary, leading and visionary provider organizations are investing into areas of the business that can be turned into strategic investments during the migration to consumerism. Pre-services are a logical starting point given that this is often the first point of contact from which the customer experience is built.