Going Above and Beyond: Improving Internal Customer Satisfaction

By Jan Myers

There is no question that the work done by central service (CS) departments in healthcare organizations across the country has a direct impact on the health and safety of patients. The technicians in CS departments are charged with properly sterilizing instruments used in patient carefrom the operating room suites to clinical areasand getting the right instruments to the physicians when they need them. Important work, no doubt, but another question remains. Can the satisfaction these internal customersthe doctors, nurses and others working in the hospital and clinichave with CS make an impact on our external customersthe patients we serve?

At Gundersen Lutheran Health System, we believe the answer is yes, and have set a goal to provide the best possible customer service not only for our patients, but for one another.

 As healthcare organizations strive to provide excellent service for our patients, we sometimes forget that we need to provide this same level of service to the people and departments we interact with on a daily basis, says Gale Kreibich, director of service excellence at Gundersen Lutheran Health System.

Why improve internal customer satisfaction?

We firmly believe that by providing excellent service to one another internally, we can improve employee morale, communication and cooperation between departments, and our processes and productivity. All of this will have an impact on the care we provide to our patients, and in turn, our patients satisfaction with the care they received. Its all related, and thats what makes internal customer satisfaction so important in healthcare, Kreibich says.

In support departments like CS, we work behind the scenes and rarely, if ever, have direct contact with our patients, but the work we do for the physicians, nurses and others who work with patients can directly impact their outcome. Therefore, it is critically important that the service we provide matches or exceeds the expectations of our internal customers.

Since 2007, weve taken a number of measures in CS to improve the service we provide to our customers. We believe the lessons we learned here can help other organizations improve their internal customer service, too. Before discussing those measures, a little background on Gundersen Lutheran and the CS department may help put our customer service work into perspective.
Headquartered in La Crosse, Wis., Gundersen Lutheran is a comprehensive, physician-led healthcare network with hospitals and clinics throughout Wisconsin, Minnesota and Iowa, serving about 500,000 residents.

More than 5,500 employees support the more than 700 medical, dental and associate staff in our system. With a 325 licensed bed hospital, 22 operating rooms (OR), a nationally verified Level II Trauma Center, and more than 40 clinics and affiliated hospitals, our busy facility records more than 52,000 inpatient days, 1,470 live births, 21,600 emergency room visits, 4,560 inpatient surgeries, 12,000 outpatient surgeries and 1 million clinic visits each year. We do so while consistently ranking in the top 5 percent of healthcare organizations in the country by independent healthcare ratings organizations.

The CS department at Gundersen Lutheran reprocesses instruments and trays for the inpatient surgery suites and ambulatory surgery as well as most of the clinics. CS employs about 39 full-time employees who are located in two sites. One site supports the inpatient surgery suites and nursing units, including the Trauma & Emergency Center, Labor & Delivery and Specials Lab. The other site supports outpatient surgery and all clinic sterilization. In 2011, the CS technicians processed more than 429,000 trays and packs containing nearly 4.7 million components.

Clearly, the CS department is a busy place and the work we do is a vital part of keeping everything running smoothly for our doctors, nurses and patients. That makes customer service a top priority.

Taking the First Steps
Our first customer service improvement initiative was aimed at reducing delays in the OR to save the organization time and money. It has been estimated that every minute of delay in an OR costs the organization and/or patient $40. With the number of surgical procedures our organization performs, these delays can be costly.

We implemented a computerized tracking system and adopted Lean manufacturing methodology to streamline the supply chain between CS and the OR. We saw immediate improvements. Some of the most notable include decreasing the percentage of incomplete trays from 16 percent to 0.03 percent, dramatically decreasing response time in locating trays and instruments for the OR, and standardizing processes to reduce the surgical tray preparation process.

In addition, the teams created an OR/CS liaison position to facilitate better communication between CS and Surgery. The liaison handles all emergent requests and problems. According to Pat Johnston, RN, who is an OR/CS liaison, when misunderstandings occur the liaison can work both sides of the issue for a quicker and calmer resolution. He is able to talk directly with the surgeons and team leaders to help identify and clarify problems that arise between the two departments. Johnston also addresses issues with case-cart stocking and manages the high volume of loaner instrument sets that come through to ensure the OR receives more complete and accurate supplies and instruments. This, in turn, creates better outcomes for patients undergoing surgery, and improved satisfaction for the OR teams.

Measuring Internal Customer Satisfaction
Our next step was measuring our internal customer satisfaction levels, and taking steps to improve those levels. Gundersen Lutherans Service Excellence team implemented this system-wide initiative, and provides departments with support and guidance to reach a higher level of customer service. In CS, we were able to apply simple solutions that resulted in great improvements in the service our team provides.

In order to measure the satisfaction of internal customers, Service Excellence developed surveys that are distributed twice a year.

If you ask most people, theyll probably tell you that theyre providing great service. Thats why it is important to do surveys. It gives you a better picture of the reality, Kreibich says.

The survey asks respondents to rate the department in three categories:
Courtesy/friendliness of Central Service in person and on the phone
Extent to which Central Service meets my needs
Promptness of Central Service in responding to my requests

The ratings include: poor, fair, good, very good or excellent. The goal is for departments to have 85 percent of respondents rating them very good or excellent.

The survey for CS is sent to a randomly selected panel of Gundersen Lutheran employees. The results of the first survey in February 2007 showed that internal satisfaction was much lower than desired, with only a 76 percent rating of very good and excellent for courtesy/friendliness; 79 percent for meeting my needs; and 69 percent for responding to my requests. 

The results showed us that we needed to get a better understanding of our customers wants and needs, and then make changes to better meet those needs.

Getting Feedback Directly from the Source
We knew that the CS department needed to build a rapport with the OR, hospital and clinic staff in order to reach the established goals. The question was, how?

It can sometimes be difficult for departments to figure out what they can do to improve. In Service Excellence, our goal is to give them to tools they need to make changes and improve their customer service, Kreibich says.

When departments receive the survey results, managers are also given any written feedback the respondents provide. The comments for CS were mixed. Some employees who participated in the survey expressed positive feedback, saying that CS met the needs of the hospital quickly and pleasantly and that the CS staff is always friendly and willing to help get us what we need. Others expressed their desire for change. Some questioned whether the CS staff understood what was being asked for, while others said staff was not always prompt with requests.

The feedback was valuable and helped us narrow down the changes we needed to make as a department. In addition, Service Excellent provided CS with customer service improvement tips and ideas that were easy to implement and impactful. They include:
Get into the habit of smiling and greeting your colleagues and people you pass in the hallways.
Help visitors find directions, or take them yourself.
Be aware of facial expressions and nonverbal language; 93 percent of communication comes from nonverbal cues.
Answer the phone professionally, and with a smile. Example: Central Service, this is Julie. How may I help you?
Recognize the achievements of others.
Ask others what they think.
Be open to feedback.
Remember: The attitude you portray is the impression you leave.
Set realistic expectations for follow-up. Get back to your coworkers and customers when you say you will, even if you can only give them an update.

The CS department took information gathering one step further, going directly to the source for information. Twice a week, the CS supervisors interviewed customers from the departments CS supports. They asked the customers what was being done well, and what CS could do better.  This feedback provided even more valuable information regarding the customers wants and needs.

Taking Action
With all of the information gathered, the CS team was ready to take action. Some of the most effective steps taken include:
Answering phone calls within the first couple of rings.
Using the friendly phone answering etiquette guidelines provided by Service Excellence.
Immediately sending requested items to the requesting department.
Asking co-workers for assistance if requests could not be easily filled or the technician was unsure about a request.
Getting back to the customer as quickly as possible and with as much information as possible if there was a problem fulfilling the request.
Conducting employee training sessions to improve the use of the computer tracking system that is used to locate requested trays and instruments.
Establishing extra clinic pick-up times, and creating lists to accompany clinic instruments so the departments would get back exactly what was sent.

In addition, CS updated an internal department website that provided additional information to help distinguish CS from similar departments. A mission statement was added to the website to showcase the departments commitment to providing a higher level of customer service. The statement included our goals to provide 100 percent complete and accurate supplies and instruments, our dedication to reliability and our commitment to adhering to the highest standards of infection control while reducing waste and improving efficiencies.

Seeing Measurable Results
The actions the CS department took resulted in measurable improvements in terms of our internal customer satisfaction scores. A survey in October 2011 showed very good and excellent ratings of:
84.3 percent rating of very good and excellent for courtesy/friendliness (compared to 76 percent in February 2007)
83.3 percent for meeting my needs (compared to 79 percent in February 2007)
80 percent for responding to my requests (compared to 69 percent in February 2007)

While the team fell just short of the 85 percent goal, the increase in internal customer satisfaction is impressive. With support from the Service Excellence department, CS employees at Gundersen Lutheran continue to use the skills acquired over the last several years and strive to go above and beyond the organizational target in 2012.

While many of the steps taken at Gundersen Lutheran may seem intuitive, our experience shows the importance of measuring not just patient satisfaction, but internal customer satisfaction, too.

Jan Myers is a central service technician who has 10 years of experience with Gundersen Lutheran Health System. Gale Kreibich has been the director of Service Excellence at Gundersen Lutheran for six years and has worked for the health system for 30 years. Pat Johnston, RN, is a hospital expert leader in the surgery department at Gundersen Lutheran and has acted as the OR/CS liaison since 2007.