As healthcare professionals across the US ponder the future of our profession, Michael Porter and Elizabeth Olmsted Teisberg point out why the industry is facing the predicament it is in. We are engaged in the wrong kind of competition:
As we pointed out in a previous post, cost cannot be the dominant criteria for performance – rather, we must measure value. Performance must be measured in terms of value which depends on outcomes and is organized around the patient (customer).
At the Physician Leadership Institute, we help healthcare organizations break the cycle of failure by re-evaluating their purpose. We help them build an integrated performance framework that includes organizational strategy, standards, processes, execution, and measurement. A very good starting point is a service quality model that has been around for some time.
The service quality model (SERVQUAL) was originally introduced to us by Parasuraman, Zeithaml and Berry in their 1985 classic Delivering Quality Service; Balancing Customer Perceptions and Expectations. It highlights the main requirements for delivering high service quality by identifying five ‘gaps’ that lead to unsuccessful performance:
SERVQUAL originally focused on 10 aspects of service quality, measuring the gap between customer expectations and experience. The basic assumption of the measurement was that customers evaluate a firm’s service quality by comparing their perceptions of delivered service with their expectations. SERVQUAL has its detractors and has been criticized for its complexity, subjectivity and statistically unreliability. In healthcare specifically, there have been numerous attempts to measure the efficacy of the model.
The Physician Leadership Institute has modified the SERVQUAL model to create a usable model that allows healthcare organizations an integrated process of continuous improvement. Our version of the model covers strategy and execution, process optimization, outcome measurement and customer perception:
The original model introduced us to ten dimensions of quality:
- Competence is the possession of the required skills and knowledge to perform the service. For example, there may be competence in the knowledge and skill of contact personnel, knowledge and skill of operational support personnel and research capabilities of the organization.
- Courtesy is the consideration for the customer’s property and a clean and neat appearance of contact personnel, manifesting as politeness, respect, and friendliness.
- Credibility is the factors such as trustworthiness, belief and honesty. It involves having the customer’s best interests at prime position. It may be influenced by company name, company reputation and the personal characteristics of the contact personnel.
- Security is the customer feeling free from danger, risk or doubt including physical safety, financial security and confidentiality.
- Access is approachability and ease of contact. For example, convenient office operation hours and locations.
- Communication means both informing customers in a language they are able to understand and also listening to customers. A company may need to adjust its language for the varying needs of its customers. Information might include for example, explanation of the service and its cost, the relationship between services and costs and assurances as to the way any problems are effectively managed.
- Knowing the customer means making an effort to understand the customer’s individual needs, providing individualized attention, recognizing the customer when they arrive and so on. This in turn helps in delighting the customers i.e. rising above the expectations of the customer.
- Tangibles are the physical evidence of the service, for instance, the appearance of the physical facilities, tools and equipment used to provide the service; the appearance of personnel and communication materials and the presence of other customers in the service facility.
- Reliability is the ability to perform the promised service in a dependable and accurate manner. The service is performed correctly on the first occasion, the accounting is correct, records are up to date and schedules are kept.
- Responsiveness is to the readiness and willingness of employees to help customers in providing prompt timely services, for example, mailing a transaction slip immediately or setting up appointments quickly.
In the 1990s, however, the complexity of measuring all these dimensions led the authors to refine the model to measure the following attributes:
This RATER model is easier to implement, but we’ll show you how to avoid common mistakes most organizations make.
The next series of blog posts will describe each aspect of our healthcare performance model in detail.