​The long term care industry has many challenges ahead, particularly in three areas that are sure to impact bottom-line results: compliance with the new Centers for Medicare & Medicaid Services (CMS) quality-of-life requirements, implementing resident satisfaction initiatives, and achieving high levels of satisfaction among the ever-increasing short-term care population.

The New Realities

Complying with new quality-of-life requirements could be a significant challenge for many long term care providers. Issued last year, the requirements encompass 12 F-tags and are focused on resident-centered care, with a particular emphasis on quality of life. This means that surveyors will pay closer attention to how nursing facilities create homelike environments that enhance quality of life in accordance with resident preferences.
This leaves the facility with the responsibility of actively seeking information about resident preferences and choices and attempting to accommodate them. If a facility has not done so, surveyors will require them to provide an explanation. Moving from a facility-centered environment to a resident-centered culture could be a major challenge for some providers.
The second challenge for providers is implementing programs and practices that increase resident satisfaction. There is a very real possibility that facilities will be required to undergo satisfaction surveys by an outside vendor. CMS may consider integrating resident satisfaction data into the Five-Star Quality Rating system and making the data public. If that happens, the data would enable consumers to decide which long term care facility they will ultimately choose.
Nursing facilities have worked hard to develop clinical and professional standards, but they have not focused on developing quality service standards that will be necessary to meet and exceed customer expectations. In order to be effective, quality service standards need to be developed and integrated into all systems, processes, and procedures within a facility.
The third challenge for nursing facilities is improving the satisfaction level of the short-term resident. Although related to the second challenge, the nature of the population makes this challenge quite different.

The Short-Term Stay Factor

There has been a significant increase in the growth of this group over the past 10 years. These short-term residents bring with them a whole new set of criteria in terms of achieving high levels of customer satisfaction.
They are, for the most part, younger and more discriminating in terms of what it takes to satisfy them and their family members. It is likely that their family and friends will be at the facility more often and will be in a position to evaluate service quality more critically.
In turn, they will be making more of their decisions about choosing a facility based on the recommendations of family and friends, which places a greater demand on a facility that wants to increase market share to implement proven programs that will improve quality service.
All three of these challenges have the same thing in common: changing the organizational environment from a facility-centered to a resident-centered culture.

Long Term Care Versus Hospitality Industry

Fortunately, there is a direction in which to go. The long term care industry must examine the best practices that have been put in place and tried and tested over the years in the non-health-care sector. Long term care can borrow practices and experiences from the hospitality industry, restaurants, hotels, and virtually any organizations that have direct customer interaction as an integral part of what they offer their customers.
When looking at the best non-health-related businesses, they have a lot in common with long term care. They are looking to gain the competitive edge and increase market share through repeat and referral business.
But there are major differences as well. For example, most customers in this sector want to purchase their products and services, unlike long term care, in which customers are typically forced to make a choice in a very short period of time.
In addition, the interactions with non-health businesses can be measured in terms of minutes, hours, or sometimes days. Whether it is going into a department store, a restaurant, or hotel, the time factor is relatively short.
In long term care the challenge is much greater for just the opposite reasons. First, and probably the greatest, is that customers of long term care typically do not want to be there. Couple that with the fact that residents are there 24 hours per day for days, weeks, months, or longer, and the number of interactions they will have is countless. This just makes achieving a resident-centered culture more difficult.

Manage Moments Of Truth

What does industry do in terms of best practices for achieving high levels of quality service? First, it looks at its delivery of the service, not from what it does but from what the customers experience. Managing these experiences in a way that will meet and exceed customer expectations is key.
It is important to note that the physical environment in which the services take place, the personal appearance of employees, interaction with the employees, and processes that interface with all contribute to residents’ levels of satisfaction.
In addition, many of the customers’ experiences happen in a fairly predictable way, with a defined starting point and a predictable end point. This can be called the “customer experience cycle.” For example, when one dines in a restaurant, the experience cycle may start with making a reservation, followed by arriving at the restaurant, and then all of the intermediate steps in between, ending with paying the bill.
In a quality-service-focused restaurant, management has carefully studied and put in place the small, individual but important elements to make the dining experience live up to customers’ expectations.
From the initial greeting by the host to meeting the wait staff, all have been looked at one “moment of truth” at a time, with a moment of truth being defined as any incident in which the customer forms an impression of the quality of the restaurant’s services.
Moments of truth are formed by what the customer sees, hears, or experiences in the course of receiving a service. They are neither positive nor negative on their own. It is what is done at that moment that makes it a plus or a minus. It is all of these moments of truth, taken together, that form the customers’ score cards and ultimately their levels of satisfaction.

Quality Service Standards

Do these concepts apply to the long term care environment? Absolutely. For example, when the resident is first admitted, does she experience a predictable series of events, from arriving on the nursing unit, being taken to her room, and being assessed and oriented by nursing personnel? After this occurs, the new resident is visited by an array of staff from various departments who further the assessment and orientation process.
How does a long term care facility manage the customer experience in a way that meets and exceeds her expectations? It does it in the same way as the non-health-care sector does it, one moment of truth at a time.
As with any other entity that has a service component to its business, long term care providers need to identify their quality service standards—those actions that must be built into how service is delivered. Identifying these standards and implementing them will take a concentrated organization-wide effort and the senior management team leading by example.
Once these standards are developed, the facility needs to study its customer-experience cycles and build in these standards, which should be integrated into every aspect of the organization: job descriptions, job-specific performance standards, training programs, screening and selection practices, performance evaluations, orientation, and monetary and nonmonetary reward and recognition programs, just to name a few of the important areas.

Staff Satisfaction Paramount

One other major factor that cannot be left out of this equation is the satisfaction and commitment level of the employee who is delivering the service. To be effective, an employee must be both satisfied and committed to provide high-quality service. Rarely has an employee who is unmotivated or disgruntled ever delivered high-quality service.
That circles back to the management of the facility and how the employees are treated and valued as internal customers. Employees need to fully understand what is expected of them, and quality service standards need to be built into all aspects of their jobs, much the same way that clinical standards are.
Managers need to provide feedback and recognition to the employee and create an environment that helps them feel motivated to deliver high-quality service. A strong emphasis on resident satisfaction needs to be a major focus for long term care and must be built in as an integral part of the strategic planning process.
Service quality is one of the most important parts of the customer value package, along with clinical quality and price. Having one or two of these alone will not be enough to maximize repeat and referral business and market share. All three are essential to success.
Norm Burns is founder and president of Organization Dimensions (ODI), a consulting firm focused on helping clients find solutions that contribute to their productivity, customer satisfaction, and bottom line. He can be reached at (352) 588-0890 and at normburns@odiconsultants.com.