​Senior care professionals are accustomed to change, but it is one thing to meet the daily challenges of your calling when the road ahead is well marked and brightly lit. It is quite another to stay on track when conditions make that road less visible, or doubts creep in as to whether it is the right road at all. Some may have begun to wonder if they even have control of the steering wheel anymore.

An anemic economy; battered federal and state budgets; record public debt levels; health care reform that is sweeping, conflicted, and confusing; political unrest and uncertainty—all these together (if not the Great Depression revisiting) can certainly lead to a feeling of depression, if not paralysis, in individuals and companies. 

Under such conditions, it is imperative for forward-thinking leaders to gain an understanding of the changing environment. It is equally important for them to retain control of what matters most—the basics that define what they do, why they do it, and what must be in place in order to survive and thrive under any conditions. In past recessions and periods of health care policy change, there were always new opportunities hidden inside the apparent threats. Successful leaders will assess both—and find ways to capitalize on those openings. 

Meeting new opportunities with a new value proposition.

In the world of Medicare and Medicaid, traditional top-down regulatory strategies and fee-for-service payment policies still prevail, but are in slow-but-sure retreat as the twin poles of quality and value are brought into closer alignment. Signs abound that Congress, state legislatures, and public agencies will continue to invoke nontraditional methods of assessing the performance of nursing facilities as part of a general policy evolution toward value-based purchasing and greater public transparency of price and quality information in the health care sector.
Health care reform, even if altered by a new Congress, will only accelerate these trends, while bringing to the forefront two specific, related objectives:
1. Avoidance of costly rehospitalizations; and
2. Bundling of payments across provider settings with the potential of making money follow value in a way not possible under fee-for-service.
Neither of these evolving trends is guaranteed to be effective, but point to a new game-changing status quo in the next few years.
While new ways of measuring technical outcomes of care are receiving their proper attention, the fundamentals of a broader concept of a quality culture from the perspectives of residents, families, and caregiving staff now occupy a comparable level of consideration for both practice and policy.  

Some states now require satisfaction surveys to be made public.

As noted in My InnerView’s November 2009 report, “Rewarding Quality Nursing Facility Care: State Quality Programs and Purchasing Models Point the Way,” several states are experimenting with “market-based” reforms, which commonly include offering more actionable information to consumers, together with steps to directly align Medicaid payment incentives with measurable quality outcomes and demonstrated improvement.
Customer satisfaction is a measure of performance found in nearly all such programs, and employee satisfaction is or will be used in a majority of them.
A small group of states, also likely to expand, have enacted legislation requiring or enabling nursing facilities to periodically obtain independent assessments of resident satisfaction and make the results public.
While these trends were under way before the appearance of the current severe strains on public and private budgets, the new prospect of sector rationing has only focused attention more sharply on the desire to define and seek greater value within available resources.
Long term care providers, no less than other health system participants, are caught up in a political and fiscal vortex that is unlikely to abate in the foreseeable future. Thus success, or even survival, of providers will require timely adaptation to the requirements of value-based and evidence-based practice. A key variable will be the ability to engage customers and staff in a common commitment to deliver services in a culture of excellence. 

Customer expectations will continue to grow.

In the world we live in today, the mantra is “doing more with less.” But what does that mean to the post-acute health care provider? Consumers’ expectations are high and will continue to grow. Today’s consumers are more knowledgeable and much more demanding, as they have lived their adult lives accustomed to having choices and information about a broad spectrum of the products and services they have purchased.
As health care providers scramble to understand and prepare for health care reform and other changes, leading organizations will be rewarded for being customer-centric and maintaining a fully engaged and motivated workforce. In the new world of greater transparency, there will be no place to hide. The old ways of doing things will no longer work.
Over the next five to 10 years, the senior care profession will see transformational change like never before. So, what should providers do that will allow them to lead the way in the care and services their customers want and expect?

Competitive advantage No. 1: You must be customer-centric.

Don’t manage your customer experience in a vacuum.

Before your organization can improve the customer’s experience and satisfaction, you must understand what you are currently offering to your customer and exactly where you might or might not be meeting their expectations. Forrester Research has found that the most significant obstacles to improving the customer experience/satisfaction are:
1. Lack of a clear customer experience/satisfaction strategy.
2. Lack of a customer experience/satisfaction management process.
First, you can improve customer experiences only if you know and understand what those experiences are. The organizational culture and business processes that you have put in place translate into the service that your customer experiences. How often does the customer experience your intent to deliver get lost in the translation?
Your care delivery processes have been mainly designed to support your organization internally and meet regulatory specifications; in many cases, they put up customer barriers, confuse your customer or, at best, make it difficult for them to effectively communicate with you.
Second, not all of the customer experiences are created equal. The customer experience is not a static phenomenon. Jan Carlzon in his classic book, “Moments of Truth,” says that through the customer life cycle with your organization, there are many moments of truth where your customer experiences what it is like to do business with you.
It is important for your organization to understand the weight each moment of truth plays in your design of systems and processes.
Be sure that you communicate frequently with your customers throughout the customer life cycle.
My InnerView has processed millions of resident and family surveys and has never had a single survey returned that said the nursing facility over-communicated with them.

Know where you have service gaps, and fix them.

It is critical that your organization start measuring and managing the potential gaps in your customer’s experience. Through research conducted at My InnerView, we know that three major gaps can exist in any nursing facility:
1. The gap created by the communication the customer receives (both verbal and written) prior to being admitted to your facility. The organization may overstate services to be provided or talk about “best case” rather than “more likely.” These types of communications raise customer expectations and can damage later customer perceptions.
Leading organizations will continuously monitor and adjust the initial communication that their customers receive to make sure those expectations are set on a factual foundation.
2. The gap that can exist between what customers expect and what management thinks they expect.
Regularly surveying your customers using common as well as targeted instruments is an effective way to help narrow this gap, and can pick up changes in expectations based on actual experiences that occur during the customer’s stay.
One can get a false sense that because you have worked in the profession for a number of years that you know exactly what the customer wants. Leading organizations will dialogue with their customers frequently in order to understand expectations and service requirements.
3. The gap between processes put into place to deliver the customer experience and the actual experience that the customer receives. Be sure that systems and processes are actually delivering the desired experience for your customer.
Many times what makes life easier for your organization can in fact make life more difficult for your customer. Leading organizations will redesign the resident-care processes to ensure a more positive, memorable, and powerful customer experience. 

Change your paradigm.

There are three key paradigm changes that leading service excellence organizations make:
1. View each resident/patient first as an individual customer and then as a partner in service delivery. Leading organizations know that success can only be attained by recognizing customers as partners in conceiving, developing, and delivering care systems and processes. This is a difficult jump for many organizations to make, but once they do, improvement and satisfaction accelerate exponentially.
The best way to ensure that your customers are happy with the care and service you deliver is to involve them in the design and delivery process. Who knows better than the customer how, when, and where they prefer to receive their care and your service.
2. Move from viewing the focus on service excellence as a program or initiative to that of realizing it is a key strategy that should be embedded in the organizational culture. Service excellence is not a flavor of the month or “that latest program being pushed down from senior management.” Leading organizations know that service excellence must be a key pillar of the organizational culture and that every employee knows the strategy by heart.
3. Move from “management is responsible for the experience the customer has and their overall satisfaction” to “everyone in the organization is responsible for the experience the customer has and their overall satisfaction.” Leading organizations are embedding responsibility for the customer experience into everyone’s job description—holding everyone accountable for the results.

Competitive advantage No. 2: You must have an engaged workforce.

The power of an engaged workforce is invaluable.

Committed employees are loyal and not only drive their own performance but the performance of the organization as a whole. Every leader wants their workforce to be committed to who they work for and passionate about their work.
Employees need to have a clear focus and understanding of the organization’s mission, vision, and values and how it relates to their own future. And they need to understand how their roles and efforts in the organization make a difference in achieving the overall organizational goals.
As Jack Welch, retired CEO of General Electric, said, “No company, small or large, can win over the long run without energized employees who believe in the company’s mission and understand how to achieve it.”
Employees who are engaged in their work and committed to their organization provide the critical competitive advantage in today’s marketplace through lower turnover and higher productivity. They also drive higher customer satisfaction.
The overall employee engagement numbers in North America, according to Blessing White, are not as impressive as one would like. Less than one-third of employees are fully engaged, and 19 percent are actually disengaged. There is a clear correlation between engagement and retention in that 85 percent of engaged employees plan to stay with their employer through the next year.
Employee engagement is a complex equation that reflects the unique and dynamic characteristics that each employee brings when he or she walks in the door each day. There is no silver bullet when it comes to employee engagement. A multi-faceted, ongoing approach to engagement is usually the most effective. Most managers will tell you that the best thing that they did was to do a lot of things.

Leader Must Set The Tone

This article was written by Neil Gulsvig, President/Founder, and Bruce Thevenot, Senior Vice President, My InnerView, www.myinnerview.com, (715) 848-2713. My InnerView is an applied research company that promotes evidence-based management practices in U.S. senior care organizations.