Where is the Patient Advocate? – A Story in 3-Emails

Three secure messages, sent through the My Health eVet secure messaging system, all related to a need for VA Hospital services, and all reflecting something in common, the VA’s refusal to act.

First Email: Good Morning,

I have but one question, I would appreciate a timely and thorough response, within 24-hours. “Where is the advocacy from the patient advocates?”

Last Wednesday I needed to discuss the problems I am having with pharmacy refills, but was bounced off VA property because I can NOT Physically. Wear. A. mask! This is for patient safety concerns. Why am I being discriminated against and refused care at the VA Hospital and the patient advocates office is doing nothing to help improve this situation?

I was promised a letter from the VA Hospital Director over the incidents from June and July, still no response from the director or advocacy from the patient advocates. Why?

I need to be able to access the VA Hospitals services and cannot do so when the VA Police are enforcing a mask policy that puts my life in jeopardy! Without an adequate workaround to the mask policy, I suffer from refills that are delayed, and without the drive thru pharmacy, now have no recourse to develop a solution!

Why? Where are the Patient Advocates in standing up against the bureaucracy and demanding solutions for patient problems? Where are the Patient Advocates regarding the incidents from June and July, using hard evidence to improve VA Hospital performance?

Enough is enough! Where do I find a patient advocate?

Thank you!
Dr. Dave Salisbury

Second Email: Hello,

Is there a reason the drive-thru pharmacy is no longer?  I must get refills and the refill process through the mail is taking 3-5 times longer than normal; thus, reordering when you have a 10-day supply remaining is not good advice as I keep running out before the delivery is made.   Only because of the drive-thru pharmacy have I been able to stay ahead of medication emergencies with the refill process being broken.

Why? How do I get refills; when, because I cannot physically wear a mask, I cannot be seen in the VA ER or walk into the VA Pharmacy for refills?

I am thoroughly and completely out of two medications, they have both been reordered and I have no word on when they will arrive. The last refill on a diabetic medication took longer than normal (7-10 business days) to be received and I wonder when I should schedule reordering that medication with the added slowdowns and longer delivery times.

How do I gain refills when I have zero access to the VA Hospital and the refill process has failed to delivery on time?

Thank You!
Dave Salisbury

Third Email: Dr.

I do not know what is happening with pharmacy, but something must give! I reordered my refills with plenty of time since March 2020 through the Phoenix, VAMC, and I keep running out before the meds arrive!

Due to the continued increased symptoms, usage of medication increased, but the refill process has slowed, and without the drive-thru pharmacy I am stuck without access to pharmacy.  Especially, since I can never get a straight answer when trying to use the phone.

As of this morning, I had to wake up, and take the remaining dosage and two Advil for the crushing, horrible light sensitivity, facial pain, twitch bordering, headache! How do I get this refilled with the drive thru pharmacy out of operation, and the VA Hospital off limits because I cannot physically wear a mask?

I have, as if this writing 0330 27 October 2020, been out of one medication for two days, having taken the last pill on Sunday (25 October 2020)! One of the reasons why I had 90-day supplies, instead of the VA (policy?) 30-day supply in Albuquerque was because of this exact reason, I kept running out before the deliveries were made. I must be able to trust the VA Pharmacy Refill process, and the pharmacy refill process is untrustworthy, and currently in disarray.

I showed up at the hospital last week (21 October 2020) trying to have this conversation with pharmacy and was first kicked out of the hospital, then escorted off property because I cannot safely wear a mask and asked why.  I also asked for a copy of the mask policy, and had a supervisor turn himself into a pretzel trying to explain why he cannot produce a policy upon request. What do I do?

Thank you!
Dave Salisbury

Before leaving Albuquerque, NM., I had the privilege of being able to discuss certain topics with local hospital representatives.  I had the ability to talk to directors, medical department heads, patient advocates, and so many more dedicated healthcare professionals who work in in non-VA or government run hospitals.  Every one of them stated categorically that if their hospital was run like the VA Hospital system, they would have been fired, and more than likely legally charged with malpractice, shut down, and sued.

Let that sink in for a moment.  The VA Hospital purports to be doing a service for veterans, but the biggest problem in veterans receiving care is too often the VA Hospital system, and if a non-VA Hospital was run in a similar manner, criminal, legal, and other repercussions would sink that hospital system forcing the government to take over to “rectify the situation.”  Yet, this atrocious behavior is tolerated where the veteran’s hospital system is concerned; I can only ask why?

“The VA Hospital purports to be doing a service for veterans, but the biggest problem in veterans receiving care is too often the VA Hospital system!”

Why is it that every time a solution begins to show the promise of working, the VA bureaucracy stifles the momentum, destroys the people involved, and the veterans keep suffering?  A recent VA Advertisement on LinkedIn talked about how the VA is available with a ready hand to help, it was very well marketed, the advertisement was full of great phrases, sound bite captions, and solemnity; except too often the marketing hype does not reflect reality. Yet, the veteran, the spouse, and the dependents suffer!

Want reality in a VA Hospital, if you and your symptoms do not meet a predetermined checklist of boxes, you are considered the problem and the VA Hospital cannot/will not help you.  The VA Physician cannot issue a diagnosis, nor can the records of patient interactions have sway with the Veterans Benefits Administration for a claim determination.  America sends troops all over the world, places them in literally thousands of crazy environments, but the Department of Veterans Administration still demands cookbook medicine, checklists, and cookie-cutter one-size-fits-most medical practices.

Want reality in a VA Hospital, ask a bureaucrat behind a desk why the patient is being inconvenienced, and watch how fast that veteran is labeled as “The Problem,” and the veteran gets surrounded by the VA Police who then threaten, attempt to intimidate, and arrest/fine that veteran.  Average current time is less than 2-minutes!

Want reality in a VA Hospital, look at the lack of cleanliness, everywhere, and monitor how long spills, blood on walls, black “gunk” stuck in corners, etc. stays around.  I have personally witnessed blood spots lasting on doors and walls for months before being removed, even after complaining about the mess multiple times.  One incident, on an ER treatment room door, there was a roughly 2″ blood spot, dried, sticking to the back of the door, was there for 18-months before finally being removed. Yet, the VA Hospital system will always cheer, about cleanliness, friendliness, and helpfulness of VA Staffing.

Want reality in a VA Hospital, depending upon the tier upon service conclusion originally assigned to, you will experience a significantly different VA Hospital experience.  Even if the Veterans Benefits Administration changes your disability rating, you do not change treatment tiers, and receive reduced medical care accordingly.

Need hospital records, run the leviathan and draconian process of filing a Freedom of Information Act (FOIA) request, and wait.  Need to understand policies and procedures, there is a FOIA for that as well, but do not expect anything written down; because, the VA operates upon the philosophy that if it is written down, then you can be punished for not complying.  Not having operational procedures, patient care processes, standards of behavior, etc. written down provides a ready-made excuse for when the VA Office of Inspector General (VA-OIG) calls investigating.  In over 10-years of reading and commenting upon VA-OIG reports, this remains the number one excuse for failures to comply, dead veterans, and incompetence masquerading around as leadership.

Where is the media, the watchdog of society?  Where are the elected officials whose job it is to monitor the actions of the bureaucrats to ensure these problems do not begin, let alone thrive?  Where is the patient advocate’s whose job is to stand between the bureaucracy, and the patient, to aid the patient in completing tasks that the patient cannot do for themselves?  Where are the patient advocates who are supposed to be making suggestions for improvement based upon the data they collect from complaints and failures of hospital bureaucracy?  Where are the patient advocates in improving operational policies to protect the health and safety of patients, before that patient ever arrives at the hospital facility?

The VA has removed my access to the VA-OIG reports, it has been two-months since I saw a VA-OIG report in my email box.  This is standard practice for the VA, when problems arise, shoot the messenger instead of working to find and fix the problems, and this too is a reality at the VA!

© Copyright 2020 – M. Dave Salisbury

The author holds no claims for the art used herein, the pictures were obtained in the public domain, and the intellectual property belongs to those who created the pictures.

All rights reserved.  For copies, reprints, or sharing, please contact through LinkedIn:

https://www.linkedin.com/in/davesalisbury/

Call Center Chaos and Appreciative Inquiry

While this article discusses government call centers generally, and New Mexico (NM) Government call centers specifically, please do not think the problems described are specific only to, or lessons could not be applied to, many other call centers.  New Mexico Government call centers all have a common problem, they are purposefully designed to not help or serve the customer.  Worse, the work processes are convoluted to the point that work takes anywhere from 10 – 15% longer than it should, costing 30 – 50% more than it should.  Worse, if a customer gets connected to an “Escalation Department,” the workers in that department have no authority, no tools, and nothing they can do but repeat marketing materials, and hope the customer goes away.

Cute CalfEssentially, the NM Government call centers, at the city and state levels of government are as emasculated as a spring-born calf!  Let that sink in for a moment.  No tools, no authority, no support, and only their verbal wits to make the customer go away.  If you think this problem is only apparent in government call centers; well, you are wrong.

AT&T has a very similar, though not as endemic issue.  Sprint, the problem is both apparent and not considered a problem.  AIU, COX, Comcast/Xfinity, FEDEX, UPS, UoPX, and more, you all have very similar issues where the work processes and the customer service are disconnected, leaving employees emasculated and stuck spouting marketing lines in the hope of appeasing the customer.  Sure, some of you have better call escalation processes, but these escalation processes only show the emasculation of your people more exactly.

For example, take today’s interactions with a NM Government Call Center.  The representative on the call escalation line could very easily reach out to their supervisor and take the criticisms and ideas from the customer’s call, put them forth as their own ideas, and improve the call center and customer attentiveness of the organization.  Unfortunately, sad experience has shown that new ideas in NM Government Call Centers are anathema to the good order and discipline of the call center.  Thus, proving that the endemic lack of customer attentiveness is systematic in NM Government Call Centers and considered a benefit to the customer/taxpayer using the government service.

Purposeful customer abuse is not appreciated, not acceptable, and eventually leads the call center to ruin.  Which is a monumental waste of the potential in your employees, as well as being ruinously expensive for some future disaster.  In speaking with retail associates at Comcast/Xfinity and COX Communications, one learns from frontline representatives what to expect from calling the call centers.  If the retail associates are frustrated with the inability to be served, this is automatically passed to the customer.  Bank of America has this problem in spades!

Appreciative InquiryAppreciative inquiry is a growth mechanism that states that what a business organization needs, they already have enough of, provided they listen to their employees.  Appreciative inquiry and common sense tells leaders who want to know and change their organization, how, and where to go to begin.  Appreciative inquiry-based leadership is 6-continuous steps that start small, and cycle to larger problems as momentum for excellence permeates through an organization.  But the first step, just like in defeating a disabling addiction, is admitting there is a problem.

Coming back to the NM Government Call Center, the front-line supervisor upon hearing about this representative’s experience, chooses to believe there is a problem.  Knowing that the problems are endemic and systematic in the organization, decides, “For my team, we will be the core of excellence.”  Thus, this supervisor is now motivated to take the second step in the appreciative inquiry cycle, “Define.”

The supervisor defines what they can change, and then from that list of items that they can control will select the first item to change by asking themselves and their team, “Which item on this list can we tackle first?”  Thus, leading to the third step in appreciative inquiry, “Discover.”

Imperative at this step is the focus upon what is already going right on the topic selected.  Not focusing upon what is wrong, or upon what cannot be controlled or influenced by the team.  Focus on the positive, list the best of what is going right!  For example, if the inquiry will be reducing hold times, and the team has been trending down from multiple hours to single hours of hold time, focus on the positive, and get ideas about tips used from those who are successful in reducing hold times.

The idea in discovery is to create the motivation for the next step in appreciative inquiry, “Dream.”  But, do not dream small!  Remember, when you shoot for the sun and miss, you still land among the stars.  Dream BIG!  Dreaming is all about setting your sights on what currently is considered impossible, that your team can make possible.  Going back to reducing hold times, set the dream at 30-minutes.  You can always come back and dream bigger or repeat the appreciative inquiry cycle on this topic again in the future.

Next, “Design,” design the future and it becomes your destiny; which also happens to be the remaining two steps in the appreciative inquiry cycle.  President Thomas Monson is quoted as saying, “Decisions DO Determine Destiny” [emphasis in original].  If you decide the status quo is acceptable, that decision determines the destiny, and ruination will follow.  If you decide to pursue excellence, this decision will determine how successful you and your team can be.  Design the future you desire, state the goal, write it down, post the goal, speak positively about the goal, and build momentum through accomplishing small steps towards the goal.

Thus, the destiny is born into fruition and what today is impossible, is tomorrow’s reality.  Destiny in the appreciative inquiry cycle is defined as creating what the future will be.  Positive growth occurs through incremental steps and changes the destination.

A pilot friend of mine loves the story about a new pilot who is making their first cross-country flight with a more experienced pilot.  The young pilot is close to being able to solo, and the experienced pilot knows the route, the weather, and decides to let the young pilot fly solo for a few hours.  The new pilot gets bored holding a single course and wavers a little to the left, and a little to the right of the base course and does not think anything of the consequences.  Several hours go by and the experienced pilot returns to the flight deck to discover bad weather is moving in fast, the small lane cannot fly in the weather that is coming necessitating an unscheduled landing, and the plane is 400-miles off base course.  The young pilot said, I only moved a few degrees left and right, we cannot be that far off course.  Later the experienced pilot shows a track of the airplane on a map to the young pilot and reality sinks in, by a matter of a few degrees, over time, the plane got in trouble.

A few DegreesAppreciative inquiry is exactly like the plane, by having a destination, defined according to positive desires, through the process of discovery, dreaming of the possible future, while designing the future, the appreciative inquiry leader can make the small changes today that move the destination from ruination to success.

The first step is admitting there is a problem, and desire to fix that problem at all costs.  What are you passionate enough about to fix at all costs?  Whether you are a representative or a company director, the same question applies and the answer will determine your ultimate destiny.  The key is action at all costs.  The efforts, time, resources, etc. will be spent to achieve does not matter, the new destination does matter.

A call center supervisor friend of mine had three stellar and highly experienced employees on their team.  My friend also had some young talent with incredible potential.  Because the three stellar employees did not want to become supervisors, this effectively blocked the new employees from achieving potential.  My friend had to make a choice, lose the new potential, or reorganize the team.  My friend chooses to keep the experienced people, and shortly after this decision was made, two quit for other opportunities, the new potential quit because they longed for professional growth, my friend was promoted, and the new supervisor had no depth of experience left on the team.

Some would blame the new employees for quitting too soon, others would lay the blame on the supervisor for not developing the talent pool, others might express dismay at the senior talent leaving; honestly, they are all right, and all wrong!  My friend decided to hang the costs, and the decision was a tremendous learning experience.  Using appreciative inquiry will provide similar learning experiences, prepare, and commit, now to learn first and stay focused on the positive.

Appreciative inquiry can help; there are six operational steps:

  1. Admit there is a problem and commit to change.
  2. Define the problem.
  3. Discover the variables and stay focused on the positive.
  4. Dream BIG!
  5. Design the future and outline the steps to that future.
  6. Destiny, create the destination you desire.

Follow the instructions on a shampoo bottle, “Wash, Rinse, Repeat.”  The appreciative inquiry model can be scaled, can be repeated, can be implemented into small or large teams, and produce motivated members who then become the force to producing change.  Allow yourself and your team to learn, this takes time, but through a building motivation for excellence, time can be captured to perform.

© Copyright 2020 – M. Dave Salisbury

The author holds no claims for the art used herein, the pictures were obtained in the public domain, and the intellectual property belongs to those who created the pictures.

All rights reserved.  For copies, reprints, or sharing, please contact through LinkedIn:

https://www.linkedin.com/in/davesalisbury/

 

Moving Past Active Listening to Facilitate Communication: Shifting the Paradigm

GearsIn several previous professional positions, especially those in call centers, there has been considerable time spent training people to actively listen.  The problem; active listening can be faked, and fake active listening is as useful as a shower without soap or shampoo.  You might get wet, but you do not feel clean.

Listening has four distinct levels, these are:

  • Inactive listening – Hearing words, seeing written communication, zero impact mentally. Mostly because your internal voices drown out the possibility for communication.
  • Selective listening – Hearing only that which confirms your own voices, opinions, and biases. While others are speaking, you are already forming your response.
  • Active listening – Show the other person you are paying attention, engage with meaning in a reply. Focused upon removing barriers to get your point across.
  • Reflective listening – Paying attention to intent and content, reducing emotion, two-direction as both parties are engaged in achieving mutual understanding.

Tools for listening effectively, which for all intents and purposes, means listening reflectively, requires several tools, along with considerable experience in using these tools.  Customer service focus – not sales in disguise, not having a hidden agenda, and not covertly looking for opportunities to turn the conversation back to you.  The attitude of service – is all about what your intention is after listening.  Sales are all about attitude and winning over someone else; however, how many sales require first being able to reflectively listen; every single one.  Desire – desire determines your choices, your choices form decisions, and decisions determine destiny!

ElectionConsider the press conferences at the White House.  A room is full of people who would claim they are professional listeners, who then report what is being said.  Yet, how many times do you see questions asked with an agenda, personal opinions warping what is said into what they desired to hear, and then reporting what they erroneously heard to satisfy their desires politically; every single time.  Hence, the problems with active listening and how active listening can be faked.  Desire and attitude of service are not being applied to improve customer service focus.

Communication occurs in two different modalities, verbal and non-verbal.  Good communicators adapt their message to the audience.  Adapting the message requires first a choice, determining who the primary and secondary audience is, then focus the message onto the primary audience.  Next, adaptation requires prior planning, which includes mental preparation, practice, and channels for feedback.  Finally, adaptation requires listening to achieve mutual understanding, careful observation, asking questions designed to lead to mutual understanding, and clarifying what is being said to achieve mutual understanding.

Too often, those labeled as “good communicators” cannot listen reflectively.  They have never learned how to use the tools of desire and attitude of service, in a manner that builds customer service focus into reflectively listening.

Leadership CartoonConsider two people the media has proclaimed as great communicators, Presidents Reagan (R) and Obama (D).  President Reagan was listened reflectively, asked good questions, listened to the answers, asked more questions, and then listened some more.  In listening and asking questions, President Reagan built people (customer service focus) and was respected by enemies and friends for his ability to communicate (personal desire determined destiny).  President Obama has been labeled by the media as a good communicator; but by all accounts, he never listened, his questions showed he desired to be heard, and his focus was all on him as the smartest person in the room.  Desire builds an attitude of service, which then forms the customer service focus, which then reflects a desire to reflectively listen and achieve mutual understanding with those being communicated with.

One of the most despicable problems in customer service today is a theme established by Stephen Covey, “Most people do not listen with the intent to understand; they listen with the intent to reply.”  On a recent issue, a letter was sent to Senator Martha McSally (D) of Arizona, the response has formed the epitome for not listening in written communication as the response had nothing of the original issue even discussed.  The response was a form letter, on a different topic, and lacked any response that the sender had been heard; but, the letter advertised Sen. Martha McSally and her commitment to listening to her constituents.  But, you might say, a Senator is too busy to respond to every communication delivered, a few other examples of both verbal and non-verbal communication failures.

  • Two lieutenants, representing the Department of Veterans Affairs, Federal Police Service, stationed at the Phoenix VA Hospital. Engage a person not wearing a mask.  Body language clearly states they are the authority and will broker no resistance.  The officers spend 45-minutes haranguing the patient before cuffing and frog-marching the patient to a holding cell, where the patient who was seeking services in the emergency room, waits for an additional 60-minutes before being forced off Federal Property.  The patient informed the officers multiple times of their pre-existing condition and inability to physically wear a mask.  The hospital mask policy allowed for a face shield to be worn instead of a mask, and after the patient put the face shield on, the officers continued to verbally engage without listening, until the foregone conclusion of arresting the patient could be justified.  The patient was fined $360.00 (USD) for “disorderly conduct” by refusing to wear a mask.
  • Calling a major cellular phone provider (AT&T) with questions about the price plan. The representative answered every question but needed to make a sale, and their focus was on making that sale, not on assisting the customer.  Not the agent’s fault, the policy of the call center is to up-sale on every call.  If the agent does not up-sale, the call is automatically downgraded in quality assurance and the agent gets in trouble.  Hence policy dictates that the customer not be listened too reflectively as the sale must come before the customer.
  • Hotel check-in, online registration was made specifically for a particular sized bed, but due to late check-in, the customer is not provided what was asked for, and the attitude of the clerk is one of disgust at being bothered. Verbal and nonverbal cues are sending messages that the customer is the problem and is interrupting the life of the clerk.
  • A patient receives a call to make an urgent appointment with a VA medical provider in general surgery. The medical provider has demanded the patient be seen in the clinic, thus negating a phone or video styled appointment.  The patient’s record clearly states the patient has trouble complying with mandatory masking for patients seen in the clinic.  The provider arrives 20+ minutes late to the appointment, and because the patient is not wearing a mask immediately refuses to see the patient, wasting 90-minutes of the patient’s day.  The provider gets off in 10-minutes, and seeing the patient will make the provider late getting off.  Was the mask really the problem; not likely.

Social Justice Warrior 2Not listening is probably the largest social problem in the world today.  Everywhere fake active listening is observed, along with copious amounts of observable inactive, selective, and active refusals to listen.  Some of the problems in improving listening are policies and procedures that do not allow for individual adaptation or situational understanding.  However, too often, the individual choices to grab power, exercise authority, and pass along inconvenience are the real problems in not listening.  Harvey Mackay is reported to have said, “Easy listening is a style of music, not an attribute of communication.”  Proving again that listening is a choice, a personal choice, borne from desire, bred on attitude and reflected in verbal and non-verbal patterns of communication.

The following are some launch points for improving listening in society:

  1. Understand your desire.  Know that your desire choices are determining your destiny.  If your destiny is not one, you appreciate, return to the desire and make different choices.
  2. Practice mental preparation, based upon previous situations, to make different choices. Listening is a voyage of discovery to reach a mutual understanding, but mental preparation is key to safely reach the destination.  Prepare, use a mirror, practice until what currently feels alien becomes familiar.
  3. Reduce emotion. The principle of empathy and sympathy are destroying listening and only reflect the internal voices.  The volume of internal voices is silencing the ability to reflectively listen, necessitating the need to fake actively listening for employment’s sake.
  4. Listen as you would have others listen to you. This is an adaptation of the “Golden Rule” and remains applicable as a personal choice.  How you choose to listen will determine your destiny.
  5. Listening remains the number one tool you control and has application to written communication and verbal communication channels. Body language is a non-verbal communication channel that can be heard as well as seen.  How are you communicating non-verbally, which is interfering with your written and verbal communication attempts?

Listening is a choice.  Listening is hard.  Yet, many people have pointed out that we have two ears and one mouth so we can listen twice as often as we speak.  Choose to reflectively listen, choose to reach a mutual understanding, watch your destiny change.

© Copyright 2020 – M. Dave Salisbury

The author holds no claims for the art used herein, the pictures were obtained in the public domain, and the intellectual property belongs to those who created the pictures.

All rights reserved.  For copies, reprints, or sharing, please contact through LinkedIn:

https://www.linkedin.com/in/davesalisbury/

Tiger Teams – A Potential Solution to VA Issues: An Open Letter to Secretary Wilkie

I-CareTo the Honorable Secretary Robert Wilkie
Department of Veterans Affairs
Washington D.C.

Dear Sir,

For almost a decade, I have read and studied the Department of Veterans Affairs (VA) from the position of patient, employee, concerned citizen, and now as an organizational psychologist.  During this time, I have read many Department of Veterans Affairs – Office of Inspector General (VA-OIG) investigation reports, and yearned to be of fundamental assistance in improving the VA.  I have an idea with potential for your consideration, “Tiger Teams.”

In the US Navy, we used “Tiger Teams” as “flying squads” of people, dedicated to a specific task, and able to complete work quickly.  The teams included parts people, technicians, specialists, and carried the authority of competence and dedication to quickly fixing whatever had gone wrong during an evolution, an inspection, or even in regular operation.  It is my belief that if your office employed a “Tiger Team” approach for speedy response, your job in fixing core problems the VA is experiencing would be easier.  Please allow me to explain.

Tiger TeamThe VA-OIG recently released a report regarding deficiencies in nursing care and management in the Community Living Center (CLC) at the Coatesville VA Medical Center, Pennsylvania.  The inspection team validated some complaints and were unable to validate all complaints because of poor complainant documentation.  Having a Tiger Team able to dispatch from your office, carrying your authority, would provide expert guidance in rectifying the situation, monitoring the CLC, and updating you with knowledge needed to answer the legislator’s questions regarding what is happening.  The VA-OIG found other issues in their investigation that were not covered under the scope of the investigation, leaving the VA-OIG in a difficult position.  Hence, another reason for a Tiger Team being created, to back stop and support the VA-OIG in correcting issues found outside their investigatory scope.

Fishbone DiagramFor a decade now, I have been reading how the VA-OIG makes recommendations, but where is the follow-up from the VA-OIG to determine if those recommendations are being followed and applied?  Too often there is no return and report feature built into the VA-OIG investigation, as these investigators just do not have the time.  Again, this is what a Tiger Team can be doing.  Taking action, training leaders, building a better VA, monitoring and reporting, building holistic solutions, and being an extension of your office on the front lines.  Essentially using the tools from your office to improve the operations locally, which builds trust between the patients and the care providers, building trust between the families and the VA, and delivering upon the Congressional mandate and VA Mission.

Another recent VA-OIG report also supports the need for a fast response Tiger Team.  Coordination of care and employee satisfaction concerns at the Community Living Center (CLC), Loch Raven VA Medical Center, in Baltimore, Maryland.  In geographic terms, this incident is in your backyard.  While the VA-OIG inspection was rather inconclusive, and recommendations were made, it appears some things are working in this CLC and other things are not working as well as they should.  By using a Tiger Team as a flying squad, intermittent and unannounced inspections by the Tiger Team can aid in discovering more than the VA-OIG could investigate, monitoring the situation, and reporting on progress made in improving performance.

As an employee, too often the director of HAS would claim, “That problem is too hard to fix because it requires too many people to come together and agree on the solution.”  Or, “The solution is feasible, but not worth the effort to implement because it would require coordination.”  Getting the doctors and nurses talking to and working with administration is a leadership role, providing support to leaders is one of the best tools a Tiger Team possesses one authority is delegated.  The Tiger Team presents the data, presents different potential solutions, and the aids the leadership locally in implementation.  As an employee I never found a problem in the VA that could not be resolved with a little attention, getting people to work together, and opening lines of communication.  Thus, I know the VA can be fixed.

Root Cause AnalysisThe Tiger Teams need to be led by an organizational psychologist possessing a Ph.D. and a personal stake in seeing the VA improve.  The organizational psychologist can build a team of like-minded people to be on the flying squad, and these team members should be subject matter experts in VA policies, procedures, and methods of operation, and should change from time to time.  I have met many people from the VA who not only possess the passion, but are endowed with the knowledge of how to help the VA, and I would see the VA succeed.  Yet, I am concerned that the VA is not changing, not growing, and not developing the processes and procedures needed to survive, and this is damaging the VA, which leads to wasted money and dead veterans.

Why not have a flying squad for each VISN, who can meet to benchmark, compare notes, and best practices.  Who work from home and visit the local offices in the VISN, reporting directly to your office with a copy to the VISN leadership.  Whose job is to build the Tiger teams needed to oversee, provide expert support, and practical analysis.  The idea is to help you gather real time data, improve implementation of VA-OIG recommendations, and meet the demands of Congress.  If a Tiger Team, with the functioning Flying Squad, can save one VA-OIG inspection in each VISN, by improving that VISN, medical center, CLC, etc. before it becomes a major problem on the sSix O’clock News, then the Tiger Teams have paid for themselves.

All veterans know of the Phoenix VA Medical Center debacle, where veterans died while waiting for appointments.  I fully believe that had the VA Secretary had a Tiger Team in place, the root causes of that incident would have triggered the necessary flags to save lives and avoid or mitigate the catastrophe.  Flying squads are the Tiger Team in action, and action should be the keyword for every member of the team.  The mission of the Tiger Team should be to find and fix root causes, repair trust, and implement change needed to improve VA operations at the Veterans Benefits Administration (VBA), the Veterans Health Administration (VHA), and the National Cemeteries.

The VBA is especially vulnerable, and in need of outside resources to support change.  Recently the VBA was involved in another scandal involving improper processing of claims for veterans in hospital over 21-days, resulting in millions of dollars either overpaid or underpaid to the veterans.  Training, managerial oversight, and proper performance of tasks was reportedly the excuse the VBA used, again, to shirk responsibility.  Tiger Teams can provide the support needed to monitor for, and encourage the adoption of, rectifying measures and VA-OIG recommendations, not just at the VBA, but across the full VA spectrum of operations.

Please, consider implementing Tiger Teams, from your office, assigned to a specific VISN, possessing the authority delegated to run the needed analysis, build support in local offices, and iron out the inefficiencies that keep killing veterans, wasting money, and creating problems.  I firmly believe the VA can be saved and improved, built to become more flexible, while at the same time delivering on the promise “To care for him who shall have borne the battle, and for his widow, and his orphan” by serving and honoring the men and women who are America’s Veterans.”

I-CareThank you for your time and consideration.

Sincerely,

Dave Salisbury
Veteran/Organizational Psychologist

© Copyright 2020 – M. Dave Salisbury

The author holds no claims for the art used herein, the pictures were obtained in the public domain, and the intellectual property belongs to those who created the pictures.

All rights reserved.  For copies, reprints, or sharing, please contact through LinkedIn:

https://www.linkedin.com/in/davesalisbury/

Customer Service Begins with Employees – Knowing the Paradigm

During the last 60 days, I have had the ability to see two different companies and their training programs up close and personal.  Both companies provide call center employees, and currently, both companies are employing a home shored or remote agent to conduct call center operations.  Neither company is handling remote agents very well; and, while both companies have excellent credentials for providing exterior customers with excellent customer service, both companies fail the first customer, the employee.

ProblemsCompany A thinks that games, contests, prizes, swag, and commissions adequately cover their inherent lack of customer service to employees.  Company B does not offer its employees any type of added compensation to its employees and treats their employees like cattle in a slaughterhouse yard.  Both companies talk an excellent game regarding treating their employees in a manner that promotes healthy exterior customer relations, but there is no substance, no action, no commitment to the employee.  Company B has an exceedingly high employee churn rate, and discounts that rate because of employees working from home and not being able to take the loneliness of an office atmosphere.  Company A has several large sites and is looking forward to having employees back on the call center campus.

When the conclusions for employee dissatisfaction were shared, the question was raised, “How does the leadership team know when the employees are not feeling served by their employer?”  The answer can be found in the same manner that the voice of the customer is found, mainly by asking the employees.  Neither company has an employee feedback process to capture the employee’s thoughts, ideas, feelings, and suggestions; relying solely upon the leadership team to provide these items.  Neither company overtly treats its employees poorly, Company A does have a mechanism to capture why employees leave the organization.  Company A was asked what they do with this information and refused to disclose, which is an acceptable answer.

Consider an example from Company A, a new hire has been in the hiring process since January, was informed they were hired around the first of April but was also told the next start date/new hire training class has not been scheduled due to COVID-19.  The employee is finally scheduled for a new hire class starting the first week of June.  Between the time of being hired and the start date, the employee begins taking classes Mon thru Fri, 1800-2100 (6:00pm to 9:pm).  The employee is scheduled to begin work at 1030 in the morning and work until 1900 (7:00pm).  The new hire asks for help with the schedule, the classes being taken will improve the employee’s skills upon graduation on the first of August.  Training is six weeks long, but the overlap is only 9 working days.  Company A’s response, either drop the classes or quit the job.

Internal-CS-Attitude-Low-ResThus, the attitude towards employee customer service is exposed to sunshine, and regardless of the games, prizes, food, swag, commissions, etc., the employee-customer service fails to keep highly talented employees.  This example is not new, and is not a one-off, unfortunately.  The example is regular business for employee treatment, and as the trainer stated, there are always more people for positions than positions open, so why should we change operations?  Since January Company A has been working unlimited overtime to fill the gap in open positions.

Company B informed all new hires that training is four-days long, and upon completion on the job training commences.  On day 3, training is extended to five days, on day 4 training is extended, and on Saturday, training is extended to a mandatory Sunday.  No excuses, no time off, no notice, and no reasonable accommodation is provided to make other accommodations for children, medical appointments, etc., and by the time Sunday arrives, the new hire class has already logged 60-hours in a week that began on Tuesday.  Several employees are unable to make Sunday and as such are now kicked out of training, and will lose their jobs once HR gets around to giving them the ax.

Neither employer offers reasonable accommodation to employees working from home, as working from home is an accommodation already.  Marking the first area of risk; if an employee works for your organization, regardless of the attitude of employee treatment, reasonable accommodation is the law in America, and similar laws are on the books across the world.  Yet, both companies were able to eschew the law and deny reasonable accommodation.  Company B did it by never responding to the employees after they missed a day of work during training.  Company A did it by forcing the employee to decide without the aid of HR, claiming HR does not have any power in the decisions of training.

Now, many people will advise the employees hindered in their job search that the company does not serve them.  That fit into a new organization is more important than money.  That if an employer does not serve their employees, that employer has no value and the ex-employee is better off.  Yet, the companies hired these people, went to great expense to onboard these people, and now must spend more money to hire more people to fill the gap.  Both companies will have to pay overtime and other incentives to get the newest new hires through training.  All because of the disconnect between serving internal customers and external customers.  Many business writers have said, the only customer business has, are the employees.

Leadership CartoonMyron Tribus used a water spigot to help explain the choices of business leaders where employees are concerned.  A business is either a money spigot and customers, employees, vendors, stakeholders, do not matter, so long as the money keeps rolling in to pay off the shareholders.  Or business is a spigot with a hose on it to direct the efforts of the business through the relationships with employees, customers, vendors, stakeholders, and shareholders, to a productive and community-building long-term goal of improvement.  Either a business is a money spigot or a community building operation, the business cannot do both.

With this analogy in mind, the following four suggestions are provided for businesses that either want to change spigots or need help building the only customer relationship with value.

  1.  Decide what type of business you want to be, and then act accordingly.  No judgment about the decision is being made.  Just remember, the greatest sin a business can commit is to fail to show a profit.  Employee costs can make and break employers and profits.
  2. Provide a feedback loop. Employees are a business’s greatest asset, the greatest source for new products, new procedures, new methods of performing the work, and new modes of operation, and until the leadership team decides the employees have value, the business cannot change to meet market demands.  In fact, that business that does not value employees, cannot change at all, ever!
  3. Be “Tank Man.” As a child, I remember watching the Tiananmen Square incident unfold in China.  I remember watching a man, stand in front of a tank and bring that tank, and several more behind it, to a standstill.  Nobody knows this man’s name, but many remember his stand.  Be the example of world-changing customer service, even if no one will ever know your name.Tank Man - Tiananmen Square
  4. Many parents have told their children, “Actions speak louder than words.” At no other time has these words been truer.  Act; do not talk!  Show your employees’ customer service and they will conquer the world for you.  Actions to take might not mean expending any money.  Showing someone you care is as simple as listening, and then helping.  LinkedIn daily has examples of hero employees who do more, serve better, and act all because their leader acted on the employee’s behalf.
    • Blue Money BurningConsider Company A for a moment, the time of class overlap was 1-hour. The number of days the overlap was going to affect that employee, 9.  Thus, for the cost of nine hours at $17.00 per hour, or $153.00 USD total, an employee was lost.  How much blue and green money was lost getting that employee hired, just to see that employee leave within two days of starting?  How much more blue and green money will be lost to replace that lost employee?

No longer can employer hope to treat employees poorly and still achieve financial success, between social media and modern communication, the word gets out that an employer does not care about their employees.  No longer can labor unions abuse non-union members autonomously.  No longer can a business walk away from social and community abuses with impunity.  The choice to treat people as valuable assets is an easy choice to make, choose wisely!

© Copyright 2020 – M. Dave Salisbury

The author holds no claims for the art used herein, the pictures were obtained in the public domain, and the intellectual property belongs to those who created the pictures.

All rights reserved.  For copies, reprints, or sharing, please contact through LinkedIn:

https://www.linkedin.com/in/davesalisbury/

The Department of Veterans Affairs: The Liars and Thieves Edition

I-CareIn December 2019, I witnessed an employee of the Department of Veterans Affairs, Hospital Administration, create rules to inconvenience a veteran, lie to a veteran, obfuscate, and generally mock a veteran.  The incident included the employee threatening the veteran with throwing away documentation, the primary care provider needed because the veteran was not mailing the forms to the doctor as the employee demanded of the veteran.  The veteran must travel and thought dropping off the forms would be acceptable; until he met this employee.  23 January 2020, I was the veteran being lied to, and my “cherub-like demeanor” evaporated faster than dew in a July sun.  For the December incident, I signed my name to a letter going to the Hospital Director Andrew M. Welch, written by the abused veteran, and testified that I witnessed the treatment this veteran received.  To the best of my knowledge, no action was taken by the hospital leadership where this employee is concerned, I asked.  A copy of this article will be sent to hospital leadership.  If any additional information comes available on this issue, I will write an addendum and update this article.

23 January 2020, 1505-1510, I went to my primary care provider’s clinic at the Albuquerque, New Mexico VA Hospital.  I had another appointment, was early, and went to ask why I am receiving letters claiming the primary care clinic is “having difficulty” contacting me.  The employee is titled “Advanced MSA,” which means they are a Medical Support Assistant who has been promoted.  For my other appointment, I have received two text messages, one automated call, and three appointment emails.  For my next appointment, 24 January 2020, I have received two text messages, one automated call, and three emails.  For my appointment in December 2019, I received two text messages, one automated call, and three emails.  I regularly receive calls from other clinics in the VA Hospital.  My cellphone has voicemail, and the voicemail is regularly checked and responses made.  Yet, the MSA claims, “I have tried calling you, and you do not have voicemail.”  I checked my recent calls, and showed the MSA where I had not received any calls from the VA on the days indicated, and asked why I can receive all these other calls from the VA, including the text messages, but only his calls are not showing up.  The MSA then became intransigent, resolute, and adamant, raised his voice, and told me our conversation was done.  After observing the ways and means of this VA employee over the course of many months previously, I wonder, “how many other veterans are not being contacted in a timely manner, while this person lies, cheats, and steals?”

Quality of FindingsUnfortunately, this is the standard, not the exception for the MSA’s in the HAS (Hospital Administration Services) Department, led by Maritza Pittore, at the Albuquerque VA Hospital.  I have witnessed multiple MSA’s committing HIPAA violations through record diving, gossiping about veteran patients, acting rudely, ignoring veteran patients and their families to complete conversations, and refusing to do their jobs.  As a point of fact, one assistant director one told me, “if what the VA does was replicated by a non-government hospital, they would be closed down and sued.”  While employed from June 2018 thru June 2019, I brought this to the attention of the leadership, including multiple emails and voice conversations with Maritza Pittore, Sonja Brown, and several other high-ranking leaders and their assistants, all to no avail.  I have had nursing staff tell me confidentially that they cannot do anything where the MSA’s are concerned because “it’s none of their business and outside their job duties.”  Yet, the VA continues to proclaim the MSA, the Nurse, and the doctor, along with the patient, are a “healthcare team.”  Upon being discharged, without cause, reason, or justification, I brought this information to the OIG, my congressional and senate representatives, among many others, all to no avail.  The level of customer service, especially at this VA Hospital, is far below the pale because the leadership refuses to engage and set standards for customer service, with enforced penalties. I-CareMore to the point, the employees mimic the customer service they receive from the leadership team.  Thus, even though the Federal VA Office has launched “I-Care” as a customer service improvement initiative, the customer service in this hospital continues to fall and will continue to fail until the leadership exemplifies the standards of customer service expected.

As a dedicated customer service professional, I have offered multiple solutions to the continuing problems veteran patients experience in the Albuquerque VA Hospital at the hands of the MSA’s and other front-line customer-facing staff; but the suggestions all continue to fall upon deaf ears.  I do not paint all the MSA’s and staff as liars, thieves, and cheaters, because there are some great people working at this VA Hospital.  Unfortunately, the rotten apples far exceed the good workers by multiple factors and powers, to the shame of the leadership team who continues to ignore the problem, deleting emails, and generally lying when placed on the spot about the problems.

An example of this occurred recently where a member of the staff of a congressional representative asked about communications sent from an employee to the Director of VISN 18, with carbon copies being sent to Maritza Pittore HAS Director, Ruben Foster MSA Supervisor, and Sonja Brown Associate Director of the Hospital.  None of those emails “magically” exist when asked for, and the verbal conversation included outright lies, misdirection, and complete fallacies.

Since the VA-Office of Inspector General (VA-OIG) continues to appear disinterested, I can only ask, “what does a person do to see action taken to correct the problems, right the abuses, and bring responsibility and accountability to the employees of the Federal Government?”  President Trump is providing great leadership, VA Secretary Wilkie is doing a good job and needs more help, but the elected officials in the House and Senate refuse to do their job, and the middle management of the VA is entrenched, obtuse, and inflexible.  The US Media treats veterans’ issues as a punchline to a bad joke.  Still, the problem worsens; still, the abusers maliciously treat people abhorrently; and still, those placed in leadership positions stall, obfuscate, and hinder.

My treatment at the VA Hospital in Albuquerque includes being physically assaulted by an employee, my medical records perused by, and then gossiped across at least four separate clinics, and still that MSA remains employed.  In fact, this employee was promoted for her “good work and dedication to helping veterans.”  I am sick and tired of the poor treatment, the harassment, and the vindictiveness served to veterans of all types, sizes, and colors, at the hands of petty bureaucrats as they visit the Department of Veterans Affairs.  The Albuquerque VA Hospital is one of the most egregious examples of bad behavior and nepotism in the country and it is past time the leadership was replaced and the assaults and crimes brought into the sunshine for some “sunshine disinfectant.”

cropped-snow-leopard.jpgUpdate to this article, 10 May 2020: By the first week in April 2020, the Advanced MSA in the clinic was moved to a less customer-facing post and a new MSA hired.  The quality of that individual was never experienced due to relocating.  The supervisor of the MSA was not very interested in correcting the problems and that showed when I visited with them while trying to obtain an appointment that the Advanced MSA refused to schedule.  Change must come to the VA!

© 2020 M. Dave Salisbury

All Rights Reserved

The images used herein were obtained in the public domain; this author holds no copyright to the images displayed.

Let’s Talk Customer Service – Internal and External Processes

I have been shopping for a new financial institution since Washington Mutual was gobbled by Chase ten years ago this October.  Washington Mutual was not perfect, but they offered two things I rate all business transactions upon, ease of business, and functionality.  The functionality occurred with precision, veracity, and good customer experience.  Ease of business meant that the customer experience was not inhibited by internal processes, the need for conducting business (external) was not clogged or overshadowed by processes (internal).

Why does this matter? – Because when the customer needed a transaction concluded at Washington Mutual, the bank philosophies of ease of business and functionality made the customer experience more robust and easier for employees and customers alike.  It is to ease of business and functionality, as a core business mentality, the following is addressed, in the hopes of promoting improvements in customer attention, focus, and support.

Blue Money BurningAs a financial institution shopper, especially when the customer approaches a manager or assistant manager, regarding a poor experience, the mentality of ease of business and functionality should be the cornerstone of the conversation with customers (external & internal).  10 October 2019 – I approach the “Welcome Desk” at Navy Federal Credit Union (NFCU) and ask to speak to a manager.  The person behind the desk claims, “I am an assistant manager; how may I help?”  I explain, I am shopping financial institution shopping and have a problem depositing a check using the NFCU App.  Then I ask if the check I was presenting for the deposit, and the endorsement were acceptable for both an ATM and the counter.  When the endorsement was verified as acceptable; I asked, “Why is the endorsement unacceptable for the NFCU App?  To which my answer was, “The verbiage specified for deposits through the APP is different to protect NFCU from double or triple deposits of the same check.”  Interestingly enough, the verbiage is not standard across the website, the NFCU App, or the email received rejecting the deposit through the NFCU App.  Meaning, my check deposit was denied through the App because NFCU’s internal processes are insufficiently designed for ease of business and functionality; thus, the customer is inconvenienced because NFCU cannot function properly in the back office in support of front office customer facing-transactions.  Why is it an external customers job to make the back-office employees work less?

There is a trend in financial institutions, Government offices, and emergency rooms to hide the employees behind the double and triple walls of an impenetrable polymer.  Chase branches have all been upgraded, my local VA Hospital is being updated, and the local Social Security Office was upgraded several years prior.  At the Chase branch, the counters appear to have shrunk to improve the ability to hear and be heard through the thick polymer; good job Chase, Thank you!  The VA ER, no such luck, no such plans, hearing a patient’s concerns has been trumped by the business stated need to “protect the worker.”  At the local Social Security Office, the desks and counters equate to more than 4-feet of separation between the speaker and the listener, and communication is non-existent for anyone with hearing difficulties, speech difficulties, etc.  Functionality and ease of business have been eternally sundered, and the customer pays the price in time, frustration, aggravation, and the inability to conduct business.  In the dangerous times we live, it only makes sense to have a security plan, to implement security options, and to support a safe business environment.  However, security should never be the excuse for killing ease of business or functionality.  I recently traveled from Albuquerque, NM to El Paso, Texas, to visit my “local” Chase branch.  Where I then had to repeat myself no less than twice for every verbal request, and the teller had to repeat themselves the same to conduct business.  Was a transaction concluded; yes, but the functionality and ease of business were abnegated and not conducive to continuing a customer relationship.

3-direectional-balanceEase of business and functionality should not be sacrificed as a cost-savings measure or staff reduction model.  The Chase branches I have visited in the last two-to-three years have been changing, staff reductions have occurred, while automation has increased. During a previous visit to a Chase branch, three teller positions had been replaced with ATMs inside the branch office.  I applaud Chase for the investment made in making technology work; but, when I visit a branch, I want to speak to a person, not be hassled by another machine.  I want to be treated as a person whose time is as important as the banker/teller’s time, and have a human experience.  Hence, when I witness people replaced by machines, no matter how good the technology is, my cherub-like demeanor takes a significant hit.  I understand Federal Minimum Wage, State, County, City Mandated Minimum Wage Laws have all gone crazy increasing the human cost in business, I understand the need for physical security increases costs for human transactions, and I know that the human element is expensive in other ways and means, requiring more back-office work and humans.  Do not sacrifice ease of business and functionality on the alter with the humans.  If you have physical, armed guards, checking, x-raying, and hassling customers, you should not need the polymer and technical stations.  Strike a balance and err on the side of human-to-human contact, not technology.

Corporate LogosSpeaking of the need to strike a balance between technology and human-to-human contact, ease of business, functionality, and customer service, those “Self-Checkout” stations forced upon customers in retail stores remain a significant point of contention.  Home Depot and Lowe’s, thank you for not sacrificing customer attention and customer responsiveness on the altar of technology as “Self-Checkout” has proliferated in your stores.  Walmart, Smith’s, Kroger, Fry’s, and so many more stores could learn from your example.

My spouse has several Walmart locations she visits as “local.”  In every one of these stores, the same thing has transpired, the self-checkout stations have multiplied exceedingly, but the number of floor employees has dropped exponentially.  In fact, there is less customer attention in Walmart since the explosion of self-checkout than before across the five states I have been measuring; thus, I can only conclude, this is a tactical exercise from Walmart Corporate Offices to reduce staff, while not improving the customer experience.  Between the constant game of “Musical Shelves,” where products are in continuous movement from shelf to shelf and location to location, and the reduction in customer support, I find myself losing my cherub-like demeanor when trying to complete shopping.  Back in the 1990s I read a research report discussing how for every minute spent in a store, the balance of the shopping cart increases $10.00; thus, I understand the psychology of playing “Musical Shelves,” but the human-to-human involvement has led to less functionality in the shopping experience, throwing ease of business in the garbage.

Leading to the following suggestions:

  1. When looking to strike a balance between expenses and functionality and ease of business, err on the side of ease of business. Functionality will automatically improve when ease of business is sufficiently provided.
  2. Never allow a process, a procedure, and a business standard of measure to celebrate a second birthday. The ease of business should be a constant aspect of the daily workflow.  Functionality, as an extension of ease of business, should be the second prerequisite in the evaluation of processes to meet customer service goals.  Never forget, if a process, procedure, or business matrix cannot be explained completely in a single elevator ride, then that process, procedure, and business matrix are too complicated and need revision.
  3. Customer service should never involve telling a customer about an internal process. Thus, if the back-office is demanding a customer inconvenience that hinders ease of business or functionality, the back-office needs to be held to task and the process changed.

Businesses cannot long shirk ease of business and functionality and survive.  Human-to-human interactions are customer service, and when anything gets between the customer and the employee, business leadership must return focus to ease of business and functionality, not cut out the human.  Customer service should never be tossed because of technology, ease of employees, or as a staff reduction effort.  Your employee today is your customer tomorrow, and your customer today is your employee tomorrow, do you really want to proliferate problems handed to external customer’s as they become tomorrow’s internal customer?

Trader Joe'sTrader Joe’s remains the pre-eminent example of ease of business, functionality, and customer service working in an environment that is well balanced.  No self-checkout, no hassle when asking questions, and several of my local stores have added physical security without changing the human element.  Ease of business and functionality are apparent from the prices to the products, the shelves, to the physical store environment.  No technology separates the customer from a robust shopping experience that is both pleasing and adventurous.  Nothing special is done as a process by Trader Joe’s, but the ease of business and functionality promote the customer experience, which is shared by customers who spend short or long periods shopping and desire to return.  I recently witnessed a Trader Joe’s employee explaining to a customer how to improve fruit ripening techniques, the employee then went out of their way to guide the customer through what to buy and how to use the methods discussed with several different varieties of fruit.  This example is not a one-off singular event, but a regular occurrence at every Trader Joe’s store I have visited.  When you commit to ease of business and functionality, as a person and as a professional, opportunities develop.

© 2019 M. Dave Salisbury

All Rights Reserved

The images used herein were obtained in the public domain, this author holds no copyright to the images displayed.

 

Customer Service Surveys – Bringing Sanity to the Survey

Nissan sent me a post car sale survey. I answered the questions honestly, and the sales rep did a great job; yet, those servicing and supporting the sales rep did some stuff, and I am not particularly pleased. I was specific in the comment section, praising my sales rep, and particular on who and where the ball was dropped creating issues. Not 30-minutes after completing the survey, I receive a call from a senior director at the Nissan Dealership who said that my sales rep was going to be fired and lose all his commissions for the month because the survey is solely his responsibility. The senior director went forward and said, “This is an industry-wide practice and cannot be changed.”

I disagree!

As a business consultant, long have I fought the “Voice-of-the-Customer” surveys for measuring things that a customer service person, salesperson, front-line customer-facing employee, does not control. If the customer-facing employee does not control all the facets that create a problem, then the survey should only be measuring what can be controlled. For a car salesperson, they have a challenging job, and they rely upon a team to help close the deal. Including a service department, a finance department, sales managers, and more. The blame all falls upon the sales rep for problems in the back office.

I sold my Kia Soul for a Nissan Juke, my salesperson at Peoria Nissan was excellent and I wound up purchasing three vehicles from Peoria Nissan. I have purchased a Rogue from Reliable Nissan, and a Juke from Melloy Nissan, both of which are in Albuquerque, NM. Tonna Yutze at Peoria Nissan is a great salesperson. Shawn Walker, at Reliable Nissan, is a young salesperson, with great potential. Of all the cars I have purchased, these are the car salespeople who have made a sufficient impression that I remember their names long after the sale — speaking more about the salesperson, than a post-sale customer survey.

Quantitative data is useful but means nothing without proper context, support, purpose, and a properly designed survey analysis procedure. Even with all those tools in place, at best, quantitative data can be construed, confused, and convoluted by the researcher, the organization paying for research, or the bias of those reading the research report.

Qualitative data is useful, but the researcher’s bias plays a more active role in qualitative research. Qualitative research suffers the same problems as quantitative research for many of the same reasons. Regardless, quantitative and qualitative data does not prove anything. The only thing qualitative and quantitative data does is supports a conclusion. Hence, the human element remains the preeminent hinge upon which the data swings.

Leading to some questions that every business sending out a “Voice-of-the-Customer Survey” instrument needs to be investigating and answering continuously:

  1. Is the data being captured relevant, timely, and accurate?
  2. What is being measured by the survey instrument, and why?
  3. How is the information being used to improve upon that which is measured?
  4. Who benefits from the survey and why?
  5. Who is harmed by the survey, and why?

Even with all this taken into consideration, business leaders making decisions about “Voice-of-the-Customer” survey data need to understand one person can make or break the service/sales chain; but, it requires a team to support the customer-facing employee.  Juran remarked, “When a problem exists, 90% of the time the solution is found in the processes, not the people.” Hence, when bad surveys come in, defend your people, check how your business is doing business, e.g., the processes.

The dynamics of “Voice-of-the-Customer” survey instruments require something else for consideration, delivery. AT&T recently sent me a “Voice-of-the-Customer” survey via text message. Collecting the barest of numerical (quantitative) data, three text messages, three data pieces, none of which gets to the heart of the customer issue.  Barely rating the salesperson in the AT&T store I had previously visited. Recently, I received a call from Sprint, where the telemarketer wanted to know if I wanted to switch back to Sprint and why.  The nasal voice, the rushed manner, and the disconnected mannerisms of the telemarketer left me with strong negative impressions, not about the telemarketer, but of Sprint. Nissan sends emails and while the data collected has aspects of the customer’s voice (qualitative) and numerical rankings (quantitative), my impressions of Nissan have sunk over the use of the survey to fire hard-working sales professionals. My previous bank, Washington Mutual, had a good, not great, “Voice-of-the-Customer” survey process, but the customer service industry continues to make the same mistakes in survey delivery and application.

How and why in “Voice-of-the-Customer” surveys, or the delivery and use of the survey data, leaves a longer-lasting impression upon the customer than the actual survey. Thus, if you are a business leader who purchased an off the shelf “Voice-of-the-Customer” survey analytics package, and you cannot explain the how, why, when, where, what, and who questions in an elevator, the problem is not with the customer-facing employees doing your bidding. If your back-office people supporting the customer-facing people are not being measured and held accountable, then the survey is disingenuous at best, and unethical at worst.

I recommend the following as methods to improve the “Voice-of-the-Customer” survey process:

  1. All business leaders using the customer service survey data must be able to answer the why, what, when, who, and how questions clearly to all who ask about the survey tool.
  2. If you have sections for the customer-facing employee and mix in other questions about the process, the customer-facing employee’s responsibility begins and ends with the specific questions about the customer-facing employees’ performance. You cannot hold a customer-facing employee responsible for broken back-office processes!
  3. Revise, review, and research the data collected. Ask hard questions of those designing the survey. Know the answers and practice responding to those asking questions.
  4. Get the customer-facing employees involved in forming what needs to be measured in a survey, have them inform and answer why. You will be surprised at what is discovered.
  5. Use the data to build, teach, train, coach, and mentor, not fire, customer-facing employees. Support your people with data, not destroy them.
  6. If you cannot explain a process or procedure in an elevator speech, the process is too complicated. No matter what the process is, use the elevator as a tool to simplify your business organization, processes, procedures, and tools.
  7. Be a customer! When a customer, ask tough questions, drive for answers that work, and if the customer-facing employee is struggling, train through the chain of command!

Never forget, the value of the “Voice-of-the-Customer” survey is found in actionable data, to improve cohesion between the front- and back-office, training talking points, and the power to return a customer to your business. Anything else promised is smoke and mirrors, a fake, a fallacy, and sales ruse.

© 2019 M. Dave Salisbury

All Rights Reserved

The images used herein were obtained in the public domain; this author holds no copyright to the images displayed.

 

What “Going the Extra Mile” means in Customer Service: A Call Center Labyrinth

cropped-snow-leopard.jpgI met a unique call center representative, who when asked by management to “go the extra mile for the customer,” remarked, “I go the extra mile for the customer by simply answering the phone.”  Recently, “going the extra mile” has resurfaced as a customer service topic, and I think we need some parameters for understanding the term to really appreciate what it means to “go the extra mile.”

The saying, “go the extra mile,” has origins in the beatitudes as discussed in the New Testament, which includes a discourse on when asked to walk a mile with a person, go with them two.  Obviously, the customer service representative, especially in a call center, cannot walk with the customer two miles.  Thus, what exactly and specifically is intended when management wants the representative to “go the extra mile?”  Think about this for a moment.  In a metrics measured call center, does the representative have the time to engage the customer in idle chit-chat and remain productive per the parameters?  Is the representative expected to perform an account analysis for the customer while answering the customer’s questions and extend the call to ensure each customer is taking the fullest advantage of the available products and services offered?

In a related question, what organizational policies are prohibiting, interfering, or downright anathema to the agent “going the extra mile?”  As an agent, I worked in a call center with this exact problem; the company instructed agents “go the extra mile” for every customer, but then discouraged agents with policies, procedures, and back office personnel whose sole purpose, it seemed to the front-line agents, was to always say no before yes.  When these issues were brought to the attention of the business leaders, the solution was to add more bureaucracy and another person to the back office, which further complicated delivering upon the customer service commitment.

Raising the first point for “going the extra mile” organizational support for delivering a higher level of customer service.  If the front-line agents are being asked to “go the extra mile,” the entire organization already needs to be delivering a higher level of support to the front-line agents.  Business leaders, “going the extra mile,” begins with you exemplifying the “go the extra mile” attitude.  Then, get into the “how” of work performance including the logic of processes and procedures, the reasons “why” business is done in the manner and style of your organization, and smooth the transitions between the front and back office.  The best approach for this is to take each business process from origination in customer service and walk it through every whistle stop in your business to completion, and at every stop asking “why.”  I guarantee you will find ways and means to improve the process every single time.Kindness Quote

Second, when someone is asked to “go the extra mile,” it is human nature for that person to ask or think, “What is in it for me?”  If there is no discernable value in “going the extra mile,” the person asked to put forth more effort could become hostile, depressed, and/or simply put less quality into the action wasting potential and defeating the purpose of “going the extra mile.”  There will always be a psychological value aspect to this discussion.  As a business leader looking to deliver a higher level of quality service, are you prepared to reward agents for “going the extra mile?”

Third, be specific, detailed, and precise in communicating what is meant by “going the extra mile.”  My unique colleague has a point.  If the agent considers answering the phone “going the extra mile,” how will you as the business leader address the need to act differently?  Some might think my colleague was flippant in answering as he did, but the callers at this time were more hostile than normal, technology was changing and customers were experiencing more problems than normal with the services provided, and due to employee churn, all the agents were being asked to work longer hours.  It takes real courage in these difficult circumstances just to answer the phone, let alone resolve customer problems; forget “going the extra mile!”  As a business leader, are you fully cognizant of the issues in the front office?  When asking for an agent to “go the extra mile,” have you specifically defined what this means, detailing actions that fit the description, and do you know it is possible for others to accomplish?

Speaking of accomplishing an action, on the day I was hired as a call center agent, the call center had a six-month backlog of work in the back office, meaning six months prior to my date of hire a customer had requested a bill credit or some other change, and the issue remained open on my date of hire.  After 60+ hour weeks, for three months, the backlog had been reduced to 45-days, and this was considered acceptable by the business leaders.  Thus, the front-line agents had to be prepared to explain why it would take a minimum of one and a half billing cycles for the change to become visible to the customer and encourage the customer to continue to make the payments as shown on the bill to keep from suffering any adverse consequences.  Being possible to accomplish requires business leaders to know what is happening in the front-office and the back-office simultaneously and understand from the customer’s point of view the “why” behind business processes.

Fourth, training as an ongoing, regular, and value-added action is necessary.  Too often training is considered “one and done,” and then annual compliance training is required that everyone suffers through.  If this is the attitude of training in your call center and the training is not value-added, as in “is the training useful immediately” and the value apparent, there is a failure in training, a failure in leadership, and the failure is visible to customers.

The Extra Mile Just Ahead Green Road Sign Over Dramatic Clouds and Sky.I worked as an agent for a great call center that believed in ongoing training at the team level where front-line managers held daily training and the trainers held monthly refresher and targeted performance training.  The problem was that no one measured the training for value, and the agents began to see the time off the phone for training as an exercise in futility.  Value-added is a critical component of ongoing training and begins with asking where are you, as an agent, struggling?  Value-added training ends with an agent overcoming that specific struggle and growing to find another struggle and knowing that training is there to aid them in finding a solution to the new struggle.  Build value-added training as an ongoing conversation, which will be visible to the customer, and the agent is prepared to make the opportunity to “go the extra mile.”

Is the difference clear?  Be specific, clear, and concise when directing “going the extra mile,” and agents will begin testing the waters for organizational support based upon their current levels of knowledge.  Agents will want to make opportunities to “go the extra mile” when they are properly trained and are confident in the training to help them meet the customer’s request and desires.  Agents will make opportunities to “go the extra mile” for customers when they are confident that the business stands behind them in processing, in a timely manner, the agent’s requests made on behalf of that customer.  Agents will make opportunities to “go the extra mile” when their leaders are exemplifying “going the extra mile” for internal customers.Extra Mile  Agents will create opportunities to “go the extra mile” when there is value to them personally for the extra effort and when “going the extra mile” does not harm their scores in a metric based call center.  Finally, agents will create opportunities to “go the extra mile” when they know specifically what “go the extra mile” entails; remember, amorphous feel-good lines do not clear instructions make.

© 2018 M. Dave Salisbury

All Rights Reserved

The images used herein were obtained in the public domain, this author holds no copyright to the images displayed.

 

Fundamentals of Customer Interaction: A Leadership Primer

Gitomer (1998) was very specific about why customer satisfaction is worthless and provided keen insights into how to build loyalty.  While many businesses value and find the “voice of the customer” desirable to the organization, the focus is on satisfying the customer and not interacting with the customer.  Sinek (2009) adds the variable needed, why, as in why are businesses still trying to satisfy when loyalty is needeAre we in trouble?  We didn't do it!!!d?  Why are customers still being taken advantage of when logic claims the long-term relationship is more critical than short-term gains; thus, making the need for loyalty that much more valuable in dollars to the business.  Why serve the customer when the customer needs more than simple “service?”

Customer service is simply geared to expeditiously interacting with the customer in a mass environment.  For example, a recent call to a cell phone provider remains an excellent illustration of mass service hysteria.  During this call, a simple question was asked, why is my statement so high?  The representative placed the caller on hold four separate times, never answered the customer’s question, and because the customer changed their plan, the call was considered a success.  The customer then went online, spent an additional hour in Instant Message (IM) with a second customer service rep, and finally was given less of an answer before quitting in exasperation.  Foolishly, the call center sends an automatic survey to the customer asking for his or her opinion.  The customer is going to express his or her dissatisfaction in the “customer satisfaction survey.  Why was it sent?  Why place the financial future of a low-paid customer service rep in jeopardy simply because the customer remains upset, and the managers deem that information valuable?

The customer call center remains the epitome of the carrot and stick approach to customers with the customer and the front-line customer-facing representatives squeezed into numbered boxes, small cubicles, and an individuality draining environment making the customer and the customer representative soulless zombies held captive in an endless cycle of frustration.  Offer a carrot to a customer to go away, threaten the customer representative with a stick if they do not fit squarely into the business environment and achieve all the key-performance indicators (KPI’s) demanded by the business, although the KPI is in direct opposition to serving the customer.  The above incident is a perfect example of KPI’s being anti-customer.  The representative needs to make a quota for call plan changes and sales, the customer needs serviced, but to actually answer the question means that the time the representative spent on the phone would have surpassed a KPI.  The carrot and stick approach is to offer the customer bill credits to go away quickly so the representative can move onto the next call, a KPI mindset causing frustration for the representative and the customer.

Let’s use one more recent example as a comparison.  The Department of Veteran’s Affairs has been in the news a great deal recently.  Veterans remain the forced customer trapped in an endless cycle of bureaucratic red tape.  The result is that veterans are now being called for a customer service survey to determine how veterans feel they were served.  Why would this information be valuable with all the customer hostility in the veteran population?  Why waste taxpayer dollars to obtain veteran “customer” insight when the bureaucracy has not changed, the red tape remains stifling, and the officers enforcing the bureaucracy continue to kill and harm veterans as the captive customer?  Veterans are reporting that after every interaction with the various VA bureaucrats a customer satisfaction survey is thrust upon them and sold to them as an improvement tool.   Doubt remains as to the value to the veteran, and to the VA as a whole, and provides more KPI’s harming the customer, eliminating service to the customer, and destroying any hope of correcting the actual problems; but the VA is gathering a ton of additional information for office clerks to sort through and make reports upon.

With these thoughts in mind, what do we do and where do we go from here?  Better yet, why are these the preferred actions when logic relates there is a better path forward?  Finally, since KPI’s are needed, how should KPI’s be adjusted to provide more actionable data personalized to the individual employee while remaining valuable to the entire business?

On the subject of KPI’s, when was the last time that each KPI was evaluated and the questions “Why” and “What” were asked to justify that specific item on a list of measurable actions in a KPI process review?  If the answer is “I don’t know” or longer than 18-months, there is a significant problem with the KPI’s reporting obsolete data and doing more harm than good.  As a consultant in a call center, I walked item-by-item through the KPI matrix my first day on the job and successfully concluded a project shortly thereafter by simply moving the KPI matrix back into providing actionable and non-obsolete data.  If each piece of data cannot be explained and justified by the newest member on the floor receiving scores on performance, the KPI matrix is obsolete, confusing, and ineffective in driving actions that actually benefit the employee and those the employee contacts.  Ask the managers to define what the KPI’s are, what is being measured, and detail specific actions an employee should be coached in to improve a specific indicator.  If the answers are not clear and easy to understand, the KPI is ineffective and doing more harm than good.

Juran’s rule that the KPI is expected to form a pathway to progression as a business process remains powerful.  When problems arise in KPI data and employee adherence, the problem is 90% of the time not the employee, but the KPI in question.  Is Juran’s rule being applied consistently, effectively, and powerfully to drive understanding and communication in the organization or is the answer to “blame the employee?”  Dandira (2009) remains powerfully applied here: ineffective KPI’s can be, and many times are, a dynamic source of organizational cancer because of employee confusion about what to do to improve, resulting in employee morale problems.

Moving forward, the way remains clear:

  1. Never allow a business process or procedure to be older than 12-months without a full and comprehensive review justifying that process and every step in that process.

I was called in to discuss a customer influencing process.  The process had more than 30 steps involved and 12 separate employees to accomplish the task.  The process could not be described in 30 minutes, and customers were upset from experiencing this process, adding to the already upset nature of the involved customers and the frustration in the front-line employees assisting them.  Technology improved this process by a third, but the company could not determine how to improve the process.  I asked why on each step and employee involved.  Four hours of discussion resulted in cutting 8 of the involved employees from the process.  Asking “what” resulted in further steps cut in the process.  At the conclusion of the contract, the complicated process was described in a single elevator ride, which simplified the results for the customer and set the business on the road to continuous improvement of business processes.  Pick a process, look at the age, and ask in an elevator ride for the process to be described.  Keep riding the elevator until the entire process from beginning to end is detailed.  How many elevator trips were needed?  Never create a process or a measurement that cannot be explained in a single elevator ride.

  1. Who is catching the blame on recorded calls: technology, the customer, or the customer service rep? The problem is not with any of these parties, and properly naming the problem remains the first step in solving the problem.

For example, on a contract for a manufacturing company, a problem existed that could not be explained causing issues in quality control and proper billing to customers.  The problem observed was not the problem; the process and actionable data capture were the problems.  Until the company could properly identify and act on the real problem, they continued to blame the employee and burned through several highly talented employees in the process.  The action taken began with identification of the real problem and the underlying processes.  Then, we began working out the actual solution.  The first and second actions projected and beta-tested were abject failures.  Once the full measure of the problem was identified in a series of continuous events, the third proposed solution worked, not great, but worked.  The fourth and fifth solutions worked better.  Finally the sixth review fixed the problem.  Identify the problem, and then make the resolution an intuitive process of learning and developing.  Failure is okay provided the current failure is moving the problem forward towards solutions and new thinking.

  1. Who is the customer? Are we wasting time on separating internal and external customers when that time would be better spent treating them both equally?  Rarely should the internal customer be treated better than an external customer, but many times resources are limited and external customers must come first.  Do internal customers know why this decision is being made and when the experience is projected to end?

During a merger, I was contracted as a W-2 employee on start of contract.  At the conclusion of the merger, employees were told external customer resources were being moved back to support internal customers, and benefits and resources would flow back to the employees.  Upon the successful completion of the merger, this policy was not honored, and the mass of employees leaving the company was monumental, as employees felt betrayed.  Knowing the “why” and the “what” behind organizational decisions by all customers is important.  If this company had been more forthcoming about the “why” and the “what,” the loss of so many employees would not have been so great.  More to the point, the loss of employees created post-merger problems resulting in “right-sizing efforts,” “down-sizing,” and finally “post-merger consolidation of facilities,” all of which are euphemisms hiding the real problem, failure to treat all customers with respect and valuing the customers.

  1. The “Why” and the “What.” While the “Why” is critical, both remain powerful, and communicating these simply, effectively, and persuasively remains the role of leadership.  Ask yourself, can employees define “what” we do?  Can employees define “why” we do the things we do?  Do employees know “why” we compete in our marketplace the way we do?  What are the answers and why are the answers coming in with the trends?  Can you answer this, and what is the action to move forward?

I had the pleasure of working as a W-2 employee for a company that did this right.  On the first day of training, the employee learned the “Why” and the “What.”  Then, everyday the employee learned how each process, procedure, and daily task fed into the “What” and the “Why.”  This promoted the employee to understanding and becoming an agent for action in the business.  This pattern is replicable, but employees must know the “why” and the “what” and business leaders must know the “Why” and the “What” and disclose this information to the full organization?

  1. Stop only “serving” the customer. “Serving” the customer is useless, wasteful, and ruins the power of customer interactions reducing these opportunities to filling needs, not building relationships.  If your customer-facing employees are only providing “service,” the business has settled for failure and has become a self-fulfilling prophecy.

This is not a subject of semantics, word plasticity, and mind games.  This is a fundamental mindset of the power possessed by loyal customers acting as marketing tools to drive profitability.  If the customer only receives “service,” the customer is not satisfied, the customer-facing employee is not satisfied, and precious resources are wasted on fruitless gimmicks and useless action.  Worse, the ROI is zero at best, but usually negative.  If internal and external customers are simply treated as customers, how can a business leader expect to build customer and employee loyalty or experience bottom-line growth?  Make time to build customer-reaffirming experiences and the bottom-line will grow.  Stop serving the customers, stop blaming the employees, stop looking for solutions in technology without knowing the business and identifying the problems.  If not, Dandira’s (2012) counsel will be the reward, organizational cancer, and organizational death.

References

Dandira, M. (2012). Dysfunctional leadership: Organizational cancer. Business Strategy Series, 13(4), 187-192. doi: http://dx.doi.org/10.1108/17515631211246267

Gitomer, J. (1998). Customer satisfaction is worthless – Customer loyalty is priceless. Atlanta, GA: Bard Press.

Sinek, S. (2009). Start with why: How great leaders inspire everyone to take action. New York, NY: Penguin Group.

 © 2016 M. Dave Salisbury
All Rights Reserved