In 1999, the Journal of the American Medical Association published a study titled “Service Quality in Healthcare,” which revealed that medical outcomes are not dependent solely on the technical ability of the doctor to diagnose and treat illnesses, but also significantly are impacted by the quality of the end-to-end medical service experienced by the patient. The practice-changing article defined service quality as “the myriad characteristics that shape the experience of care for patients and their loved ones other than the technical quality of diagnostic and therapeutic procedures.”
It's not a stretch to see the analogies between the ergonomist-employee relationship and the doctor-patient relationship discussed in the JAMA article. The employee looks to the ergonomist for expertise to improve comfort at work, just as a patient seeking improved health looks to a doctor for guidance. Therefore, it seems logical to assume that an improvement in end-to-end service quality provided by an ergonomics program would increase the effectiveness of its efforts to prevent and manage workplace injuries.
In fact, upon further inspection of the doctor-ergonomist analogy, service quality might have an even greater impact on the employee receiving ergonomic interventions than the patient receiving medical treatment. Imagine that a patient had to call the doctor's office three times to make an appointment, was treated poorly by the receptionist and then was rushed through the appointment by the doctor who diagnosed his illness and provided a curative pill — the pill will cure his ails, regardless of his negative experience.
The ergonomist is all too aware that unlike many aspects of the work doctors do, there rarely is a “curative pill.” For the employee experiencing work-related discomfort due to ergonomic issues, or the myriad of other problems that lead to repetitive strain injuries (RSIs), the effectiveness of the recommendations made by the ergonomist almost always is dependent upon the motivation of the employee to implement them. While the authors of the JAMA article are unclear on the mechanics that lead improved service quality to improve medical outcomes, they theorize that it is the result of patients' motivation and willingness to follow through on treatment and fully engage the medical resources that are available to them. From personal experience, this hypothesis makes sense.
Consider Maria, who requests a workstation ergonomic evaluation because of work-related back pain. She doesn't hear back from the ergonomics department for weeks, so she sends another email because the pain is increasing. Finally, a week later, she receives an email response that an appointment is available in 2 weeks.
By the time the ergonomist arrives, Maria already is frustrated by her experience with the ergonomics program. As a result, Maria has diminished trust in the recommendations made, despite the fact that the ergonomist is the most technically competent member of the team.
The ergonomist suggests that she adjust her sitting position and the placement of her chair — but when Maria still feels pain a few hours after the evaluation, she moves everything back to its original position, because the new setup feels awkward. A month later, she files a workers' compensation claim and ends up on leave.
In this case, Maria had such a poor experience prior to the evaluation that the technical expertise of the ergonomist and the information communicated during the evaluation had no impact on her. The truth is that employees have no insight into how experienced or knowledgeable your staff is in the discipline of ergonomics or other technically laden safety disciplines, as they most likely have little or no familiarity with them. In the absence of their own expertise, they will look to your program and evaluator's timeliness, communications, interpersonal skills and professionalism to form an opinion.
In creating a program focused on delivering high quality service, it all comes down to thinking like an employee. The ergonomics processes within your organization likely have been designed by safety experts with a narrow focus on delivering technical expertise to at-risk employees. This is an inarguably necessary focus of an occupational health program. However, a focus on service quality can ensure that the outcomes of these technical services are not undermined by service quality failures, and even are improved by excellent service.
DESIGNING THE EMPLOYEE EXPERIENCE
To improve the service quality in your program, consider your end-to-end ergonomics process from the perspective of the employee, and make changes in the places that currently fail to provide a consistently excellent experience. After all, these changes will improve your employee injury rates. Your ergonomics program should be designed for quality from the ground up.
Here are some quick tips and reminders you can use to design a quality-oriented program:
- Logistics impact perceived quality
Finding the phone number to call for assistance, ease of scheduling of an appointment and other similar tasks should be considered an integral part of the employees' experience, rather than exclusively mechanical components of your program.
- Consider all elements of your program either as enhancing or undermining the effectiveness of your expertise
Recently a colleague declared, “If an employee has a bad experience with my intranet-based request system, I end up spending half of their in-person ergonomic evaluation rebuilding credibility.” The JAMA article indicates that this sort of problem negatively impacts not only credibility, but also the health outcomes of your expert recommendations.
- Design your process to deliver a quality experience even on unusual days
Examples include when ergonomists are absent, employees re-schedule appointments or when you experience consultant evaluator turnover. These occurrences aren't as uncommon as one might think.
- When possible, use concrete measures in your program design
Managing quality is significantly more achievable with the requirement “respond to communications within 48 hours” rather than the vague and immeasurable goal of “respond quickly.”
To assist in the task of identifying a comprehensive set of criteria to define an excellent service experience, we have looked to hospitality industry, with their deep expertise in service, as suggested in the JAMA article. Table 1 below shows the hospitality industry's RATER service quality scale, adapted for use in ergonomics programs.
While the RATER system provides a helpful framework for understanding “service quality,” there is a variety of alternate frameworks from service-based industries that you may find useful and easily adaptable to your safety program.
After creating your new process, be prepared for the fact that it might not be perfect. Commitment to resolving kinks in the process is critical to delivering great service and positively impacting employee health. Management and business process frameworks like Six Sigma remind you that you should always design with the need to change in mind.
Two questions can help measure the success of your new process design:
Question 1: Are we implementing the design successfully?
Business process management studies indicate that 1-5 percent of tasks in a typical business process fail to be completed. This failure can happen at any step in the complex processes inherent to ergonomics programs — from responding to requests, to scheduling evaluations, to delivering follow-up resources. Make sure you have systems in place to measure two things concretely:
Are the steps in the process happening? You need to know the rate of “total failure” for all the steps in your process in order to deliver a quality employee experience.
Are the steps in the process happening reliably? Include concrete measures and tolerances for response and communication with employees in your design. Are you late? How much? How often?
Remember, a good design will have no effect if it's not being implemented consistently. In other words,“You can't manage what you don't measure.”
Question 2: Is our design achieving the desired outcome of employee satisfaction and the perception of quality?
There are two basic ways to find the answer to this question. First, administer an employee satisfaction survey at the end of each employee's interaction with the ergonomics program. A survey is an excellent way to reveal subjective aspects of quality.
In a recent conversation with an ergonomist at a large Fortune 500 company with an excellent safety program, I was told that their program does a good job of consistently surveying employee satisfaction with their ergonomic evaluation. The problem with this company's survey, however, is that it assesses only the evaluator during the time of evaluation. While this is a critical moment in the process, it is not the entirety of the employee's experience. Additionally, asking employees to evaluate a person rather than a system and a process will provide very different feedback. Both are valuable and both can drive improvements and change.
In order to gain feedback on the employee's entire experience, your survey should include questions that target the concrete goals, as well as the “big picture” snapshot of the employee's general level of satisfaction. The survey also should be made available on the ergonomics department Web site or other accessible location — so that any employees who requested service, but whose request slipped through the cracks, will still be able to submit feedback.
In addition, ask your staff about their experiences with employees. When they arrive for an evaluation, do employees often respond with an exasperated “Finally!” or do they instead comment on how helpful the service has been? This information is valuable in keeping your staff engaged with thoughts and conversations about the quality of the service that they provide.
The JAMA article encourages us to think about our jobs and programs differently. A focus on service quality can result in improved employee health, comfort and productivity.
Ben Archibald is the project team lead for Remedy Interactive Inc., an enterprise injury prevention software company that helps organizations prevent workplace injuries, reduce injury-related costs and increase productivity and profitability. He can be reached at email@example.com.
TABLE 1 — RATER SCALE
The hospitality industry service quality framework as adapted for ergonomics programs
|Quality||Defined for Ergonomics Programs|
|Reliability||Ergonomic services performed accurately, dependably and as promised|
|Assurance||Safety team is courteous and knowledgeable; inspires confidence|
|Tangibles||High quality reporting and documentation of ergonomic evaluations|
|Empathy||Employees receive individualized attention|
|Responsiveness||Prompt service; easy access to information; willingness to help employees|