Empathy is important enough to patient care that even doctors are studying it.
Massachusetts General Hospital has become the first hospital in the nation to establish a training and research program designed to teach its doctors how to show empathy to their patients. According to the Boston Globe, the hospital’s “tenets and approach have been catching fire, and gaining wider notice. If the idea of doctors finally having to learn empathy is astounding, it may be in part because the Healthcare Industry is late to the party. Empathy is increasingly thought to be important to patient care.
Empathy for patients has a place outside of healthcare settings as well, especially in the healthcare service industry helping patients manage chronic diseases like diabetes. Diabetes is an incurable disease that affects nearly 30 million Americans. Managing the illness requires patients to constantly monitor their glucose levels and adjust diet, exercise and/or medication. According to the American Diabetes Association website, blood glucose monitoring is the “main tool” patients have for keeping their diabetes in check so they can lead normally active lives.
But monitoring glucose levels is intensely important and pervasive in a patient’s life. Author Riva Greenberg, who has written several books on living with diabetes, writes, “I don’t know any other illness where so much work must be done by the patient on a daily basis.”
Helping patients manage their diabetes more easily is the focus of many medical device manufacturers. One of the largest medical device companies makes a line of monitoring products for both consumers and hospitals. Each day, approximately 16 percent of diabetes patients in the U.S. use this company’s glucose monitoring products. These range from monitors designed for varying lifestyles as well as test strips, lancing devices and tools and other accessories.
Because proper use of the monitors is vital to the management of each patient’s disease, the company provides a consumer hotline for patients to use when they have questions or problems using their device. Patients can call when they have a question about using one of the devices or related tools, or if they are having a problem or issue with the equipment. The call center representatives must provide accurate assistance to callers whose lives could depend on the information they receive. Further, representatives must comply with complex Health Insurance Portability and Accountability Act (HIPAA) and Food and Drug Administration (FDA) regulations. These requirements can be extensive. Any perceived complaint must be documented and then reported to a Medical Surveillance Group (MSG). Because patients calling often have more than one issue, the required paperwork the call center representative must complete can be 90 pages in length. Failure to report complaints – some within 24-48 hours — to the MSG must then be reported to the FDA. With anxious patients on one side and the weight of the federal government on the other, the pressure is on. Call center representatives must be quick, precise and thorough.
At the same time, the agents have to find the capacity to be empathetic to the patients despite the pressure. To ensure that the diabetes patient support program runs in compliance with both the rules and the need to be caring and understanding, the agents must be carefully hired, trained and their morale maintained. This paper explores the elements of a successful patient service support line that is based on providing empathy and quality service.
Establishing empathy in the call center begins with new employee screening. Potential agents are screened for empathetic responses and experiences. During the interview process they are asked if they have a family member or know someone with diabetes or another chronic condition.
Prospects are also assessed on their “soft skills,” especially their ability to be “active listeners,” a critical ability that enables empathy.
“What is essential,” says Marshall Rosenberg, psychologist and founder of Non-Violent Communication (NVC), “is our ability to be present to what’s really going on within – to the unique feelings and needs a person is experiencing in that very moment.”
Prospective agents are asked to listen to recorded calls with patients and report back what they hear to recruiters. Interviewers are looking to see if the prospect comments on the expressions of understanding and support made by the agent in the call regarding the caller’s situation. The ability to recognize a lack of empathy is also important. If the representative on the recording launched into probing questions in a robotic manner, an emphatic prospect using his or her active listening skills will note this. The ability to pick up on lack of empathy is an expected part of agent recruitment.
Testing for empathy in the hiring process is just the beginning. A key part of new agent training is devoted to developing empathetic awareness.
Hiring for Empathy
One important element of learning to walk in another’s shoes – specifically stepping into the shoes of a person living with diabetes – is giving trainees the opportunity to learn first-hand what it’s like to live with the disease. Veteran agents who themselves have diabetes volunteer to give a talk about what their lives are like so new agents better understand what callers are experiencing. These agents discuss the process of pricking their fingers with a lance to obtain a droplet of blood and squeezing it on to a test strip, which they insert into the monitoring device. The device gives them a reading of their current blood glucose level. That level must be within certain guidelines – and if it falls outside the ceiling or floor the patient must take action to alter their glucose level through medication or diet. This is a process that in some cases must be repeated multiple times throughout the day. The agent who is sharing talks about the difficulties of managing their lives around a constant testing regimen.
A diabetic who does not stay on top of his or her blood glucose levels risks complications. The agent explains what it’s like to experience hypoglycemia, when a person’s blood glucose falls too low. When that happens, patients can experience shakiness, confusion, blurred or impaired vision, lack of coordination and other symptoms, all of which might be experienced by someone calling in asking for help with a monitoring device.
Mentoring for Empathy
After a four-week training period where agents are taught the substance of the program, veteran representatives mentor them for two weeks. During mentoring, the trainees, who are paired two-to-one with a mentor, listen to calls as the mentor takes them. The trainees listen as the experienced agent talks to patients. Trainees then take calls themselves with their mentor and other trainee listening. While they have practiced calls in role-playing scenarios prior to the mentoring process, talking to a customer presents a more intense dynamic. They have to balance their speaking skills, anticipate questions, show attentiveness to the caller and use positive language. They must demonstrate confidence and competence in the subject matter. And they must manage the call efficiently – moving quickly to providing solutions – so the customer does not lose patience with them. Agents must do all of this within a relatively short period of time so they can move on to waiting patients. The goal is that 70 percent of calls are answered in 60 seconds or less.
While answering the patient’s questions or helping them resolve an issue is the clear purpose of the call, the patient is likely to feel unsatisfied if he or she doesn’t feel a sense of empathy from the representative.
Seven Habits of Empathy Based Programs
1. Develop an interactive exercise to screen for empathy during the hiring process.
2. Provide opportunities for agents to hear directly from patients with the disease or condition they will be helping.
3. When possible, provide exercises for the agents that simulate the conditions patients must face.
4. Mimic the patient environment (equipment, instructions) for your agents.
5. Mentor new agents into the role. Provide transition support.
6. Create a space where agents can support each other, peer-to-peer
7. Develop programs to create a sense of fun and camaraderie, to help build cohesion and ease the pressure.
LISTENING WITH EMPATHY
According to a report from AchieveGlobal, consumers said that being heard, understood and respected are more important than having their issue resolved on the first call. According to the report, “Employees must read customer’s emotions, express empathy, listen carefully, and above all show genuine care and respect during every interaction.”i Perfecting this combination of “hard skills” – knowledge of the product and procedure – and “soft skills,” like empathy, is the purpose behind the two-week mentoring program.
Daily, the trainees will debrief with their mentor to discuss calls they either heard or conducted themselves. They discuss areas they were not comfortable with or didn’t know how to handle. They also discuss their successful calls. This gives them a chance to build their confidence and skills in a safe and supported environment.
At the end of the mentoring program, each trainee must pass 10 calls with a QA score of 85 percent or higher. Some of the QA requirements that are scored relate directly to empathy, including
Acknowledge and/or apologize for the issue(s). Incorporate the following components for the phone call (IMPORTANT: does not have to be verbatim) Set agenda prior to troubleshooting complaints.
- Additional information will be obtained (non-complaints and complaints)
- Call will be documented
- Troubleshooting will be performed
- Product will be replaced if necessary
Pace and Tone
- Use appropriate language (i.e. avoid slang, etc.)
- Use an appropriate rate and volume of speech
- Avoid excessive dead air or hold time
- Avoid interrupting the customer when he/she is speaking
- Use a friendly and professional tone
VISUALIZING AND SHARING THE PATIENT EXPERIENCE
Experts say that empathy is an act of the mind.
Guy Winch, PhD., writes, “Experiencing empathy requires a Jedi mind trick of sorts, albeit one we do in our own minds. It involves directing our awareness to a place our mind does not go of its own accord to what it feels like to be another person – lingering there for a moment so we register the emotional and cognitive landscape, and then returning to our own reality.”
You don’t need to rely on a reverse Jedi mind trick to make this happen – there are ways to aid call center representatives in personalizing what it means to experience some of the challenges their callers may be facing.
For example, to simulate the blurred vision someone with hypoglycemia may be experiencing, agents will don glasses with the lenses smeared with Vaseline. Their vision thus temporarily impaired, the agents will attempt to work with the monitors or other products the diabetic patients have to use.
In addition, agents will also put on heavy gloves and work with the devices, to get a sense of what it’s like to use a monitor when a patient might lack the dexterity needed to perform simple tasks, like changing the batteries.
Agents are able to get their hands on all of the products used by the patients. As they walk callers through tips on using the devices or answer questions they can have the equipment in their hands and be looking at and doing the same thing as the patient on the other end of the phone. Patients are also more likely to have paper instructions – and not be looking at online guides – so agents also have paper copies. With paper instructions in hand they can give clear, specific guidance such as, “look two-thirds of the way down on the first page” to help orient patients on what to look for. The ability to hold in their hands the same thing being held in the hands of the patients makes the agents more able to connect with callers as they guide them through problem solving.
Aided-role playing exercises like these not only help agents understand what a patient on the other end of the line may be going through, but also help them understand any anger or frustration that may be expressed towards them as they try to provide assistance. If a patient’s monitor needs its battery changed and diabetes is altering their vision, mood or ability, complying with normally simple instructions may prove difficult; causing deep frustration and irritability that gets vented to the agent. The agents, by simulating these difficulties, understand the anger is not directed at them personally and is a byproduct of the disease. The agents are better able to remain calm and conduct a smoother and more effective interaction with the patient.
Although online support is offered, customer service representatives responding to questions sent by email still encourage patients to call back – contrary to the practice of many customer service programs to encourage their callers to use digital support. Although there are methods for personalizing email interactions, person-to-person communication is preferable because empathy happens more easily. Patients would seem to agree; as those who use email the first time generally call the next time they need help.
CREATING A SUPPORTIVE ENVIRONMENT FOR EMPATHY
There is no doubt that handling calls from patients whose health depends on their understanding and use of blood glucose monitoring equipment can be a high-pressure situation. This is compounded by the fact that the patients calling in can be frustrated and irritable, as noted, due to their condition.
Agents need a space to share, vent and regroup. To help facilitate that purpose, they have a “huddle room” which allows for more intimate one-on-ones with supervisors or their peers. Experiences can be shared and mutual lessons learned. While these sessions can happen as needed, scheduled sessions with teams of agents are held every two weeks.
Building camaraderie between the agents and management also facilitates a collegial environment that helps foster understanding and empathy. Agents have an “Ambassador” program that creates both internal and community outreach activities, both of which foster camaraderie and boost morale. The Ambassador program hosts “theme days” at the center, like a Kentucky Derby Day, where the agents dress in costume and drink non-alcoholic mint juleps. Other examples include crazy hat day, or favorite sport team day. The Ambassador program also organizes activities to support community groups, recently raising money to benefit leukemia lymphoma, and raising awareness for issues like domestic violence and autism.
These programs build bonds between the agents and play a role in boosting retention, as does a dual incentive program, with rewards for both individual agents and teams. Building morale, promoting cohesion and support for team members all create a sense of spirit that helps maintain empathy when a patient in need calls in for help.
A relationship with an outsourced customer service center can be handy in a crisis. It is a resource that is familiar with your program, products and patients and can ramp up quickly. A medical device supplier found this to be true when it became necessary to recall one of its products. The call center service provider had an existing foundation of technical knowledge and experience in providing support to the device maker’s customers. It could quickly recruit additional agents solely for the recall, create an abbreviated training program to provide the necessary technical knowledge and soft skills, and get the program up and running in just over three weeks. Nearly 28,000 calls were handled in a seven-week period, along with normal call volume. Not a single call was lost due to a busy signal.
Empathy and expertise in combination are powerful. Patients calling the line give it a 92% percent satisfaction score.
Sarah Boodman, writing for the Washington Post, says, “Clinical empathy was once dismissively known as ‘good bedside manner’ and traditionally regarded as far less important than technical acumen.”ii In a patient-based customer service setting, clearly both are important. As Boodman notes, “a spate of studies in the past decade has found that it [empathy] is no mere frill. Increasingly, empathy is considered essential to establishing trust, the foundation of a good doctor-patient relationship.”iii That trust is also vital when a patient calls a medical device manufacturer, or an after-care line or other medical device support services that are a matter of health.
While doctors may need to go to a special class to start learning empathy skills, call centers already know how to find, train and maintain agents able to practice the art of empathy. They are delivering it to patients today.
Author: Lisa Kuloszewski, Senior Account Manager, Healthcare Services at Sykes
Lisa has been in the contact services industry for over 15 years. She has had increasingly complex client programs in banking and healthcare. Her expertise is in the budgeting process, contractual metric attainment, process improvement, revenue growth and profitability, employee development, Quarterly Business review meetings, and ensuring ISO compliance across all programs. When Lisa is not working, she enjoys eating wings with her family in Buffalo.
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