Eleanor Feldman Barbera, Ph.D.

At the front desk, the workers were having an argument. Some residents watched the proceedings with interest and others with expressions of alarm. A waiting family member shifted from one leg to another and began sighing with exasperation as the loud conversation wore on without her presence being acknowledged.

We may talk about the term “customer service” and ask our staff members to avoid public arguments like the one above, but nevertheless, similar situations happen every day. Why does it matter so much? Using the model of the family as a guide, I discuss the psychological importance of good customer service in all our interactions.

With other staff members – Just as the relationship between parents forms the foundation of a family, our relationships with our coworkers are the foundation of good customer service.

o   As shown in the above example, the residents observe how we treat one another. If our conversations are respectful and collegial, residents feel comfortable discussing concerns because they perceive their caregivers to be levelheaded and understanding. Angry, shaming interactions between staff members create an unsafe environment, making residents less likely to share information — including details that may affect medical care.

o   Difficult interactions with coworkers are frequently transmitted to resident care. This is known in psychological terms as displacement. In the classic case, the boss yells at the father, who comes home and yells at his wife, who yells at the kid, who kicks the dog. If the nursing supervisor publicly criticizes the nurse who then chastises the aide, the residents are likely to be on the receiving end of the aide’s aggravation. Alternatively, if the nursing supervisor compliments the nurse who in turn praises the aide, the residents are more like to be met with a cheerful, upbeat caregiver.

o   How senior staff members talk to subordinates is passed along to the next level of subordinates, not just through displacement, but also through modeling. Senior staffers are showing through example “how we handle things here.” When an administrator uses “teachable moments” to calmly point out what aspects of a crisis were managed well and what could be done differently for mismanaged parts, this becomes its own teachable moment in terms of how to provide constructive feedback.

o   Positive staff interactions enhance team functioning by creating friendly relationships where staff members feel comfortable sharing their observations and expertise. This is essential in an interdisciplinary model where each department sees key aspects of resident functioning not observed by other departments. Recreation therapists, for example, may witness a decline in social functioning that could be overlooked by medical staff and yet signal a physical problem.

With residents – Using this family model, how we treat residents is akin to how parents treat their children.  

o   Residents are in a vulnerable position, relying on staff for care in a manner similar to how children are reliant on their parents. Due to medical conditions and environmental changes, residents are often anxious and sometimes confused. The challenge here is to recognize the power differential between residents and staff while creating respectful, supportive interactions that aren’t infantilizing.

o   When people are reliant upon others, they become close observers of the moods and behaviors of those they count upon. Just as you may know the meaning of your mother’s sigh or your father’s raised eyebrow, residents can sense that overly vigorous pill-crushing, for example, is a sign the nurse is in a bad mood. Cognitively intact residents observe how staff members treat those less able, and confused residents can be exquisitely sensitive to the positive and negative vibes of staff members.

o   Residents who are treated respectfully and have their concerns acknowledged and addressed are more likely to become partners in care. If residents are hesitant to communicate with staff, care suffers. For example, I once worked with a nurse who routinely yelled at patients who came to her with medical concerns. “Why didn’t you tell me this before?!” she would shout. (Um, because I was afraid you would yell at me?) The facility handled this by pairing the angry nurse with a “mama” nurse who would immediately jump in and soothe the resident, allowing the angry nurse to provide excellent medical treatment.

o   Which brings out the point that you could be giving top-notch medical care, but if it comes with an attitude, it won’t be perceived as such. Resident satisfaction depends not only on the care, but also on the manner in which it’s delivered.

With families — To continue with the family unit example, family members are also in the child role because they depend upon staff members to provide good care for loved ones.

o   Family members are often anxious about placement and may feel guilty about it. Most families have no prior experience with LTC and are relying on us as experts to guide them.

o   As in the case with coworkers and residents, pleasant and respectful interactions with family members encourage them to participate in the team process by sharing vital information that only they hold. For instance, it’s the family who would know that listening to the music of Benny Goodman is likely to calm Mom’s agitation.

o   Families may have heard the worst about long-term care and anticipate the need to fight for their loved ones. Good customer service such as explaining procedures and following up with phone calls can reassure family members and increase their cooperation with the team and with treatment recommendations.

o   Studies indicate that “showing empathy, improving reliability, and increasing responsiveness are three main ways to improve family satisfaction with direct care.” It’s satisfied families who are more likely to provide the word of mouth that brings in new residents — and that’s good for all of us.

Eleanor Feldman Barbera, PhD, is a 2014 Award of Excellence winner in the Blog Content category of the APEX Awards for Publication Excellence program. She also is the author of The Savvy Resident’s Guide, and an accomplished speaker and consultant with nearly 20 years of experience as a psychologist in long-term care. This blog complements her award-winning website, MyBetterNursingHome.com, which has more on how to create long-term care where EVERYBODY thrives.