3. QSE Customer Focus

According to the CLSI, “Customer Focus describes the laboratory’s identification of its customers and their expectations and the need to design work to meet those expectations and any applicable requirements. It also describes methods for assessing whether the laboratory fulfilled its customers’ expectations”.^[1]

Some of these people are internal customers and others are external to the organization but they all have expectations and needs that the service provided by the laboratory is expected to meet. Since the overall purpose of the QMS is to improve patient outcomes, it is important for the organization to make sure it knows who its’ customers are and to identify how to best meet the needs of the various groups successfully. The idea of continually improving on the delivery of this service is inherent in the whole premise of the Quality Management System.

To aid in meeting the requirement to focus on customers, the CLSI (GP26-A4) has identified 4 areas where policies must be in place to address customer needs and expectations:

• To identify customer and user expectations
• To determine the laboratory’s capability to meet customer expectations
• To measure customer and user satisfaction
• To record and manage complaints

In order to satisfy these policies, there are several processes which must be developed:

• A process for identification of customer expectations
• A process for evaluating laboratory capability
• A process for gathering customer and user feedback, including staff feedback
• A process for handling complaints

In turn, these processes are carried out using set procedures that cover the following:

• Conducting customer expectation surveys
• Assessing laboratory capability
• Collecting patient, customer and staff feedback
• Reporting and responding to patient, customer, and staff complaints

Customer Expectations

In identifying customer expectations, it is first important that all customers of the laboratory are identified and a means of communication has been established with them to collect feedback from them on an ongoing basis. Patients, healthcare providers, other laboratories, government agencies, the general public, and accrediting bodies all have expectations of the laboratory and they don’t all have the same ones so the laboratory must be able to identify which expectations are important to individual customers. For instance, a referring laboratory may have expectations around the quality processes employed by a laboratory while the physicians who order tests from that laboratory may be more concerned with the speed and accuracy of the results they receive back from the lab so they can proceed with the diagnosis and treatment of their patients.

Some common means of collecting information from customers about their expectations may include personal communication or a Request for Services form to be completed. This provides the laboratory with the base information they need to be able to put procedures in place to address the various customer expectations.

Expectations of customers may revolve around a variety of services such as:

• Volume and type of testing they require
• Collection and transport of their specimens for testing
• Expected turnaround times for results
• Reporting mechanisms such as fax, phone, electronic or paper means
• Consultation needs and expectations

Which of these expectations are required by given customers and why they vary between customers may be related to a number of variables such as:

• The hours they work – are they only working during daytime hours or are they providing a 24-hour service?
• The environment in which they work – needs of physicians in an ICU may vary dramatically from those of a physician in a family practice who sees patients in his office
• The sharing of resources – are the physicians in an outpatient clinic waiting for results before they can complete a scheduled procedure? (equipment, people, space)
• The uses of specimens – are they being shared between testing areas or do the tests all get run on one analyzer? Or are some of the requested tests being referred to another section of the laboratory to even to a referral site?

Capability to meet Customer Expectations

Although a laboratory may have every desire to meet each and every expectation of their various customers, there may be legitimate reasons why that goal may not always be possible. Some of the limiting factors may include funding, staffing resources, equipment, supplies or suppliers. When there are legitimate capability factors that limit the laboratory’s ability to meet expectations, then it is important to make sure these limitations are known to the customer so that realistic expectations can be agreed to or so that the customer may take their business elsewhere.

For example, if a blood collection centre has a large influx of patients at 7am each morning, it may be necessary to increase staffing to meet expectations of a shorter wait time. The laboratory will have to complete an investigation of their service in order to first determine what the current wait times are. Then they will have to look at the problem and come up with possible solutions to address this issue. However, if the centre is limited by space as to how many collection stations it can set up, or it is limited by the number of phlebotomists the laboratory can afford to hire, then the customer may have the option of going to a different site to have the collection performed. (We will be studying quality improvement processes in more detail later in this course)

Another example of a customer expectation may be that a physician wants to receive the results of his inpatients’ early morning collections before he goes on Rounds at 10am. If the laboratory knows that his request is for a legitimate reason, such as reviewing the results with the patient and nursing staff during rounds so that adjust can be made to treatments, it may be possible for the laboratory to have the collections from this physician given priority over some other patients. On the other hand, if all the hospital physicians have this expectation, it may be necessary to adjust the start time for early morning collections so that there is enough time to complete the testing and have results delivered to the floor in time for Rounds at 10am. Or, it may be necessary to look at other possible solutions to meet this expectation so that the customer needs are met satisfactorily. As you can see, there are always several factors to take into consideration when looking the laboratory’s capability to meet customer needs and expectations.

One interesting effort to meet customer expectations that has been implemented in most hospital labs in Nova Scotia in recent years is the implementation of Point of Care Testing (POCT) for glucose monitoring.The reason for the initial implementation was so that physicians could get immediate test results at the patient’s bedside. This was a benefit for both physicians and their patients because it meant that treatments could be adjusted sooner and patient conditions would improve faster. In order for this process to be successfully implemented, communication between many different healthcare professionals was required to meet clinical, managerial and technical requirements to provide a high quality product.

The Clinical role in this initiative was to make sure the physician received the test results in a timely fashion so that patient treatments could be adjusted. The Managerial role was to make sure that a reliable product could be used to perform the testing that was cost effective and easy to use. The technical role in the implementation was to ensure that proper quality control programs were set up and monitored, that nursing staff closest to the patients’ bedside were properly trained in the use of the devices, and that high quality results were achieved so that the patients received the highest possible quality of care.

In this case, it was possible for healthcare professionals from different disciplines to work together to provide an improved service to the patient. Both the physician customer and the patient customer benefited from this collaborative effort.

Measuring Customer and User Satisfaction

If customer and user satisfaction is an essential component of a Quality Management System, the laboratory must have processes and procedures in place to be able to measure satisfaction levels. Generally, feedback on customer satisfaction is acquired through surveys, personal communications, and other means of data collection. Once the data is acquired, the laboratory must have an objective means of analyzing the data. In our module on assessments, we will be looking at various tools that can be used for these purposes. In the interim, it is important to recognize that once data is collected and analyzed, then the laboratory has a responsibility to act on the feedback to improve services on an ongoing basis.

Recording and Managing Complaints

As important as it is to act on all feedback from customers, complaints are given additional consideration and must be handled in a respectful, thoughtful manner. Aside from including the data gathered from complaints in the analysis of all customer satisfaction data, it is also necessary to follow up on any customer complaints with an investigation. There are several reasons for this. First of all, the validity of the complaint must be established, the people involved in the event must be given an opportunity to provide input into what happened, and the organization must make certain that the complaint can and will be addressed effectively. Often customer complaints are handled through the non-conformance event process that we will be studying later in this course. Other times, complaints may be received via telephone or email methods. These complaints may have more to do with the quality of the service than with any particular harm that occurs to the patient. Regardless of which type of complaint process is brought forward, it is always necessary to follow-up in a timely fashion.