Embracing Change

However, most companies are reluctant to embrace this change. Many still operate as if a letter sent overnight via FedEx is the height of speed.

Most organizations favor steady qualities like compliance, caution, and consensus over speedy traits like imagination, initiative, and improvisation. That's the nature of the beast. Big business is designed to move forward according to plan, at a measured and deliberate pace.

I've talked with people all over the world who are wrestling with the challenge, and most are not at all comfortable with adopting a real-time mind-set for dealing with customers. It's not on the corporate agenda or the business school curriculum. And when the notion is put to them, many people dismiss quick response to opportunities or threats as reckless or risky.

What's Expected in the Corporate World

• Respond to customers on your time frame.
• Wait, to make certain.
• Work from checklists dictated by multiyear business plans.
• Measure results quarterly and annually.
• Execute based on a long-term new product launch mentality.
• Organize around multimonth communications campaigns.
• Get permission from your superior.
• Run decisions by your staff.
• Bring in the experts, the agencies, and the lawyers.
• Conduct extensive research.
• Carefully evaluate all the alternatives.

None of this is inherently wrong. Clearly, research, planning, and teamwork are essential. The problem is that speed and agility are too often sacrificed for the sake of process. To overcome that, you need to consciously and proactively adopt a real-time mind-set.

The Real-Time Customer Engagement Mind-Set

Today consumers set the pace. Left to their own devices, they imagine all sorts of things. They take unpredictable initiatives, like starting a blog about your products. They improvise all over the map at high speed. They tweet, and post on Tumblr, and talk about you on review sites.

As I first discussed in my 2011 book (subsequently revised in 2012), Real-Time Marketing & PR: How to Instantly Engage Your Market, Connect with Customers, and Create Products That Grow Your Business Now, organizations must rise to this challenge and communicate to their customers in real time. I see definite progress in marketing and public relations functions at companies large and small. Many, but certainly not all, are using agile techniques to engage their marketplace.

Now it is time for customer service to step up and to do the same.

Real-Time Customer Engagement

• Respond to customers on their time frame.
• Act before the window of opportunity vanishes.
• Revise plans as the market changes.
• Measure results today.
• Execute based on what's happening now.
• Empower your people to act.
• Move when the time is right.
• Encourage people to make wise decisions quickly, alone if necessary.
• Make swift inquiries, but be prepared to act.
• Quickly evaluate the alternatives and choose a course of action.
• Get it done and push it out, because it will never be perfect.

Developing a real-time mind-set requires sustained effort: encouraging people to take the initiative, celebrating their success when they go out on a real-time limb, and cutting them slack when they try and fail. None of this is easy.

Let's take a look at a variety of companies that have been successful with agile customer service.

How Boeing Used Real-Time Communications during the 787 Dreamliner Crisis

Imagine that your newly launched product, one that hundreds of millions of people around the world are aware of, suddenly has safety issues forcing the product out of service and disrupting the lives of tens of thousands of people. That's the customer communications challenge Boeing faced when the 787 Dreamliner encountered battery problems in early 2013.

Airlines around the world had been eager to take delivery of the new plane because it was touted as Boeing's most fuel-efficient airliner. But when several 787 Dreamliners experienced onboard fires related to its lithium-ion batteries, the U.S. National Transportation Safety Board (NTSB) and the Japan Transport Safety Board (JTSB), Japan's equivalent organization, launched investigations that prompted the grounding of every commercial 787.

Boeing was quick to take a strategic approach by creating real-time content. Information was freely made available through digital channels and social media to educate and inform constituents around the world.

I had an opportunity to connect with Gary Wicks, who manages much of the digital communications activities for the Boeing Commercial Airplanes unit. He told me how he and his team used real-time content to keep everyone up to date on the situation.

“This was an unprecedented situation for us,” Wicks says. “No one expected the airplanes to be grounded. So we quickly had to identify, evaluate, and communicate to key audiences. We asked ourselves, ‘Whom should we be addressing?’ Our customers, employees, and third-party experts who were being asked to comment on this situation were certainly high on the list. But we also needed to communicate to the flying public and government officials.”

Wicks and his team created content to help clarify relevant issues with factual information. For example, a web page about the 787's electrical system included basic information about the airplane's power and details about the 787 systems—in text, print-ready graphics, and video. They used their Twitter feeds, including @Boeing and @BoeingAirplanes, to get the word out.

“Our best content is providing information that only we can provide,” Wicks says. “It has to be compelling and informative, but we tried to give a look into the problem that no one else can. We had to keep that in mind when we developed the videos or infographics, because we wanted to make sure this offered a look at what we were doing from our perspective.”

Notably, many media outlets took content directly from the Boeing site and used it in their stories. “It was shared widely,” he says. “It was picked up by the Wall Street Journal, for example. A lot of our content was just taken straight from our site and put into other media like GeekWire and AV Week.”

The Boeing team quickly learned that people amplified the #dreamliner story on social media, especially Twitter and Facebook. “There was a great deal of interest and conversation about it,” Wicks says. “So we embraced that. We had a story to tell, and we had valuable information to provide that helped clarify the situation. Believe me, there was a lot of misinformation out there.”

The Boeing team noticed there were a lot of questions raised via the social channels asking about what the batteries actually do. “We needed to explain the batteries in a manner that is easily sharable and understandable for a wide set of audiences,” Wicks says. A page titled Batteries and Advanced Airplanes was created for this purpose.

Once government officials in Japan and the United States deemed the planes airworthy, Boeing ran a live social media chat with Mike Sinnett, 787 chief project engineer, and Captain Heather Ross, flight test pilot. The chat was broadcast as video from Ustream, and viewers could engage via the #787chat hashtag.

“We have a loyal fan base for this airplane,” Wicks says. “And we wanted to give them an opportunity to engage directly with us. The great thing about tools like Ustream and live chat is it's so affordable to do these kinds of events, and the technology works. We wanted to take the opportunity to talk about the battery solution but also talk about what's next for this airplane. There were about 5,000 viewers, and the comments on it were really positive.”

As I followed the 787 Dreamliner battery crisis story as it unfolded, it was clear that most media, customers, and members of the flying public were giving Boeing a fair listen. Sure, batteries potentially catching fire on your plane is a serious matter, and people were vocal. But because Boeing communicated well, and in real time, the public was also understanding about the glitches that need to be ironed out in any new product launch.

“Even with this unprecedented event, we delivered 65 Dreamliners in 2013,” Wicks says. “There are over 100 in service, and the 787 has carried more than 11 million passengers and flown over 95 million miles.”

Putting Your Customers First

As long as we are talking about Boeing 787 Dreamliners, I've got another interesting example of real-time customer engagement around 787s, but this one doesn't involve a fire.

Like many people, I'm on hundreds of email lists. I get dozens of customer email messages each day from organizations I support and companies I do business with. I also get a lot of unsolicited emails. You probably do, too. Many of these unwanted messages are so-called graymail—email lists that you technically agreed to opt in for, but are used in ways you don't expect. For example, you buy a shirt at an online retailer. You give your email address in the checkout process. And now you're getting unexpected sales messages every day. Graymail isn't spam because at some point you actually gave permission for that company to send you email. But it abuses the privilege by sending unwanted messages.

Most of the content of graymail is just advertising. You know, things like:

• Ten percent off your entire order!
• Free shipping!
• Two for the price of one!
• Act now while supplies last!
• Available until Friday only!

Very few of the companies that I do business with send me anything of value, especially the six or eight airlines that send me email. The airlines are always bugging me with “sale prices,” “special offers,” “vacation packages,” and other crap. Most airlines just don't understand that someone who travels an average of 150,000 miles a year for business doesn't book travel based on sale prices and special offers.

I was surprised and delighted when American Airlines actually sent me interesting information via email. For a number of years I have been an Executive Platinum American Airlines customer. That represents a great deal of travel and hundreds of thousands of dollars in ticket purchases over the years, making me one of the airline's best individual customers.

The email I got announced American Airlines' plans to acquire 42 new Boeing 787 Dreamliner aircraft. That's actually a big deal because Boeing designed the 787 Dreamliner from the passengers' perspective, thinking that people would book travel based on the plane. That's exactly what I do, and what other frequent travelers do as well. When you're in the air as many hours as I am—about 300 hours a year, nearly two full weeks in a metal tube at 35,000 feet—comfort is the most important thing. It becomes more important than price, special deals, and other things.

The American Airlines email said: “Boeing's Dreamliner aircraft offers a new level of comfort for our passengers. It features improved air and water purification systems, as well as new humidification techniques and lower cabin pressure, which are expected to reduce passenger fatigue. In addition, the 787 advanced engine design provides a quieter operation, with an expected noise footprint 60 percent smaller than other aircraft of similar size, benefiting those in the air as well as those on the ground. The plane's lower overall weight and improved design means we also will reduce our impact on the environment by burning less fuel. The 787 aircraft also has the largest overhead bins in the industry—approximately 30 percent larger than comparable aircraft bins. The large 19-inch windows are designed to make the cabin feel more spacious.”

The real-time nature of this email made it work so well. It was sent at the time the airline ordered the planes. American Airlines reached out to me at the precise time when it would have the most impact, before I read about the order in the newspaper or online.

I'm amazed at how often companies send press releases to the media but fail to inform their customers of important news. In this example, American Airlines did send a press release about the new aircraft, but was also smart enough to alert its frequent travelers.

In early 2014 I finally had an opportunity to fly on a 787 when I traveled from my home in Boston to Bangkok for a speaking engagement. No, the plane's batteries didn't catch fire. And yes, the plane offers a wonderful passenger experience.

Customer Service Using Social Media

To learn more about how American Airlines communicates in real time with its customers, I spoke with Jonathan Pierce, director of social communications for the company. Pierce is responsible for defining the company's social strategy and then bringing it to life day-to-day based on an analysis and understanding of customers' comments and what they want from American Airlines. Internally, he works to instill social concepts throughout the different business units with the goal of making social communications a significant aspect of their business, not just a check box on a to-do list.

Because I fly American often, I've been connected to @AmericanAir on Twitter for years. They have 1.3 million followers as I write this, and I have always found them responsive. “We listen to where customer conversation is trending for American; we understood fairly early that about 70 percent to 75 percent of all social mentions for the brand are on Twitter,” Pierce says. “We noticed early in its existence that our customers use Twitter for pre-travel and day-of-travel help and support; its short-form text communication is quite appropriate for that kind of transactional customer support. So we focused our customer service on building a very robust solution within Twitter 24/7.”

Curiously, Pierce noticed that although people like to use Twitter to communicate with American Airlines before they travel and on the day of travel, after their trip they more often connect on Facebook. This reveals that being active in only one social network is not enough. It also indicates that when staffing support teams, people working with specific social media networks may need differing skill sets. As of this writing, there are 22 people assigned to social customer service at American Airlines. “From an organizational perspective, we consider the type of skills and expertise needed when managing the different teams. Pre-travel and day-of-travel concerns tend to be primarily about reservations. Concerns that arise post-trip tend to lean toward customer relations and after-sales support on Facebook. These groups work together and they sit together, but they just prioritize the channels differently.”

On Twitter, Pierce's team actively focuses on real-time customer engagement, and I got to witness this in action. I tweeted a question to @AmericanAir while at Chicago's O'Hare airport and received a reply in less than five minutes. “We've put a lot of our resources into relationships,” he says. “The customer service team engages with our clients conversationally, and we hear what our customers want from us: ‘What's the status of my upgrade?’ or ‘What flights are available?’ or ‘Is my flight on time?’ or ‘I need a refund.’ We look at all of those traditional customer service issues and support. But we also get people asking about our products, the number of seats on a specific aircraft, and the angle of the seats in business class. We get feedback on flight attendants, feedback on agents, questions about pets traveling in the hold, and questions about our policy and procedures. I mean, it literally covers everything related to American Airlines. We try to handle them quickly, and to be able to do that we have to have a lot of connections behind the scenes. We have a very robust information-sharing process so that the person who is handling the issue on Twitter can get the relevant information or the answer to the question very quickly.”

While many companies continue to allow glacially slow customer service efforts, Pierce has a definition of real-time support at American Airlines that stands in stark contrast to the norm elsewhere. “Our target is a 15-minute response time 24/7 to every actionable tweet,” he says. “An actionable tweet is a genuine customer conversation. (We don't respond to every single tweet, such as someone sharing a press release. There's no need for us to respond to those.) Actual response times depend on many factors, and they can be longer if there is a weather event disrupting travel or when Twitter volume is overwhelming, but overall we are beating our goal. We are at around 11 minutes at the moment. Everyone pays attention to the target, and we have technology to help us manage the target with a ticker that counts down when we are getting close. The team knows that when the ticker goes into the red more than 15 minutes have elapsed, so we know we have to prioritize things differently, or we need to add extra resources to make sure that we are delivering to target and meeting the customers' expectation of us.”

Because of the nature of air travel, there are inevitable delays due to weather, aircraft mechanical issues, and whatnot. Sometimes when such circumstances occur, people vent their anger on social networks. “Our strategy is pretty simple,” Pierce says. “It's about being responsive and not letting that angry tweet sit out there and gather more anger and more frustration and involve more people. We found that the sooner that we can respond, apologize, improvise, and act on it, the better. We do our best to resolve the issue, or if we can't resolve it we try to make sure that at least the customer knows that we heard them and we are sharing feedback. Our strategy is about efficient, immediate response and empathy and then action where appropriate. People are surprised when we reply and they often say, ‘Oh, I wasn't really expecting a response.’”

Many people are astonished when @AmericanAir tweets back in a few minutes, Pierce says. “They say, ‘I just needed to vent.’ In which case we respond, ‘Thanks, and know that we are here for you.’ I think people like that.”

Occasionally a more serious issue surfaces through social media that might require escalation within American Airlines. “We will capture it, follow up internally, and share it with the appropriate department, and if required there will be investigation,” Pierce says. “We will encourage the customer to create a customer relations file, which is the formal process required by the U.S. Department of Transportation. We help facilitate that and make sure to speed that process through to resolution to make sure the customer is happy.”

There are certainly similarities in the skills and experience required to do telephone-based customer service and for interacting with customers on social media. However, in comparison, the biggest difference is the public nature of conversations on social networks. Only the people on the telephone know how that interaction went down. However, a public tweet can be read by anybody on the planet with an Internet connection. So the skills required for success in social customer service are quite specific.

“We look for people who have both a very positive outlook and can be quick,” Pierce says. “Because they are going to live and breathe social, they need to have that right outlook on life. Anyone doing social is put into a position where what they write not only is directed to the customer but also becomes the public face of the company brand, which is a tall order. Every tweet is being analyzed for typos and for grammar. The tweet could be used in a customer relations file. The media could pick up on it. In addition, to be successful, the company's social people need to have a general handle about what's happening in the news, what's happening in current affairs, and what's happening in celebrity gossip and sports, because that all gets talked about on social networks.”

Vodafone Egypt Proves Social Customer Service Works Worldwide

In recent years I have delivered talks in more than 40 countries and on all seven continents. Frequently in my live presentations people express skepticism about doing real-time customer service via social tools such as Facebook and Twitter. They want to know if the way American Airlines handles real-time social customer service would work in their country as well. While the tools may vary—in some countries local social networks are more important than global ones—there is no doubt that in almost every country social networks are an important way to communicate with customers.

When I was in Cairo, Egypt, and in Doha, Qatar, to lead social media marketing masterclasses in late 2013, I had an opportunity to meet with many businesspeople who are using real-time engagement and social media effectively to reach and communicate with customers in the Middle Eastern markets.

In particular, Vodafone Egypt has been very active and successful in its efforts to use Twitter and Facebook for real-time customer service. I learned the details from Ahmed Sabry, CEO of IT Vision, a Cairo-based digital marketing agency working with Vodafone Egypt.

With eight million Facebook likes, Vodafone Egypt has the largest presence on Facebook in the Middle East. On Twitter, the company counts well over 1.4 million followers at @VodafoneEgypt.

According to Sabry, the company employs 25 social media specialists organized into teams who focus exclusively on social media. Besides Facebook and Twitter, they are also active in networks like Instagram and Foursquare. Each team specializes in one network, and they operate 24/7. Team members follow what's being said about the company and, if required, they respond immediately. In true real-time fashion, anyone who makes a customer service query via one of the networks gets an instant response.

Partly through its excellent social media customer support, Vodafone Egypt has grown to become the leading mobile operator in Egypt in both revenue share and its customer base, which numbers more than 36 million.

While it is impossible to make a definitive correlation between the company's growth and its social customer support, it isn't surprising to me that the company with the best real-time engagement is also the one with the largest market share.

Vodafone Egypt also uses social media for crisis communications. Talking about crisis communications in a country that has recently witnessed a revolution, operates under curfews, and experiences daily protests may seem rather odd. But people draw a distinction between what's going on politically in the country—a series of seemingly constant crises—and what is happening with the companies they do business with.

This became an issue for Vodafone Egypt when in 2011 the company ran a Shokran (“Thank you” in Arabic) campaign during the month of Ramadan. The social media campaign encouraged people to show their appreciation to someone they wanted to thank. Vodafone Egypt promised to retweet messages using the hashtag #VodafoneShokran and measure who received the most votes.

When supporters of former president Hosni Mubarak voted him to the top of the list, suddenly a fun social game became political and turned into a crisis. The social media team flagged the issue, and very quickly executives decided that Mubarak's name needed to be removed. People vented on Twitter using the hashtag, but it could have been worse if the company hadn't acted quickly.

In fact, according to Sabry, Vodafone Egypt faces a social crisis nearly every month. But using real-time monitoring tools, they know immediately what's going on and they can deal with it right away. And once they engage, they monitor the situation to determine if mentions are increasing or decreasing.

Executives of large organizations often ask me whether real-time customer engagement via social networks is really effective. With eight million Facebook fans, real-time engagement at Vodafone Egypt is a decisive contributor to the company's position as the number one mobile phone provider in the marketplace. With concrete examples such as this, the answer is yes: Real-time social customer engagement works all over the world.

People Want to Do Business with Other People

Do you remember the last time you called a toll-free number and were routed through phone-tree hell (“Press 4 for customer support; press 5 for sales”) and then had to wait on hold? How did that make you feel?

Or consider the websites you've visited recently. How many were dull and uninspiring and didn't answer any of your questions? Did it feel like these organizations cared about you?

Of course not.

People want to do business with other people. We're human, and we crave interaction with people who know us and respond as individuals. That's why the real-time customer service techniques practiced by Vodafone Egypt, Boeing, and American Airlines work so well. These companies interact with people on a personal level. The representatives are hired for their social skills and traits like empathy. And they understand context before they act.

When you communicate with customers in an agile and human way, you build a relationship with people much like you would if you met them in person.

When customer service communications and online content seem created by some nameless, faceless corporate entity, it doesn't entice us, and often it alienates. And as a result we're just not interested in doing business with that company.

We all want to do business with other humans. We want to know there's a living, breathing person behind the communications. And we want reassurance that those humans on the other side understand and want to help us.

There's no secret to building great customer service. The answer is to be human.

In this chapter so far, we've looked at three huge companies: Boeing, American Airlines, and Vodafone Egypt. These organizations have 20 or more people dedicated full-time to agile, real-time social customer service.

Now we turn our attention to much smaller organizations as well as independent practitioners to see how they communicate in today's social, networked world.

The Value of Personal Communications

In our modern world of web interfaces, online purchases made easy with a few clicks, pre-populated order forms, and social media share buttons, it's easy to interface with dozens or even hundreds of companies and never have an encounter with a human.

Maybe that's why when somebody does reach out to us personally, we notice. A human interaction can be delightful.

I booked a speaking engagement in Quebec City, Canada, and since it is a lovely six-hour drive from our home near Boston, my wife and I decided to go together and enjoy a few days in beautiful Old Quebec.

Prior to our journey, we researched restaurants on TripAdvisor and other services and made several dinner bookings using online booking engines Open Table at one place and Bookenda at another.

As I usually do, I added a short message in my booking form at each place, something like: “We are looking forward to dining with you!”

Whenever I make an online restaurant booking through a service like Open Table or a hotel reservation through an online interface, I add a personal message. I'm imagining that if there is a person at the other end who is processing a bunch of reservations, I want mine to stand out just a little and perhaps brighten that person's day.

In perhaps 100 restaurant online bookings I've made, I've never had anybody respond to my notes. Until now!

Marcela at Restaurant Saint-Amour replied to my reservation via Bookenda with this: “So do we! Until then, have a lovely week monsieur Scott! Marcela”

This was so unique and unexpected that I immediately shared it with my wife. And during my presentation in Quebec City, I shared it with the audience. We agreed that Marcela's personal reply made us even more excited to dine at Restaurant Saint-Amour. Marcela humanized the restaurant in a way that a hundred other restaurants failed to do when given the opportunity.

And it took just a moment.

When we finally walked into Restaurant Saint-Amour with positive vibes already established, we were hoping that Marcela would be there to greet us because I felt like we already knew one another. While she wasn't working that night, the staff were wonderful and we had a fantastic meal.

Oh, and the rock band Metallica was at the table next to us! They had a show the next night in Quebec City. For a music geek like me, that was fun.

What small function at your organization can humanize in order to delight your customers? It seems so easy, right? Just communicate as a human would. However, that just doesn't happen with most organizations. To illustrate this point, I'm going to focus on the industry that in my personal experience is among the worst at customer service—the healthcare industry.

Lost in Clinical Gobbledygook

Would you want people in this organization to take care of you or someone you love?

We have assembled surgical and clinical expertise second to none, have a state-of-the-art trauma center, developed sophisticated minimally invasive techniques, and called on innovative training and technology to ensure the highest level of patient safety and quality of care. These clinical initiatives, a thriving research enterprise and an unparalleled [famous university]-affiliated medical education program all enable [Hospital Z] to fulfill our mission.

When I read this world-class, cutting-edge hospital gobbledygook I don't imagine the people working at this hospital as having a great bedside manner. How you communicate with your customers is important. Humans don't speak in what I call gobbledygook, the vaguely important-sounding big words and industry jargon contained in the preceding paragraph.

Can you imagine using this language when you speak to someone in person?

The way you communicate with customers is meant to build a relationship with them. You need to understand your audience and use the words and phrases that they use.

This is particularly true when you're a doctor and you're communicating with a patient. After all, confusion in meaning could lead to serious medical issues.

Terrible Healthcare Customer Service

In my experience as a patient and as a family member of patients, I'd have to say that the healthcare industry has the absolute worst customer service imaginable. It's crazy! If I need to make an appointment with my primary care physician, I can't do it online. I must call the doctor's office “during normal business hours,” which is a three-hour window in the morning and a three-hour window in the afternoon, weekdays only. No, you cannot call the office before 9:00 a.m. No, you can't call when they are on a lunch break.

And when you do call, there's no way you can actually speak with the doctor. All they will do is grant an appointment.

And don't even get me started about service after an appointment. Typically, the doctor gives you a prescription and sends you on your way with very little information. Sure, you can read the 10-page medicalese that comes with the pills, but that's not helpful. Answers to my questions like “Can I exercise when I take this medication?” aren't included because there are so many warnings that the various government agencies require.

I recall a few years ago when I injured my leg and needed to go to physical therapy. The therapist wanted me to do exercises at home between sessions. So how did he help me to learn the exercises? Well, he demonstrated once, had me do them once, and then gave me a one-page handout that was a series of terrible stick figure drawings of a person doing the exercises. The photocopy itself was awful quality, probably a hundredth-generation reproduction. Got a question about the exercise? Tough. You have to wait until the next appointment to ask.

I'm not sure why healthcare treats its customers so badly. Is it because doctors, with their fancy degrees, are so revered that we patients can't insist on better service? Is it something related to the American healthcare system that removes from doctors any incentive to take care of people properly? I'm not sure of the underlying reasons, but there is no doubt that in my case, the experience has been horrible.

But it doesn't have to be this way. Next, I'll introduce you to several doctors who are pioneering great customer service in healthcare. We will meet an emergency room physician who uses video to provide patients with information they need upon discharge from the hospital, a pediatrician who uses social networks to communicate with her patients and their families, and a clinical psychologist who cares deeply about patient communications.

Healthier Patients through Video Customer Service in Healthcare

According to a report issued by the Center for Information Therapy, five minutes afterward patients remember only half the information conveyed to them during a healthcare consultation. This disconnect between doctors and patients means a huge customer service problem in healthcare.

“Clinicians assume patients understand the terminology we are using with them about their diagnosis and plans for treatment, and clinicians also assume their patients' understanding and cognition can occur very rapidly. These are two very incorrect assumptions,” says Kate Burke, MD, an emergency physician at Milford Regional Medical Center in Massachusetts. She also serves as president of Orion Emergency Services, a group practice employing 22 physicians, and holds a clinical associate professorship at the University of Massachusetts Medical School. “Patients are not in our heads as we rifle through our differential diagnoses of what's wrong with them, nor do they have the training, background, or vocabulary that we spent a long time learning. It is not acceptable to think that patients can remember things as rapidly as we verbally deliver information to them, especially if we are also used to talking to other healthcare professionals who also share our knowledge. This results in a real communication gap between what clinicians believe they have communicated clearly to patients, and what the patients understand about what the clinicians were trying to tell them.”

Dr. Burke became interested in this disconnect through personal experience with an orthopedic injury she suffered while skiing. She struggled to recall exactly how to do her physical therapy exercises at home. Then she had an idea: On the next visit to her therapist, she took her video camera, asking him to record her correctly performing her exercises in his office so she could remember exactly how to do each movement at home.

“It was a real ‘aha’ moment for me as a doctor,” Dr. Burke says. “I thought, ‘Wow, this is unbelievable. I can play my own rerun to revisit my physical therapy sessions and store them on my computer. I can have all of the content that was shared with me from three and four years ago to use regularly and routinely, not requiring me to go back to the provider.’”

Since that experience as a patient, Dr. Burke has introduced video in her own practice, shooting clips for patients at the end of an emergency room visit, explaining the treatment and what to do upon returning home. And she has become involved with the Center for Information Therapy in Washington, D.C., whose sole focus as a not-for-profit organization is working to close the gap so that patients will remember more than 50 percent of what a clinician was trying to communicate. “This led me to trying to figure out a way to share HIPAA-compliant videos with patients in a more scalable fashion,” Dr. Burke says. “Video shot during a healthcare consultation can help patients recall important information and instructions later. It's a game changer and will become the standard for ongoing physical care and in other areas of healthcare, too.” (The U.S. Health Insurance Portability and Accountability Act [HIPAA] protects the privacy of individually identifiable health information, and sets the national standards for security of electronic health information.)

This communication disconnect between doctors and patients is a hidden problem because doctors are expected to communicate well, and patients are usually too intimidated to speak up about things they don't understand. Together, these issues lead to a terrible customer service problem in healthcare delivery.

“We are talking about communication, basic routine skills that everybody assumes a clinician who goes into healthcare possesses, whether a doctor, therapist, or nurse,” says Dr. Burke. “But communication skills are not necessarily inherent in every individual who works in medicine. But it is a skill that can be amplified and taught. And now we all have the ability to capture critical information in the simplest of ways, by using technology at our fingertips: our smartphones.”

Dr. Burke films herself discussing the patient's condition and treatment near the end of the emergency room visit. Depending on the situation, she might film the patient. Sometimes she films a member of the patient's family who is involved in care or assistance, such as learning the motions to safely lift someone who needs help being moved. Or she might film herself talking directly into the camera as she gives details about how to take medicine or what foods to avoid. She then shares the information via Postwire Health, a web-based, HIPAA-compliant patient engagement tool used to create a private, customer-friendly place for each patient. She may share articles and links to other content on the Postwire private page, too.

“We all have iPhones or Androids, so clinicians have the ability to capture and share information that's critical and curated to a particular patient,” Dr. Burke says. Patients already have the tools required to view the content, simply by firing up their computer or tablet. “It can be shared literally within seconds and integrated into a clinical encounter. I've shared my idea with many different clinicians, and it's now part of my fourth-year elective course, Best Practices in Communication. I have seen it integrated into the medical school curriculum. When I discuss this concept with students, their response is, ‘Yeah, of course we would do that.’ I have seen an amazing growth in its acceptance.”

Dr. Burke describes the problems faced by those who receive a cancer diagnosis. It's a very difficult time for patients and their families as they come to grips with the nature of their disease. Many do a great deal of research on their own. “There are many confusing opportunities for patients relative to cancer care,” she says. “Patients have all these questions and learn how important it is to get different opinions. But how, as a patient, can you keep track of this? How can you remember in detail the experts' nuanced suggestions given during a visit? Clinicians can help by curating the content. They can help direct each patient to really good sources that are germane to that patient.”

Additionally, patients and their families benefit from sharing these videos, links, and supporting information on a personal site. “This is a very powerful way to take care of a human being,” Dr. Burke observes. “And by sharing, equalization and transparency are much more likely to take place. We can stamp out confusion or misunderstanding very early during in the doctor–patient relationship.”

The tools required to do this sort of information sharing are fairly simple to implement, yet can significantly increase patient satisfaction. All that's needed are a smartphone camera and a secure online place to store information.

You don't need to be a physician to employ this beneficial approach to detailed customer service. Individually intended content curation and video customer service can work in any business. In this example, just substitute the word customer for patient to understand how it might apply to your business.

“Medical technology and digitized information storage are evolving at an exponential rate,” Dr. Burke says. “Several years ago there were many clinicians who could not imagine using an electronic medical record, but that's routine now. It's incumbent upon physicians to improve how we communicate with patients, facilitate the retention of information we want them to carry forth in their recovery process, and share with their families. Once you admit there is a problem with how we communicate and how much information patients remember from that communication, then you can move on to finding solutions. One wonderful way to do it is by leveraging technology. For me, this is incredibly exciting because finally we are going to address the problem of patients either being unable to understand or failing to retain the information they are provided.”

People are naturally reluctant to change the way they work with customers, and doctors are no different. However, making a radical change in how we communicate is not difficult. All that's required is eliminating a fear of the unknown and learning a new routine. Sure, the first few weeks might involve a learning curve. But after that, there should be no additional effort required to communicate with customers in a way they will appreciate.

Making Clients Feel More Connected

Peggy Kriss, PhD, is a clinical psychologist in Newton, Massachusetts, and like Dr. Burke she provides each of her psychotherapy clients with a Postwire Health resource page where she shares videos and other content.

“On their pages might be personalized relaxation breathing practice, or mindfulness videos, or a video clip of the summary of one of our sessions,” Dr. Kriss says. She also provides psychoeducational resources such as helpful websites, articles, blogs, referral links, and even motivational photos.

“One client was nervous about upcoming elective surgery and asked me during a session to add a video for her page that included a reminder of all the benefits that would result if she did in fact have the surgery,” Dr. Kriss says. “She watched that video many times before actually making her decision. We actually made two videos: one with my voice, summarizing her choices, and then later, an interactive video with the two of us discussing the advantages. She thought she would not want to hear her own voice, but she actually came up with the idea in a later session after concluding that it would be important for her to hear herself saying the words.”

Each client's personal page allows the client to communicate with Dr. Kriss, and includes a notification that records whenever the client accesses information on the page. “Some of my clients refer to this page daily,” she says. “This might happen if they are having a particularly hard week. Others just engaged in the therapy find the resources very helpful, and have integrated the use of the page into their self-care routine. The notifications I get when they look at the page are very useful to see how engaged they are. So when they are back in the session I already have data to explore with them.”

Dr. Kriss believes this way of communicating with her clients both structures and supports them. They have something they can turn to that gives them a road map toward feeling better. “Clients feel they are not alone,” she says. “They feel more connected to me and to the therapy process. And since the page can be shared with others, it is an awesome way to communicate with family members, caregivers, and other healthcare providers.”

Making Healthcare Personal

Natasha Burgert, MD, a full-time primary care pediatrician at Pediatric Associates in Kansas City, Missouri, has a passion for educating families. She does this in unique ways through her blog and in social media. However, like Dr. Burke, she is another physician who noticed that people weren't retaining the information she shared on visits, in particular the parents of her patients. “The clinic space is not a good learning space,” she says. “It's an information gathering space, but it's not conducive to learning.”

Dr. Burgert uses her @doctornatasha Twitter feed, her Facebook page, and her KC Kids Doc blog to share information with parents, the teenagers she serves, and the community at large. Like Dr. Burke, she sees tremendous value in delivering follow-up information via social tools. “If you ask me why your child gets a fever, what you need to do about it, what are the myths, and what are the facts, that will prompt a long discussion. And quite frankly you are going to understand only about 10 to 20 percent of what I say,” she explains. “So I deliberately don't answer those questions during a visit. I'll say, ‘Here are three blog posts that I wrote that are going to explain all that you want to know. When your kid gets a fever, go back to it and look again; that's the time that you are going to learn.’ I specifically won't answer certain questions that I have written about, because I just don't believe that's time well spent. It's especially hard to retain verbal information if your kids are distracting you during an office visit. You may be worried about their fear of getting a shot that day. Maybe they're not feeling well.”

Dr. Burgert's KC Kids Doc blog allows her to deliver important health information but with her personal spin and in real time. Because she's seeing patients every day, the content is derived from her experience in the office. “The Academy of Pediatrics site and WebMD are wonderful places for consumer health information, but sometimes the information doesn't turn over quickly enough to be practical. So that's why I started my blog,” she says. “The blogging is to respond to specific things that I was seeing in my day-to-day practice. This covers topics important to families that I was often asked about and provides opinions and direction that weren't necessarily found on the larger health information sites.”

For example, some teenage girls asked Dr. Burgert about “thigh gap.” So she asked the teens a number of questions and learned that the girls were trying to achieve a valued gap between their thighs when standing with their ankles touching. Girls who didn't display a visible gap were given diet tips and exercise routines by their peers so as to create one. Dr. Burgert was horrified. She did some research and noticed there was very little written using the phrase thigh gap. But she realized she was seeing an early trend and quickly wrote a blog post entitled “Thigh Gap: The Newer and Disturbing Trend in Body Awareness” to get the word out to girls and their parents that this is not a healthy choice. The post provides tips about how parents should to talk to their children about a healthy body image and details of early warning signs of an eating disorder.

“My blog, Facebook, and Twitter are a bit of real life,” Dr. Burgert says. “It's my opinion, although I try to support my comments with as much evidence-based literature as I can. I think that's the beauty of having a place where you can speak your mind as a physician. We have these amazing conversations with families that I think are really valuable and need to be shared. The teenagers I see in my practice are very open with me about their concerns and the issues they are dealing with. I hope I can alleviate the anxiety of other teens and possibly prevent them having similar troubles. Without this platform I couldn't share my advice as widely as I do. Parents enjoy the fact that they can turn to one trusted place and know it will have both the research evidence and my opinion.”

Dr. Burgert typically creates content for her blog and then shares links via Facebook and Twitter. But she gets the information to parents in any way they are comfortable. “Our community is very technologically savvy, so many people will just look it up,” she says. “But my job is to offer as many ways to get the information as possible. If someone needs a particular piece of information, I will just text or email the link. I have bit.ly short codes for all of them. I can write them down. And I have QR codes that I pop onto my computer screen when I am doing my electronic medical record, so they can just scan it on-screen with a QR reader. For those who don't want all that electronic stuff, I have paper copies. It is my patients' choice how they get that information.”

As Dr. Burgert was explaining all this to me, I was struck by the huge contrast between how she and Dr. Burke give information to patients and how my physical therapist gave me the old photocopy of the stick figure cartoon diagram.

In addition to providing information to patients and parents following a visit, Dr. Burgert also anticipates what people may need prior to a visit.

“If I know that you are going to see me about a specific issue, I can guess what your questions will be,” she says. “I can preempt that visit by giving you answers to those preliminary questions, so when we come together we can talk about how those answers are specifically relevant to your family, and not just dispense general information that you can get anywhere. I develop a plan and specifically ask questions about what may be unique to your family.”

Beyond the value of her blog and the social presence it provides to individual patients and their families, Dr. Burgert says there is a sales aspect to what she is doing as well. “It goes beyond information distribution,” she says. “It's actually a relationship-building tool and a valued place for families seeking advice and who are trying to make the best decisions for their kids.”

She has also seen lots of evidence that her blog posts are shared via social media and discussed among parents in her community, resulting in a raised awareness of her practice. “That's how my brand is marketed and how people find the clinic. They bring in their families because they heard about us on the soccer field,” she says. “I can track how my posts are being shared through Facebook and where they are getting linked.”

While the agile service she provides to families and the community serves to bring in new patients, she sees a much larger role for her efforts. “A lot of people ask why I started doing the blog, but I think the bigger and more revealing question is ‘Why do you keep doing it?’” she says. “Medicine is changing, and the manner in which patients make health decisions is changing as well. As a pediatrician who went to school for a long time, I want to be able to use my knowledge and use my training effectively. There are new ways to distribute the knowledge that I have learned, so I keep doing it because it provides such great value within the community. That's an amazing feeling for a physician: to realize that you are improving on what's already an amazing career by trying something new.”

Dr. Burgert continues, “Parents come in and tell me they were really, really worried about a particular medical issue. It was causing them to lose sleep. But then they tell me, ‘Luckily, I knew I could turn to your Facebook page, and there I got a lot of reassurance and calm, and then I could rest well.’ I'm often told by parents, ‘There is so much information out there, but I want to know what you think.’ They have already chosen me as their pediatrician. They trust me. Now they just want to know what I think so they don't have to worry about doing all of this research themselves.”

Customers and Business Growth

Throughout this chapter, we have looked at a variety of organizations and how they interact with their customers in an agile way. The proactive approach to customer service—anticipating needs and being available around the clock, like Vodafone Egypt and American Airlines—means people are more likely to use your business next time. When your doctor keeps in touch with you throughout the year by providing valuable information via social networks, you tell your friends about it. There can be little doubt from the examples cited here that agile customer support results in happier customers, and that, in turn, leads to business growth. Happy customers keep coming back to you for repeat business.

“You're not doing your job if you don't pay attention to me all year and then call me 30 days before the contract is due to expire to check in about the renewal,” says Cliff Pollan, CEO of Postwire. Postwire Health is the personal sharing platform used by Dr. Kate Burke and Dr. Peggy Kriss to share videos and other content with their patients. “You're going to lose the most valuable customers you have. The easiest dollar is always to save the customer you have. The second easiest is to sell more to the customers you currently have. And the most difficult is getting new customers.”

Pollan believes that sending information to existing customers about once a week is the right frequency. This keeps you and your organization in their minds. But you need to send information of value, such as what Dr. Burgert shares with patients throughout the year via social media, and what American Airlines sent me about the new 787 Dreamliner aircraft via email.

“Ideally, you are giving customers added value every week—something that will help them,” Pollan says. “It could be a tip on how to use the product. It could be an interesting blog post. A company called StandUpPouches creates a page for each customer. The business has grown more than 25 percent each year because the company created a place to share information with its customers. New information is added all the time, which is placed in context for each customer. This enables StandUpPouches to maintain a good back-and-forth dialogue. Added information also creates additional sales for its product, which translates into orders to different departments, as well as referral business. Should a key person working for one of StandUpPouches' accounts leave that company, the history is retained for the next person who comes into the job, meaning StandUpPouches is more likely to keep the account.”

Implementing Agile Customer Service

The more people you have in an organization, the tougher it is to communicate in real time. In a command-and-control environment where no action can be taken without authority, without consultation, and without due process, any individual who shows initiative can expect to be squashed.

The challenge is to develop a new balance that empowers employee initiative but offers real-time guidance when it's needed—like a hotline to the higher authority.

Some companies are making substantial progress at this, and we've looked at some examples. One good indicator is whether employees are allowed to do real-time social networking on the job. If your company blocks access to Facebook or Twitter, you do not work for a business with a real-time mind-set.

Companies with a real-time mind-set allow decision making as far down the ladder as possible. Frontline service reps are given the authority to decide how best to deal with customer issues. In a real-time corporate culture everyone is recognized as a responsible adult.

If you're the leader and you want to cultivate a real-time mind-set throughout your organization, tear down the command-and-control mentality. Recognize your employees as responsible adults. Empower them to take the initiative.