Sharing SHARE

Upon arrival in Malawi anyone will realize that the concept of “Customer Service” or “the customer is always right” is as unheard of as 12 lane highways, “high-speed” internet, and Taco Bell. The second realization if you come to work in a hospital in a management position is that there is GREAT NEED for training in this area. The third thing to come to mind is “where in the world can we start to teach this?” At this last point is where I have spent the last year or so. Not long after I came I contacted my former employer (Adventist Health System) and asked if they would let me use the customer service program that they use – designed for healthcare employees from an Adventist perspective. They graciously mailed me the training manual, the powerpoint presentation and some of the props and materials.

Every month or so I would look at the binder and flip through the slides and wonder how in the world to make this apply to Malawi and then give up being daunted by the task. Finally in October we decided in our strategic plan that customer service was a priority and my name was attached to the task. Now it was on paper which made me realize I cannot procrastinate very much longer. Finally in January I finished modifying the power point presentation to be what I thought would work here and what seemed like it would fit into 4 hours.

This week was it – the first session. The goal is that every employee will attend this training (200+ employees) and it will be two sessions, each two hours with 20-25 people each time. I talked to the matron, put up a sign to advertise and wondered if anyone would come. Wednesday and Thursday this week were the first sessions. About 20 people completed the four hours. They weren’t the nurses the matron had assigned but rather a mixture of people – so translation was needed which I did not account for in my preparation for a four hour class. Although I had to skip a bit of the points I was able to cover the topics as an overview and am hoping for opportunities to emphasize each point. So what did we cover?
Reputation – what is it? what kind of reputation do you want? what about the hospital?

Loyalty – what does this mean and what is the difference between loyalty and satisfaction?

What is customer service?

SHARE acronym – Sensing others needs before they ask, Helping each other out, Acknowledging people’s feelings, Respect the dignity and privacy of others, and Explain what is happening.

Body language

All of this sounds good but as we were going through the presentation I realized the slides and concepts I thought would work didn’t always make sense in this context. Also teaching in a setting where English is not the primary language caused challenges. How do you explain the statement, “patients judge their experience through their perception which is subjective not based on outcomes which is objective”. Those are big words and have to be explained and simplified or illustrated on the spot. I found it challenging to teach with a cross-section of the employees because about half of the people were the housekeeping staff and some don’t know how to read or write while the nurses and secretaries are quickly answering questions, taking notes, and filling in the worksheets while I’m not even sure some of the cleaners understood a word that I said. How do you teach to all levels?

Another interesting dilemma was talking about respecting the dignity and privacy of others. First when I asked what it meant they thought I was talking about respecting your elders which is one of the tenets of the culture. I said not exactly but more looking at how people are different yet treating them all the same. We looked as some pictures of different people and situations and illustrated how people felt differently about the photos and it is based on upbringing, etc. But how is Malawi diverse? It is completely different than the US – it is mostly a homogenous culture here but yet there are subtle differences in social standing, tribal differences, family values, religion, etc. I did approach the subject of how people are treated based on how they look. If someone is poor are they treated the same as someone who is rich? What about people from another country? or someone with white skin? I emphasized that white people should not be treated better than anyone else rather that everyone should be given the same excellent care. This was responded to with nervous laughter which means they knew that it is common to treat the “rich white person” differently. I wonder if they’ve heard a white person talk about this before? I think it’s important though and something that needs to be said and probably important for a white person to say it.

Then we talked about PRIVACY!! I recently had a discussion with Kelly about what is actually private here. The answer is basically the bedroom and the bathroom – that is it – not your kitchen, your yard, or the porch. So the concept of not talking about your neighbor who is admitted into the hospital is a foreign concept. Knowing your friends’ business is normal. What kind of privacy can we teach? So I used the illustration of HIV status which is still not talked about widely. This they understood but I didn’t know where else to go to teach about privacy because there isn’t much else that is culturally private. I realize I can’t change the culture and that is not my intent so the challenge is to adapt to what make sense here.
So the first class is over. I have some modifications to do to the presentation.

Also I have a better idea of some of the things that work and things that don’t. I hope the next class will go more smoothly and that overall our staff will begin to incorporate these ideas into their work. The goal is that Malamulo can be a preferred choice for patients to come for healthcare. That isn’t just sound clinical care but also good personal attention and customer service… Is it a “pie in the sky” kind of dream? Maybe, but I’ll work hard to do what I can to move towards that goal. As my good friend Phyllis always says, “hope springs eternal” and I continue to have hope that something I’m doing here will actually make an impact.