Managing Expectations

I decided to consult a Chiropractor last week to see if I could get relief from some pesky neck pain I’ve been experiencing on and off for a number of years. It’s not the result of any accident or trauma but rather payback for several decades of being tied to a desk or hunched over a laptop in a hundred different locations and body positions. While I’m pretty good about my diet and exercise, I know that I have poor ergonomic habits and suspect that stress is a contributing factor as well. I’m working on these things but they require time and discipline – two things that are always a challenge to muster.

I have no previous experience with Chiropractics; however, I have several friends who do and they tout its benefits. So, based on a referral, I contacted a local Chiropractor. I was able to get an appointment on the same day that I called, with a series of follow-up visits scheduled at convenient times over the next week. That kind of scheduling ease is a rare occurrence in my experience with the general health care system. Granted, Chiropractors live on the fringe of that system and probably have more freedom of movement. Sorry, for that crack. Anyway, besides the scheduling, I was amazed at how well the Chiropractor’s office managed my expectations. For example, during my call to arrange the initial consultation, the receptionist asked me if I had access to the Internet and then navigated me to their website. She told me that the office personnel have been working very diligently to minimize the amount of paperwork that patients have to complete and I could save myself a little time if I downloaded and completed the health history form before my appointment. I’m sure that my mouth was open at this point. Reduce the paperwork? Save me time? Say what? Who are you people? The items on the one and half page form all made sense and it took me about five minutes to fill out. It’s interesting to me that the office receptionist made no assumptions about me. She obviously knew that I was a new patient but didn’t know if I had any familiarity with Chiropractic care. She didn’t ask and I didn’t tell.

When I arrived for my appointment, I was greeted warmly by the same receptionist who I spoke to over the phone earlier that day. She gave me some new forms to complete related to medical insurance, HIPAA compliance and payment terms. The receptionist had previously advised me about this so I wasn’t surprised by the additional paperwork. The documents were pretty straightforward but I did have to repeat some of the information I had provided earlier on the health history form. I chalk that up to “the system” and give the Chiropractor a pass on that one. Everyone with a skin in the health care game has their own forms and procedures. Before I sat down with my clipboard and papers, the doctor came out of his office to say hello and thank me for coming. What’s up with that? No doctor (I don’t care what you think of Chiropractors) comes out from behind the veiled curtain to greet you before your 15-minute audience is granted. I’m thinking to myself that this is getting weird. If they offer me some Dunkin’ Donuts coffee and a Snickers Bar, I’m moving in. That didn’t happen but I was treated to some other pleasant surprises. After I handed in my final round of paperwork, the receptionist walked me to the exam room and set up a 5-minute DVD for me to watch about Chiropractic care. This was all about managing my expectations and addressing my preconceived notions about these mysterious back crackers. The DVD was a generic production about Chiropractics but it was very informative and professionally done. It appeared to me that the DVD was produced with three objectives in mind: (1) provide relevant and easy to understand information to patients about chiropractic treatments, (2) establish the credibility of the practitioners by emphasizing the extensive training requirements, and (3) counter any “voodoo” notions people have about the Chiropractors and other health care fringe dwellers. I was impressed by this and even more impressed by the doctor himself. Nice guy, articulate, seemed to know his stuff, good posture. Doc (we were on familiar terms now) reviewed my health history and did three x-rays that felt a little bit like mug shots with front and side views. Doc said that he would evaluate the films and see me again in two days. I was in and out in about 30 minutes.

The follow up visits have been even better. The staff and I are on a first name basis and I have the routine down. After checking in, I go into an adjoining room with three automated massage beds. I pick out a bed, lie down on my back, set the intensity level, and then chill as I’m treated to a head to tail massage (literally) for 8-10 minutes. Afterwards, I go see Doc for my treatment. I’m not exactly sure what the full therapeutic benefits are of the massage bed but I do know that it loosens you up better than cool jazz music and a good glass of wine. And, it beats the heck out of sitting in a traditional waiting room reading old magazines and listening to people cough. My visits are now almost exactly 20 minutes, with no downtime. Dang, I’ve spent that much time standing line to get to the unfriendly medical receptionist who would give me poorly printed forms to complete so that I could be put in the queue and sit in the waiting room listening to people cough while waiting for the overworked nurse to escort me to the cold room with the funny paper on the uncomfortable table waiting for the man or woman in the white coat to emerge from behind the curtain.

You may not be sure at this point what all of this has to do with good leadership practices. Well, actually a lot. Managing expectations is a relational art. I don’t believe it is taught as a leadership competency but it should be. Unmet expectations are the source of much of the angst people experience in their personal lives and at work. Mismanaged expectations are at best lost opportunities. At worst, they are relationship killers. Here’s what the language of mismanaged expectations sounds like:

· You said…

· You promised…

· It was my understanding…

· You’re the boss, I thought…

Unmet expectations are dangerous because people can equate them to a breach of trust or a broken promise. Trust is one of the most difficult things to achieve in any relationship. It takes time. Unfortunately, it takes no time at all to dismantle it. One broken promise can do it.

Like many of the other topics we discuss each week, managing expectations is a deep subject. Let me just draw out seven of the more poignant lessons that have emerged from my Chiropractic experience and the work I’ve done with other organizations over the years. I’ve described these lessons using a business context, though they are equally applicable to families, friendships, and social relationships.

1. Learn and then anticipate the needs, interests, fears and perspectives of your employees and customer. This requires careful observation, active listening, and openness to feedback. The Chiropractor’s office incorporated the use of the DVD to allay some of the fears and doubts of new patients and to explain what to expect in terms of the treatment regimens and results.
2. Practice empathy. This is similar to #1 above but actually involves “wearing someone else’s moccasins” to the fullest extent you can. The Chiropractor’s office placed themselves into the role of the patient in order to streamline the intake process. It’s wise to periodically evaluate your services from the perspective of those who use them.
3. Don’t make promises that you can’t keep. This is timeless wisdom. It’s better to either avoid promises altogether or to under promise and then over deliver.
4. Be careful about making “representations” that others may interpret as a promise. For example, a manager might say, “Don’t worry Bill. I’ll take care of you when it’s time for your annual review.” Statements like this, especially when made by someone in authority, can be interpreted many different ways and can come back to bite you.
5. Adopt the “No Surprises Rule” with regard to your employees and customers. Be forthright and clear in your communications. Avoid ambiguity and subtleties. If you want to surprise people, makere you do so with something unexpectedly good.
6. Don’t make assumptions about what people expect. Keep in mind that the expectations of your employees and customers are constantly being shaped. Stay in touch. Pay particular attention to the media and to your competitors.
7. Apologize and ask for forgiveness when you are wrong or have a service-related blunder. Practice service recovery when you fail to meet the legitimate expectations of employees or customers. Don’t bother rationalizing or providing excuses because no one wants to hear them. People do care about being treated with respect. The humility associated with a sincere apology and request for forgiveness communicates a genuine concern for the relationship.

It is obvious that my Chiropractor’s office has worked to evaluate their practice from the perspective of the patient. They’ve aligned their business and clinical processes to minimize trauma, the trauma in this case being wasted time and the frustration that results from excessive bureaucracy. In a little over a week, they’ve succeeded in not only managing my expectations, but exceeding them. We can all learn something from the excellent example they’ve set.