In this blog I will periodically discuss particular numbers and other metrics that I think can be of value in helping you run your business.
In this installment, I discuss the concept of “triage,” which ultimately derives from the Latin word for “three.” Literally and historically, “triage” refers to a simple way of allocating emergency medical care among a group of injured people who outnumber available medical resources.
In its original form — dating from the Napoleonic Wars — these were the three categories to consider when doing triage:
1. Those who will likely survive regardless of the level of immediate attention they receive;
2. Those who are much more likely to survive if they do receive immediate attention;
3. Those who will likely not survive regardless of the level of immediate attention they receive.
Metaphorically, “triage” can refer to any system of determining how best to allocate resources when more resources are needed than are immediately available. It’s important for a small business to have a (metaphorical) triage system in place, but it’s even more important to keep in mind that if you find yourself actually needing to do triage, something has gone wrong, and once the crisis has passed you need to be sure to do a root cause analysis.
The long-term strategy to develop from that analysis is the creation of systems that enable you to avoid triage situations to begin with — what I like to refer to as making the transition in your business from fire fighting to fire prevention.
Memory is undependable
A year ago I had to witness triage in its most primitive form, and only recently have I been able to start to sort out what I learned.
I was standing near the finish line of the Boston Marathon when the first bomb went off about 15 feet away. My sister was between me and the bomb and was hit by clusters of shrapnel. She’s fine now, no lost limbs — she was the second luckiest person in our immediate circle of spectators. I was the luckiest.
I don’t remember very well what happened right after the explosion. When the FBI questioned me in the hospital afterwards, I was very careful to distinguish for them between those things that I thought happened and those things that I knew happened. I later found out that almost everything that I “knew” happened was wrong. For instance, I was convinced we were right in front of a French café when the blast hit us. I had had time to study the storefront sign while trying to tend to my sister, call my wife and brother-in-law to let them know we were basically OK, and avoid looking at some of the more seriously wounded getting cared for around us. It turned out we had not been in front of a French café; we had in fact been in front of a Lenscrafters franchise.
I do recall that after a bit of time a series of trained professionals started to come by to evaluate my sister, who was on the ground and in shock. They were performing triage, trying to figure out whether to get her right to an ambulance, get her to a wheelchair to take her to the medical tent, or let her lie there for a bit longer while they tended to more urgent cases. Eventually (3 minutes? 30 minutes?) a wheelchair and a first responder arrived and she was taken to the medical tent.
Exceptional care
That tent was a horrific scene, as you can imagine. But it was also a model of self-organization by exactingly trained and dedicated professionals. Although in this blog I am making an analogy between the work of those first responders and the work of a small business owner, I want to be very clear how well I understand that those first responders, in any five minute period that afternoon, did (and do) more good than I can ever hope to accomplish over the span of my entire career. I understand that as clearly as anyone.
The personnel in the tent were tagging victims with color-coded cards that had a 1, 2, or a 3 on them. There was some question whether my sister was a 2 or a 3, and they eventually settled on a 3. I was mostly relieved, partly disappointed — relieved because her injuries were manageable compared with those of the people around us, disappointed because I wanted her to be a 2 so that I could get her (and me) the hell away from the awful scenes in that tent as quickly as possible.
The staff at Boston Medical Center were every bit as wonderful at caring for the blast victims as you may have heard they were, in every capacity — from the doctors who met our ambulance at the emergency room doors to the aides who brought the meals to the people who kept the rooms clean and tidy. At one point my sister, groggy from painkillers, mildly complained to a nurse about a delay in getting a test done that might mean she would have to spend an extra night in the hospital. Within minutes, there appeared in her room a team consisting of a nurse supervisor, two senior physicians, a social worker, and a comfort dog. My sister apologized to them for having complained.
A cell phone company that strictly follows the rules
The day after my sister was discharged from the hospital, we went to a Boston-area storefront of her cell phone service provider to get her iPhone replaced. It had taken a direct hit from some shrapnel and was unusable. She was told that since she had no insurance and it was too early for an upgrade, she was going to have to pay $750 for the replacement. We figured this was just a poorly trained sales clerk, so we went to another store. Same story: nothing could be done, regardless of the unique circumstances of the damage to the phone.
My sister resorted to the provider’s website and customer service phone numbers and got the same response from every source: she would be allowed no leeway whatsoever on the rules, and it didn’t matter what she had just gone through. No one was prepared to let the matter go one step up in the hierarchy to someone who might have more latitude in easing the situation.
There seemed to be a deeply entrenched fear of hinting that there might be even the smallest chink in the institutional armor — the customer service representatives appeared to have been trained to think that if they were to show one customer any sort of humanity, the barbarians would be at the gate the next morning. To this company, no customer with a complaint was any higher than a “3” on a triage scale of three — if even that high.
Keep in mind my sister was not asking for a lot: she just wanted a little bit of a break on the $750. Legally and technically, the provider’s representatives were in the right not to offer any sort of discount. They were following rules that my sister had bought into when she acquired the phone. Yet somehow it seemed weird and Orwellian to be so rules-bound — the whole nation was rallying behind the bombing victims, it seemed, except for this one company.
Better customer service from Apple
My sister gave up and returned home, without a phone. The morning after her arrival she walked into an Apple store. I’ll let her finish the story:
“We checked in at the Genius Bar. An employee, Reece, asked if there was anything she could do to start my process. I took a deep breath, pulled out my phone, and said, ‘A week ago today, I was in Boston watching my niece finish the marathon…’ She stopped me and said, ‘Wait here, I am going to get my manager and we are going to get you a new phone.’
“They let me stand in a quiet corner while I cried, again, but with relief that I was finally being treated like I warranted even just a little bit of attention after a horrible week of pain, fear, and frustration.
“I wish I could remember the name of the Genius Bar employee who helped me set up my replacement phone to 100% of what my old phone looked like. It was amazing to me that I didn’t have to re-download my apps and music, or even set up my folders. It looked just like my old phone. I said I was happy to pay the $229 replacement cost, and he looked at me like that was the craziest thing he had heard. He explained how he couldn’t sell me AppleCare, which I wanted to be sure I had after what I had gone through. He put a note on my phone how I could call and order it, but made sure I understood it might not be available as that product is going away.
“He asked me if there was anything else he could do for me. The only thing I asked was if I could give him a hug, and I am not one of those people under normal circumstances.”
In effect, the staff at the Apple store understood that, in the context of all customers who would come into that store that day — perhaps even that year — my sister was a “1” on their triage scale, and they responded accordingly.
Nip problems in the bud
Here are some lessons I think I can draw from these experiences:
1. Your reality and your client’s reality are not the same. You might be in front of a French café, but they might be in front of a Lenscrafters. Make an earnest attempt to put yourself in their shoes and hear their story.
2. Nip problems in the bud. Respond quickly and decisively even to what appear to be small complaints. Our clients put a huge level of trust in us and can be reluctant to criticize — many of them don’t want to come across as difficult to work with, because, in custom remodeling and construction, they’re going to be stuck with us for a long haul. A seemingly small complaint can represent the tip of a seriously big iceberg.
3. But be aware that sometimes, with some clients, you can end up at the bottom of a deep hole, frantically digging to try to get yourself out of the hole. Know when you have to admit defeat and stop trying to make a terminally angry client happy, so that you can move on and apply your time and energy more productively for all around.
To illustrate this last point, my sister’s cell phone provider e-mailed her a customer satisfaction questionnaire a few days after she had gotten the free phone from the Apple store. She filled out the online form, describing her customer “service” experience in frustrated detail. Very shortly afterwards she got a sheepish and embarrassed call from a high-ranking representative of the cell phone service provider — who ended up offering her a screen protector as way of apology. The call only served to make the company look even more ridiculous and insensitive.
Priorities and values
A larger point to keep in mind is that triage is for emergencies, not for day-to-day operations. If it seems like you’re always performing some sort of triage — shifting staff around to respond to client annoyance levels, frequently fixing mistakes or having to explain what the scope of work is to someone or another, constantly putting out fires — then it’s time to step back and perform a sort of macro-triage on your business. Think hard about which bad habits and flawed practices need to be fixed immediately, for once and for all, and focus all your resources on one or two of those problem areas, where your efforts will have the most leverage.
I have one last bit of advice for you. This, too, I learned as a result of the bombing, and although it comes just by itself and not as one of a group of three, I think of it as a form of triage, an effective way to determine if you’re allocating limited resources appropriately.
At the end of each day ask yourself, “What did those closest and dearest to me learn about my priorities and my values by how I chose to spend my time today?” Answer the question as honestly as you can. As you learn over time how to get the answer you want, you’ll find that in this practice is the essence of triage: Attend to those things where your efforts will do the most long-term good, and let everything else take care of itself.
Paul Eldrenkamp is founder and owner of Byggmeister, Inc (www.byggmeister.com); a principal of the DEAP Energy Group (www.deapgroup.com), and an instigator of Building Energy Bottom Lines (www.nesea.org/be-bottom-lines). If you have any interest in donating to a good cause that that was created in response to the Boston Marathon bombings, Paul urges you to consider the Martin W. Richard Charitable Foundation, established to honor the generosity, kindness, and memory of 8-year-old Martin Richard.
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5 Comments
Fantastic article
The warning about always being in triage is something I can certainly relate to, and had to examine in my own biz (still am).
I also think that, like w/ first responders, there's a danger of becoming an adrenaline junkie. I realized at some point I had a counter-productive enjoyment of being the knight in shining armor, sweeping in to solve a problem, instead of taking the time to do the boring, compulsive work of making sure that we're avoiding mistakes in the first place.
And your point about attending to "patients" is critical too - behind closed doors you can unburden to crew or family about your PITA clients, but you need to be able to take their concerns seriously and either solve a problem if it exists or explain to them that their worries have been addressed already or are not needed. Dismissing their concerns, even if they aren't valid, doesn't help to make them feel taken care of.
fascinating
This is a fascinating story. I'm a little surprised you felt the need to keep the cell phone provider's name out of it though.
cell phone provider
David,
I wanted the take-aways from the piece to be more about kindness and generosity than about vindictiveness or comeuppance. I'm doing my best to be kind and generous to the cell phone provider by not mentioning their name. That being said, if we run into each other I'd gleefully tell you which provider it was -- I'm not THAT kind and generous.
Triage
Paul-
This is a superb piece. Thanks so much for sharing it with us.
I used to have a friend, long ago, who was an ER triage nurse in a major big-city hospital. Whenever she would talk about her work it made me think about mine - it felt like that was what I did all the time, (but of course my triage was triage of the mundane). Unfortunately, I didn't, at the time, make the connection between what I was actually doing and what I should have been doing - I thought I was supposed to be a firefighter; it came with the territory.
It was only much later (it makes me cringe to think how much later) that fire prevention entered my consciousness.
Thank you, Paul
Wonderfully told story and lessons we can all benefit from!
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