OVER THE past decade, I've made more than 4,000 secret-shopper calls to customer service representatives at home medical equipment companies in almost every state of the union-and the results have changed little in those 10 years. The same mistakes are still made, and you still can tell instantly which CSRs have been trained to handle customer inquiries.

Do you know what your reps say to customers who call your company? One good way to find out is to conduct random secret-shopper calls. Such calls identify not only which CSRs deserve a pat on the back but also which ones need additional training.

Following the Rules IT TAKES good preparation and quick thinking on the phone to make sure the customer service representative never catches on that the call is a test. To make the shopper's scenarios realistic, gather as much background information as you can. Have the names of actual doctors, hospitals and insurance companies at the ready. You should also know a real address and neighborhood in the area. I once got caught by saying I lived on Maple Street-and the town had no streets named for trees.

Second, anticipate as many CSR questions as you can and have responses ready. Nothing will give the secret-shopper call away like inappropriate hesitations or contradictory information. Your preparations should also include ways to end the phone call graciously and believably without raising the CSRs' suspicions.

Conduct the first series of calls without warning the CSR staff. This will give you baseline data and identify areas where immediate remedial training is needed. Just make sure you introduce the new training without referring to the calls that were conducted. Rather, emphasize that this is the way you want all future calls to be handled.

After the training, inform the CSR staff that random secret-shopper calls will be made. Over time, you probably will discover that when CSRs believe each phone call might be a test call, they tend to focus on doing their best on every call.

A warning: Never use the call results as an excuse to punish employees. The best outcomes from the calls are achieved when the top performers are recognized for their good work and the poor performers are counseled privately on how to improve. The staff should regard calls as opportunities to shine, not possibilities to be feared.

Making the Grade THE OTHER key to successful secret shopping is establishing criteria to measure the CSRs' current performance against your company's expectations and, over time, their improvement.

Using the following grading system, you probably will find that the average pre-training score will be about 40 points out of a possible 100. With continued application of a secret-shopper program, the average grows to about 65 points within six months. After a year, the average reaches about 80 points, with most poor performers being the new hires who haven't been fully indoctrinated.

Customer Relations (20 points) THIS CATEGORY rates how professionally the CSRs answer the phone. Do they sound eager to help? Are they reassuring? How do they handle transferring the call if necessary? Points are lost for long hold times, having to repeat basic information or reluctance to help, all of which could cause callers to go elsewhere.

In the calls I've made, automatic call routers have been the biggest problem. Ten years ago, no one used them. In my last survey, 12 percent of the companies employed them. Routers might seem cost efficient, but be aware of the hidden cost: Many callers hate them and will hang up to call another company where a real person answers. Why? Instead of getting a live person, the caller is greeted with, "If you need repairs, press one" or something similar. The worst menu I ever heard took the caller through eight choices before saying, "And if this is an emergency ..."

Long hold times are also far too common. About 35 percent of the calls I made included hold time, and it was not unusual to be on hold for three to five minutes. That might not sound very long, but if you want to test it, play your staff a recorded conversation in which you've left a long gap of silence. Even three minutes can seem like an eternity on the telephone. Most callers will give up after one minute. If you're lucky, they'll call back, but they might just call another company.

Another problem area to watch for is CSRs who give the perception they are not thrilled about helping the customer. CSRs need to be reminded that their attitude-whether they are tired, frustrated or just having a bad day-is conveyed instantly in their tone of voice.

Remind them, too, that their worst day is still probably better than the day of a home care customer calling for help. Before they pick up the receiver, they should take a deep breath and smile. It's almost impossible to sound annoyed when you're smiling-and callers can hear the difference.

Equipment and Insurance Knowledge (20 points) THIS IS a subjective rating. In the course of the conversation, do you get the feeling the CSRs know what they are talking about when it comes to equipment and payment sources? Points are lost when CSRs fail to provide essential information to the caller.

One of the most obvious failures in this area is when CSRs concentrate almost exclusively on the insurance aspects of the transaction. During the most recent series of almost 300 calls I made, better than 80 percent of the CSRs were guilty of this. The bulk of the conversations centered on the difficulties of getting the necessary documentation, prior approvals and limits of coverage-facts about which most customers don't care.

Customers call your company with needs they hope your company can handle for them. They do not care that much about the many hoops you might have to jump through to get the job done.

Much of the fault here lies with habits developed while taking referral calls from hospital professionals. CSRs all too easily fall into an "order taker" mode in which they rely on the medical professional's expertise to guide the conversation. The patient/customer call, conversely, is a chance for CSRs to exercise their knowledge and to work with the caller to arrive at the best solution. That means examining all possibilities, describing all the alternatives and working with the caller to determine the equipment and payment requirements.

Gathering and Giving Information (30 points) THE MOST important part of the customer service transaction is identifying the caller's real needs and determining which products or services best fit those needs. The CSRs then should help the caller understand how the product serves him or her and what financial responsibilities the transaction involves.

This process is a 50/50 proposition-gathering and giving information-so the 30 points should be divided between the two functions. Points are lost when CSRs fail to ask the probing questions needed to arrive at the best caller solution or when they fail to explain fully to the caller what will happen.

The biggest problem I found in CSRs' ability to gather information is their tendency to make snap decisions about a caller's needs. For example, when CSRs were told, "My father is coming to visit, and I need to rent a wheelchair. How much are they?," 70 percent of them quoted a monthly rental price without asking about the type of wheelchair needed, size or special features. This causes problems when it turns out the caller needs a power wheelchair and the CSRs quoted the rental on a manual chair.

In giving information, the most frequent errors involved assumptions by CSRs about the patient's desires. Conversations can confuse callers quickly when CSRs use medical terminology instead of customer-friendly language. Instead of asking for a patient's diagnosis, for example, CSRs should ask, "Can you tell me the medical reason why you need ... ?"

Another assumption CSRs often make is that all Medicare patients are poor or unwilling to pay for products. In my secret-shopper calls, I intentionally ask about products that are not covered by Medicare or are acceptable to providers only on a nonassigned basis. My conversations are revealing: As soon as Medicare is mentioned, many CSRs launch into gloomy stories of how difficult things will be, how expensive the services will be or how the caller will have to do without the equipment.

That Medicare is a key payment source does not change the patient's needs and the suitability of the services or equipment to satisfy those needs. If something is necessary and helpful, many people will pay for it. Medicare recipients are not all poor. Many have money but just don't want to spend it if they don't have to. Don't blame them for this attitude. Educate them about their choices.

Asking for the Order (20 points) THERE IS no excuse for this failure, so the category is an all-or-nothing score. This is also the biggest failing of improperly trained CSRs: In organizations that offer no training, better than 90 percent of the CSRs failed to ask for the order.

No one wakes up one morning and says, "Because I have nothing better to do, I think I'll call around and price wheelchair rentals." When customers call your office about products and pricing, it is because they need the products. After CSRs have determined the patient's needs, explained the product features and costs, and confirmed their suitability with the caller, the next question should be, "Can I arrange to have the equipment delivered to you?"

In the secret-shopper calls I made, CSRs often tried to help. They provided lots of good information, explaining product features and helping to work through payment issues. But then they often just let me hang up, hoping I would call back with the order. The reality is, many patients will call another provider, and most patients will give their order to the first provider who offers to take it.

Even when a caller wants to hang up, insisting that he or she just is gathering information, CSRs have at least two next steps they can take.

The first would be to ask, "Is there a question I have failed to answer that prevents you from placing this order now?" The other would be to offer to follow up later, saying, "I know it can be very hectic at times like this, and it is easy to forget things. If you don't mind, I'd like to follow up on your needs. When would be a good time for me to call you?"

If your company doesn't ask for the order, someone else will-and will get it!

Offering Something Extra (10 points) THIS CATCH-ALL category judges whether the CSRs offered related products with a piece of equipment, sought to identify additional equipment needs or offered the caller a special alternative to get the order. The starting score is zero, and points are added for each consideration offered.

Failings in this area can be traced to emphasizing what your company cannot do instead of offering alternatives or telling the caller what can be done. For example, when callers told CSRs they were homebound with dead batteries in a scooter, 65 percent of CSRs said the only way to take care of the problem was for the caller to bring the scooter into the office.

In another survey, CSRs handled a caller who wanted to rent a hospital bed on a cash basis. Despite the caller's objections to the high prices, only 12 percent of the CSRs offered a discounted price or a package deal for cash. And less than 5 percent of the CSRs asked if the caller needed sheets, underpads, an overbed table or any other helpful item to go with the bed.

A Competitive Tip In addition to making your CSRs more responsive to your customers' needs, embarking on a secret-shopper program can pay off in other ways. While you make those secret-shopper calls, for instance, why not call some of your competitors? You almost surely will discover at least one product line, service or policy you did not know your competition offered.

Finally, as you rate your competitors' customer service (or lack thereof), remember that their failings are meaningless unless you know your staff serves the customer better.

1 Not asking for the order: CSR gives lots of helpful information, but then lets the callers hang up.

2 Failing to probe sufficiently: CSR doesn't ask enough questions to arrive at the best solution for the patients.

3 Quoting prices without adequate information: CSR gives the first price that comes to mind without getting specifics.

4 Asking questions a caller cannot answer: CSR forgets that callers usually don't know technical or medically specific information.

5 Making the patient jump through hoops: CSR tells customers all of the things they have to do before the company can help.

6 Not offering additional equipment: CSR rents beds, for example, without asking about sheets, underpads, trapeze, etc.

7 Not asking about the home environment: CSR recommends a scooter, for example, which isn't much help to a patient in a three-story house.

8 Not offering to initiate action: For example, the CSR tells a caller, "Call your doctor and get him to send me the blood gas report" when it would be more efficient for the CSR to make that call.

9 Giving incorrect insurance information: CSR says items are covered or how much will be paid without verifying information.

10 Accepting Medicare assignment before knowing diagnosis: CSR doesn't ask what the diagnosis is, forgetting that even if an item is needed, Medicare won't pay without correct diagnosis.-H.W.