THE THING about doing business in a small town is that everyone knows in short order if you're bad or good.

"You had better do your job in a small town," says Steve Lancaster, the president and owner of Banner Medical Equipment, a 16-year-old home medical equipment and respiratory company in New Madrid, Mo. He knows that firsthand-New Madrid has only 3,500 people, and Jackson, where his branch office is located, has only 9,300. So unlike providers in large towns, Lancaster can't depend on walk-ins, and he doesn't have a vast pool of prospective customers upon which to draw. He has to keep the customers he gets, and to do that, he must serve them well.

Sometimes, that means walking away from the wrong kind of business. When patients of other HME providers call and want to switch to him, for example, Lancaster advises that they talk first with their current provider and try to resolve their complaints. He might even make the call himself, suggesting to the HME business owner that he or she contact the patient. The end result of this philosophy of putting customers first? He sometimes loses a prospective patient.

"I might have lost business, but I've gained sleep, peace of mind and the joy of coming to work," says Lancaster. "I love my business. I can't wait to get to work the next day."

Lancaster has the zeal to "do right" by the people he serves. He sees it as a ministry, a way of living out his Christian faith. He's proud to have built his business on the ethical high road, and it is a path willingly followed by his staff, which includes his wife, son, daughter-in-law and a respiratory therapist "who is not related, but it's like she's a part of us."

"I think our philosophy-our business-is the service and the smile we provide," Lancaster says. "My people are instructed that. . .they don't just rush in, do a setup and rush out. You make a friend while you're there, if it's appropriate." And if it's inappropriate-if the patient just wants to be left alone-that's OK too. There will be another opportunity to make a personal connection. "The person who set up that equipment is the same person who is going to do the follow-up the next day," Lancaster says. "There's a trust that's going to build up."

Patient training is also a key component of Banner Medical's customer service. "Our job is not just to provide equipment but to make patients comfortable with that equipment," he says. This means, for example, ensuring that an oxygen patient "is not going to be afraid of lighting a pilot light or doing something in the kitchen."

The whole idea is to meet people at their point of need, says Lancaster, adding that his staff might be the only people some folks ever see. "So we really try to brighten the home when we go in," he says.

The payoff for all this is a growing roster of extremely loyal patients. "We don't have turnover," Lancaster says. "It very seldom happens."

There's another bonus, too. "The fact that I'm making a difference in someone's life is a good feeling," he says.