Originally seen in ACSM'S HEALTH & FITNESS JOURNAL® MAY/JUNE 2007. Repurposed with permission.
Developing a Medically Integrated Health and Fitness Center: How to Optimize Your Success
By Daniel J. Lynch, M.S.
Learning Objective
Readers will learn the critical steps necessary for planning and developing a successful medically integrated health and fitness center.
Key words
Business Planning, Feasibility Study, Medical Advisory Board, Architectural Plan, Membership Presale
Although health/fitness continues to grow on all fronts, there is always the mystique of running your own center. This is a passion that often can quickly turn from elated images of building a large health/fitness center, and serving thousands of community residents, into a nightmare that drains the owner's pockets. And, it can happen quickly if the right plans are not in place.
So, how can you go about developing one of these unique opportunities? First, you should know that the medically integrated sector of health/fitness continues to grow. According to Cary Wing, Ed.D., executive director of the Medical Fitness Association, ''the organization [MFA] experienced a 30% growth in conference attendance in 2006, and its membership continues to grow.'' The primary reason is that the baby boom population is finally turning 60 years. According to the September 2005 edition of Forbes Magazine, someone will turn 60 every 9 seconds for the next 19 years. With this aging population comes lifestyle-related diseases like hypertension, obesity, and diabetes, to name a few. Research continues to support the fact that exercise and lifestyle modification can positively affect lifestyle-related diseases.
To bring you the most up-to-date information on how to avoid the pitfalls of a poorly planned medically integrated health/fitness center, I have asked some esteemed colleagues to explain what it takes to successfully open a medically integrated health/fitness center. Let's take a look at what the experts say about each of these critical areas.
Feasibility Study
Rick Caro, B.S., M.B.A., is president of Management Vision, a New York City based company that has performed over 850 feasibility studies for the health/fitness industry: ''All fitness facilities are service businesses, so they are subject to local market conditions. Using the accepted economic law of supply versus demand, each proposed site should be analyzed to determine if the concept can be supported by the demand compared to the existing supply. If, in fact, the demand was not greater than the supply, that proposed club might not be able to succeed even in the long run, despite the quality of the facility, variety of offerings, prior experience of management, appropriate user-friendly system, and provision of current programs and services.
The first step is to conduct an independent market analysis which involves driving (or walking, if in a downtown urban area) each of the eight spokes of the wheel (N, NE, E, SE, etc.) for 8 minutes at prime time in the evening to define the primary market and another 4 minutes to define the secondary market. The intersection points are then connected, and up-to-date demographics are ordered.
Then, accepted penetration rates specific to the health club industry are applied to create a total demand calculation. The supply involves each type of fitness component who could garner even a little market share. This would include commercial health clubs, small express clubs, pure yoga, Pilates or personal training studios, nonprofit facilities, university recreation centers, parks, recreation centers, and major fitness facilities in off ice or residential complexes. Visit each and analyze strengths and weaknesses, and do follow-up research to determine the amount of market share each has. Announced, but not yet open, facilities also should be taken into consideration. If the market analysis indicates that demand is greater than the supply, then the next step is to involve an economic analysis.''
Creating a Medical Advisory Board
Brad Roy, Ph.D., FACSM, is a hospital administrator for Kalispell Regional Medical Center in Kalispell, MT, and oversees The Summit, a 115,000-square-foot medically integrated center.
''The Medical Fitness Association's Facility Standards and Guidelines state that 'A Medical Fitness Center must have medical oversight.' This is achieved either by having a physician serve as medical director or advisor, or by forming a Physician Advisory Committee consisting of a cross section of the medical staff.
The committee model offers a number of benefits including:
• input from a cross section of medical experts
• opportunity to garner support from a broad range of the medical staff
• elimination of 'political' challenges when a medical director falls out of favor
• additional ability to meet with medical experts on a regular basis
• enhanced input regarding community needs and facility performance.
The duties are to provide oversight for:
• the facilities emergency response (code) policies and procedures
• the facility's AED program; staff CPR/AED and first aid training
• any actual incident reviews.
The medical director/advisory committee also should offer advice regarding program referral strategies, communication, and outcome reporting. In addition, they should provide advice regarding clinical program development and participate in the performance improvement review process.
Additionally, the Advisory Committee model offers the opportunity to tap into a wide range of expertise for community educational presentations and workshops. The medical advisory committee should consist of a cross section of medical disciplines such as: cardiology, internal medicine, orthopedics, and oncology, just to name a few. It is essential that at least one physician has expertise with emergency response procedures.''
Developing an Architectural Plan
Randy Key, M.S., is a principal in Key Architecture located in Florence, SC. Key and his team have designed multiple medically integrated health/fitness centers ranging in size from 10,000 sq ft to 100,000 sq ft: ''For too many architects success is measured in praise from peers, personal satisfaction, or some sort of award. Success is not a dynamic design.
Success should be gauged for architects just as it is for owners.
There are two different design problems that an architect faces. The design of a new facility is far easier, and typically more lucrative, than a renovation/addition. But both have the same set of guidelines and needs in order to be successful.
Drawing people in
The first impression of a facility has an impact on most prospective members. The design should evoke a sense of warmth and welcome but also should project a sense of excellence. A design that is too classical and stodgy will send a signal of exclusivity that may be intimidating. A design that is not carefully studied, appropriately colorful, and well balanced in detail may send a signal that the business inside is equally askew.
Enhancing the experience
Upon entering the center, the layout must be easily understood. A plan that contains a labyrinth of rooms and a confusing maze of halls is a recipe for failure. A member should be able to easily choose from a number of visible options—locker rooms, cardio, weights, classes, massage, etc. once in the center. Activity should be seen in or near the entry to enhance membership sales. A prospective member must see people who have similar levels of fitness, so they feel comfortable in the center.
Welcoming clients
We know intrinsically that color will either improve or devalue a design. We also know that the details of the millwork (how each piece will function) can impact the operational aspects of any business. Because of this, it is imperative that the design firm include skilled interior designers with an eye for detail.
Because getting healthy or f it is often hard work, it is important to have a sense of delight or even playfulness in the design. If this aspect evokes feelings of enjoyment, then memories are positive. And after all, that is the overall goal of the designer—to infuse each person using the center with enjoyment.''
Planning and Executing the Presale
Doug Ribley, M.S., has successfully operated Lifestyles which is part of Akron General Health System in Akron, OH. Here are some important action items that Ribley has learned: ''The most important first step in opening a successful center is the membership presale. This is truly a retail sales strategy that is intended to build a membership base prior to opening the doors of a new or renovated center. There are significant expenses associated with the operation of a center. What makes a presale so important is that operating expenses don't fluctuate significantly regardless of whether a center has 100 members or 1,000 members. A center that does not conduct a presale or is unsuccessful with this effort incurs significant losses. A more successful presale equates to small losses and a reduction in the time it will take to reach the break-even category.
Why would someone join a center when it is still under construction and not available for use? During presale, the best price that will ever be made available is offered, and there is no risk. Prospective members are only required to put $50 toward their enrollment fee. Once opened, each member has one week to come in and experience the center. If their expectations are not met, they can choose to receive a full refund.
The most successful presale tends to run for approximately 6 months. It is important to note that one should always research local and state laws and regulations related to membership presales since many regions have unique stipulations that include, but may not be limited to:
• the length of the presale
• the amount that can be collected during a presale
• surety bond requirements (in some states)
Since the typical presale will extend over several months, it is important to create incentives that encourage people to join early in the presale rather than waiting until the end of the presale. This is referred to as, 'creating a sense of urgency,' and a sample presale pricing strategy is presented below to illustrate this point.
Finally, during a presale, it is important that a location is identif ied that allows for an environment that resembles the new center. Many organizations set up presale trailers on the actual construction site. This is a very effective way to generate excitement and show membership prospects the progress that is being made at the same time. The space within the presale off ice should paint a picture of what people will be able to experience once the center opens. Center renderings, floor plans, virtual tours, equipment samples, etc. are all effective tools to present your new center when there isn't a center to present.''
Using Technology to Measure Outcomes
The objective of a medically integrated health/fitness center is not only to improve health but to be able to report on the outcomes of each individual. Important areas are as follows:
Member Management:
• Demographic information
• Electronic membership contract
• ID card and security controls
• Electronic funds transfer—member billing
• Point of sale
• Financial management to general ledger
Fitness Areas:
Equipment on its own will have many programming options built right into it like heart rate control, intensity variables, or entertainment options. When connected to information tracking systems, the cardio and weight equipment can become focal points for collecting information regarding a member's progress
Nutrition Areas:
Many companies are creating weight management programs that are personalized and Web based, use scientif ic information to measure basal metabolic rates, and deliver meal plans to help guide an individual through the process of weight management.
Miscellaneous Technologies:
The use of performance-based technology is one of the fastest growing segments. These companies are providing the opportunity to measure performance and store critical information on speed, agility, reaction time, and other important variables.
Checklist for Opening
Mike Dupuis, M.A., has been operating clubs for more than 25 years and is currently the executive director of HealthWorks Fitness Center in Eldorado, AR. Dupuis has developed a checklist of tasks that will help get a center started:
''Every start-up is unique, challenging, and wroth with surprises. Over the years, I have attempted to minimize the surprises by completing a list of tasks along with the approximate time with which you should begin to undertake each task. This start-up list is designed to be a template for opening a center. This is intended to be a boiler plate and is by no means comprehensive.''
So, if you are planning on opening a new health/fitness center anytime soon, I suggest you reread this article and begin your planning.
Condensed Version and Bottom Line
If you've ever considered running your own medically integrated health and fitness center, extensive planning is a must for success. To avoid the pitfalls of a poorly planned medically integrated health and fitness center, make sure you follow advice from experts in the field and conduct a feasibility study, create a medical advisory board, develop an architectural plan, execute a membership presale program, and use technology to measure outcomes.
Originally seen in ACSM'S HEALTH & FITNESS JOURNAL® MAY/JUNE 2006. Repurposed with permission.
Involving the Physician in Medical Fitness: A Must for Success
by Daniel J. Lynch, M.S.
If you have not read Douglas A. Ribley's article on "The Integration of Rehabilitation Services and Medical Fitness," stop reading this column now and go back to read his thoughts first. Doug does an excellent job of laying out the important features of a hospital- affiliated, medically based, integrated model for rehabilitation within the health and fitness environment. His information is critical to the success of blending health and fitness with orthopedic, cardiovascular, and other disease management needs under one roof.
There are huge opportunities in the medical fitness market. Countless studies support the benefits of exercise on lifestyle-related disease. Some estimates indicate that the following categories of people can be directly affected by exercise and lifestyle change:
• hypertension: 105 million
• cholesterol: 137 million
• type II diabetes: 59 million
• obesity: 130 million
• heart disease: 60 million
• cancer of the breast or prostate: 50 million
• arthritis: 66 million
• osteoporosis: 10 million
• depression: 9 million
• metabolic syndrome: 47 million
According to American Sports Data in 2005, there was a 4.5% growth in health club memberships from 2004. There is currently an estimated 41,340,000 members broken down into 52% women and 48% men. Forbes Magazine, November 2005, estimates that beginning January 1, 2006, a baby boomer will turn 60 years old every 9 seconds for the next 19 years. Finally, in September 2005, the Federal Government passed Internal Revenue Service 502, Revised Ruling 2002-19, which allows fees paid by an individual for physician- prescribed exercise programs for specific health issues (such as those listed above) to be considered as a tax-deductible "qualified medical expense" by the Internal Revenue Service.
Critical to this entire integrated model is the role of the physician in influencing people to begin a lifestyle change. First and foremost in your success journey is that the facility needs a physician champion. Find a passionate physician who has a sincere interest in health and fitness and make that person your medical director. You can choose to pay the physician a salary, or if possible, have one of the hospital's employed physicians do the job. It is critical that this physician be well respected in the medical community. You can get more information on the medical director's role and other standards from the 31-page "The Medical Fitness Model: Facility Standards and Guidelines," Medical Fitness Association, 2006, www.medicalfitness.org.
Once this physician champion is on board, he or she can help you access the physicians in the community. When I was at Stamford Hospital in Stamford, Connecticut, we had a very enthusiastic cardiologist who served as our medical director. He would open the doors to physician offices and take members of our fitness team on visits with the doctors to explain our medically based approach to health, fitness, and integration. Of the 1,500 people that were presold as members in the center, approximately 60% were referred by a doctor and 70% were first time joiners. This demonstrated that the model was attracting people who had never belonged to a health dub before and were usually intimidated by the typical environments of traditional health and fitness centers.
Mike Dupuis is vice president of development and executive director of Healthworks Fitness Center in El Dorado, Arkansas. Healthworks is a 50,000 ft2 multipurpose facility serving dose to 4,400 members. "One of our successfUl programs has been the clinical membership. We offer physicians throughout the county the opportunity to refer patients to our health and fitness center for a 10-visit guest pass. The 10 visits must be used within a 30-day period of the start of the guest pass. The prospective member must also have a prescription for our services from their primary care or specialty physician. Once the physician's prescription comes in with the prospect, our membership and fitness team develops an open dialogue with the physician's office relative to assessments, programming, and progress that the member is making," explains Dupuis. "Each member has an appointment to meet with an exercise physiologist for a complete fitness assessment. This appointment is followed up with three additional personal appointments. The cost per visit is 50% of the regular guest fee charge, and the entire 10-day fee is collected up front. At the end of their 10 visits, or 30 days, whichever comes first, the prospective member has the option to enroll as a permanent member or to cancel their trial membership. If they choose to continue their membership, the enrollment fee is waived. In the past 3 years, we have received referrals from over 80% of the physicians in our county and we are currently converting 90% of the referrals from lO-day trials to permanent members."
This is an excellent example of the power of the physician referral and how to convert it into an ongoing paying membership. The critical lesson is to have good communication with the physician's office staff. They are the real key players in the model. If you can get the office managet on your side, member referrals will come often.
There also are some real benefits that the physician can enjoy as a result of working with a health and fitness center. If your center is EYE ON THE FUTURE following the guidelines of the American College of Sports Medicine or the American Heart Association, you should be screening every prospective member that enters your facility. This means that many of them should be cleared for exercise by their primary care or specialty physician. This can be as simple as faxing a clearance form to the physician. The doctor can then determine if his or her patient needs to have a physical examination before beginning an exercise program. This can generate an office visit, laboratory fees, and so forth. With the 502 tax ruling, the patient must see their doctor for the prescription, and it also will generate a follow-up visit to see if the program should continue or if the patient should just become a regular member in the health and fitness center.
Finally, the last thing you need to realize is that the process takes time. One visit to a doctor's office is not going to open the floodgates to referral patterns. You have to be diligent, be consistent in your follow-up, and deliver member outcomes to the doctor's office. They will be interested in the progress their patient is making in your center. Good luck!
Originally seen in ACSM'S HEALTH & FITNESS JOURNAL® MAY/JUNE 2005. Repurposed with permission.
What Will It Take to Reach 2010?
by Daniel J. Lynch, M.S.
The 1979 Surgeon General's report Healthy People started an initiative by the government to help improve the quality of health in the United States. In 1980, Promoting Health/Preventing Disease: Objectives for the Nation was published, listing 226 specific, measurable health objectives to be achieved in 1990. When it became clear that these objectives would not be met by 1990, they began work on Healthy People 2000: National Health Promotion and Disease Prevention Objectives. This document established national health objectives and served as the basis for the development of state and community plans. Building upon these two plans, Healthy People 2010 was established as a national project for the first decade of the 21st Century to establish initiatives for improving health and to report outcome measurements as a result of these initiatives.
The following is taken from the official Web site of Healthy People 2010 (1):
The Leading Health Indicators will be used to measure the health of the Nation over the next 10 years. Each of the 10 Leading Health Indicators has one or more objectives from Healthy People 2010 associated with it. As a group, the Leading Health Indicators reflect the major health concerns in the United States at the beginning of the 21st century.
The Leading Health Indicators were selected on the basis of their ability to motivate action, the availability of data to measure progress, and their importance as public health issues.
The Leading Health Indicators are as follows:
1. Physical activity
2. Overweight and obesity
3. Tobacco use
4. Substance abuse
5. Responsible sexual behavior
6. Mental health
7. Injury and violence
8. Environmental quality
9. Immunization
10. Access to health care.
One measure of how we are actually improving health is life expectancy. Clearly we have made significant strides in this area from the turn of the 20th century, when life expectancy was a short 47.3 years. From 1900 to 1950 life expectancy increased 20.9 years to an average of 68.2 years, and during the time frame from 1950 to 2000, it improved an additional 8.8 years to an average of 77 years for both genders. A recent government release prepared by the U. S. Centers for Disease Control and Prevention's (CDC) National Center for Health Statistics (NCHS) (2) found that in 2002, life expectancy in the United States had reached a new high of 77.4 years, up from 77.2 in 2001.
Among the Nation's leading causes of death, there were declines in mortality from heart disease (3%), stroke (nearly 3%), accidents/unintentional injuries (nearly 2%), and cancer (1%). How- ever, mortality rates increased for some leading causes of death, including Alzheimer's disease (up 5.8%), influen- za and pneumonia (up 3.2%), high blood pressure (up 2.9%), and septice- mia or blood poisoning (up 2.6%) (2).
Another government press release (3) states the following:
Americans are consuming more calories than they did 30 years ago, and the rate of increase is three times greater in wom- en than men, according to the latest anal- ysis of the diet of the U.S. population published in the February 6 issue of Morbidity and Mortality Weekly Re- port. The study finds U.S. women in- creased their daily calorie consumption 22% between 1971 and 2000, from 1542 calories per day to 1877 calories. During the same period the calorie in- take for men increased 7% from 2450 calories per day to 2618 calories. The increase in calories is mainly due to an increase in carbohydrate consumption.
Men increased the percentage of their daily calorie intake resulting from carbo- hydrates from 42.4% to 49%. Women increased their carbohydrate consump- tion from 45.4% of daily calorie intake to 51.6%. With heart disease on a slight decline, most of which is caused by advances in technology, and obesity and hypertension going up, there seems to be only one solution: increasing physical activity and improving nutrition and eating habits. Pretty simple, isn't it? Let's take a look at some of the government's goals for improving physical activity by the year 2010. More detailed government statistics can be found at http:// wonder.cdc.gov/data2010/obj.htm, where the Healthy People 2010 Database is located. With specific reference to physical activity and f itness (by gender), the Table indicates the percentage of individuals meeting the objective at ''baseline'' (i.e., 1997, 1998, and 1999) and the ''target'' for 2010.
The Figure provides a clear example of the kinds of changes desired in physical activity between current values and 2010 goals. In 1999, only 65% of adolescents engaged in the recommended amount of physical activity; the goal is to increase that number to 85%. In contrast, we hope to double the percentage of adults performing the recommended amount of physical activity. Because 40% of adults engage in no leisure-time physical activity, that is clearly a worthy goal.
Based upon the following, it is clear that current health problems are not caused by physical inactivity alone.
Data Trends—Edward Sondik, Ph.D., director of the U.S. Centers for Disease Control and Prevention's (CDC's) National Center for Health Statistics, presented an overview of data that measure the status of the six focus area objectives featured in the review. In emphasizing the severity of the problem of obesity, Dr. Sondik noted that the cost to the United States in 2000 was more than $100 billion. Dietary factors are associated with 4 of the 10 leading causes of death—coronary heart disease, some types of cancer, stroke, and type 2 diabetes—as well as with high blood pressure and osteoporosis (4).
So where does all of this leave us? In my view, a Herculean effort will be required to meet these objectives. It will take a combination of the federal government, the health-care industry, health/fitness clubs, nutrition centers, and insurance companies working together to accomplish the task.
Insurance companies are finally seeing some benefit and the federal government has at least taken a position on Medicare and Medicaid for obesity reimbursement. We need the government and the insurance industry to take a stronger position on supporting the reimbursement of an active lifestyle and nutritionally sound behaviors. One insurance company taking an active role is Oxford Insurance, which pays up to $400 per primary insured and $200 for spouses, per year, if they can document exercising twice per week. Let's see whether we can influence more of this kind of change.
Originally seen in ACSM'S HEALTH & FITNESS JOURNAL® MAY/JUNE 2004. Repurposed with permission.
Customer = Service
by Daniel J. Lynch, M.S.
Is it really that simple? Those in the service industry wish it was! Everyone at some point gets to experience the service world. You do this by either being the customer or you happen to be delivering the service. Either way, you should expect exceptional delivery, and it should be delivered or received flawlessly.
One of the classic service studies was done by the Disney Company. They studied the patterns of their customers in the parks with regards to how frequently customers would drop garbage on the streets of the park. After careful analysis they determined that a customer drops a piece of garbage every eight steps. What do you think resulted from this service study? Garbage cans in place every eight steps! This demonstrated the company’s commitment to pattern its service trends to the needs (understood or not) of the customer’s use of the service. In this case the customer isn’t aware of his or her pattern for dropping garbage, but the service is provided for him or her anyway.
Companies like Virgin Atlantic, Stew Leonard’s, Scandinavian Airlines, Nordstrom’s, and many others have refined their service techniques to fit the customers they serve. This results in millions of dollars of product sales as a result of satisfied customers. So, what are we doing in the fitness industry to meet similar expectations from a service perspective?
The first thing you can do is take a survey of your customer’s needs. Often exceptional service is just a matter of listening to your customers and delivering what they are asking for. We can’t always be on the cutting edge of thinking about services our customers need. Use a survey, have employees collect information during customer interactions, or use email to collect your member’s thoughts, wishes, and desires. You may find that ideas that you and your staff think are great aren’t even close to what the customer expects. You also may find that members want products and services that you haven’t even considered.
The basic benchmarks of companies with great customer service start with employee training and role playing. Disney has an example of this very effective technique in that they refer to their employees as ‘‘cast members’’ so that the employee always remembers that when he or she is in uniform, he or she is on stage acting out his or her role and responsibilities as an employee. This keeps the employee in the mindset that he or she is performing in front of the customer.
So how do we make each ‘‘moment of truth’’ (the actual face time in front of a customer) a successful and rewarding experience for the customer every time? If I had that answer, I wouldn’t have to work anymore!
It is important to empower your employees to make decisions and feel safe in delivering the customer service that your establishment has benchmarked as the desired level of customer service. When this doesn’t happen, we need to plan for the service recovery opportunity. This takes place when we realize that a specific moment of truth did not go as planned, and you now must try to recapture the experience for the customer.
In most leading customer service companies the employee also is empowered to make decisions regarding the service recovery option (because it should take place as near to the failed moment of truth as possible). This gesture might mean a nominal gift for the customer or just a token of sincere apology for the missed moment of truth on the part of the staff. These are important strategies in regaining a customer’s satisfaction while making the customer feel as if he or she hasn’t been slighted. But the most important factor in service recovery is to deliver exceptional service the next time the same situation occurs.
The newer techniques that help employees in the delivery of exceptional customer service fall under the category of Virtual Training Programs (VTPs). VTP is a training technique that can provide a visual training opportunity on specific customer service issues that might be unique to your work environment. These can be customized for your specific service environment and deal with specific issues that you face with your customers in delivering exceptional service.
For instance:
- If a front desk employee makes a mistake in handling a customer transaction at the point of sale, he or she could go to a pre-programmed training option on the computer system to allow him or her to see how he or she should have done the transaction correctly.
- In the fitness department, a fitness instructor could review how he or she should have performed a battery of fitness test if he or she didn’t perform it correctly the first time.
- In the child care area, a worker could see techniques in trying to calm an upset child.
- In maintenance, an employee could review the proper technique in maintaining a piece of equipment or procedures for correctly cleaning a spill.
- All of these techniques, and associated visual feedback systems, can help the employee correctly learn how to turn a customer service issue into a moment of truth and clearly exceed the customer’s expectations.
VTPs also help deliver a consistent training technique for employees who deal directly with your customer. Sales training, front desk controls, fitness assessments, locker room care, and many other areas can be customized to your situation for consistent employee training. These systems also can track and monitor what type of service problem is most encountered by your staff. Measuring this kind of information can help you plan for the most common types of training you need to offer your staff.
Finally, the personal touch is the most effective customer service technique you can teach your staff. If nothing else, have your staff get to know the customers by name. Greeting someone at the front desk with, ‘‘Hi John, have a great workout today,’’ or seeing a regular customer walk through your business and saying, ‘‘Good morning Sally, how is your family doing?’’ are natural door openers that allow barriers to be broken down and permits other service encounters to take place. Just by making customers feel comfortable or more at ease, they may begin to open up on other issues from which you can improve your business. This is where they might actually begin gving you suggestions that you normally may not have thought about.
The most telling situation in my career was when I was working the exercise floor in one of my fitness centers and I used the personal touch approach. After greeting the individual with a big hello, he started to open up a bit more and engaged in deeper conversations, and eventually the person started to discuss some family issues he was having at home. I was able to take a simple service encounter and turn it into a life-changing event for the individual. Once I learned of his distressing situation at home, I was able to connect the individual with someone in the health-care system that I was working with, and the proper counseling sessions started, which eventually helped his family members deal with the stress they were experiencing.
So next time, ‘‘make yourself the customer,’’ and let’s see if your company’s service delivery system would have satisfied you.
