The Client as Customer: Achieving Service Quality and Customer Satisfaction in Rehabilitation

Rehabilitation, both public and private sector, is part of the service industry, which employs seven of ten people and generates nearly 70% of the gross national product in the United States (Cina, 1989). Faced with rising prices and increased competition, the service industry in general has adopted marketing concepts, which traditionally have been associated with the goods industry. Two focal points in marketing for the organizations that comprise the service sector are service quality and customer satisfaction. In business, extensive research on service quality and consumer satisfaction has been conducted during the past 15 years (Uhl & Upah, 1983) to enhance marketing efforts. Although rehabilitation is part of the service industry, the research on consumer satisfaction with rehabilitation services is more limited (e.g., Rubin, 1975) and has been primarily restricted to vocational evaluation services (e.g., Early & Bordieri, 1988; Janikowski, Bordieri, & Musgrave, 1991). Although Cook (1977), as well as Patterson and Leach (1987) specifically addressed the importance of consumer satisfaction in rehabilitation, most articles (e.g., Banja, 1990; Megivern, 1991) more indirectly address this issue in their discussions of advocacy, empowerment, partnerships (Howe, Minch, & Fay, 1980), consumer involvement (Department of Education, 1990), self-determinism (Department of Education, 1985) and self-management (Sawyer & Crimando, 1984). Consumer satisfaction encompasses more than these areas, however, and some rehabilitation consumers have expressed dissatisfaction with rehabilitation. An illustrative example is the rehabilitation consumer publication, This Brain has a Mouth, which clearly expresses consumer dissatisfaction with rehabilitation services and rehabilitation professionals. The cover of a recent issue (May/June 1991) titled "How to promote your client to customer" highlights the need for service quality and consumer satisfaction to be more effectively addressed in rehabilitation and also supports Boynton and Fair's (1986) contention that: Rehabilitation providers have traditionally been product-driven. That is to say, they have created programs and services using the expertise of professionals regardless of the needs and wishes of the consumers. (p. 174) The purpose of this article is to review the business literature on services marketing that is directly relevant to the achievement of service quality and customer satisfaction in the delivery of rehabilitation services. Characteristics of services, determinants of service quality, and the differences between professional and generic services are defined, and direct implications for rehabilitation professionals are discussed. An important consideration in applying the general business services marketing literature to rehabilitation is the difference between client and customer. Client vs. Customer One major difference between private industry and the public service sector is the terminology used to identify the consumer of services. In private industry, consumers are referred to as customers. However in the public sector, consumers are usually referred to as clients. Although the differences may be viewed as "professional semantics," Webster's (1985) definitions of the two do not support this view. Client has been defined as "one that is under the protection of another: Dependent" or "a person who engages the professional advice or services of another (lawyer)" or "a person served by or utilizing the services of a social agency (welfare)" (p. 248). In contrast, customer is defined as "one that purchases a commodity or service" (p. 318). It is evident in these definitions that the term client conveys an image of an active professional in a paternalistic role and a passive consumer, whereas the term customer conveys an image of an active consumer selecting or purchasing a service or product. The active vs. …