Key Takeaways from a very insightful author....
Drivers for patient satisfaction
Likely to recommend
How well staff worked together to care for you
Overall cheerfulness of the hospital
Response to concerns/complaints made by you during your stay
Amount of attention paid to your personal & special needs
Staff sensitivity to the inconvenience of hospitalization
How well nurses kept you informed
Staff’s effort to include you in decisions about your treatment
Nurses attitudes towards your requests
Skill of nurses
10. Friendliness of nurses
Overall satisfaction
Nurses anticipated your needs
Staff and departments worked together as a team
Staff responded with care and compassion
Staff advised you if there were going to be delays
Nurses explained about medications, procedures, and routines
nurses respond promptly to pain management
nurses respond in a reasonable amount of time
Outcomes vs. Perceptions
The patient judges quality by perceptions NOT outcomes
perceptions lead to loyalty & revenue increases
outcomes lead to satisfaction & cost reductions
To improve Outcomes:
focus on team responsibility
map and study processes
understand process variation
improve staff competence & skills
stress what people should be doing
seek measurable results
“zero defects” thinking
Eliminate carelessness
To improve Perceptions:
Focus on personal responsibility
Take action on information - just do it
Understand patient perceptions
Improve staff behaviors & attitudes
Stress what people should be saying
Seek to impact impressions
“best possible” thinking
Eliminate avoidance
Culture trumps strategy in healthcare (communications & behavior drive perceptions)
People complain about what can be measured objectively not about perceptions and people’s attitude
People complain within the scope of what is conventionally expected (they don’t talk about behavior that would win their loyalty)
Only 4 out of 100 dissatisfied people complain, because most don’t feel that it will result in any action….so many rely on negative word of mouth (even more destructive = anti-loyalty)
Prioritized Values:
Safety
Courtesy
Show
Efficiency
Workers do what their managers pay attention to !
Shifting work to other departments is artificial efficiency (it’s really phony)
Internal functions need to compete with outside agencies on Cost, Quality, and Service
W. Edwards Deming said “The most important numbers for an organization are unknown & unknowable”
Accountabilities drive structure AND structure drives culture
Efficiency / Courtesy Paradox:
Efficiency First > internal focus > turf protection > compete for resources
= leads to inefficiency
Courtesy & Service First > external focus > responsiveness > share resources
= leads to efficiency
Promote Teamwork & Responsiveness over Competition
Foster a climate in which departments & managers are held accountable AND rewarded for service instead of being punished by it (in favor of efficiency)
IDEA: Provide room service for everyone in the hospital (including families)
Measure customer loyalty NOT customer satisfaction
Loyalty is generated by memorable events that we don’t expect
Use Daily Huddles
Taking a personal interest in each employee
Praise and role-model employees going the extra mile
Create loyalty (one customer at a time)
Customer Behavior is driven by:
Promoters (= loyalty)
Passively Satisfied
Detractors
There’s a strong correlation between % of Promoters & % of Detractors against the company’s revenue growth rate.
Question: Can we leverage Lateral Thinking & Appreciative Inquiry to come up with ways to address outcomes for perceptual jobs ?
There are 4 prerequisites for measuring patient feedback:
It would need to get the most honest response possible
It would be gathered immediately, while the patient was still in the hospital, and again right after discharge while the experience is still fresh in the mind and staff can take action as soon as possible.
It would be statistically valid and reliable
It would encourage comment and special examples
Leverage housekeepers or volunteers to capture patient feedback
Use discharge phone calls from attending nurse (w/in one day) – not a marketing task !
What gets noticed, gets done.
Teams should lead out and design the measurement process & tools
Must include one question associated with courtesy
Dismantle the Functional Silos and put decision making closer to the front lines:
You are always right when satisfying a customer
Empower people to say YES to a customer (instead of passing the decision up the chain of command)
Nordstrom model (empower employees to offer service recovery on the spot)
Key need for employees is to have control over one’s work
Folks find it debilitating and discouraging
Employees want to feel empowered, helpful, and effective
A culture of dependency creates bureaucracy
Employees thrive on autonomy & grow helpful through practical, sound judgment
Insecure managers tend to centralize power & control
Structure drives culture
Not possible to create a world class service culture as long as we keep structures that are defined by layers of bureaucracy and departmental barriers to speed & responsiveness
Need to empower front line staff to say YES
Make courtesy more important than efficiency
Inoculation theory
Small dose of a weak virus that is fought off by the body’s internal defenses (resistant to change)
If a program for change is not successful (due to internal resistance) it is called a failure not the management systems and structures that kill “these viruses”
Post mortem for a failed initiative must include management who “fought” the program. They need to answer the question “How did I (and my policies) contribute to the demise of an important opportunity for us to change and/or transform ?”
Jack Welch’s management philosophy into 3 values:
Speed
Simplicity
Self-Confidence
Comprehensive knowledge + self-confidence = simplicity of ideas, decisions & systems
First rate managers hire first rate people and turn them loose
Second rate managers hire 3rd rate people who need to be told what to do
A manager’s success is not measured by what he can do, rather it is measured by what his people can do w/o him.
Unilateral service recovery (across departments) makes the silo walls disappear
Recovery service should get triggered whenever a company makes an error that impacts the customer
Make use of huddles (using the form deployed by coaches):
Inspiration
Share information
Solve problems
Daily status
Key department heads
Issues & complaints
Spontaneity is the most important characteristic for loyalty
Improve the guest’s experience instead of providing better service
4 Levels of economic offering:
Commodities
Goods
Services
Experiences
Value & Profits increase exponentially as you mature from commodities to experiences
A hospital is like a theater where the employees create an experience for the patients
Process steps towards this include:
Creation of storyboards to script out communications and behaviors with patients covering a variety of scenarios (This is a collaborative effort across depts.)
Define the functional & emotional jobs to be performed
We’re not using a rote script to create spontaneity, we create spontaneity by:
What we do
What the customer needs to know & feel
What we say to build a memorable experience
Instead of hiring employees, audition for talent to perform a role rather than function in a job. A role means more than just a job, but it requires a higher level of commitment. There are 4 levels of motivation:
Compliance – must do it
Willpower - should do it
Imagination – want to do it
Habit – comes naturally
When creating an experience, you need to deal with customer anger in a creative manner. Try diffusing anger using LAST:
L – Listen
A – Apologize
S – Solve the problem
T – Thank you
PDCA = Plan + Do + Check + Act
Gap created by inadequate management:
Deming assails management for:
Merit pay
Individual pay-for-performance
Management by objectives
This type of management equates to management by fear:
Encourages short term performance
Discourages long term planning
Discourages teamwork
Encourages rivalry & competition
Unfair as performance is linked to the system, where the individual has little control
Command & control management structure needs to be replaced by empowered teams
Closing the gap:
Execution of universally shared values & desired behaviors
Managers are held accountable for customer & employee surveys
Traps to avoid in closing the gap:
Expecting trainers & committees to transform the culture
Training doesn’t change behavior
Need to have leadership
Only directors & managers have authority over performance & can have change
Hiring a service excellence coordinator
Thinking more knowledge will close the gap
Letting assessment substitute for action
Permitting managers to stall indefinitely with the “HOW” questions. Stalling equates to:
How long will it take ?
How much will it cost ?
How do we measure it ?
How have others done it ?
Companies move from good to great when they cross the “tipping point” that results from relentless improvement for the core competencies (flywheel effect)
To move a culture from bad to good, leverage compliance
To move a culture from good to great, leverage commitment
Accountability is NOT contingent on being told “HOW”
Managers should focus on the WHAT & the WHY…..not the HOW
Reference:
Book Cover - If Disney Ran Your Hospital
Additional materials of interest:
Book: Out of the Crisis
Book: The Loyalty Effect (Loyalty in Hospitals come from compassion)
Book: Loyalty Rules & Loyalty Effect
Book: 13 Fatal errors managers make & how you can avoid them
Book: The experience economy (B. Joseph Pine & Gilmore)