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Book Review: If Disney Ran Your Hospital

Updated: Apr 11, 2019

Key Takeaways from a very insightful author....

Drivers for patient satisfaction

  • Likely to recommend

  1. How well staff worked together to care for you

  2. Overall cheerfulness of the hospital

  3. Response to concerns/complaints made by you during your stay

  4. Amount of attention paid to your personal & special needs

  5. Staff sensitivity to the inconvenience of hospitalization

  6. How well nurses kept you informed

  7. Staff’s effort to include you in decisions about your treatment

  8. Nurses attitudes towards your requests

  9. Skill of nurses

10.  Friendliness of nurses

  • Overall satisfaction

  1. Nurses anticipated your needs

  2. Staff and departments worked together as a team

  3. Staff responded with care and compassion

  4. Staff advised you if there were going to be delays

  5. Nurses explained about medications, procedures, and routines

  6. nurses respond promptly to pain management

  7. 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:

  1. Safety

  2. Courtesy

  3. Show

  4. 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:

  1. Expecting trainers & committees to transform the culture

  2. Training doesn’t change behavior

  3. Need to have leadership

  4. Only directors & managers have authority over performance & can have change

  5. Hiring a service excellence coordinator

  6. Thinking more knowledge will close the gap

  7. Letting assessment substitute for action

  8. 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


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)


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