Some Things You Would Do Some Things You Would Do DifferentlyDifferently

Fred Lee

Some Things You Would Do Some Things You Would Do DifferentlyDifferently

Fred Lee

3 Key Premises

We have reached the ceiling in how much we can improve patient satisfaction scores with our current approach.

We cannot go from good to great in patient perceptions by copying and deploying what they do at service companies like Ritz-Carlton or Nordstrom’s.

Culture is driven by management systems, not workers or values.

Table of Contents

1. Focus on What Can’t be Measured2. Make Courtesy More Important Than Efficiency3. Regard Patient Satisfaction as Fool’s Gold4. Measure to Improve, not to Impress5. Decentralize the Authority to Say “yes”6. Change the Concept of Work from Service to Theater7. Harness the Motivating Power of Imagination8. Create a Climate of Dissatisfaction9. Cease Using Competitive Rewards to Motivate People10. Close the Gap Between Knowing and Doing

If Disney ran your hospital you would…

If DisneyRan Your

Hospital You Would...

1.1.Focus on What Can’t Be Focus on What Can’t Be

MeasuredMeasured

On Measurement

“Not all that can be counted, counts. And not all that

counts can be counted.” -- Albert Einstein

“The most important figures one needs for management

are unknown and unknowable…(invisible also used)…

What is the value, for instance, of the multiplying effect of

a happy customer and the opposite effect from an

unhappy customer…(or the) Loss from inhibitors to pride

of workmanship?”

-- W. Edwards Deming, Out of the Crisis, p. 122

Measurement

Outcomes Perceptions

Clinical Financial Satisfied Loyal fanGood to Great

PERFORMANCE IMPROVES

Total Quality

Reputation improves

Place of choice

Productivity improves

Customers sing our praises

Costs go down

Processes improve

Outcomes

Perceptio

ns

Impact of PI on Total Quality

AnalyticalSkills

EmotionalSkills

Talent

You can’t manage perceptions in the same way you manage outcomes.

Objective, MeasurableCreated by teamsMap and study process stepsImprove technical competence“Zero defects” thinking

Based on what you doEliminate carelessness

Subjective, ImpressionsCreated by individualsTake action -- just do it!Inspire attitudes and behaviors“Best possible” thinking

Based on what you sayEliminate avoidance

Outcomes (left brain) Perceptions (right brain)

80% of our PI scores 80% of our PS scores

If DisneyRan Your

Hospital You Would...

2.2.Make Courtesy MoreMake Courtesy More

Important Than Important Than EfficiencyEfficiency

1. Safety2. Courtesy3. Show4. Efficiency

Disney’s Quality Priorities

PERSONAL EXAMPLES

Personal efficiency vs. Accessibility

Job efficiency vs.Saying “yes”

Process efficiency vs.Responsiveness

How do you make courtesy more important than efficiency?

Paradox: Customer First is More Efficient

Results in overall organizationalinefficiency

Results in overall organizational

efficiency & teamwork

unit efficiency first courtesy first

internal focus

unresponsive

compete for resources

external focus

responsive

share resources

If DisneyRan Your

Hospital You Would...

3.3.Consider Patient Consider Patient

Satisfaction Fool’s Satisfaction Fool’s GoldGold

Wilderness Lodge

In Commercial BusinessesResearch on satisfaction shows…

On a scale of 1 to 5, people who mark a 4 are six times more likely to defect to the competition than those who mark a 5.

Harvard Business Review, Nov-Dec, 1995

Why is it so hard to raise our scores?

+2+1

0 -1 -2 -3

4

Meeting expectations = 0

Satisfied = 0

Satisfied patients have no story to tell

Hampton Inn, huddle

It’s the same as zero!Neither good nor bad.

Patient satisfaction is a fool’s gold.

Singing our praises…

Caring, Cared, Cares +32Kind, kindness +24Compassionate +15Help, helpfulness +15Comfort, comforting +13

Friendly +8Professional +9Attention, attentive +7Concerned +6Listens +4

Loving +3Sweet +3Respect +3Quick +3Polite +3Patient +3

CommittedWarmUpbeatGenerousSoftnessPleasantSupportive

CheerfulInformativeCompetentEfficientProficientPromptHardworkingCourteous

Understanding +2Thoughtful +2Knowledgeable +2Smiling +2Bedside manner +2Empathy +2

Tender +1Takes time +1

SensitiveReassuringSelflessGentleNiceConscientious

Hire

Require

Inspire

4

3

1 & 2

5

Fire

Staff Motivation

PatientEvaluation

Staff Performance

The Three Levels of Care

Judy

Courtesy

Compassion

Competence

Courtesy

Compassion

CompetenceIncompetence

Rudeness

Indifference

Enemyis not..

This is about

Three enemies of caring

Judging

Avoidance

Carelessness

EnemyIs…

What I Feel

What I Say

What I Do

If DisneyRan Your

Hospital You Would...

6.6.Change the Concept of Change the Concept of Work from Service to Work from Service to

TheaterTheater

Disney is not a service and neither are we.

Commodities

Extract

Goods

Make

Services

Deliver

Experiences

Stage

O V

E R

T I

M E

Sinc

e 1

900

Joe Pine, The Experience Economy

The progression of economic value

Entertainment?

Theater is about life – comedy and tragedy.

Hospital:Meeting the emotional needs of a family suffering a tragedy together.

Disney:Meeting the emotional needs of a family to have fun together.

A hospital without compassion is like Disney without fun.

Focus on the patient’s experience, not our service…

Companies stage an experience whenever they

engage customers, connecting with them in a personal, memorable way.”

“They actually occur with any individual who has

been engaged on an emotional, physical, intellectual, or even spiritual level. The result? No two people can have the same experience – period.”

B. Joseph Pine II, The Experience Economy

At the Wilderness Lodge

Think Disney experience, not just department or hotel

service.

Think patient experience, not just

department or hospital service.

Or…Or…

Our Service Or Their Experience?

High anxiety Pain

No PainLow anxiety

CourtesyWhat you sayNo clinical effect

CompassionWhat you feelClinical effect

Depends on the emotional needs of the patient.

Service paradigm Experience paradigmOR

THE DIRECTOR:

Start by describing the experience you want the guest

to have (see, hear, and feel) and how to make each

scene memorable.

Cast for the talent to play the role called for in the guest

experience, rather than just the skills to do a job.

Clarify each person’s role in creating a memorable

experience and get their commitment to their role.

Borrowing from Theater

THE ACTOR:

Actors learn how to be real by becoming emotionally

engaged with their character.

Actors rely on sense memory and imagination to become

real in their role.

Borrowing from Theater

Acting is not pretending…Eric Morris, No Acting, Please (first sentence)

Acting is the art of creating genuine realities on the stage. No matter what the material, the actor’s fundamental question is: “What is the reality and how can I make it real to me?”

Acting must “come from a real place.”

To paraphrase…

Care giving is the art of creating genuine realities on the hospital stage. No matter what the event, the caregiver’s fundamental question is: “What is the reality of this patient’s experience, and how can I make it real to me?”

Compassion also must “come from a real place.”

Theater changes the service paradigm…

From patient satisfaction – to a fan with a story to tell

From just being courteous – to engaging the guest

From our service excellence – to their memorable experience

Theater changes the service paradigm…

From hiring for the skills to do a job – to casting for the talent to play a

caring role in the guest experience

From teaching body language –to teaching acting principles(being real through imagination)

Knowing how is not the problem…

Like losing weight, our problem is not with knowing how. When we want to enough, we figure out how and learn by doing.

Our problem is with being committed enough to do what it takes every day, and do it permanently, not just in short bursts of inspired energy.

W. Edwards Deming might add…

What is the value of a committed

ensemble of care givers who have

become compassionately engaged in the

patient’s experience?