Abstract
Next, let's look at surgeon No. 2. He's sweet as cherry pie, but his hands shake during surgery (from Jack Daniel's or nerves, it doesn't matter). The question I have for you: As a patient, would you want the surgeon with the life-saving skills, or the one with the great bedside manner — the one who provides a better patient experience?
I didn't pose this question because I actually want you to answer it, or even think about it for long. It's a nonsense question, really. If the choice is between bad bedside manner and life-threatening clinical incompetence, it's obvious which option a patient would choose. Of course you'd want to live long enough to be able to complain about the customer service in a hospital, rather than getting killed with incompetent kindness. I bring the question up, rather, because I feel that this imaginary choice lurks in the back of the minds of professionals when thinking about where the customer experience fits in the healthcare mix. I wanted to move it to the foreground, so we could look at it directly.
And now, let's dispense with this artificial either/or. Real choices in healthcare don't often resemble the choice between a friendly, clumsy surgeon and a barbarian with magic hands. The choices you run into, if looked at properly, tend to be more “consider this one positive, and another positive may hitch a ride with it, as well.” Or, just as often, they're doubly negative choices. Factors that are negative in the patient experience can undermine clinical outcomes, as well, as the institution gets sabotaged over time by rebelling staff and noncompliant patients alike.
Healthcare: hospitality with healing
The way I see it, healthcare is hospitality with healing, a combination of two positives. Or it's healing with hospitality. The emphasis one way or the other probably does actually matter, and should be chosen depending on the patient, the ailment and other factors. But either way, I see healing and hospitality both as positives.
Because we all agree that clinical outcomes (the healing part of the equation) matter, I'll leave that aside right now and discuss hospitality, the customer experience side of the equation. One of the best things to do to improve the patient experience is to consider the world your oyster bed of inspiration, to open your thinking to include models outside, as well as inside, of healthcare.
Stop only benchmarking other hospitals
An obstacle to improving patient satisfaction in healthcare is the industry's insular nature, which makes the status quo self-reinforcing. In other words, healthcare providers and institutions compare themselves to each other – to the hospital in the next town, the surgeon in the next O.R. – and benchmark their customer service accordingly. But to do so is to set the bar in the wrong place.
It's not as if patients stop being consumers – customers – when they put on a hospital gown. And it's not as if their loved ones surrender their identities as businesspeople and users of Twitter and Facebook users, either, when they enter your institution. So it's time to benchmark healthcare customer service against the best across all service-intensive industries, because that's what your patients and their loved ones will do.
Every patient's interaction with healthcare is judged in part on the basis of expectations set by the best organizations in retail, foodservice, the hospitality industry, financial services and other areas where expert players have made a science and an art of customer service.
However: nurses aren't waiters, doctors aren't baristas
I don't want to overstate the case. I know consultants who take such things to an extreme. I've run in to (and competed with) consultants who make it sound like staying at the Ritz-Carlton and staying at a community hospital should be equivalent. Or that ordering a latte at Starbucks and getting an outpatient procedure are, in concept, more are less the same. And I argue back with what a nurse wrote to me recently. “Healthcare is a calling, and we don't treat it like working in fast food. If we had wanted to be waitresses, we would be working as waitresses—and we're not.” I think that's absolutely correct, and that the analogy to other service-intensive industries is also strained by the fact that your patient didn't, all things being equal, choose to “check in” with you either. Healthcare is enforced hospitality. Involuntary hospitality. Which makes things a bit, or more than a bit, different.
But there's so much to be learned from the powerful, tested practices of organizations across many industries — and these do include Starbucks and Ritz-Carlton, in spite of my disclaimer. Here are a half-dozen valuable principles that will get you started.
1. Purpose vs. function
You can only build a foundation for great patient service if you work to ensure, from the first day of orientation onward, that every employee understands what his or her underlying purpose is in your organization. An employee has both a function— day-to-day job responsibilities—and a purpose: the reason why the job exists. For example, “To create successful medical outcomes and hospitable human experiences for our patients” is a purpose. “ To change linens” is a function. A properly trained and managed employee will know to — and will be empowered to — stop changing linens if creating successful medical outcomes or being hospitable requires a different action at the moment. And afterward, management will celebrate the employee for his or her purpose-driven decision, not scold the person for being a few short in the number of linens changed.
2. First things first: Fix your service beginnings and endings
Because of how human memory works, the first and last items in any list are the ones most easily remembered. In the customer experience, the same principle holds true: The first and last moments of a customer interaction are what customers are likely to hold in memory as permanent snapshots that represent the whole event for them in memory.
This means it can be hard to recover the goodwill of a patient or family member whose first impression is:
A front-desk staff member's irritation at being interrupted – even for that telltale half-second.
Spending a long, tense time finding a parking space. And when patients do find it, the space is a six-minute walk to the front door — and they are on crutches.
Signage in the building that is confusing – once they finally do manage to hobble the six minutes to the front door.
As far as goodbyes, your goodbye needs to be better than just a chilly invoice sent through the mail by your billing service. (Why do veterinarians universally follow up to see how Rover is doing, but physicians rather rarely do the same with their human patients? It could make all the difference.)
3. Great customer service — true hospitality — is best delivered on the schedule of the customer. Strive to deliver service on patient-centered timetable, not just a schedule that happens to be convenient for your institution.
For example:
Avoid unnecessarily long waits for/batching of lab results to be distributed; this practice is disrespectful and even cruel.
Consider implementing something along the lines of the Vocera Communications Badge, with which the patient speaks the name of the nurse and is directly in communication with him or her instead of waiting on a response to a call light.
Look at the Cleveland Clinic's same-day appointment model. Do you really need to surrender your patients-in-a-hurry to a chain drugstore clinic — or is it possible that you could reorganize your operations to see them right away?
When reviewing your standards and approaches in the area of timely, patient-centered scheduling, always keep in mind that expectations of speed have changed. Your patients are not as patient as they used to be. Today's patients and their families live in a world in which Android devices and iPhones, laptops and iPads, can connect them – instantly – to vetted advice from the Mayo Clinic, where Amazon.com can get them a book of expert advice instantly in electronic form, or within 11 hours in hardcover. So getting back to patients with information at the same sluggish pace at which you've always responded isn't going to cut it. Patients don't want you to shoot from the hip, but they need to be kept informed, frequently and speedily.
4. Every single employee needs know how to …
Handle a complaint or concern from a patient or family member. Even if handling the concern means “I'm finding you someone right now who can address this,” that is far better than “I can't help you, I'm the wrong person.”
Apologize to a patient or a loved one. To resolve, and avoid escalating, an issue with a patient, you need to know how to apologize for service lapses that a patient or family member points out to you. It means getting rid of the defensiveness and legalistic responses that tend to mar the healthcare industry when confronted by upset patients or family members. Employees need to actively strive to share the patient's outlook in these situations, immediately and with empathy, regardless of what the employee thinks the rational allocation of blame should be. Spread this approach throughout your staff through role-playing and other training devices, and it will serve you fully every time a patient goes through the roof.
5. Cues to quality matter — and everything you do as a healthcare professional gives off such cues, for better or for worse.
Don't expect your patients to be nonjudgmental just because they're at a disadvantage and in distress. Lipstick on your teeth implies incompetence in a healthcare setting, the same as it does in the outside world. While I sympathize that you just pulled a double, your patient won't.
Many cues to quality are related to poor use of language and nonverbal snubs, such as hospital employees avoiding eye contact with civilians in the hospital and acting like they are “other.” (Speaking of which, employees need to understand that good customer service is their job from the time they get on the property to the time they leave the property; the negative cues that someone “not yet on duty” or “just of duty” can convey while traveling from the car down the hall to his or her station, or from the station down the hall back to the employee's car, can ruin all of the effort his or her colleagues have invested.)
6. One more thing.
(And, yes, I've managed to make you wait through the rest of this to hear the first mention of HCAHPS.) You'll make the most progress on HCAHPS and as an institution by taking a broad approach to the subject. Being too selectively focused on the individual HCAHPS questions, while not bad as a once-in-a-while, all-hands project, can backfire if it becomes your day-to-day approach. A more effective and powerful goal is to create an organizationwide halo effect that raises your scores as well as your actual rate of referral — not just the hypothetical “willingness to recommend.”