All of these talks and my recent vacation with the family to Disney World has brought my memory back to a book written by Fred Lee entitled, "If Disney Ran Your Hosptial: 9-1/2 Things You Would Do Differently." What Fred discusses in his book however is not a focus on patient satisfaction, but on patient loyalty. Having never been to Disney World before this trip, it was hard to relate to what Fred was writing about. After this trip though, I now understand the message that he was trying to convey. What Disney does so well is that it is not just another theme park, but a complete experience that surrounds their guests from the moment they step on property. Everything from the hotel registration process and meals, to the parks themselves are focused on creating a "magical" experience for all to enjoy. My boys enjoyed the rides at the parks, but I was amazed at the amount of intricate detail and thought that is put into every attraction that a guest encounters. We also took a 3-day cruise on the Disney Cruise Line and there too everything was a notch above the ordinary fare right on down to their "Disney-fied" lagoon on their private Castaway Cay island, complete with the Flying Duthman ship from Pirates of the Caribbean and an underwater Mickey and Minnie Mouse aboard the sunken ships that can be seen while snorkeling. I have to say that I am a now a convert and can understand why Disney has been a destination that so many people flock to each year and keep going back for more.
As it relates to the hospital then, the question I have is how to create that same experience for our patients? While most of our patients (and payors) hope that our guests don't have return visits, our goal should certainly be to create that same loyalty and experience that people know, trust, and seek out in their time of need. "Patient Satisfaction" is one of the hospitals' "Pillar Goals" and has been a key focus area for our organization for years - in fact it should be seen as one of our core competencies. While we have made good progress in attaining this goal, we must realize that patient satisfaction is both a continuous journey as well as a series of individual events. Every aspect of care that a patient touches adds to the complete experiecne we provide. The question is how do we shape our culture to attain that high level of desirability by our patients? More to come on this topic...
40 comments:
Great article Marty and welcome to the Disney Fanatic Club.
How can you have good patient satisfaction when you have terrible team member satisfaction??
Well...glad to see you back from yet ANOTHER vacation! Had to get back to the sinking ship huh??
Fascinating commentary. How would you compare the Disney registration process with the process JH patients experience when registering for procedures or tests? How 'magical' is their experience? What concrete, specific steps have you taken to transform our process to be more like theirs, or to make it at least not infuriatingly slow and dangerously inaccurate?
How can you be so insensitive as to gush about your family vacation at the same time that you are cutting positions, hours and benefits for your own employees?
How can you be sure that Disney customers are satisfied without input from consultants, or access to the charts and spreadsheets you rely on while ignoring input from 'Team Members' (a laughable term in this institution) with years of actual experience in patient care?
Disney doesn't run our hospital, Mickey Mouse does.
To all of my anonymous comments, I will start my response in summary since the comments were generally of the same tone...
From my perspective, one's personal satisfaction is largely a personal issue. We each have the ability to choose our own attitude and our situation. If you don't think we are moving in the right direction, then I would welcome any constructive comments that you have to share, that is if you would be willing to come out of the cover of your anonymity and actually have a discussion about things. Many others have done this and many issues have been resolved as a result of those willing to be part of the solution.
I do not believe I was insensitive or "gushing" about my vacation, but rather trying to point out a parallel to an experience. To leave out the specific details would make it pretty difficult to illustrate the point. In keeping with the transparency theme I have embraced during my tenure, I see no reason to hide these facts.
In closing, I am happy to be a part of this "ship" and I can assure you it is not sinking. Together we have made some tough decisions this year that have saved many jobs, but at recognizable cost to the rest of us. In this economy, I feel thankful that we have been able to protect our team as much as we have and hope we can continue to do so. There are many others in our community that can't say the same thing.
Going forward, we still have many more challenges to deal with
as both the economy and our industry evolves through reform. If you aren't comfortable with change, I hate to be the messenger, but prepare yourself to be uncomfortable!
As for the Mickey Mouse comment, I will take that as a compliment, thanks!
Anon 4:30am -
First of all, our last hospital wide satisfaction survey showed that our team member satisfaction was actually above average and not the "terrible" that you mention.
In addition, there is an interesting Harvard Business Review on your question in the April issue from this year entitled, "Employee Happiness Isn’t Enough to Satisfy Customers." What the study found is that customer and employee satisfaction are not as linked as we like to believe. They found that the factors that increase customer satisfaction and loyalty we typically things that decrease employee satisfaction. While we are implementing changes to hold ourselves accountable to meeting the needs of our patients and customers, it does not surprise me that there could be a perception that our team satisfaction has declined. However, accountability has been something I have heard the team say loud and clear that we need to have. Thanks for the comment.
Anon 8:28am -
There are new processes being put in place to ease our registration and billing processes. We now offer an online pre-registration and bill-pay process, but unfortunately we still do not have many people that participate in using them. We have also recently made changes to decentralize some of our access points to be more friendly to our patients.
There are a lot of things that make us different from Disney, such as insurance forms, pre-authorizations, and other processes we have to contend with that will always make it challenging for us to provide the same "magical" experience, but what we do have the ability to deliver on is a caring and compassionate staff to help our patients through the process which can make all the difference in the world when someone is in need. If you have other ideas on how we can improve this process, I'd be happy to hear them if you are willing to share.
Perhaps you ar unfamiliar with the meaning of the terms 'gushing' and 'insensitive' - I assure you, you were both.
Clearly you are unfamiliar with the connotation of the term 'Mickey Mouse'.
Conversely, 'out of touch' and 'adminispeak' are both terms with which you are well versed.
Most of us are comfortable with change for the better - it is change in the form of an accelerating downward spiral that most people find uncomfortable.
When success is defined as the size of administrative bonuses, it is not surprising that patient care, patient safety and patient satisfaction can be allowed to founder and be hailed as 'process improvement'.
Anon 1:28pm -
Everyone is entitled to their perspective, thank you for sharing yours.
Marty,
I would be interested to hear more about the study mentioned "Employee Happiness isn't enough to Satisfy Customers." From my perspective, (at the bottom looking up as far as the corporate latter goes)I have seen increased workloads placed on staff, unsafe staffing ratios, and cuts in employee benefits with more to come. I understand that sometimes staffing will be short, but it has become the norm. I see team members being forced to use vacation days to make a paycheck. It seems like the little guy is bearing the major burdon in meeting all the financial targets. Please explain to me how this is good for customer satisfaction. I am around patients and families in my line of work...to that patient or family member..."I AM Jewish Hospital...a reflection of the organization as a whole....I am a large part of the memory they will take away from Jewish hospital. And this goes for my coworkers as well...and over the last year the general tone is negative. I have heard this from team members as well as physicians. Positive work environments do not come from all the above mentioned cuts and constantly worrying about a job. Thank you for your time and consideration....and hopefully this can provide a glimpse of insight from the frontlines.
When is the next team member survey?
Marty,
I think some ways to improve team member satisfaction is think like:
1. Improve flexibility for team members and give them the option of leaving early if they are not needed in certain roles for the remainder of the day. I am not referring to te areas that are short staffed but other areas and facilities. This would improve flexibility and bring cost savings. For example, I am a student and I also work full-time. I would have liked to take some classes on a certain day and I would need to leave early, but I am not permitted off for classes so I will have to take online classes or find somewhere else to go and have high tuition as well. I would like to see better flexibility for those of us that are trying to improve our economic situations.
2. Why not look try to find ways to allow team members to work from home who are students as well? Areas such as pre-reg and others can be accomplished at home. Most the company communications are via email anyway. I think this would really be welcomed by students such as myself and others who are facing tough times but we still have our head up and are trying to be optimistic.
3. Why not be a little more open regarding the challenges that JHSMH has and lay it out in a simple manner with our options and consequences of not doing anything. People should be able to relate when they have a certain amount of monthly expenses in certain areas and that have a certain amount that they bring in. So when household expenses rise we many times have to write out a new budget and re-figure, and sometimes we may have to make difficult choices as to what to cancel or cut in order to "make ends meet". That is really the same principle that we have here isn't it?
4. I myself have applied for various positions that I am qualified for. I would see that same position get posted to external applicants that I didnt even get an interview for. For a team member that is trying to improve oneself, that is very discouraging. I think we should give more effort in helping our current team members to advance before posting them to external applicants.
5. One thing that will lower team member satisfaction is when you send communication such as an email to other team members and they do not respond to your question or comment. I have personally contacted some that hold respectable positions and I got no response.
I wish you well in your decisions and thanks for listening.
I was directed to this blog comment by a very prominent, highly regarded, well established, very reserved physician (I am at work in the main building working today) who states it is "spicy", good reading" and "on the money from where I stand" Jsut want to say the Cinderellas castle is not a good hiding place for you.
No comments since July 14th what are you hiding???
Anon 8:56am -
We typically complete the surveys for team members in the fall each year. Given the changes we have made with our survey vendor this year, I do not have a firm answer this year on how or when the survey process will take place.
Anon 9:54am-
Thank you for your well thought out and constructive feedback! Comments like yours really start to get to the root of our opportunities and allow us to think through ways to improve upon them. I think we are making progress in a number of areas you mention, but still have a way to go in others.
I agree with you that flexibility in the workplace is a worthy goal, our challenges are limited based upon the work that needs to be done and the technology we have to link in to do those jobs from a remote location.
If you have questions or examples you could provide about positions you have applied for, I would suggest speaking with your HR consultant to better understand our current processes. They are a dedicated team of people who are here to help develop our team and our organization.
As to the transparency you refer to, that has been one of the goals of starting this blog in the first place. Please scroll down and see previous posts about our challenges and what we are doing about them.
Thank you again for the constructive comments, and if I failed to answer any of your specific issues, please contact me directly. Thank you!
Nothing to hide here. If I wanted to hide I wouldn't have team member meetings, forums, or host a blog to solicit input and discussion. For the same reasons, I do not respond "anonymously". I'm not afraid to have a real conversation and confront the issues we face in attempts to better our organization. When those that want to criticize wish to become part of the solution and reveal themselves instead of hiding behind the cloak of "anonymity" we will truly be making progress! Until then, there is not a lot more to say to the naysayers...
I think above all else, in the end, mistakes factored and all, the patients want to feel respected. So maybe the experience might not be perfect for everyone...the main thing is how it's handled. People know life/experiences aren't perfect--and I think most of us allow for certain mistakes to be made without vowing to never go back. And of course there are some that are never satisfied no matter what, and will feel the same about every place--ours included. The main thing is treating them with kindness, respect and dignity. This goes much farther than a fast registration process or a paper gown that doesn't fall open at the most inopportune of moments.
As a long time Disney family, I think our hospital would run well if Disney ran us. We should all be trained in customer sevice like Disney, the lines at Disney are long but they keep you well entertained while you wait, your every wish is listened to and they make you feel very important, even if they cannot grant your wish and they appear to care about you and only you at that moment. This is just good customer service in any field. My son went through Disney University as did my daughter in law, and at their companies love them and they seem to train others to be 'magical' in dealing with others. Gooo Disney, GO Jewish
Renie, I too have been through the Disney University with a previous organization, and I don't think it would take "Disney" running us to achieve the desired outcome. Anyone can achieve that same level of service if they truly dedicate themselves to being the best at what they do. We too can get there if we work together as a team! I appreciate that we are able to have a productive conversation about this and thank you for your comments!
Marty,
Of all of your blogs, it is funny to me that this one has gotten this much attention. I read your posting and thought..it would be nice to have an environment like Disney for employees and patients. How fun!
I would like to let my fellow Anonymous poster know that not all team members view JH in a negative way. Some of us like to be part of the solution.
It is very easy to sit back in the recliner and complain about the institution with placing blame on the CEO. It seems to be a pretty easy and comfortable spot to me. Let someone else fix the problem, they don't pay me enough--does that sound like you?
Now to be part of solution, it takes thought and risk, two things not alot of people are willing to do. To institute change:
1. You will need to list your concerns and ideas.
2. Discuss with your supervisor, team members, manager, director, etc.
3. Develop a plan of action to create a better environment for the patients or team members.
4. Follow through with the plan.
Yes, much harder but effective. It worked in my area, and we are excelling more and more everyday. At some point, you have to step it up or move on.
I work at several different hospitals locally and the one thing I have noticed about Mr. Bonick is that he cares enough to make change and he is present. It takes a lot of guts to run a blog and put yourself on the line. Is JH perfect? Nothing is perfect, but I wouldn't slander someone who is working toward a lofty goal. You can't please everyone all of the time. When one leads, not everyone can follow. In tough economic times, its not all going to be a bed of roses. Lets try to remain positive and continue to do our best to help patients.
Hey Marty:
There are several of us who have been with JH for years. "This is the worst we have ever seen it" is the general consensus among the nursing staff out on the floors. If you really have a sit down and ask questions with someone who is open and honest, you will realize that you are being kept in the dark about several of the issues surrounding the nursing staff. Yes, most are upset, however they are dedicated and those of us who have decided to stay around, and white knuckle it through the tough changes are optimistic of the outcomes. However, one concern, if we were to come out of the anonymity of these blogs, we would experience major repercussions from those close to you. I, along with a couple peers would like to sit and talk with you one-on-one regarding these issues, however if those close to you were to find out, we are concerned we would be without jobs. I really hope this part you understand.
We are here, we are dedicated and this is our home away from home, but if there was a way you and Brian could see the real side of the nursing world, you would see why you are getting the negative comments you have received thus far. They are not necessarily directed to you or the job you have done with the organization so far. I really think most are just frustrated and fed-up with the take-aways.
Thanks for your time and listening.
OK here goes, We are seeing and influx of patients from "other" hospitals. This would be the perfect time to strut your stuff. We need to make the best impression on these potential life customers, we need to have tests completed in a timely manner, we need to have bedside staff to check on them every hour, we need to treat each quest as just that a quest. Our physicians are frustrated and this is coming across to the patients. We know we can't please everyone all the time, but at least we can give it a good shot. Staff this facility with the good people you have, offer overtime, and see if you don't have better patient satisfactions. Maybe we can retain some of those new guests and make them old customers.
As a RN at a northern California hospital, I am impressed that your manger wishes his hospital "ran like Disney". With Disney's business model, profitablity and customer satisfaction scores, any hospital would run more smoothly. I wish the managers at our hospital would spend a week a Disney and then implement their ideals.
They can spend a week at Disney on their own dime. I'm not interested in paying for any AIG type junkets if I'm not getting a raise, a turkey, a t-shirt, or a holiday dinner.
Anon July 22, 2009 1:21 PM:
I appreciate you sharing your feelings and voicing your concerns. Please contact my office if you would like to discuss anything privately and without fear of repercussions. I don't condone that type of behavior and would like to know more about why you feel that would be the case. We need to be able to share our ideas and work through our problems. While there have been some nonconstructive comments made in this forum, when handled and discussed constructively there should not be anything to be fearful of. Thank you for sharing.
Anon July 28, 2009 1:59 AM;
Thank you for the comments. I was just curious...coming from California, a state that has mandated staffing ratio's and high-union activity, I find it interesting that you still see your hospital as needing improvements. Would appreciate hearing your thoughts on what you see as important success factors in the hospital.
I think the reason that so many people, including myself are so dissatisfied is that we have been asked to give up so much. There definitely was a lot of fat that needed to be trimmed at this hospital and that has been done. Now we are cutting into the meat while trying to get rid of the fat and have turned our big juicy ribeye marbled with fat into a burnt up (and out) petite sirloin. We've all given up so much, and many are asking what next? We already know our retirement program is about to be cut into. We've sacrificed our raises, our holiday dinners our turkeys and t shirts, and honestly we probably could have cut some of that already. Like most, I would like to see what sacrifices the HOSPITAL is making instead of the obvious sacrifices the hospital has asked it's team members to make. Some of that was fat that was cut should have been cut. However, there are a lot of places where we would have liked to seen the fat trimmed but haven't seen it yet. I suppose that those areas were not viewed as being able to save enough money so they weren't bothered with. We still water the landscaping several times daily during what has been a very rainy summer. The doctors are still drinking Starbucks gourmet coffee while on the floor it is often hard to find a simple packet of John Conti. We are opening a new facility and losing a lot of employees to that, but we are barely hiring anyone new to replace those who have moved on. All around me I see employees working massive amounts of overtime just to keep a department running or a unit open because we are so short staffed and we aren't hiring. At the management level we have lost so many people, once again some fat that should have been trimmed, but with so many positions not being refilled and so many responsibilities redistributed everyone is getting burnt out. We can't get anything out of our management because they are all so tied up doing what used to be 4 other people's jobs. The meat of this organization has been sliced into so much that the body is weak. With all this cutting, what have we accomplished? Are we more effective at increasing patient satisfaction or have we only made these strides in order to balance our checkbook and thrown patient and team member satisfaction by the wayside?
Marty, I so agree with the anonymous comment regarding repercussions for discussing the bedside part of this equation. We have new managers who are being schooled in cooperate ways and none other, they are not allowed to bend or even support their staff. They have daily meetings to discuss the staffing for the previous day, to either be reprimanded or congratulated on their staffing. The "holes" in the schedules are not being filled, some days the med-surg units have 3 nurses scheduled to care for 24 patients. We have been told by house managers that we will have to provide care for eight patients on day shift. This is wrong, it is dangerous and it does contribute to patient or staff satisfaction. I really don't know about the two new people in nursing management, they are so cooperate they hardly speak to the bedside staff unless it is to bitch via the manager. The managers do not stand up for their staff because they are afraid for their own jobs, without that support what is going to happen on the units? Nurses will show up to work, work 12 hours and go home, never really caring just maintaining a job. Believe me if you could poll the staff you would find many legitimate complaints and no one to tell them to for fear of loosing our jobs.
The staff that are hanging in here and weathering the storms are the ones who care about Jewish Hospital, but most importantly, our patients. Most of us have been approached by other facilities to "jump ship." But dammit, I like where I work, like what I do and put up with the crap I get. Because of that many days I wonder why I come to a place where no one cares one bit about what I think.
Craigreg, I appreciate your honesty and constructive candor. We are definitely feeling the challenge of increased volumes while at the same time 4 new healthcare facilities are opening up in our market. We are hiring people as quickly as we can find them, but no extra nurses, techs, or others were trained this year to fill those positions new positions and new facilities. Not that it will make you feel any better, but I was talking to one of my fellow peers at another hospital in town today and was told they lost over 50 nurses to the new start-up facilities and they are feeling the same pressure as us. I am open to suggestions or ideas on how we can get together and brainstorm other solutions. Let me know your thoughts. Hang in there, things will get better!
PS, If you see a doctor drinking Starbucks, they bought in the cafeteria like everyone else, it's not handed out for free!
Anon July 30, 2009 1:11 PM -
Please let me know your ideas on how to "poll the staff." I do care about what people are thinking, and no one is going to lose their job for speaking their mind in a professional and constructive manner. Many people have shared their ideas and thoughts with me and our leaders and we HAVE been able to find and implement agreeable solutions.
Healthcare is not an easy field to be in right now, and truth be told it probably isn't going to get any easier in the foreseeable future. To be successful in our industry will require sharing our collective thoughts on how we can be more efficient and productive while maintaining quality for the patients we serve. Not every problem has an easy solution, but if we don't make a valid effort at trying we are sure to fail. And those yearning for the old days to come back are likely to become very frustrated. Let me know your thoughts on how to make meaningful improvement and I will be here to listen. Thank you!
Well the common belief that I know at least used to be true is that Starbucks is served in the Doctor's Lounge. We all would like to see some sacrifices made that are not made by the team members.
Marty,
Since you quoted a survey in your July 14th reply, I'd like to ask you to take a little time and read an article I found online entitled, "Seven things employees want most to be happy at work." It was published in 2008 by the Christian Science Monitor and I think in part, that this is the point that staff members are trying to get across. Thanks for taking the time.
Anon: August 5, 2009 7:08 PM -
Great article, thanks for sharing. I agree with the article, and believe we are striving to create the environment that is being described therein. It sounds like you are suggesting that some of our staff don't feel like that is happening. With the amount of changes taking place throughout the hospital that are necessary to sustain our mission, my guess is that some people define appreciation, respect, and trust as issues related to compensation and benefits, and not as they are defined in the article.
If you have any specific advice on how we could improve upon this, I am all ears! Thank you!
Marty,
You are correct that I am suggesting that some of the staff does not feel as if this is happening. One of the key words in this article that I had hoped you would pay close attention to is "sincere." I see where things are happening and from your point of view, the management staff is doing what they are supposed to...but in some cases, they are lacking in sincerity. Trust was also an important factor and as you can tell from earlier posts, there are many staff members afraid of repercussions for speaking out and giving an opinion other than those viewed by the management staff of this institution. I believe that I wanted to make the point given in this statement in the article..."People want to be paid what they're worth, treated like adults, and rewarded for their good work." Your employees are trying to tell you that we do not feel as if this is true.
Do I have specific advice on how this can be accomplished? Not at this time, I am still trying to comprehend why the patient care workers and ancillary staff appear to be bearing the brunt of the cutbacks that have been going on over the past year. I truly wish I did have some suggestions, I can just tell you how I honestly feel and hope that we can all come to some kind of agreement on how to get along better. Most of us are excellent at our jobs and care very much for our patients.
Anon - August 7, 2009 7:34 AM
Point well taken, and I appreciate your point of view. I will say it does bother me to hear that there is fear to speak up and I would appreciate knowing any examples as that is something that I don't condone or tolerate of my team. As to the quote, I agree and we are doing the best we can with the resources we have to make that a reality for our team members. Thank you for the perspective and the reminders!
Post positions in publications that nurses actually read (OR Nurse, KBN newsletter, Journal of nursing, COURIER JOURNAL, etc.) It is the height of arrogance to think you can attract new staff by only posting on the intRAnet or monster.com. Nortons, Baptist East, even ST Joe's in Lexington are all over these publications,and Jewish Hospital ads are nowhere to be found. It offends me that you say "no one is coming to fill empty positions" and you assume I will not notice the shocking lack of advertising!
As one who consults in healthcare, I think you missed the point some on the Disney question. First of all, I think the mistak most make are to limit themselves to fixing the broken things which is a major factor in the problems of healthcare, rather than serving the consumers. Right now hospital want no part of services that lose money under the current system which is understandable, but is also want many consumers actually need and want. If provided, it would also result in less use of things the hospital does make money on which is also an issue.
Could Disney run a hospital on the current system and have the same goals? I think one major factor missing from what I have seen is that most hospital leadership thinking is limited to inside the box solutions that seldom truly impact that the consumers need or want.
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