2. Some Things You Would Do Differently Fred Lee Some Things You Would Do Differently Fred Lee

3. 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.

4. Table of Contents 1.Focus on What Can’t be Measured 2.Make Courtesy More Important Than Efficiency 3.Regard Patient Satisfaction as Fool’s Gold 4.Measure to Improve, not to Impress 5.Decentralize the Authority to Say “yes” 6.Change the Concept of Work from Service to Theater 7.Harness the Motivating Power of Imagination 8.Create a Climate of Dissatisfaction 9.Cease Using Competitive Rewards to Motivate People 10. Close the Gap Between Knowing and Doing If Disney ran your hospital you would…

5. If Disney Ran Your Hospital You Would... 1. Focus on What Can’t Be Measured

6. 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

7. Measurement Outcomes Perceptions Clinical Financial Satisfied Loyal fan Good to Great

8. PERFORMANCE IMPROVES Total Quality Reputation improvesPlace of choice Productivity improves Customers sing our praises Costs go down Processes improve Outcomes Perceptions Impact of PI on Total Quality Analytical Skills Emotional Skills Talent

9. You can’t manage perceptions in the same way you manage outcomes. Objective, Measurable Created by teams Map and study process steps Improve technical competence “Zero defects” thinking Based on what you do Eliminate carelessness Subjective, Impressions Created by individuals Take action -- just do it! Inspire attitudes and behaviors “Best possible” thinking Based on what you say Eliminate avoidance Outcomes (left brain)Perceptions (right brain) 80% of our PI scores 80% of our PS scores

10. If Disney Ran Your Hospital You Would... 2. Make Courtesy More Important Than Efficiency

11. 1. Safety 2.Courtesy 3.Show 4.Efficiency Disney’s Quality Priorities

12. PERSONAL EXAMPLES Personal efficiency vs. Accessibility Job efficiency vs. Saying “yes” Process efficiency vs. Responsiveness How do you make courtesy more important than efficiency?

13. Paradox: Customer First is More Efficient Results in overall organizational inefficiency Results in overall organizational efficiency & teamwork unit efficiency firstcourtesy first internal focus unresponsive compete for resources external focus responsive share resources

14. If Disney Ran Your Hospital You Would... 3. Consider Patient Satisfaction Fool’s Gold Wilderness Lodge

15. In Commercial Businesses Research 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

16. Why is it so hard to raise our scores? +2 +1 0 -2 -3 4 Meeting expectations = 0 Satisfied = 0 Satisfied patients have no story to tell Hampton Inn, huddle

17. It’s the same as zero! Neither good nor bad. Patient satisfaction is a fool’s gold.

18. Singing our praises… Caring, Cared, Cares +32 Kind, kindness +24 Compassionate +15 Help, helpfulness +15 Comfort, comforting +13 Friendly +8 Professional +9 Attention, attentive +7 Concerned +6 Listens +4 Loving +3 Sweet +3 Respect +3 Quick +3 Polite +3 Patient +3 Committed Warm Upbeat Generous Softness Pleasant Supportive Cheerful Informative Competent Efficient Proficient Prompt Hardworking Courteous Understanding +2 Thoughtful +2 Knowledgeable +2 Smiling +2 Bedside manner +2 Empathy +2 Tender +1 Takes time +1 Sensitive Reassuring Selfless Gentle Nice Conscientious

19. Hire Require Inspire 4 3 1 & 2 5 Fire Staff Motivation Patient Evaluation Staff Performance The Three Levels of Care Judy Courtesy Compassion Competence

20. Courtesy Compassion Competence Incompetence Rudeness Indifference Enemy is not.. This is about Three enemies of caring Judging Avoidance Carelessness Enemy Is … What I Feel What I Say What I Do

21. If Disney Ran Your Hospital You Would... 6. Change the Concept of Work from Service to Theater

22. 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 Since 1900 Joe Pine, The Experience Economy The progression of economic value Entertainment?

23. 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.

24. 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

25. At the Wilderness Lodge Think Disney experience, not just department or hotel service. Think patient experience, not just department or hospital service. Or…

26. Our Service Or Their Experience? High anxiety Pain No Pain Low anxiety Courtesy What you say No clinical effect Compassion What you feel Clinical effect Depends on the emotional needs of the patient. Service paradigm Experience paradigmOR

27. 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

28. 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

29. 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.”

30. 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

31. 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)

32. 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.

33. 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?