Introduction
Where did all the patients go? When were they replaced with savvy, well-informed consumers with high expectations of their health care providers?
Alas, life used to be so easy when we health care leaders knew for certain that we were in charge of health care. When we could tell the patients how things were going to be. When we could design services and processes for both our convenience and the physicians' preferences.
Today, however, we are operating in an era of consumer-driven health care. Transparency and consumer demand are forcing us to deliver our services in new and different ways. This shift requires a set of well-developed leadership skills that will elevate our organizations to a new level - one more patient-centric than provider-centric. For most health care organizations, this requires a culture shift directed by talented, multifaceted leaders.
Experience has shown that there is an art and a science involved in the process of shifting organizational culture. The science of a culture shift involves having the right people, processes and priorities in place. The art of culture-shifting requires passionate leadership and the ability to engage people at all levels of the organization.
Some might say that it is the passion, above all else, that determines a leader's ability to impact the culture. I'll never discount the importance of a leader's passion, but passion alone cannot possibly transform the culture. Passion must be coupled with each of four other essential elements in order to become more than a state of mind or one person's dream. First, a passionate leader must be able to clearly articulate priorities that align the organization on a clear path toward goals. Second, with priorities established, the passionate leader must have the right people doing the right things in order to move the organization forward in pursuit of the prioritized goals. The third essential is to have processes and systems in place that will support the people in order to maximize their efforts. And finally, a passionate leader will have the ability to help each individual define and foster a sense of purpose that furthers the goals of the organization.
When combined with people, priorities, and purpose, a passionate leader creates an unstoppable momentum that can transform entire organizations. And when the process allows that passion to be communicated from the top down (as well as the bottom up) in an organization, the results are amazing. Passionate leadership, combined with a grassroots approach to engaging the hearts and minds of all staff, is the secret to making significant changes.
This book is the result of a journey spanning the 30 years of my health care experience. It encompasses lessons learned at the bedside as well as those acquired in the executive suite. The one resounding lesson I have learned through the years is that a culture of service excellence requires persistence, insistence and consistence in order to move from good to great.
I think of the current era as the end of the Third Generation in customer service. The First Generation began in the late 1980s and early '90s. During this stage, health care leaders looked up one day and said, “Uh-oh, consumers expect us to serve them according to the same service standards held by other industries. How can that be? We are different. We are more sophisticated. We have powers to cure the sick and make the lame walk again.”
During that First Generation, many health care leaders believed that this customer service fad would go away. Relatively few health care leaders saw our patients as active, informed consumers with a choice. At this phase many of us poured money into advertising to tell the world just how compassionate we were. Commercials filled the airwaves and printed materials poured into mailboxes (and, ultimately, landfills.) And, lo and behold, nothing really changed.
The Second Generation began in the late 1990s. In this period, health care organizations began actively measuring patient satisfaction. At first, many providers confused measuring satisfaction with actually taking action to change the patient experience. It took some time for us to figure out that simply measuring satisfaction wasn't going to change experience and ultimately raise satisfaction scores. But as the science of measuring patient satisfaction evolved, so did the providers' insight into what it would take to change the patient encounter. Once we understood that we had to change the way we did things in order to change the scores, many of us made significant changes in improving patient satisfaction, and the results were measurable if not palpable.
We are now at the end of the Third Generation, which began around 2001. During this period, we have invested in leadership development, staff training, and recognition. We have sought out best practices and learned from the stars. Many of us believed our organizations had finally “arrived.” We breathed a sigh of relief that we could finally rest easy, knowing that our patients loved us. We have been doing the right things, and our satisfaction scores proved it. All was right with the world. But this time of self-congratulation was merely a blip on the radar screen as we begin to usher in another era.
Now we're stepping into the Fourth Generation, and our greatest challenge is to continue raising the bar. It's no longer acceptable to rest on the laurels of clinical quality, or to pat ourselves on the back for winning awards or hitting the 99th percentile in satisfaction. All of that can change in an instant if we don't have a strong foundation. HCAHPs, and social media such as patient blogs, are telling patients' stories publicly. Regardless of where you have been on the journey to service excellence, the consumer continues to raise the bar.
Now, clinical quality is simply a given. Today's consumers expect you to deliver competent services. What they want is a totally seamless experience anchored in trust. And we continue to fall short. The bottom line is this: You simply cannot implement your strategic plan if you don't have the culture to support it. That culture is about people doing the right things, at the right time, for the right reasons.
There is truth in the adage, “You never get a second chance to make a good first impression.” Most of us accept the inherent truth in this statement. But when it comes to our patients' experience, we still leave so much up to chance. Some holdouts want to keep making excuses because, they say, health care is a unique field and therefore cannot be held to the same customer service standards as other industries.
It's true: health care is an unusual business. Just consider a few of the characteristics that differentiate our industry from others:
•Our customers are vulnerable and often in pain, physically and/or emotionally, when they present themselves to us. Knowing that our customers put their very lives in our hands is often a daunting - even humbling - experience for many health care professionals.
•Each customer group brings a vast range of expectations to its encounters with us. Consider the expectations of physicians compared to those of patients and employees. Each has a set of variables that influences their degree of satisfaction, engagement and, ultimately, loyalty. Some of these variables overlap, while some are important only to a single group. Either way, we have a responsibility to excel in all areas in order to recruit and retain the best talent and build a loyal customer base at the same time.
•Regulations and reimbursement are factors as well. In the health care field, we serve many masters in addition to the patient. Regulations have been put into place to ensure a prescribed standard for quality. While necessary, much of the associated documentation is laborious and time-consuming, and it places additional pressure on staff. The same person we expect to spend time with patients and be attentive at the bedside is also the source of data that must be entered into the computer, as the right documentation is needed for seamless communication and good clinical results, as well as for financial reimbursement.
Okay, we're different. That said, we need to stop playing the “we're different” card and start recognizing that consumers don't care about our workload or the regulations behind the scenes. They care about their experiences with us. It's time to raise the bar on service in health care. That means designing
