The Performance Improvement Blog

Patient Experience

Having recently assisted a family medicine department with their annual retreat where the “patient experience” was a major topic of discussion, I have renewed my interest in the customer experience economy and, in particular, how that notion applies to healthcare.

Studies of customer experience (although sometimes confused with customer service) in other industries are quite common. For example, the Beyond Philosophy 2011 Global Customer Experience Management Survey reports:

The top three companies most admired by CE experts for the customer experience they deliver are technology companies, with Apple ranking first, followed by Amazon and Zappos. “Apple has married all the elements of its experience and connected with its customers in a deeply emotional, irrational way,” said Walden, adding, “Amazon put a stake in the ground when it announced it would become the world’s most customer-centric company, and Zappos claims to be a customer service organization that happens to sell shoes.”

But what about healthcare? Who are the leaders in customer experience in doctors’ offices, clinics, and hospitals? The Beryl Institute defines the “patient experience” as “the sum of all interactions, shaped by an organization’s culture, that influence patient perceptions across the continuum of care.” Are there good examples of healthcare organizations that put this holistic view of quality into practice?

Some examples of healthcare organizations that care deeply about the customer experience are:

UCLA Hospital System – Their mission is “Healing humankind one patient at a time, by improving health, alleviating suffering, and delivering acts of kindness.” Dr. David T. Feinberg, Associate Vice Chancellor and CEO for the UCLA Hospital System, describes how that mission has been applied in the following entertaining and inspiring TED talk.

  

St. Jude Children’s Research Hospital – One of its strongest values is “a commitment to provide our patients with the highest quality of medical and supportive care, and their families with the level of information and support necessary for them to make informed decisions and to become active participants in the care of their children.” I saw this played out at St. Jude in the way spaces are designed for families and the care that employees show for children and their parents.

Sharp Healthcare – This San Diego hospital system is striving to be:

The best place to work — attracting highly skilled and passionate staff members who are focused on providing quality health care and building a culture of teamwork, recognition, celebration and professional and personal growth.

The best place to practice medicine — creating an environment in which physicians enjoy positive, collaborative relationships with nurses and other caregivers.

The best place to receive care — providing a new standard of service in the health care industry by employing service-oriented individuals who see it as their privilege to exceed the expectations of every patient by treating them with the utmost care, compassion and respect.

Are there other examples of a superior patient experience? Every clinic and hospital says that it cares about patients, but which ones are making that experience top priority? What are they actually doing to reduce patient anxiety, build trust and confidence, encourage healthy behavior, develop loyalty, and, of course, achieve positive outcomes for patients? 

 

Breaking Down Communication Silos: One Approach

In my September 20, 2011 blog post, I presented a scenario about communication silos from my new book, Communication in High Performance Organizations: Principles and Best Practices, and invited readers to submit possible solutions. The scenario is this:

Bill Smith, VP of Sales at High Tech Inc, and his leadership team, had gathered feedback from customers and concluded that the sales department needed a major reorganization. Customers were complaining that they were no longer receiving the customized solutions they had come to expect from High Tech Inc.  

Originally, the department had been regionally-focused, with U.S., China, and India sales offices providing services to all industries, types, and sizes in their specific regions.  This strategy had been extremely effective during the past ten years as High Tech Inc was perfectly positioned to take full advantage of the rapid regional growth in the computer industry. However, new entrants into the market had increased competition making the old structure no longer effective. 

Based on the customer feedback, Bill and his team determined that there was a clear need for change.  They decided that the structure that would enable High Tech to compete most effectively was to change from five U.S. regionally-focused sales offices and two global offices (China and India) to one centralized office with salespeople dedicated to particular industries and sizes of companies. They also understood the magnitude of this change and potential impact it would have throughout High Tech. To make a change of this size, Bill and his team would need company-wide support.

Paul Angileri submitted a lengthy comment that deserves it's own blog post. He writes:

Hi Stephen. I definitely wanted to make sure I revisited this. The fairly obvious problem I'm seeing is that individuals not local to the location of the proposed new central site would either have to relocate, or move on. Being sales professionals, perhaps this is not as big an issue as it seems, and "comes with the territory". I think the task ahead of Bill is for him to make the company feel like a tight, interknit whole. A change of this apparent magnitude can send people running to update their resumes, and potentially cause some brain drain as an after effect. Bill should be open in communicating the situation, let everyone know that jobs are not be "re-org'd" in any way, and that the move will strengthen internal bonds.

I think Bill can also create some buy-in by having each site participate actively in the plan to move to the achieve the intended ends. But without doubt, the internal culture will have to change to accommodate the new way of doing business. Bill may have some work to do in getting the internal culture to adopt new communication habits, powered by new tools. He needs to get employees thinking about communication differently, and start by treating sales as a global organization with individuals responsible for certain global regions, rather than a group of groups, who each have their own sphere of responsibility.

In my past experience, I cannot recall any situation that had similar element as this thought experiment. There is one case where a portion of a business was consolidating a particular business-sensitive operation into one or two sites, and existing global sites saw a change, but that change was largely procedural, with only one or two closings of minor facilities. That change was fairly aggressive in its schedule, but was an obvious win for the company because of waste in the system with respect to product shipments. Anyone whose job was affected more than likely was at least offered the opportunity to join a different team at another local or global site. I'm not sure if you were looking for specific PI solutions to this question, but the above is where I see things, generally speaking.

Paul's response to the scenario empasizes the importance of open and honest communication amd involving stakeholders in the decisions. Also, his response points out the importance of changing the culture, not simply increasing the amount of and direction of communication.

Communicating for Organizational Change

Every organization I know has said, at one time or another, that it had a communication problem. Lack of productivity, lack of efficiency, failure to meet budget requirements, failure to meet market demands, delivery of products to customers that are out-of-the-box failures, and a whole host of departmental, team and interpersonal issues are all attributed to a “communication problem.” No doubt there is some truth to this attribution, but what does it really mean when we say that we have a communication problem?

The following scenario is adapted from Chapter Four of Communication in High Performance
Organizations: Principles and Best Practices, a Kindle e-book. The book presents fictional situations that exemplify common communication problems in organizations and offers proven solutions to those problems.

The scenario in Chapter Four is about communication related to organizational change. Communicating a change that will affect everyone in an organization can be very challenging. Often decisions are made with too little information and from only a narrow, biased segment of the organization. More needs to be done to receive input from a range of voices before major changes are implemented. Often a broader understanding of who needs what and why, results in better decisions.

In the scenario, the IT department of a large diversified organization, BFG Automotive, is responsible for maintaining all computers in the company. The department had started receiving complaints from employees because BFG had not adopted the most recent Windows operating system and some of the files they received from vendors were difficult to open. In response to these complaints, the department decided to explore updating the operating system sooner than they had originally planned. 

Jane Washington, the new Manager of IT in BFG, circulated a memo in her department explaining that user complaints had raised the possibility that the transition to the new operating system may need to be moved up in the schedule. 

What should Jane do next? How could she communicate with the organization in a way that would facilitate a successful transition to an updated operating system? In what ways is this scenario similar to your organization?

Breaking Down Communication Silos

This post is adapted from, Communication in High Performance Organizations: Principles and Best Practices, a Kindle e-book. The book presents scenarios that exemplify common communication problems in organizations and offers proven solutions to those problems. The scenario in this post is about functional silos. 

People working in organizations often say, “We live in silos and do not communicate very well across these boundaries.” This malady becomes exaggerated when the successful completion of the work depends on the outcome of a cross-functional project. Leaders of cross-functional projects are faced with complex communication and alignment issues beginning with departmental or functional goals that may compete with those of the project, with individual performance goals, with scarce resources, and with language differences. In the following case, Bill Smith and his leadership team are confronted with decreasing customer satisfaction from solutions that were regionally based and no longer meet the demands of growing global markets.   

Bill Smith, VP of Sales at High Tech Inc, and his leadership team, had gathered feedback from customers and concluded that the sales department needed a major reorganization. Customers were complaining that they were no longer receiving the customized solutions they had come to expect from High Tech Inc.  

Originally, the department had been regionally-focused, with U.S., China, and India sales offices providing services to all industries, types, and sizes in their specific regions.  This strategy had been extremely effective during the past ten years as High Tech Inc was perfectly positioned to take full advantage of the rapid regional growth in the computer industry. However, new entrants into the market had increased competition making the old structure no longer effective. 

Based on the customer feedback, Bill and his team determined that there was a clear need for change.  They decided that the structure that would enable High Tech to compete most effectively was to change from five U.S. regionally-focused sales offices and two global offices (China and India) to one centralized office with salespeople dedicated to particular industries and sizes of companies. They also understood the magnitude of this change and potential impact it would have throughout High Tech. To make a change of this size, Bill and his team would need company-wide support.

What should Bill do to gain company-wide support and improve communication between regions? In what ways is this scenario similar to your organization?

 

Change Management: Tips, Tools, and Techniques

The latest Inspire 10X10 from RealTime Performance is about "managing change". It strikes me that in this day and age, in this economy, and given the global nature of our lives, if an organization is not thinking about change then it is risking unsustainability. I can't think of a business, a nonprofit, or a government agency that is not faced with dramatic change in what and how it does things. 

All issues of Inspire 10X10 are excellent sources of ideas and best thinking on a wide variety of management and leadeship topices. And it's a free download for people who register with RealTime Performance. They describe 10X10 in this way:

The tips and resources presented are taken from the topics and resources available in Inspire, a web-based tool that empowers employees to take ownership of their leadership development by enabling them to build, drive and track their own leadership development plan. Using Inspire, employees are able to quickly and easily identify strengths and weaknesses, create relevant and useful development plans and engage in meaningful discussions with their manager about leadership development. In short, Inspire connects employees with targeted activities and resources for learning, giving them the tools and information they need to drive their own professional development.

This month's issue, on managing change, takes the reader through 10 key steps to implementing successful change in an organization, whether that be change due to new technology, shifting customer preferences, evolving demographics, new markets, fluctuating economies, or increasing competition. With each step is a recommended book or video that goes into depth about the topic.

I am pleased to see included William Bridges' book, Managing Transitions: Making the Most of Change, which is one of my favorites for understanding the human dynamics of personal and organzational change.  

One caution that I would offer to using this issue of Inspire 10X10 is that learning about managing change separate from the context of an actual organizational change process probably won't have much lasting value. Understanding will be limited and retention very short-term. I would encourage users to apply the tips, tools, and techniques in these resources to an actual change going on in their organizations. That shouldn't be hard given the enormous upheavel occuring in nearly all organizations today.

Evidence-Based Management: What Else Is There?

Jeffrey Pfeffer and Robert Sutton, in a recent article in the New York Times (Check out the “uncut” version.}, argue for “evidence-based-management”. They write…

…the growing pile of studies on the human and financial costs of employee disengagement, management distrust, poor group dynamics, faulty incentive schemes and other preventable damage suggests a need for an evidence-based management movement.

I admire these two Stanford University thought-leaders, but my immediate reaction to their thesis is, “Duh!” What have companies been doing for the past hundred years of modern management…managing by the-seat-of-their-pants? I suppose the answer is, “Yes.” However, I don’t think it’s a conscious choice or because they didn’t listen during their MBA classes. If you ask corporate leaders if they use research to make their decisions, I’m sure most, if not all, would say, “Of course I do.” They already believe that they practice evidence-based management.

However, they, like most human beings, have a “confirmation bias”. They tend to look for data that confirms what they already believe to be true and disregard the rest. A good example of this was surfaced at the International Monetary Fund. The Independent Evaluation Office of the IMF studied events and actions leading up to their failure to anticipate the 2008 world financial crisis and concluded that the IMF was operating on a strong confirmation bias during this period. The authors of the study write:

The IMF’s ability to correctly identify the mounting risks was hindered by a high degree of groupthink, intellectual capture, a general mindset that a major financial crisis in large advanced economies was unlikely, and inadequate analytical approaches. Weak internal governance, lack  of  incentives  to  work  across units and raise contrarian views, and a review process that did not “connect the dots” or ensure follow-up also played an important role, while political constraints may have also had some impact.

Another problem with the way managers use evidence is when they attribute a causal relationship to factors that occur close in time. I have written previously about what Chabris and Simons call the “illusion of cause”. I wrote:

Within companies the “illusion of cause” occurs, for example, when executives attribute business success or failure to their leadership, or to a new marketing program, or to a reorganized sales department, or to innovative products, or to a change in the economy. These events might be highly correlated but they are not necessarily the cause of business success or failure.

The problem is not that managers choose to ingnore the evidence; it’s that they, like most human beings, suffer from “confirmation bias” and the “illusion of cause.” The challenge is to help managers become aware of their bias and how to overcome these ways of thinking. If you can get past your biases and you want to understand and apply evidence more effectively, Wally Bock offers some good suggestions in his blog.