Presentatie Fred Lee Part 1+2 Maart 2009

transcript

Some Things You Would DoSome Things You Would DoDifferentlyDifferently

Fred Lee

3 Key Premises

We have reached the ceiling in how muchwe can improve patient satisfactionscores with our current approach.

We cannot go from good to great in patientperceptions by copying and deployingwhat they do at service companies likeRitz-Carlton or Nordstrom’s.

Culture is driven by management systems,not workers or values.

Table of Contents

1. Focus on What Can’t be Measured2. Make Courtesy More Important Than Efficiency3. Regard Patient Satisfaction as Fool’s Gold4. Measure to Improve, not to Impress5. Decentralize the Authority to Say “yes”6. Change the Concept of Work from Service to Theater7. Harness the Motivating Power of Imagination8. Create a Climate of Dissatisfaction9. Cease Using Competitive Rewards to Motivate People10. Close the Gap Between Knowing and Doing

If Disney ran your hospital you would…

If DisneyRan Your

Hospital YouWould...

1.1.Focus on What CanFocus on What Can’’t Bet Be

MeasuredMeasured

On Measurement

“Not all that can be counted, counts. And not all thatcounts can be counted.” -- Albert Einstein

“The most important figures one needs for managementare unknown and unknowable…(invisible alsoused)…What is the value, for instance, of the multiplyingeffect of a happy customer and the opposite effect froman unhappy customer…(or the) Loss from inhibitors topride of workmanship?”

-- W. Edwards Deming, Out of the Crisis, p. 122

Measurement

Outcomes Perceptions

Clinical Financial Satisfied Loyal fanGood to Great

PERFORMANCE IMPROVES Total Quality

Reputation improves

Place of choice

Productivity improves

Customers sing our praises

Costs go down

Processes improve

Outcomes

Perceptions

Impact of PI on Total Quality

AnalyticalSkills

EmotionalSkills

Talent

You can’t manage perceptions in thesame way you manage outcomes.

Objective, MeasurableCreated by teamsMap and study process stepsImprove technical competence“Zero defects” thinkingBased on what you doEliminate carelessness

Subjective, ImpressionsCreated by individualsTake action -- just do it!Inspire attitudes and behaviors“Best possible” thinkingBased on what you sayEliminate avoidance

Outcomes (left brain) Perceptions (right brain)

80% of our PI scores 80% of our PS scores

If DisneyRan Your

2.2.Make Courtesy MoreMake Courtesy More

Important ThanImportant ThanEfficiencyEfficiency

1. Safety2. Courtesy3. Show4. Efficiency

Disney’s Quality Priorities

PERSONAL EXAMPLES

Personal efficiency vs. Accessibility

Job efficiency vs.Saying “yes”

Process efficiency vs.Responsiveness

How do you make courtesymore important than efficiency?

Paradox: Customer First is More Efficient

Results in overallorganizational

inefficiency

efficiency & teamwork

unit efficiency first courtesy first

internal focus

unresponsive

compete for resources

external focus

responsive

share resources

If DisneyRan Your

3.3.Consider PatientConsider Patient

Satisfaction FoolSatisfaction Fool’’ssGoldGold

Wilderness Lodge

In Commercial BusinessesResearch on satisfaction shows…

On a scale of 1 to 5, people who mark a 4 aresix times more likely to defect to thecompetition than those who mark a 5.

Harvard Business Review, Nov-Dec, 1995

Why is it so hard to raise our scores?

+2+1 0 -1 -2 -3

Meeting expectations = 0

Satisfied = 0

Satisfied patientshave no story to tell

Hampton Inn, huddle

It’s the same as zero!Neither good nor bad.

Patient satisfaction is a fool’s gold.

Singing our praises…Caring, Cared, Cares +32Kind, kindness +24Compassionate +15Help, helpfulness +15Comfort, comforting +13

Friendly +8Professional +9Attention, attentive +7Concerned +6Listens +4

Loving +3Sweet +3Respect +3Quick +3Polite +3Patient +3

CommittedWarmUpbeatGenerousSoftnessPleasantSupportive

CheerfulInformativeCompetentEfficientProficientPromptHardworkingCourteous

Understanding +2Thoughtful +2Knowledgeable +2Smiling +2Bedside manner +2Empathy +2

Tender +1Takes time +1

SensitiveReassuringSelflessGentleNiceConscientious

Require

Inspire

Staff Motivation

PatientEvaluation

Staff Performance

The Three Levels of Care

Courtesy

Compassion

Competence

Courtesy

Compassion

CompetenceIncompetence

Rudeness

Indifference

Enemyis not..

This is about

Three enemies of caring

Judging

Avoidance

Carelessness

EnemyIs…

What I Feel

What I Say

What I Do

If DisneyRan Your

6.6.Change the Concept ofChange the Concept ofWork from Service toWork from Service to

TheaterTheater

Disney is not a service and neither are we.

Commodities

Extract

Services

Deliver

Experiences

Joe Pine, The Experience Economy

The progressionof economicvalue

Entertainment?

Theater is about life –comedy and tragedy.

Hospital:Meeting the emotional needsof a family suffering a tragedytogether.

Disney:Meeting the emotional needs ofa family to have fun together.

A hospital without compassion is like Disney without fun.

Focus on the patient’s experience, not our service…

Companies stage an experience whenever theyengage customers, connecting with them in apersonal, memorable way.”

“They actually occur with any individual who hasbeen 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

At the Wilderness Lodge

Think Disneyexperience, not justdepartment or hotel

service.

Think patientexperience, not just

department or hospitalservice.

OrOr……

Our Service Or Their Experience?

High anxiety Pain

No PainLow anxiety

CourtesyWhat you sayNo clinical effect

CompassionWhat you feelClinical effect

Depends on the emotional needs of the patient.

Service paradigm Experience paradigmOR

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

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.

Acting is not pretending…Eric Morris, No Acting,Please (first sentence)

Acting is the art ofcreating genuinerealities on the stage.No matter what thematerial, the actor’sfundamental question is:“What is the reality andhow can I make it real tome?”

Acting must “come froma real place.”

To paraphrase…

Care giving is the art ofcreating genuine realitieson the hospital stage. Nomatter what the event, thecaregiver’s fundamentalquestion is: “What is thereality of this patient’sexperience, and how can Imake it real to me?”

Compassion also must“come from a real place.”

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

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)

Knowing how is not the problem…

Like losing weight, our problem is not withknowing how. When we want to enough,we figure out how and learn by doing.

Our problem is with being committedenough to do what it takes every day, anddo it permanently, not just in short burstsof inspired energy.

W. Edwards Deming might add…

What is the value ofa committed

ensemble of caregivers who have

becomecompassionatelyengaged in the

patient’s experience?

In The BoxYou can’t get different results by doing more of

the same old things in the same old way.

Centralized ControlUnit Efficiency Focus

Silo mentalityPercentile ranking

Compliance cultureOutsourced coachingCompetitive rewards

Just tomention afew…

Correlating patient and employee satisfaction.

PREMISE: Excellence is Fun

There is nothing like excellence to improve morale.

Anything done poorly is hard work and a real drag.Persistent mediocrity is discouraging, depressingand saps all our energy.

Anything done at the level of excellence or in thepursuit of excellence with a great coach is FUNand energizing.

Overcoming InertiaVision of

“could be”Knowing“how to”

OrganizationalInertia

Dissatisfactionwith “as is” + >+

Comfort zoneForce of habit

Must begreater

The WallCommitment

Inoculation

Compliance

LoyaltySatisfaction

OwnershipAutonomyExcellenceEnthusiasmTeamwork

Program

Old Paradigm to New

Service excellenceStarts at the top

LeadershipEmpowermentAccountability

ComplianceDo by learning

Memorable ExperienceStarts anywhereCitizenshipOwnershipResponsibilityCommitmentLearn by doing

Fallacy of asking, “How?”

“Asking How? Is a favorite defenseagainst taking action.”

Peter Block, The Answer to How is Yes

Knowing how is not the problem…

Like losing weight, our problem is not withknowing how. When we want to enough,we figure out how and learn by doing.

Our problem is with being committedenough to do what it takes every day, anddo it permanently, not just in short burstsof energy.

3 Key Premises

Baldrige CriteriaCategory: Patient Satisfaction

APPROACH: How will we talk about goingfrom good to great in patient perceptionsthat is inspiring and motivating for our staff?

DEPLOYMENT: Who will lead out, and howwill we generate commitment throughout theorganization at every level?

RESULTS: How will we get, track, and usefeedback?

3 Key Premises

APPROACH: Going from good to great by usingthe experience approach rather than a serviceapproach. Moving from the good of…

Our service

Dept Efficiency first

Hardwired courtesy

Patient’s experience

Dept Courtesy first

Emotional support

DEPLOYMENT: Involving everyone. From just…

Committees Departmental ownership

Educators training Managers coaching

Hardwiring service Inspiring compassion

RESULTS: Use feedback that motivates. From…

Satisfaction (avg.)

Courtesy / service

Quantitative (data)

Loyalty (% top box)

Compassion / healing

Qualitative (stories)

If DisneyRan Your

2.2.Make Courtesy MoreMake Courtesy More

Important ThanImportant ThanEfficiencyEfficiency

Pillars are Equally Important

SERVICE • PEOPLE • QUALITY • FINANCIAL

1. Safety2. Courtesy3. Show4. Efficiency

Disney’s Quality Priorities

What’s missing for patients? Internal customers?

Hospitals Need To Add Compassion1. Safety/Quality

Evidence based medicine.Zero defects / Reducing variation (Deming)

2. CompassionEmotional support as best clinical practice, affectingstress, anxiety, pain, and the immune system.

3. CourtesyConstantly seeking out guest contact. (Disney)

4. PresentationWe are always on stage.What will the audience see, hear, and feel?

5. EfficiencyUnit efficiency vs. courtesy and overall efficiency.Reducing the cost of poor quality (Deming)

Two Biggest Barriers to InternalCustomer Service

2. Poor teamwork, by which they mean:• competing for resources• unresponsive, unhelpful processes• silo mentality, workarounds

1. Poor communication, by which they mean,“Someone in another department makes adecision that affects us without consulting withus first.”

Deming Principles

EFFICIENCY: Calculate the COPQ (costof poor quality) in each step of theprocess.

When the process breaks downWorkaroundsRedundancyUnclear responsibilities

QUALITY: Reduce variation

Paradox: Customer First is More Efficient

inefficiency

efficiency & teamwork

unit efficiency first courtesy first

internal focus

unresponsive

compete for resources

external focus

responsive

share resources

What is a grand slamin performance?

WIN on quality (you reduced variation)

WIN on efficiency (your reduced overall costs)

WIN on customer satisfactionWIN on staff job satisfaction

Budgeting Process Questions

3. Have you discussed your plans withthem and gotten their agreement thatthis way is the most efficient overall?

2. Will anything you do affect anotherdepartment? If so, explain.

1. Where and how will you reduceexpenses this year?

ConversationWhat do you do for your ownefficiency that frustrates otherdepartments or patients?

If you changed it to be morecustomer friendly, estimate the costto your department, then estimatethe cost benefit (value added) tothose you serve.

How would your people like thechange?

If DisneyRan Your

6.6.Change the Concept ofChange the Concept ofWork from Service toWork from Service to

TheaterTheater

Disney is not a service and neither are we.

Commodities

Extract

Services

Deliver

Experiences

Joe Pine, The Experience Economy

The progressionof economicvalue

Theater is about life –comedy and tragedy.

Hospital:Meeting the emotional needsof a family suffering a tragedytogether.

Disney:Meeting the emotional needs ofa family to have fun together.

A hospital without compassion is like Disney without fun.

Our Service Or Their Experience?

High anxiety Pain

No PainLow anxiety

CourtesyWhat you sayNo clinical effect

CompassionWhat you feelClinical effect

Depends on the emotional needs of the patient.

Service paradigm Experience paradigmOR

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.

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.

Video clip: Connie

1. What is Connie’sproblem? What does herbody language and toneof voice tell you?

2. Make a list of behaviorsyou wish Connie wouldfollow.

Coaching Tips1. Plan your coaching sessions, do not “wing it.”2. Ask leading questions to get the other person to say

to you what you wanted to say to them. Rememberthe mind instinctively “reacts” to statements.

3. Use imagination to get them to put themselves inother peoples’ shoes, or your shoes.

4. Listen and reflect back all important points beforeresponding.

5. Say, “I need a person in your position whowill________” not, “I need you to__________”

6. Add, “…and I wish it could be you.”

If DisneyRan Your

7.7.Harness the MotivatingHarness the MotivatingPower of ImaginationPower of Imagination

What determines our response to stimulus?

S I RStimulus ResponseImagination

EmotionsFight or Flight

EmpathyBody languageTone of voice

Freeway

(pain & fear) (empathy)

All growthhappens

Four Levels of Motivation

44 Habit(based on character)

Compliance(based on authority, rewards, threats)

Imagination(based on feelings)

Will Power(based on values and beliefs)

Strongest

Weakest

Handling an Upset Customer

Listen

Apologize

Disney Teaches:(Left brain approach)

There’s a better way…

Dealing With an Irate Person

Stay Calm

Listen

Empathize Cool Off

Explain Listen

Ventilate

When someone goesballistic…

If DisneyRan Your

9.9.Stop Using CompetitiveStop Using Competitive

Rewards to MotivateRewards to MotivateStaffStaff

Some characteristics of high IQ typesthat make for poor manager coaches.

• Don’t listen because they are used to knowingmore than others, and love to prove it.

• Underdeveloped EQ (emotional intelligence),not needed for academic success.

• Success built on critical analysis, therefore tendto critique ideas, rather than consider or trythem, which tends to kill creativity and

“thinking outside the box.”

Some characteristics of high IQ typesthat make for poor manager coaches.

• Stingy with compliments, because they don’tneed them. For the exceptional one only.

• Have a greater need to be “right” than “liked.”

• Highly judgmental, so tend to lack the empathy& tact needed in a collaborative world.

• Succeeded in an independent, competitive environment (school), so think individual competition succeeds everywhere.

Add three Requirements for Promotion(High IQ = To get an “A”)

1) Has this person shown an ability to inspire,coach, and motivate others without resortingto threats and bribes?

2) Has this person demonstrated a commitmentto customer service that is verified bymeasurable results or feedback?

3) Does this person understand and talk aboutour focus on the patient’s emotionalexperience, not just courtesy standards?

In theater it’s an ensemble, not a team. Describe the characteristics of an ensemble

All are on the same page, take turnsbeing the soloist, and support each other.

Can improvise but must know the tuneand the rhythm to stay in sync.

Joy is in the playing, and making amemorable experience for the audience,not in competing with each other.

Success is in the overall performance, notin winning or losing.

Do not need a “leader” to become great.

Which Model is More Usefulfor Hospitals?

• The thrill of winning• In competition with others• To defeat another team• And win their trophy

• The joy of performing• In concert with others• To engage an audience• And win their applause

In theater, an ensembleis motivated by…

In sports, a teamis motivated by…

What does the applause of a patient sound like?

Paradox of Competition“You can’t have the fruits of cooperation froma paradigm of competition.”

Steven CoveyA basic drive in somepersonalities…especially males.

A healthy source of motivationbetween organizations,dysfunctional within.

Separating Recognition from Competition

Stories:• TWA attendant• ED compliment cards.• Boys and the old man

Employees want recognition for good work, notcompeting with other members of their team.

Employees are hungry for appreciation, not contests.

They want more individual, spontaneous praise, notmore trophies or coffee mugs at special events.

According to virtually allthe research on motivation..

Extrinsic rewards tend toextinguish intrinsic motivation, andwith it the values the rewards wereintended to encourage!

See Punished by Rewards by Alfie Kohn

What is gained by…

Searching only to reward the “best” and not the rest?It makes all but one feel like losers.Hampers teamwork.Fosters jealousy and sabotage.

Rewarding only those who do something unusualthat goes above and beyond? How about those whoare…

Always cheerful?Always responsible?Always dependable?

InstantFeedbackCards

If DisneyRan Your

10 .10 .Close the Gap BetweenClose the Gap Between

Knowing and DoingKnowing and Doing

Lee Performance Evaluation Grid

PEOPLECompassionate

CourteousHelpful

ATTITUDE

TASKAccuracy / Speed / Consistency

DELIVERABLES

51 2 3 41

Shaded zonemust change orleave.

Focus on andpraise relatingand doingstrengths.

Work aroundweaknesses.

Expert

Friend

Average

Overcoming InertiaVision of

“could be”Knowing“how to”

OrganizationalInertia

Dissatisfactionwith “as is” + >+

Comfort zoneForce of habit

Must begreater

––––––––––––––––––––––––––

FeedbackData

Organizational ChangeModel (Fred Lee)

“could be”

performance“as is”

––––––––––––––––––––––––––

FeedbackData

“could be”IN

performance“as is”

Manager

–––––––––––––––––––––––––

FeedbackData

performance

communication

servicestandards

Leadership Commitment

“At the moment of commitment, theuniverse conspires to assist you.”

Goethe

Manager commitment

–––––––––––––––––––––––––

FeedbackData

performance

communication

servicestandards

ModelingRelatingCoachingLearn by doing

10 Key Ideas To Start Immediately1. Have a daily huddle to value and encourage staff, and

share best practices.2. Determine how to seek out and use feedback on

frustrations (rounding).3. Do discharge phone calls to patients within 48 hrs.4. Do the avoidance exercise (the enemy of courtesy).5. Focus on the patient experience, not our service.6. Use patient letters and comments instead of numbers to

motivate and generate specific ideas for improvement.7. Talk to each about “your role in the patient experience.”8. Make courtesy more important than efficiency, especially

in the support services.9. Ask, “Why is it easy to feel compassion for some

patients and not others?” (Judging)10.Teach the ballistic curve in dealing with anger.

Ownership

What is the value ofa committedensemble of

caregivers who havebecome

compassionatelyengaged in the

patient’s experience?