SPOTLIGHT ON SUCCESS

Spring Tracker | Tracker Back Issues

References & Links

National Institute of Occupational Safety and Health (NIOSH)
www.cdc.gov/niosh

Journal of the American Medical Association (JAMA)
jama.ama-assn.org

Everyone knows we live and work in a service economy. Most managers have seen the statistics on customer retention and its impact on the bottom line and program performance. Maybe your health system has even put a couple of slogans into the employee handbook or instituted a "customer service" program. Real customer service is much more than that—it is a complete change of organizational perspective and a new way of doing business. Quality care is still the first priority, but the healthcare industry is realizing, if slowly, that service is a big part of quality care and often the only part the patient is in a position to evaluate.

Looking for industry leaders, the Tracker contacted Joe Eppling, the Occupational Medicine Program Director at East Jefferson Hospital in Metarie, Louisiana, to discover how a focus on customer satisfaction has transformed this hospital and especially the hospital’s occupational health business. East Jefferson Hospital made a strategic decision in the late 1980s to borrow from Disney (yes, Disney!) and their way of providing service, which is intensely focused on the needs of the customer.

"Of course we had to tweak the Disney model to apply it to occupational medicine. We used certain components that were more suited to our unique needs as a hospital," he explains. According to Mr. Eppling, the Guest Relations (versus "Patient" Relations) program, as the hospital now calls it, involves a fundamental shift in attitude of the physicians, staff, and management. Visitors, physicians, and patients are globally referred to as "guests." While patients are still called "patients," training the staff to view them as "guests" creates a different mindset and helps establish a culture where patients are customers for whom services are performed, rather than patients on whom services are performed—a subtle but extraordinary shift in perspective.

"The people who work here are team members and not employees," he continues. "This is not a frivolous change of words but another basic change in the culture. We have team member lounges. All documents and policy papers use the phrase ‘team member’ exclusively. What does this mean? It means that every individual working here is a contributing member, they are directly and collectively responsible for occupational medicine working for the guest."

This approach has greatly improved interaction among the staff members (or rather team members), not to mention communication with the guests. "We treat each other with more respect because each understands that the other is just as important and crucial to everyday functioning. For instance, our interaction with the pharmacy has improved substantially because of behavioral changes. This affects not just the staff but also the guest who is filling a prescription. If you treat people well they treat you nicely in return and even go the extra mile. It is a basic tenet of human interaction," Mr. Eppling emphasizes. In other words if internally your clinic or hospital works like a well-oiled machine, it is bound to produce positive external results experienced by your customers.

Real service begins with every internal interaction and ends with every external exchange.

Perhaps the most visible aspect of the program is the dress code, spelled out in meticulous detail. Each person’s dress is color-coded based on profession. For example, all the nurses in the hospital wear all white, all teal, or a combination of white and teal. Each person wears an East Jefferson Hospital identification tag stating their profession but not their position or administrative level. The impact of this seemingly superficial change is two-fold. The "guests" walking down the hallways quickly grasp a sense of what everybody does, so they waste less time directing their queries to the wrong individual. At the same time, the guests feel less intimidated approaching team members, as the rank of these individuals are unknown.

Other details of the dress code cover such topics as jewelry, shoes, and fingernails. According to Mr. Eppling, examples are: "No loop, hoop, or dangle earrings; only one earring per ear; one ring on each hand (except married women who can wear a wedding set); closed-heel and closed-toe shoes; hair away from the face; natural hair colors (purple is not one of them); no sleeveless shirt or dress; and so forth."

You are probably thinking that senior management sitting in their offices filled with mahogany furniture designed the conservative dress code, right? Wrong. The dress code was tailored with results from customer surveys and customer focus groups. "This is what people want. The dress code is conservative but this is what our guests who come from all walks of life expect from a healthcare provider. This is what is pleasing to their eye. I believe that in people’s minds this is the image of professionalism. Think about it for a minute. Most guests are not in a position to judge clinical competence when they walk in. But they can and do judge the appearance of staff and their behavior. This is one of the many things that contributes to a positive impression and a positive experience which is ultimately what makes them come back. Customer loyalty is imperative in this field," Mr. Eppling observes.

The Platinum Rule: Do unto others as they want to be done unto—their tastes may not be the same as yours.

Mr. Eppling adds that East Jefferson Hospital hires individuals who are "people-oriented" and are willing to make a commitment to service excellence. To help prevent misunderstandings, all applicants are required to view a 15-minute video detailing the culture of the hospital and its many aspects. If they are not willing to abide by the dress code, for instance, they have no obligation to stay and complete the application process. Those who decide to apply and are hired go through a process of rigorous orientation during which the culture of East Jefferson Hospital is detailed and service expectations of employees are specifically outlined.

Furthermore, managers are expected to lead by example, demonstrating customer-driven behaviors like going the extra mile to resolve patient complaints or even picking up litter in the hallway that in other hospitals might sit, awaiting the night janitor. "It is about keeping ‘our house’ clean. If we do not keep it clean, then how can we convince our guests that this is a good place to receive their health care?" Mr. Eppling reasons. Employees mirror the behavior of management, so it is imperative that managers lead by example and set the standards of superior performance.

"Also we (management) constantly reward and acknowledge those who excel in service excellence. We have Team Member of the Month and Team Member of the Year awards and other such perks. Management cares about the bottom line, but we also take care of those who make it happen," he adds.

Hire people with the right attitude (personalities cannot be fixed later), train them well, and keep reinvesting in their training.

An important concept in the Disney system is "stage"—at any given moment, a team member is either "on-stage" or "off-stage." When on-stage, the team member makes a concerted effort to respond immediately and thoroughly to the needs of guests. When off-stage, they can relax in team member lounges and slip out of their professional, on-stage roles.

East Jefferson Hospital puts only "people with thorough knowledge" on its front lines, so as to maximize productivity and "on-stage" customer interactions. The feedback that these frontrunners provide is taken seriously by the managers and often forms the guidelines for policy evolution, modifications in service delivery, or other CQI activities.

At the same time, every team member is expected and trained to be a "problem solver." Any guest can approach any team member in plain view and ask for assistance. Rather than directing the guest to another person or their manager, team members take "ownership" of the problem and follow it through to successful resolution. The guest is saved from navigating an unfamiliar environment and having to repeat his or her question or problem to numerous individuals before resolution. This also creates an atmosphere in which guests feel that the team members really care about their overall experience.

If you resolve a complaint on the spot, 95% of customers will do business with you again.

As with any effective customer-driven culture, East Jefferson Hospital is largely driven by feedback from customer surveys, complaints, and suggestions. In fact, fifty percent of each team member’s annual performance evaluation is based on customer satisfaction indicators. Those employees who do not meet the hospital’s standards are put on probation and scheduled for later review.

Service excellence and guest relations programming have proven vital to East Jefferson’s financial performance and market share, especially in an environment where competition is abundant and often cutthroat. "Customers do have a choice and they do exercise it. We have been fortunate to receive national recognition for our excellence in service in the form of several awards. In fact, Disney itself has awarded our approach to healthcare. Based on their positive experiences with us, people trust us and the end result is guest loyalty, which is really important in occupational medicine. Our guests revisit us," Mr. Eppling comments proudly.

So can any clinic and/or hospital learn and borrow from Mickey Mouse and Disney’s Guest Relations approach? He is of the strong opinion that it can be done. "It is difficult, but it goes a long way. Our biggest challenge was to convince the team members that we were serious and this was no joke. It was not a change in the vocabulary of the hospital but a permanent change in the East Jefferson system itself," he points out. "I cannot stress enough that the constant and consistent support of the hospital administration was critical to the initial and continued success of this program. You know, it takes time for results to become visible and if the administration is not behind you, the effort will fail. In the long term it is worth the time and effort. This approach is backed with statistics, but more importantly it is just plain common sense," Mr. Eppling concludes.