Presentatie Fred Lee Part 1+2 Maart 2009

Some Things You Would Do Differently Fred Lee

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.

Table of Contents If Disney ran your hospital you would… 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... 1. Focus on What Can’t Be Measured

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

Measurement Outcomes Perceptions Satisfied Loyal fan Clinical Financial Good to Great

Impact of PI on Total Quality Talent ns tio Place of choice p ce r Emotional Pe Reputation improves Skills Customers sing our praises Total Quality PERFORMANCE IMPROVES Processes improve Analytical Ou Skills Productivity improves tco m es Costs go down

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

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

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

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

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

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

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

Why is it so hard to raise our scores? +2 Meeting expectations = 0 +1 04 Satisfied = 0 -1 Satisfied patients have no story to tell -2 Hampton Inn, huddle -3

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

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

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

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

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

Disney is not a service and neither are we. Experiences The progression of economic Stage value Services 00 19 e Deliver nc Si Goods E IM Entertainment? T Make R E Commodities V O Joe Pine, The Experience Economy Extract

Theater is about life – comedy and tragedy. Disney: Meeting the emotional needs of a family to have fun together. Hospital: Meeting the emotional needs of a family suffering a tragedy together. A hospital without compassion is like Disney without fun.

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

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

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

Borrowing from Theater 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, To paraphrase… Please (first sentence) Care giving is the art of Acting is the art of creating genuine creating genuine realities realities on the stage. on the hospital stage. No No matter what the matter what the event, the material, the actor’s caregiver’s fundamental fundamental question is: question is: “What is the “What is the reality and reality of this patient’s how can I make it real to experience, and how can I me?” make it real to me?” Acting must “come from Compassion also must a real place.” “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 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.

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?

In The Box You can’t get different results by doing more of the same old things in the same old way. Centralized Control Unit Efficiency Focus Silo mentality Percentile ranking Compliance culture Just to Outsourced coaching mention a Competitive rewards few…

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, depressing and saps all our energy. Anything done at the level of excellence or in the pursuit of excellence with a great coach is FUN and energizing.

Overcoming Inertia > Organizational Dissatisfaction Knowing Vision of + + Inertia with “as is” “how to” “could be” Must be greater than Comfort zone Force of habit

The Wall Compliance Commitment Loyalty Satisfaction Improvement Ownership Autonomy Excellence Enthusiasm Teamwork Program Inoculation Time

Old Paradigm to New Memorable Experience Service excellence Starts anywhere Starts at the top Citizenship Leadership Ownership Empowerment Responsibility Accountability Commitment Compliance Learn by doing Do by learning

Fallacy of asking, “How?” “Asking How? Is a favorite defense against taking action.” Peter Block, The Answer to How is Yes

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 energy.

Baldrige Criteria Category: Patient Satisfaction APPROACH: How will we talk about going from good to great in patient perceptions that is inspiring and motivating for our staff? DEPLOYMENT: Who will lead out, and how will we generate commitment throughout the organization at every level? RESULTS: How will we get, track, and use feedback?

Baldrige Criteria Category: Patient Satisfaction APPROACH: Going from good to great by using the experience approach rather than a service approach. Moving from the good of… Patient’s experience Our service to Dept Courtesy first Dept Efficiency first to Hardwired courtesy Emotional support to

Baldrige Criteria Category: Patient Satisfaction DEPLOYMENT: Involving everyone. From just… Committees Departmental ownership to Managers coaching Educators training to Inspiring compassion Hardwiring service to

Baldrige Criteria Category: Patient Satisfaction RESULTS: Use feedback that motivates. From… Loyalty (% top box) Satisfaction (avg.) to Courtesy / service Compassion / healing to Quantitative (data) Qualitative (stories) to

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

Pillars are Equally Important SERVICE • PEOPLE • QUALITY • FINANCIAL

Disney’s Quality Priorities 1. Safety 2. Courtesy 3. Show 4. Efficiency What’s missing for patients? Internal customers?

Hospitals Need To Add Compassion 1. Safety/Quality Evidence based medicine. Zero defects / Reducing variation (Deming) 2. Compassion Emotional support as best clinical practice, affecting stress, anxiety, pain, and the immune system. 3. Courtesy Constantly seeking out guest contact. (Disney) 4. Presentation We are always on stage. What will the audience see, hear, and feel? 5. Efficiency Unit efficiency vs. courtesy and overall efficiency. Reducing the cost of poor quality (Deming)

Two Biggest Barriers to Internal Customer Service 1. Poor communication, by which they mean, “Someone in another department makes a decision that affects us without consulting with us first.” 2. Poor teamwork, by which they mean: • competing for resources • unresponsive, unhelpful processes • silo mentality, workarounds

Deming Principles QUALITY: Reduce variation EFFICIENCY: Calculate the COPQ (cost of poor quality) in each step of the process. When the process breaks down Workarounds Redundancy Unclear responsibilities

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

What is a grand slam in performance? WIN on quality (you reduced variation) WIN on efficiency (your reduced overall costs) WIN on customer satisfaction WIN on staff job satisfaction

Budgeting Process Questions 1. Where and how will you reduce expenses this year? 2. Will anything you do affect another department? If so, explain. 3. Have you discussed your plans with them and gotten their agreement that this way is the most efficient overall?

Conversation What do you do for your own efficiency that frustrates other departments or patients? If you changed it to be more customer friendly, estimate the cost to your department, then estimate the cost benefit (value added) to those you serve. How would your people like the change?

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

Disney is not a service and neither are we. Experiences The progression of economic Stage value Services 00 19 e Deliver nc Si Goods E IM T Make R E Commodities V O Joe Pine, The Experience Economy Extract

Theater is about life – comedy and tragedy. Disney: Meeting the emotional needs of a family to have fun together. Hospital: Meeting the emotional needs of a family suffering a tragedy together. A hospital without compassion is like Disney without fun.

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

Borrowing from Theater 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.

Video clip: Connie 1. What is Connie’s problem? What does her body language and tone of voice tell you? 2. Make a list of behaviors you wish Connie would follow.

Coaching Tips 1. 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. Remember the mind instinctively “reacts” to statements. 3. Use imagination to get them to put themselves in other peoples’ shoes, or your shoes. 4. Listen and reflect back all important points before responding. 5. Say, “I need a person in your position who will________” not, “I need you to__________” 6. Add, “…and I wish it could be you.”

If Disney Ran Your Hospital You Would... 7. Harness the Motivating Power of Imagination

What determines our response to stimulus? R I S Imagination Response Stimulus (pain & fear) (empathy) Emotions Fight or Flight All growth Empathy happens here Body language Tone of voice Freeway

Four Levels of Motivation Weakest 1 Compliance (based on authority, rewards, threats) 2 Will Power (based on values and beliefs) 3 Imagination (based on feelings) Habit 4 Strongest (based on character)

Handling an Upset Customer  Disney Teaches: (Left brain approach) Listen Apologize Solve Thank There’s a better way…

Dealing With an Irate Person When someone goes ballistic… Empathize Cool Off Ventilate Listen Explain Listen Thank Stay Calm

If Disney Ran Your Hospital You Would... 9. Stop Using Competitive Rewards to Motivate Staff

Some characteristics of high IQ types that make for poor manager coaches. • Don’t listen because they are used to knowing more than others, and love to prove it. • Underdeveloped EQ (emotional intelligence), not needed for academic success. • Success built on critical analysis, therefore tend to critique ideas, rather than consider or try them, which tends to kill creativity and “thinking outside the box.”

Some characteristics of high IQ types that make for poor manager coaches. • Stingy with compliments, because they don’t need 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 resorting to threats and bribes? 2) Has this person demonstrated a commitment to customer service that is verified by measurable results or feedback? 3) Does this person understand and talk about our focus on the patient’s emotional experience, 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 turns being the soloist, and support each other. Can improvise but must know the tune and the rhythm to stay in sync. Joy is in the playing, and making a memorable experience for the audience, not in competing with each other. Success is in the overall performance, not in winning or losing. Do not need a “leader” to become great.

Which Model is More Useful for Hospitals? In sports, a team In theater, an ensemble is motivated by… is motivated by… • The joy of performing • The thrill of winning • In concert with others • In competition with others • To engage an audience • To defeat another team • And win their applause • And win their trophy What does the applause of a patient sound like?

Paradox of Competition “You can’t have the fruits of cooperation from a paradigm of competition.” Steven Covey A basic drive in some personalities…especially males. A healthy source of motivation between organizations, dysfunctional within.

Separating Recognition from Competition Stories: • TWA attendant • ED compliment cards. • Boys and the old man Employees want recognition for good work, not competing with other members of their team. Employees are hungry for appreciation, not contests. They want more individual, spontaneous praise, not more trophies or coffee mugs at special events.

According to virtually all the research on motivation.. Extrinsic rewards tend to extinguish intrinsic motivation, and with it the values the rewards were intended 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 unusual that goes above and beyond? How about those who are… Always cheerful? Always responsible? Always dependable?

Instant Feedback Cards

If Disney Ran Your Hospital You Would... 10 . Close the Gap Between Knowing and Doing

Lee Performance Evaluation Grid Shaded zone 5 must change or AR d en ST leave. i Fr PEOPLE 4 Focus on and Compassionate praise relating 3 e Courteous ag ert er and doing Helpful p Av Ex strengths. 2 ATTITUDE Work around 1 weaknesses. 2 3 4 5 1 TASK Accuracy / Speed / Consistency DELIVERABLES

Overcoming Inertia > Organizational Dissatisfaction Knowing Vision of + + Inertia with “as is” “how to” “could be” Must be greater than Comfort zone Force of habit

Organizational Change – Model (Fred Lee) – Feedback – Data – – – – “could be” – – – – – – – – – – – – “as is” – performance – – – – – –

Organizational Change – Model (Fred Lee) – Feedback – Data – – – – “could be” – – – – INERTIA – – – – – – – – “as is” – performance – – – – – –

Organizational Change Model (Fred Lee) – Feedback – Data – – – er – g – na – a M – – INERTIA – – – – – – – – – performance service – – standards – – – communication –

Leadership Commitment “At the moment of commitment, the universe conspires to assist you.” Goethe

Organizational Change Model (Fred Lee) – Feedback – Data – nt – e itm – – m om – c – er – g na – a INERTIA – M – Modeling – – – Relating – – – Coaching – performance service – Learn by doing – standards – – – communication –

10 Key Ideas To Start Immediately 1. 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 of a committed ensemble of caregivers who have become compassionately engaged in the patient’s experience?

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Presentatie Fred Lee Part 1+2 Maart 2009

by Kjeld Harald Aij MBA on Apr 07, 2009

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Presentatie Fred Lee Part 1+2 Maart 2009 — Presentation Transcript