Emergency Department Directors Academy Phase II. Customer Satisfaction: Beyond the Ordinary

Transcription

1 Emergency Department Directors Academy Phase II Customer Satisfaction: Beyond the Ordinary May 2011

2 Customer Service Beyond the Basics Thom Mayer, MD, FACEP, FAAP Founder and CEO BestPractices, Inc Medical Director NFL Players Association Let Me Be Very Clear YOU HAVE MY PERMISSION TO USE ANY OR ALL OF THIS MATERIAL, INCLUDING THE SLIDES, TO CREATE OR ENHANCE A CUSTOMER SERVICE PROGRAM AT YOUR EMERGENCY DEPARTMENT Thom Mayer, MD

3 Patient Satisfaction Scores Press Ganey Jackson Organization NRC-Picker Gallup Home-grown by Hospital Home-grown by you Patient Satisfaction Surveys SCALE TYPE #?s MD Press 1-5 Mail 29 6 Ganey Gallup 1-4 Phone 20 2 Jackson 1-5 Phone 18 5 Picker/ 1-3 Mail 24 6 NRC

4 There Are Only Two Issues 1. WHY Customer Service? 2. HOW Customer Service? The #1 Reason To Get Customer Service Right Is

5 It Makes Your Job Easier! A-Team Members Positive Proactive Confident Competent Compassionate Communication Teamwork Trust Teacher Does whatever it takes Sense of humor Moves the meat

6 B-Team Members Negative Reactive Confused Poor communication Lazy Late Constant complainer BMW Club Can t do Always surprised Nurse Ratched Dr Torquemada How many B-Team members does it take to destroy an entire shift?

7 Compliments Complaints A-Team Behaviors B-Team Behaviors Identify Them Analyze Them Accentuate Them Train for Them Insist on Them Hire for Them Reward Them Identify Them Analyze their effects Eliminate Them The Remedial Course Fire for Them The more horizontal you are - the more you re a patient. The more vertical you are the more you re a customer.

8 The 3 rd Survival Skill - Building Moments of Truth Into the Clinical Encounter Jan Carlzon and SAS 50,000 moments of truth per day Do you think your patients know how many They know you! To them, you are the institution Life is an Open Book Test!!!!

9 Proven and Practical Customer Service Skills 1. Empowerment Point of Impact Intervention Service Recovery 2. Dealing with Difficult Patients Dealing with B-Team Members 3. Personal Patient Satisfaction Coaching 4. Rounding Yours, next, sign out 5. Scripts-Right Words, Right Time 6. Hire Right-Screen for the Gene 7.Taking 4s to 5s 8. The Psychology of Waiting 9. Reward Your Champions 10. Leave a Legacy Tool #1 EMPOWERMENT Empowerment exists to the extent that those who deliver the service have the freedom to adapt the service to meet the needs of the patient/customer in real time.

10 Are You Empowered? They tell us we are! You ll never treat your patients any better (and often worse) than you treat yourselves No company has ever gotten service right without first getting empowerment right Empowerment is not a slogan - it is fundamental cultural change The Soul of Empowerment There are only 3 Questions to ask 1. Is this good for the patient? 2. Is this good for the people who take care of the patient? 3. Can the provider change the system on the fly?

11 Empowerment Are you a Thick Rulebook company or a Thin Rulebook Company? Are you a Narrow Corridor For success company or a Wide Corridor for success company? Great service companies have Thin Rulebooks and Wide Corridors for success Key Question-Who makes the rules? The 12 Gold Standards Tool #1A-Point of Impact Intervention 1. Identify the problem and address it immediately 2. Establish the fact you know there has been a breakdown. 3. Wipe the slate clean. 4. Establish their expectations. 5. Negotiate and resolve issues. 6. If possible, meet their expectations 7. Offer reasonable alternatives. 8. When all else fails, offer an alternative person to talk to

12 Tool #1B-Service Recovery Listen Apologize What can I do to make this right? Fix it Follow up, follow through Something extra Keep and communicate data/trends Tool #2A-Dealing with the B Team Patient Sit down Open body language Active listening Establish expectations Shift the power and control I don t have what you want I m not trained in chronic pain management! Be proactive

13 Tool #2B-Dealing with the B-team Employee Be specific When you do,it makes others feel. Try this. When you do B Team behavior, it has this effect. Try this A Team behavior. Give them examples Give them a mentor. Tool # 3Personal Patient Satisfaction Coaching The majority of surveys calculate individual scores for the emergency physician These scores are broken out by category The target score is also identified (e.g. 85 th Percentile) Plotting these scores is relatively simple, as shown in

14 What s a Good Doctor? Doctor s Courtesy Doctor Took Time to Listen Doctor Informative Doctor s Concern for Comfort Overall Score Courtesy, Timeliness, Informed, Comfort, Overall 85th Percentile Doctor 90.1 Cour Tim Inf Co m Ov th Percentile Doctor

15 So What? In this case, in both Courtesy of the Doctor and Doctor took time to listen this physician is knocking it out of the park, with scores approaching the 95 th Percentile BUT, he still has a 66 th Percentile score overall-what gives? His scores on Doctor was informative regarding treatment and Concern for comfort, the scores were dramatically lower. IN FACT, THEY WERE NEARLY 5 POINTS BELOW HIS OTHER SCORES!!!! Let s Look at a Different Doctor Same hospital Same sample period Different sample size (25 vs 16) But where to hit with the hammer is quite different And the percentile skew is RAZOR THIN!! 87.0 = 77 th percentile while 88.o is 85 th percentile

16 Courtesy, Timeliness, Informed, Comfort, Overall 85th Percentile Doctor 90.1 Cour Tim Inf Co m Ov th Percentile Doctor In this case Courtesy and Took time to listen are the areas in which h the scores are below target Informed regarding treatment and concern for comfort/pain are at or above target What s the point?

17 What s the Point? Personal Patient Satisfaction is key Smile, be nice doesn t and never has worked Focus, focus, focus Simplify but not too much

18 Camden-Clark Clark Sets Gallup Record for Largest One Year Jump in Patient Satisfaction Scores Focused Coaching 33 Key Drivers of Excellence for IFH by Month

19 Key Drivers of Excellence for IFH by Month Key Drivers of Excellence for IFH by Month

20 Key Drivers of Excellence for IFH by Month Same hospital PRC Key Drivers Same ED-but pediatric section Same time period Same demographics Different key drivers

21 Key Drivers of Excellence for IFHC by Month Key Drivers of Excellence for IFHC by Month

22 Key Drivers of Excellence for IFHC by Month Key Drivers of Excellence for IFHC by Month

23 PRC Key Drivers General ED Overall Quality of Care Respect for Patient s Privacy Overall Level of Safety Doctor s explanation of treatment/tests Pediatric ED Overall Quality of Care Staff s Management of Pain Doctor s explanation Respect for Patient s Privacy PRC There is no Finish Line! General ED-2008 Key Drivers 1. Overall Level of Safety 2. Overall Teamwork 3. Nurses Level of Understanding and Caring General ED-2009 Key Drivers 1. Respect for Patient s Privacy 2. Overall Level of Safety 3. Doctor s explanation of treatment/tests

24 Tool #4-Rounding on Your Unit What could we do to make this a better experience for you? What do you want to see more of? Less of? What can I do to make your job easier? What can I do TODAY that will make things better for you TOMORROW? Rounding on Next Unit Pick 1-2 patients Write their name and bed assgnment down Come in early or day off Just wanted to check on you Thanks Doc! I m checking to make sure you are taking good care of MY patient!

25 Sign-Out Rounds This is my partner and we ve discussed your care Review PE, lab, etc What if you were the patient? Service, safety, risk reduction, quality Mandatory, not desired Tool #5-Scripts Do you have any questions-i have plenty of time. How can I help you? Joe Smith, please come to the desk. We have more pain medication than you have pain I m sorry this happened to you.

26 Scripts-Paganussi s Pearls I m going to be here all night-if if you have any questions when you get home, give me a call. I ll be on duty Tuesday and Wednesday nights. If you need to see me, feel free to come back then. You ve already had to wait tonight-if if you come back Tuesday, give this card to the triage nurse and I ll see you there. Tool #6-HIRE RIGHT!!!!!! The most expensive decision you will ever make in your career??? Hiring your partners!

27 A Team Members Hire A Team Members B Team Members Hire C Team Members

28 Tool # 7-Taking 4s to 5s The skew in patient satisfaction scores (all of them!) is very narrow The difference between sky and cellar isn t that big (There s a life lesson here somewhere ) Moving about 1/3 to ½ of people whoa re already predisposed to like us from Very Good to Excellent is 4 - Good The customer may return The customer may have positive word of mouth (if asked) The customer feels the care they received was acceptable, but not excellent The customer thought employees were courteous Ultimately, customer loyalty is at risk

29 5 Very Good The customer will return The customer will tell others about their positive experience Customer received exceptional care The customer had a WOW experience Loyalty behavior is most likely. Very Good to Excellent Take half the 4s to 5s We want to give you Excellent! Care! 1 s 2 s 3 s 4 s 5 s 99th Percentile Hospital 1% 1% 1% 5% 23% 70% 66th Percentile Hospital 1% 2% 8% 35% 53%

30 Let s look at Service 4 vs 5 Sample distribution of inpatient satisfaction score responses to achieve excellence 1 s 2 s 3 s 4 s 5 s 99th Percentile Hospital 1% 2% 7% 24% 66% 64th Percentile Hospital 1% 2% 8% 34% 55% 35th Percentile 2% 2% 8% 36% 52% Reference: Press Ganey and Associates, March Issues to Consider Percent Excellent or Mean Score? Frequency: Inpatient Overall Quality of Care Based on 2006 PRC Hospital Client Data Excellent Very Good Good Fair Poor 2.4 Top 5 Hospitals PRC Norm Bottom 5 Hospitals

31 Tool # 8- Flow and the Psychology of Waiting The Hardwired Definition of Flow Quality exists to the extent that value is added Value consists of a ratio of the benefits received compared to the burdens endured Thus quality/value can actually be measured - and made controllable, manageable, and real - by looking at the benefit/burden ratio

32 Hardwiring Flow To the extent that value is added (Treasure Hunt) and Waste (Non-value) is eliminated (Bounty Hunt) As our patients move through our service transitions and queues The 7 Rights! of Hardwiring Flow 1. The right resources 2. To the right patients 3. In the right environment 4. For the right reasons 5. With the right team 6. At the right time 7. Every time!

33 The 7 Elements of The Flow Toolkit 1. Demand Capacity Management 2. Real-Time Monitoring 3. Forecasting Demand 4. Queuing Principles 5. Constraints and Bottlenecks 6. Managing Variation 7. Building a Systems Team and Culture (Fundamental EBL) Demand Capacity Management Is Patient Flow is Predictable?

34 Demand Capacity Management Key Words We knew you were coming in today-we just didn t know your name! A BAD Idea What are you doing here?

35 Is the Glass Half-Full or Half- Empty? Well, it depends d on whether you are pouring- or drinking! Grandpa Jim The Key Elements of Hardwiring Flow 1. The front door drives flow 2. Triage is a process, not a place 3. Fast Track is a verb, not a noun 4. Horizontal patients value real estate, vertical patients value speed 5. Fast at fast things, slow at slow things 6. Let Docs do Doc stuff and nurses do Nurse stuff 7. The best patient satisfier is a smoothly running ED and hospital

36 The Front Door Drives Flow Direct to Room Advanced d Triage/Rx Team Triage UltraTrack Results Waiting Room High Leverage Inpatient Flow Connecting the ED to the rest of the Hospital Be a Bed Ahead Adopt A Boarder Value-Added Admission Process A Bed Czar/Flowmaster A Bed Tracking System Board Rounds Multidisciplinary rounds A Hospitalist Program An Engaged Medical Staff Service Line Optimization Specialized Units or Services Flexible Units/Flexible ibl Staff A Diversion Plan A Saturation Plan Effective Case Management A Minimized Boarding Burden Adopt a Boarder Smoothing Surgical Flow Coordinating Admissions/Discharges

37 Fast Track-Mayer s Rule It s s a VERB Not a Noun! Real Flow Perceived Flow Be a Bed Ahead Scripts Direct to Room Charge RN Rounding Advanced Psychology of Triage/Advanced Waiting Initiatives Expectation Creation Team Triage and Negotiating Treatment expectations Adopt A Boarder FlowMaster Bed Reservations for ED Patients

38 Horizontal vs. Vertical Patients Horizontal Stretcher bound Ambulance Arrival Sick Older Perceived serious or life- threatening Condition Value (Traditional Healthcare) Speed Safety Preservation of Life/Limb Vertical Ambulatory Arrival by Triage Well Younger Perceived urgency or convenience factor Value (Starbucks and McDonalds) Speed Convenience Financial Other non-medical factors What I Said Versus What I Meant

39 Tool #8-The Psychology of Waiting Occupied Beats Unoccupied In-process Beats Pre-process Anxiety is Bad Limited Certainty Beats Uncertainty Explained Beats Unexplained Equitable Beats Unfair More Valuable the Service, More Tolerable Group Waits Beats Solo Waits The Psychology of Waiting-So Whats Occupied TVs, magazines, health In-process Anxiety Certain Previews Company ROS forms Beds? No triage! AT/AI Team Triage CS Dx and Rx Address obvious-scriptsscripts Previews Green-Yellow-Red Traumas, CPRs

40 The Psychology of Waiting-So Whats Explained In-process preview Family feud Equitable More Valuable Group Announce Codes FT Criteria known The Value Equation Maximize benefits Eliminate burdens Visitor Policy-The Deputy Sheriff Tool #9-Reward Your Champions Rewards at the bedside Praise publicly and liberally Star Of The ER Post compliment letters Recognize A-team behaviors Fee-for-service nursing

41 Tool # 10 What Will Your Legacy Be? You Are The CEO of ME, INC!!!!

42 The Stock Value of ME, INC Goes Up Exponentially Every Time You Act of Behalf of the Patient Instead of Yourself Everything can be taken from man but one thing: the last of human freedoms - to choose one s attitude in any set of circumstances, to choose one s own way. Victor Frankl Man s Search for Meaning

43 Of all the will toward the ideal in mankind only a small part can manifest itself in public action. All the rest of this force must be content with small and obscure deeds. The sum of these, however, is a thousand times stronger than the acts of those who receive wide public recognition. The latter, compared to the former, are like the foam on the waves of a deep ocean. Albert Schweitzer, MD Out of my Life and Thought Selected Readings Mayer T, Cates:Leadership for Great Customer Service:Satisfied S Patients, t Satisfied Customers. 2004, Health Administration Press. ( or Peters T: Re-imagine! Business Excellence in a Disruptive Age. 2003,London, DK Ltd Wears RL: Patient Satisfaction dth C fk l i A

44 Selected Readings Studer Q:Hardwiring Excellence, 2003,Gulf Breeze, Fl Firestarter Press Peters T:Talent: Develop it, sell it, be it, 2005, New York, DK Publishing Mayer T, Cates R: Service excellence in healthcare. JAMA 1999; 282: Maister DH: The psychology of waiting at davidmaister.com Berry LL:The Soul of Service,2004, New york, Free Press Beeson SC:Practicing Excellence:A Physician s Manual to Exceptional Health Care. Firestarter Press, 2006