Those of us in the on-demand medicine space all face a daunting challenge. It stems from the fact that on-demand medicine now attracts a mass market of consumers who have much higher expectations from their experience, the same expectations they have of retailers like Starbucks, Amazon or Target.
But there is also an exhilarating opportunity. On-demand medicine — urgent care, virtual health, retail clinics and employer clinics — represents a starting point to revolutionize the ultimate patient experience for the entire healthcare industry.
This year’s focus at our annual strategy symposium in January is customer experience (CX). In August we wrote about the CX challenge from the perspective of measurement. This month we cover an equally complex challenge: what to do when your CX measures are below what they should be or how to take your CX scores to the next level.
Over the last few weeks I have had the good fortune to meet and interview several great CX leaders. I will draw upon the knowledge and expertise of these CX leaders, some of whom are speakers at the upcoming symposium. I hope this article motivates you to join us in Scottsdale to bring your own energy and ideas around CX to this community of healthcare innovators and disrupters.
As we mentioned in August, measuring CX is nothing new. What is new is the sophistication and availability of tools for doing this. There is certainly the legacy of Press Gainey, which to their credit is trying to move from paper surveys via snail mail to more real-time data gathering. Unfortunately, the healthcare industry, by the very fact that it faces so much compliance, tends to spend more time measuring clinic operations than true elements of customer experience.
Operational measures have both limits and risks. The September/October issue of the Harvard Business Review makes this abundantly clear in a series of articles under the title, “Are Metrics Undermining Your Business?” And even some of the latest approaches to CX measurement, such as net promoter scores (NPS), only scratch the surface and don’t get at some of the underlying issues that lead to bad customer experiences.
Don’t underestimate the importance of clinic operations. Mayo is a good example of this. Compared to other health systems, they are masters at moving and staging large numbers of patients efficiently from waiting areas to their diagnostic and treatment rooms. And Mayo rapidly applies what they learn from patient feedback into their clinic operations. Anyone who has been to Mayo in Rochester, Jacksonville or Scottsdale knows they have proven you can improve customer service from systems and processes that they architect intentionally. Furthermore, our work with clients through clinic diagnostic engagements reveals how far many health systems can go on improving clinic operations in general and workflow in particular.
However, beyond the obvious CX and clinic operations measures, there are a number of measures that are moving to the forefront of healthcare. Though much less common than the “hard numbers” like clinic operations and NPS, you’ll see from both the HBR article and other examples that “soft” measures may have an equally important impact on how your customers perceive your service and your brand.
The HBR article essentially concludes that organizations are missing a key element that should be prioritized ahead of measurement: purpose. At most healthcare organizations it is missing completely or at best it is given lip service through short-lived campaigns to introduce a new vision or mission. If you want a case study on “purpose” you must look at Disney. Disney’s common purpose is “We Create Happiness.” Ask any cast member (Disney’s term for all employees) what Disney’s common purpose is and you will be greeted with a smile, those three words, or something that supports that idea. It is what cast members are taught the first day on the job when they attend Disney University.
You might say, “Oh that’s so cute.” But the most admirable aspect of Disney’s common purpose is that it has been consistent since the very early days of the company’s founding. There are audio clips of Walt Disney himself talking about creating happiness as the core of the company’s purpose. They communicate it with a passion; it pervades the culture; and it guides every decision to this day.
“The Disney organization has been operating longer without Walt Disney than with him,” says Joseph Gardner, a former Disney and Ritz-Carlton executive and a speaker at our upcoming symposium in January. “Yet they operate as if Walt could walk through that door any time.”
Happiness is an emotion. So at Disney, everything is geared around creating an emotional connection with guests at their parks, hotels and resorts, from who they hire to how they design cast member name badges. Name badges have the cast member’s home town, purposefully engraved to start conversations. Those name tags are handed out as part of a celebration when cast members finish their first course at Disney University appropriately called “Traditions.” In other words, Disney leadership is creating an emotional connection with their cast members; they want cast members to be happy too.
One of Joseph Gardner’s first jobs while going to school was with the famous toy retailer, FAO Schwarz.
“My first job was supposed to be floor sales,” he says. “But my boss wanted me to focus not on selling but on WHY someone walked through that door to begin with. It taught me a critical lesson about touch-points and creating emotional connections.”
Gardner realized early on that his boss at FAO Schwarz was an expert at engaging and motivating her team. And in many ways that was much more important than any kind of operational expertise she brought to the job.
So the question is, whether you have one center or 100, what would be the common purpose that drives all decisions in your urgent care operation? Dr. Charlie Ireland, a speaker at our last symposium and a facilitator at our next one, created a common purpose for Advocate urgent care in the Chicago area: “World Class Medicine Fast.” Everything at the urgent care centers for which Dr. Ireland is medical director is connected to that common purpose.
In fact, one result of that common purpose was a complete change in clinic operations. It used to be that physicians were considered the leaders of how the practice was run, and staff would take direction from those physician leaders. Today nurses are the leaders and providers take direction from those nurses. Why? Because most of the time providers are behind closed doors with patients. They can’t possible know what’s happening on the floor and in the check-in area that might cause a slowdown. By inverting the leadership roles, Advocate found that new ideas surfaced around how to deliver care at a much higher level of attention and at much greater pace. After this change in leadership, patient volume more than doubled, yet outcomes improved.
“We went from a blaming culture to a learning culture,” says Dr. Ireland. “All of a sudden everyone felt empowered — front desk, nurses, MAs and providers. People were willing to speak up with respectful candor.”
You might say that it is unrealistic for a hospital to expect “fast” to trump everything. And sometimes there will be bumps in the road, as has happened at Advocate. When the hospital dictated that the urgent care adopt the same standard version of Epic used across the organization, this was a violation. Fast no longer trumped everything because the new version of Epic was much slower. But the team met and found workarounds independent of Epic that enabled them not to miss a beat. In the end, “World Class Medicine Fast” still prevailed.
However, this study shows that managers need to understand the importance of not only customer satisfaction but also delight in directly driving customer loyalty. They need to take steps to ensure the generation of both customer satisfaction and delight, which can provide stronger influences in the creation of customer loyalty because the changes in the hospitality industry demand more than customer satisfaction–style management.
Healthcare has an image problem. It is perceived as expensive. Front desk people are often viewed as grumpy and insensitive. Doctors are portrayed as having one hand on the doorknob while seeing patients.
Research shows that customer satisfaction is based around cognitive responses to a product or service. But one study shows that emotions, such as “delight,” are just as important when it comes to loyalty. The study published in the Journal of Hospitality and Tourism Research shows that managers need to understand the importance of not only customer satisfaction but also delight in directly driving customer loyalty.
This leads to the next concept. Urgent care, telemedicine and employer services are great starting points for you to rupture the healthcare stereotype. But you must figure out what specific behaviors you want to define your culture, and make that intentional over the long haul.
Start with a smile. You might say that not everyone is happy or can smile naturally. Disney would say, “Fine. Then don’t come work for us.” On the other hand, people can be taught to smile and they will exhibit that behavior if you reinforce it.
Front desk people in particular should be expert at smiling while greeting patients. Smiling is disarming. It helps patients relax when they don’t feel well and are unsure about their decision making. And, it creates an emotional connection. If you have a front desk person who doesn’t smile and can’t learn to smile, you need to find a replacement.
Desired behaviors don’t just apply to clinic support staff. They apply just as much to providers. Sometimes we focus too much on the desired behavior from providers when they are seeing patients. Of course that is important, and probably you’ve invested a lot in that particular issue already. But just as important is how providers interact with support staff. If that interaction is negative, it creates a toxic environment that will ultimately lead to negative customer experiences.
Advocate urgent care surveys clinic support staff on their interactions with providers. The results of those surveys are posted for all staff to see. The entire team, providers and support staff, know that this is a critical part of “World Class Medicine Fast,” and they buy into it 100 percent.
“The 360-degree review enables deep engagement with our staff,” says Dr. Mark Bowman, one of Advocate’s urgent care physicians. “They tell us our strengths and weaknesses and we’re open to that. If they are comfortable speaking freely, they will do a better job. And all of this spills over to the patients we see.”
“Physicians can’t really stand back and see the big picture,” says Barb Gilmour, front desk manager at the Advocate urgent care in Aurora, IL. “The docs want to keep things moving and are grateful for getting direction that keeps the pace moving. There isn’t a person on the staff, front desk, nurse or whoever, who can’t go to the doctor and speak freely.”
“Once you get that mindset, we can overcome most things,” says Diana Michels, an RN at the Aurora urgent care facility. “I was grateful to have that come about. You have to have that ability to speak to one another with trust and respect.”
Changing organizational culture requires authentic and intentional leadership. Authentic leadership demonstrates that you care about your employees. Leaders, providers and support staff should be viewed as one team. We have learned that in most high-performing organizations the extent to which you care for your people is the extent to which they will care for your customers.
But most health system executives with ambulatory care service line responsibility will admit they seldom round and interact with care team members. When you inquire about why that is you hear a common refrain: “back-to-back meetings.”
The restaurant chain Golden Corral requires the entire C-suite and next level directors to spend a minimum of one week per year working at their restaurants as cashiers, hosts, cooks and even janitors.
Disney leaders must be walking the floor of their designated leadership areas no less than 70 percent of their time. That means only 30 percent of their time can be spent in meetings.
If you round once a year, you won’t build trust. Frequent rounding will create an environment where the care team trusts you such that information flows to you instead of you having to chase what’s “really going on” within your business. Regular access to the perspectives of your employees enables you to equip your team with the tools and resources they need.
The healthcare industry suffers from what Zeev Neuwirth, MD, calls supply-side thinking versus “demand-side thinking.” It is what creates command and control cultures. Neuwirth is chief clinical executive for care transformation and strategic services at Atrium Health in Charlotte. He just published a new book called “Reframing Healthcare” and hosts a popular podcast called “Creating a New Healthcare.” He will lead the CX sessions at our symposium in January.
“There is good reason and good evidence for treating your teammates and colleagues as internal VIP customers,” says Neuwirth. “I have learned and discovered that if you treat your people well, that will enable them to treat their customers well. But this can’t be at the expense of understanding and servicing your customers and providing the best possible experience, care and outcomes.”
CX WHITE SPACE
Though healthcare has a poor reputation when it comes to customer experience, there is a tremendous amount of what we call CX white space. Think about it. Do your competitors excel at delivering an amazing customer experience? Probably not. So there is ample opportunity for you to shine in your market and set yourselves apart by grabbing this CX white space.
There are three trends that will have a huge impact on healthcare over the next decade: First, we believe healthcare is moving back toward managed care and capitation. Second, millennials, generation X and Y are becoming the key demographic groups for on-demand medicine. And third, CX measurement is reaching a point where we can capture fault lines through the various touch points with those patients.
These three macro trends make on-demand medicine the perfect starting point to begin a CX revolution in healthcare. Listen to your patients. Create a speak-up culture. Find out what the hassles and missing needs are. Solve for amazing.
As they say at Disney: “We do what the moment requires.”
Please join us at our 12th annual ConvUrgentCare On-Demand Strategy Symposium in Scottsdale, which will take place January 27-29, 2020.
 Kim, Miran & Vogt, Christine & Knutson, Bonnie. (2013). Relationships Among Customer Satisfaction, Delight, and Loyalty in the Hospitality Industry. Journal of Hospitality & Tourism Research. 39. 170-197. 10.1177/1096348012471376.