If Disney Ran Your Hospital

1. If Disney Ran Your Hospital Some Things You Would Do Differently Fred Lee

2. 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. 3 Key Premises Culture is driven by management systems, not workers or values.

3. If Disney ran your hospital you would… Focus on What Can’t be Measured Make Courtesy More Important Than Efficiency Regard Patient Satisfaction as Fool’s Gold Measure to Improve, not to Impress Decentralize the Authority to Say “yes” Change the Concept of Work from Service to Theater Harness the Motivating Power of Imagination Create a Climate of Dissatisfaction Cease Using Competitive Rewards to Motivate People Close the Gap Between Knowing and Doing Table of Contents

4. 1.Focus on What Can’t Be Measured

5. “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 On Measurement

6. Measurement Outcomes Perceptions Satisfied Loyal fan Clinical Financial Good to Great

7. Place of choice Reputation improves Customers sing our praises Processes improve Productivity improves Costs go down Talent Perceptions Emotional Skills Impact of PI on Total Quality Total Quality PERFORMANCE IMPROVES Analytical Skills Outcomes

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

9. 2.Make Courtesy MoreImportant Than Efficiency

10. Disney’s Quality Priorities 1. Safety Courtesy Show Efficiency

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

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

13. 3.Consider Patient Satisfaction Fool’s Gold Wilderness Lodge

14. 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. In Commercial BusinessesResearch on satisfaction shows… Harvard Business Review, Nov-Dec, 1995

15. +2 +1 0 -1 -2 -3 Meeting expectations = 0 4 Satisfied = 0 Why is it so hard to raise our scores? Satisfied patients have no story to tell Hampton Inn, huddle

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

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

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

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

20. 6.Change the Concept of Work from Service to Theater

21. Experiences The progression of economic value Stage Services Disney is not a service and neither are we. Deliver Goods O V E R T I M E Since 1900 Entertainment? Make Commodities Extract Joe Pine, The Experience Economy

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

23. Companies stage an experience whenever they engagecustomers, connecting with them in apersonal, memorableway.” Focus on the patient’s experience, not our service… “They actually occur with any individual who has been engaged on an emotional, physical, intellectual, or evenspirituallevel. The result? No two people can have the same experience – period.” B. Joseph Pine II, The Experience Economy

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

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

26. Borrowing from Theater 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 DIRECTOR:

27. Borrowing from Theater 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. THE ACTOR:

28. Eric Morris, No Acting, Please (first sentence) Acting is the art of creating genuine realities on the stage. No matter what the material, the actor’s fundamental question is: “What is the reality and how can I make it real to me?” Acting must “come from a real place.” To paraphrase… Care giving is the art of creating genuine realities on the hospital stage. No matter what the event, the caregiver’s fundamental question is: “What is the reality of this patient’s experience, and how can I make it real to me?” Compassion also must “come from a real place.” Acting is not pretending…

29. From patient satisfaction – to a fan with a story to tell From just being courteous – to engaging the guest From our service excellence – to theirmemorable experience Theater changes the service paradigm…

30. 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) Theater changes the service paradigm…

31. 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 dowhat it takes every day, and do it permanently, not just in short bursts of inspired energy. Knowing how is not the problem…

32. What is the value of a committed ensemble of care givers who have become compassionately engaged in the patient’s experience? W. Edwards Deming might add…