ASQ - Team and Workplace Excellence Forum

Online Edition - May 2001


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  Special Feature: Behind the Teams

Just What The Doctor Ordered
Large Group Engagement Strategies Accelerate Service Recovery Program

Most likely at some point in our lives, we’ve been a patient in a hospital and there’s a possibility we weren’t thrilled about the service. Whether it was the infamous hospital food, being forgotten in the recovery room or waiting for someone to bring you a pain reliever, almost everyone has a story. Most health care professionals agree that there is an inherent link between patient or customer satisfaction and employee satisfaction; but how can it be justified?
  There are integrated teams in the manufacturing and service industries, but what about health care? With the help of AQP’s School for Managing and Leading Change, the University of North Carolina Hospitals, Chapel Hill, realized the importance of assembling a team of senior-level vice presidents and representatives from the quality, clinical diagnostic services, support services, nursing and public relations departments. Each was chosen because they were involved on a daily basis in trying to improve patient and employee satisfaction.

Your mother is scheduled for gall bladder surgery at 9 a.m. at your local hospital. You have dutifully taken a half-day off from work to be with her and your father. All is going according to plan and you should be back in the office for a meeting with your regional vice president by 1 p.m. Arriving at the hospital at 8 a.m., you locate the floor nurse who informs you that they will take your mother from her room at 8:45 and suggests you and your father grab a quick cup of coffee. You agree. You and your father return to the room by 8:30 and visit with your mother who, while sedated, is slightly anxious. For the next 45 minutes, nothing happens. No one comes to check on you or your mother. At 9:30 you track down the same floor nurse who says it will be at least another hour. That hour turns into three and your mother is worried, your father is worried and you are angry.

  Unfortunately this scenario occurs all too often in today’s health care industry.

  But, if your mother were at the University of North Carolina (UNC) Hospitals, you most likely would have had a staff person attempt to make up for this inconvenience. Maybe something as simple as a free parking permit or even a meal in the restaurant—all symbolic of the UNC Hospitals’ commitment to patient satisfaction.

  UNC Hospitals are the cornerstone of the UNC Health Care System. People from all 100 North Carolina counties and throughout the Southeast are patients at the 684-bed facility—more than 27,000 each year. And more than 2,500 new Tar Heels are born each year at UNC Hospitals. In 2001, new babies and their families will be welcomed in the new N.C. Children’s Hospital and N.C. Women’s Hospital, state-of-the-art facilities designed to offer high-quality health care in a comfortable, family-friendly environment. From well-baby check-ups and chronic disease care to life-saving surgeries and cutting-edge gene therapy, UNC Health Care is improving health and treating disease across North Carolina. In addition to comprehensive medical, surgical and psychiatric care, UNC is a leader in health promotion and disease prevention.

Linking Patient Satisfaction to Employee Common—Not Scientific—Sense
Most health care professionals agree that there is an inherent link between patient or customer satisfaction and employee satisfaction. Unfortunately, scientific evidence is not readily available to support that claim. And in a field driven by clinical trials and scientifically based decisions, that can be a problem.

  Peter Barnes, vice president of human resources for the University of North Carolina Health Care Systems, wanted to find a way to solidify the link. His solution: Bring a team of multi-level, multi-functional health care professionals and the organization’s leaders to AQP’s School for Managing and Leading Change.

  The School for Managing and Leading Change is about organizational change through engagement and choice, rather than change through direction and inducement. The school brings together organizations from diverse sectors of communities or regions. Teams from health care, government, education, not-for-profit and business convene for a series of workshops over four to six months. Its basic theory is that the old story of re-engineering or “change management” was based on the belief that change can be “installed” if we can just get the engineering right. While the concept is logical, it suffers from its mechanistic nature and its tendency to produce reactive employees and cosmetic results. Everyone realizes that this is not producing the change that’s required. The new story is based on the belief that there is a technology to engage others in action, and to create workplaces and communities that achieve sustained results and a better quality of life. The School for Managing and Leading Change’s powerful methods for employee and citizen engagement eliminate the need to convince and sell people on the idea that change is good for them.

Managing Change is the Name of the Game
So why would Barnes believe that intensive workshops on managing and leading change would help University of North Carolina Health Systems establish a link between employees and patient satisfaction?

  “My gut feeling was that the organization was going to have to undergo some significant changes. Not necessarily to drive the link between employee and patient satisfaction, but just to participate and understand it. We had been looking at this for a few months and knew that the task was gargantuan and significantly important to our future,” recalls Barnes.

  Barnes, with the help of AQP’s regional partner, The Learning Consortium, assembled a team of senior-level vice presidents and representatives from the quality, clinical diagnostic services, support services, nursing and public relations departments. Barnes chose each because they were involved on a daily basis in trying to improve patient and employee satisfaction.

  “The School for Managing and Leading Change taught us to look at the impact of change on both employees and patients and how the change process should really view the two as individuals with needs and concerns that couldn’t be addressed in a vacuum,” states Barnes.

  One of the major changes was employee morale about the profession in general. “Health care is not a popular profession or preferred career choice for many and its image is very embattled,” emphasizes Barnes. “And the new economy has left it behind. We wanted, and felt it was important, to show employees that health care is a great and noble profession. We had been running focus groups and conducting in-depth interviews and were well aware that morale was low and the stressors were high.”

High Risk 24/7 Environment
And it is no wonder. Most health care facilities suffer from, for example, nursing shortages and shortages of several professional groups.

  Hospitals are the epitome of a 24/7 environment. But unlike the glamorous dot-comers, stress is rampant, and contrary to popular belief, pay is low in comparison to high-tech wages and there are no stock options. In fact, according to Barnes, hospitals are not making a profit and no hospital gets paid fully for all of its services. “I often theorize that hospitals should run ads showing what we pay for the drug you are given, or what this prosthesis costs when we purchase it from the vendor. The public, in general, has a very unrealistic understanding of the actual cost of health care. And unlike manufacturing, you cannot import health care from developing countries or economies and you do not want the lowest cost products in every case—it is a human interaction business.”
  As a result of the team’s participation in the School for Managing and Leading Change, University of North Carolina Hospitals changed their patient satisfaction tool and began communicating results back to the staff more frequently. Previously this data was communicated annually only to those directly involved in patient care. Now, it is distributed quarterly to everyone through managers and supervisors who are expected to discuss the importance of the customers’ opinion.

  In addition, the organization formed a change management group. This group routinely feeds advice and information to the Quality Improvement Council, and they are taking a visible leading role in change management by overtly looking for ways to work with staff people using the techniques of engagement learned in the workshops.

Establishing a Continuum for Service Recovery
For example, University of North Carolina Hospitals are currently utilizing several small group engagement principles and techniques in a pilot service recovery program. A service recovery program involves handling a patient or caregiver when their expectations have not been met—when service has lapsed. University of North Carolina Hospitals’ engagement program involves employees from pre-anesthesia, day-op, operating room and recovering room in establishing a continuum for service recovery.

  “We are developing engagements where we can help these departments help us implement service recovery,” says Barnes. “Unlike quality circles, these departments are not collecting data or new techniques, but are taking personal responsibility and are empowered to implement service recovery.”

  The issue for Barnes is displaying to the entire staff that there is a recognition and need for standards of service, and that despite what happens, employees can recover back to those standards of service. “If a patient had to ring the buzzer six times to get a nurse’s attention, that might be a lapse of service even if the nurse was occupied with another patient and couldn’t respond quickly enough. We want individuals to feel empowered to recover the patient’s expectation and to be able to apologize, explain and empathize. We want them to feel engaged in those standards. It might be as simple as saying, ‘here is a coupon for free parking or the gift shop’ and discovering how can we make it better,” says Barnes. “It really is the same concept that other high-profile service industry leaders teach their employees to say, “We are sorry. What can we do to make this better?” Health care professionals generally do not say they are sorry for small inconveniences that the patient experiences, which is not the way it should be.”

  University of North Carolina Hospitals’ experience with the School for Managing and Leading Change was so successful that plans are underway to send a second team through the program. And Barnes is well aware that changes of this type take a long time to implement saying, “We are not where we want to be yet, and the journey is really just beginning.” But nonetheless, it is time and energy well spent.

  The University of North Carolina Hospitals may not have found the scientific link between employee and patient satisfaction. But one thing is for certain, patients should notice a difference and employees will understand their role in providing outstanding health care.



May 2001Homepage



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