A competitive edge

As health care consumers get more savvy and patient care advances, hospitals need to respond with new levels of customer service.

No longer is it acceptable only to deliver solid medical care – hospitals have to deliver an experience.

“It used to all be focused on clinical care…but every hospital is working toward the same standards and a lot have risen to the top, so now it’s how you distinguish yourself as a hospital,” said Christopher Cauch, regional director for quality management at St. John Medical Center in Longview.

“If you have a choice as a consumer where you receive medical care and the standard of care is pretty much the same across the board, you’re going to go where you feel you’re treated as a person.”

Customer service is essential in building a hospital’s reputation and bringing in repeat customers, and yet it’s often an afterthought in health care organizations, said Jonathan Avery, hospital administrator of Legacy Salmon Creek Hospital.

But three area hospitals say they certainly are not ignoring it.

The ‘wow’ factor

Southwest Washington Medical Center has employed a national consulting firm to help implement leadership practices that the hospital is hoping will lead to a culture of better customer service – starting at the top.

Customer service is common sense – doing the right thing for the patient, said Dan Keteri, vice president of patient care services at Southwest Washington Medical Center.

Keteri was one of the first proponents of implementing the Studer process several years ago.

“Basically, it means doing the right thing for the customer, even if that means the rules go the wayside sometimes,” he said. “If someone needs their dog, they can bring the dog. You’re there for the patient, not vice-versa.”

The hard part is changing the culture of an entire organization, he said, and that’s why changes have to start from the top down.

The time is coming when the hospital will begin “coaching managers up, or coaching them out,” Keteri said. “We can’t tolerate substandard management or patient care. We have to deliver excellence.”

The hospital wasn’t bad before, he said, just average.

“My philosophy is, when is it ever OK for a patient to have a bad experience?”

The Studer process emphasizes strong communication among staff and recognition of achievements. The goal is hard wiring the values it teaches into the organization so that excellent customer service happens all of the time with all of the hospital staffs – the day, night, holiday and weekend staffs.

A Studer coach comes on-site every month to meet with leadership, and two days a quarter, every manager in the hospital – about 175 people – are taken off-site for training.

The financial investment was huge. Keteri didn’t know the actual cost, but said it was in the hundreds of thousands of dollars.

With the hospital’s recent financial trouble that led to layoff of about 50 staff members, “it’s huge that this didn’t go away,” Keteri said. “That says to me this is a priority, and it’s going to work.”

The point of focusing on customer service, he said, is developing patient loyalty.

The hospital contracts with a national research group that conducts patient surveys specifically looking at the patient experience.

In 2005, 51 percent rated their stay as excellent, which increased to 54 percent in 2006. So far in 2007, Keteri said the hospital is holding its gain, and less then 3 percent rated the quality fair or poor.

During that time period, 88 percent of respondents said the quality was good or excellent, but Keteri said only with excellent care does the hospital get patient loyalty.

Ideally, he would like to see more than 68 percent excellent ratings, which would place it in the top 10 percent in the nation.

What garners those percentage increases is the “wow factor,” like making post-discharge phone calls to most patients to ensure they’re recovering well, have the proper prescriptions and refer them to resources to avoid readmissions.

Staff also has been known to record a patient’s favorite soap opera while they’re in surgery or giving a jacket to a patient being discharged on a cold day who doesn’t have one.

Starting from scratch

At Legacy Salmon Creek Hospital, leaders had the unique opportunity almost two years ago to open a new hospital and design its own practices.

Leaders implemented a “Values in Action” orientation class that every employee in the hospital from housekeepers and security staff to physicians and administrators participated in.

“When we opened the doors, everybody was in the same place, and we were able to hire with what we wanted in mind,” said Lani Gaskill, director of patient care services.

The class included the “Give ’Em the Pickle” approach to customer service – i.e. what patients want, they get.

It’s the idea that customer service is the hospital’s number one priority, said hospital administrator Jonathan Avery.

That includes staff bringing positive attitudes into the hospital and working with other staff as a team.

The hospital was designed with that customer-service value in mind.

It doesn’t have visitor’s hours because when patients need their family, they need their family, Gaskill said.

All rooms are private with built-in daybeds for visiting family, valet parking is available for the medical office buildings and there is a three-bedroom apartment built into the Neonatal Intensive Care Unit that has a full kitchen and laundry facilities.

Those details are being noticed, Avery said.

Eight out of 10 patients gave the hospital quality a score of nine or 10 out of 10, beating the Northwest average of 63 percent. And 85 percent would strongly recommend it to their families and friends, again beating the Northwest average of 69 percent.

Volumes at the hospital also are increasing. In its first year, the average patient count on any given day was 51. In 2007 it was 81 and in July, it was 99.

The same goes for the Emergency Department.  Its first year, the department averaged 88 daily visits, and in the first quarter of this fiscal year, the average was 135.

Establishing the three-hour customer service program initially cost about $75,000, and Avery said it was money well spent.

“Nobody wants to be here, so it’s our job to make it the best journey a patient can have,” Gaskill said.

We are listening

At St. John Medical Center, hospital staff is beginning to incorporate patients into leadership committees to ensure their needs are being met.

The approach allows patients to take information back to their communities, while allowing the hospital to improve with their input, Cauch said.

“A lot of experience patients have is word of mouth,” he said. “If they didn’t have a good experience, their family and friends are going to hear about it. Word gets around quickly.”

There are three committees geared specifically toward customer service, and the hospital also has a full-time patient advocate, whose entire job is to listen to patients and answer their questions and concerns. Cauch said the advocate is very widely used.

Like Southwest and Legacy Salmon Creek, St. John contracts with a research firm that conducts patient surveys. Results were not available.

It also has “Dove boxes,” placed around the hospital campus where patients and community members can report their experience.

“And we are listening,” Cauch said.



Local success with a national consultant

The Studer Group is a national health care consulting firm that focuses on evidence-based practices to allow hospitals higher employee retention, greater patient and customer satisfaction and healthy finances.

Studer coaches can work on-site, one-on-one with hospital managers to reach that organization’s goals.

Southwest Washington Medical Center officially began contracting with the company a year ago, and has started seeing pockets of success, said Director of Marketing Chad Dillard.

What that means day-to-day in the hospital is greater communication, and it starts at the top.

The CEO “rounds” with executive staff to chat about work, life and to find out who’s doing an outstanding job. Then the executives round with hospital directors, who round with managers and so on and so forth.

At each level, the feedback is summarized and brought back to the level above to give administrators a solid idea of how the hospital is actually running.

A major component of these rounds is recognition of staff who are performing well with thank you notes. In the notes, a supervisor should recognize the hard work while mentioning who he or she heard the good deed from. The intention is to instill a feeling that the employee’s hard work has been noticed and discussed.

Similarly, hospital staff round with patients hourly. The hospital has found that doing so has reduced the use of call lights because patients know they will be seen regularly, so “what’s the point of calling if you know someone’s coming in 10 minutes anyway?” said Dan Keteri, vice president of patient care services.

This leaves staff time to do their routine work and ups productivity, he said.

Other important keys are employee selection – good employees don’t have to be taught customer service skills –  and leadership accountability.

With accountability, staff turnover and vacancy rates go down.

The top two reasons employees leave their job is a poor relationship with management and working with an incompetent workforce.

“If you tolerate low performers, high performers will leave,” Keteri said.

—Megan Patrick



A locally-grown customer service approach

Legacy Salmon Creek has implemented Bob Farrell’s “Give ‘Em the Pickle” training, a popular customer service training program based on a singular experience that defined the Portland-based Farrell’s Ice Cream Parlour and Restaurant approach to service.

As the story goes, a longtime Farrell’s customer ordered his usual – a #2 burger and milkshake with an extra slice of pickle. The new waitress – wanting to follow the letter of the sales policy – offered to sell the customer a side of pickles for $1.25. When he balked, she offered him a single slice for a nickel. Offended, he fired off a note to Bob Farrell and Farrell gave him a free hot fudge sundae and started the “Pickle Principle,” which he applied to all of his ventures and marketed worldwide as a customer service training approach. The organization offers extensive company training, complete with DVDs and office paraphernalia like posters and pocket cards.

Visit www.giveemthepickle.com.

– Jessica Swanson