Dr. Delos (“Toby”) Cosgrove, President and CEO of the famed Cleveland Clinic, wrote an article on LinkedIn recently: “Patient Experience: Time for Hospitals to Look Under the Bed.”
Cosgrove described his process of going to visit patients after heart surgery (good, which sounds like the Lean practice of “going to the gemba” to see what's really happening and it shows customer / patient focus).
During one visit (“many years ago”), Cosgrove had a patient's family tell him that he needed to look under the bed… what was there?
I looked, and to my everlasting humiliation, saw litter and dustballs. The patient and family felt neglected and disrespected – and they were right to be offended.
It's good that Cosgrove would be willing to tell this story in a fairly public forum. As I wrote about yesterday, it's important to first expose problems so we can solve problems.
When a Lean leader goes to the gemba, he or she then “asks why” and “shows respect” to the customers and those doing the work.
I'm not sure if Cosgrove's assessment of the situation seems plausible…
Ultimately, patient experience is determined by your caregivers – all of your caregivers, not just doctors and nurses. Receptionists, housekeeping, greeters, administrative staffers – they all impact the patient experience. They need to be motivated and engaged. Patient experience should be top-of-mind in everything they do. Employees will follow the agenda set by senior leadership. Administrators need to be clear about what service and experience is and why it's important; you can't let employees guess. Ask employees to imagine what it's like to be a patient or the family member of a patient. Ask them how they would like to be treated. Remind them that this is consistent with the ethical practice of medicine. Finally, explain the link to reimbursement. Medicare has begun indexing payments to patient satisfaction scores and commercial payers are following suit.
I'm not sure if staff members have lost sight of the patient being the priority. Nurses, doctors, housekeeping staff – they see patients every day.
It could be interpreted as Cosgrove falling back on a somewhat traditional management approach of blaming the workers (they aren't aware or motivated?) I wish he had asked “why?” or at least said something about this being a system issue and not being the workers' fault.
A Lean problem solving approach would ask WHY there is dust under the bed, with questions such as:
- Do we have the proper housekeeping staffing levels (in general and on each particular day)?
- Is there clear standardized work for how to clean a room (including under the bed)?
- Are there good management practices in place to ensure work can be done properly?
- Do staff have all of the tools and supplies they need?
- Do staff have enough time to do the work properly?
- Are staff pressured into cutting corners on quality in order to get the work done more quickly?
These are all systemic issues, owned by management and senior leadership.
I could think of a lot of potential countermeasures to ensure the rooms are always cleaned properly… I don't think a bunch of training about “remember the patients” would really solve that problem. There's got to be something in the nuts and bolts of the operation to be improved.
Cosgrove did make one closing point I agreed with:
The move by Medicare and other payers to reward patient satisfaction is important. But it will not make or break our institutions. The real motivation for change needs to come from the heart. Not everything can be measure by ROI. We can't forget why we became doctors and nurses and administrators. In the final analysis, we work for a better patient experience because it's the right thing to do.
Yes, sometimes it's just the right thing to do.
Coincidentally, Bill Waddell wrote a post today about how manufacturing leaders can't expect to get cycle time reduction by merely pressuring people to work faster. I think the same lesson applies in healthcare and other settings.
…these guys think you reduce the time line by measuring it and lighting a fire under people to get stuff done faster. Getting them to work faster, according to these guys requires getting people to “feel the jungle” (an absurd phrase if ever I heard one) and make an “emotional investment.”
“Threatening people is a good means of getting them to make that emotional investment in feeling the jungle. When people are working as hard as humanly possible, reduce cycle times by outsourcing or getting people to fail fast to enter a white space with a higher probability of success” – another academic soufflÃ© of a phrase.
As Bill called it — “nonsense.”
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