How To Transform Your Organisation By Centring On The Customer

I’d like to re-start blogging by sharing with you what shows up for me as a most enlightening and inspiring tale of leadership, customer-centricity, and organisational transformation.  Let’s start.

I encourage you to listen to Dr David Feinberg tell his story

When Dr. David Feinberg arrived at UCLA’s executive suite, the majority of patients said they wouldn’t recommend the hospital to a friend — even if the hospital saved their lives. He went on to transform the organisation. How did he go about it? I’ve listened to his story and I say it is well worth listening to him because it is a story from the man who has lived the experience – not an academic, not a guru, not a consultancy…..

You can find out by listening to Dr Feinberg share his story.  If you are not in a position to listen to his story then I have extracted the following highlights for you and me. Please note this post is long and it will reward only those with a genuine interest in leadership, customer-centricity, and organisational transformation.  Let’s start.

He started by talking with and listening to customers every day and in person

“What I did, and what I have done every day over the last six years, I went up and met with our patients… I knocked on the door ‘Hi, I’m Dr Feinberg. Can I sit down?’ And I’d ask how the care was, how were things going. I did this for 2 to 3 hours every day for the first three months.”

What did Dr Feinberg learn from his talks with patients? He says he learnt two important lessons:

1.  “At UCLA we perform miracles…. We do very high end high touch stuff”

2.  “The compassionate side we were missing. No-one [patients] knew who was in charge of their care. Nobody knew what was coming next in their care…… hot food that was never hot, cold fold that was never cold. The place was dirty. Two thirds, despite us saving their lives, would not refer us to a friend.”

Was Dr Feinberg or the UCLA hospital system under any pressure to make any changes? “After eight days in the job, US News and World Report changed our ranking from 5th best to the 3rd best hospital.”

So why did Dr Feinberg end up taking a stand, being a leader, making changes and eventually transforming the organisation? On the very day that UCLA moved from 5th best to 3rd best he met a patient who told him that he could not get a bed pan. As Dr Feinberg says, when you need a bad pen you need a bed pan!

Dr Feinberg comes face to face with complacency and ridicule

“I talked to the team. Why do we not have enough wheelchairs and bed pans?”

Their response? “We can never be like those other places. We are an academic medical centre, we are about curing ….. these are minor issues.”

Dr Feinberg goes on to shares his encounter with a 16 year old girl dying of leukaemia:

“Met a sixteen year old girl dying of leukaemia. The tv did not work in her room… did not have lot of family.. soap operas were her connection to the outside world… developmental age of 12 due to illness. Went back to the executive suite ‘We got to get the tv fixed upstairs! They laughed at me and gave me a screwdriver.”

Exercising leadership and focusing on patient

“After about three months of doing this I said ‘We’re going to focus on the patient. We’re going to take are of patients the way I want my family to be cared for.'”

How did the rest of the team react to this stance, this declaration, this exercise of leadership? “People looked at me as if I was crazy and said ‘We should have never hired a psychiatrist… We’ve done customer training before, I’ve got the coffee mug. Why are we doing this again?'”

Focusing on one thing and exercising leadership by living the stand

Faced with this resistance and being in the role only as an interim, Dr Feinberg sought advice. “Mentor of mine told me stay focused. Stay focused on one thing. And that can be something you can drive through the organisation.”

What did Dr Feinberg do? He lived his stand, he became a living example of the desired commitment and behaviours.  “I got the girl’s tv fixed. I helped patients to the commode. I went down to the pharmacy to get meds. I pushed patients in wheelchairs. And I still pick up trash all the time.”

Results: great accomplishment or cream of the crap?

“Went from 38th percentile to 99th percentile on question of would you refer us to a friend. Six thousand hospitals in the USA, we’re ranked at the very top…… academic-teaching hospitals, we’re ranked No1 on would you refer us to a friend.”

When I heard this, this statistic showed up as a fantastic accomplishment. What does Dr Feinberg say about this accomplishment?

“That actually sucks. To get 99th percentile on patient satisfaction, in my industry, 85 out of 100 checked the box. So, I say we are the cream of the crap. We now have brand new buildings. We have got great structure and customer service programmes that we developed over the last five or six years to sustain this. We’re making lots of money. We have the best doctors and nurses in the country. And yet out of the last 100 people we’ve taken care of, fifteen of them would not refer us to a friend.

By definition these fifteen people are somebody’s mom, somebody’s brother, a child, a co-worker, a parent etc. Occasionally you meet people with unrealistic expectations maybe 1 or 2 out of the fifteen, but the other thirteen or fourteen people are like you and me..

My journey hasn’t stopped at all…. Still have a long way to go to get 99 out of 100 people, not 99th percentile, telling us how great we’ve done. “

On turning a vacuous mission statement into a meaningful-compelling one

“About five years ago … I don’t know what our mission statement was. It was something like ‘We’re UCLA. aren’t you lucky you get to see us’ cause that’s how we acted. We changed that ‘Our purpose is to heal mankind one patient at a time. And we do that by alleviating suffering, promoting health, and delivering acts of kindness.”

Is the reference to acts of kindness just marketing or CEO fluff?  Dr Feinberg shared the example of a grandmother dying of cancer whilst her daughter was delivering in San Francisco. The nursing staff, without asking for permission, flew in the daughter so that the granddaughter could be held by grandmother before she passed away.

What was the business impact of this mission?  Dr Feinberg mentions that UCLA has the ability to recruit and retain the best. And “deliver incredible volumes [of patients] to our institution”.

Flip it: shifting from provider-centric to customer-centric orientation

“I really believe if we get it right in  the room with the patient, that everything else will take care of itself….. The way we thought at UCLA … the illness didn’t begin until they got to us. Really the illness begins after that family when mom might have cancer or when the elderly parent falls. I think it’s our job to engage with our patients in a way that we connect with them from the second they call us until they are back in girls scouts, back doing their work, or back living independently.

What we had done historically, in healthcare, is create times when you came to see us in the medical profession and we used you as inventory and lined you up. And it was what we would call provider centric instead of patient centric.

So we are changing our waiting rooms…. Patients who come to see us will have a smart card on their dashboard. So when they come to see us, we know we have four minutes to get ready before they arrive upstairs. And we’ll have the room ready before they get upstairs. And the waiting room will be for the doctors waiting to see the patient. Patient will be in the room.

When you just flip it and take it as the view of the patient it becomes really clear what you need to do.

When we have clinic retreats now, when we talk with leadership, we never start a meeting without a patient being present and holding us to accountable.”

Breakdowns: what happens when staff members hear directly from the customer?

The access to breakthroughs is provided by breakdowns. Dr Feinberg seems to have an intuitive understanding of this.  In his talk he tells the story of 63 year old woman who turns up at UCLA at 2am in the morning. Here is the sequence of events:

2am – she turns up at emergency centre with abdominal pain.  Scans are done on her. She is told that she needs to have her gall bladder removed. Husband is sent home and asked to come back for 6am. He leaves the hospital taking his wife’s purse and coat.

Medical staff re-read the scans, determine the woman is OK and tell her she can go home. She asks for a taxi voucher to get home (9 miles away) as husband has already left with her purse. She is told she doesn’t qualify. She finds a few dollars in her sweater and takes taxi part way home.

Husband meets her half way and drives her home. On reaching home, phone rings and UCLA asks her to come back in for surgery: UCLA have re-read her scan and determined this is an emergency. Husband and wife drive back to UCLA where her gall bladder is successfully removed.

In recovery, she is asked to sign a consent form – to be tested for HIV. Why? UCLA made mistake: used a syringe on her that they had used on a previous patient. Test comes back negative.

What does Dr Feinberg have to say on the matter?

“Talk about this a provider centric way… we did a phenomenal job! We took out her gall bladder successfully. We didn’t give her an infection. But if you thought about that as your mom, how pissed off are you?

I brought together everybody who had anything to do with her care: valet parking, emergency room, transporters, social work, OR staff, ER staff, everyone from billing, collecting and IT….. She came in and told her story… She tells it a lot better than I do, there’s a lot more feeling….

What happens when these people hear the actual patient? Incredible things happen in the organisation. Nobody will ask twice for a taxi voucher at UCLA again. We had all kinds of policies about how not to use syringes twice….But now because her story is connected to it, I go to bed at night really believing that there’s a greater chance that we’re not going to mess up. There’s a real sense that that person and that face is connected to everything we do.

Did Dr Feinberg follow best practice: devise a strategy, follow a formulaic model, develop plans and then execute? 

“The journey has included a lot of changes and it sounds like we know what we were doing. I want to tell you that I had no idea what I was doing. I do know that we were focussed on getting it right for that very next patient”

Other lessons

Dr Feinberg points out the critical importance of:

1. selecting the right talent in the right way. In particular, he points out the need to recruit people  who are both competent AND have the service mindset; 

2. codifying and communicating the expected behaviours during the induction (on boarding) process; and

3. rigorously measuring and communicating performance against these behaviours.

On the second point, he states that UCLA clearly spell out and train their staff on:

– how to go in and introduce yourself to a patients;

– how you ask permission before you touch patients;

– how you explain what is coming next;

– how you tell patients when you’re leaving and do they have any questions.

“In the past it was you’re a nurse, your a doctor come on in and take care of the patient. No patient at UCLA gets touched without permission, everybody introduces themselves, everybody gives their name and cellphone number.

I give my cellphone number out probably 100 times a day to patients and say call me 24 hours a day if there’s anything that I can do to assist you and your family.

We don’t always get it right, there are plenty of challenges that face us. I do believe being centred around the patient is the right way to go.”

Timpson: shifting/transforming culture through ‘language and practices’

Why did John Timpson commit to making this shift in culture?

This is what he says:

“I am embarrassed that it took me 22 years as a Chief Executive before I found the secret behind good personal customer service.  But i’s true.  I didn’t discover Upside Down Management until I met Ian Siddall at UBS……  I learned that we faced a new threat, a competitor with more money than I could possibly imagine, who was well placed to inflict major damage to our business.  He could have opened shops next door, bribed our best people to jump ship and undercut our prices.  To survive we had to be good at shoe repairing and key cutting, engraving and watch repairs and be great at looking after our customers.”

What are the  fundamental principles behind Upside Down Management?

There are five fundamental principles:

  1. All colleagues have the freedom to do their jobs they way they choose;
  2. Every boss’s job it to help his or her team;
  3. No KPI’s, no boxes to tick;
  4. Bosses don’t issue orders;
  5. Head Office is a helpline – it does not run the day to day business.

What does it take to make this shift in culture?

I suspect that some of you are confronted by this.  Upside Down Management is not just some change from ‘business as usual’ (command and control management), it is transformation – a genuine one akin to that of the caterpillar and the butterfly.  What does it take to make this shift?  Is it a question of technique or implementing a new information technology?  No, it requires an existential quality – courage.  Here is how John Timpson puts it:

Upside Down Management isn’t for wimps, it’s for managers with the courage to give people their freedom……….. It took me 10 years to ingrain this way of working into our culture.  My deepest thinking colleagues realise that this is never ending project…….’We always live on a tightrope – it wouldn’t take long for the magic dust to disappear‘”

How easy was it get the people in the organisation to step up, embrace, live into/from Upside Down Management? Here is what John Timpson says about that:

“I put an upside down chart on the front of our weekly newsletter and wrote a letter to everyone explaining my new philosophy, but nothing changed…..  What I proposed was so contrary to the way a normal business is managed that they simply didn’t trust me.  I discovered that lots of people like rules; they don’t want the freedom to make up their own mind.  The rules give a degree of comfort, providing something to complain about and something or someone else to blame.” 

And here is a revelation about the role of the middle managers in any culture shift:

One of our biggest challenges is to get area teams to treat their people the way we want………  It was only when I spent a day out with one of the most experienced that I understood why they seemed to be so uncooperative…… Then he revealed the real problem.  ‘Apart from anything else,’ he said, ‘if I let my assistants do my job, what will be left for me to do?’  That comment made me realise my mistake.  I had changed the job of an area manager but I hadn’t described what their new job was or how to do it.”

Shifting the culture through language and practices

I say that shifts in organisation culture occur through the heartfelt and persistent shift in the language and practices of the CEO and the Tops.  When I use the term ‘language’ I mean more than speech, with ‘language’ I am pointing at everything about the CEO that speaks to people who come into contact with the CEO.  If the CEO comes into meetings late that speaks to people.  If the CEO dominates talk and shoots down anyone that disagrees with him then that speaks to people.   Allow me to give you an example, back in the 90s Ernst&Young got a new ‘CEO’ and he asked partners to ‘give up their offices’ as they took up a lot of space and were rarely used.  Nothing changed.  Then the new ‘CEO’ gave up his office, this spoke to some partners and they followed in his tracks, and then more followed.

So what did John Timpson do to get the people in the Timpson shops to get that he was serious about Upside Down Management?  Through language that spoke powerfully to everyone – the customers, the staff in the shops, the area managers.  Here is how he puts it:

After a time I realised that just telling people that they’ve got the freedom to act was not good enough.  I had to give them examples of what that freedom meant, so I stuck a notice up in every branch:”

I want to draw your attention to a feature that is so important and you might miss.  John Timpson, the CEO, went in person to each of the retail shops and stuck that notice up in every one of them.  He did not delegate to anyone else.  He didn’t just visit one shop – he visited every single shop.  This is powerful language, I say the most powerful language.  It says this is mine, I own this, it matters to me, I mean it, I trust you, I take responsibility.   It occurs to me that here you have an act of leadership and an existential commitment that is in the same vein as the American Declaration of Independence signed by the founding fathers of the USA.

Now onto practices,  these are not exhaustive and yet should give you a good insight as to what I am pointing at when I say that the access for shifting culture is to shift ‘language and practices’:

Notice, the change in ‘language’ around the Head Office.  The most obvious example is the change in name from Head Office to Timpson House.  The less obvious is the fact that no-one is allowed to use the term Head Office.   And that is accompanied by practices that do genuinely take away Head Office.  Put differently, a Head Office that does not have the right/authority to issue edicts and expect compliance is no longer a Head Office.  Which is my way of saying that the ‘language’ and ‘practices’ have to complement one another to be effective in shifting culture.  Finally, notice how the practices tie up as a whole under an overarching philosophy around doing business.  The philosophy guides the language and practices and in turn the language and practices give life to the philosophy – a virtuous circle.

For those of you grappling with culture and culture change, you might want to read the two earlier posts I wrote on culture change:

Culture change: what does it take to change culture in business? In banking?

‘Collaborative customer-centric’ culture: what does it take to make the shift?

This post concludes this mini-series on culture and culture change.  I hope that you have found at least some of it disturbing / thought provoking.  Last tip/POV – most of the stuff out there on culture change is mistaken and not useful, it really isn’t because it works from a mistaken view of human beings. If you want a more useful access to people and culture then contact me I can point you in more useful directions.