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.”

Customer Experience: What Can We Learn From An Organisation That Kills It’s Customers?

I am coming out of my self imposed August retirement to write about something that calls to me, deeply. And to share with you insights and learnings which show up for me as being valuable if you are up for improving service, orchestrating a caring customer experience, and improving organisational effectiveness.

What can we learn from an organisation that kills its customers?

The NHS is more than an organisation it is an institution. Like the BBC, it used to be an institution that was held in affection and even revered. It was an organisation and institution to be proud of. It is also an institution that has been draining resources and has been subjected to the management mindset obsessed with targets, measures and an obsession to drive down costs.  The result? This institution has been killing its customers and driving out employees (managers, doctors, nurses) that raised concerns about the functioning of the organisation and the treatment of customers – the patients.

The Berwick report on patient care and patient safety in the NHS

How does the Berwick Report on patient care and safety begin?  It begins with this assertion:

Place the quality of patient care, especially patient safety, above all other aims.

Engage, empower, and hear patients and carers at all times.

Foster whole-heartedly the growth and development of all staff, including their ability to support and improve the processes in which they work.

Embrace transparency unequivocally and everywhere in the service of accountability, trust and growth of knowledge.

How is this relevant to business and the customer experience?

When I read this opening passage it struck me that the same is true for organisations who genuinely want to compete with the likes of Amazon, USAA, and John Lewis.  As such I have modified this opening passage so that it speaks to business:

Place the quality of customer care, especially the customer experience, above all other aims.

Engage, empower, and hear customers and customer facing employees at all times

Foster whole-heartedly the growth and development of all staff, including their ability to support and improve the processes in which they work.

Embrace transparency unequivocally and everywhere in the service of accountability, trust and growth of knowledge.

Who killed the customers? And what can we learn about what drive organisational behaviour and performance?

When breakdowns occur our temptation, those of us who live in the West and speak the English language, attribute agency and cause to people.  Put differently, we blame people for the breakdowns. In the world of business the blame gets placed on the employees. In the NHS the politicians, the managers and the media have placed the blame on doctors and nurses.

What does the Berwick report say? It says “NHS staff are not to blame.”.  It goes on to say:

Incorrect priorities do damage: other goals are important and the central focus must always be on patients. 

In some instances……clear warning signals abounded and were not heeded, especially the voices of patients and carers. 

Fear is toxic to both safety and improvement.

In the vast majority of cases it is the systems, procedures, conditions, environment and constraints that the NHS staff faced that led to patient safety.

As I read these words my experience working in and consulting with many businesses comes to mind. And I say that these sage words apply equally insightfully to the world of business.

I draw your attention to the assertion “Incorrect priorities do damage”.  And the recommendation that “the central focus must always be on patients.” Now I ask you, is the central focus of your organisation on the needs/concerns of your customers?  And how do the real priorities of your organisation match the talk about customer focus and customer experience?  Is there a big gulf?  That has been the case with the NHS for many years now. The Tops speak the right words, their actions have not been alignment with their words.

What are the recommendations? 

Recognise with clarity and courage the need for wide systemic change.

Abandon blame as tool and trust the goodwill and good intentions of the staff.

Make sure pride and joy in work, not fear, infuse the NHS.

Reassert the primacy of working with patients and carers to achieve healthcare goals.

Use quantitative targets with caution. Such goals do have an important role en route to progress, but should never displace the primary goal of better care.

Recognise the transparency is essential and expect and insist on it.

Let’s rewrite that for business and private sector organisations which genuinely want to excel at the Customer Experience game:

Recognise with clarity and courage the need for wide systemic change if you are to orchestrate and deliver experiences that work for customers and call forth their loyalty.

Abandon blame as tool and trust the goodwill and good intentions of your staff. 

Make sure pride and joy in work, not fear, infuse your workplace even the call-centres. 

Prioritise working with your customers and customer facing staff to achieve your business goals.

Use quantitative targets – like first call resolution, AHT, NPS etc.- with caution. Such goals do have an important role en route to progress, but should never displace the primary goal of taking care of your customers. 

Recognise the transparency is essential and expect and insist on it.

Summing up

Excellence in customer experience is no easy matter for most organisations. What is required is courageous leadership and wide systemic change that involves the entire organisation. It is easy to work on the people. And it is also stupid because organisational performance is driven by the priorities, structure, systems, processes and practices that exist and are maintained by the Tops.

How much VoC work-investment-feedback will it take for your organisation to get off its backside and act?  Honestly, how much of VoC is really eye opening as opposed to already known within the organisation?

Why an authentic customer orientation requires a transformation (Part I)

Are we living in an age of inhumanity, hypocrisy, and moral bankruptcy?

It occurs to me that we live in an age of greed, inhumanity, hypocrisy, and moral bankruptcy.  I say that this inhumanity and moral bankruptcy both enables and is enabled by the doctrine of management.  I say it is folly of the highest degree to be applying the practices of scientific management in the 21st century. I say it is folly to expect an authentic customer-orientation when the name of the game is greed: making as much money as possible, today, irrespective of the cost as long as the cost is paid by someone else – today or tomorrow.

I am clear that the cancer of greed, inhumanity, hypocrisy, and moral bankruptcy has spread from the world of big business into just about every institution – the government, the civil service, the police, the NHS – in the UK. And into society itself.  Today we got a wake-up call, will we listen?

The NHS Mid Staff scandal: 400 – 1,200 human beings died as a result of poor care over 50 months

Let’s first get present to what has occurred.  According to the Guardian:

“An estimated 400-1,200 patients died as a result of poor care over the 50 months between January 2005 and March 2009 at Stafford hospital, a small district general hospital in Staffordshire. The report being published on 6 February 2013 of the public inquiry chaired by Robert Francis QC will be the fifth official report into the scandal since 2009, and Francis’s second into the hospital’s failings.

The often horrifying evidence that has emerged means “Mid Staffs” has become a byword for NHS care at its most negligent. It is often described as the worst hospital care scandal of recent times. In 2009 Sir Ian Kennedy, the chairman of the Healthcare Commission, the regulator of NHS care standards at the time, said it was the most shocking scandal he had investigated.”

What was the customer experience like?

Julie Bailey says head must roll. Why?   Let’s listen to her describe the customer experience:

“You only had to open a ward door at the hospital to smell the stench of urine, hear patients screaming in pain and see staff being bullied, and know that the care was appalling

My mum died in that hospital terrified of the people that should have cared for her. She was recovering from an operation when nurses dropped her and hurt her. After four days in the hospital I could see that unless I was there to feed and wash her she would have just been left without care. Even with me at her side, a nurse refused to administer a life-saving drug. My mother died a few hours later, eight weeks after going into hospital. She was a strong woman. She should never have died in there. In 2002, Dr Peter Daggett, a former senior doctor at the hospital, had already raised concerns that the hospital was out of control…”

Does this sound dramatic to you?  Not to me. My father went to hospital with a stroke.  Like Julie, I found myself at the hospital feeding and taking care of my father.  I had to threaten to go to the media to get the care that my father needed.

What led to such shocking disregard for patients – their humanity, their wellbeing?

As one trained in systems thinking and modeling it is rather easy to figure out the what kind of system structure would cause that which occurred:

– start with an inefficient system that is just about coping with existing demand;

– inject increasing unrelenting demand including an ageing population;

– cut budgets significantly whilst insisting on higher levels of service;

– demand instant improvements which are most likely to be made through headcount reductions and other simplistic cost reduction measures;

– apply pressure through targets and leave targets open to being gamed;

– introduce a management philosophy and practices that are detrimental to an ethos of care, of public service;

– ensure that there is political pressure to provide a misleading/flattering image of the beneficial effects (better patient care, more efficient NHS) of the cuts and changes to the NHS.

Viola, you have a system that will look healthily on the surface, whilst killing customers – the patients in this case.

What does Julie Bailey say?

“This shift away from patient care started to happened under the Labour government. It destroyed the culture of care in the NHS by replacing it with a top-down, target-driven culture. Former health secretary Andy Burnham contributed to this. He wouldn’t even meet the grieving relatives at Stafford hospital and he only gave us a secret inquiry so that the NHS’s dirty linen wouldn’t be aired in public.

In 2007, I set up Cure the NHS, a patient campaign group formed to highlight the poor care at Stafford Hospital, following the death of my 86-year-old mother, Bella, after she went in for a routine hernia operation. While we were campaigning outside, Peter Carter, head of the Royal College of Nursing, visited Stafford hospital. He wrote to our local newspapers saying what a good hospital it was, with good management and good staff...”

To be continued in Part II – coming soon.