Going from good to great is Studer program’s goal

It’s all about service excellence’

Aligning with the health care customer service model of the Studer Group — whose Road Map to Excellence is guided by five pillars: service, quality, people, finance, and growth — was a natural fit for Providence Health System, says Patricia Weygandt, manager of access services at Providence Milwaukie (OR), one of three system hospitals in the Portland area.

"It’s all about service excellence," she adds. "The pillars of the [Gulf Breeze, FL-based] Studer Group come very close to our strategic priorities."

What’s striking about the Studer program, and gives it more substance than the average customer service initiative, Weygandt contends, can be summed up in one word: accountability.

"It’s a change in culture, and it requires buy-in from everybody within the health system," she says. "It’s not just, This is a good idea,’ and maybe you do it and maybe you don’t. It requires the complete support of all levels of leaders."

Information on the company’s web site, www.studergroup.com, describes how it has applied to health care the concepts in the book, Good to Great, by Jim Collins, which is about the momentum created by the power of continued improvement and the delivery of results.

Under the Studer plan, Weygandt says, every member of the organization is asked to sign a service commitment and receives a star pin to wear as evidence of that commitment. Providence Hood River — also located in Oregon — was the first system hospital to adopt the program, with some modifications, she notes, and the three Portland-area facilities began implementation in late November and early December 2003.

A three-tiered rollout of the program started with manager education, and was continuing this year with an employee forum, or seminar, on service excellence, Weygandt continues. "It will take from a year to two years to get it fully implemented."

Highlights of the program, she says, include the following initiatives:

Leader rounding

Using a "rounding log," managers go to employees and ask a series of questions, Weygandt explains. "We ask if there are any coworkers they would like to recognize, and why, and then if there are any physicians they’d like to recognize, and why. Then we ask, Is there anything I can do that will help you with your job?’"

The form on which these responses are recorded (see illustration below) also has a place to indicate action taken by the manager, she says. "Every manager is expected to do one rounding a week, and then the logs are sent to administrators, who keep a record."

Weygandt said, for example, that she rounded on one of the emergency department registrars, asking the employee, "What’s going well down here. Is there anyone I can recognize?"

The registrar immediately gave the name of a nurse, citing her compassionate attitude, and then listed four physicians who are always supportive of admitting staff, as well as a co-worker and another nurse.

Asked if there was anything that could be done to make her job easier, the registrar mentioned that the department’s insurance eligibility software was not working properly. Weygandt wrote personal notes to those mentioned, citing the specific reason for the thank-you, and followed up on the software service request.

The five-10 rule

Within five feet, employees are expected to make eye contact with and greet whomever they meet, be it a co-worker, physician, or patient. Within 10 feet, they are expected to make eye contact and smile. Those who’ve made this commitment are given a "smile" button to wear.

At Providence Milwaukie, Weygandt says, "we have all noticed a real difference in the hallways and throughout the hospital as people have acknowledged patients and co-workers. People who before would put their head down and look away are now saying, Hello’ or Good morning,’" she adds. "Those who are a little reticent can’t help but respond."

Asked if a required greeting might seem artificial to some, Weygandt notes, "If it is artificial, then people need to examine their attitudes and why they’re here. That’s how culture change happens. It’s amazing how contagious it is. You see a light in patients’ and families’ faces when they are recognized and acknowledged."

Managing up

"This means positioning someone or something in a positive light," Weygandt explains. "An example would be to say to a patient, Dr. Smith is your physician. He’s a very good surgeon. You’re in great hands."

"You can almost always think of something positive, even if it’s about equipment," she adds. "You can say, We’ve just installed an MRI [magnetic resonance imaging machine] that is the best in the field."

To contrast, she notes, "managing down" would be to tell employees something like, "Management won’t get us the equipment we need," or "I called the doctor three times about your pain, but he won’t call back."

Because it’s such an ingrained habit to consciously or unconsciously pass the buck to avoid being blamed, Weygandt points out, managing up is the most difficult practice for staff to implement consistently.

Follow-up — as in the seven thank-you notes generated by one employee — is imperative to the program’s success, she emphasizes. "If you don’t follow up, it’s just so much lip service. If it doesn’t translate into action, it’s just one more program that will fall by the wayside."

Although the follow-up described above was more extensive than the norm, Weygandt notes, there is no question the Studer program represents a major time commitment. "It’s worth it," she says. "It’s part of what we need to do to turn us from a good hospital to an excellent hospital. Many times people are happy with good, but we’re not."

Program practices yet to be rolled out, she says, include identifying the level of each employee’s performance as either a 5 (highest), 4, or 3, with appropriate feedback given, and instituting telephone calls by nurses to all patients following discharge.

The idea behind implementing the program in phases, Weygandt explains, is to "hardwire the behavior change for at least three months and then move on to the next step." That way, she adds, "it becomes part of the everyday routine."

(Editor’s note: Patricia Weygandt can be reached at patricia.weygandt@providence.org.)