Patient Satisfaction Planner: Service excellence begins with behavioral change

Initiative works because everyone owns it

"This is a journey; we’ll know we’ve arrived when they don’t need us anymore," says Sandy Gregg, RN, MN, MHA, director of service excellence for Providence Health System in Portland, OR. "My goal is to work myself out of a job."

Although Gregg’s is a full-time position, the team that is responsible for implementing the message throughout the system’s Oregon hospitals is not comprised of full-time service excellence employees, she adds. "That’s purposeful, because service excellence is not a role; it’s the organization’s work. So everyone owns it."

To further explain the concept, she first makes note of the strategic planning that takes place to determine the health system’s visions and then the steps by which it will turn those visions into reality.

The service excellence initiative, Gregg says, "is about how we do that work. It’s not a goal in itself, but the culture in which we do our work." Service excellence, she continues, addresses not only the employees’ technical skills but their behaviors.

"It’s not just being technically competent, but being value-based and respectful." The service excellence team is responsible for setting what the expectations are for those standards and holding people accountable for them," Gregg explains.

"We are committed to being the best place to work, the best place to be a patient, and the best place to practice medicine," she says. In the Oregon region, of which the Portland service area is the largest component, that effort starts with chief executive Russ Danielson.

Providence has had strong quality programs in place since the 1980s, Gregg says, so the focus on process improvement is not new.

However, in the past three or four years — with a formalizing of roles in September 2004 — the commitment has become, "We’ll measure, communicate this, and build an infrastructure," she adds.

There is the understanding, Gregg explains, that for all Providence customers to have an excellent experience, "it takes every person in the room. It’s about helping all of the staff to understand how they impact that experience, whatever their role is."

The service excellence initiative follows a model created by Quint Studer, founder of the Studer Group ( and author of the book Hardwiring Excellence, she notes.

In examining the goal of wanting all customers to have an excellent experience, Gregg notes, it’s important to recognize that "some of our patients, as a group, are always more satisfied. When we look at the reason for that, we find out that it’s not just technical. We find out that it’s something about the staff on those floors."

Taking it a step further, she says, the question becomes, "Why are some groups of nurses so much more satisfied with their jobs?" The answer, she adds, "is almost always that they have a very good manager."

Every hospital needs to have "great medical care, good nurses, OK food, but meeting all those needs just gets you to a certain level of satisfaction," Gregg explains. "We’re trying to find out how to get [patients on] every [nursing] floor [to the level of the most satisfied and] to get the management skills that build a high performance level."

Over the last half of 2004, she says, Providence began obtaining monthly feedback on patient satisfaction, with plans for moving to weekly surveys in 2005. To get even more immediate feedback, the system is introducing discharge phone calls, Gregg adds.

Every patient who leaves the hospital — unless it is not appropriate for some reason — will be called within 48 hours in an effort to understand what his or her experience was, she says. "If they tell us [the stay] was wonderful, we can thank them, and if the experience was not good, we can hear about it in a timely way and do whatever service is necessary," Gregg notes.

One way the health system is improving the quality of inpatient stays, she adds, is by placing in every person’s room a white board on which pertinent treatment information is written.

Listed there, for example, are the nurse’s name, if and at what time blood will be drawn, and when the physician will be in, Gregg says.

"If someone comes in to draw blood and that’s not on the board, that’s a quality check for us."

Providence also has a "5-10 rule," she says, meaning that employees must look at people who pass within 10 feet, and greet those who pass within 5 feet. "The idea is that no one is invisible. You don’t break up a conversation, but you let people know that it matters that they’re there."

Apart from being a courtesy, Gregg points out, the practice is "an amazing way of finding out who has walked into our facility. If you greet people, often they will ask you a question. It’s a simple way to reach out to people who are really vulnerable."

Creating service excellence is about "key words at key times," she adds, and about every person who leaves an interaction asking, "What else can I do for you?" and meaning it.

"Regardless of your ZIP code, when you walk into Providence, we want your experience to be that people take the time to hear you," Gregg says. "It’s the customer experience that’s important to us."