Surprise and Delight

I recently came across a book called The Power of Moments: Why Certain Experiences Have Extraordinary Impact by Chip and Dan Heath. If you haven’t read it, I strongly suggest you do. Once I picked it up, I couldn’t put it down and it completely changed the way I approach my work in patient experience and employee engagement.

In healthcare, we talk a lot about Evidence-Based Best Practices, things that have been tested and shown to be effective. We work tirelessly to implement and measure best practices and then we wonder why our patient experience scores are so low. It’s frustrating.

I took a look at our comments on our surveys and the responses we get on our discharge follow-up phone calls. They largely consist of, “Everything was fine.” Ugh. Fine. I hate fine. Fine is the kiss of death.

Turns out, these best practices, things like introducing yourself to patients, explaining what the next steps are in the plan of care, or describing the possible side effects of their medications are things patients have come to expect from us. We’re not going to get outstanding surveys if we only give them what’s expected. It’s like buying a car with air conditioning. We’re not going to wow people with the awesome air conditioning package; they expect it. They didn’t always. I can still remember cars without air conditioning but it’s unthinkable now. Same with these best practices. Patients notice when we don’t do them.

So how do we create a hospital stay memorable enough for patients to even bother filling out a survey and then to describe their stay as exceptional?

This is where Dan and Chip’s book changed my whole perspective. They dive into the science behind what makes things memorable and offer real-life, practical examples of what staff can do to create those peak moments that patients will remember more than anything else. They don’t have to be expensive or labor-intensive or time consuming. They can be quiet moments of connection or surprising moments of responsiveness. And they not only delight the patients, they can touch the other staff, re-engage them, reconnect them to their passion and have a ripple effect across departments.

Best practices are important, they’re the minimum level of service we should be providing every time, and they’re not going to get you anything but middle-of-the-pack results. If you want to deliver a truly exceptional experience, surprise and delight.

The other piece is knowing that, as leaders, we are very good at solving problems. We know how to smooth out the potholes but we probably don’t know how to create peak moments for patients. You know who does? Your front line staff, that’s who. Let them drive this. Don’t roll out some ‘moment making’ program in which administration tells the staff exactly what they are to do to delight patients. Empower them to come up with those ideas and deliver them.

And while they’re out there pouring their hearts into this, you’d better be doing everything you can as a leader to surprise and delight them. Fill their cups, do a few unexpected things to show your support and appreciation of them. Don’t expect them to create any moments for patients that you wouldn’t also create for them. Watch how fast your culture changes, how happy your staff members are, and how infrequently you hear the words, “Everything was fine,” in your discharge follow up phone calls.

What’s Wrong with Employee Engagement?

A couple of years ago, I attended The Cleveland Clinic’s Empathy Summit, a terrific conference about patient experience, staff burnout, and relationship-centered care. Among the many powerful presentations was one about employee engagement that stuck in my head long after my flight home.

Essentially, the speaker said that no one is more excited about their job than a new employee on their first day. They come in, full of energy, ready to get started, and eager to learn all the new things about their new role. And then a year goes by and they have their annual evaluation and we see the enthusiasm has waned. Fast forward another year or so and these same eager, excited employees are cynical, tired, and looking for a better opportunity.

We tend to blame the employees. They’ve lost their passion. They’ve forgotten why they got into this field. They just don’t seem to care. What’s wrong with them?

Companies will then spend all kinds of money on things designed to re-engage the workforce: they rent out an entire amusement park for a day, they have a black-tie event at a banquet hall, they host a day at a racetrack, all kinds of things.

But the speaker at the conference said simply, “The idea shouldn’t be to re-engage employees, the idea should be to not beat the engagement out of them in the first place. They come to us on their first day with more excitement and enthusiasm than ever and we’re the ones that drain it out of them.”


So what is it exactly that we’re doing to them?

#1 Micromanaging

When we hire really smart people, the worst thing we can do is look over their shoulder and tell them not just what to do but how to do it. My work style isn’t necessarily the same as yours and that should be okay.

#2 Not Empowering them to Make Decisions

Nothing shuts people down faster then being reprimanded for coming up with a new idea or doing something out of the box to help a customer. When workers step outside the boundaries of their job description and are slapped on the hand for it, you’ve guaranteed they’ll never do it again.

#3 Pigeonholing Them

One of the worst things you can do to a person is think of them only in terms of their title. When an employee expresses a desire to learn a new skill or move to a different department, we should encourage them. People are so much more than their job title; allow them to spread their wings a little and learn about other areas of the organization.

#4 Theory X Management

You’ve heard of the carrot and the stick, right? When a manager rules by fear, pits employees against one another, and says the workers’ primary job is to make him look good, it’s no wonder they thank God it’s Friday. Carrots will always make for a more productive workforce, as will teamwork and a manager who understands servant leadership.

#5 Not Aligning Goals with Resources

Employees need certain tools and resources to get the job done. Asking more of them than they could possibly do and not providing the staff or equipment to get it done is a great way to frustrate and demotivate.

The next time you’re at a new employee orientation, take a look around the room at all the excited new faces and ask yourself how you can keep that excitement going, instead of trying to re-engage it after it’s gone.

…But I Don’t Deal With Patients

Early on when I first started doing Patient Experience training, I spent a lot of time talking about all the ways we can better connect with patients, starting with simple courtesy and friendliness and moving to more personalized interactions with them, like the Platinum Rule.  

The nurses, medical assistants, reception and scheduling staff were always very complimentary on their evaluation forms after completing one of my sessions. But I seemed to miss the mark when it came to the nonclinical staff who didn’t interact with patients. Over and over again, I saw the same comment, “Good presenter, but I don’t deal with patients. This training had nothing to do with my job.”

The Information Technology staff saw themselves as I.T. experts who were there to ensure that users were able to log in and everything computer-related was working. Working in an office building or a hospital didn’t seem to matter. Their approach to their work was identical.

Same thing with the finance team. They were brilliant when it came to budgets and forecasts and managing accounts receivable and accounts payable. But they hadn’t connected the dots as to how their role impacts patient experience.

My talking about connecting to purpose and focusing on the tactical ways we connect with patients and their families didn’t resonate at all with them.

So I started focusing on company culture.

My trainings began to emphasize everyone’s role in creating exceptional service for everyone: patients, their families, and other employees. It wasn’t just fixing a computer system, it was ensuring that the electronic medical record didn’t go down right in the middle of an exam, creating a whole bunch of headaches for staff and patients alike. The ‘why’ behind the ‘what’ began to drive the content of each session.

Soon, my evaluation forms were reflecting the change and, more importantly, the patient satisfaction and employee engagement scores were improving. People in all departments started feeling like they were a part of something bigger, more important and meaningful.  

When putting together new employee orientation and on-boarding, it’s imperative to help every individual understand how his or her role contributes to delivering exceptional experiences at every turn. Once employees see themselves as part of the process, you won’t hear “This training has nothing to do with my job,” again.

Tactics vs. Culture

I had a conversation with a senior leader not long ago; we were talking about what kind of an organization we wanted to be, what kind of talent we wanted to draw, what we wanted patients to think of us. I mentioned that I’d worked for a hospital with many clearly defined expectations and standards that at first seemed uncomfortable but eventually became habits.

Certain things were so ingrained at that hospital that they became a natural part of me even in other places. For example, if we saw any kind of trash on the floor – paper, wrappers, anything – we were expected to pick it up instead of walk past it and hope that someone from environmental services came around soon. I haven’t worked for them for several years but I still can’t imagine walking past a piece of trash on the floor. I still pick it up when I see it.

The vice president I was speaking to said, “But does that really matter? If it doesn’t impact patient experience, I don’t want to waste any time training staff to do it.”

And that’s when I knew it was going to be an uphill struggle.

When we think of patient experience as a series of tactics designed to raise scores, we’ve not only missed the point, we’ve put the cart in front of the horse. We were trying to shape our organization’s future, define want we want to become. That can’t be expressed merely in a series of things you can measure, it’s more than that.

It starts by having employees take pride in where they work. Part of that means acting like an owner and taking action when you see something wrong, like trash on the floor. It may seem like a small thing but it’s those small things that add up to create your organization’s culture.

When you step outside of your expressed job responsibilities and take action when something is wrong, you’re more engaged, you’re part of something larger than yourself. That’s a big part in creating a positive, patient-centered culture with employees who feel connected to purpose.

The employees still walk past trash on the floor. Patient experience scores haven’t improved. Think there’s a connection?

Manage Up

One of my pet peeves (and it appears I have a lot of them) is being led to an exam room by a receptionist who puts me in exam room 4 saying, “Someone will be with you shortly.”

Someone? Someone who? Who will be with me shortly? I sit and I wait. For someone.

It would be so much nicer if the receptionist said, “Okay you’re going to be right here in exam room 4. Tom will be your medical assistant today and he’ll be in to take care of you in just a few minutes. Tom is great. He’s one of the best we have here and patients love him. You’re in good hands.”

Three great things come from those simple words.

  1. A nervous patient starts to relax. She has heard that this other care provider is good at his job and is good with patients. She feels better already.
  2. Employees actually do a better job after a set of expectations has been set. I step up my game when I know someone has heard that I’m good at my job. If someone says I’m warm and friendly, I am turning up the warm and friendly for sure.
  3. Co-workers get along better when they get into the habit of speaking well of one another. Less gossip and more praise mean higher morale. And by the way, patients pick up on that, too.

But what are you supposed to do if you’re handing a patient off to Tom and you don’t like Tom? Do you lie and make something up so the patient feels better? Of course not. Find out a little something about Tom, like how long he’s worked here or how many years of experience he has.

Maybe patients like Tom just fine, even if you don’t. Try this, “Okay, here we are in room 4. Tom is going to be your medical assistant today. He’s been with us for about three years now and patients love him. I’m sure you’re going to love him. He will be here in just a few minutes.”

That wasn’t so hard, was it?

And you know, there’s a very good chance that after hearing you say nice things about him every day, Tom might actually become easier to work with. You might start to genuinely like him. You’ll like coming to work, patients will pick up on the energy and collegiality around the office, and nervous patients aren’t so nervous anymore.

All because you managed up.

What’s stopping you?