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position paper

Impact Healthcare Delivery:

Service
Excellence
Contents:
Competing on Service
Excellence: A Healthcare
Delivery Strategy
The Basis for Competitive
Differentiation in
Healthcare
The Critical Importance of
Non-clinical Services
Positioning in a Consumer-
driven Marketplace
Promoting Service
Excellence
The Role of Organization
Development in Building a
Service Culture
Partnering to Build a
Culture of Excellence

Sponsored by:
Impact Healthcare Delivery:
Service Excellence
Objective
This position paper examines how new competitive realities in the healthcare field are redefining
the notion of “excellence” and compelling every hospital to adopt service strategies that will
differentiate it from other hospitals. It describes how the proliferation of published rankings across
a wide range of healthcare service categories are placing greater pressure on hospitals to focus on
the patient experience in its entirety, and how hospitals are more and more looking to non-clinical
services as the basis for defining service quality, as well as relying on outsourcing to acquire the
market positioning, organization development, and communications expertise required for
competitiveness. Also discussed is the role of a “culture of excellence” in maintaining competitive
standing in the marketplace.

Outstanding Competing on Service Excellence:


customer service is A Healthcare Delivery Strategy
Everyone is a consumer. Everyone appreciates—or would appreciate—the service available at a five-
the product of an star restaurant or world-class hotel. In fact, we define our consumer experiences in large measure
organization’s by the quality of service that we receive in such venues. We have always known this; however, we
may not truly understand and value that hospital patients and their families, as well as other visitors,
culture. are also consumers who have the same need for, and appreciation of, quality service.

Indeed, it is the commercial world that patients use as a point of reference in setting their
expectations of customer service in hospital environments. Observing that only one of the 10 drivers
of patient satisfaction is specific to hospitals, Fred Lee, author of If Disney Ran Your Hospital, notes
that patients do not compare nurses to other nurses, but rather to service providers anywhere (such
as the wait staff in a restaurant). He writes, “We now know quantitatively what we have always
known intuitively—patients reserve their good word of mouth and loyalty for hospitals where their
needs were anticipated and met by a courteous, caring staff.”1

Attentive behavior and excellent service that meet and exceed patient expectations go beyond
mere isolated acts of kindness. As in the commercial world, outstanding customer service is the
product of an organization’s culture, rather than the result of specific directives. It is behavior
that springs from deeply held attitudes and beliefs. Culturally based behavior is predictable and, to
some extent, inevitable. It is also a requirement for achieving competitive differentiation based on
service excellence.

Healthcare industry consultant Quint Studer describes the pervasive behavioral influence of a
culture of service excellence through reference to a “healthcare flywheel.” At the center of the
flywheel are organizational values, which consist of having purpose, doing worthwhile work, and
making a difference. Revolving around and driven by this core are three components that keep the
flywheel in motion: the first is getting people to believe that they can make a difference; the
second is prescribing the actions needed to achieve results; and the third is seeing results. The
accomplishment of these results motivates individuals and helps create a culture of excellence in
the organization.2

1
The Healthcare FlywheelSM
Adapting Hardwiring Excellence, by Quint Studer

commercial-world
best practices to
create the ideal
patient experience
is becoming a
standard practice
in healthcare.

The evidence suggests that hospitals are indeed getting the message that customer service is
where competitive differentiation can be achieved, and that cultural change is the means for
getting there. Baptist Hospital, Inc. (BHI), which comprises two hospitals and an ambulatory care
complex, responded to low satisfaction marks from patients, staff, and doctors by seeking to
improve the quality of its services. It adopted five “Pillars of Operational Excellence—People,
Service, Quality, Financial, and Growth;” set goals for each; and used this initiative to drive all
hospital activities. Other programs encouraged staff suggestions for improvement and tracked
clinical quality data results and trends. As a result of its efforts, BHI has ranked in the 99th percentile
for overall patient satisfaction for several years, with positive staff morale rising from 47 percent in
1996 to 84 percent in 2001. (Its closest competitor was at 70 percent.)3

Borrowing customer service best practices from the commercial world for use as service quality
benchmarks in hospitals is becoming an increasingly mainstream idea in the industry. In working
with healthcare institutions, The Disney Institute, for example, has taken a page from its own
customer service philosophy in advising its client hospitals to treat patients as guests. One of its
clients, the University of Chicago Hospitals, wanted to break away from its traditional approach to
training as a response to regulatory requirements and instead use it to increase employee pride and
create a more welcoming environment. Its exposure through The Disney Institute to customer
service methods used outside the healthcare field led to its undertaking the initiative to build a
culture of continuous learning. The University of Chicago Hospitals have set up improvement teams
aimed at “improving the quality of food in the Children’s Hospital, improving the quality of patient
education materials for children’s radiology treatments, and improving appointment scheduling
processing times.”4 The organization also identified what it called the “ideal patient encounter.”
The idea was to flowchart every process that involved the patient and identify specific opportunities
for increased efficiency.5

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The creation of detailed processes to represent the ideal patient experience also is rapidly becoming
standard practice. As healthcare industry consultant and author Wendy Leebov points out, if a hotel
that has its employees use scripts for customer interactions receives improved marks for customer
satisfaction, why shouldn’t a healthcare institution try the same approach? She suggests that
managers work with employees to make them comfortable with the script and to encourage them
to inject some of their own personality and communication style into the script while adhering to
its main objectives. The script itself should be based on patient interviews designed to uncover
sources of anxiety or concern at each step of a particular process, anticipate those concerns, and
relieve anxiety.6

Oklahoma-based Duncan Regional Hospital faced competition from big-city hospitals in a state that
receives among the lowest Medicare payments in the country. Its Press Ganey ratings showed that
The creation of patient satisfaction was already above the 95th percentile; however, management wanted to do
better, believing that the bar needed to be set higher in the healthcare industry. They succeeded in
detailed processes to getting employee buy-in to improve things for the patients, including the creation of service
represent the ideal standards. As a result of a number of changes, such as revising the orientation program to include
the service theme and service standards through hands-on training, Duncan Regional’s market
patient experience share increased from 58 percent to 64 percent, and patient satisfaction ratings improved as well,
also is becoming including an increase from 75 percent to 99 percent in the Emergency Department.7

standard practice. East Jefferson General Hospital of Metairie, Louisiana, recognized the need to improve the quality
of the patient experience. CEO Peter Betts sought to “create a hospital that ran more like a
business, one that was focused as much on customer service as on clinical excellence.”8 The
Hospital successfully addressed its parking shortage, painted murals on ceilings, removed clutter
from hallways, and devised a way for the operating room receptionist to know when to advise
visitors that a patient had been moved to recovery while letting orderlies know that the room was
ready to be cleaned. The hospital became accessible from any floor in the new parking garage. The
Hospital built new rooms so that families could visit with post-surgery patients in recovery, as well
as an outdoor courtyard next to the ICU.9 The result of these improvements was increased market
share, accompanied by an increase from 46 percent to 57 percent in “top of mind” awareness.10

A 2004 survey of CEOs across several industries, including healthcare, found that “there is still a
significant gap between familiarity and actual use when it comes to quality initiatives or business
process improvements.”11 The quality techniques addressed in the surveys included total quality
management (TQM), benchmarking, ISO 9000, Quality Circles, Six Sigma, and Baldrige. Among
healthcare industry respondents, 62.1 percent believed that quality is a management tool,
compared with 73.3 percent of service industry respondents and 55.3 percent of manufacturing
industry respondents. A little more than half (54.2 percent) of healthcare industry respondents said
that they measure the economic impacts of business process improvements, which is a lower
percentage than found in the service industry (58.8 percent) and significantly less than found in the
manufacturing industry (73.1 percent).12

3
2004 Survey on CEO Perception of Quality
A 2004 survey of “What Do CEOs Think About Quality?,” American Society of Quality by G. Walter

CEOs across Believe Quality Is a Management Tool


several industries
found that “there
is still a significant
gap between
familiarity and
actual use when it
comes to quality
initiatives or
business process
improvements.” 62.1 percent of CEOs in healthcare believed quality is a management tool
compared with a higher percent (73.3 percent) of service industry respondents.

Organization Measures the Impact of


Business Process Improvement Initiatives

A little more than half of healthcare industry respondents said that they
measure the economic impacts of business process improvements, which is a
lower percentage than found in the service industry and significantly less than
found in the manufacturing industry.

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The Basis for Competitive Differentiation in Healthcare
The notion of having to compete for patients is evolving in the healthcare industry. Just as some
companies in the telecommunications industry suffered a rude awakening following deregulation and the
sudden pressures of a competitive marketplace, many hospitals are just beginning to recognize that they,
too, are businesses that must compete for customers like any other business.
So on what should a hospital seek to achieve and maintain a competitive advantage? The traditional view
of hospitals would suggest that better doctors and surgeons are the key to competitive
differentiation. Patients come to hospitals for medical care, so wouldn’t the quality of medical care
received be the sole factor in a patient’s evaluation of the hospital experience?
In a word, no. Most patients lack the specific medical knowledge needed to assess either the relative
The quality of expertise of a physician or the level of competency exercised in their particular cases. Barring obvious and
“non-clinical” readily documentable breaches of standard medical or surgical praxis, hospitals will have a difficult time
differentiating themselves on this basis. Many hospitals advertise particular specialties; however, their
services are critical claims are typically no different from those of their competitors.
to a patient’s If we view the issue not from a healthcare perspective but from a traditional consumer behavioral
evaluation of a perspective, a different basis for competitive differentiation emerges. In a hospital, the patient is the
consumer, and it is the collective experiences of those individual consumers that determine how that
hospital stay and hospital is perceived in the marketplace.
can define their Consider the nature of the patient experience. Patients do not spend most of their time in a hospital
overall experience. receiving medical services from physicians, but rather engaged in activities such as eating, sleeping,
watching television, interacting with nurses and nurses’ aides, transporting to and from test labs,
recovering, and receiving visitors. These are activities about which patients do possess firsthand knowledge
and about which they often harbor strong preferences and opinions. Some patients may not know an
EEG from an EKG, but all patients know cold soup when they taste it. The quality of these “non-clinical”
services are critical to a patient’s evaluation of a hospital stay and can define their overall experience.

The Critical Importance of Non-clinical Services


With healthcare costs skyrocketing, the quality of non-clinical services would seem a likely first casualty in
the attempt to trim budgets. Hospitals are, after all, in the business of providing medical care to patients.
All those ancillary services certainly contribute to accomplishment of that primary mission; however, they
have not traditionally been included in the category of “critical” services.
Yet the evidence suggests that hospitals do appear to be looking primarily to hospitality and non-clinical
services such as food, facility, and clinical technology services—rather than medical and surgical
services—as the focal point for improved service quality. Patient surveys by Gallup and Press Ganey
Associates found that patients judge their experience by the way they are “treated as a person, not
clinical competencies.”13 Yes, patients are focused on recovering; however, it is their day-to-day
contact with non-clinical services that makes patients like and recommend one hospital and speak poorly
of another, even though the quality of medical care may be identical.

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Press Ganey Associates: Top 10 Drivers of Patient Satisfaction
The task faced Mail-in survey questions (out of 48) that correlate most highly with “likely to recommend”

by hospitals is to
1. How well staff worked together to care for you .79
develop and 2. Overall cheerfulness of the hospital .74
differentiate 3. Response to concerns/complaints made during your stay .68
an intangible 4. Amount of attention paid to your personal and special needs .65

“product” to 5. Staff sensitivity to the inconvenience of hospitalization .65

create a positive 6. How well nurses kept you informed .64


7. Staff’s effort to include you in decisions about treatment .64
and memorable
8. Nurses’ attitude toward your requests .64
marketplace
9. Skill of nurses .63
identity. 10. Friendliness of nurses .62
If Disney Ran Your Hospital, by Fred Lee Press Ganey Satisfaction Report, August 2003

Gallup: Top Seven Drivers of Patient Satisfaction


Telephone survey questions (out of 27) that correlate most highly with “overall satisfaction”

1. Nurses anticipated your needs .64


2. Staff and departments worked together as a team .64
3. Staff responded with care and compassion .62
4. Staff advised you if there were going to be delays .61
5. Nurses explained abut medications, procedures, and routines .60
6. Nurses responded promptly to pain management .60
7. Nurses responded in a reasonable amount of time .60
If Disney Ran Your Hospital, by Fred Lee The Gallup Organization, 1999

The task faced by hospitals is to develop and differentiate an intangible “product”—that is, to promote
these non-clinical services and, thereby, create a positive and memorable marketplace
identity. The intangibles used by patients to evaluate hospitals include the perceived attentiveness of the
nursing staff; the willingness of staff at every level to interact with them in more than a cursory manner;
the availability of clinical equipment; the ability to have food customized and delivered “after hours,” as
well as the physical appearance of the food tray; and the cleanliness and attention given to the comfort
of the room. It is tempting to dismiss these intangibles as mere “touches;” however, it is the

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accumulation or absence of such touches that defines the total patient experience. This is why
successful hospitals recognize the need to build these intangibles into their culture and to make them
tangible for the patient from the time they enter the hospital to the last touchpoint when they leave.

Positioning in a Consumer-driven Marketplace


With increasing consumerism in the healthcare industry come the inevitable by-products of a competitive
marketplace, including competitive ratings of healthcare facilities. Hospital rankings in both clinical and non-
clinical categories are increasingly available to consumers, thus creating a more competitive market for those
who provide healthcare services. Hospitals turn to commercial sources of ratings such as Press Ganey and
Solucient to see how they stack up against the competition. A hospital profiled by the Advisory Board
Successful hospitals Company of Washington, D.C., mails out Press Ganey surveys to nearly 100 percent of
recognize the need its discharged patients.14 Such rankings, and their attendant impact on patient volume and revenues, increase
the pressure on hospitals to invest seriously in quality improvement initiatives.
to build intangibles
According to the Studer Group, hospitals participate in quality award competitions, “not because they
into their culture want to receive an award,” but because “they want to get results; they want to improve.”15 Monitoring
and make them and measuring customer satisfaction is critical to achieving world-class patient services, but so is
translating survey results into behavioral objectives. The survey results available from Solucient, Press
tangible. Ganey, and others are valuable only to the extent that a hospital translates them into behavioral
objectives, rather than simply publishing the results to impress potential customers. “Measure to improve,
not to impress,” says Fred Lee, and that means using a scoring system that provides the
granularity needed for drawing conclusions that can be acted upon.16
How many healthcare institutions possess the in-house marketing expertise to interpret suitable research
instruments, and then translate the findings into behavioral and customer service objectives? How many
institutions even recognize the distinction between customer satisfaction and customer loyalty, and the
importance of that distinction to achieving leadership in a competitive marketplace? A 2004 original
inquiry brief issued by The Advisory Board Company of Washington, D.C., states that customer loyalty is a
more accurate measure than customer satisfaction in determining “the likelihood that a patient will bring
future business back to the hospital.”17 Citing an article by Fred Lee in which customer satisfaction is
labeled “fool's gold,” the brief suggests that the most important contributor to patient satisfaction and
loyalty is “the law of the memorable event.”18 A memorable event can be something as simple as a
nurse spending a few extra moments responding to a question about procedures or medications, a
dietary worker expediting a special request, or a member of the housekeeping staff extending some
special courtesy.
According to The Advisory Board Company, hospitals may focus on satisfaction rather than loyalty
because administrators believe that “enhancing satisfaction will grow loyalty in the long term.”19
On the previously mentioned Press Ganey survey mailed by a hospital to almost every discharged patient,
at least two questions zero in on customer loyalty, including whether the respondent would recommend
the hospital to family and friends. Administrators have found that most patients are
likely to answer with a four or five (out of five), but have also cited studies showing that patients who
rate the hospital a four are “six times more likely to choose another hospital in the future.”20

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With the redefinition in the healthcare marketplace of notions such as “excellence” and “best in class,”
Employees who meeting the needs of patients has become increasingly complex. In addition to having to understand and
apply marketing concepts in a highly competitive environment, hospitals must succeed in building a
understand and culture of service if they are to deliver on their promises. Customer service is not simply a job function
that can be assigned to particular employees; rather, it is a value that needs to be built into the culture
believe in the of the organization. If employees are merely given stand-alone customer service “directives,” it is only a
meaning of your matter of time before those directives will be interpreted in light of, or completely overshadowed by,
preexisting cultural values.
organization’s
mission become Promoting Service Excellence
ambassadors As noted earlier, the key to increasing market share and perception is promoting your competitive
differentiation, or how consumers and your employees recognize and think of your organization in the
through their marketplace. The credit card you should never leave home without, the cellular phone that works
actions. anywhere, the fresh-squeezed orange juice that contains no concentrate—these are shorthand messages
that evoke in consumers a series of positive associations with the marketed product each time they are
seen or heard. In effect, they encapsulate an entire marketing campaign in a single, easily recognizable
phrase or image. This is what effective promotion is all about. It is what every company strives for, and it
is what hospitals in today’s healthcare marketplace must strive for as well.
There is also a significant internal benefit to promoting your differentiation, namely the creation of a
valuable framework for employee decision-making. Employees who understand and believe in the
meaning of your organization’s mission become ambassadors through their actions. The way you position
your organization provides a context within which employees are better able to evaluate their own efforts
and to ask themselves the right questions:
Am I contributing to the organization’s mission?
Is my behavior consistent with an organization that stands for this set of principles?
Even if employees cannot always accurately predict the consequences of a particular action, strategic
positioning serves as a constant reminder of which types of behavior are likely to be desirable or
undesirable, productive or unproductive.
For hospitals, opportunities for differentiation include the developing of niche services—these include
categories within hospitality services, food services, and facility services—and the repackaging of existing
services for targeted consumer groups. A Wall Street Journal article describes some of these efforts as part
of a growing trend of consumerism in healthcare, noting that hospitals are “hoping to lure
customers with private rooms and consultation spaces, in-room Internet access, and even plasma-screen
television.”21 St. Vincent’s Hospital of Birmingham, Alabama, retained LodgeNet Entertainment
Corporation to install an interactive television system that would afford patients access to hospital
information, patient education, patient services, on-demand entertainment (including movies, music, and
games), patient surveys, and patient requests.22 According to a study presented at the American Dietetic
Association’s Food and Nutrition Conference and Expo in Anaheim, California, patient
satisfaction ratings rose “dramatically” in each surveyed hospital that offered room service, whereby
patients can call the Food Service Department directly and order a meal or snack when they want it. One

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hospital rose from the 25th percentile to the 99th percentile.23 At Holy Cross Hospital in Silver Spring,
Maryland, another survey found an increase in food service satisfaction from the 52nd
percentile to the 92nd percentile.24

The Role of Organization Development


in Building a Service Culture
The key to building a service culture is organization development (OD), which makes possible the
breaking down of department silos within the organization. Using OD processes, hospitals can monitor
employee behaviors and evaluate them on the basis of whether they contribute to the achievement of
business goals. It is a way of engaging employees, making them feel a part of the process, and giving
The key to building them a stake in the organization’s success. However, OD is another function—along with non-clinical
a service culture is services (such as food services), marketing, and branding—that hospitals are not in the primary
business of performing. To become and remain competitive, hospitals are increasingly retaining the
organization services of outside consultants whose primary business encompasses such activities, which in this case
development would include strategic planning, group-team evaluation, organization and culture assessment,
experiential learning, and assessment and coaching. A full-service vendor, such as ARAMARK Healthcare,
through engaging is able to choose from a wide range of OD applications in tailoring solutions to the specific needs and
employees, making character of a client hospital. For ARAMARK Healthcare, the range of possible applications includes,
among others, group facilitation, goal alignment, focus group meetings, scripting of employees,
them feel part of pre- and post-retreat assessment, consensus-building, coaching, and informal group and individual
the process, and interviewing. Results achieved by clients have included reduced employee turnover rates and increased
giving them a stake teamwork ratings, improved patient satisfaction scores, and the establishment and achievement of value
analysis team goals.
in the organization’s
For any hospital to develop a true service culture requires that employees leave their individual comfort zones;
success. helping employees accomplish this is one of the primary purposes of OD. Another key element in the
transition to a service culture is the creation of recovery strategies. When something goes wrong,
employees must have an effective and consistent strategy for reacting, always keyed to the patient’s
comfort requirements. Patients have only secondary interest, if that, in the service provider’s perspective on
the details of a mistake it had made; what matters most to the patient is what the patient is
experiencing, and it is there that employees must act to make an immediate and positive impact. Ideally,
hospitals should address the full range of non-medical patient needs and organizational service-related
issues through a single relationship with a full-service vendor as a way to ensure the coordination and
consistency required for success.

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Partnering to Build a Culture of Excellence
Healthcare Building the kind of culture of service described above may be only a transitional stage in the
organizations transformation of an organization to a culture of excellence. When excellence is effectively built into the
organizational culture, all aspects of customer service become derivative of that standard, without the need
can accelerate the for prescribed behaviors on a case-by-case basis.

process of culture How does an organization—with the help of an outside partner—achieve a culture of excellence? The
first requirement is that the impetus come from the top. Management needs to demonstrate
change and its commitment to the initiative, including leading by example and building in a reward system that
reflects organizational priorities in this area.
increase its
Maintaining a culture of excellence requires work and a stable frame of reference, but one with
likelihood of sufficient flexibility to enable the organization to react to change. In addition, good communication is
success by critical. Healthcare organizations can accelerate the process of culture change and increase its
likelihood of success by partnering with an expert company that meets the following criteria:
partnering with an Provides non-clinical services as its primary business mission
expert company. If the basis for differentiation in healthcare facilities is the quality of non-clinical services, it makes sense
to select a partner for whom the providing of non-clinical services is mission-critical.
Understands market positioning
Choose a partner able to rely on its experience in other hospitals and, of equal importance, in other
types of commercial businesses. A partner should have sufficient experience to be able to compare a
hospital’s service delivery issues with “best practices” across a range of industries and identify the most
effective solutions.
Communicates concepts and benefits to employees
Establishing a culture of service excellence depends on obtaining employee buy-in. Employees are the
ones who come in contact with patients and, from the patient’s standpoint, are synonymous with “the
hospital.” If an employee is not providing good service, then by definition the hospital is not providing
good service. Some ways to obtain buy-in are more effective than others, with much depending on the
personality of the workforce and the institution. A hospital should leverage its partner’s experience in
devising an appropriate strategy. Maureen Bisognano, executive vice president and COO at the Institute
for Healthcare Improvement, credits quality guru Joseph Juran with having taught her that “recognition
and celebration had to be connected to quality results.” As a result, Bisognano says, her celebrations
“became more closely connected to meaningful changes for patients and were more
sincere recognition of performance excellence.”25
Has expertise in training hospital employees
Because it is the employees of healthcare organizations who will be called on to deliver these higher-
quality services, the selected vendor must also be able to train existing staff and communicate to them
the importance of raising service standards and practices. Knowing what to do but not how to do it will
have little impact on customer service.

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Communicates with patients
Communicating with patients is critical to successfully building a culture of service excellence. As Fred Lee
notes, hospitals concern themselves with objectively measurable outcomes, but the patient “judges
quality by his or her perceptions . . .”26 Hospitals must communicate to their patients what they are doing
and why they are doing it—and they must do it in a way that resonates with the patient. The use of more
healthful ingredients in a dinner entrée or a change in housekeeping procedures that reduces the noise
to which patients are exposed may not be remembered or even noticed by patients unless someone calls
attention to them in a way that is both memorable and understandable. Such communications must be
geared to patients’ cognitive and intellectual capacities.
The test of a solid market position is not how clever it is, or how informative, or how innovative, but rather
how it is received by the patient. How many hospitals possess this skill in-house? How many hospital
It is the delivery of managers are aware, for instance, of the limited reading ability possessed by a large percentage of the
hospitality and individuals that make up a significant portion of the inpatient population? According to a 1992 survey
conducted by the US government, almost half the population read at an eighth-grade level or below,
non-clinical including “76 percent of older Americans, 66 percent of people living in poverty, and 76
services—such as percent of people with chronic health conditions.”27 Is it possible to communicate information in
language that is easy to understand yet does not insult patients who read at a higher level? In an
food, facility, and environment where patient perceptions have a direct impact on the bottom line, an experienced
clinical technology outside service provider for whom the crafting and communicating of such information is mission-critical
services—that can be an invaluable strategic asset.

defines the patient


Conclusion
experience.
In the current consumer-driven healthcare marketplace, the ability of healthcare facilities to differentiate
themselves has become increasingly important. The sole basis for competitive differentiation is
not the quality of medical services; in most cases, patients lack the requisite knowledge to make a
nuanced evaluation in that area. It is the delivery of hospitality and non-clinical services—such as food,
facility, and clinical technology services—that defines the patient experience. The concepts of
“excellence” and “best practices,” normally associated with the commercial world, are rapidly becoming
service quality benchmarks in healthcare. Published rankings place greater emphasis on the patient
experience in its entirety. An increasing number of hospitals have recognized the need
to establish a service culture, one in which every employee knows that every patient contact is an
opportunity for having a positive impact on the patient experience. They also appreciate the
importance of relying on outside expertise to market and differentiate their services, to provide
organization development, to communicate the need for service excellence to employees and the results
of service excellence to patients, and to achieve a culture of excellence that enables them to maintain
competitive standing in the marketplace.

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Notes
1. Lee, Fred. If Disney Ran Your Hospital, 9 1/2 Things You Would Do Differently. Bozeman, MT:
Second River Healthcare Press: 2004.
2. Studer, Quint. Healthcare Flywheel [Chart]. Studer Group. 2005. Available from http://www.
studergroup.com.
3. Baptist Hospital, Inc., Case Study.
4. Case Studies, University of Chicago Hospitals. The Disney Institute, 3.
5. Ibid., 4.
6. Leebov, Wendy. Using Scripts for Patient Interactions. Health Forum, University of North Carolina,
School of Public Health. 2004. Available from http://www.hospitalconnect.com.
7. Case Studies, Duncan Regional Hospital. The Disney Institute.
8. Case Studies, East Jefferson General Hospital. The Disney Institute, 1.
9. Ibid., 2.
10. Ibid., 3.
11. Walter, G. What Do CEOs Think About Quality? American Society of Quality. May 2004. Available
from http://www.asq.org.
12. Ibid., 54.
13. Lee, 11.
14. The Advisory Board Company. Measuring Patient Loyalty. Original Inquiry Brief.
Washington, D.C. 2004.
15. Studer, Quint. Drive for Quality and Focus on Results. Studer Group. 2004. Available from
http:// www.studergroup.com.
16. Lee, 63-78.
17. The Advisory Board Company, 2.
18. Ibid.
19. Ibid., 5.
20. Ibid., 7.
21. Rundle, Rhonda. “We Hope You Enjoy Your Stay.” Wall Street Journal. November 22, 2004.
22. St. Vincent’s Hospital Goes Live with Horizon PatientVision System. December 9, 2004. Available
from http://www.lodgenet.com.
23. “Nurse, Where’s My Foie Gras?” ScoutNews, LLC. October 2004. Available from
http://www.forbes.com.
24. Ibid.
25. Nielsen, D.M., Merry, M.D., Schyve, P.M., Bisognano, M. “Can the Quality Gurus’ Concepts Cure
Healthcare?” Quality for Healthcare. September 2004. Available from http://www.asq.org.
26. Lee, 12.
27. Coyne, M.K. and Price, J. “Patient Education and Health Literacy.” Future Dimensions in Clinical
Nutrition Management, Vol. XXIII, No. 2, Spring 2004.

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1.800.909.7373 • solutions@aramark.com • www.aramarkhealthcare.com

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