Each year the swallows return to San Juan Capistrano on March 19 and the Summer Solstice occurs on June 21. July 1 is also a date to remember, as it should strike terror in hearts of those who find themselves in need of hospitalization. This is because July 1 is the traditional date on which new medical residents start their practice of medicine in earnest each year, taking care of patients in the hospital without their doctor training wheels. It is a well-documented phenomenon that, in contrast to all other months of the year, July is the month when medication errors, surgical mistakes and other patient safety problems spike. Note to self, if you get sick on July 1, try leeches first.
The New York Times wrote last week about a recent study published in the Annals of Internal Medicine, in which, ”…researchers at the UCSF School of Medicine looked at 39 published studies and concluded that while there is mixed evidence, “our analysis suggests that mortality increases during the changeover months,” says co-author John Young, associate program director of the residency training program in the school’s department of psychiatry. Lower efficiency, as measured by longer hospital stays and surgical times and higher hospital charges, also seem to be a particular problem during the seventh month of the year.”
It is clear that this July 1st problem has multi-faceted roots. It results, in part, from the lesser experience of the newly minted medical residents, an accompanying lack of adequate supervision, and extreme schedules. The problem is also a result of a lack of training about how to integrate into the culture and flow of the hospital. Lastly, it is a problem of the inadequate communications skills that young physicians entering the system sometimes bring along with them. While some physicians are born with a great bedside manner, this is an area that has long been overlooked in the minting of new doctors. Medical schools have, by and large, lacked any training in how to relate to patients and other hospital colleagues as customers and partners in the delivery of care.
In some quarters there is an effort afoot to breed a new race of doctors who are pleasant and cooperative. At least 8 medical schools, including Stanford, UCLA and Virginia Tech Carillion have adopted the practice of weeding out applicants by using a test designed to elicit potential physicians’ ability to communicate, work in teams, and overcome negative responses when people disagree with them. Maybe if this test works the venture capital field can adopt it, as we have our share of overly confident egomaniacs too—some of them are both doctors and venture capitalists. Shudder.
But because they know how to part people from their money like no one else, it is the Disney Corporation that has charged forward into the July 1 breach to use their magic to improve the quality of interaction that patients can expect to receive at hospitals from physicians and others alike. On July 1, 2011, just as a whole new field of sleep-deprived, inexperienced and overly self-confident residents were issued their permanent hospital name tags, Disney issued a press release announcing that their wholly-owned Disney Institute has launched a new professional development program created specifically for hospitals and healthcare organizations to “Build a Culture of Healthcare Excellence”. While the program isn’t specifically focused on helping new medical residents (and their unwitting patients) survive until August, it is oriented towards improving the entire patient hospitalization experience at both clinical and customer service levels. Leave it to the folks at Disney to make the phrase, “Mickey Mouse organization” a good thing.
The Disney Institute, founded in 1986, is a professional development enterprise that was founded to help bring best practices of the Disney experience to other unrelated enterprises. Serving primarily the Fortune 1000, Disney uses its experience as one of the world’s most revered brands to help treat those suffering from chronic bad service delivery disorder. Sadly, hospitals are among the most afflicted by this disease, as evidenced by their poor state of operating affairs and the fact that all too many people leave their hospital stay frustrated and confused by the experience they have had and the lack of clarity about what happens next.
The program launched specifically for the hospital profession is said to incorporate the five most powerful Disney philosophies – leadership excellence, people management, quality service, brand loyalty and creativity/innovation – to help healthcare administrators, physicians, nurses and other manager-level personnel consistently exceed the expectations of patients. The primary catalyst for this program was not the curse of July 1st, and was certainly not due to a sudden realization by hospitals that they need to be more consumer-friendly. I know you’ll be shocked to read this, but the initiative was spurred by money, and specifically the potential economic impact of the imminent implementation of a nationally standardized survey that will hit hospitals where it hurts: their finance department. 
Known as HCAHPS, which stands for Hospital Consumer Assessment of Healthcare Providers and Systems, the survey gives patient’s a way to report their experience with their hospital care and to compare hospitals based on measures of how effectively they are satisfying patients’ needs and expectations and includes areas of inquiry outside of the truly clinical, such as communication with doctors and nurses, responsiveness of hospital staff and perception of hospital cleanliness, noise, etc. In other words, HCAHPS is intended to capture patients’ views of their actual personal experiences, not just their perceptions of whether they received clinical services that made them healthier. This really matters because HCAHPS scores will be used by the Center for Medicaid and Medicare Services to determine, in part, how much CMS will pay hospitals for services rendered. Hospitals that fail to report their HCAHPS scores will not be eligible to receive bonus payments and will definitely be eligible to receive a 2% reduction in their base reimbursement rate. Starting this month, hospitals will be required to publicly report the results of these surveys, which will be published by the Centers for Medicare and Medicaid Services on its Hospital Compare website.
HCAHPS presents a wholesale change in how hospitals have tended to measure themselves and a stark contrast to how consumers are accustomed to measuring their satisfaction with services rendered by pretty much any other kind of organization. Traditional consumer businesses, like Starbucks and Best Buy and Southwest Airlines, know that it is the actual customer experience that results in brand loyalty and all that comes with it. They worry about how their place of business looks and smells, what emotions the environment creates, how the staff treat the customers, how long customers have to wait and whether mistakes are made; consumer business spend a lot of time worrying about how to ensure they attract customers back. In hospitals, the more common approach to brand loyalty has been to tell patients, “Hey, you–you aren’t as sick anymore. We gave you some good medicine so put a sock in it, move on out and make room for the next warm body.” That is so not Disney.
“Our program helps hospitals and healthcare organizations focus more on the overall patient experience, rather than just clinical outcomes,” says Disney Institute consultant Patrick Jordan, a former healthcare executive, in the press release about the new program and in a resulting New York Times article. “This is incredibly important for building a culture of excellence. The overall experience is driving hospital volume today. It’s becoming increasingly important for patients to feel like their doctors and nurses are communicating with them, and that they are in a safe, comfortable environment while they heal. As a result some of the health plans are looking at this information to decide where to send their insured. As with guests in Disney theme parks, the patient has to feel that he or she is getting the best possible service in all areas and at all levels, from the receptionist to the nurses and physicians. That starts with leadership.” Somewhere, Prince Charming is getting ready for his close-up.
So what does Disney training get you as the average hospital administrator? It gets your clinical and administrative team training in how to work together and communicate effectively; it gets your executive team some serious leadership training; it gets you a meaningful lesson in how to develop a corporate culture that values excellence and the customer; it also gets you a lesson in how to provide Disney-like amenities to encourage customer satisfaction, such as private rooms and on-demand dining services. Somehow I picture Chip and Dale providing a course in 
how to be extremely polite to one’s colleagues (“After you Dr. Chip,” … “No, I insist, after you Dr. Dale!”). Maybe they’ll even figure out how to provide those Fentanyl pain lollipops in rainbow Mickey form.
Interestingly, while there have been only a few case studies for this program so far, it seems to be highly effective, at least according to the Disney folks. For example, Orlando-based, 1,200-bed, Florida Hospital for Children, a facility ranked that in the bottom ten percent of hospitals nationwide on satisfaction scales, implemented what it learned from the Disney Institute and rapidly raised the hospital’s satisfaction ratings to the high 90th percentile— among the highest in the nation. That’s quite a transition, transforming from the Beast to Beauty in just one year. With those kind of results, maybe the music in the hospital elevator will change from “Someday My Reimbursement Will Come” to “Be Our Guest, Be Our Guest, Put Our Service to the Test.”
ps–click below to see what the hospital cafeteria of the future will look like, after the Disney intervention.
httpv://www.youtube.com/watch?v=ov4tE7XRTUA
