Memorial Hospital Customer Service Scenario
You are finishing your Master of Healthcare Administration (MHA) at Walden, and you are thrilled to have landed an internship with the chief executive officer (CEO) of Memorial Hospital. Memorial is a 250-bed, not-for-profit hospital in your community. CEO Chris Early is a Walden alumnus with an impressive résumé and outstanding reputation. After holding a series of vice president (VP) level roles at other hospitals in the region, he started as CEO at Memorial 6months ago. You know from your interview with him that he has a mandate to make significant changes at Memorial in order to improve the patient experience.
The first day of your internship is a whirlwind. You spend the morning observing a contentious board meeting. You and Chris debrief on the meeting over a sandwich in the hospital cafeteria. You feel fortunate to have this kind of access to Chris, and you try to learn as much as you can over lunch. That afternoon you go back to your desk to look over the files that Chris’s administrative assistant pulled for you.
Description of characters:
Lunch Conversation WithChris
You: What did you think of the board meeting today?
Chris: What a way to start your internship! That board meeting didn’t go well, but that is not unusual. The good news is that the leadership agrees we need to take action to address some fundamental issues at Memorial. The bad news is that they are all over the place in terms of what needs to be done. Everyone has his or her pet project, based on functional expertise. No one is looking at the big picture. We operate in silos around here.
You: Has the board been like this since you started?
Chris: Yes. It’s been like this for years. As CEO, my biggest challenge is to bring together the leadership team. It’s what I’ve done in my previous jobs and what I was brought in to do here. I’ve had 6 months to learn about Memorial and to get to know the team. Now, I’m preparing an action plan. And I’m happy to have someone with your experience and education here to help.
You: I’m excited to be here. What do you see as the next steps?
Chris:We need to rally the leadershiparound a vision of patient-centered, quality care and outline a clear action plan for improvements. You heard the board griping today. There’s real urgency here. The physicians are starting to complain too—they say they are not being treatedwith the respect they deserve. A few have even mentioned that they choose to practice at Memorial, and they can choose not to practice here. Those aren’t veiled threats; they’re real threats. The nurses are not happy either. Nurse turnover at Memorial was up 50% last year, whichis double the national average. Morale here is low. We conducted our first-ever employee satisfaction survey, and Memorial scored significantly below the benchmarks on key metrics.
You: Do you have any customer-satisfaction data?
Chris:Our Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores continue to decline. We’re expecting topline results from last quarter today; I’ll make sure you get the results. The number of complaint letters has doubled in the last year. I’ll get you copies of those too.
Listen, I know I’m throwing a lot at you on your first day. I’ve been thinking about this for months. I have some big challenges here, and I think that your support will be valuable. This is going to be a great internship project—some really meaty stuff.
First, I need you to write a white paper. The topic is the implementation of a high-reliability quality program at Memorial. We have to make a case for why we need a high-reliability quality program and give examples of specific improvement tools that could be used in the quality program. Also, we’ll outline the customer assessment and improvement to be used to improve quality and safety in the hospital. We have a board meeting 8 weeks from today. You can present the white paper to the board, and then facilitate the discussion so that we can get consensus to move forward. I’ll make sure we have time on the agenda for the presentation and discussion.
You: Great. I’ve studied high-reliability quality programs, and I’ve done research on how to implement them.
Chris: I know; that’s what made you stand out when I was interviewing interns!
The second initiative I need your help on is a plan to address the cultural sensitivity issues at Memorial. This has been on my mind since I heard an excellent presentation on this at the Healthcare Executive Conference last month. I’ve analyzed our complaints, and I attribute about half of the increase to cultural sensitivity issues. I want you to put together a plan to address the fundamental cultural sensitivity issues at Memorial.
You: You’re looking for the framework for a cultural sensitivity plan?
Chris: Yes. We’ll want to explain why a cultural sensitivity program is important andoutline the key elements for one at Memorial. Also, consider how to roll out the program and the best way to deliver ongoing training. Please put together a slide presentation for the two of us to discuss with the VP of HR and the COO. I’ll get a meeting on the calendar for the end of the month.
[Chris looks at his watch] It’s one o’clock already. I’ve got to run to a meeting. I’m an early bird, so the morning is generally the best time to bounce ideas off me. I’ll set aside a specific time on my calendar to review the drafts with you. It’s great to have you on board!
ComplaintLetter Excerpts From Last Month
My adult daughter is currently hospitalized at Memorial. I have durable healthcare power of attorney for her because she has significant health issues and her husband travels often. I am frustrated that your physicians and nurses do not consult with me about her treatment and instead confer only with her husband. All of her records and documentation are updated to show that I have durable healthcare power of attorney. If this situation is not addressed immediately, I will be forced to take legal action.
Dear Medical Director:
My father went to the ER at Memorial for vertigo and nausea last week. He was very upset that the ER doctor ordered a blood draw and blood work. He immigrated to the US from China 50 years ago. My father believes that blood taken from his body will never be replenished. By the time I arrived at the ER to be with my father, he was distraught. Surely you have many elderly Chinese patients, given the demographics of the community. This situation was not handled well, and I am writing to ask for an apology.
My family and I have only been in this country for one generation. We talk with accents and may look as though we are from our native country because of how we dress. We are frustrated with the poor treatment we received during our father’s visit to the emergency room. The poor treatment continued after he was admitted to the hospital.
The attitude of your staff was condescending. My father was treated as though he didn’t understand your language or as though he was too dumb to understand. He said that doctors and nurses made decisions about his care without consulting him, as though he couldn’t understand their words. My father had a slight stroke about 6months ago and slurs some of his words, but he understands and can make decisions on his own. Why did your people treat him with so little respect? What are you going to do?
I was at Memorial for 2nights last week because I had pneumonia caused by the flu. I feel that I received outstanding medical care, and I am feeling much better. I am writing to complain about the housekeeping staff. During the 3days and 2nights that I was there, my room and bathroom were not cleaned. On my second day, I requested housekeeping service when my room was not cleaned by noon. No one from housekeeping ever came, and I felt my room was unsanitary. Eventually my wife used some Clorox wipes to clean the bathroom. What are you going to do to make sure this does not happen to other patients?
Dear Pharmacy Director:
My son was at Memorial overnight after having his tonsils removed. His physician approved his discharge at 10:15a.m. We sat in his room for over 2hours, until 12:45p.m., waiting for his prescription for antibiotics to be filled. The nurse assured us the prescription had been requested at 8:30a.m. It is cruel to make a child, who wants to go home, wait that long in a dreary hospital room. The delay was unacceptable.
Dear Nursing Supervisor:
Our daughter gave birth to her second son last evening—her first was also born at your hospital. There was no way for her to sleep because every 2hours someone came in to check on her, the baby, or both of them. When she left the hospital, she was more tired than when she arrived. What will you do to prevent this from happening to another young mother? This just isn’t right—it’s not a good way to introduce a young mother to your hospital.
I had a minor outpatient procedure at Memorial last week. I am 80 years old, and I remember when your hospital was the best in our community. My recent experience shows that Memorial has changed. I left your facility so frustrated with the inefficiency of the outpatient surgery unit. Last Wednesday, I checked in at 6:15a.m. for an 8a.m. surgery, as I was instructed to do. I sat in the waiting room until 8:35a.m., and my procedure began just before 11a.m. To make matters worse, the front desk staff and the nurses were rude. They complained about working at the hospital right in front of me, as if I wasn’t there. The nurses were more interested in texting on their phones than in caring for their patients. I am so disappointed by this experience that I will not return to Memorial for treatment.
E-Mail Concerning Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Data
[When you arrive at 7a.m. on the second day of your internship, you find a hard copy of this e-mail on your desk with a handwritten note from Chris that says, “I want you to attend the meeting on the HCAHPS reports. Watch your email for an invite.”]
E-mail from Vivian.email@example.com
Just got a look at the topline data from the HCAHPS reports for the last quarter. Our numbers are falling in a couple of strategic areas. Our numbers have been going down for the last 5quarters and merely hopingfor better results“next quarter”hasn’t worked. The directors need to get together to look at the questions that relate to their work area, and we need to collectively figure out how to address the issues.Are you available 1week from Thursday at noon to meet with us?
I’ve included two charts that show the responses to questions I feel are particularly important. I’ll have a full packet of data for you to review as soon as it is available—by the end of the week at the latest.
Patients were mailed a survey a week after being discharged as inpatients at the hospital. Memorial received 422 surveys, a 31% response rate. They were asked to answer the following question on a scale of 1 to 10, where “1” means “not at all likely,” and “10” means “very likely.”
After answering all other questions on the survey, patients answered a separate question that asked for an overall rating of the hospital. Ratings were on a scale from 0 to 10, where “0” means “worst hospital possible,” and “10” means “best hospital possible.”
Vivian Sands, MD, MHA
VP Operations, Memorial Hospitals
[You stop by Chris’s office first thing in the morning on your third day to say hello. His phone rings but he motions for you to come in. Chris has just received a phone call from his friend and former colleague, Raj Patel. Chris puts the conversation on speaker.]
Raj: Hi, Chris.
Raj: How’s the new job?
Chris: It’s keeping me busy. How’s the consulting gig?
Raj:Crazy. I’m all over the country these days. Last month I was on the road for 18 nights. The demand for our kaizen events is exploding. Listen, Jim (COO of Memorial) and I were out on the golf course on Saturday and began talking shop. Jim tells me that Memorial is evaluating how to improve the quality of patient services. I think my firm can help.
Chris: How’s that? Listen, before you answer, you’re on speaker. My super-star intern is here and should be hearing this conversation.
Raj:Great to meet you over the phone. I’m a partner at Health Care Solutions. It sounds like Memorial can benefit from working with us. My firm has had tremendous success with our kaizen events at other hospitals. We have a two-pronged approach. We focus on a series of mini-kaizen events that let us have quick hits. The wins get the team excited and create momentum. At the same time, we focus on selecting a few key areas for major kaizen events that will have the biggest impact.
Chris: Tell me more about your approach.
Raj: We are focused on immediate results and return on investment (ROI). We need to find the low-hanging fruits and address the big issues. Let’s have lunch next week. Bring your intern. I want to get both of your perspective on the issues. I can share some case studies and present a proposal. Your board will love it. Based on some preliminary numbers I ran, the ROI will be outstanding.
Chris: I’ll look forward to it.
[Chris and Raj set a date and time to meet for lunch]
Conversation WithAunt Gloria
[After arranging to meet Raj for lunch, you and Chris walk to the cafeteria to get coffee. On the way you run into an elderly woman in a volunteer smock.]
Chris: Hi, Aunt Gloria. How are you?
Gloria: Just fine, dear, and you?
Chris: Good. Aunt Gloria, this is my intern.
You: Pleased to meet you.
Chris: How was your visit with the pulmonologist at Memorial yesterday?
Gloria: She was . . . very young.
Chris: She may seem young but she’s highly trained—and one of the best in the field. Did she answer your questions?
Gloria: She gave me her opinion. Frankly, I found her very arrogant. I don’t think she is the right doctor for me.
Chris: I’m surprised to hear that. She comes highly recommended by her peers and, given her specialty, she should be a great match for you. Why would you want to find another pulmonologist?
Gloria: Well, Chris, she called me Gloria. Everyone at the clinic did. I know I must sound old and stodgy but I find that so off-putting. At my age, I prefer to be called Mrs. Sanchez. I guess I’m just old-fashioned.
Chris: Aunt Gloria, I’m so glad you shared that with me.
Summary of Memorial Hospital’s First Annual Employee Satisfaction Survey
Number of Complaints by Quarter
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