By Steve Kelman

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Another highly cost-effective management tool

Shutterstock image (by Ismagilov): businessmen holding check boxes, decision making concept.

(Image: Ismagilov / Shutterstock)

In my last blog post, I wrote about a management tool available to any government manager seeking to influence employee performance -- no new legislative authority or budget required. (After the blog published, Harvard Kennedy School Dean Ellwood wrote me a note saying that nothing else has ever written to Kennedy School employees had gotten as favorable a reaction as his email did. He said it really taught him just how important simple caring and consideration can be.)

A recent New York Times article, meanwhile, made an analogous point about available management tools that require neither legislation nor money, yet can improve an organization's performance delivering good customer service. This example involved customer satisfaction surveys that Medicare requires patients to complete when leaving a hospital after an in-patient visit.

Given the fact that illness has put me in personal touch with the hospital system recently, this example very much hit home. (In fact, I had just recently completed the exact survey the article mentioned, and indeed remembered the questions the article discussed.)

The article notes that many hospitals do nothing with the data that comes from these surveys. (I will for now avoid going on one of my hobby horses, namely that performance measurement can help an organization improve its performance only if they are used by managers.) But it discusses several examples of ways some hospitals creatively used insights from the data to improve the customer experience.

One example involved a question in the survey (I remembered answering it!) asking whether the patient's room was quiet at night. It would be easy to interpret the question literally, or, if results showed patient dissatisfaction, to spend money on noise-dampening equipment or thicker doors in rooms. But the article noted that Dr. Michael Bennick, medical director for patient experience at the Yale-New Haven Hospital, put himself into the patient's shoes and asked a different question: Is the patient saying whether they can get a good night's sleep without interruption?

With that thought in mind, Dr. Bennick hypothesized that maybe the real issue for many patients was having their sleep interrupted in the middle of the night by nurses coming in to take "vital signs" -- temperature and blood pressure -- and draw blood. (This example really hit home for me; I had in fact asked during my first hospital visit why I had to be awakened at 4 am to have my vital signs checked. When I told my sister, she reacted: "Well, Florence Nightingale did it, so they think they need to do it.") So Bennick decided to experiment with eliminating middle-of-the-night vital signs, and also to require attending doctors to call him at 4 am as well if they felt they needed to have blood drawn at that hour! These changes produced an improvement in the hospital's rating on this question from the 16th to the 47th percentile. "And it did not cost a penny," Dr. Bennick was cited as saying. "The only cost was thinking not from our perspective but from a patient's perspective."

The other example in the article involved a hospital at the University of Utah. One doctor there, James Ashworth, found out his ratings were in the lowest 1 percent of doctors nationwide, a result he initially attributed to coding error. But then he decided to take the criticisms to heart, slowing down and listening to patient questions. The next quarter his ratings soared to the upper 90th percentile.

As with the example I cited last week with my dean, using these management tools to improve performance requires only the right attitude, and a willingness to convert that attitude into the right behavior. I will repeat again what I wrote in my last blog – if we as government managers (or private-sector ones for that matter) don't do this, we have only ourselves, not hostile legislators or miserly budgeteers, to blame.

Posted by Steve Kelman on Mar 02, 2015 at 4:22 PM


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