Not sure why so many were up in arms about Veterans Affairs (VA) Secretary Robert McDonald's Disney comment when what the Secretary said is so well-known in healthcare, VA or not. And that is that waiting in line is not measured with regard to the customer experience, period. And that is a fact whether at the Cleveland Clinic, the Mayo Clinic, or any other healthcare organization, waiting in line is just not measured. Actually, and something the Secretary left out, the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), which today is the driving force and the be all end all of what really matters in healthcare today, does not measure wait times either. So to those calling for Secretary McDonald’s head for bringing to light such an obvious fact then they must call for the head of every healthcare administrator in the land as well, as this well kept silent fact is across all tiers of healthcare care, VA or not. If anything, Secretary McDonald deserves credit for spilling the beans, regardless if his words were intentional or merely a gaffe.
Why Disney? The history as to how healthcare gets compared to Disney.
“Now of course when I was in the hospital business in the 1980s we saw ourselves a new frontier was service excellence. And we were going to learn from all the service industries how to have great services. And the way we went about it, of course, was to take all their scripts and standardize them for our staff. And tell them this is what you say, introduce yourself, smile, tell the patient why you are here and what you were going to do. And when you leave the room you say, ‘Is there anything else I can do for you.’ Just like a waitress…In the 80’s…we began to diverge into the service economy and we thought patient satisfaction and patient satisfaction scores and all those things would lead us to the same things that service does in the service industry…Are we in the same sector as Disney but offering a different experience?” –Fred Lee
Who is Fred Lee? No one really, just one of many outsiders who found a need to fill in healthcare and so he did, like so many outsiders. Can you blame them? In 2014 the global healthcare consulting market was $6.3 billion. That’s BILLION with a “B”! With that said, by no means is any of this about Fred Lee other than this specific story with regard to the comments Secretary McDonald made, as Fred Lee is just one of so many outsiders driving healthcare down the wrong tracks.
“[Fred] Lee started his healthcare career as Director and then Vice President of Marketing and Development at Shawnee Mission Medical center near Kansas City. Then he joined Florida Hospital in Orlando. In the 1990’s he became a trained Baldrige examiner and a consultant in Total Quality Management, instructing hospital facilitators in the Deming PDCA [plan, do, study, act] process improvement cycle.”
In the 1980s Total Quality Management (TQM) suddenly appeared onto the national economy stage. TQM consisted of installing and making “permanent a climate in which an organization improves its ability to deliver high-quality products and services to customers.” That included healthcare where and when for the first time the patient became a client or customer and our treasured colleagues caring for patients as well became “the competition up the street”. With that said, the “publicly” stated principle for the management paradigm shift of TQM was across all industries, healthcare included, and was that by improving customer service the quality and cost of products and/or services would improve as well. With that goal in mind and as an incentive for all industries the Malcolm Baldrige Award was created.
The Malcolm Baldrige Program/Award: “In the early and mid-1980s, many U.S. industry and government leaders saw that a renewed emphasis on quality was necessary for doing business in an ever-expanding and more competitive world market. But many U.S. businesses either did not believe that quality mattered for them, or they did not know where to begin.” This being the period, the 1980s, Fred Lee describes as when healthcare diverged into the service economy and the chasing of patient satisfaction scores began and not the present; despite so many in healthcare believe the present as the beginning of customer satisfaction scores.
“The Malcolm Baldrige National Quality Improvement Act of 1987, signed into law on August 20, 1987, was developed through the actions of the National Productivity Advisory Committee, chaired by Jack Grayson. The nonprofit research organization APQC, founded by Grayson, organized the first White House Conference on Productivity, spearheading the creation of the Malcolm Baldrige National Quality Award in 1987. The Baldrige Award was envisioned as a standard of excellence that would help U.S.A. organizations achieve world-class quality.” Sound familiar?
A total of eighteen Baldrige Award Recipients are possible every year, however, since 1988 to 2015 (a possible 324 awards**) only 109 awards have been presented, including six repeat winners. A record I say makes for a not-so-coveted accolade but others would say the sparingly awarded recognition makes the award even more prestigious—but who am I to say otherwise.
The Baldrige Award Healthcare Recipient for 2015 was Charleston Area Medical Center Health System. Today, 1 June 2016, the HCAHPS star rating for Charleston Area Medical Center is 3 of 5 with 71% of patients who reported YES, they would definitely recommend the hospital. The national average to the same HCAHPS global topic question, question number 22 on the HCAHPS survey, is 71% as well. Par for the course I say and not exceptional. Yet, Charleston Area Medical Center is the only, of 4,000+, healthcare organizations to earn the so-called prestigious award in 2015. That recognition despite Charleston Area Medical Center’s Medicare’s “Hospital Compare” (where information on the quality of care at over 4,000 Medicare-certified hospitals across the nation is consolidated and accessible so that customers of healthcare can find and compare the quality of the hospital’s care) value care for heart attack patient rates is “No different than the National Rate” and at a “Greater than the National Average Payment”. On top of that, with regard to value care for heart failure and pneumonia patients the Baldrige Award Healthcare Recipient for 2015 rates “Better than the National Rate” but rates at a “Greater than the National [Payment] Rate” for heart failure care and “No Different than the National Average Payment” for pneumonia care. How is any of that exceptional or award winning? Wouldn’t being “Better than the National Rate” and “Lower than National Average Payment” be a better qualifier as to being exceptional and award winning than just average?
To be fair, the mention of those facts were not to single out or bash Charleston Area Medical Center but only to point out why rating healthcare is not only a bad idea for healthcare but a bad for the health of patients as well. But I digress.
Back to Fred Lee and where Secretary McDonald’s comments might shine some light on our nation’s silent national crisis, not only at the VA but for all of healthcare as well, that healthcare is being taken down the wrong tracks.
“Fred Lee has the enviable distinction of having been both a senior vice-president of a major medical center [Florida Hospital] and a cast member at Disney. At Disney [Lee] helped develop and facilitate Disney’s 3-day healthcare seminar, and its additional seminar on “Customer Loyalty”. Using an insider’s experience and a keen eye for cultural comparisons, [Lee] authored the healthcare all-time best seller, ‘If Disney ran your hospital: 9 ½ things you would do differently…Disney recruited [Lee] because of his expertise in helping hospitals achieve a culture that inspires patient and employee loyalty. [Lee] now shares his insights with healthcare groups all over the world.”
Most recently [2014?] “the newly appointed Secretary of Veterans Affairs, Robert McDonald has tapped Fred Lee to serve on an external advisory board to help revitalized the nation’s veteran and family healthcare experience.”
That is likely where Secretary McDonald’s Disney comment comes from. From the idiot-ology [sic] “If Disney ran your hospital: 9 ½ things you would do differently”. However, that is not the whole story and why a bit more of history with regard to the idiot-ology [sic] of rating healthcare.
With the seismic paradigm shift of the 80s-90s that was the insertion of TQM into healthcare, and when patients became clients or customers and our treasured colleagues became “the competition up the street”, a paranoia set into healthcare. The paranoia being in regard as to who in healthcare would endure the changes. That paranoia setting off a survival of the fittest race and a culture change to be the chosen.
With healthcare organizations jockeying to be the chosen ones, by any means necessary and at any cost, the pressure of attaining those goals was passed down to healthcare workers. And because of threats of losing their jobs healthcare workers turned to strategies that placate to customers in order to keep their jobs. These appeasing strategies, still today, include but are not limited to inappropriate admissions, diagnostics, procedures, and medicines (especially antibiotics and opioids) without indication and more significant placating that DO NOT benefit anyone, other than assured healthcare administrators high satisfaction scores and healthcare workers job security.
From this survival of the fittest race emerged a slue of players trying to get a piece of the $255.3 billion pie spent on healthcare in 1980, Fred Lee and Press Ganey were but two chasing such lucrative pie. A lucrative pie that keeps on giving and which by 2014 has grown to $3.03 TRILLION spent on healthcare annually. Again, who can blame outsiders, as there is a lot of money to be made with little effort? Not to mention, outsiders are always so cunning with their claims that, “It’s ALL in the patient’s best interest.” And healthcare’s altruistic, submissive, and accommodating culture falls for it every time without firing a single shot in challenging outsiders.
Outside the outsider, the inside outsiders, most of them not healthcare workers but MBA-types, emerged as healthcare’s new administrative elite class who were, and continue to be, determined to outperform their competition, again, by any means necessary and at any cost. Like in the previous decade, 1995-2005, when they turned up the already ridiculous arms race, of being the chosen one, a few more notches claiming standard uniforms, valet services and luxurious lobbies, to name a few, would be the needed investments that would set their organizations apart from those “up the street”.
In 1999, the Institute of Medicine (The National Academy of Medicine, today) published a disconcerting monograph titled, “To Err is Human” which described the consequences of consuming healthcare in the U.S.A. at the cost of 44,000 to 100,000 deaths per year. Those findings setting off a separate agenda that healthcare had to be fixed. Or did it?
At a similar time, by 2000, the ceiling as to what management idiot-ologies [sic], luxurious lobbies and placating could do to attract patients, oops, customers and customer loyalty, had been reached.
At the same time, although for the most part it was Press Ganey who owed the customer satisfaction rating market, there were a few companies doing the same. Because of the inconsistent data from different companies the public complained to lawmakers that deciphering such data from different sources was challenging. By 2000 the chatter began of standardizing how healthcare would be rated.
Not the perfect storm but a storm nonetheless and a storm that would challenge the status quo and potentially kill the cash cow of so many outsiders. What if another “Malcolm Baldrige National Quality Award-like” were envisioned as a standard of excellence to help healthcare achieve world-class quality? Sound familiar?
With chatter that the cash cow was about to be history and the ceiling to management, luxurious lobbies and other changes were not moving the satisfaction needle any longer outsiders scrambled to remain relevant. Being the innovators they are outsiders simply repackaged and renamed their failed idiot-ologies of the 90s from customer satisfaction to the new and improved customer experience, just like they have it at Disney. And why patients are now being called guest and where we find healthcare today. And why the Secretary’s comparison of Disney and the VA, and any other healthcare organization for that matter, are accurate. Not just that waiting in line is not measured but the greater underlining message that healthcare has been dragged, for decades now, down a slippery slope healthcare may not recover from.
Yes, Disney and healthcare are apples and oranges. But ALL food*. More important, food for thought.
**Baldrige Award Recipients initially 6 per year but currently 18 possible.
To be continued...