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Hey Doc: Thanks for the surgery - and the great service

Doctor comforting patient in x-ray

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When you go to a hospital, are you a patient or a customer? Dr. Robert Howard, president and CEO at St. Michael's hospital in downtown Toronto, believes you're both. While he says the institution's first job is to make you better, another is to meet your emotional needs.

"Once you start thinking about patients as customers it becomes much more patient-centric care, and that's where we need to go," Dr. Howard says. "People get out of bed, walk and get moving faster if they have a positive attitude about everything that's happening to them. How we treat them directly impacts their attitude."

In health care, Dr. Howard explains, the advantage of combining both approaches is that treating patients as customers addresses the needs they tell you about, and serving them as patients retains the built in responsibility and commitment caregivers have always had.

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"It's not just that I'm going to give you a good transactional experience," says Dr. Howard, who first joined St. Michael's as a cardiologist in 1982. "I'm going to make a commitment that goes beyond that, maybe cuts into my personal life – coming in early, or staying late for a patient. But 'customer' brings the notion that what you want, I should give."

Dr. Howard, who also holds an executive MBA from the Richard Ivey School of Business at the University of Western Ontario, suggests that any business can learn from this new way of looking at customers – through both their heart and mind.

"We often play to the mind because we're trying to convince someone about a certain strategy or thing to do," Dr. Howard says. "But if you deal with their heart at the same time, if you get both, then you have a very committed, happy customer."

A great customer experience is all about staff engagement, he says. Leaders mentoring staff is crucial, as is the mission of the institution.

"What we're talking about is fundamentally changing many of our processes – the way we provide care," Dr. Howard says of the hospital. "The status quo of doing things the same way is not going to get improvement. Tinkering on the edges isn't the answer, either. Only through fundamental redesign of our care models will we get world-class, outstanding care. That's hard and long term, not a project that's going to be done in a month or a year. This will be forever."

Dr. Howard says staff are already committed to their patients. His challenge is to convince them there's a room for improvement, because a lot of them think things are already working well.

"The best way to convince staff that things can be improved is to actually measure things," Dr. Howard says. "If you can measure what they're doing, show them the data, then compare that data to the best in class, worldwide, they can get very interested in finding how they can do better."

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He then brings in an improvement program and re-measures afterward. As the data gets better, the staff get excited about the possibilities.

"Little incremental improvements motivate the staff to do more and more and then it snowballs," Dr. Howard says.

St. Michael's uses a patient experience survey. Patients are mailed the survey after they go home and that data is analyzed continuously. Response rates are about 40 per cent.

"We drill it down by service," Dr. Howard says. "Each service owns their own data and has to speak to their data. I have a quarterly meeting with all of the service leaders in the hospital and they have to present that data to me every three months. We have targets for them and we hold them accountable."

The trains the front line staff to deal with complaints immediately. Patients also can visit a staffed patient advocate office where they can register a formal complaint that is followed up, either in person or in writing.

"If people complain, it's usually a communications issue – they're upset about what somebody said or didn't say," Dr. Howard says. "They often write them to me. I respond to every letter that I get and either solve it or direct it to someone who's in a position to solve it."

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