The Baptist Health Care Journey to Excellence

Creating a Culture that WOWs!

Al Stubblefield

• Publisher: Wiley
• Year: 2011
• Print ISBN: 9780471708902
• eBook ISBN: 9781118046098
• Edition: 1
• Topic: Business
• Subtopic: Management
• Index: Business

An insider's look at corporate culture at one of Fortune's Top 100 Best Companies to Work for in America

A business can purchase, imitate, or replicate most of its elements, but when a business places its competitive advantage with its people, it can become the market leader. The Baptist Health Care Journey to Excellence illustrates how Baptist Health Care went from a customer satisfaction rating of less than 20 percent to being consistently ranked in the 99 percent range. Written by the man who made it happen, this book sets benchmarks and best practices for organizations to measure themselves against by creating a service-centered culture that cares first and foremost about customer satisfaction.

"This crystal-clear book offers to any who will listen invaluable, detailed guidance on how and why to move toward a true culture of excellence in hospital care. It isn't easy, but, as their results show, it's a journey well worth taking."
— Donald M. Berwick, MD, president and CEO, Institute for Healthcare Improvement

The Baptist Health Care Journey to Excellence presents tested principles and best practices to help improve your corporate culture and customer satisfaction, which will lead to loyalty, stability, sustained productivity, and profitability in your own organization. Order your copy today!

CHAPTER 1

In Search of Competitive Advantage

Competition is a painful thing, but it produces great results.

-Jerry Flint, in Forbes Magazine

Just as our amazing turnaround has not happened overnight, neither did our descent to such dismal satisfaction ratings occur quickly. A variety of factors contributed to our downturn, including poor management decisions, changes in the healthcare industry, and other distracting pursuits that ultimately proved more harmful than beneficial. These factors, combined with lack of vision, caused us to lose our focus as a healthcare organization.

We had meandered into the last decade of the twentieth century, maintaining our status, as I like to put it, as an “outstanding mediocre hospital system.” We were doing okay, although our accomplishments were not especially noteworthy. With the unique challenges that the next few years brought, however, our status, even as “mediocre,” came into question.

I often refer to the period of the early 1990s as “Merger Mania.” The “bigger is better” philosophy reigned in the business world, and the healthcare sector eagerly bought into that ideology. We at Baptist Health Care became convinced, along with most in our industry, that we needed to form partnerships with other companies to create larger and stronger organizations if we were going to survive. We began seeking potential partners as we attempted to prepare ourselves for the future of healthcare.

Our leadership team spent about five years in major merger discussions. We looked at three potential partners and held untold numbers of strategy meetings with board members and the senior management team. We met frequently with staff from the other organizations, calculating the potential savings of merging information systems and dreaming of increased negotiating strength and purchasing power. However, all three times, our grand plans fell through, and we found ourselves back at the drawing board.

Although none of these talks led to a deal, merger mania affected us on the local level as well. While we had been busy pursuing various state- and regionwide ventures, we had also been actively expanding our local presence by both acquisition and innovation. By 1995, we had successfully added a large community mental health center to our organization, affiliated with two area rural hospitals, and started building a physician company. In three years we had grown from 2,300 employees to over 5,000.

Finally in 1995, after five years of looking off into the distance, our leadership team began to turn its focus toward home. Baptist Health Care was growing; however, we had taken our eye off the ball. The disconcerting survey data that we were receiving was telling us that we had lost sight of our mission. Employees were unhappy with senior management, patient satisfaction was plummeting, and overall morale across the healthcare system was low. Clearly, we had become so obsessed with what was going on outside of the organization that we had forgotten to pay attention to the people on the inside. We had allowed Baptist Health Care to stray from its roots, evolving into an organization that was not performing up to its potential and was not satisfying its employees, not to mention its customers.

As this reality sank in, we began to see that in order to survive, we were going to have to make some dramatic changes. While we had not yet fully identified our problem, much less found the right solution, we were taking our first steps toward improvement. We had acknowledged that things had to change, and we were ready to do what it took to better our organization.

FINDING A COMPETITIVE EDGE

Before we could begin moving toward the change we sought, we needed to assess our present condition. An evaluation of our current position in the market identified some major challenges. Our two local competitors were hospitals owned, respectively, by the Daughters of Charity, an organization whose $2 billion war chest led the Wall Street Journal to call them “the Daughters of Currency,” and the Hospital Corporation of America, an organization with immense equity capital. One of these local systems was at that time making a $300 million enhancement to their Pensacola campus, while the other was in the heyday of its equity accumulation. We were clearly at a financial disadvantage.

We recognized that we could not compete by out-spending our competitors on technology, facilities, or programs. Even if we had possessed the financial means to do so, those things were too easily duplicated, imitated, or outdone by competing organizations. So we asked ourselves: “How can we build a sustainable competitive advantage in our marketplace?” This question became even more critical when we considered that our main hospital facility, Baptist Hospital, was losing market share among insured and paying patients while its share of patients unable to pay for the care they received continued to grow. We began to see that even being as good as our competitors was not going to be enough. In order to survive, we were going to have to be noticeably better than the competition. But we still didn’t know how to get there.

As we were asking these questions and searching desperately for a way to compete, a new ideological wave was sweeping American business. In what looked to us like just another business fad, consultants for Continuous Quality Improvement (CQI) encouraged corporations to strategically focus their efforts on improving quality and service. Not to be left out, we bought into these ideas, although somewhat half heartedly, hiring a CQI consultant, and establishing a Quality Committee of our board of directors.

Robin Herr, a local plant manager for Armstrong World Industries and member of our board, was named chair of our quality committee. In meeting after meeting he would take the floor and emphatically announce, “Quality can be a competitive advantage!” I remember nodding politely, all the while thinking, “He doesn’t know health care. You can’t measure quality in health care.” I wasn’t sure what the answer to our problems was, but I was sure that it could be found in something much more concrete and measurable than “quality.”

Eventually, though, we ran out of other options. We had already eliminated programs, facilities, equipment, and location as potential competitive advantages. What was left? As we continued to hear the quality message preached to us from a variety of sources, I began to wonder if maybe Robin Herr was right. Perhaps quality was an area where we could shine. I was also strongly encouraged by Jim Vickery, the President/CEO and my boss and mentor at the time, to grab hold of this “quality stuff” and make it work for Baptist Health Care.

If quality and service were truly going to be our competitive advantage, I knew that we would have to be able to measure them. Change happens much more slowly (or not at all) if you fail to keep track of where you’ve been and how far you’ve come. When we examined our current assessment tools, we found that we did have at least one instrument already in place to measure quality—our quarterly patient satisfaction surveys. These surveys measured how we rated against our peers in the area of customer service, an important quality indicator in healthcare.

So we decided that we could start there, with a new, strategic focus on service excellence. We said, “Let’s build a service culture that will be very difficult to duplicate or compete with.” We pledged that we would outperform our competitors by providing a level of service that our community—and even our nation—had never experienced before.

And that is how the turnaround began. Our organization reached a crucial turning point on the day that we committed to providing the highest level of customer service possible. While it may have gone unspoken at the time, that commitment to service excellence included a willingness to make the difficult changes necessary to get there. We knew we had a long road ahead, but we were ready to start moving in the right direction.

While turning our focus to service excellence may sound like a noble endeavor, it was born largely out of desperation. In effect, we heeded the sage advice of author and consultant Peter Drucker: “You don’t have to change—survival is optional.” We knew that without drastic changes, we would not survive; thus, creating a culture committed to service excellence was no less than a survival strategy. We saw no other option. In hindsight, I am convinced that there was no better option; service excellence should have been our focus from the beginning.

Another fortuitous part of this puzzle fell into place just as we began this journey eight years ago. Around that time, I began the transition into a role that better fit my management style. Jim Vickery, who was just the second CEO in the forty-eight-year history of Baptist Health Care, asked me to assume the role of Chief Operating Officer (COO) as he began to anticipate retirement.

I say this new role fit my style because I reveled in numbers and believed that objective survey data had the power to drive improvement. So, as COO, I began to look even more closely at the customer service measures that we already had in place. At the time, you had to have a strong stomach to digest the data we were getting. Our patient satisfaction scores in the eighteenth percentile meant that eighty-two percent of the hospitals in the survey were doing a better job of pleasing their customers than we were.

There was certainly room for improvement, and we believed that we might have found the key to turning those scores around. We had become convinced that an intense, unwavering focus on excellence in customer service would give us the competitive advantage we were so desperately seeking. Now the question was, “How do we get there?”

FOCUS ON EXCELLENCE

In October 1995, I walked into our board meeting and promised that we would raise our patient satisfaction scores from the eighteenth percentile in patient satisfaction to the seventy-fifth percentile in nine months. This was a radical but (I hoped!) achievable goal, and I believed that creating some quick wins was crucial to our success.

When I walked out of the room after making that announcement, one of my senior officers took me aside and said, “Do you realize what you just did in there? You set us up for failure!”

Part of my reason for sharing this is that nine months later, when we had not only reached the seventy-fifth percentile but surpassed it, that officer was no longer with the organization. He and a handful of others who were unwilling to completely embrace our new culture had to be replaced. Those who remained, however, experienced the satisfaction of achieving that first challenging goal, and it only made them hungry for more.

How did we achieve such a tremendous turnaround so quickly? We discovered that the key to patient satisfaction is to focus not on patients first, but on your employees. We quickly realized that the satisfaction of our patients was directly related to the satisfaction of our employees; only happy, fulfilled employees will provide the highest level of healthcare to our patients. Therefore, we reasoned, “all” we had to do was find a way to satisfy every employee, who would then in turn create happy customers. With that determination, we faced an even harder question: How do we fill our organization with satisfied employees?

Every aspect of an employee’s job, from compensation and benefits to management and supervision to reward and recognition, affects his or her overall job satisfaction. Therefore, an environment that breeds satisfied employees must be satisfying in every area. We were beginning to see that employee satisfaction was an all-encompassing goal. We were not going to find a quick fix; what we needed was genuine, “from the ground up” culture change.

The “aha” moment for me came when I recognized that all the deals we might make, all the joint ventures and all the mergers, and all the improvements in our financial position wouldn’t mean much if our employees were miserable. We had to make our hospital a place where they were happy to be and happy to serve, and that would only be possible through a radical, thorough cultural transformation. True transformation would require a commitment from all of us. Creating a culture built on service excellence would demand some painful adjustments in our leaders and in our organization; every individual from the mailroom to the board room would have to wholeheartedly embrace our new cultural ideals. We knew that this kind of radical shift would never happen without a great deal of hard work, but we believed that the end result would be worth the effort that it took to get there.

Today, I can testify that creating an environment where employees are empowered to perform at the highest level has resulted in more than an inspired workforce. It has resulted in customer satisfaction ratings that are consistently in the ninety-ninth percentile—the best in the industry. Not surprisingly, these ratings have earned us considerable recognition.

Nearly all of Baptist Health Care’s affiliated organizations use the Press, Ganey and Associates survey, the largest such database in America, to measure patient satisfaction. Incredibly, our Gulf Breeze Hospital has ranked number one in inpatient satisfaction for eight consecutive years. Gulf Breeze Hospital’s Emergency Department has ranked first in its category for over three years. Inpatient scores for our affiliates Atmore Community Hospital, D. W. McMillan Hospital, and Jay Hospital combined have ranked second for most of the last five years. Our Baptist LifeFlight air ambulance service has had the top score for air ambulance programs for over two years. Scores for our comprehensive outpatient facility, Baptist Medical Park, have been in the top one percent since its doors opened three years ago. In 2004, Baptist’s affiliated behavioral health services provider, Lakeview Center, was named number one in custo...

Table of contents

• Praise
• Title Page
• Copyright Page
• About the Author
• Foreword
• Acknowledgments
• Introduction
• CHAPTER 1 - In Search of Competitive Advantage
• FIVE KEYS TO ACHIEVING SERVICE AND OPERATIONAL EXCELLENCE
• KEY ONE - CREATE AND MAINTAIN A GREAT CULTURE
• KEY TWO - SELECT AND RETAIN GREAT EMPLOYEES
• KEY THREE - COMMIT TO SERVICE EXCELLENCE
• KEY FOUR - CONTINUOUSLY DEVELOP GREAT LEADERS
• KEY FIVE - HARDWIRE SUCCESS THROUGH SYSTEMS OF ACCOUNTABILITY
• APPENDIX - What about the Physicians?
• INDEX