Can empathy be taught?

On May 29th, I spoke to the leaders at Adventist HealthCare at our semiannual Mission in Motion conference where patient experience was the theme of the day. As part of the plenary session I explained to our leaders why I am so passionate about the work of improving patient experience.

One of the reasons, I explained, was that last year, we touched nearly 80% of our community within 1-degree of separation. By one degree of separation, I am assuming that each employee and each patient has at least, on average, one other member of their household. For example, if we treated a mother, her experience in our care would have influence on her whole family. Imagine if we demonstrated kindness and compassion in a way that exceeded the patient’s expectations. If our team and our patients take those behaviors home, imagine the multiplier effect it could have of people leading by an example of deep kindness.the war for kindness

If you attended the Mission in Motion conference, you would promptly leave the plenary for a mandatory breakout session on selecting the right employees for the job. The session educated attendees on certain behaviors, like empathy, which lead to kindness and compassion that can’t be taught. If leaders do not follow a good process for hiring, it may hurt the whole group. This conventional wisdom is present in the literature around excellent service organizations, like the Ritz-Carlton, that deploy a rigorous hiring process to prevent “bad apples” from entering the bunch.

Enter Stanford University psychologist Jamil Zaki, who presents a compelling challenge to the notion that empathy is not a learned trait. In his recently published book, The War for Kindness: Building Empathy in a Fractured World, Zaki describes how his work and research can help people become more empathetic.

Zaki describes his childhood living in parallel worlds after his parents divorced. He described this experience as an “empathy gym,” noticing how two people could have completely different and yet totally valid views of life. He has created a similar type of course at Stanford, sending students to various exercises and experiential learning environments to build their empathy muscles. While the work is rigorous and difficult, he has shown results.

Further, Zaki shows his work in a way that builds trust in the research. At the end of the book, he takes the reader through each study mentioned, chapter by chapter, and rates the quality of the research on a 5-point scale. While some of the research is yet to be validated, it is certainly interesting, controversial at times, and quite progressive.

The initial set up of the book is quite dense, describing several research studies, as well as a general orientation to historical notions on empathy. It was worth the dense crash course to get to the stories and real world examples of building empathy. Zaki takes us through experiments in using literature to stop recidivism, truly understanding “compassion fatigue” in hospitals, and positive and negative impacts of technology on empathy.

The War for Kindness has many implications. It is a helpful roadmap for how we can be more kind, compassionate, and empathetic as a society. It has challenged my thinking on hiring in health care. While I still strongly believe that systems and processes help protect the team and enhance service, I now believe that a motivated candidate can be taught how to empathize. I also believe that we must coach motivated caregivers to have empathy in a way that does not cause burnout or eventually result in emotional numbness towards patients.

I have already bought copies of this book to give away to friends and colleagues, because it is powerful, hopeful, and challenges assumptions about how we can repair our seemingly broken world. It is surely worth the read not only if you lead people, but if you are interested in making society a better place (this should be everyone!).

KEY TAKEWAY: Can empathy be taught? Jamil Zaki in The War for Kindness argues that it can be. The implications in healthcare mean that our team members would benefit from a culture that has built in systems to train people on demonstrating empathetic concern for patients. This is a must-read book.


The War for Kindness is available for purchase on Amazon for $27.00 (does not include Prime discount).

If you work with people, work on culture

In my current role as a patient experience leader for a health care system, a large part of my focus is on culture. If you are already familiar with this blog, you have already seen me discuss culture a lot in the context of leadership and in book reviews. I talk so much about culture because it is what makes systems and processes work reliably and without constant auditing.

For years, I have been working to put the pieces together in terms of how to build culture. Using ideas from authors like Simon Sinek, Malcolm Gladwell, Joseph Michelli, and Adam Grant (to name a few), I have created my own definition of leadership and have advocated for articulating a vision and creating systems and processes to bring that vision to life. However putting the pieces together both from research and experience, has at times has felt like a struggle.

Culture CodeThen along comes Daniel Coyle, author of the best-selling book The Culture Code. In this book, Coyle has compiled a clear and well explained definition around the common characteristics of organizations with exceptional cultures that lead to consistently excellent outcomes. Using examples from organizations like Pixar, the San Antonio Spurs, the famous Upright Citizens Brigade improv group, and Navy SEALs, Coyle shows us what these organizations do differently that allows them to deliver results for the enterprise and its people.

The three over-arching characteristics that every group has in common are:

  1. Build Safety
  2. Share Vulnerability
  3. Establish Purpose

Under each of these simple two-word ideas are many different anecdotes, research studies, and case studies that show not only what these concepts mean, but what building them entails for leaders.

He also delves into the nuances of these concepts that may vary depending on the business. For example, in the book he compares organizations that build a culture for high service reliability (Union Square Hospitality Group – think Shake Shack) vs. creativity and innovation (Pixar).

Health care service delivery is an example of a setting where the culture must be built for high service reliability. Much of this work involves creating genuine connections with patients and their families, which helps determine how to meet their needs both including bridging the gaps in their understanding of their condition, the treatment, the workings of a hospital, and the health care system at-large.

Coyle covers the impact of empathizing with the patients in order to the increase their health outcomes and covers how to create an environment for the staff that promotes empathic behavior.

In the book, Coyle discusses a Harvard neurologist named Marci who researched the impact of listening in the medical setting. She studied non-western healers who used methods that were scientifically questionable, yet found that some practitioners had remarkable results.

To explain these outcomes, she says, “What these healers all had in common was that they were brilliant listeners. They would sit down, take a long patient history, and really get to know their patients…They were all incredibly empathic people who were really good at connecting with people and forming trusting bonds. So that’s when I realized that the interesting part wasn’t the healing but the listening and the relationship being formed. That’s what we needed to study” (Coyle p.154).

In health care, we tend to think of communication as “provider to patient”, with the patient simply answering the provider’s questions. As I take a few steps back think about it, wouldn’t someone want to feel known as a person, and not just by a diagnosis? Just listening to the patient gives the provider an opportunity to create that relationship.

Culture in the health care setting, because of the nature of the work at times being life-or-death, is especially important. Guides like The Culture Code help us build those cultures in a safe and sustainable way.

KEY TAKEAWAY: The best companies are deliberate about building their cultures. In health care, specifically, culture can deliver superior patient outcomes if there’s a focus on the caregivers and seeing the patient as a person, rather than a diagnosis.


The Culture Code is available for purchase on Amazon for $28.00 (does not include Prime discount)

How important is the customer experience to Apple?

Remember, back in 2001 when everyone thought Apple was crazy for opening retail stores? Now, almost 18 years later, the world’s most profitable company looks like they will have the last laugh.

What Apple knows well is that they cannot really rest on their success in the past to ensure future success. They need to continue to innovate and keep the customer experience on top of mind if consumers are going to continue to pay a premium for Apple products over increasingly formidable competitors both at home and abroad.

Going into retail was Apple’s initial innovation, which was soon followed by the Genius Bar (technical support), then followed by the open concept layout of their stores. Despite this innovation, for some of us, the Apple store was losing its charm and felt more like we were being herded to various queues, surrounded by crowds, rather than having a positive experience. They needed to do something to continue their retail success

I started thinking more about this when I was recently in the Apple store with my wife to replace her iPhone 6 with an iPhone XS. We went to the Apple store in one location but then ended up following-up at a different Apple store to get the actual phone because it required an ID for the cellular account and I forgot mine at home. I couldn’t help but observe how their flow had changed from my last visit.

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At the first store, we were greeted before we even walked into the store. I must have looked determined, because when I was about 15 feet from the threshold of the store, one of the sales associates was already waving “hi” to me. He asked us what brought us to the store, talked to us for a few minutes to assess our need and then handed us off to another sales associate. The sales associate’s responsibility was to help us with our device of choice. Once we chose the phone, it was retrieved from inventory by a third associate, called a “runner”.

Observing the same dynamic at the second store, I did something my wife only reluctantly tolerates – I began talking to the sales associate about her training and the flow of the stores. Just to note, I have done this an embarrassing number of times, most recently also shopping at Lululemon and comparing notes with a friend who works for Madewell.

According to the sales associate I spoke with, Apple changed their workflow with one objective in mind: keep the customer company throughout the process of making a purchase. Once customers are initially greeted, they are then led into 1 of 2 queues: one for service and one for sales. Customers who are “just browsing” are left on their own. The sorting process prevents associates from wasting their time with customers who were just in the store to wander around.

For service, the queue is straightforward: If you had an appointment, they honored the appointment and hand you off to a technician. If you did not have an appointment, they would schedule one for you, thus moving you to a different queue. The annoying part of the technician queue was that you needed an appointment to be seen, which could be weeks from now. Not super helpful once you have purchased your device.

The sales queue is more complicated than the service queue: Based on your input to the greeter, you are then sorted by product and are directed to meet a sales associate at the correct product display/demo table that houses the product you are interested in purchasing. That person then stays with you for the remainder of your experience at the Apple store. While the sales associate used to also pull the desired item from inventory, Apple has now chosen to hire runners to pull products from inventory, ensuring that the sales associate remains with the customer until the purchase is complete. My math suggests that they had to add staff in this model.

This begs the question: Why? Did Apple have trouble with customers leaving while the associate is going to the back to retrieve the item from inventory? Is this somehow a faster experience for customers? What is this new system about?

My view is that this change is all about making the purchase of a premium product a premium experience. The sales associate now functions both as a concierge and troubleshooter for any issue the customer may have with their new, beautiful, device. The sales associate can also make sure the device is set up correctly, limiting return visits for technical service that is really more about the user’s competency with the device. The associate could also up-charge some subscriptions or accessories, although, truthfully, I have not witnessed them doing that behavior.

Apple, like many other companies, is focused on getting their customer service system right as much as they are in getting their products right. Paying attention to the experience of buying an item or interacting with it in a physical place is crucial.

Apple is not the only example of a company making the purchase of a premium product a premium experience. Recently, my wife and I bought a Peloton (incidentally, we love it). We bought it after walking into a Peloton retail location in our neighborhood. The sales associate, Danny, gave us a memorable experience, answering many questions (we didn’t go to the store with the initial intention of buying anything), and setting up time for us to try the bike, taking a class in a private room in the store with plenty of water and clean towels. We went back three times before we made the purchase, each time with no pressure. Delivery was also easy, featuring complete set up and orientation to the bike, right in our home by a two-member delivery team.

A positive experience with these companies doesn’t happen by accident.

In business, it is critical that we not only pay attention to the product, but the experience people have in accessing that product. In health care, we have a lot to learn from retail regarding how to match clinical (product) excellence with experience excellence.

KEY TAKEAWAY: Businesses design the shopping and customer experience with a similar focus to how they design their products. A lot can be learned from companies, like Apple, who take the retail experience seriously.

Book Review: Be our Guest

Disney is known for excellence in customer experience at their parks, hotels, and on their cruise ships. The company formed The Disney Institute so that other companies could learn from Disney’s approach. While a Disney Institute summit may set you back over $4,000, a lot can still be learned from its considerably more affordable book, Be Our Guest: Perfecting the Art of Customer Service.

beourguestLike Starbucks and The Ritz Carlton, Disney has a well-defined, self-reinforcing, and rigorous system for customer experience. Disney’s “magic” is delivered through its organizational knowledge of guest psychographics combined with demographics (Disney calls it “Guestology”), its simplicity, and the complete integration and alignment of its system. Disney’s core purpose (like a vision statement) is defined as “We create happiness by providing the finest in entertainment for people of all ages everywhere”.

Guestology

Disney invests time, talent, and treasure in its efforts to not only know who are their guests (demographics), but also what their guests expect and want to feel (psychographics). While demographics are important and relatively easy to access through existing systems, psychographics are even more vital to delivering a superior customer experience.

Disney looks at the mental states of its customers by evaluating all of the parts of their experience through 4 dimensions: Needs, wants, stereotypes, and emotions.

Applying this principle to another business, like in an urgent care, for example, this matrix would resemble something like this:

Screen Shot 2019-02-05 at 11.07.44 AM

This analysis is a helpful tool to get a chance to match your service offerings to the perceptions and emotional states of your customers. Disney implements processes to respond to its guests’ emotions throughout their parks and resorts. For example, Disney was the first to entertain guests who are waiting in long lines to help them be less bored and pass the time quicker. Since guest needs, wants, stereotypes, and emotions can change over time, Disney revisits this framework often to match their systems to guest expectations.

The lesson here is that knowing your customer, not just who they are but what they expect and why they expect it, is an essential component of building a superior and lasting customer experience. Another essential component is making sure your system for responding to these factors is actionable by the employees (Disney calls them “cast members”) who are expected to bring it to life. This is accomplished, in part, through simplicity.

Simplicity

Disney’s customer service system has only two components:

  • The Four Quality Standards
    • Safety
    • Courtesy
    • Show
    • Efficiency
  • Three Delivery Systems
    • Cast
    • Setting
    • Process

The four quality standards are listed in order of importance, giving cast members an idea around prioritization. These standards are deployed up and down the organization and are reinforced through constant training and coaching. To build a culture around the two components, Disney uses its own language to refer to customers, employees, and attractions. Further, cast members are given guidelines, not scripts, for them to use to deliver consistent service to guests.

Part of the art of the four quality standards and the three delivery systems are what Disney calls, “Think globally, perform locally”. Doing so allows individual hotels or resorts to integrate their own flavor and uniqueness into Disney’s approach to service delivery. Disney empowers its cast members by soliciting their feedback as well as recognizing and rewarding performance.

Disney’s cast can also then focus on the three delivery systems, including seeing themselves as a part of a larger whole and responsible for themselves as well as the setting and process. That is also where integration and alignment become important.

Integration and Alignment

The Disney Institute defines integration as, “the work of aligning and distributing your service stands over the three delivery systems of cast, setting, and process” (p. 185). Integration is a way to, “build a service organization greater than the sum of its parts” (p. 185).

Disney has built-in accountability to its components of service through its emphasis on integration. It ensures that Disney is staying true to its core purpose by making sure that its cast, setting, and processes are always accounted for in everything they do. It also makes sure that the three delivery systems are developed with the customer needs, wants, stereotypes, and emotions of the guest in mind.

To make Disney’s guest experience consistent and reliable, the leadership is committed to this model and includes new initiatives through the lens of integration to provide context for staff at all times. At other companies, initiatives often appear disparate and unrelated due to the lack of context. By using an integrated model like Disney’s, companies can usually avoid this type of cognitive dissonance.

Conclusion

Healthcare organizations can learn a lot from Disney and many have worked with the Disney Institute or read books like If Disney Ran Your Hospital. In order to successfully follow the ways of Disney, the leadership of the organization needs to agree to an aligned model that they will always use as context.

KEY TAKEAWAY: Learning about your customers, developing a simple system for delivering to their expectations, and creating integration and alignment around those elements is how Disney creates its “Magic”. Doing it in your organization requires the same level of intentionality and discipline.


Be our Guest is available for purchase on Amazon for $24.99 (does not include Prime discount)

There are No Accidents

Oogway-white

“There are no accidents” – Master Oogway, Kung Fu Panda

Does anyone else love Chick-fil-A sandwiches?

I remember going with my Mom to Columbia Mall in Maryland and stopping for samples of Chick-fil-A nuggets in the food court. Years later, tasting that delicious recipe again brought me back to my childhood.

While I don’t own a Chick-fil-A franchise and am not affiliated with the company in any way (including any controversial political views), I do admire their approach to not only their product – chicken sandwiches – but also to service. When you arrive at any Chick-fil-A restaurant, there are some service elements that you assume will be there, like the cashier’s always saying, “my pleasure” when you say thank you for extra sauce or a refill on a drink.

But, how do they deliver that experience every day at every location? The answer is that it is deliberate and not done by accident.

Take a look at the Chick-fil-A Service and Hospitality training video posted on YouTube:

In this video, each element of the guest experience is described both from the perspective of the team-member and of the guest. It makes service very easy to understand. The narrator says, “Just like we have a tried and true recipe for our crave-able Chick-fil-A chicken sandwich, we have a tried and true recipe for our service.” The recipe consist of what the company calls the “Core 4” and the, “3 required second mile service behaviors”, which they explain both in words and in practice.

Ingraining and aligning these universal behaviors in a large organization is no easy feat. But, Chick-fil-A has managed to deploy it across their restaurants almost universally. This happens because team-members understand what is expected of them and re-enforce these behaviors among each other. What Chick-fil-A and other companies known for their excellent customer service (Starbucks and The Ritz Carlton come to mind) have figured out is how to create standards that are universally accepted and encouraged not only from management but peer-to-peer.

This system is deliberate and strategic. The goal is provide an excellent customer service experience along side an excellent product and these companies have figured out how to deploy an experience in addition to a product.

For most businesses, they have employees that create an excellent experience and then the next shift comes in and the experience is completely different. Has that ever happened to you? Maybe you go to a restaurant one evening and have great service, only to come back the next week and have poor service. When I see that happen, it feels to me like on of my experiences was probably “by accident”. I really just do not know whether the accident was the good or the bad experience!

That is why it is so important to build reliability into the customer service experience. To do that, many companies emphasize not only behaviors, but values, and room to use those values to deliver the customer experience in new and innovative ways. This is only done through an intentional and deliberate hiring, orientation, training, and engaging leadership model.

TAKE-AWAY: In successful businesses, there are no accidents. They deliver an excellent experience carefully, deliberately, and nearly universally without variation. In our organizations, we must create systems and culture to deliver the desired experience every time. Our customers deserve it!