Customer Service

Empathy in action

/ Jonathan Sachs

Several months ago, I ran across this emotional video about the power of empathy and leadership in health care:

I often share this video and Jap’s story for several reasons. His positive attitude, coupled with his thoughts of wanting to do more with his life are inspiring. While his injury took away the use of his legs, it gave him a fresh perspective and new motivation in his life.

From a health care delivery standpoint, Jap’s story teaches us that we must do more for our caregivers and that anyone in the hospital can lead to make a patient’s experience better.

As you watched the video, did you notice what happened when Jap woke up from his accident? The first thing he did was scream out. But, nobody came to his aid. He was on the “diving accident floor” in the hospital, and according to the nurses, everyone on that floor screams after they regain consciousness. To the nurses, every scream was, “just another day at the office.” To Jap though, it was one of the scariest and worst moments of his life, and he was alone.

In my current role, one of my main responsibilities is to work on this very issue. Clinicians can become used to or numb to other people’s suffering. It is not because our bedside caregivers are bad people or doing something wrong, it is simply because of the nature of the work. Part of the role of patient experience is to create systems to remind caregivers that, for the patient, this is not just, “another day at the office.” Part of this work is done by creating mechanisms to constantly remind caregivers that our patients do not come to work in a hospital and the days they are here are unique to them. We must help caregivers connect to the fundamental emotions of most patients: That they are scared, stressed and confused.

The other lesson Jap teaches us is that anyone can lead. Carlos, Jap’s nurse in the ICU, not only goes to him when he screams, but instructs the other nurses how to comfort Jap. Carlos was behaving in a way that creates positive, peer-to-peer accountability. Carlos authorized himself to help the entire team care for Jap in his hour of need. Carlos took it upon himself to provide the reminder that this was a unique day in Jap’s life and he will need help to get through it. Carlos embodied how, in hospitals especially, patients expect more than just us treating a disease or an injury; they expect to be treated like people.

This powerful video shares these lessons elegantly and they apply to any work that we do interfacing with other people.

Thank you for sharing your story, Jap.

KEY TAKEAWAY: Patient experience is about reminding people to see care through the eyes of the patient and to treat their emotions, not just their physical condition. Anyone can lead in patient experience, it is up to leaders to create mechanisms for peer-to-peer coaching and accountability. 

Customer Service or Customer Experience?

/ Jonathan Sachs

One of the recurring topics of this blog relates to, “How we treat each other.” I am passionate about improving the patient experience at hospitals because I believe it has powerful implications for how we treat each other. If clinicians can demonstrate compassion, courtesy, and kindness during a difficult moment in a patients’ life, imagine how that level of care could impact how that patient will treat others in the future. Like other social epidemics, I believe that kindness can catch on as well.

A colleague of mine at Adventist HealthCare shared this 17 minute video with me. In the video, Fred Lee, the author of If Disney Ran Your Hospital, gives a TED talk about the difference between customer service and customer experience.

Lee defines a service as, “Labor done for me that I would otherwise do for myself”. He goes on to share and explain how an experience is far more emotional, difficult to measure, and impossible to fully control through mechanisms like scripting. Defining the journey of a patient as an experience allows us to embrace the fact that it doesn’t mean our patients have to be happy all the time when they are under the care of a hospital.

Lee uses a helpful analogy in the talk to explain this idea. When we go to the theater, sometimes we go to see plays and musicals that make us happy, while other times we see dramas or tragedies that touch our emotions in a different way. Both instances are experiences that speak to the human condition, not necessarily only positive emotions.  Lee describes this as, “We in the hospital business have the job of meeting the emotional needs of a family going through fear, pain and even tragedy together.”

Further, he says that “A hospital without compassion is like a trip to Disney without fun.”

When hospitals and other companies deliver an experience, it resonates with the consumer emotionally. In a hospital setting, emotion is already present. How clinicians understand the emotions of the patient and anticipate the patient’s needs shows how much they care and that they are attentive to the situation.

Lee tells a story of a caregiver who comes to take blood from a patient. In the first scenario, the caregiver follows a script. In the second, the care giver provides an experience. He quotes a Gallup organization study that found that just using the word “gentle” reduced a patient’s pain when receiving an injection. Small touches can radically change a patient’s care experience but it has to be individualized – not every interaction will be the same or have the same effect for every patient.

Lee posts this quote during his talk: “Experiences occur with any individual who has been engaged in a personal and memorable way…on an emotional, physical, intellectual, or even spiritual level. The result? No two people can have the same experience – period.” B. Joseph Pine III, The Experience Economy

Since experience is so individualized, it involves developing active listening skills, focus, compassion and empathy. Conveniently, these are the same skills that we can all demonstrate on a daily basis to each other to make the world a better place, not just in the work setting. While health care is a powerful setting to deliver an incredible experience, we can all be human experience ambassadors with our friends, family, colleagues, neighbors, and even strangers.

The first step is to want to make a difference in this way. Will you join me in being a human experience ambassador?

Can empathy be taught?

/ Jonathan Sachs / 2 Comments

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

/ Jonathan Sachs

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?

/ Jonathan Sachs

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.