Customer Experience

Navigating Healthcare: The Importance of a Hospital Advocate

/ Jonathan Sachs

Working for the last decade in large hospitals, I get calls. Even though I am not a doctor or nurse, family and friends call when they get sick. All are experiencing some combination of being scared, stressed, and confused by how healthcare works in the United States. They generally ask for advice about how to navigate being a patient.

I always give them the same advice:

Make sure you have someone advocate for you while you are in the hospital.

I will share in this post why I absolutely hate having to give this advice and what can be done about it.

Why it is Important for Patients to Have a Hospital Advocate

Family and friends can serve as hospital advocates

Hospitals are busy places. They are designed to care for the sickest of the sick. A good rule of thumb is if you feel like you are not getting enough attention at a hospital, it means that your doctors do not consider you among the sickest patients in the hospital.

So that’s the good news.

With that said, it can also mean long wait times for simple tests, bumps in the operating room causing your surgery or procedure to be postponed, and limited face-time with your care team. Unfortunately, these delays are all patient dissatisfiers and the uncertainty involved can be stressful to anyone receiving care.

There are many reasons why hospitals operate this way, many of which are economic and operational, so I won’t get into that for this post. (Although if you want to know, just ask, I’d be happy to hear from you).

Because of these factors, navigating care at a hospital can be difficult. Furthermore, The patient in the hospital is usually in a compromised and vulnerable state. They are sick, medicated, in pain, anxious, bored, and sleep deprived, among other things.

That is why you need an advocate in the hospital.

The Best Hospital Advocates

The best advocate for a patient is generally a family member or a close friend. For more complex cases, there are for-hire patient advocates who are usually trained medical professionals.

Sometimes, there is an employee or volunteer affiliated with the hospital called a “Patient Advocate” or “Patient Representative.” These roles range in functions from risk (Dealing with the threat of legal action) to service recovery (Trying to fix a patient’s experience reactively) to ombudsman (Listening to patients and investigating issues to correct them for future patients).

Unfortunately, many hospitals cannot provide someone to advocate for your needs as a patient like a family member or friend can. The simple act of walking over to the nurse’s station, getting to know them, and asking questions about your loved one’s care can go a long way to helping to improve a patient’s care.

To check myself on this advice, I have asked former colleagues of mine what they think about it. Almost universally, doctors, nurses, and administrations I speak with agree with this advice.

The best thing you can do as a patient is to have someone with you to advocate for giving you care and attention while you are in a hospital.

The Downside to a Friend or Family Being a Hospital Advocate

Within the last 13 years, my father, mother, and sister have all been neurosurgery patients. Without exception, during any hospital stay, none of them were alone for any period of time. When my father had emergency surgery, my mother never left the hospital and vice versa. My mother stayed with my sister during the entirety of her multiple hospital stays as well.

At first, I thought they were crazy. But, having now worked in hospitals, it is clear to me that this had major benefits to each of them as patients. Furthermore, the nurses and physicians welcomed the help. My mother and father refilled water, brought up food, and helped to make sure the room was tidy. These responsibilities almost always fall to a nurse or another member of the care team.

In fact, during the COVID-19 pandemic, we frequently heard from doctors and nurses that patient experience was worse when family members were restricted from visiting.

However, this schedule was not without cost. Both of my parents are self-employed and had to miss work and reschedule other life events. They often slept upright in an uncomfortable chair. They didn’t shower. The stress they felt was palpable. While they appreciated the people on their care team, they didn’t trust the hospital to take care of them.

It shouldn’t have to be like this.

I often say that my life’s work as a leader in healthcare is to create an environment where I wouldn’t have to give this advice.

In this reality, family and friends can stay with a patient, of course, but could feel confident that their love one is in good hands. That they can go home and shower, sleep in a bed, and work knowing that the people at the hospital care about their loved one.

What Can be Done?

Fundamentally, patients need an advocate in the hospital due to a lack of trust.

Hospitals generally don’t do a great job building trust. Hospitals are almost always running late and timelines get missed. Doctors and nurses are overworked, rushed, and often burned out. It is difficult for doctors and nurses to empathize with patients because of the mundanity effect, which happens when something extraordinary (like caring for patients and saving lives) becomes routine.

From my point of view, the solution here is three-pronged:

  1. Fix the aspects of the hospital operation that make doctors and nurses jobs unnecessarily difficult or that take them away from patient care.
  2. Create and enforce behavioral expectations for how doctors and nurses treat patients and family members.
  3. Create ways for patients to see more of their doctors and nurses.

While this list is pretty easy to type out, actually making these changes could take decades. Most hospitals are still operating under business strategies and process improvement models from the 1980s. Remember, healthcare is highly regulated and complex. Making change doesn’t take weeks, months, or years. It usually takes decades.

The issues in healthcare are systemic and ingrained. There are many large stakeholders involved in the system today including large care providers, insurance companies, health plan administrators, etc. Large players like Amazon and Walmart are even trying to disrupt this behemoth of an industry, which has been notoriously hard to do.

Trying to change or cure the underlying diseases of healthcare has too long of a time horizon to make meaningful change for struggling patients and families today.

The Role of Technology

Luckily, technology can help with #3 – Create ways for patients to see more of their doctors and nurses.

This is why I made a career change recently.

I recently joined a company called WUWTA (pronounced “What-ah”) as their CEO. I first met WUWTA co-founder and Chairman of the Board, Jock Putney, when I was Chief Experience Officer at Robert Wood Johnson University Hospital.

On the WUWTA platform, physicians can guide patients through their healthcare journey personally from referral to discharge and follow up appointment. When I led Patient Experience, I spoke to patients every day. They desperately wanted more of their physician’s time and often were so excited when the physician spoke to them, they could not retain what the physician said!

WUWTA addresses this patient experience pain point simply. At each stage of the patient’s journey, the patient gets a video from their physician, explaining their next step in simple terms. The WUWTA platform enables doctors to hold a patients hand digitally and at scale.

Platforms like WUWTA are the necessary interim step to helping patients have a better experience without having to immediately address every systemic healthcare system disfunction.

After meeting with Jock, I felt so passionate that WUWTA represented a way forward to make healthcare better for patients, that I left RWJ to join the company.

What’s Next

We are far from my dream of a hospital system where having an advocate would not be necessary. Technology offers an important interim step to achieving this goal.

My belief is that it is a good thing that technology has enabled patients have access to more information. As the healthcare system continues to shift to be more consumer centric, patients will use that information to demand a better experience. That is when real change will happen faster. I am excited to be a part of it.

Key Takeaways

A hospital advocate is essential for patients navigating complex healthcare in the US, ensuring personalized attention and care in busy hospital settings. Technology platforms like WUWTA provide interim solutions by improving patient access to doctors, empowering them with information, and enhancing their healthcare experience.

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The connection between customer experience and leadership

/ Jonathan Sachs

Everybody wants to be a part of an organization known for having the best customer experience. Organizations in every industry market themselves as having “The #1 rated customer service” or “We’re known for our customer service,” but often fail to deliver on that brand promise.

In this post, I am going to explore why that is, starting with the relationship between achievement in customer experience and leadership.

Customer Experience and Leadership work together
Strong Leadership and Strong Customer Experience Go Hand-in-hand

Customer Experience as a Differentiator

I was recently listening to a speech by the famous billionaire investor Warren Buffett. In the speech he shared that any business that excels in customer service, can be a successful business.

In that speech, Buffett described the story of Jack Taylor, the founder of Enterprise Rent-A-Car. When Taylor got into the rental car business, there were two dominant companies in that market: Hertz and Avis. Taylor started Enterprise with 17 cars compared with Hertz and Avis having thousands, Enterprise was located in undesirable locations because the larger companies already had prime real-estate (think airports, for example), and the 17 cars he had were no different than the other companies.

Enterprise’s value proposition focused around customer experience and treating the customer better than any other rent-a-car company in America. For example, Enterprise is known for their slogan, “We’ll pick you up,” a commitment to free customer pickup when they need a rental car.

When Taylor passed away, Enterprise Rent-A-Car was worth more than all the other car rental companies put together, despite starting later and with many disadvantages in a commoditized industry.

The power of superior customer experience is real. It is a business imperative to get customer experience right and a business opportunity in industries known for poor customer experience.

What it takes to create a business that delivers incredible customer service

I have led the customer experience function for two large organizations. I know that most companies want their brand to be synonymous with excellence in customer service. However, most senior leaders of these companies do not understand what it takes to accomplish this goal.

A number of companies are known for excellence in customer experience. They include well known brands like the Ritz Carlton, Disney World, Chick Fil-A, Zappos, Starbucks, and Trader Joe’s.

While most companies say that they want to deliver the best customer experience, these companies above have actually done it. Their tactics are published in books, their leaders have explained what it took for them to do it, and their cases have even been studied in business schools.

These companies all follow the same framework to achieve their successes. They do the following:

Step 1: Define the universal behavioral expectations of the company in simple terms.

Example: At Disney World, they teach behavioral expectations aligned to 5 “Keys”: Safety, Courtesy, Inclusion, Show, and Efficiency.

Step 2: Create a campaign of engagement around these universal expectations.

Example: At the Ritz Carlton, the “Ladies and Gentlemen” read from their Credo Card that includes the Ritz Carlton service values on a daily basis during their lineup process.

Step 3: Educate all team members about the expectations.

Example: At Disney World, new hire orientation is called, “Traditions”. This immersive program is the first step of many training and education opportunities for Disney “Cast Members” to live the 5-Keys.

Step 4: Create reinforcing systems that show the employees and the customers the importance of the expectations.

Example: At Zappos, orientation for all positions includes time to answer calls at the call center. Also at Zappos, the company celebrates long customer service calls, where other companies establish Key Performance Indicators (KPI’s) to reduce the length of calls with individual customers.

Step 5: Empower team members to live the behavioral expectations in new and creative ways.

Example: At Ritz-Carlton, every “Lady and Gentleman” are empowered to spend up to $2,000 per day per guest to rescue a poor guest experience.

Despite the roadmap being relatively simple, it is difficult to execute. Many businesses struggle with customer experience, including basic customer service.

The Zappos approach to building a fantastic customer experience

Former Zappos CEO Tony Hsieh gave a 54-minute talk at Stanford University about Zappos’ culture. I would encourage you to watch the seminar in its entirety here:

In the seminar, Hsieh speaks to the discipline and focus a leader needs to run a high performing customer experience organization. Leadership at the highest level of these companies have a relentless focus on the needs of the customer. They prioritize customer experience over short term interests to build high performing cultures.

And, truly, that is the rub when it comes to building a high performing customer experience company. Most senior leaders want the result without understanding the work that excellence in customer experience entails.

Why leadership matters for customer experience

As you heard in the seminar, Tony Hsieh studied how great organizations create cultures that achieve results. A high performing customer experience organization cannot exist without leaders who understand how to build a culture that can execute on the five steps to create a high performing customer experience organization we discussed earlier.

Leaders like Jack Taylor and Tony Hsieh embodied the values they promoted. They were trusted because they would sacrifice short term gains for those values. Furthermore, they understood that the people closest to the work should love their jobs and feel equipped to create human connections with customers, while the leaders create the space for them to do that.

This may seem simple but it is not at all easy. Many leaders treat customer experience as an initiative to improve a KPI like net-promoter-score (NPS) or, in healthcare, the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. They often try to achieve the targets through tactics likes scripting, pushing customers for survey scores, or through financially incentivizing their teams to achieve those scores.

These tactics represent traditional command, control, and manipulative leadership. At best, the results of initiatives like this are temporary. At worst, they become an outright joke.

When Customer Experience Goes Wrong

Here’s what I mean by outright joke: Call AT&T, or whoever your cell phone provider is. Mine is AT&T.

I had an issue with AT&T that took 18 months to resolve. It took 18 months, multiple phone calls, multiple customer service chats, and one desperate plea at an AT&T store, which got me to a number where an agent finally was empowered to resolve the issue. It was painful.

After the experience, I was certain that my number one goal was to become a customer of literally any other cell phone carrier.

But won’t you believe that after every interaction, I was asked to give them 5-stars in the survey after the call. As a Chief Experience Office (CXO), I was embarrassed for AT&T by that request.

Leadership matters. It sets the tone and direction of the organization. Leadership that prioritizes customer experience also prioritizes humanness.

Why customer experience matters so much to me personally

We share planet earth with more than 8 billion other people. Our world, especially the lens in our head, is a tiny spec in the universe.

My own thoughts and needs are a dichotomy. On one hand, they are all I have to keep me safe as I experience the world. On the other hand, in the grand scheme of the world, I realize that my thoughts and needs are insignificant. 1/8,000,000,000.

It’s a humbling thought.

I have found that the more I can be kind and helpful, the better I can use my spec in the universe to make the human experience easier for other specs in the universe. I do not want to live in a world where everyone is so focused on their own thoughts and needs that the rest of humanity is irrelevant for them. Imagine if we all lived in that world. It would be miserable for all of us.

Organizations, whether public or private, not-for-profit or for-profit, giant companies or small businesses, are fundamentally just organized groups of people. They have the power to make someone’s life a little easier or a little harder. Organizations that choose to prioritize customer experience are also prioritizing making other people’s lives a little bit better.

In my life, I have experienced how frustrating it can be to interact with people and businesses that make my life just a little easier. It makes a difference in my day.

Mission BBQ

There’s a local chain that started here in Maryland called Mission BBQ. I absolutely love this place. The food is great, and they are connected to the brotherhood and camaraderie of the military. The restaurant is not fancy, it’s just the people who work there are genuinely good people. They take care of me at Mission BBQ no matter which location I go to.

When I am having a day where I feel like I need life to get just a little easier, I go to Mission BBQ. It is a company that has become a haven of sorts for me.

Customer experience matters. To me, it’s really making a better human experience in a fast and crowded world. It can be done well, but it requires real leadership.

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3 Ways New Leaders Can Start Strong

/ Jonathan Sachs

Impactful leaders are usually excellent listeners, able to organize lots of information, and communicate effectively. To master those three skills over time, there are a few things new leaders need to know and understand at the outset.

First, a new leader will usually inherit a team and that team’s current results. In these cases, assumptions are your biggest enemy. Do not assume that because the area you are leading is achieving its desired results now, the success will last forever. Do not assume that the team was achieving results because it was being led well. In fact, assume as little as possible. Learn as much as you can.

How New Leaders Can Start Strong

Build Relationships

The first few months for any new leader is about developing relationships and educating themselves on the department. The first few months will be focused on getting to know your team, supervisor, peers, and customers. By approaching conversations with those groups with authenticity and curiosity, letting them also get to know you in the process, you will be off to a great start. Engage with everyone you can during those first few months. Have lots of coffee and lunch dates. Meet with groups and meet with individuals. Ask lots of questions. Listen twice as much as you talk.

In some cases, a new leader will be starting a new department from scratch. The rules here are a little different. Learning as much as possible about the goals and expected deliverables will serve a new leader well in this context. Action planning based on those goals and resources will be an important next step.

Define the Work

Second, define the work. Answer the following questions. If you do not know the answer, start by asking supervisors, colleagues, your team, and your customers for their perspectives. Remember, these are their perspectives, not facts:

  • What results am I responsible for?
  • How are those results measured and in what timeframe?
  • Who are my customers? What would I like my customers to say about their experiences with my team? How is the team currently meeting customer expectations?
  • What is the value of my area of responsibility to the business? If my area of responsibility did not exist, what would it mean for the business?

Change Your Mindset

Third, a new leader must change their mentality from being that of a guest to that of a host. Simply coming to work, doing your job, and going home will not be enough in most leadership roles. To clarify, I am not suggesting that you will be working longer hours or will never have any time for vacation, but you are taking on a much more demanding set of responsibilities.

Instead, when anything happens impacting your new area of leadership, it is your responsibility to identify problems and come up with solutions. When something is going well in your department, you can explain why it is going well because it was intentional on your part. When something is not going well, you own both the problem and the solution to improving it in a lasting manner.

While you are still expected to operate in your scope, your direct supervisor is likely leading multiple areas of responsibility. The good supervisors will count on you to know what you are empowered to do with your team and what requires your supervisor’s permission. In instances where your supervisor has ultimate decision-making authority, most will appreciate giving them multiple options and thinking ahead about the possible consequences, both positive and negative, for each option.

In leadership, especially in a first role as a leader, it is important that new leaders get to know their area of responsibility top to bottom, which means understanding how each part works separately and together. As a leader learns the different parts of the business, they should also focus on the following areas where results may be expected of them and their teams.

Key Takeaway

Strategies for new leaders to succeed include avoiding assumptions, developing relationships, defining goals and responsibilities, and taking ownership of both problems and solutions. Effective communication, learning, and a mindset shift from being a guest to a host will help new leaders have a greater positive impact in their new role.

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How Leaders Attract and Keep Top Talent

/ Jonathan Sachs

In today’s business world, finding and keeping top talent is essential to a businesses’ success. As a result, leaders in some companies are using unique tools to find their newest employees. These companies focus on identifying the best candidates who fit with their culture and values. At the same time, these companies also ensure that their hiring strategies are legal and ethical.

There is also an important economic driver to hiring. For many companies, their biggest financial expense is salaries. Despite recent business norms, like routine layoffs, employee retention is important for leaders when thinking about the financial success of their organization. According to a study from the Center for American progress, it can range from 50%-200% of an employee’s salary to replace them. There are also the costs that are hard to quantify, like the value of the history and knowledge of the organization a current employee may have that could be impossible to replace.

Luckily, certain companies have put together methods to, “Hire for will and train for skill.” This means that they look for a candidate’s cultural fit and then provide robust training to educate them and keep them engaged.

Netflix

Let’s start with Netflix, the popular streaming service.

Leaders can learn from Netflix hiring practices

Netflix has a company culture that values empowerment (freedom and responsibility). The company believes in giving employees the freedom to shape their work and trusts them to take responsibility for results. Netflix has designed an intense hiring process to identify candidates who can thrive in a self-starting culture.

One of the unique practices that Netflix uses in its hiring process is the “keeper test.” The keeper test is a simple but effective way of identifying whether a candidate will fit with their company’s culture. The keeper test works like this: Would the leader making the hire fight to keep this candidate if they were considering leaving the company? If the answer is yes, the candidate passes the keeper test, and if the answer is no, the candidate is not a good fit for the company.

Wegmans

Wegmans is one of my favorite places to shop for groceries. The grocery store chain seems to always have what I need and offers great customer service.

Leaders can learn from Wegmans hiring practices

One of the unique practices that Wegmans uses in its hiring process is the group interview. The group interview is a collaborative process that involves many candidates interviewing with the leader at the same time. This approach allows Wegmans to observe how candidates would work in a team environment, especially when the stakes are high.

Wegmans also looks for people who have a track record of providing excellent customer service in their previous jobs. By asking behavioral questions, which are scenario-based questions, companies like Wegmans look to identify service minded candidates to join their companies.

Risks to Keep in Mind

While these companies have achieved success with their unique approaches to hiring, it’s important to remember that some new strategies may not be legal or ethical. For example, some companies use pre-employment assessments that measure cognitive, emotional, and behavioral traits. While this method can be effective in identifying talent, it can also be discriminatory and result in legal action.

Companies that want to stand out from the competition in recruiting and retaining top talent must think in new ways. For many companies, their employees are their competitive advantage. By finding the right people and training them, these companies stand out from the competition.

Key Takeaways

For most companies, their employees are their competitive advantage. For that reason, hiring the right employees is extremely important. Companies like Netflix and Wegmans developed unique ways to increase the likelihood of finding candidates that will fit the culture they want to maintain. When practicing leaders do the same in their organization, they can achieve better results.

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.

Embed from Getty Images

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.