The document discusses 10 ways that a hospital run by Disney would be different, focusing on prioritizing the patient experience over service or efficiency. It advocates changing from a service paradigm to an experience paradigm where staff see themselves as actors in a theater production aimed at creating memorable experiences for patients. Key recommendations include making courtesy more important than efficiency, considering patient satisfaction scores as "fool's gold", and harnessing the power of imagination to inspire compassionate engagement with patients' experiences.

1. Some Things You Would Do
Differently
Fred Lee

2. 3 Key Premises
We have reached the ceiling in how much
we can improve patient satisfaction
scores with our current approach.
We cannot go from good to great in patient
perceptions by copying and deploying
what they do at service companies like
Ritz-Carlton or Nordstrom’s.
Culture is driven by management systems,
not workers or values.

3. Table of Contents
If Disney ran your hospital you would…
1. Focus on What Can’t be Measured
2. Make Courtesy More Important Than Efficiency
3. Regard Patient Satisfaction as Fool’s Gold
4. Measure to Improve, not to Impress
5. Decentralize the Authority to Say “yes”
6. Change the Concept of Work from Service to Theater
7. Harness the Motivating Power of Imagination
8. Create a Climate of Dissatisfaction
9. Cease Using Competitive Rewards to Motivate People
10. Close the Gap Between Knowing and Doing

4. If Disney
Ran Your
Hospital You
Would...
1.
Focus on What Can’t Be
Measured

5. On Measurement
“Not all that can be counted, counts. And not all that
counts can be counted.” -- Albert Einstein
“The most important figures one needs for management
are unknown and unknowable…(invisible also
used)…What is the value, for instance, of the multiplying
effect of a happy customer and the opposite effect from
an unhappy customer…(or the) Loss from inhibitors to
pride of workmanship?”
-- W. Edwards Deming, Out of the Crisis, p. 122

6. Measurement
Outcomes Perceptions
Satisfied Loyal fan
Clinical Financial
Good to Great

7. Impact of PI on Total Quality
Talent
ns
tio Place of choice
p
ce
r Emotional
Pe Reputation improves Skills
Customers sing our praises
Total Quality
PERFORMANCE IMPROVES
Processes improve
Analytical
Ou Skills
Productivity improves
tco
m
es Costs go down

8. You can’t manage perceptions in the
same way you manage outcomes.
Outcomes (left brain) Perceptions (right brain)
Objective, Measurable Subjective, Impressions
Created by teams Created by individuals
Map and study process steps Take action -- just do it!
Improve technical competence Inspire attitudes and behaviors
“Zero defects” thinking “Best possible” thinking
Based on what you do Based on what you say
Eliminate avoidance
Eliminate carelessness
80% of our PI scores 80% of our PS scores

9. If Disney
Ran Your
Hospital You
Would...
2.
Make Courtesy More
Important Than
Efficiency

10. Disney’s Quality Priorities
1. Safety
2. Courtesy
3. Show
4. Efficiency

11. How do you make courtesy
more important than efficiency?
PERSONAL EXAMPLES
Personal efficiency vs.
Accessibility
Job efficiency vs.
Saying “yes”
Process efficiency vs.
Responsiveness

12. Paradox: Customer First is More Efficient
unit efficiency first courtesy first
internal focus external focus
unresponsive responsive
compete for resources share resources
Results in overall Results in overall
organizational organizational
inefficiency efficiency & teamwork

13. If Disney
Ran Your
Hospital You
Would...
3.
Consider Patient
Satisfaction Fool’s
Gold
Wilderness Lodge

14. In Commercial Businesses
Research on satisfaction shows…
On a scale of 1 to 5, people who mark a 4 are
six times more likely to defect to the
competition than those who mark a 5.
Harvard Business Review, Nov-Dec, 1995

15. Why is it so hard to raise our scores?
+2 Meeting expectations = 0
+1
04 Satisfied = 0
-1 Satisfied patients
have no story to tell
-2
Hampton Inn, huddle
-3

16. Patient satisfaction is a fool’s gold.
It’s the same as zero!
Neither good nor bad.

17. Singing our praises…
Caring, Cared, Cares +32
Kind, kindness +24 Committed
Understanding +2
Compassionate +15 Warm
Thoughtful +2
Help, helpfulness +15 Upbeat
Knowledgeable +2
Comfort, comforting +13 Generous
Smiling +2
Softness
Bedside manner +2
Friendly +8 Pleasant
Empathy +2
Professional +9 Supportive
Attention, attentive +7
Tender +1
Concerned +6 Cheerful
Takes time +1
Listens +4 Informative
Competent
Sensitive
Loving +3 Efficient
Reassuring
Sweet +3 Proficient
Selfless
Respect +3 Prompt
Gentle
Quick +3 Hardworking
Nice
Polite +3 Courteous
Conscientious
Patient +3

18. The Three Levels of Care
Patient
Staff Staff
Evaluation
Motivation Performance
Inspire 5
Compassion
Require 4
Courtesy
Hire 3
Competence
1&2
Fire Judy

19. Three enemies of caring
This is about
Enemy Enemy
is not.. Is…
Compassion
Indifference Judging
What I Feel
Courtesy
Rudeness Avoidance
What I Say
Incompetence Competence Carelessness
What I Do

20. If Disney
Ran Your
Hospital You
Would...
6.
Change the Concept of
Work from Service to
Theater

21. Disney is not a service and neither are we.
Experiences
The progression
of economic Stage
value
Services
00
19
e
Deliver
nc
Si
Goods
E
IM
Entertainment?
T
Make
R
E
Commodities V
O
Joe Pine, The Experience Economy
Extract

22. Theater is about life –
comedy and tragedy.
Disney:
Meeting the emotional needs of
a family to have fun together.
Hospital:
Meeting the emotional needs
of a family suffering a tragedy
together.
A hospital without compassion is like Disney without fun.

23. Focus on the patient’s experience,
not our service…
Companies stage an experience whenever they
engage customers, connecting with them in a
personal, memorable way.”
“They actually occur with any individual who has
been engaged on an emotional, physical,
intellectual, or even spiritual level. The result?
No two people can have the same experience – period.”
B. Joseph Pine II, The Experience Economy

24. At the Wilderness Lodge
Think Disney
experience, not just
department or hotel
service.
Think patient
Or…
experience, not just
department or hospital
service.

25. Our Service Or Their Experience?
OR Experience paradigm
Service paradigm
Depends on the emotional needs of the patient.
High anxiety
No Pain
Pain
Low anxiety
Compassion
Courtesy
What you feel
What you say
Clinical effect
No clinical effect

26. Borrowing from Theater
THE DIRECTOR:
Start by describing the experience you want the guest
to have (see, hear, and feel) and how to make each
scene memorable.
Cast for the talent to play the role called for in the guest
experience, rather than just the skills to do a job.
Clarify each person’s role in creating a memorable
experience and get their commitment to their role.

27. Borrowing from Theater
THE ACTOR:
Actors learn how to be real by becoming emotionally
engaged with their character.
Actors rely on sense memory and imagination to become
real in their role.

28. Acting is not pretending…
Eric Morris, No Acting,
To paraphrase…
Please (first sentence)
Care giving is the art of
Acting is the art of
creating genuine creating genuine realities
realities on the stage. on the hospital stage. No
No matter what the matter what the event, the
material, the actor’s caregiver’s fundamental
fundamental question is: question is: “What is the
“What is the reality and reality of this patient’s
how can I make it real to experience, and how can I
me?” make it real to me?”
Acting must “come from Compassion also must
a real place.” “come from a real place.”

29. Theater changes the service paradigm…
From patient satisfaction –
to a fan with a story to tell
From just being courteous –
to engaging the guest
From our service excellence –
to their memorable experience

30. Theater changes the service paradigm…
From hiring for the skills to do a job –
to casting for the talent to play a
caring role in the guest
experience
From teaching body language –
to teaching acting principles
(being real through imagination)

31. Knowing how is not the problem…
Like losing weight, our problem is not with
knowing how. When we want to enough,
we figure out how and learn by doing.
Our problem is with being committed
enough to do what it takes every day, and
do it permanently, not just in short bursts
of inspired energy.

32. W. Edwards Deming might add…
What is the value of
a committed
ensemble of care
givers who have
become
compassionately
engaged in the
patient’s experience?

33. In The Box
You can’t get different results by doing more of
the same old things in the same old way.
Centralized Control
Unit Efficiency Focus
Silo mentality
Percentile ranking
Compliance culture
Just to
Outsourced coaching mention a
Competitive rewards few…

34. Correlating patient and employee satisfaction.

35. PREMISE: Excellence is Fun
There is nothing like excellence to improve morale.
Anything done poorly is hard work and a real drag.
Persistent mediocrity is discouraging, depressing
and saps all our energy.
Anything done at the level of excellence or in the
pursuit of excellence with a great coach is FUN
and energizing.

36. Overcoming Inertia
> Organizational
Dissatisfaction Knowing
Vision of
+
+ Inertia
with “as is” “how to”
“could be”
Must be
greater
than
Comfort zone
Force of habit

37. The Wall
Compliance Commitment
Loyalty
Satisfaction
Improvement
Ownership
Autonomy
Excellence
Enthusiasm
Teamwork
Program
Inoculation Time

38. Old Paradigm to New
Memorable Experience
Service excellence
Starts anywhere
Starts at the top
Citizenship
Leadership
Ownership
Empowerment
Responsibility
Accountability
Commitment
Compliance
Learn by doing
Do by learning

39. Fallacy of asking, “How?”
“Asking How? Is a favorite defense
against taking action.”
Peter Block, The Answer to How is Yes

40. Knowing how is not the problem…
Like losing weight, our problem is not with
knowing how. When we want to enough,
we figure out how and learn by doing.
Our problem is with being committed
enough to do what it takes every day, and
do it permanently, not just in short bursts
of energy.

41. 3 Key Premises
We have reached the ceiling in how much
we can improve patient satisfaction
scores with our current approach.
We cannot go from good to great in patient
perceptions by copying and deploying
what they do at service companies like
Ritz-Carlton or Nordstrom’s.
Culture is driven by management systems,
not workers or values.

42. Baldrige Criteria
Category: Patient Satisfaction
APPROACH: How will we talk about going
from good to great in patient perceptions
that is inspiring and motivating for our staff?
DEPLOYMENT: Who will lead out, and how
will we generate commitment throughout the
organization at every level?
RESULTS: How will we get, track, and use
feedback?

43. 3 Key Premises
We have reached the ceiling in how much
we can improve patient satisfaction
scores with our current approach.
We cannot go from good to great in patient
perceptions by copying and deploying
what they do at service companies like
Ritz-Carlton or Nordstrom’s.
Culture is driven by management systems,
not workers or values.

44. Baldrige Criteria
Category: Patient Satisfaction
APPROACH: Going from good to great by using
the experience approach rather than a service
approach. Moving from the good of…
Patient’s experience
Our service to
Dept Courtesy first
Dept Efficiency first to
Hardwired courtesy Emotional support
to

45. Baldrige Criteria
Category: Patient Satisfaction
DEPLOYMENT: Involving everyone. From just…
Committees Departmental ownership
to
Managers coaching
Educators training to
Inspiring compassion
Hardwiring service to

46. Baldrige Criteria
Category: Patient Satisfaction
RESULTS: Use feedback that motivates. From…
Loyalty (% top box)
Satisfaction (avg.) to
Courtesy / service Compassion / healing
to
Quantitative (data) Qualitative (stories)
to

47. If Disney
Ran Your
Hospital You
Would...
2.
Make Courtesy More
Important Than
Efficiency

48. Pillars are Equally Important
SERVICE • PEOPLE • QUALITY • FINANCIAL

49. Disney’s Quality Priorities
1. Safety
2. Courtesy
3. Show
4. Efficiency
What’s missing for patients? Internal customers?

50. Hospitals Need To Add Compassion
1. Safety/Quality
Evidence based medicine.
Zero defects / Reducing variation (Deming)
2. Compassion
Emotional support as best clinical practice, affecting
stress, anxiety, pain, and the immune system.
3. Courtesy
Constantly seeking out guest contact. (Disney)
4. Presentation
We are always on stage.
What will the audience see, hear, and feel?
5. Efficiency
Unit efficiency vs. courtesy and overall efficiency.
Reducing the cost of poor quality (Deming)

51. Two Biggest Barriers to Internal
Customer Service
1. Poor communication, by which they mean,
“Someone in another department makes a
decision that affects us without consulting with
us first.”
2. Poor teamwork, by which they mean:
• competing for resources
• unresponsive, unhelpful processes
• silo mentality, workarounds

52. Deming Principles
QUALITY: Reduce variation
EFFICIENCY: Calculate the COPQ (cost
of poor quality) in each step of the
process.
When the process breaks down
Workarounds
Redundancy
Unclear responsibilities

53. Paradox: Customer First is More Efficient
unit efficiency first courtesy first
internal focus external focus
unresponsive responsive
compete for resources share resources
Results in overall Results in overall
organizational organizational
inefficiency efficiency & teamwork

54. What is a grand slam
in performance?
WIN on quality (you reduced variation)
WIN on efficiency (your reduced overall costs)
WIN on customer satisfaction
WIN on staff job satisfaction

55. Budgeting Process Questions
1. Where and how will you reduce
expenses this year?
2. Will anything you do affect another
department? If so, explain.
3. Have you discussed your plans with
them and gotten their agreement that
this way is the most efficient overall?

56. Conversation
What do you do for your own
efficiency that frustrates other
departments or patients?
If you changed it to be more
customer friendly, estimate the cost
to your department, then estimate
the cost benefit (value added) to
those you serve.
How would your people like the
change?

57. If Disney
Ran Your
Hospital You
Would...
6.
Change the Concept of
Work from Service to
Theater

58. Disney is not a service and neither are we.
Experiences
The progression
of economic Stage
value
Services
00
19
e
Deliver
nc
Si
Goods
E
IM
T
Make
R
E
Commodities V
O
Joe Pine, The Experience Economy
Extract

59. Theater is about life –
comedy and tragedy.
Disney:
Meeting the emotional needs of
a family to have fun together.
Hospital:
Meeting the emotional needs
of a family suffering a tragedy
together.
A hospital without compassion is like Disney without fun.

60. Our Service Or Their Experience?
OR Experience paradigm
Service paradigm
Depends on the emotional needs of the patient.
High anxiety
No Pain
Pain
Low anxiety
Compassion
Courtesy
What you feel
What you say
Clinical effect
No clinical effect

61. Borrowing from Theater
THE DIRECTOR
Start by describing the experience you want the guest
to have (see, hear and feel) and how to make each
scene memorable.
Cast for the talent to play the role called for in the guest
experience, rather than just the skills to do a job.
Clarify each person’s role in creating a memorable
experience and get their commitment to their role.

62. Borrowing from Theater
THE ACTOR:
Actors learn how to be real by becoming emotionally
engaged with their character.
Actors rely on sense memory and imagination to become
real in their role.

63. Video clip: Connie
1. What is Connie’s
problem? What does her
body language and tone
of voice tell you?
2. Make a list of behaviors
you wish Connie would
follow.

64. Coaching Tips
1. Plan your coaching sessions, do not “wing it.”
2. Ask leading questions to get the other person to say
to you what you wanted to say to them. Remember
the mind instinctively “reacts” to statements.
3. Use imagination to get them to put themselves in
other peoples’ shoes, or your shoes.
4. Listen and reflect back all important points before
responding.
5. Say, “I need a person in your position who
will________” not, “I need you to__________”
6. Add, “…and I wish it could be you.”

65. If Disney
Ran Your
Hospital You
Would...
7.
Harness the Motivating
Power of Imagination

66. What determines our response to stimulus?
R
I
S
Imagination Response
Stimulus
(pain & fear) (empathy)
Emotions
Fight or Flight
All growth
Empathy
happens
here Body language
Tone of voice
Freeway

67. Four Levels of Motivation
Weakest
1 Compliance
(based on authority, rewards, threats)
2 Will Power
(based on values and beliefs)
3 Imagination
(based on feelings)
Habit
4 Strongest
(based on character)

68. Handling an Upset Customer

Disney Teaches:
(Left brain approach)
Listen
Apologize
Solve
Thank
There’s a better way…

69. Dealing With an Irate Person
When someone goes
ballistic…
Empathize Cool Off
Ventilate Listen Explain Listen
Thank
Stay Calm

70. If Disney
Ran Your
Hospital You
Would...
9.
Stop Using Competitive
Rewards to Motivate
Staff

71. Some characteristics of high IQ types
that make for poor manager coaches.
• Don’t listen because they are used to knowing
more than others, and love to prove it.
• Underdeveloped EQ (emotional intelligence),
not needed for academic success.
• Success built on critical analysis, therefore tend
to critique ideas, rather than consider or try
them, which tends to kill creativity and
“thinking outside the box.”

72. Some characteristics of high IQ types
that make for poor manager coaches.
• Stingy with compliments, because they don’t
need them. For the exceptional one only.
• Have a greater need to be “right” than “liked.”
• Highly judgmental, so tend to lack the empathy
& tact needed in a collaborative world.
• Succeeded in an independent, competitive
environment (school), so think individual
competition succeeds everywhere.

73. Add three Requirements for Promotion
(High IQ = To get an “A”)
1) Has this person shown an ability to inspire,
coach, and motivate others without resorting
to threats and bribes?
2) Has this person demonstrated a commitment
to customer service that is verified by
measurable results or feedback?
3) Does this person understand and talk about
our focus on the patient’s emotional
experience, not just courtesy standards?

74. In theater it’s an ensemble, not a team.
Describe the characteristics of an ensemble
All are on the same page, take turns
being the soloist, and support each other.
Can improvise but must know the tune
and the rhythm to stay in sync.
Joy is in the playing, and making a
memorable experience for the audience,
not in competing with each other.
Success is in the overall performance, not
in winning or losing.
Do not need a “leader” to become great.

75. Which Model is More Useful
for Hospitals?
In sports, a team In theater, an ensemble
is motivated by… is motivated by…
• The joy of performing
• The thrill of winning
• In concert with others
• In competition with others
• To engage an audience
• To defeat another team
• And win their applause
• And win their trophy
What does the applause of a patient sound like?

76. Paradox of Competition
“You can’t have the fruits of cooperation from
a paradigm of competition.”
Steven Covey
A basic drive in some
personalities…especially males.
A healthy source of motivation
between organizations,
dysfunctional within.

77. Separating Recognition from Competition
Stories:
• TWA attendant
• ED compliment cards.
• Boys and the old man
Employees want recognition for good work, not
competing with other members of their team.
Employees are hungry for appreciation, not contests.
They want more individual, spontaneous praise, not
more trophies or coffee mugs at special events.

78. According to virtually all
the research on motivation..
Extrinsic rewards tend to
extinguish intrinsic motivation, and
with it the values the rewards were
intended to encourage!
See Punished by Rewards by Alfie Kohn

79. What is gained by…
Searching only to reward the “best” and not the rest?
It makes all but one feel like losers.
Hampers teamwork.
Fosters jealousy and sabotage.
Rewarding only those who do something unusual
that goes above and beyond? How about those who
are…
Always cheerful?
Always responsible?
Always dependable?

80. Instant
Feedback
Cards

81. If Disney
Ran Your
Hospital You
Would...
10 .
Close the Gap Between
Knowing and Doing

82. Lee Performance Evaluation Grid
Shaded zone
5 must change or
AR
d
en ST
leave.
i
Fr
PEOPLE 4
Focus on and
Compassionate
praise relating
3 e
Courteous
ag ert
er and doing
Helpful p
Av Ex strengths.
2
ATTITUDE
Work around
1 weaknesses.
2 3 4 5
1
TASK
Accuracy / Speed / Consistency
DELIVERABLES

83. Overcoming Inertia
> Organizational
Dissatisfaction Knowing
Vision of
+
+ Inertia
with “as is” “how to”
“could be”
Must be
greater
than
Comfort zone
Force of habit

84. Organizational Change
–
Model (Fred Lee)
–
Feedback
–
Data
–
–
–
–
“could be”
–
–
–
–
–
–
–
–
–
–
–
–
“as is”
–
performance
–
–
–
–
–
–

85. Organizational Change
–
Model (Fred Lee)
–
Feedback
–
Data
–
–
–
–
“could be”
–
–
–
–
INERTIA
–
–
–
–
–
–
–
–
“as is”
–
performance
–
–
–
–
–
–

86. Organizational Change
Model (Fred Lee)
–
Feedback
–
Data
–
–
–
er
–
g
–
na
–
a
M
–
–
INERTIA
–
–
–
–
–
–
–
–
–
performance service
–
–
standards
–
–
–
communication
–

87. Leadership Commitment
“At the moment of commitment, the
universe conspires to assist you.”
Goethe

88. Organizational Change
Model (Fred Lee)
–
Feedback
–
Data
–
nt
–
e
itm
–
–
m
om
–
c
–
er
–
g
na
–
a
INERTIA
–
M
–
Modeling
–
–
–
Relating
–
–
–
Coaching
–
performance service
–
Learn by doing
–
standards
–
–
–
communication
–

89. 10 Key Ideas To Start Immediately
1. Have a daily huddle to value and encourage staff, and
share best practices.
2. Determine how to seek out and use feedback on
frustrations (rounding).
3. Do discharge phone calls to patients within 48 hrs.
4. Do the avoidance exercise (the enemy of courtesy).
5. Focus on the patient experience, not our service.
6. Use patient letters and comments instead of numbers to
motivate and generate specific ideas for improvement.
7. Talk to each about “your role in the patient experience.”
8. Make courtesy more important than efficiency, especially
in the support services.
9. Ask, “Why is it easy to feel compassion for some
patients and not others?” (Judging)
10. Teach the ballistic curve in dealing with anger.

90. Ownership
What is the value of
a committed
ensemble of
caregivers who have
become
compassionately
engaged in the
patient’s experience?