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Experience Mapping and Operations
NACCDO/PAN
May 2012
Agenda

1. About Us (Briefly, I promise)
2. Satisfaction ≠ Advocacy
3. The Holistic View
4. Who Are Your Patients?
5. Becoming Operationally Integrated
6. If We Build It, Will They Come?


PAGE 2
1.0




Gelb Consulting, an Endeavor Management Company

ABOUT US
Our Strategic Competency
     Enable our Clients to Design and Execute their Transformational Endeavors


                                       Enable the organization to perform



                           Energize the organization to pursue the endeavor
         e4

                       Engage the organization to see how to achieve the outcome



                Envision the desired future outcome and align the leadership




PAGE 4
The Basis of Our Insights

Work with Nationally-recognized Institutions:
•    5 “Honor Roll” institutions
•    3 out of the top 5 cancer programs
•    2 out of the top 4 pediatric hospitals
•    2 out of the top 4 cardiovascular programs
•    Similar client base in top rated
National Benchmarking Studies:
• Patient experience
• Marketing
• Physician relations
• International programs
PAGE 5
Our Thought Leadership books…
              We wrote the

         Change is the Rule                                           Red Zone Management
         This book is considered by many to be                        THE Playbook for today’s troubled business
         the most useful and practical                                environment…when all businesses find
         explanation of how changes are                               themselves in the Red Zone. The Principles of
         managed in the modern organization.                          Red Zone Management clearly spell out the
                                                                      proven management roadmap for making
                                                                      changes during these turbulent times.



                                      Engineering Organizational Change
                                      THE template for dealing with organizational change as a technical as well as a
                                      social engineering problem. Includes step-by-step moves that are absolute
                                      requirements for an organization to have lasting change.


                                      Change Management Toolkit
                                      Purchased by more than 200 firms for use in guiding their Change Management
                                      projects. Including detailed, proven and tested tools and templates to ensure
                                      change success.



PAGE 6
Transformation Requires Step-Changes
    •   Non-linear progression between evolution levels
    •   “Leap of faith” into the next level
    •   Higher the proficiency level, the more directly the
        organization articulates the impact on performance.

                                                           Excelling/Innovating
                                                                                      • Innovation in new practices
                                                                                      • Culture is a strategic core competence

                                                        Mastering
                                                                            • Practices well integrated and
                                                                              pervasive throughout the enterprise
Strength                           Operational
                                                        • Practices understood with actions in-play to
                                                          fully integrate, measure & internalize
Opportunity
                     Emerging
                                       • Some evidence of the practice present
                                       • Not consistently applied or followed

  Discovering

                      • Very little evidence of the practice present
                      • More ad-hoc than systematic




   PAGE 7
Cancer Strategy Challenges (Operational)

Proper segmentation
Managing referring physician relationships
Creating a broader catchment area
Defining and delivering multidisciplinary care
Facility location and service optimization
Increasing word of mouth advocacy
Improving employee efficiency and morale (in the midst of change)


PAGE 8
2.0             People are not inherently opposed to change…but they
                 don’t like surprises. It is a leader’s responsibility to let
                 people know what the issues are.”

                 Mark Wallace,
                 CEO, Texas Children’s Hospital




Customer Enchantment

SATISFACTION ≠ ADVOCACY
Links

               EXPERIENCE                    Culture and your brand promise are
                                             linked through the experience
                                             delivered.

                                             Leaders translate customer
                                             expectations to the organization and
                                             reinforce desired employee behaviors.

 Cultural       Transformational    Brand    This alignment creates an exceptional
Alignment          Leadership      Promise   experience and a sustainable
                                             competitive advantage.

            EXPECTED BEHAVIORS               We call this desired state
                                             enchantment.

PAGE 10
How Enchantment is Different




             Loyal Customers
             Satisfied and might use again
            •   Will recommend you if asked
            •   But won’t give you a second chance
            •   Have minimum investment in your future
            •   See you as a choice among many
PAGE 11
How Enchantment is Different




           Enchanted Customers
               Raving Fans and Spread the Word
           •    Go out of their way to recommend you
           •    They forgive you for missteps
           •    Demonstrate a strong commitment
           •    They are part of your future
PAGE 12
Elements
                                 EXPERIENCE
                                    Realization
                                       Care
    Delivering                     Communication
    the Ideal                       Coordination                    Communicating a
    Experience                                                      Resonant Brand
                                                                    Promise




 Cultural Alignment     Transformational Leadership              Brand Promise

Employee Enthusiasm             Leadership Index                    Brand Trust
       Tenure               Transformational Strategy                Familiarity
   Employee Pride            Drives Cultural Alignment            Customer Value
   Employee Value      Operational / Organizational Alignment   Competitive Difference
 Employee Experience                                            Consistent Experience

                        EXPECTED BEHAVIORS
Process
    Reinforce the promise
                                                                         Listen to customers, their
       and deliver in all          Reinforce               Listen          influencers and other
     communications &
                                                                                stakeholders
         interactions




                              Deliver                               Define
                                                                                Define how your
  Deliver flawlessly on the
                                                                             organization will meet or
          Promise
                                                                                 exceed needs
                                               Promise
                                        Communicate a resonant
                                             Promise



PAGE 14
Take Advantage of Other Resources

Alignment with Lean Process Development
      •   Our outputs for “Voice of the Customer” align with lean processes
      •   We have successfully engaged such teams at other healthcare organizations, specifically focusing on
          the “coordination” and “care” aspects of the implementation planning

Strategic planning
      •   Study materials, scope and implementation plans are created with strategic objectives in mind
      •   The prioritization of initiatives developed are weighed against strategic priorities

Culture
      •   We have found that cultural initiatives (like core values or service standards) are supported by this work
      •   Our approach works from the bottom up, allowing those on the front lines to create their own standards
          which consistently align with the higher level values or standards
      •   This is particularly important as we examine the “care” and “communications” components of the plan




PAGE 15
Get Ready…Transformational Leader

              Demonstrates                                Creates a shared vision
             self-awareness

   Builds trust on all levels                             Motivates the heart


Challenges the status quo                                 Models moral behavior


                                                          Develops and enables
                                                          others to act



       Transformational leadership is the process whereby a person engages
       others and creates a connection that raises the level of motivation and
              morality in both the leader and the follower (Northouse).



PAGE 16
Getting Started: Identifying Spheres of Action
Breadth:
             Cancer center
             Physician experience
             Clinical Service line
             Department/unit/division
             Patient education
             Call center
             Satellites

Depth:
             Business processes
             Technology
             Organization, roles, and skills
             Management systems
             Culture

Leadership:
             Strategic imperative
             Change agency
             Ownership
             Enthusiasm
             Resources
PAGE 17
3.0                   “Customer experience is bigger than
                       customer service in that it is the full, and end
                       experience. It starts when you first hear about
                       Amazon from a friend and ends when you get
                       the package in the mail and open it.”

                       Jeff Bezos, CEO, Amazon.com




Customer Enchantment

THE HOLISTIC VIEW
Touchpoint Management
                                  • A Touchpoint is the interaction between
                                    an organization and its customers

                                  • It is the means by which a physician or
                                    patient realizes the promise of your
                                    brand

                                  • These touchpoints are service clues and
          Personal Interactions     require management




             Environments              Written and Digital Communications
PAGE 19
Experience Mapping: Fitting it All Together

Experience Mapping is an in-depth qualitative research technique that utilizes a visual
cue (the experience map) to help patients, staff, and other influencers recall specific
episodes in their journey.

Assessment of the entire experience
• Expectations - before first encounter through each step
• Activities and Touchpoints
• Changes in attitudes, if any

Framework for action
• Experience stewards who are responsible for delivery
• Steward can see the big picture for better planning / behaviors
• Interactions or “touchpoints” are categorized at each step for resourcing



PAGE 20
Experience Map
           Need                 Scheduling                        Visit                  Treatment               Follow-up




• Symptoms                • Education                    •    Wayfinding             • Instructions          • Communication
• Medical/family          • Financial                    •    Checking-in              (verbal/written)        with referring
  History                   paperwork                    •    Waiting Area           • Hand-offs               physician
• Self-Education          • Medical                      •    Nursing care           • Contact information   • Follow-up visits
• On-line Assessment        Paperwork                    •    Physician care         • Staff assistance      • Patient portal
• Diagnosis               • Contact Info                 •    Assessments            • Call-backs for        • Advocacy
                          • On-line Assistance           •    Diagnostics/Exams        assistance            • Surveillance



                          •   Call Center               •    Faculty/Medical Staff   •   Faculty/Medical     •   Faculty/Medical
•   Family/friends        •   Front Desk Staff          •    Support Staff               Staff                   Staff
•   Referring physician   •   Faculty/Medical Staff     •    Family/friends          •   Support Staff       •   Support Staff
                          •   Family/friends            •    Volunteers              •   Family/friends      •   Family/friends
                          •   Physicians                                             •   Volunteers          •   Volunteers
                                             Primary Experience Stewards



                                                      Key Touchpoints
4.0




Customer Enchantment

WHO ARE YOUR PATIENTS?
Anatomy of a Complete Patient Profile

          Demographic descriptors

     Psychographic descriptors

                        Behaviors

                         Attitudes



                           Don’t be fooled by shorthand –
            not all patients are the same nor should be your approach

PAGE 23
Behaviors

                                                  What is your percentage?
        The general population is most
        often physician directed…                    • Physician referred
        Patients who are choosers (self
        referred) are often those seeking a
                                                     • Self referred
        second opinion.
                                                     • Physician directed
               Unknown

  Self
  Referred
                                                  Use these break downs to determine
                                                  where best to allocate efforts
Physician
Referred                              Physician
                                      Directed




    PAGE 24
Needs
          Functional                                Emotional




    What we do…                             How we do it…
          •   Services offered                  •   Inclusion in treatment
          •   Clinical outcomes                 •   “Feel” of the interactions
          •   Transfer efficiency               •   Subjective quality judgments
          •   Scheduling delays                 •   Feeling valued


PAGE 25
Differences in Insight
          Functional                                Emotional




              NUMBERS                                  STORIES

    What we measure…                        What they say…
          •   Satisfaction scores               •   Richness and detail
          •   HCAHPS scores                     •   Connection
          •   Mystery shopping                  •   Context




PAGE 26
Sample Discussion Areas




Patients / Families          Physicians                      Staff / Executives

•Current Perceptions         • Referral Roles / Process      • Vision of Ideal

                             • Ideal Relationship            • Current Barriers
•Decision Criteria
                                                             • Patient Dissatisfiers
•Sources of Frustration      • Self / Patient Assessment
                                                             • Opportunities for Improvement
•Areas of Praise             • Recommendations
                                                             • Model Employee
                             • Likelihood to Refer and Why
•Usefulness of Touchpoints
                                                             • Likelihood to Recruit and Why
•Likelihood to Recommend and How
  PAGE 27
Personae: Female Cancer Patient (A)
                                                                                                    A



                                   “No other case is like mine. I’ve done my homework.
                                   Respect me and I’ll respect you. I need a physician who
                                   is at the top of her game – someone who will be my care
                                   partner. Let’s beat this together.”
            Karen



DESCRIPTORS                        BEHAVIORS                                 NEEDS
• 90% Females (due to diagnoses)   • Despite her attitudes, is more likely   • Ability to qualify physician expertise
• 60% from outside PSA                to consult physician specialists in    • Knowledge of technique/technology
• Anxious about diagnosis             developing options                     • Indirectly evaluates facility
• Demonstrates “take charge” in    • Will choose among many options             “outcomes” based on WOM
   personal life, health care      • Distance does not appear to be a        • Manages own referral process
                                      constraint

                                        SR           PD         PR




 PAGE 28
Consumer Insights Dashboard
The search view allows you to see results specified by the filter chosen. You have the option of previewing
each file before saving. Once you open the file you can then save the file to your home page. You may then
organize all files saved into folders so they are easily accessible.




                                                                          Source: MD Anderson
PAGE 29
Operational Implications

•Not all patients have the same needs

•While standards don’t change, your services should

•Increase the distance and compound the problems

•Develop specific initiatives to meet these needs
      • Destination programs (UMHS)
      • Contact center (askMD Anderson)



PAGE 30
5.0




Customer Enchantment

BECOMING OPERATIONALLY
  INTEGRATED
Referring Physician Experience Map
                                                     Scheduling/                                   Transition of
    Awareness                 Need                                          Treatment
                                                       Transfer                                        Care




Perceptions of your     Diagnosis                Initial contact with   Coordination of care    Discharge summary
organization                                     referral facility      with specialists
                        Evaluation and                                                          Coordination of
Knowledge about you     selection of treatment   Scheduling/transfer    Progress notes and      on-going care
                        providers                process                methods of
Marketing or                                                                                    Ongoing patient
                                                                        communication
educational resources   Discussion with          Timing and ease of                             care/support
                        patients (diagnosis,     process                Family feedback about
Ideal relationship                                                                              Call-backs for
                        referral options)                               their clinical
                                                 Managing insurance                             assistance
                                                                        experience
                        Preparing patients for   requirements,
                        what to expect           accommodations or      Support offered to
                                                 travel for families    family




                                Methods of Communication (In each phase)



  PAGE 32
Sample Discussion Areas



Patients / Families                 Physicians                   Staff / Executives
• Current Perceptions                                            • Vision of Ideal
                                    •Referral Roles / Process
• Decision Criteria                                              • Current Barriers
                                    •Ideal Relationship
• Sources of Frustration                                         • Patient Dissatisfiers
                                    •Self / Patient Assessment
• Areas of Praise                                                • Opportunities for Improvement
• Usefulness of Touchpoints         •Recommendations
                                                                 • Model Employee
• Likelihood to Recommend and How   •Likelihood to Refer and     • Likelihood to Recruit and Why
                                     Why
   PAGE 33
From Data…

1.




                         Communications
                                            Video / Audio
                                             Recordings
             Physical
           Environment            2.
                                          Transcripts:
                                          Patients
                                          Physicians
                                          Staff


 PAGE 34
…to Insights



                                   4.
                                        Day in the Life
                                        Touchpoint Assessment:
3.
                                        •   Key Recommendations
     Detailed Findings:                 •   Illustrate with pictures
                                        •   Enrich with clips
     •    Key themes
     •    Verbatim comments
     •    Strengths and barriers




PAGE 35
Profile




PAGE 36
Prioritizing Communications

There are distinctions between richness of               high
communications and the content.
                                                                                        Content 3




                                                           Situational use
Richness in this context might refer to printed
materials, conversations, or events/face-to-face.                                    Content 2

Therefore, it is critical to determine how distributed
                                                                              Content 1
information is used, the best means by which to
disseminate it, and the outcome of such use.
                                                                             low                  high
This is something you can test quantitatively:
          What matters most                                                        Need for richness
          When should we deliver
          What impact does it have on physicians


PAGE 37
Best Practices




                                                MD Anderson
                                                Mayo Clinic




          Source: Gelb/PAN benchmarking study

PAGE 38
Prioritizing Action
                                High
                            Satisfaction
                                                                                      The Kano model shows how tangible
                                                                                      customer needs, wants, and
                                                                                      suggestions can be segregated into 3
                                                                 Competitive Pressure
                                                                                      separate requirement categories:
                                            Enchanted
    Enchantment Needs
    Unexpected and unspoken,                                                        Basic Requirements
    adds value but not required                 Performance                             Meet these requirements quickly and
                                                Needs
                                                                                        with the lowest cost possible
                                                                         Quality    Performance Requirements
                                                     Satisfied                          Selectively meet these requirements to
                                                                                        achieve highest ROI
                                           Basic Needs                              Enchantment Requirements
                                           Expected, minimum                            Meet these requirements to achieve
                                           requirements
                                                                                        elite status




                        Dissatisfaction


PAGE 39
Implications

•Referring physician relationship is key to segments

•They initiate the patient experience with a diagnosis

•Meeting their functional and emotional needs is what
separates “best in class” from others

•Becoming operationally integrated is likely easiest here




PAGE 40
6.0




Customer Enchantment

IF WE BUILD IT, WILL THEY COME?
Location Optimization Options

•Affiliate (Duke)
      • Clinical practices
      • Staff augmentation                            There’s no “one right
      • Typically don’t carry the master brand        way” – all have a role
                                                      (which needs definition)
•Host (MD Anderson)
      • Provide infrastructure
      • Can be branded or co-branded
      • Adhere to higher standards

•Owned (Siteman)
      • Operationally integrated
      • Receives direct resources – staffing, facilities, practices


PAGE 42
In Their Eyes

   Using on-site observation, prioritize and
   assess touchpoints and the patients
   experience at key steps of their journey.

   Snapshots and other multimedia should be
   used to illustrate meaningful observations,
   with a particular focus on areas that have
   improved and those that require further
   resources.

   Consider this:
   Capture the patient perspective by “sitting”
   in each of the chairs they do through the
   journey. Document what you see.


Source: Memorial Sloan Kettering

   PAGE 43
Sample Discussion Areas



Patients / Families                 Physicians                      Staff / Executives
• Current Perceptions               • Referral Roles / Process      •Vision of Ideal
• Decision Criteria                 • Ideal Relationship
                                                                    •Current Barriers
• Sources of Frustration            • Self / Patient Assessment
                                                                    •Patient Dissatisfiers
• Areas of Praise                   • Recommendations
• Usefulness of Touchpoints
                                                                    •Opportunities for Improvement
                                    • Likelihood to Refer and Why
• Likelihood to Recommend and How                                   •Model Employee

                                                                    •Likelihood to Recruit and Why
   PAGE 44
Defining the Operating Model

• How health services are delivered

• Operating Model consists of:
       – What the hospital does (Process)
       – Who does the work (Organizations)
       – How the work gets done (Activities)

• Operating Model represented by a matrix that shows:
       – X axis What the hospital does (Process)
       – Y axis Who does the work (Organizations)
       – X-Y intersection How the work gets done (Activities)

• Projects affect both the X and the Y axis: how the activities are done in each part of
  the organization


PAGE 45
Operating Model for Care Center
                                                          Need   Scheduling          First Visit             Treatment   Follow up

                                                                              What the Hospital Does (Process)


  Main
 Campus
                      Who Does the Work (Organizations)




Satellite
Facilities




   Back                                                                               How the
   Office                                                                            Work Gets
                                                                                       Done
Scheduling, Billing                                                                  (Activity)




     PAGE 46
Defining Various Operational States

• The way business operates changes over time from the impact of other projects.
  Attaining the desired Future Operating Model will be a multi-year process.

• “Snapshots” of the Transitional Operating Models can be constructed each year (or
  some other unit of time) to illustrate those changes as the business moves towards
  the Future Operating Model.

• These Transitional Operating Models over time are represented by the Z axis.

• The Business is affected by the Z axis: Success is determined by how well the
  business is prepared for the changes & transitions.




PAGE 47
Managing the Transition

                                                                                                                                                   FOM                                                            Moving and                        Controlling   Controlling the   Managing the
                                                                                                                                                               Marketing            Planning        Trading                         Settling
                                                                                                                                                                                                                   Tracking                          Trading        Business         Business




                                                                                                       2014                                 Front Office


                                                                                                                                                                           Moving and                         Controlling   Controlling the    Managing the
                                                                                                                  Marketing          Planning              Trading                             Settling
                                                                                                                                                                            Tracking                           Trading        Business          Business



                                                                    2013   Marketing
                                                                                               Front Office

                                                                                            Planning           Trading
                                                                                                                                Moving and
                                                                                                                                            Mid Office


                                                                                                                                                    Settling
                                                                                                                                                                        Controlling     Controlling the   Managing the
                                                                                                                                 Tracking                                Trading          Business         Business




                                  2012    Marketing
                                                           Front Office

                                                         Planning         Trading
                                                                                                Mid Office
                                                                                         Moving and
                                                                                                             Settling
                                                                                                                              Controlling
                                                                                                                                            Back Office


                                                                                                                                              Controlling the        Managing the
                                                                                          Tracking                             Trading          Business              Business



   COM                     Front Office                     Mid Office
                                                            Moving and
                                                                                                Back Office
                                                                                             Controlling      Controlling the    Managing the
               Marketing       Planning        Trading                        Settling
                                                             Tracking                         Trading           Business          Business



Front Office               Mid Office                      Back Office

                                                                                                                                                                                                                                                                              The Business must be prepared
Mid Office                 Back Office
                                                                                                                                                                                                                                                                              for each step on the way to the
Back Office
                                                                                                                                                                                                                                                                                  Future Operating Model

                                                                                                                                                                                                                                                 COM = Current Operating Model
                                                                                                                                                                                                                                                     FOM = Future Operating Model


PAGE 48
Monitoring the Experience




PAGE 49
Site Selection
•Use census information to develop market insight
      •   Demographics (meeting your segment criteria)
      •   Number of competitors in area
      •   Growth of population
      •   Disease incidence
      •   Traffic patterns


•Regress the current patient volumes against these criteria
for existing locations
      •   Helpful to have satellites in place
      •   Weight the criteria
      •   Among these data, what is highly correlated with current success
          (to narrow list)


•Estimate the volume, update the model
      •   Site modeling will provide an estimated as to expected volumes
          based on previous experience
      •   Can help when choosing among locations or setting targets
                                                                             Source: AnySite
•Can also use this to determine best referral opportunities
PAGE 50
Operational Implications

•Satellites and affiliates are extensions of your brand

•Locations have unique roles in the patient experience

•Internal stakeholders must understand these roles

•The key is deliberate strategic design and stepwise
implementation




PAGE 51
Resources

•White papers         Today: On USB drives or mail
•Articles
•Presentations        Tomorrow: www.endeavormgmt.com


Or contact:
email: jmckeever@gelbconsulting.com
phone: 800-846-4051



PAGE 52
Endeavor Management is a strategic transformation and management
                                  consulting firm that leads clients to achieve real value from their
                                  initiatives. Endeavor serves as a catalyst by providing the energy to
                                  maintain the dual perspective of running the business while changing the
                                  business through the application of key leadership principles an-d
                                  business strategy.

                                  The firm’s 40 year heritage has produced a substantial portfolio of proven
                                  methodologies, enabling Endeavor consultants to deliver top-tier
                                  transformational strategies, operational excellence, organizational
                                  change management, leadership development and decision support.
                                  Endeavor’s deep operational insight and broad industry experience
                                  enables our team to quickly understand the dynamics of client companies
                                  and markets.

                                  In 2012, Gelb Consulting became an Endeavor Management Company.
                                  With our Gelb experience (founded in 1965) ,we offer clients in-depth
                                  insights in the healthcare industry and unique capabilities that focus their
                                  marketing initiatives by fully understanding and shaping the customer
                                  experience through proven strategic frameworks to guide marketing
                                  strategies, build trusted brands, deliver exceptional customer
                                  experiences and launch new products.

                                  Endeavor strives to collaborate effectively at all levels of the client
                                  organization to deliver targeted outcomes and achieve real results. Our
                                  collaborative approach also enables clients to build capabilities within
2700 Post Oak Blvd., Suite 1400   their own organizations to sustain enduring relationships. For more
Houston, TX 77056                 information, visit www.endeavormgmt.com and www.gelbconsulting.com
+1 713.877.8130
www.endeavormgmt.com

PAGE 53

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Experience Mapping and Operations

  • 1. Experience Mapping and Operations NACCDO/PAN May 2012
  • 2. Agenda 1. About Us (Briefly, I promise) 2. Satisfaction ≠ Advocacy 3. The Holistic View 4. Who Are Your Patients? 5. Becoming Operationally Integrated 6. If We Build It, Will They Come? PAGE 2
  • 3. 1.0 Gelb Consulting, an Endeavor Management Company ABOUT US
  • 4. Our Strategic Competency Enable our Clients to Design and Execute their Transformational Endeavors Enable the organization to perform Energize the organization to pursue the endeavor e4 Engage the organization to see how to achieve the outcome Envision the desired future outcome and align the leadership PAGE 4
  • 5. The Basis of Our Insights Work with Nationally-recognized Institutions: • 5 “Honor Roll” institutions • 3 out of the top 5 cancer programs • 2 out of the top 4 pediatric hospitals • 2 out of the top 4 cardiovascular programs • Similar client base in top rated National Benchmarking Studies: • Patient experience • Marketing • Physician relations • International programs PAGE 5
  • 6. Our Thought Leadership books… We wrote the Change is the Rule Red Zone Management This book is considered by many to be THE Playbook for today’s troubled business the most useful and practical environment…when all businesses find explanation of how changes are themselves in the Red Zone. The Principles of managed in the modern organization. Red Zone Management clearly spell out the proven management roadmap for making changes during these turbulent times. Engineering Organizational Change THE template for dealing with organizational change as a technical as well as a social engineering problem. Includes step-by-step moves that are absolute requirements for an organization to have lasting change. Change Management Toolkit Purchased by more than 200 firms for use in guiding their Change Management projects. Including detailed, proven and tested tools and templates to ensure change success. PAGE 6
  • 7. Transformation Requires Step-Changes • Non-linear progression between evolution levels • “Leap of faith” into the next level • Higher the proficiency level, the more directly the organization articulates the impact on performance. Excelling/Innovating • Innovation in new practices • Culture is a strategic core competence Mastering • Practices well integrated and pervasive throughout the enterprise Strength Operational • Practices understood with actions in-play to fully integrate, measure & internalize Opportunity Emerging • Some evidence of the practice present • Not consistently applied or followed Discovering • Very little evidence of the practice present • More ad-hoc than systematic PAGE 7
  • 8. Cancer Strategy Challenges (Operational) Proper segmentation Managing referring physician relationships Creating a broader catchment area Defining and delivering multidisciplinary care Facility location and service optimization Increasing word of mouth advocacy Improving employee efficiency and morale (in the midst of change) PAGE 8
  • 9. 2.0 People are not inherently opposed to change…but they don’t like surprises. It is a leader’s responsibility to let people know what the issues are.” Mark Wallace, CEO, Texas Children’s Hospital Customer Enchantment SATISFACTION ≠ ADVOCACY
  • 10. Links EXPERIENCE Culture and your brand promise are linked through the experience delivered. Leaders translate customer expectations to the organization and reinforce desired employee behaviors. Cultural Transformational Brand This alignment creates an exceptional Alignment Leadership Promise experience and a sustainable competitive advantage. EXPECTED BEHAVIORS We call this desired state enchantment. PAGE 10
  • 11. How Enchantment is Different Loyal Customers Satisfied and might use again • Will recommend you if asked • But won’t give you a second chance • Have minimum investment in your future • See you as a choice among many PAGE 11
  • 12. How Enchantment is Different Enchanted Customers Raving Fans and Spread the Word • Go out of their way to recommend you • They forgive you for missteps • Demonstrate a strong commitment • They are part of your future PAGE 12
  • 13. Elements EXPERIENCE Realization Care Delivering Communication the Ideal Coordination Communicating a Experience Resonant Brand Promise Cultural Alignment Transformational Leadership Brand Promise Employee Enthusiasm Leadership Index Brand Trust Tenure Transformational Strategy Familiarity Employee Pride Drives Cultural Alignment Customer Value Employee Value Operational / Organizational Alignment Competitive Difference Employee Experience Consistent Experience EXPECTED BEHAVIORS
  • 14. Process Reinforce the promise Listen to customers, their and deliver in all Reinforce Listen influencers and other communications & stakeholders interactions Deliver Define Define how your Deliver flawlessly on the organization will meet or Promise exceed needs Promise Communicate a resonant Promise PAGE 14
  • 15. Take Advantage of Other Resources Alignment with Lean Process Development • Our outputs for “Voice of the Customer” align with lean processes • We have successfully engaged such teams at other healthcare organizations, specifically focusing on the “coordination” and “care” aspects of the implementation planning Strategic planning • Study materials, scope and implementation plans are created with strategic objectives in mind • The prioritization of initiatives developed are weighed against strategic priorities Culture • We have found that cultural initiatives (like core values or service standards) are supported by this work • Our approach works from the bottom up, allowing those on the front lines to create their own standards which consistently align with the higher level values or standards • This is particularly important as we examine the “care” and “communications” components of the plan PAGE 15
  • 16. Get Ready…Transformational Leader Demonstrates Creates a shared vision self-awareness Builds trust on all levels Motivates the heart Challenges the status quo Models moral behavior Develops and enables others to act Transformational leadership is the process whereby a person engages others and creates a connection that raises the level of motivation and morality in both the leader and the follower (Northouse). PAGE 16
  • 17. Getting Started: Identifying Spheres of Action Breadth:  Cancer center  Physician experience  Clinical Service line  Department/unit/division  Patient education  Call center  Satellites Depth:  Business processes  Technology  Organization, roles, and skills  Management systems  Culture Leadership:  Strategic imperative  Change agency  Ownership  Enthusiasm  Resources PAGE 17
  • 18. 3.0 “Customer experience is bigger than customer service in that it is the full, and end experience. It starts when you first hear about Amazon from a friend and ends when you get the package in the mail and open it.” Jeff Bezos, CEO, Amazon.com Customer Enchantment THE HOLISTIC VIEW
  • 19. Touchpoint Management • A Touchpoint is the interaction between an organization and its customers • It is the means by which a physician or patient realizes the promise of your brand • These touchpoints are service clues and Personal Interactions require management Environments Written and Digital Communications PAGE 19
  • 20. Experience Mapping: Fitting it All Together Experience Mapping is an in-depth qualitative research technique that utilizes a visual cue (the experience map) to help patients, staff, and other influencers recall specific episodes in their journey. Assessment of the entire experience • Expectations - before first encounter through each step • Activities and Touchpoints • Changes in attitudes, if any Framework for action • Experience stewards who are responsible for delivery • Steward can see the big picture for better planning / behaviors • Interactions or “touchpoints” are categorized at each step for resourcing PAGE 20
  • 21. Experience Map Need Scheduling Visit Treatment Follow-up • Symptoms • Education • Wayfinding • Instructions • Communication • Medical/family • Financial • Checking-in (verbal/written) with referring History paperwork • Waiting Area • Hand-offs physician • Self-Education • Medical • Nursing care • Contact information • Follow-up visits • On-line Assessment Paperwork • Physician care • Staff assistance • Patient portal • Diagnosis • Contact Info • Assessments • Call-backs for • Advocacy • On-line Assistance • Diagnostics/Exams assistance • Surveillance • Call Center • Faculty/Medical Staff • Faculty/Medical • Faculty/Medical • Family/friends • Front Desk Staff • Support Staff Staff Staff • Referring physician • Faculty/Medical Staff • Family/friends • Support Staff • Support Staff • Family/friends • Volunteers • Family/friends • Family/friends • Physicians • Volunteers • Volunteers Primary Experience Stewards Key Touchpoints
  • 23. Anatomy of a Complete Patient Profile Demographic descriptors Psychographic descriptors Behaviors Attitudes Don’t be fooled by shorthand – not all patients are the same nor should be your approach PAGE 23
  • 24. Behaviors What is your percentage? The general population is most often physician directed… • Physician referred Patients who are choosers (self referred) are often those seeking a • Self referred second opinion. • Physician directed Unknown Self Referred Use these break downs to determine where best to allocate efforts Physician Referred Physician Directed PAGE 24
  • 25. Needs Functional Emotional What we do… How we do it… • Services offered • Inclusion in treatment • Clinical outcomes • “Feel” of the interactions • Transfer efficiency • Subjective quality judgments • Scheduling delays • Feeling valued PAGE 25
  • 26. Differences in Insight Functional Emotional NUMBERS STORIES What we measure… What they say… • Satisfaction scores • Richness and detail • HCAHPS scores • Connection • Mystery shopping • Context PAGE 26
  • 27. Sample Discussion Areas Patients / Families Physicians Staff / Executives •Current Perceptions • Referral Roles / Process • Vision of Ideal • Ideal Relationship • Current Barriers •Decision Criteria • Patient Dissatisfiers •Sources of Frustration • Self / Patient Assessment • Opportunities for Improvement •Areas of Praise • Recommendations • Model Employee • Likelihood to Refer and Why •Usefulness of Touchpoints • Likelihood to Recruit and Why •Likelihood to Recommend and How PAGE 27
  • 28. Personae: Female Cancer Patient (A) A “No other case is like mine. I’ve done my homework. Respect me and I’ll respect you. I need a physician who is at the top of her game – someone who will be my care partner. Let’s beat this together.” Karen DESCRIPTORS BEHAVIORS NEEDS • 90% Females (due to diagnoses) • Despite her attitudes, is more likely • Ability to qualify physician expertise • 60% from outside PSA to consult physician specialists in • Knowledge of technique/technology • Anxious about diagnosis developing options • Indirectly evaluates facility • Demonstrates “take charge” in • Will choose among many options “outcomes” based on WOM personal life, health care • Distance does not appear to be a • Manages own referral process constraint SR PD PR PAGE 28
  • 29. Consumer Insights Dashboard The search view allows you to see results specified by the filter chosen. You have the option of previewing each file before saving. Once you open the file you can then save the file to your home page. You may then organize all files saved into folders so they are easily accessible. Source: MD Anderson PAGE 29
  • 30. Operational Implications •Not all patients have the same needs •While standards don’t change, your services should •Increase the distance and compound the problems •Develop specific initiatives to meet these needs • Destination programs (UMHS) • Contact center (askMD Anderson) PAGE 30
  • 32. Referring Physician Experience Map Scheduling/ Transition of Awareness Need Treatment Transfer Care Perceptions of your Diagnosis Initial contact with Coordination of care Discharge summary organization referral facility with specialists Evaluation and Coordination of Knowledge about you selection of treatment Scheduling/transfer Progress notes and on-going care providers process methods of Marketing or Ongoing patient communication educational resources Discussion with Timing and ease of care/support patients (diagnosis, process Family feedback about Ideal relationship Call-backs for referral options) their clinical Managing insurance assistance experience Preparing patients for requirements, what to expect accommodations or Support offered to travel for families family Methods of Communication (In each phase) PAGE 32
  • 33. Sample Discussion Areas Patients / Families Physicians Staff / Executives • Current Perceptions • Vision of Ideal •Referral Roles / Process • Decision Criteria • Current Barriers •Ideal Relationship • Sources of Frustration • Patient Dissatisfiers •Self / Patient Assessment • Areas of Praise • Opportunities for Improvement • Usefulness of Touchpoints •Recommendations • Model Employee • Likelihood to Recommend and How •Likelihood to Refer and • Likelihood to Recruit and Why Why PAGE 33
  • 34. From Data… 1. Communications Video / Audio Recordings Physical Environment 2. Transcripts: Patients Physicians Staff PAGE 34
  • 35. …to Insights 4. Day in the Life Touchpoint Assessment: 3. • Key Recommendations Detailed Findings: • Illustrate with pictures • Enrich with clips • Key themes • Verbatim comments • Strengths and barriers PAGE 35
  • 37. Prioritizing Communications There are distinctions between richness of high communications and the content. Content 3 Situational use Richness in this context might refer to printed materials, conversations, or events/face-to-face. Content 2 Therefore, it is critical to determine how distributed Content 1 information is used, the best means by which to disseminate it, and the outcome of such use. low high This is something you can test quantitatively: What matters most Need for richness When should we deliver What impact does it have on physicians PAGE 37
  • 38. Best Practices MD Anderson Mayo Clinic Source: Gelb/PAN benchmarking study PAGE 38
  • 39. Prioritizing Action High Satisfaction The Kano model shows how tangible customer needs, wants, and suggestions can be segregated into 3 Competitive Pressure separate requirement categories: Enchanted Enchantment Needs Unexpected and unspoken, Basic Requirements adds value but not required Performance Meet these requirements quickly and Needs with the lowest cost possible Quality Performance Requirements Satisfied Selectively meet these requirements to achieve highest ROI Basic Needs Enchantment Requirements Expected, minimum Meet these requirements to achieve requirements elite status Dissatisfaction PAGE 39
  • 40. Implications •Referring physician relationship is key to segments •They initiate the patient experience with a diagnosis •Meeting their functional and emotional needs is what separates “best in class” from others •Becoming operationally integrated is likely easiest here PAGE 40
  • 41. 6.0 Customer Enchantment IF WE BUILD IT, WILL THEY COME?
  • 42. Location Optimization Options •Affiliate (Duke) • Clinical practices • Staff augmentation There’s no “one right • Typically don’t carry the master brand way” – all have a role (which needs definition) •Host (MD Anderson) • Provide infrastructure • Can be branded or co-branded • Adhere to higher standards •Owned (Siteman) • Operationally integrated • Receives direct resources – staffing, facilities, practices PAGE 42
  • 43. In Their Eyes Using on-site observation, prioritize and assess touchpoints and the patients experience at key steps of their journey. Snapshots and other multimedia should be used to illustrate meaningful observations, with a particular focus on areas that have improved and those that require further resources. Consider this: Capture the patient perspective by “sitting” in each of the chairs they do through the journey. Document what you see. Source: Memorial Sloan Kettering PAGE 43
  • 44. Sample Discussion Areas Patients / Families Physicians Staff / Executives • Current Perceptions • Referral Roles / Process •Vision of Ideal • Decision Criteria • Ideal Relationship •Current Barriers • Sources of Frustration • Self / Patient Assessment •Patient Dissatisfiers • Areas of Praise • Recommendations • Usefulness of Touchpoints •Opportunities for Improvement • Likelihood to Refer and Why • Likelihood to Recommend and How •Model Employee •Likelihood to Recruit and Why PAGE 44
  • 45. Defining the Operating Model • How health services are delivered • Operating Model consists of: – What the hospital does (Process) – Who does the work (Organizations) – How the work gets done (Activities) • Operating Model represented by a matrix that shows: – X axis What the hospital does (Process) – Y axis Who does the work (Organizations) – X-Y intersection How the work gets done (Activities) • Projects affect both the X and the Y axis: how the activities are done in each part of the organization PAGE 45
  • 46. Operating Model for Care Center Need Scheduling First Visit Treatment Follow up What the Hospital Does (Process) Main Campus Who Does the Work (Organizations) Satellite Facilities Back How the Office Work Gets Done Scheduling, Billing (Activity) PAGE 46
  • 47. Defining Various Operational States • The way business operates changes over time from the impact of other projects. Attaining the desired Future Operating Model will be a multi-year process. • “Snapshots” of the Transitional Operating Models can be constructed each year (or some other unit of time) to illustrate those changes as the business moves towards the Future Operating Model. • These Transitional Operating Models over time are represented by the Z axis. • The Business is affected by the Z axis: Success is determined by how well the business is prepared for the changes & transitions. PAGE 47
  • 48. Managing the Transition FOM Moving and Controlling Controlling the Managing the Marketing Planning Trading Settling Tracking Trading Business Business 2014 Front Office Moving and Controlling Controlling the Managing the Marketing Planning Trading Settling Tracking Trading Business Business 2013 Marketing Front Office Planning Trading Moving and Mid Office Settling Controlling Controlling the Managing the Tracking Trading Business Business 2012 Marketing Front Office Planning Trading Mid Office Moving and Settling Controlling Back Office Controlling the Managing the Tracking Trading Business Business COM Front Office Mid Office Moving and Back Office Controlling Controlling the Managing the Marketing Planning Trading Settling Tracking Trading Business Business Front Office Mid Office Back Office The Business must be prepared Mid Office Back Office for each step on the way to the Back Office Future Operating Model COM = Current Operating Model FOM = Future Operating Model PAGE 48
  • 50. Site Selection •Use census information to develop market insight • Demographics (meeting your segment criteria) • Number of competitors in area • Growth of population • Disease incidence • Traffic patterns •Regress the current patient volumes against these criteria for existing locations • Helpful to have satellites in place • Weight the criteria • Among these data, what is highly correlated with current success (to narrow list) •Estimate the volume, update the model • Site modeling will provide an estimated as to expected volumes based on previous experience • Can help when choosing among locations or setting targets Source: AnySite •Can also use this to determine best referral opportunities PAGE 50
  • 51. Operational Implications •Satellites and affiliates are extensions of your brand •Locations have unique roles in the patient experience •Internal stakeholders must understand these roles •The key is deliberate strategic design and stepwise implementation PAGE 51
  • 52. Resources •White papers Today: On USB drives or mail •Articles •Presentations Tomorrow: www.endeavormgmt.com Or contact: email: jmckeever@gelbconsulting.com phone: 800-846-4051 PAGE 52
  • 53. Endeavor Management is a strategic transformation and management consulting firm that leads clients to achieve real value from their initiatives. Endeavor serves as a catalyst by providing the energy to maintain the dual perspective of running the business while changing the business through the application of key leadership principles an-d business strategy. The firm’s 40 year heritage has produced a substantial portfolio of proven methodologies, enabling Endeavor consultants to deliver top-tier transformational strategies, operational excellence, organizational change management, leadership development and decision support. Endeavor’s deep operational insight and broad industry experience enables our team to quickly understand the dynamics of client companies and markets. In 2012, Gelb Consulting became an Endeavor Management Company. With our Gelb experience (founded in 1965) ,we offer clients in-depth insights in the healthcare industry and unique capabilities that focus their marketing initiatives by fully understanding and shaping the customer experience through proven strategic frameworks to guide marketing strategies, build trusted brands, deliver exceptional customer experiences and launch new products. Endeavor strives to collaborate effectively at all levels of the client organization to deliver targeted outcomes and achieve real results. Our collaborative approach also enables clients to build capabilities within 2700 Post Oak Blvd., Suite 1400 their own organizations to sustain enduring relationships. For more Houston, TX 77056 information, visit www.endeavormgmt.com and www.gelbconsulting.com +1 713.877.8130 www.endeavormgmt.com PAGE 53