At East Jefferson General Hospital in Metairie, La., the staff fondly recalls the magic moment when it won a Mickey Mouse award.
Mickey himself presented the honor, which proponents say is nothing goofy. In fact, it's the first "Mouscar" ever won by a healthcare institution.
The Mouscar, a takeoff on the Oscar, was bestowed by Mickey in February in a streamer-strewn auditorium crowded with hospital board members, elected officials and employees-oops, make that "team members."
Mickey and crew traveled from Disney University in Orlando, Fla., to honor the hospital as the first to fully exemplify the guest relations philosophy of Walt Disney World.
Since 1991, the suburban New Orleans hospital has been studying and adapting Disney precepts of hospitality and service. They include the "EJ Look," the "on-stage/off-stage" idea and the aforementioned transformation of mere employees into members of a team.
"From our perspective, guest relations is a definition of quality," says Peter J. Betts, the hospital's president and chief executive officer. "We can't expect our patients to be able to appraise the quality of radiology, laboratory or operating rooms .*.*.*A large part of the patients' perception of quality is how they're treated. Is the room clean? Are meals served on time? Does a nurse come when I press the call button?"
Those are some of the details that East Jefferson's entire work force is sworn to attend to in the interest of customers' ease and comfort. Of course, this hospital is hardly alone in its desire to buff and shine "guest relations." Baptist Hospital of Miami is working with Ritz Carlton hotels on a similar program.
And Marriott Health Care Services in Avon, Conn., is revving up a program to build a service culture at such clients as St. Joseph Healthcare in Nashua, N.H., and Nassau County Medical Center on Long Island, N.Y.
Competitive hospitality. East Jefferson, a county-owned institution, has long used its guest services strategy to get a leg up on the competition. For the past five years it has been sending managers to the four-day course in Orlando to learn how Disney creates "magic moments" that keep its visitors coming back time after time.
"We can't teach East Jefferson healthcare," says Debbie Dickinson, who manages Disney University's healthcare training program. But, she says, "we have some of the obvious in common: Their focus is on patients, ours is on guests. They have heads in beds, we have heads in beds. They have food service, we have food service. We both have check-in and check-out processes. While the reservation is in one person's name, there is usually a family behind that."
On this foundation Disney has built a new business unit. Disney has been selling its philosophy and corporate culture to other business managers in a training course since 1986. Healthcare personnel have constituted about 30% of participants in its training sessions, the largest contingent from any industry.
Interest has been so strong, in fact, that starting this year Disney has tailored a program specifically to healthcare. A second industry-specific course has been designed for automotive distribution and sales.
Disney teaches organizations to always understand their guests. "That's not always the patient," Dickinson says. "Typically in a hospital setting that includes the patient, the patient's family and the physician."
The other lesson Disney imparts is to break down the hierarchy and the departmental boundaries. Everybody is on a first-name basis; everybody takes responsibility for the whole; nobody can say "that's not my job."
Guest principles. Over the past five years, East Jefferson has adopted Disney's four cardinal principles of guest relations: safety, courtesy, show and efficiency. But managers have altered them to suit their facility's needs. Beyond the obvious safety concerns in a hospital, East Jefferson has applied the safety precept to way-finding and signage. It installed new signs designed to accommodate the weaker eyesight of the elderly.
As to courtesy, Disney requires all employees (or cast members, as they are called) to smile within 10 feet of any other person. At the hospital that's been modified to a knock-before-entering policy at patient rooms. The patient must give permission to come in.
At Disney World, areas are designated on-stage or off-stage. Show, says Dickinson, "is everything that a guest sees. It makes an impression whether this is a pleasant experience."
So East Jefferson's grounds are manicured, everybody picks up trash in the halls and team members keep their work areas uncluttered.
Beyond that, she says, East Jefferson has done some surprising things to make patients comfortable in their surroundings. In the rehabilitation room, "people (had been) spending a lot of time lying on those tables, doing exercises, looking at ceiling tiles with fluorescent lights," Dickinson notes.
The hospital concealed the fluorescent lights and painted a mural of the sky on the ceiling. "You walk in the room and instead of looking at all this equipment, your first impression is, `Oh, how interesting, how nice,"' says Dickinson.
As for efficiency, says Bruce Curson, the hospital's chief operating officer, "Many organizations, in healthcare or not, think introducing these standards adds costs. I totally disagree with that. It doesn't cost any more to train your employees to pick up a little litter off the grounds and make everybody part of the housekeeping crew. It doesn't cost any more to train people to answer the phone on the third ring, or knock on the door before you enter, whether it's a co-worker or a patient."
East Jefferson redesigned its name tags to eliminate last names, titles and professional designations, except for doctors and nurses. It also created a dress code, the "EJ Look," for team members based on response from community focus groups. The hospital knows exactly what its patients and neighbors think about men with hoop earrings and women with long decorated fingernails, and it instructs its people accordingly.
East Jefferson also invites patients to order their meals the day they are delivered, instead of the day before. "It might not sound like much, but it's a step forward. We're trying to turn the battleship," Curson says.
Signing on. To ensure that East Jefferson's staffers endorse the program before they come on board, the orientation program was revamped to stress the guest services theme. Half the performance appraisal evaluates guest relations skills, teamwork, professional appearance, telephone skills, etc.
The hospital starts screening out those who don't fit from the beginning. Anyone asking for an employment application must watch a video describing what the hospital expects of its workers.
"We lay out all the policies on competencies, attendance, attitude, guest relations," says Dee Clavin, assistant vice president for human resources. If they buy in, they can apply for a job. If not, they may discreetly leave.
Ten thousand people per year go through the employment office. Only 300 are hired. That selectivity, says Curson, allows the hospital to enforce its standards. Clavin says turnover, already low at 18% in 1990, now is down to 11.2% since the Disney approach was introduced.
East Jefferson applied the Disney precepts in designing its Joseph C. Domino Healthcare Pavilion for outpatient services, now under construction on the campus.
The building and garage have been designed so patients don't have to walk more than 35 steps to their first point of contact. People picking up home health supplies or laboratory kits don't need to get out of their cars. At each transition from the garage to the Domino building, there's a guest services station to guide the patient or visitor.
Likewise, the hospital is looking out for physician relations. Normally when a physician admits a surgical patient, he or she must make a minimum of three calls: to admitting, anesthesia and surgery. Now, all a physician needs to do is call admitting. The hospital takes care of the rest. "It makes a more satisfying experience for the doctors to do business with us," Curson says.
Personal experience. Dickinson herself had occasion to be a patient at the hospital during her visit in March. She came with the Disney team to present the Mouscar and also to make a video to use in teaching how Disney World ideas can be adapted to the healthcare setting. She got an ear infection in transit and was treated in East Jefferson's emergency room.
Even though she was a special visitor to the hospital, she says, "There were some things I was able to observe in the ER that people don't just do because they're trying to help you get back on your work schedule: Looking a person in the eye, conversing one adult to another. The manner was very competent, very relaxed. That goes a long way toward calming anxiety."
Betts, the hospital CEO, says these little details do add up in business terms. The hospital has five competitors and about 40% of the local market. "I think most hospitals are pretty much the same from the clinical quality standpoint," Betts says. "Our market share has gone up 7% since we started emphasizing some aspects of the Disney approach. Is the entire 7% due to Disney? Probably not, but certainly some of it is."
Deidra Dudley is inclined to agree. "My husband calls me Miss East Jefferson," says the registered nurse. "But once you've worked here a while and you go to other places, you see what's missing."