A Cure for the 'Been There, Done That' Syndrome
Children’s Hospital of Orange County recently launched an effort to shore up customer service and propel itself into the top echelon of children’s hospitals in the country.
But the Southern California hospital faces a big obstacle: the “been there, done that” complacency of employees who’ve seen previous attempts at culture change fizzle and die.
To make its “Journey to Excellence” initiative stick, Orange, California-based Children’s Hospital of Orange County (also known as CHOC Children’s) is using both established and unconventional tactics. Mandatory training workshops for leaders are combined with novel, once-a-month performance discussions with each employee. The company also has adopted performance-based pay for managers to hold them accountable for instilling the desired behavioral changes.
In addition, the 2,400-employee medical center is trying to hitch the quality-improvement program to two major developments: a merger with the University of California, Irvine, and a $565 million expansion at the Orange campus.
Kacee Cabanting, the hospital’s director of employee relations, concedes that selling employees on the new program isn’t easy, especially with so many big changes looming and uneven past results.
“We have to overcome resistance and skepticism that this program isn’t just another ‘flavor of the month,’ ” Cabanting says.
CHOC Children’s operates a 238-bed pediatric hospital in Orange along with a 48-bed facility in Mission Viejo, about midway between Los Angeles and San Diego. The company is known for treating “the sickest of sick kids” in the region—about 50,000 patients at its Orange facility each year, ranging from newborns to children up to age 18. Any child requiring care gets treatment, regardless of a parent’s ability to pay. Heart surgery, chemotherapy, neonatal care and complex pediatric procedures are among its specialties.
In recent years, CHOC Children’s received generally high marks for clinical treatment outcomes on patient surveys. Even so, the organization has had an image problem. The same patient surveys revealed that hospital staffers tend to be viewed as somewhat detached—not uncaring, but not exactly wowing parents with their personal touch, either. The finding resulted in some serious soul-searching for the 45-year-old company.
“Given the significance of our vision, it was obvious we couldn’t continue doing things in the same way,” CEO Kim Cripe says.
The vision Cripe refers to is CHOC Children’s aim to be considered alongside some of the nation’s most prestigious children’s hospitals. “We want to be a nationally recognized, premier children’s hospital,” Cripe says.
The company doesn’t need to look far for inspiration. Two neighboring facilities—Children’s Hospital of Los Angeles and Mattel Children’s Hospital UCLA—were ranked among the top 30 in a number of pediatric specialties in a 2010 report by U.S. News & World Report. CHOC Children’s didn’t make the top 30 in any of 10 specialty areas.
The Journey to Excellence program was launched in 2008 to lift CHOC Children’s into that top tier of institutions. But the pediatric hospital has tried upgrading its quality several times before, including a similar initiative seven years ago that produced lackluster results.
Such a “Groundhog Day” syndrome plagues many organizations that try to revamp themselves, particularly if they have a history of not following through. For changes to become second nature, top executives need to clearly state the vision, provide employees with training and resources, and tie employee incentives to a set of organization-wide goals, says Patsy Svare, a consultant with the Chatfield Group in Northbrook, Illinois.
It also may mean moving people out of the organization who don’t comply, she says. “This kind of change is not for the faint of heart. Leaders can’t be wishy-washy about it.”
In its latest push to shake up the organization, CHOC Children’s is combining traditional change tactics with some unusual methods. Training is a cornerstone. Nurses, staff physicians, radiologists, lab technicians and other health care professionals are getting a primer on customer service and satisfaction. Also, employees are asked by their supervisors to nominate co-workers whose achievements deserve special recognition—a pivotal element of the program’s success.
Less conventional is CHOC Children’s adoption of monthly performance discussions between frontline supervisors and their direct reports. Requiring managers to talk to frontline staff at least every four weeks keeps the focus on improved service, Cripe says.
Managers’ pay is based in part on the achievement of their department’s interim milestones. That ties compensation closely to performance and drives accountability, Cripe says. “Our organizational goals cascade down to the individual department heads,” who are responsible for conveying those goals to their employees.
The stepped-up performance discussions and new approach to compensation exemplify a common theme: frontline supervisors, department heads and executives have to be catalysts for change. In fact, the Journey to Excellence initiative kicked off last year with a series of mandatory training workshops for frontline leaders.
Conducted quarterly, the workshops feature a curriculum developed and delivered by the company’s organizational development staff. The sessions eschew lectures in favor of hands-on activities in which leaders collaborate across different disciplines. Leaders break off in various small groups, with each group assigned a set of tasks and asked to formulate solutions. Serving as a blueprint for the workshops is the company’s strategic growth plan, keeping leaders on track and making the learning relevant, Cabanting says.
Each workshop is built around a structured theme but remains flexible enough for leaders to steer in a different direction to explore emerging issues, says Aaron Shaffer, a consultant who guided CHOC Children’s in the early stages of the Journey to Excellence project. For example, Shaffer says participants could scrap the planned agenda to discuss news reports about the latest national hospital rankings, using the session to focus specifically on how CHOC stacks up against its peers and which areas need improvement.
The flexibility “makes it hard to measure the individual components, since the workshop is literally in flux. But it’s also what makes the learning especially powerful,” says Shaffer, a principal with San Pedro, California-based Shaffer Psychological Institute. (Shaffer is no longer directly involved with the change initiative, but does provide occasional leadership training to the hospital.)
Putting the leadership lessons into practice is even more important, says Melanie Patterson, director of the CHOC Children’s Cancer Care Institute. For example, Patterson is training her 180 supervising and charge nurses on the importance of building personal relationships with parents of critically ill patients. The focus is on simple but important steps: introducing themselves directly to family members, detailing their nursing credentials and experience, and inviting questions about the patient’s treatment plan.
It’s taken awhile for people to adjust.
“Although it makes most people really uncomfortable to manage themselves [this way], it makes our patients and their families very, very comfortable,” says Patterson, whose nursing supervisors in turn are gradually training each of their individual nursing crews.
Getting clinical staff to embrace customer service is particularly tough, says Dr. Nick Anas, CHOC Children’s pediatrician in chief and also its medical director of critical care. That’s because it involves satisfying numerous constituent groups: patients, their parents, staff physicians, referral physicians, practicing nurse staff, hospital donors as well as the larger local community.
“Customer service here isn’t like walking into Nordstrom’s,” Anas says.
Accelerating the pace of change at CHOC Children’s is a pair of initiatives that are steppingstones toward national prominence. The first is an affiliation finalized in 2009 with the University of California-Irvine Medical Center, which has ranked among the nation’s top 50 hospitals for the last decade.
Aligning with the university provides greater access to research for developing new treatments and medical technologies. It also sets up a potential culture clash.
“We are blending a staff of entrepreneurial physicians—doctors who are used to running their own practices, with an academic hospital. Those are two very different cultures,” Cripe says.
The second major development involves the massive expansion at CHOC Children’s Orange campus. The showpiece will be a patient tower encompassing nearly 426,000 square feet, including an advanced pediatric emergency department and new operating rooms along with high-tech laboratory, pathology, imaging and radiology services.
The expansion will create more than 300 jobs over the next several years, underscoring the need for frontline leaders to be adept at recruiting, assessing, hiring and assimilating workers into the changing culture, CHOC Children’s officials say.
“We are growing very, very rapidly, so it’s important that our leaders are trained to onboard the right people for the right jobs,” Patterson says.
Anas has seen numerous cultural undertakings in his 24 years at CHOC Children’s. The hospital’s spotty success rate may cause workers to tune out at first, but Anas says he is optimistic this attempt will work.
“The bottom line for us is delivering excellent health care to children. The processes we’re putting in place now gear us to pursue excellence” in all phases, from therapeutic outcomes to patient satisfaction, Anas says.
Still, the company isn’t expecting changes overnight. Conventional wisdom is that it takes three to five years for organizational cultural changes to begin producing a long-lasting impact, Cabanting says. Even then, there are no guarantees.
A certain percentage of employees are likely to resist the latest overture and leave the organization, but Cripe says she’s OK with that. Such upheaval may be necessary for CHOC Children’s to move into the national spotlight. “It’s always hard to motivate people to embrace change,” Cripe says, “but especially when things seem to be going well.”
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