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Voices for Safer Care

Insights from the Armstrong Institute

A method to the mystique

A few months ago, I posted about the pleasure of meeting Horst Schulze, a former Ritz-Carlton executive who created his own ultra-luxury hotel chain based on many of the principles he employed while working for the Ritz-Carlton. It was clear to me that the hospitality industry has something to teach health care about what it takes to create a culture of service excellence, and what it truly means to treat employees and staff with the utmost respect.

For that post, I only heard about Ritz-Carlton; I now got to experience it. As part of the Baldrige Executive Fellowship Program, I spent two days in January with the Ritz-Carlton in Pentagon City. Aside from hearing from senior leaders how they maintain excellence, I lived the Ritz-Carlton experience as a hotel guest.

The Ritz-Carlton understands deeply that to satisfy their customers, they must excel in the technical and emotional delivery of service—not only clean rooms and timely room service, but creating a feeling that guests are unique and important. And it was almost eerie For example, from the bellhop to housekeeper to concierge, the employees all knew my name, as if it was a game they played to memorize who their guests were. They seemed to be mind-readers. Once, when I left the meeting room to take a call, the concierge sensed my needs for a quiet place to speak and motioned to me to come into an empty room that was quiet and had excellent reception. A second latter, he handed me a bottle of water, which he somehow sensed I wanted. You could tell by the way that they addressed me that these “ladies and gentleman”—who are never referred to as staff—took great pride in their work. Their leadership knows that when people feel respected, they are better employees and serve customers better.

Where does this come from? How do they ingrain desired behaviors and habits across their hotels? This is something I wanted to find out on my visit. As I learned, it takes more than words to support this culture.

Here are a few of my takeaways:

Disciplined goal-setting and measurement
The Ritz-Carlton rigorously measures its performance and these measures “cascade” down across the organization, so that each hospital, department or group knows its role in helping to achieve the corporate goals. The entire organization has a widely important goal, or “WIG.” For example the main WIG, customer satisfaction, is measured as the percentage of visitors who give the highest possible rating to all three key questions that they answer in surveys after their stays: overall satisfaction, willingness to return and willingness to recommend.

We visited several departments and in every one, they had the overall WIG for their property prominently displayed on a board. The departments defined their role in meeting their hotel’s WIG, and then measured their performance in that area. For example, Room Service may measure the percentage of meals without mistakes. Every department had this type of cascading goals, and every morning in their daily “line-ups” (more on that to follow), they reviewed their WIG and departmental performance.

Focusing on behaviors
Every morning, Ritz-Carlton hotels have a “line up” both for all hotel staff and then for individual departments, such as the kitchen. Aside from reviewing their WIG performance, they read one of 16 key expected behaviors, rotating daily. For example, “I am always responsive to the unexpressed and expressed needs of our guests.” They also review plans for the day and any potential concerns. And it is not optional.

There is still an implicit trust in employees’ decision-making and ability to live out these behaviors. Any employee can spend up to $2000 per event in which a customer is dissatisfied or their needs not meet. No questions asked. However, the monetary amount is symbolic. They have rare occasions to use those funds because problem resolution training at Ritz-Carlton is comprehensive and frequent.

Cultivating employees
To echo my previous post about Schulze’s Capella hotel chain, the Ritz-Carlton does not just hire people; it selects them. Indeed, even for entry-level positions, they do behavioral profiling; they want to match an applicant’s personality with the job. For example, those who interact with customers should be extroverts, with a warm inviting smile who enjoy conversation. All employees go through 10 days of training to learn the culture, to understand expected behaviors and to ensure they have the skills to perform their jobs.

Recognition as currency
The Ritz-Carlton understands that recognition and praise are rewards in and of themselves. Two of their programs put this belief in action. Every Monday and Friday the Ritz-Carlton properties around the world share “WOW stories”—tales of random acts of kindness by employees that are shared at the daily line-ups twice a week. These stories inspire the others at Ritz-Carlton by demonstrating outstanding service

For example, one WOW story from The Ritz-Carlton New York, Central Park came from a man who had arranged a hotel stay as a special treat for an aunt who was losing her battle with cancer, as well as for his mother. He wrote about how the staff “took it upon themselves to ensure that this trip was unforgettable”—for instance, by sending flowers to their room. He praised the hotel for empowering employees “to make decisions based on guests’ needs.”

The other program is called a “First Class Card.” When a colleague witnesses outstanding service by another, they write what they saw on a postcard and present it to that person. The cards may go between peers, or from managers to subordinates. We met a housekeeper who told us how she received a first class card five years ago. She keeps it in a scrap book, proudly displaying it for her grandchildren.

My Ritz-Carlton visit further convinced me that a culture of service excellence requires organized work and discipline. It happens when the organization has clear goals, measures to support those goals, and then systems to ensure the goals are met. It happens when the organization focuses on both the technical and emotional aspects of care.

Much of what I learned from Ritz-Carlton can be applied to health care. At Hopkins Medicine, we’ve made a concerted push to clarify what our patient safety and quality goals are: to partner with patients, their families and others to eliminate preventable harm, optimize patient outcomes and experience, and reduce waste. We have identified several key measures that we will use to measure our progress toward these goals. For instance, all of our hospitals are working to reach 96 percent or better performance on all of the 30-plus Joint Commission core measures, 85 percent or better for hand-hygiene in the inpatient setting (90 percent for ambulatory), and for each ICU to have zero central-line-associated bloodstream infections. Hospitals, departments, units or clinics are being held accountable for doing their part to reach these goals, and when they fall short, we provide support to help them meet their goals. We are pilot-testing a new dashboard that summarizes our progress toward these goals and will ultimately be customized for departments and other areas.

There’s more that we could do to infuse Ritz-Carlton methods and rigor into how we care for patients. Should we send weekly success stories? Daily line-ups? Certainly, no two industries are alike. But I am confident that there is still much we could adopt from the Ritz-Carlton model, encouraging our housekeepers, environmental services staff, aids, technicians, nurses and doctors would see themselves more as “ladies and gentlemen” focusing not just on delivering the right medications or treatments, but meeting the emotional needs of our patients.


Peter Pronovost

One of the world’s leading authorities on patient safety, Peter Pronovost served a the director of the Armstrong Institute, as well as senior vice president for patient safety and quality, at Johns Hopkins Medicine from 2011 until January 2018.

2 thoughts on “A method to the mystique”

  1. Pingback: How to Respond to Complaint Letters | Heroic Technical Writing: Advice and Insights on the Business of Technical Communication

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