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- 2. INTRODUCTIONINTRODUCTION A look at the network of relationships,A look at the network of relationships, which support the delivery of customerwhich support the delivery of customer satisfaction throughout “The Shouldicesatisfaction throughout “The Shouldice Experience”Experience” Daryl UrquhartDaryl Urquhart - Director of Business Development,- Director of Business Development, Shouldice HospitalShouldice Hospital
- 3. Management PhilosophyManagement Philosophy We repair Hernias ! Nothing else !We repair Hernias ! Nothing else !
- 4. SHOULDICE HOSPITALSHOULDICE HOSPITAL HERNIAS “R” US !
- 5. Management PhilosophyManagement Philosophy We repair Hernias ! Nothing else !We repair Hernias ! Nothing else ! ““The patient’s welfare is ourThe patient’s welfare is our responsibility”responsibility” Employee empowermentEmployee empowerment Track activity and outcomesTrack activity and outcomes
- 6. CUSTOMER SATISFACTIONCUSTOMER SATISFACTION WHAT IS IT?WHAT IS IT? I got what I expected?I got what I expected? They did what they said they would do?They did what they said they would do? A great experience?A great experience? Creation of an Apostle!Creation of an Apostle!
- 7. CUSTOMER SATISFACTIONCUSTOMER SATISFACTION ANDAND “THE RELATIONSHIP TREE”“THE RELATIONSHIP TREE” TheThe ““DNADNA”” inin CreatingCreating Customer SatisfactionCustomer Satisfaction Throughout theThroughout the The Shouldice ExperienceThe Shouldice Experience
- 8. THE SHOULDICE EXPERIENCETHE SHOULDICE EXPERIENCE Abdominal wall hernia surgery?Abdominal wall hernia surgery?
- 9. THE SHOULDICE EXPERIENCETHE SHOULDICE EXPERIENCE A manifestation of emotional, physical and interactiveA manifestation of emotional, physical and interactive relationships, orchestrated in a safe environment, built onrelationships, orchestrated in a safe environment, built on focus, confidence, trust and success.focus, confidence, trust and success.
- 10. THE SHOULDICE EXPERIENCETHE SHOULDICE EXPERIENCE A bonding processA bonding process
- 11. THE SHOULDICE EXPERIENCETHE SHOULDICE EXPERIENCE A healing = strengthening of mind and bodyA healing = strengthening of mind and body
- 12. RELATIONSHIP TREERELATIONSHIP TREE PLANT THE SEEDS!PLANT THE SEEDS! IN GOOD SOIL!IN GOOD SOIL!
- 13. RELATIONSHIPSRELATIONSHIPS EmotionalEmotional PhysicalPhysical InteractiveInteractive
- 14. EMOTIONALEMOTIONAL RELATIONSHIPRELATIONSHIP THE LASTING IMPRINTTHE LASTING IMPRINT Surprise or ShockSurprise or Shock - My god ! What’s this?- My god ! What’s this? FearFear - Is it cancer? Am I going to die?- Is it cancer? Am I going to die? AnxietyAnxiety - What should I do? Surgery!!!- What should I do? Surgery!!! HopeHope - Maybe I’ll be okay- Maybe I’ll be okay ResolveResolve - I’m going to see a doctor- I’m going to see a doctor ReliefRelief - Hey, that wasn’t so bad after all!- Hey, that wasn’t so bad after all! GratitudeGratitude - Thanks to Shouldice, I’m fine!- Thanks to Shouldice, I’m fine! LoyaltyLoyalty - One good deed deserves another.- One good deed deserves another.
- 15. PHYSICALPHYSICAL RELATIONSHIPRELATIONSHIP THE MOTIVATORTHE MOTIVATOR ComfortComfort - What we are used to feeling- What we are used to feeling Relative to each individualRelative to each individual Non-motivatingNon-motivating PainPain - Discomfort - abnormal/exceptional- Discomfort - abnormal/exceptional Relative to the individualRelative to the individual Very motivatingVery motivating ReliefRelief - Calm, reflective state of mind- Calm, reflective state of mind MotivatingMotivating Promotes wonder - gratitudePromotes wonder - gratitude
- 16. INTERACTIVEINTERACTIVE RELATIONSHIP TYPESRELATIONSHIP TYPES Invisible -Invisible - those in which customerthose in which customer contact is not requiredcontact is not required Visible -Visible - those in which there isthose in which there is customer contactcustomer contact Hidden -Hidden - those which result from the efforts spentthose which result from the efforts spent on visible and invisible relationshipson visible and invisible relationships
- 17. INVISIBLEINVISIBLE RELATIONSHIPSRELATIONSHIPS Interconnected relationships behind the sceneInterconnected relationships behind the scene which facilitate visible relationshipswhich facilitate visible relationships Invisible Relationship NetworkInvisible Relationship Network Administration staff / inter-departmentalAdministration staff / inter-departmental GovernmentGovernment SuppliersSuppliers ShareholdersShareholders Lawyers / accountants / scholarsLawyers / accountants / scholars MediaMedia ““Marketing”Marketing”
- 18. RELATIONSHIP TREERELATIONSHIP TREE INVISIBLEINVISIBLE RELATIONSHIPSRELATIONSHIPS InternalInternal coordinationcoordination Government funding and licensing, Marketing, Private financing,Government funding and licensing, Marketing, Private financing, Management/ownership, Human resources, Suppliers, Lawyers, etc..Management/ownership, Human resources, Suppliers, Lawyers, etc.. Booking forBooking for surgerysurgery
- 19. RELATIONSHIP TREERELATIONSHIP TREE INVISIBLEINVISIBLE RELATIONSHIPSRELATIONSHIPS
- 20. VISIBLEVISIBLE RELATIONSHIPSRELATIONSHIPS The people who deliver the serviceThe people who deliver the service The Shouldice StaffThe Shouldice Staff Visible Relationship NetworkVisible Relationship Network Booking staffBooking staff Admitting staffAdmitting staff NursesNurses DoctorsDoctors Accounting staffAccounting staff House cleaning/kitchen/maintenance staffHouse cleaning/kitchen/maintenance staff ManagementManagement
- 21. RELATIONSHIP TREERELATIONSHIP TREE VISIBLEVISIBLE RELATIONSHIPSRELATIONSHIPS InitialInitial contactcontact SecondSecond contactcontact AdmissionAdmission ShouldiceShouldice ExperienceExperience Follow-upFollow-up
- 22. RELATIONSHIP TREERELATIONSHIP TREE VISIBLEVISIBLE RELATIONSHIPSRELATIONSHIPS
- 23. HIDDENHIDDEN RELATIONSHIPSRELATIONSHIPS Produce benefits for visible relationshipsProduce benefits for visible relationships which are key to the Shouldice Experiencewhich are key to the Shouldice Experience Friend or relativeFriend or relative Prepares the patient with positive referral commentsPrepares the patient with positive referral comments Patient to patientPatient to patient Empathetic therapeutic consultation, courageEmpathetic therapeutic consultation, courage Patient to staffPatient to staff Praise stimulates efforts to excel which create morePraise stimulates efforts to excel which create more praise in a perpetual cycle which assists in fulfillingpraise in a perpetual cycle which assists in fulfilling the relationship needs and expectations of high qualitythe relationship needs and expectations of high quality care.care.
- 24. RELATIONSHIP TREERELATIONSHIP TREE HIDDENHIDDEN RELATIONSHIPSRELATIONSHIPS Patient referralPatient referral ShouldiceShouldice ExperienceExperience ReferralReferral
- 25. RELATIONSHIP TREERELATIONSHIP TREE HIDDENHIDDEN RELATIONSHIPSRELATIONSHIPS
- 26. RELATIONSHIPSRELATIONSHIPS EmotionalEmotional PhysicalPhysical InteractiveInteractive
- 27. THE RELATIONSHIP TREETHE RELATIONSHIP TREE The strength of the relationship tree depends uponThe strength of the relationship tree depends upon the integrity of the relationships that planted itthe integrity of the relationships that planted it and upon those whichand upon those which itit plants.plants. From first referral - through hidden relationships,From first referral - through hidden relationships, visible and invisible relationships - and back tovisible and invisible relationships - and back to first referral.first referral. By the time the relationship tree has grown,By the time the relationship tree has grown, its fruit is ripe and anits fruit is ripe and an ““apostle”apostle” is created.is created.
- 28. RELATIONSHIP TREERELATIONSHIP TREE ““Shouldice Apostle”Shouldice Apostle” Patient referralPatient referral InitialInitial contactcontact InternalInternal coordinationcoordination SecondSecond contactcontact Government funding and licensing, Marketing, Private financing,Government funding and licensing, Marketing, Private financing, Management/ownership, Human resources, Suppliers, Lawyers, etc..Management/ownership, Human resources, Suppliers, Lawyers, etc.. Booking forBooking for surgerysurgery AdmissionAdmission ShouldiceShouldice ExperienceExperience Follow-upFollow-up ReferralReferral
- 29. RELATIONSHIP TREERELATIONSHIP TREE ““Shouldice Apostle”Shouldice Apostle” Patient referralPatient referral InitialInitial contactcontact InternalInternal coordinationcoordination SecondSecond contactcontact Government funding and licensing, Marketing, Private financing,Government funding and licensing, Marketing, Private financing, Management/ownership, Human resources, Suppliers, Lawyers, etc..Management/ownership, Human resources, Suppliers, Lawyers, etc.. Booking forBooking for surgerysurgery AdmissionAdmission ShouldiceShouldice ExperienceExperience Follow-upFollow-upProcrastinatorsProcrastinators ReferralReferral
- 30. RELATIONSHIP TREERELATIONSHIP TREE ““Shouldice Apostle”Shouldice Apostle” Patient referralPatient referral InitialInitial contactcontact InternalInternal coordinationcoordination SecondSecond contactcontact Government funding and licensing, Marketing, Private financing,Government funding and licensing, Marketing, Private financing, Management/ownership, Human resources, Suppliers, Lawyers, etc..Management/ownership, Human resources, Suppliers, Lawyers, etc.. Booking forBooking for surgerysurgery AdmissionAdmission ShouldiceShouldice ExperienceExperience Follow-upFollow-upProcrastinatorsProcrastinators CompetitorsCompetitors ReferralReferral
- 31. RELATIONSHIP TREERELATIONSHIP TREE Shouldice ApostleShouldice Apostle Patient referralPatient referral InitialInitial contactcontact InternalInternal coordinationcoordination SecondSecond contactcontact Government funding and licensing, Marketing, Private financing,Government funding and licensing, Marketing, Private financing, Management/ownership, Human resources, Suppliers, Lawyers, etc..Management/ownership, Human resources, Suppliers, Lawyers, etc.. Booking forBooking for surgerysurgery AdmissionAdmission ShouldiceShouldice ExperienceExperience Follow-upFollow-up CompetitorsCompetitors ProcrastinatorsProcrastinators ComplicationsComplications ReferralReferral
- 33. RELATIONSHIP TREERELATIONSHIP TREE Shouldice ApostleShouldice Apostle Patient referralPatient referral InitialInitial contactcontact InternalInternal coordinationcoordination SecondSecond contactcontact Government funding and licensing, Marketing, Private financing,Government funding and licensing, Marketing, Private financing, Management/ownership, Human resources, Suppliers, Lawyers, etc..Management/ownership, Human resources, Suppliers, Lawyers, etc.. Booking forBooking for surgerysurgery AdmissionAdmission ShouldiceShouldice ExperienceExperience Follow-upFollow-up CompetitorsCompetitors ProcrastinatorsProcrastinators ComplicationsComplications ReferralReferral Terrorists!Terrorists!
- 34. SUCCESS FROM DETAILSUCCESS FROM DETAIL “…“…while the “focused” part of the focused factorywhile the “focused” part of the focused factory is essential, it is the details of the factory’sis essential, it is the details of the factory’s operating system that makes the differenceoperating system that makes the difference between success and failure.”between success and failure.” Regina Herzlinger 1997Regina Herzlinger 1997
- 37. FOLLOW-UPFOLLOW-UP Annual Follow-Up With Every PatientAnnual Follow-Up With Every Patient For The Rest of Their LifeFor The Rest of Their Life What is the value of follow-up?What is the value of follow-up? Provides Professional Medical ResearchProvides Professional Medical Research Helps us to Deliver our ServiceHelps us to Deliver our Service Allows us to Touch the Patient RegularlyAllows us to Touch the Patient Regularly Provides Continuing Confidence in the Service ProductProvides Continuing Confidence in the Service Product for Both Provider and Clientfor Both Provider and Client
- 38. FOLLOW-UPFOLLOW-UP How Far Do We Go to Follow-up?How Far Do We Go to Follow-up? Over 130,000 Follow-up Letters AnnuallyOver 130,000 Follow-up Letters Annually Five Travelling Clinics AnnuallyFive Travelling Clinics Annually Daily Internet / E-mail ServiceDaily Internet / E-mail Service Annual Shouldice Patient Alumni ReunionAnnual Shouldice Patient Alumni Reunion Up to 1500 have attendedUp to 1500 have attended Annually since 1947Annually since 1947 12,000 Patient Follow-Up Exams per Year12,000 Patient Follow-Up Exams per Year Free Exams for International PatientsFree Exams for International Patients
- 39. THE FRUITSTHE FRUITS ofof The RELATIONSHIP TREEThe RELATIONSHIP TREE New and Continuing BusinessNew and Continuing Business Positive ReputationPositive Reputation High Quality of ServiceHigh Quality of Service Low Cost of ServiceLow Cost of Service Generally High Employee MoraleGenerally High Employee Morale Employee RetentionEmployee Retention Favorable Fiscal ResultsFavorable Fiscal Results Reduced VulnerabilityReduced Vulnerability
- 40. THE FRUITSTHE FRUITS ofof The RELATIONSHIP TREEThe RELATIONSHIP TREE Apostles!Apostles!
- 41. NET RESULTS OFNET RESULTS OF RELATIONSHIPSRELATIONSHIPS Over 20,000 patients a year come to the ShouldiceOver 20,000 patients a year come to the Shouldice Hospital for examinationsHospital for examinations Over 7,400 hernias are repaired annuallyOver 7,400 hernias are repaired annually Over 90% of patients arrive through personalOver 90% of patients arrive through personal referrals. ie. friend, co-worker or relativereferrals. ie. friend, co-worker or relative - backlog of 3,000 patients- backlog of 3,000 patients Over 300,000 hernia operations to dateOver 300,000 hernia operations to date Thousands of lifelong apostles world wideThousands of lifelong apostles world wide
- 42. Q1 Q3Q2 At Admission 2-3 days post Surgery 1-Month post Surgery SURGERY Canadian patients n = 391n = 445n = 490 MOLSON SCHOOL OF BUSINESS SURVEY TIME FRAME
- 43. LEVEL OF SATISFACTION ANDLEVEL OF SATISFACTION AND OVERALL SERVICE QUALITYOVERALL SERVICE QUALITY 9.1 9.2 4 4.5 5 5.5 6 6.5 7 7.5 8 8.5 9 9.5 10 Level of Satisfaction Overall Service Quality Delighted Satisfied Extremely High Quality Good Quality
- 44. OVERALL SERVICE QUALITY AND SATISFACTIONOVERALL SERVICE QUALITY AND SATISFACTION ARE POSITIVELY RELATED TO ADVOCACYARE POSITIVELY RELATED TO ADVOCACY INTENTIONINTENTION 8.6 8.5 9.3 9.2 9.6 9.6 7.8 8 8.2 8.4 8.6 8.8 9 9.2 9.4 9.6 Average Good Excellent Service Quality Satisfaction
- 45. SUMMARYSUMMARY Excellent process quality before, at admission andExcellent process quality before, at admission and during stayduring stay Excellent technical quality with low discomfort andExcellent technical quality with low discomfort and rapid return to normalrapid return to normal Excellent human quality in patient/personnelExcellent human quality in patient/personnel interactionsinteractions
- 46. SUMMARYSUMMARY Shouldice patients become advocatesShouldice patients become advocates Low discomfort = high advocacyLow discomfort = high advocacy High service quality & high satisfaction = highHigh service quality & high satisfaction = high advocacyadvocacy
- 47. CONCLUSIONCONCLUSION ManagerialManagerial More than expertise of surgeons and staffMore than expertise of surgeons and staff TheoreticalTheoretical Delivering high overall service quality and ensuringDelivering high overall service quality and ensuring customer satisfactioncustomer satisfaction to the point ofto the point of delightdelight =>=> benefit from patient positive WOMbenefit from patient positive WOM
Notes de l'éditeur
- Interactive relationships are those which involve the patient and/or someone else contributing to the Shouldice Experience. The Shouldice Experience is the chosen solution in this case.
- This presentation will provide a glimpse at the Shouldice model of health care delivery and a look at some of the relationships that facilitate the delivery of the Shouldice Experience.
- The Hospital is managed largely on the basis of common sense. There is an underlying philosophy which states that the patient’s welfare is the responsibility of the staff of the hospital and all decisions should be made on a daily basis with this philosophy in mind. When decisions are made with the best interests of the patients and employees we find that the long term results are also in the best interests of the business.
- Interactive relationships are those which involve the patient and/or someone else contributing to the Shouldice Experience. The Shouldice Experience is the chosen solution in this case.
- The Hospital is managed largely on the basis of common sense. There is an underlying philosophy which states that the patient’s welfare is the responsibility of the staff of the hospital and all decisions should be made on a daily basis with this philosophy in mind. When decisions are made with the best interests of the patients and employees we find that the long term results are also in the best interests of the business.
- The success of Shouldice Hospital is dependent upon our ability to repeatedly perform tasks without significant variation. The model is such that the relationship between steps in the process of service delivery as well as the steps themselves, are so well ingrained and respected that they seldom generate challenge from those performing the tasks. All other relationships stem from this, forming the DNA in the Shouldice Experience.
- In defining the Shouldice Experience the perception of the patient or customer is where the true definition lies. To some, at first, it is simply a surgical intervention. Then throughout the experience a manifestation of emotional and physical sensations occur in an organized fashion, orchestrated by experienced people, in a environment which is clearly designed to handle their specific needs. Confidence now becomes part of the patients attitude. As a result they relax and begin to develop relationships with other patients and a bonding occurs. They all have the same concerns. They see and feel the healing process and share it with each other encouragingly. Ultimately the experience delivers a strengthening of body and mind.
- Interactive relationships are those which involve the patient and/or someone else contributing to the Shouldice Experience. The Shouldice Experience is the chosen solution in this case.
- Interactive relationships are those which involve the patient and/or someone else contributing to the Shouldice Experience. The Shouldice Experience is the chosen solution in this case.
- Interactive relationships are those which involve the patient and/or someone else contributing to the Shouldice Experience. The Shouldice Experience is the chosen solution in this case.
- There are many classifications of relationships. I have selected a few for discussion. In this slide I’m taking a look at the string of emotional relationships that the patient goes through and how they become part of the marketing process. The emotional relationship touches the patient deeply and personally and, I believe lastingly. First there is the surprise or shock upon realizing that something is wrong. Second there is fear when the mind plays games with us and the pessimist in us comes out. Third there is anxiety which comes about once the patient accepts that there is actually something wrong. This step involves figuring out what to do, if in fact there is something which can be done, to try to solve the problem. Then there is hope followed by resolve. Then relief is felt when confidence that life will continue occurs. At this point the process jumps back a bit to fear and anxiety again because of the surgical aspect of treatment. In the end if we have done our job gratitude and loyalty will prevail.
- The physical relationship referred to in this slide is the physical feeling the patient goes through. I call this the real motivator. It requires a change from what the patient knows as comfort. Comfort is bliss. Then pain enters the scene causing unrest, confusion and discomfort. The patient is suddenly very motivated to do something. Anything to get rid of the pain. Once the pain is dealt with there is a sense of relief, a calm reflective state of mind , thankfulness if there was assistance from someone else. This too, is motivating and akin to rejuvenation. The patient passes on a good word.
- Interactive relationships are those which involve the patient and/or someone else contributing to the Shouldice Experience. The Shouldice Experience is the chosen solution in this case.
- The invisible relationship is the one that happens behind the scene. The patient may not be aware of its existence or importance, but they often have a direct bearing on the flavour of the visible relationships. They are the fuel that the model needs to deliver its service. Once in place they facilitate the development of the visible relationships. Without them the engine will not run. With them the marketing and business benefits achieved through the visible relationships are possible.
- In health care it is usually a person who is perceived to deliver the final solution. The Doctor or nurse for example. But the patient is aware of other people who contributed to the final solution to their problem through the activities they become involved in during the overall experience. Each of these people can contribute or deter from the quality of the experience which will ultimately influence the satisfaction level felt by the patient. In the visible relationship the patient is aware of these contributions, through attitudes and efforts demonstrated in activity and behavior.
- Hidden relationships are those which the patient sees but is not aware of as being part of the marketing objective or process. Friend or relative - a trusted person who has no reason to tell anything but the honest truth and so can become more powerful than any advertising program on an individual basis. Patient - helps to create the confidence before, during and after the experience. Helps to build courage to recover and delivers reassurance when uncertainty creeps in. Patient to patient relationships can provide the most empathetic therapy and thus are tremendously effective in delivering a confidence in the healing process. Patient to staff relationships benefit both sides of the transaction. A confident staff member instills confidence in the patient and the patient rewards the staff in turn by praising their efforts. And passing on the good word. It becomes a perpetual circle of positive efforts. The patient and the staff member thus reinforce their belief that they are part of something wonderful and feel good about passing the word.
- In examining the chain of relationships involved in the Shouldice Experience it becomes apparent that the patient/provider relationship builds or diminishes in strength on the backs of the relationships that precede it and follow it. As the relationship begins it is very much dependent on what we do and have done to support it. As it further develops it is reinforced by what we do in visible relationships and by what transpires in hidden relationships. Once the relationship has matured beyond the critical care, or high intensity stage, at the hospital, it becomes less dependent on what we do and more dependent upon what the patient himself does. If we have done our job well at every stage along the way then the patient feels positive enough to share his experience and promote our service. Once he has done this he has taken a personal stand. He has done something he firmly believes is good, for another person and becomes an “apostle”.
- Interactive relationships are those which involve the patient and/or someone else contributing to the Shouldice Experience. The Shouldice Experience is the chosen solution in this case.
- There are many classifications of relationships. I have selected a few for discussion. In this slide I’m taking a look at the string of emotional relationships that the patient goes through and how they become part of the marketing process. The emotional relationship touches the patient deeply and personally and, I believe lastingly. First there is the surprise or shock upon realizing that something is wrong. Second there is fear when the mind plays games with us and the pessimist in us comes out. Third there is anxiety which comes about once the patient accepts that there is actually something wrong. This step involves figuring out what to do, if in fact there is something which can be done, to try to solve the problem. Then there is hope followed by resolve. Then relief is felt when confidence that life will continue occurs. At this point the process jumps back a bit to fear and anxiety again because of the surgical aspect of treatment. In the end if we have done our job gratitude and loyalty will prevail.
- Once the relationship has matured, it must be maintained or it can wither. Shouldice has an annual follow-up program which insures that each patient is contacted every year after there operation for the rest of their life. This is of course is dependent upon the patient continuing to inform us of address changes. Currently the list includes approximately 130,000 patients, world wide. The follow-up permits us to build an extensive database if medical information which in turn helps us to improve our quality of service. This was originally and remains the core purpose of the program. Secondarily it provides us with an annual opportunity to touch the patient and rekindle the relationship with a news letter. It includes patients in a project that provides information which will help other patients thus reinforcing the importance of their part in the relationship. Follow-up also reinforces the patients confidence in the service we provided and at the same time, through his positive return comments, reinforces the confidence our staff have in their work and efforts to provide a top quality service.
- The extent of the follow-up program is shown in this slide.