spring singapore service from the heart - back to basic (24 jun '10)
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Service From The Heart - Back to Basic
24 June 2010
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Agenda
• Introduction
• Lessons on service and quality (70s - 90s)
• In pursue of service excellence at Alexandra Hospital (2000 -2010)
• Our dream for Khoo Teck Puat Hospital, Yishun
• Conclusion
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Work Experience
Chief Executive Officer Alexandra Hospital / Khoo Teck Puat Hospital (2000 till to-date)
Pharmacist, SGH (1978 – 1984)
Director of Pharmacy & Materials Management, NUH (1985 – 1989)
Operations Manager, KKH (1989 – 1991)
Chief Operating Officer, SGH (1991 – 1992)
Chief Executive Officer, TPH/CGH (1992 - 1999)
Other Appointment – Service & Quality
Council Member, Institute of Service Excellence at SMU (ISES) Governing Council Singapore Management University
Member, People Developer Council (2000 – 2002) Member, Standards Council, SPRING Singapore (2001 – 2007)
Member, Lifelong Learning Endowment Fund Advisory Council, Ministry of Manpower (2006 – 2009)
Member, Incentives & Grants Committee, Singapore Workforce Development Agency (2006 – 2009)
Member, Singapore Tourism Board (2004-2007)
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• Instruction manual
• Courtesy campaign
• Lessons from MUIII, SGH
• Work Study
1970s
Singapore General Hospital
National University Hospital
• Quality Control Circle (QCC)
• Total Quality Management (TQM)
• Business Process Re-engineering (BPR)
• On-The-Job Training (OJT)
• Lessons from Dr Kwa Soon Bee
1980s
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Kandang Kerbau Hospital
Toa Payoh Hospital
Changi General Hospital
• Balanced Scorecard (BSC)
• ISO Certification
• SQ Centre
• Lessons from CPF
• Lessons from Shangri-La Hotel
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1990s
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In Pursue of Service Excellence Alexandra Hospital
2000 - 2010
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• British Military Hospital • Thriving hospital in 70s • Declining fortunes from 80s • One-star hospital, historical site in 90s
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A Brief History of AH
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Before Restructuring (2000)
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Before Restructuring : Our Reputation
• One-star hospital
• A historical site
• Underground tunnel
• Hospital for the old and poor
• Cheap
• 39% would not recommend hospital to others
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AH Culture 2000
• AH is a victim of …… • AH is a cheap, one-star hospital for the old and
poor • Everything must be done through proper channel • Incremental, evolutionary change
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First get the right people on the bus (and the wrong people off the bus) and then figure out where to go.
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• Diversity
• Shared values, Trust
• Deep understanding of business
Leadership Team
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• Visualise
• Simplify
• Prioritise – operationalise
Role of Leader
Vision is nothing without execution
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• What will patients see, feel, smell … when they enter the hospital 5 years from now ?
• What services, facilities will we offer? • Who are the 5 key leaders?
Visualisation
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The Bureaucrat’s Approach
Prove to me that you are dying then I will give you what you need to barely stay alive because we didn’t want you to develop a dependency mindset.
We don’t really have to do this for you, you know? You would better appreciate it.
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We are ladies and gentlemen serving ladies and gentlemen
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Setting The Tone From The Top Our Priority
Our patients are the most important people in this hospital. We put the well-being, interests and convenience of our patients before our own in everything that we do.
No reserve car parks for bosses
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The Desired AH Culture Post 2000
• We control our own destiny (Pro-active) • We put our patients’ interest before our own • We aim for excellence but we accept failures • We will out learn, out innovate, out run and out
perform all comers • Every individual is expected to think and to add value • We care for our patients, our community, our
environment and our people
“Culture eats strategy for lunch everyday”
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Caring For Our Patients
• Immaculate physical environment (Raffles Hotel)
• Clean, well maintained
• Tranquil, restful environment
• WOW level of service (Ritz-Carlton) • Patient friendly process and system
• Friendly helpful service
• Well groomed, professional staff
• Highly competent, professional care • Highly competent, caring staff
• People & technical capability to provide quality care
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Alexandra Hospital Post 2000 Patients’ Definition of A Good Hospital • Respect patient’s dignity • Provide Information • Facilitate access to integrated care and services • Deliver consistent, good quality care and services • Provide cost effective care
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Bringing Services To Patients�
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Diabetes Centre Health for Life Centre Dental
Ophthalmology & Visual Sciences ENT Cardiology
Endoscopy Centre General Medicine Orthopaedic Surgery
Geriatric Medicine General Surgery Sports Medicine
1.5T MRI 64 Slice CT Scan Interventional Radiology Suite
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• To provide quality patient care and services at reasonable cost
• To meet and exceed expectations of our patients
• To be amongst the very best in whatever we do
Organisational Philosophy
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To provide a level of patient care and service good enough for our own mothers, without the need for special arrangements.
Quality
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• Match and exceed the best performers • Standards set by other industries • Lowest infection rate • Shortest length of stay • Lowest average bill size
Benchmarking
Kameda Medical Center, Japan
Mayo Clinic, Rochester, USA
Aravind Eye Hospital, India
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• Botanic Gardens • Citibank • City Cab • CPF • General Electric • IKEA • McDonald • National Library Board • Raffles Hotel • Ritz-Carlton Millenia • SIA • Singapore Zoological Gardens • Toyota �
Benchmarking
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“Learning from the Best”
Raffles Hotel
National Library Board
Singapore Telecoms
General Electric
Ritz Carlton Hotel
Bernard Harrison & Friends
Glaxo SmithKline
Agilent Technologies
Victoria Junior College
Ikea Chris Lowney Singapore
Prisons 32
People Participation Programmes -Quality Circles -Staff Suggestion Scheme -Support Group
Organisational Management Systems (Tools & Initiatives)
FOUNDATION INTERMEDIATE ADVANCED
6 Sigma Programme Balanced Scorecard Toyota Production System
Management & Planning -Strategic Planning -Leadership Development Programme
Customer Loyalty Programme
Process Management Statistical Tool
Innovation & Creativity Programmes -WOW @ AH -Fun @ AH -Kaizens/CPIP
Strategic HR Planning -Talent Scouting/Growing/ Retaining
Continuing Business Excellence
Voice of Customer
Process Mapping
Customer Feedback System
Process Measurement
5S House-keeping
ISO 9001:2000 Integrated QEMS ISO 9001/ISO 14001
Singapore Quality Class People Developer Standards ISO 14001
JCI
Singapore Quality Award
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Continuous Quality Improvement
• Individual’s initiative (I see, I do)
• Group Initiative (We see, we do)
• Staff Suggestion Scheme (I see, I recommend)
• Quality Circles (Plan, do, check, act)
• Six Sigma (Define, measure, analyse, improve, control)
• Task Forces (Conceptualise new ways of adding values)
• Wow Initiatives
• Fun @ AH
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• Closing quality gaps: • What we are providing what is good enough
for our families
• Improvement through: • Elimination of redundancy • Simplification • Functional integration • Automation
Quality Circle (QC)
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Toyota Production System
• Define value precisely
• Remove muda (waste)
• Continuous flow process
• Kaizen (continuous incremental improvement) and Kaikaku (radical improvement)
• Pull (rather than push) production
• Aim for perfection
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Better, Faster, Cheaper & Safer
Diagnose, Treat, Advise
Customer’s Needs :
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1. Define 2. Measure
3. Analyse
4. Improve
5. Control
Six Sigma
Process Design/Re-Design
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Grab a bite!
Paging Service
Home Sweet Home
Pre-Appointment Reminder
via SMS/Letter
Appointment Day Registration
Blood Test
Consultation
Post Consult Services Appointment & Payment
Pharmacy
“WOW @ Specialist Outpatient Clinic ”
Preparing you for Hospital Admission
Height & Weight Chaperon
Your experience starts here
Waiting for Consultation
Meal Voucher
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Simplicity
• Good quality … affordable… to many
• Find the simplest way to get work done
• Achieve BIG results with small means
- IKEA
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• Performance Indicators
• Clear performance targets
• Graphic presentation for impact
Measurement (What you cannot measure, you cannot manage)
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• Infection rates • Unplanned returns to A&E • Unplanned returns to operating theatres
Clinical Indicators
• Telephone service • Total turnaround time • Patient satisfaction
Service Indicators
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Balanced Scorecard
Financial
Internal Process
Learning and Growth
Customer MISSION AND STRATEGY
OUTCOMES
DRIVERS
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Balanced Scorecard Charts
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Paradox of Measurement It is important to measure. But the most
important cannot be measured. 会认人 会用人 会做人�
Talent Building
Recognise talent
Deploy talent
- - - - - -
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• Some people make the world go round; • Some watch the world go round; • Some are not aware that the world is going round; • Some are simply enjoying the opportunity to
complain about the way the world is going round, too slow, too fast …..
Making The World Go Round
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Recruitment
• Selecting the right staff for the right job • Matching “natural talent” to job • The “best” person may not be the “right” person
Michael Schumacher
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• Hire for Attitude
• Train for Skill
Human Resource Management
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Wanted : Happy, positive people
Career Sweet Spot
Talent
Value to Others
Passion
Thinking style : Visual, auditory or kinesthetic
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The High Performance Team • The ambitious General Manager
• The spare-no-expense Designer
• The perfectionist, take forever R&D Director
• The efficiency-above-all else Production Manager
• The stingy Finance Director
• The obliging Marketing Manager
• The give-away-for-nothing Salesman
CANNOT STAND ONE ANOTHER
Staff Training
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• Be Proactive • Begin with the end in mind • Put first thing first • Think win-win • Seek first to understand, then be
understood • Synergize • Sharpen the saw
7-Habits of Highly Effective People
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Jesuits’ Leadership
• Self awareness : strengths, weaknesses, values, worldview
• Ingenuity : innovate, adapt to and embrace a changing world
• Love : engage others with a positive, loving attitude
• Heroism : energize themselves and others through heroic ambitions
• Core values • Big hairy audacious goals • Just do it • Competition with self • Power of “And”
Built To Last
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• Cheap and Good
• Fast and Accurate
• Competent and Caring
• High Tech and High Touch
• Short and Long Term Focused
Power of “And”
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A Bias For Action “Take small steps in rapid succession.”
- Mr Khaw Boon Wan Minister for Health
Think, think, do, think, do, think, do ….. (not paralysis through analysis)�
Fast, temperamental horses, not slow docile mule
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• Can do
• Sure
• Certainly
• Happy to help
• Let me find a way to help
• Consider it done
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Execution Is Everything
Ideas (including those from CEOs) are a dime a dozen. Ability to execute, making the idea work is worth millions.
~ Mr Koh Boon Hwee Chairman, DBS
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Rewards The capable gets more responsibility but also more authority, freedom and rewards.
Equality is unfair.
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• Priority is to meet and exceed expectation of the 90% of staff who are doing their best.
• Poor performers receive counselling, training and finally, advice on alternative career.
• No surprises at annual performance appraisal.
Human Resource Management Staff Turnover Management
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“Vitality Curve”
“Top 20” “Bottom 10” “The Vital 70” General Electric
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• Just-Do-It awards • SQ awards
Recognition & Celebration
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• Hearing • Listening • Knowing • Understanding • Believing • Doing
Communication
Every time we fail to be the best that we can be, we hurt our patients and waste their money, sometimes we kill them.
• Management walk about • Feedback forms • Toll-free telephone • Telephone survey • Focus group discussions
Customer Feedback
“If your failure rate is one in a million, what do you tell that one customer?”
- IBM
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• Orientation • Management walk about • Training Programmes • Small group meetings with Senior Management • QC activities • Formal staff suggestion scheme • Employee satisfaction survey
Staff Feedback
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1. What can we do to further improve the quality of patient care and services?
2. What can we do to improve your life in AH ?
3. Who are the 3 doctors, 3 colleagues you respect the most in this hospital?
Staff Meeting with CEO Results Patient Satisfaction Rate rose from 69% (1999) to 98.8% (2009)
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The New Millennium
• Globalisation, internet & genomics change everything
Running Faster and Going Nowhere
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“Only the paranoid survive.”
- Andrew S Grove
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“Only the paranoid survive.” - Andrew S Grove
Business goes on to new heights
Business Declines Inflection Point
The Strategic Inflection Curve
The Next S Curve
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AH
Khoo Teck Puat Hospital
“I posed the challenge to the AH rebuilding team: build a hospital… designed with patients unambiguously at the centre of the focus, with technology fully exploited for the benefit and convenience of patients…. It will be a hospital which is well linked… and to which the patients can be transferred seamlessly… It will be a hassle-free hospital.”
- Mr Khaw Boon Wan Minister for Health Parliamentary Debate 17 March 2004
“Hassle-Free Hospital”
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Do to healthcare what NLB has done for library
Transforming Healthcare
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Trailblazing Hospital of The Future Touching Lives, Pioneering Care, Making A Difference
- Dr James Low, Head, Geriatric Medicine
• Hassle-free processes designed for patients’ convenience • Engaging patients and their families as partners • Safety of patients are of paramount importance • Intuitive, easy movement for patients and visitors • Minimal movement for patients • Clustering of services and facilities
Patient Centric
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• Wireless technology • Digitalized hospital • Sensing devices • Robotics
Technology As An Enabler
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• Warm, “cuddling” feeling • Calming and cheerful environment
High Touch
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• Hospital within a garden, garden within a hospital
• Tranquil, restful, healing environment
• Sight, scent and sound of nature
• Surrounding patients with nature
Healing Environment
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Finding The New Breakthrough
Learn from everyone
Follow no one
Look for pattern
Work like hell
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El Camino Hospital
Sutter Health Sacramento
Latter-Day Saints (LDS) Hospital
Make Visual the Patient Process Flow
Designing The Patient Flow
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Focal Group Discussion
Engaging URA, PUB, NParks, LTA and Sembawang Town Council in
developing Yishun Pond and
integrating with Yishun Park
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Khoo Teck Puat Hospital
Subsidized Ward Tower
Private Ward Tower
Medical Centre
Entry & Lobby A&E
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Fast Medicine
Slow Medicine
Cruise Medicine (Assembly Line)
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Design Thinking
• Human-centred approach
• Deep dive
• Extreme user
• Divergent convergent
• Visual thinking
• Rapid prototyping
• Fail early, fail often
• Enough is enough (dateline)
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Conclusion
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Selling a product ≠ Addressing customer’s needs
Eg. Seller : Selling a T-shirt
Customer : Buying a “cool” image
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All about the customers not us
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There is no secret recipe
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Service Is More Than Just A Smile
• People
• Business model
• Systems and process
• Technology
• Aesthetics and ambience
• Culture
• Leadership setting the tone
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