Excellent Execution and Mediocre Strategy will beat Mediocre Execution and Excellent Strategy

1. Excellent Execution and Mediocre Strategy will beat Mediocre Execution and Excellent Strategy Operational Execution

2. Empathy and Innovation

3. Agenda • Introduction • The Role of Empathy in Delivering Great Customer Experience (The Oberoi Hotels) • Developing and Showing Empathy in a “Legacy” Organization (Cleveland Clinic) • Open Discussion of Takeaways

4. Who has used or is familiar with the Net Promoter Score? How does it work? What is a reasonable NPS? How do Credit Unions perform on this metric?

5. Based on survey of US Consumers.

10. Oberoi Performance Competitors included include Dorchester Collection, Fairmont, Four Seasons, Jumeirah, Kempinski Hotels, Leading Hotels of the World, Mandarin Oriental, Oberoi Hotels and Resorts, Orient Express, Raffles, Ritz Carlton, Rocco Forte Hotels, Rosewood Hotels, St. Regis, and Taj Group.

11. Experience versus Expectations

12. Anticipatory Service How does a guest feel with these encounters? How does an employee feel? What does it take to create such a reaction?

13. Mrs. Liz KleinfingherLecuona told Neha that her mother who loved India had recently passed away. • Neha on hearing this helped Mrs. Lecuona plant a mango tree in the garden of the hotel in memory of her mother. • Neha made a beautiful sign, which Mrs. Lecuona placed next to the mango tree. • Neha gave me a photo frame of the picture taken by her, of the tree. Neha gave me the best experience of this trip. She is amazing and dedicated. • I keep the picture you gave me with my mother’s tree, among my most precious items… I share this experience with my family and friends. It just doesn’t get old.”

15. Service Excellence Execution and Process

17. Process Conformance: Making a Difference the Oberoi Way • While having a conversation with children, always refer to them by first name and where possible at eye level by bending down. Do not touch children except when holding their hands or carrying them. • Ring the doorbell twice at an interval of 10 seconds before entering guest rooms. Announce your department prior to entering the room and pause for a response. Strictly honour ‘Do not disburb’ signs. • When leaving a guest room enquire if the guest requires any additional assistance. • Close and lock the door securely when leaving a guest room. • Always escort guests when providing assistance with directions within the hotel. • While entering elevators, always wish guests based on the time of day with a smile and folded hands. • While driving a buggy (if applicable) stop, step down and greet guests on the hotel pathways. Do not drive the buggy at a speed which is more than a fast walking pace. • Always position yourself in guest areas in a way that results in maximum guest visibility. Be attentive to guest needs at all times. • Always maintain silence in guest areas and keep service doors closed. If you smell any odor report it immediately.

18. Patient Experience Cleveland Clinic

19. Jackie Gruzenski • “My husband was Dr. William Paul Gruzenski, a psychiatrist for 39 years. He was admitted to (a hospital she names in Pennsylvania) after developing a cerebral bleed with a hypertensive crisis. • My issue is that I was denied access to my husband except for very strict visiting, four times a day for 30 minutes, and that my husband was hospitalized behind a locked door. My husband and I were rarely separated except for work,” she wrote. “He wanted me present in the ICU, and he challenged the ICU nurse and MD saying, “She is not a visitor, she is my wife.” • But, it made no difference. My husband was in the ICU for eight days out of his last 16 days alive, and there were a lot of missed opportunities for us.” • “I am advocating to the hospital administration that visiting hours have to be open especially for spouses… I do not feel that his care was individualized to meet his needs; he wanted me there more than I was allowed. I feel it was a very cruel thing that was done to us…” • “My husband and I loved each other very deeply,” she writes to me, “and we wanted to share our last days and moments together. We both knew the gravity of his illness, and my husband wanted quality of life, not quantity.” Ananth Raman, Harvard Business School

20. A Potential Concern “The momentum now is around measuring patient satisfaction rather than measuring health outcomes. But if we measure patient satisfaction only, we’ll get the increased expense of bigger TV screens or fluffier pillows without the added benefit of improving health outcomes in ways that reduce cost down the line by having people be less sick.” --Elizabeth Teisberg, Professor, Geisel School of Medicine, Dartmouth. Ananth Raman, Harvard Business School

21. Main Campus Patient Satisfaction (2008) Ananth Raman, Harvard Business School

22. Main Campus Patient Satisfaction (2008) Ananth Raman, Harvard Business School

23. What do Patients Seek in Experience? Could a greater miracle take place than for us to look through each other’s eyes for an instant? Henry David Thoreau Going to be a dad Divorce 12-hour shift Visiting dad for the last time Cancer-free 1st vacation “Something” 7,000 miles from home. Terminally ill Malignant How to take care? Success Benign Hope If you could stand in someone else’s shoes, Hear what they hear, See what they see, Feel what they feel, Would you treat them differently? How will he pay? Determined to be there. Pain won’t go away DNR Ananth Raman, Harvard Business School

24. Understanding Patient Needs Patients did not want to be in the hospital. They were afraid, sometimes terrified, often confused, and always anxious. They wanted reassurance that the people taking care of them really understood what it was like to be a patient. Their families felt the same way. Patients also wanted better communication: They wanted information about what was going on in their environment and about the plan of care; they wanted to be kept up-to-date even on minute activities. And they wanted better coordination of their care. When nurses and doctors did not communicate with one another, patients were left feeling that no one was taking responsibility. Patients tended to be more satisfied when their caregivers were happy. It wasn’t that they craved interactions with happy employees; rather, they believed that if their caregivers were unhappy, it meant either that the patient was doing something to make them feel that way or that something was going on that they did not want to reveal. Ananth Raman, Harvard Business School

25. Ask the Right Question • Should we provide bigger TV screens so we can improve our patient experience scores? • Are there levers that can be used to improve patient experience and medical outcomes or cost? • What are the big drivers of patient experience? Ananth Raman, Harvard Business School

26. How would you improve Patient Experience at the Clinic? Who should be CXO? How long will it take to improve experience at the Clinic? Barriers to change? Ananth Raman, Harvard Business School

27. Health Care’s Service Fanatics • Leading the Change • Publicly Acknowledge the Problem • Understanding Patient Needs • Make Everyone a Caregiver • Embedding Changes • Establishing Processes and Norms • Engaging and Motivating Employees • Setting Patient Expectations

28. Leading the Change • Whom should you appoint as Chief Experience Officer at the Cleveland Clinic?

29. Hire this Surgeon as Chief Experience Officer? Cosgrove interviewed an internal candidate for the role, a leading surgeon from the Cleveland Clinic. During his interview with Cosgrove, Dr. X told a story about his father, who had been a patient at the Clinic several years earlier. That experience had been terrible: Among other things, his father felt that the nurses had been unresponsive, and his physician did not always see him daily. He had died in the hospital thinking it was the worst place in the world. “Nobody else should die here believing that,” X said. Both men admitted they didn’t know what accomplishing that goal would take. “We will need to figure it out together,” X told the CEO.

30. Explore Two Categories of Changes Ananth Raman, Harvard Business School

31. Process WE: I Ananth Raman, Harvard Business School

32. S.T.A.R.T. with Heart Smile and greet warmly S T A R T Tell your name, role and what to expect Active listening and assist Rapport/relationship building At Grady Memorial Hospital, doctors are being taught to stop interrupting patients while they are speaking. (WSJ, 10/14/2012) Thank the person Ananth Raman, Harvard Business School S.T.A.R.T. with Heart

33. First Impressions Lasting Impressions Expected Service Behaviors • Acknowledge the other person • Introduce self and role • Use person’s preferred name and greet warmly • Clearly communicate expectations • Offer to resolve concerns or forward to the appropriate person • Use active listening • Show empathy • Use common courtesy • Offer to help Ananth Raman, Harvard Business School S.T.A.R.T. with Heart

34. Communication among Caregivers • A team began investigating the problems in a unit with one of the worst patient experience scores, and quickly identified several problems. • First, the social worker and the case manager—employees critical to ensuring a smooth discharge process— did not like each other and never talked. • The floor, which conducted a large volume of gastroenterology and radiology procedures, constantly ran behind schedule. • Patients ordered to have no food or drink before a procedure might go hungry all day if the procedure was delayed; even worse, procedures were sometimes postponed until the next day with nobody informing the patient—leaving him or her not just hungry but confused. • Finally, doctors did not always communicate with nurses after rounds, and so nurses were often unaware of the plans for their patients’ care that day. • These problems were not difficult to fix. Most of them were addressed by instituting simple processes  to surface issues, get people to work better together, and keep the patient informed about what was going on. • For example, the weekly huddles forced caregivers to communicate periodically with their colleagues and even with the other caregivers in their team that they did not like very much. • The floor’s scores in the CMS survey went from among the lowest in the hospital to the highest in less than a month. •  The processes were really promoting communication, teamwork and keeping the patients up-to-date. Ananth Raman, Harvard Business School

35. Make Everyone a Caregiver Ananth Raman, Harvard Business School

36. Culture Doctors Caregivers Nurses Employees Ananth Raman, Harvard Business School

37. How do you “Make Everyone a Caregiver?” Culture Changing Exercise Ananth Raman, Harvard Business School

38. A Proposal for a Half-Day Session • Merlino proposed having all 43,000 employees participate in a half-day exercise. • Randomly assembled groups of eight to 10 people would meet around a table with a trained facilitator—a janitor might be seated between a neurosurgeon and a nurse. • All would participate as caregivers, sharing stories about what they do—and what they could do better—to put the patient first and to help the Clinic deliver world-class care. • They would also be trained in basic behaviors practiced by workers at exemplary service organizations: smiling; telling patients and other staff members their names, roles, and what to expect during the activity in question; actively listening to and assisting patients; building rapport by learning something personal about them; and thanking them. • The cost of the half-day program, including the employees’ salaries, would be $11 million. • The reaction? • “Malice” https://www.youtube.com/watch?v=8g2dkDh4ov4&feature=youtu.be

40. A Half-Day Session • Merlino proposed having all 43,000 employees participate in a half-day exercise. • Randomly assembled groups of eight to 10 people would meet around a table with a trained facilitator—a janitor might be seated between a neurosurgeon and a nurse. • All would participate as caregivers, sharing stories about what they do—and what they could do better—to put the patient first and to help the Clinic deliver world-class care. • They would also be trained in basic behaviors practiced by workers at exemplary service organizations: smiling; telling patients and other staff members their names, roles, and what to expect during the activity in question; actively listening to and assisting patients; building rapport by learning something personal about them; and thanking them. • The cost of the half-day program, including the employees’ salaries, would be $11 million. • The reaction? • The program was launched in late 2010. It took a full year for everyone to go through it. A handful of physicians asked to be excused but were refused. • Non-physician employees were amazed by the experience of sitting with doctors and discussing how they, too, were caregivers. • Participants shared frustrations about not always being able to provide a nurturing environment. • Even doctors who had been skeptical about the exercise felt it was worthwhile.

41. Main Campus Patient Satisfaction Ananth Raman, Harvard Business School

42. Main Campus Patient Satisfaction Ananth Raman, Harvard Business School

43. HCAHPS Overall Rating Ananth Raman, Harvard Business School

44. Discussion • What is the role of customer experience? • What is the role of empathy in delivering great customer experience? • Empathy for customers and for employees? • How can an organization develop and show more empathy? • What are the barriers to showing empathy in organizations? • What role can leaders play in this journey? Ananth Raman, Harvard Business School

45. Extra Ananth Raman, Harvard Business School

46. Palwinder met Mrs. Brayer on arrival and checked her into the hotel. • Later that evening, Mrs. Brayer mentioned to Palwinder that she wanted to go for lunch the next day with her friends wearing a saree. • Palwinder offered to come to Mrs. Brayer’s room to help her tie the saree. • On realizing that Mrs. Brayer did not have a saree and with not enough time to buy one, Palwinder arranged for a saree from her home and personally draped it for Mrs. Brayer. • Mrs. Brayer was overwhelmed by the gesture and wrote, “My visit to Delhi was highlighted by your kindness and I had so much fun wearing your beautiful saree. Would love to come back.”

47. Mr. and Mrs. Manik went for a walk on the “Wild Strawberry Trail,” which leads into the forest sanctuary adjacent to the hotel. • On their return to the hotel, Mrs. Manik realized that she had dropped one of her earrings, a solitaire diamond, gifted by her mother-in-law. She was very distressed. • Rupesh saw that the guest was carrying a camera and inquired if they had taken any photographs during their walk. • He then went through all the photographs with the guests and noticed that Mrs. Manik had the earring until a particular point during the walk, after which it was not seen in the pictures. • It was eight in the evening and dark outside. Rupesh went back to the area where the earring was lost. After a long search using a torch, Rupesh was able to find the earring, much to the delight of Mrs. Manik.

48. Mr. Morris Middleton, during a casual conversation with Gaurav mentioned that he was sending postcards of his trip to India to a friend in the United States who was fighting a serious illness. • Gaurav went to his office and returned with a handmade Indian silk scarf and presented it to Mr. Middleton. He requested that Mr. Middleton gift the scarf to his friend with best wishes from the hotel team for her speedy recovery. • Mr. Middleton was overcome with emotion by this thoughtful gesture as Gaurav displayed extraordinary care, warmth and concern not only for Mr. Middleton, but also towards his ailing friend.

49. Dr. Delos (Toby)Cosgrove: Transformational Experience • Cosgrove is the CEO of Cleveland Clinic and a leading cardiac surgeon specializing in valve repair. • Cosgrove attended two classes at HBS in Fall ’06 to discuss a case on CC. • “I attended two classes. The first class was good.” • In the second class, a student raised her hand and asked, ‘Dr. Cosgrove, what are you doing to teach your doctors empathy?’” • The young woman, Kara Medoff Barnett, went on to tell Cosgrove that her father–a physician in North Carolina–had needed a Mitral valve replacement in 2000. • “As a physician and father of six children, my father cared deeply about outcomes and technical skill, but there were other factors to his decision. My parents, who would be traveling far from home in pursuit of the best care, wanted care to include meaningful communication before and after surgery. They had heard that this was not always the case at Cleveland.” • Ultimately Barnett’s father had decided to have his surgery at the Mayo Clinic (Mayo) in Minnesota even though the Mayo heart program was not as highly ranked as the CC program . • Cogsrove admitted to being transformed by this experience. • Why? Ananth Raman, Harvard Business School