Building a culture of service excellence.

Mayo Clinic is on a journey to enhance its culture of service excellence. Mayo Clinic enjoys a rich history and brand reputation. It is known not only for its excellent medical care, but outstanding service.

At our Scottsdale, Arizona, location was established in 1987 and built upon the 100+ year legacy of the original practice in Rochester, Minn. With 300 physicians and scientists, 100 residents, and 3,500 employees, Mayo Clinic in Arizona is well on its way to achieving its vision as the premier academic medical center in the Southwest.

However, rapid growth as well as decreasing reimbursement and stricter regulatory requirements can threaten the service culture of any organization, including the Mayo Clinic.

Service excellence in health care is critically important in delivering quality care and maintaining both refer-ring physician and patient loyalty. Several years ago, Mayo Clinic in Arizona realized that it could not depend upon its history or culture alone to sustain a strong service-oriented approach to its patients. It became clear that a service excellence infrastructure was necessary for on-going success.

This was accomplished through leadership support, identification of service champions in the organization, more frequent measurement of patient satisfaction, and perhaps most importantly, by building key service components into the strategic plan.

As a result of this "service infrastructure," we now have the pieces in place to sustain our culture even in times of stress.

The journey to achieve an even higher level of service quality was accelerated in 2001 with a 'scholar in residence' sabbatical by Leonard Berry, PhD, professor of marketing at Texas A & M University.

In performing the largest service study ever conducted at Mayo Clinic, Berry helped our leaders understand the importance of "evidence management"--an organized, explicit approach to presenting customers with coherent, honest evidence of your abilities. This work, and the leadership lessons that followed, propelled our team of service leaders to create a vision for service quality and a strategic map to achieve our goals.

Customer confidence

A service organization's most precious asset is its customers' confidence in the service it renders.

To secure a clear direction for our efforts, our service leaders created a vision: "Mayo Clinic in Scottsdale aspires to provide the highest service to our patients, fellow employees, and other partners" and mission statement: "To build a culture of service excellence and mutual respect to facilitate service to patients, families, and staff."

The multiyear strategic plan to achieve this vision includes dimensions focused on both people and the supporting systems of care. The ultimate goal is to create an ideal environment for service excellence. Such an environment must be innovative, proactive, accountable, and emphasize mutual respect and communication.

Mayo Clinic has distinct opportunities to excel in service excellence due to its integrated model of care, with salaried physicians, nurses, and allied health staff working together within a large ambulatory practice and closed staff model acute care hospital. We believe that the ability to provide great service to our patients will differentiate MCS from other health care providers.

The key strategic goals in pursuit of the vision are outlined in Table 1. The specific objectives and operational strategies have been designed and are being implemented.

Goal #1: Engage Physicians

The leading edge of our approach to excellence in service to our patients is the engagement of our medical staff. An outstanding health care experience for the patient requires both excellence in the biomedical care and the service experience.

We also know that two of our top drivers of patient satisfaction include the physician-patient relationship and physician-patient communication.

Not all physicians are naturally wired, or have been intentionally trained, to establish and nurture an empathetic relationship with their patients. Additionally, most patients instinctively note any discord among members of the health care team involved in their care. Therefore, we have designed strategies to improve the physician-patient relationship and improve the mutual respect among all members of the health care team.

In 2004, the first onsite physician-patient communication workshop was developed and held. Adapted from the successful American Academy of Physician and Patient (AAPP) course, key physician service leaders from the clinical practice and educational programs were recruited for participation.

Feedback from course evaluations indicated an 18.4 percent improvement in participants' comfort with communications issues. The average evaluation grade for the course is 4.73 (out of 5). From the group of workshop participants, subsequent workshops in clinical departments and residency programs will spread this content deeper and more broadly into our organization.

Both global measures and individual physician pilots are under way that provide resident and staff physicians with feedback from patients on their communication skills.

All members of the medical staff are required to participate annually in learning modules aimed at enhancing awareness of work-place diversity and mutual respect. Courses offered to date include "Just for Doctors" and "Quality Interactions: A Patient-Based Approach to Cross-Cultural Care."

A Mayo Foundation-wide initiative, entitled the "Mayo Clinic Model of Care Service Essentials" (see Table 2) has provided enhanced visibility to these principles to both physician and allied health staff. Again, pilot projects are underway to gather feedback for physicians on their mutual respect and teamwork behaviors.

Goal #2: Implement a service program for front-line employees

Every service delivery organization recognizes the key role its front-line staff plays in terms of the initial customer impression of the organization. Every encounter with our patients or referring physicians presents an opportunity to hit a home run.

Whether such contact is in person or over the telephone, engaging the individual in a prompt, courteous and competent manner is essential for the rest of the service experience to be positive. We have designed an approach that equips work teams to design and implement these "first impressions" principles in a manner that is specific to the nature of their service component.

The goals of the program are to allow everyone to make a great first impression, to give everyone more responsibility and accountability if things go wrong, and to create a culture of service excellence in our work units.

There are innumerable opportunities for all staff every day to provide great service to our patients and to our internal customers. Many employees interact with patients. Every employee can make a difference.

The first impressions program is much more than educational classes, it includes metrics, supervisory involvement and ongoing measurement and reinforcement of the service principles. The commitment of management is critical to the success of this program and sustaining improvement. The front-line managers are the driving force behind the program and are expected to instill the elements of excellent customer service in their work units.

The First Impressions: Service Excellence Program (FISEP) consists of three phases: program preparation, training classes, and program implementation. The program was developed to establish ongoing customer service improvement within the work unit.

Success of the program relies heavily on:

* Incorporating the principles of customer service into the employees' daily activities

* Developing evaluation and monitoring tools to ensure that employees are striving to exceed our patients' expectations regarding customer service

* Helping employees to accept responsibility and accountability for the level of customer service the work unit provides

The FISEP Training Team provides guidance to the manager during the first two phases of the program because the program is tailored to each work unit.

Goal #3: Raise awareness and education of the Mayo service values

Raising awareness of service values is extremely important. We must all "walk the talk." The service excellence workgroup continues to collaborate across the Mayo system with the Jacksonville, Fla., and Rochester, Minn., campuses to facilitate this awareness.

A video will soon be released that reflects that foundation-wide collaboration and commitment to service. Most importantly at the Scottsdale location, we believe that a great way to raise the awareness of service is to recognize and honor our service heroes.

Annually, the organization presents its service awards. Specifically, six individuals and two teams are recognized for their commitment to service, mutual respect and teamwork. Over 600 employees attend the event each year and this is a great way to celebrate our commitment to improving service in health care and spreading awareness.

Goal #4: Analyze and recommend service metrics and measurement processes

The service excellence work-group assists the board of governors (the local governing board) in the pursuit of service excellence at Mayo Clinic, as expressed in the vision and mission statements.

Mayo Clinic in Arizona now has over three years' experience measuring patient perceptions of medical care and service quality through randomized patient telephone surveys conducted by PRC Easy View. The board members, as well as clinical department chairs, have ready access to both system-wide and specialty-specific service performance. These service metrics have provided focus for individual work units in enhancing service delivery. Additionally, the practice- wide view of metrics has assisted the governing board in setting specific goals for the entire organization.

Mayo Clinic in Arizona is well on its way to achieving its vision as the premier academic medical center in the Southwest. Our journey has been accelerated by embracing the pursuit of excellence in both the biomedical science and the service quality of health care.

The key elements to our success have been a clearly articulated vision for service excellence, the passionate support of the organization's executive team, a well-developed action plan, and specific metrics to measure our progress on this journey.

For any health care organization to sustain its efforts in service excellence, there must be strong leadership support and staff must role model and "walk the talk." Principles of excellence should be evident in the organization's culture. Finally, service excellence must be integrated into the organization's strategic plan, operational plan and measures of performance.

Keith A Frey, MD, MBA is chair, department of family medicine, Mayo Clinic Arizona, and associate professor of family medicine, Mayo Clinic College of Medicine. He may be reached at 480-860-4800 or by e-mail at [e-mail]

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Jonathan A. Leighton, M.D. is vice chair of the division of gastroenterology and hepatology, Mayo Clinic Arizona, and associate professor of medicine, Mayo Clinic College of Medicine. He has been involved in continuous improvement and service delivery at Mayo Clinic for many years. Currently, he co-chairs the Service Excellence Workgroup, which specifically focuses on ways to improve customer service through out the organization. He can be reached by email at [e-mail] or by phone at 480-301-6990.

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Katherine K. Cecala, MBA, JD, is director of patient financial services and co-chairs the service excellence committee at Mayo Clinic in Arizona She can be reached by phone at 480-301-4116 or by e-mail at [e-mail].

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By Keith A. Frey, MD, MBA, Jonathan A. Leighton, MD and Katherine K. Cecala, MBA, JD

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Phase I -- Program Preparation

The manager develops and submits:

A high-level assessment of the work unit's service environment tools to monitor and evaluate employees' customer service skills

Scenarios or real-life examples of service interactions to be used during training classes

A plan outlining how the work unit will strive to continuously improve customer service over the long-term

Phase II -- In-class Training

It is expected that the manager will attend the training sessions and play an active role by assisting in training or participating in the training exercises with his/her employees.

Playing an active role demonstrates to employees that the manager is committed to helping them improve their customer service skills and making the program successful.

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Phase III -- Implementing the Long-term Plan

Managers will use evaluation tools, metrics, and long-term plan to implement the program in the work unit. Service measurement data will be included as part of employees' annual performance evaluations.

Table 1 Strategic Goals to Promote Service Excellence at Mayo Clinic in
Scottsdale

Goal #1  Engage Physicians
Goal #2  Implement a "First Impressions" service program for front line
         employees
Goal #3  Raise Awareness and Education of the Mayo Service Values
Goal #4  Analyze and recommend service metrics and measurement processes

Table 2 Service Elements of the Mayo Clinic Model of Care

In 2003, Mayo Foundation developed the Service Elements of the Mayo
Clinic Model of Care. The following elements define standards expected
of all employees of Mayo Clinic.

Mayo service is Patient-Centered. Our patients and their families are
the focus of the care and service we provide. We seek to partner with
our patients and to understand their needs. The quality of our service
is measured by the Mayo patient's service experience.

Mayo service is Reliable. The right service is provided right the first
time and every time. Promises made are promises kept. Service is
conducted with honesty and integrity.

Mayo service is Timely. Service is conducted in a prompt and punctual
manner. Access is timely. Waiting times are short. Correspondence and
telephone calls are returned promptly.

Mayo service is Personal. We are attentive to the individuality,
diversity, and special circumstances of our patients. We value ongoing
relationships with our patients and their physicians and caregivers.

Mayo service is Employee-Driven. We create our patient's service
experience. Mayo service is delivered by employees and volunteers who
are: 1) courteous, caring and respectful; 2) possess the knowledge,
attitudes and skills necessary to provide excellent service; and 3)
demonstrate competence and professionalism in service delivery.

Mayo service is Energized and Innovative. We are empowered to serve
creatively. Mayo employees and volunteers make the extra effort, take
the extra step, and go the extra mile.

Mayo service is Team-based. Service excellence is everyone's
responsibility. We work together, share resources, and support each
other to provide the best service. We recognize and reward each other
for providing exemplary service.

Mayo service is Systems-oriented. Mayo systems enable superior service.