Wednesday, September 07, 2011

Another Hospital Putting on the Ritz

The usual definition of a hospital is an institution which treats the sick and injured,.  That is a messy business, so some hospital executives seem to yearn to be doing something a little more - shall we say - upscale.  For example, the Chattanoogan reported:
Erlanger Health System will launch in October one of the most ambitious employee training initiatives in its 120-year history. All 4,500 employees will participate in a new service excellence program based on the legendary Ritz-Carlton service model.

'This is not a program. This is the beginning of long-term cultural transformation,' says Erlanger CEO James Brexler. 'Our board and leadership team believe this initiative is one of the most significant developments in the continued evolution of Erlanger.'

The Erlanger Health System strategic plan, adopted by the board of trustees last year, identified service excellence as a priority. Funding for the initiative was approved in this year’s operating budget. The corporate university of Ritz-Carlton was selected to help take Erlanger’s patient experiences to the next level.

A hospital, of course, provides services to patients. However, it seems glaringly obvious that the sort of services required by the sick and injured, especially the critically ill, are very different than those people who go to four-star hotels. Providing care to a patient on a ventilator (breathing machine), for example, hardly resembles providing spa services to a wealthy hotel guest.

Furthermore, Erlanger Health System is a public, non-profit health system with a mission that involves service to the poor:
To deliver excellence in medical care to improve the health status of our region, while providing vital services to those in need, and training to health professionals through affiliation with academic partners

The Boston hotel in the Ritz-Carlton chain, its flagship property, boasts that it:
features hotel rooms and suites in Boston designed as sanctuaries of urban luxury.

Where is the parallel to providing health care services to "those in need" who are acutely ill and injured?

By the way, a few days after the Erlanger, Ritz-Carlton connection was announced, the Time Free Press noted questions about how the contract was awarded:
Erlanger officials defended the no-bid procedure Monday, saying the hospital was correct in bypassing a competitive bid process and awarding a 'professional services' contract to Ritz-Carlton.

'Tennessee law says government entities do not have to bid professional services,' hospital spokeswoman Susan Sawyer said.

Even early in the process, Whisman said, 'it was so clearly the Ritz going forward.'

'There was a lot of board support, executive-level support and steering committee support,' she said. 'Ritz had it all.'

Furthermore, how well the money will be spent may be difficult to find out:
In October, a Ritz-Carlton speaker is expected to lead several four-hour sessions, each of which will hold 400 employees, hospital officials said.

The bill for those sessions is $288,000. On Thursday, Sawyer said Ritz-Carlton prohibited the media from attending the sessions because of proprietary information the hotel chain prefers to keep secret.

It is not that the hospital system has money to burn, as the Chattanoogan just revealed:
Erlanger Health System officials reported a $1.3 million loss for July,...

In addition,
Admissions were under budget by 1.6 percent for the month and ahead of the previous year by 3.8 percent.

So, in summary so far, a public hospital system that is currently experiencing budgetary challenges is spending hundreds of thousands of dollars for the Ritz-Carlton luxury hotel chain to train its employees in secret sessions about "service excellence," and the hospital system's management thinks this is a top priority.

In my humble opinion, this illustrates a larger problem with the leadership of health care. Health care organizations are often lead by ultra generic managers, that is, managers trained in such fields as marketing, public relations, and finance, but without any experience or training in actually taking care of patients. (The supremacy of generic management is strange given that patient care itself has become so specialized.) The utter lack of gut feeling for what health care is really about seems to lead to managers thinking that hospitals are like automobile assembly plants, or in this case, like luxury hotels. I cannot but help believe that such ultra generic managers, who do not appreciate the values of health care professionals, and do not understand the health care context, are going to make some very bad decisions, and are an important cause of health care dysfunction.

I cannot help believe that the Erlanger CEO, Mr James Brexler, (whose most advanced degree was a "Masters of Public Affairs from North Carolina State University") was entirely off base when he was quoted:
'This is not a flavor-of-the-month thing,' continues CEO Brexler. 'This is a strategic priority and business imperative. We are committed to this. We are excited about it. Our staff is excited. Our physicians are excited. The results, we believe, will be evident to our patients and their families.'

True health care reform would make sure health care leaders actually understand health care and uphold its values.

PS - Long ago, we noted the trustees of another hospital system who seemed to think that Ritz-Carlton experience was perfect background for hospital executives.


InformaticsMD said...

I cannot but help believe that such ultra generic managers, who do not appreciate the values of health care professionals, and do not understand the health care context, are going to make some very bad decisions, and are an important cause of health care dysfunction.

When I first read this story I thought it was a spoof.

As I've written about pharma, management of specialized biomedical organizations by managers who do not understand the domain ("generic managers") is, by definition on first principles, mismanagement.

-- SS

Unknown said...

I'm not sure that training from the Ritz is going to enhance the patient/provider relationship other than cleaner sheets, but the point here is that the seeds of change have been planted. The health care industry is being forced to focus on outcomes and some doctors are driven to improve their patient feedback scores. Answering a patient's question completely, offering alternative options and unveiling the cost of procedures and medications educates the patient and is a step in the right direction in my opinion.

Roy M. Poses MD said...


But not all change is good.

And measuring outcomes indiscriminately does not necessarily improve quality. Patient satsifaction scores are not clearly good measures of quality, and are clearly biased by patients' severity of disease.

You may be right that it is generally good for physicians to communicate clearly with patients, and for health care professionals and organizations to make prices transparent. But that has nothing obvious to do with my post above, and it's not clear that Ritz-Carlton has any special expertise in these areas.

Brad Evans said...

I think this is a business fad. The source of the fad is a pretty famous article in Harvard Business Review by Paul Hemp, "My week as a room service waiter at the Ritz." It was in the June 2002 issue.

Anonymous said...

They are scared and worried what VBP - Value Bssed Purchasing will do to their bottom line.....which already sounds like it is in the toilet. Having patient surveys determine your reimbursements is totally nuts! This is only the beginning of the strange things healthcare systems will do to get the money from this new government initiative. Nuts nuts nuts!

Anonymous said...

Patients receive a form to grade the doctors and nurses in innumerable categories. For instance: "was the doctor rushed?"; "did the doctor answer your questions?" "did the nurse identify her/his self?" get the picture.

They are trying to get good grades, that incidentally, get published.

The basic tennants bedside communication has been corrupted by the time consuming EMRs and CPOEs, making minutes of time a high priced commodity, resulting in hospitals having to resort to Ritz programs.

However, I wonder if the CEO and BOD get free suites at the Ritz of their choice, sort of as an enticement??

Anonymous said...

The formulation of patient satisfaction scores driving the industry had been progressing for the last few years (from my own health care career observations). When the patient is given a survey stating, "Did the nurse do ___?" or "Did the nurse say ___?" and you, the nurse, are told to do ___ and say ___, then of course the patient will remember the specific phrase or task performed. Scripted responses and repetitive reinforcement of what the post-care survey will ask only lead to false positives of satisfaction, and does nothing to address the more serious issue of how the country can afford overly expensive health care.

InformaticsMD said...

Anonymous said...

Scripted responses and repetitive reinforcement of what the post-care survey will ask only lead to false positives of satisfaction

Except for those who end up dead as a result of all these distractions.

Maybe the hospital can hire a psychic to find out from the dead if they were satisfied with their care, too.

-- SS

Roy M. Poses MD said...

Brad Evans -

Yes, this is a business fad. Business fads are bad enough when they are applied to businesses that do not have direct implications for health and safety. But they become real problems when they are applied to hospitals and other health care organizations that do have such direct effects.

Informatics MD -

There are innumerable methodologic problems with patient satisfaction surveys as measures of quality. The issue of non-responders as likely to be sicker than responders (or even dead) is not a trivial one.

In fact there are innumerable methodologic issues with most ostensible measures of quality. Many have been debated since the 1980s. The problem is that the "business fad" that "if you can't measure it, it doesn't exist" was applied to health care both by the left and the right, by government and by commercial health care firms, and hence such measures were rushed into use before they were adequately tested and/or ready for prime time.

Anonymous said...

Not to say that a financially stressed institution has it's priorities straight in employing Ritz Carlton as a consultant, but it has been my observation (as a 30 year hospital department head) that the "hospitality industry" often displays facilities that are notably cleaner, and display a more guest friendly and caring attitude than hospitals do. So perhaps hospitals do have lessons to learn from that industry in the areas of housekeeping and guest relations, which ultimately benefit the patient's care.