|Our organization had been struggling for years with declining resident satisfaction scores, increasing employee turnover, and a highly competitive market. Not only were we competing for residents, we were competing for employees. Each year, our team met to strategize and set priorities for the coming year. Each year, our priority for world-class customer service was outlined. Each year, specific tactics were created that would move us in the direction of improving satisfaction scores and filling vacancies. But each year, we were unsuccessful in reaching our goal.|
We had listened to representatives of the Disney Institute share the success they had achieved by creating memorable experiences for their customers. We had visited other organizations that had implemented customer service programs. Our planning meetings included an assessment of our strengths, our weaknesses, and our economic “engine.” We knew that if we could really wow our customers, our residents, and our employees, we could demonstrate the value of our services and our impact on the community. By improving our services along with demonstrating uniqueness and value, we would create an environment that would make raving fans out of the residents and family members we cared for.
And yet the inspiration for this project did not come from any training session or even from a literature search. It came from a dining experience that I, the facility president/CEO, had while vacationing in Florida in early 2001. At a restaurant, I had ordered my traditional salad: “no dressing, tomatoes, or onions…just extra cheese and lots of croutons.” Usually I hear, “I’ll check, but there may be an additional charge for the cheese,” or, “I’m sorry, it’s already prepared in the kitchen.” This time, though, I was delightfully surprised when the waiter, without a moment’s hesitation, said, “When you’re a guest in my house, you can have anything you want.”
I can only describe the feeling of my response as awesome. This employee was empowered enough to want me to be very satisﬁed with my dining experience. His response changed everything for me-and, as it turned out, our organization.
Planning the Project
When I returned, I approached our management team almost bursting with excitement. What could we do in a long-term care residential and skilled nursing center that would have that same impact on our residents? How could we make them feel as if nothing they could ask for would be too much, the way that waiter made me feel? We brainstormed experiences that we had had in hotels, restaurants, physicians’ offices, veterinarians’ offices, etc., that made us feel as if we were getting “the red-carpet treatment.” We then discussed how to translate those episodes into everyday experiences for our residents. The outcome of this exercise is what we now call our RED CARPETSM Program.
The experts had been telling us that in order to satisfy our residents, we needed to treat our employees in such a way that we would raise their level of satisfaction, too. So we developed a RED CARPET Program for our employees, as well. We set a goal that resident satisfaction would be above the national mean for 2001 (as reported by Press Ganey Associates, Inc., from their national client database) and that employee satisfaction, as measured by employee turnover, would improve signiﬁcantly. We also anticipated measuring employee satisfaction through a standardized survey process, with the goal of being above the national mean for long-term care facilities.
We began our journey to excellence by service mapping the actions and behaviors that we would engage in from the moment a resident entered the facility. This included having red carpets and a sign announcing that we “roll out the RED CARPET for you” at each entrance along with brass luggage carriers. Management offered warm greetings with a gift of a teddy bear wearing a “Welcome Home” T-shirt. Beyond this, a series of speciﬁc actions were developed that would be carried out consistently and routinely by managers to create a special feeling for residents. Residents would receive a welcome letter from the president, as well as visits from key staff and managers soon after their admission. Special events would be scheduled, and family meetings would be held more frequently and attended by management staff to ensure that all issues would be dealt with in a timely manner. Following each meeting, a written feedback report would be shared identifying issues that were raised, the proposed action plan, the responsible party, and the time frame.
Meanwhile, we focused effort on the RED CARPET Program for our employees. As with the resident service mapping, we strived to create an “awesome arrival” sensation for applicants and new hires. We redesigned the facility’s application-completion area to appear more welcoming. Each applicant would be greeted by a member of the Human Resources team and offered an interview on the spot, if feasible. Applicants would be told when they would hear from us with a decision. Once hired, they would receive a welcome note from the president’s office within 24 hours, a call from their supervisor within 48 hours, and then regular calls from the supervisor up until the start date offering any needed assistance. The night before the start date, the supervisor would call to confirm where they were to arrive and ask if there were any further questions.
All of this meant a commitment from supervisors to prioritize and organize their schedules to accommodate new applicants. It also meant a more thorough, yet swift, screening process. No longer was recruitment and retention the “job” of Human Resources-it was every manager’s responsibility.
Once hired, employees are invited to lunch with the president at a restaurant to celebrate their one month, one year, and then annual anniversaries. Once a month, the president hosts a “Getting to Know You” coffee-and-Danish reception in the lobby for all night, day, and evening shifts.
Despite all of this, our satisfaction scores during 2001 were still below the mean. Employee turnover had started to improve, but we had set our goals higher. Then, in early 2002, along with other members of our healthcare system, we embarked on a journey called our “CAMPAIGN for EXCELLENCE.” Working with consultants, we developed principles that would further enhance our service culture. It was then that we discovered what was missing in the RED CARPET programs: employee involvement. All of the existing elements of the program had involved actions taken mostly by executives and senior management. Employees had not been empowered to participate. Therefore, we modified the program. Finally, we were involving frontline staff in the process, rather than just management. Staff participated on teams to build on our RED CARPET ideas. The teams developed a new recognition program, as well as standards of performance and associated behaviors that each employee committed to. In addition, applicants were to be given a copy of these standards to read before the interview process, so that they would better understand the standards to which they would be held accountable.
Several more new concepts were added to the program. For example, we created the concept of “CPPA”-that is, all staff are required to be Cheerful, Polite, and Pleasant, and Acknowledge those around them. Employees soon realized that their attitudes and behaviors had a direct impact on resident satisfaction. Key words and phrases were developed so that each time staff members came on shift (this includes nurses, aides, housekeepers, etc.), they would introduce themselves to the residents and let them know they would be there to meet their needs during the shift. In this way, residents can feel confident knowing that someone nearby is certain to be thinking about them, checking on them, and attending to their needs throughout the day.
In addition, executives and managers round with residents, staff, and family members to try to identify issues early on and gauge the level of satisfaction with their responses. Management also became much more visible at activities, resident council, and family meetings, realizing that it was not enough to attend meetings, their direct feedback was required.
In addition, a formal “service recovery” program was developed so that employees
would be empowered to immediately improve a bad situation by apologizing, using key words, and offering something to compensate for the wrongdoing. Altogether, these behaviors became a win-win situation for staff, residents, and family members.
Initially, some resistance slowed the program’s momentum. Staff were skeptical at first: How was this program different from others in the past? Would it be a “flavor of the month?” How would they find the time to attend the meetings? Would they see results? It was critical that we address these issues. In short, management had to “walk the talk”-in some cases literally. After rounding with residents and staff, for example, managers and supervisors send thank-you notes to deserving employees at their homes, citing specific examples of positive comments or situations that residents or families have mentioned. The staff take great pride in this, often sharing these notes with their coworkers and residents.
In other efforts to support staff, management arranges coverage so that staff can participate in team meetings and events and be paid for the time. Quarterly employee forums have been established for employees to share information and celebrate successes. Communication boards are placed in several locations, reporting on satisfaction levels, financial performance, community projects, etc.
Results and Evaluation
The results, measured by Press Ganey, proved to be remarkable (figure 1). Even more significant were some of the specific-question analyses (figure 2). By providing additional training and supplies, rounding with our residents and employees, and focusing on responding to requests in a timely and friendly manner, we found our residents feeling safer, more secure, and confident that they were in competent hands.
Likewise, we evidenced improvement in employee turnover (figure 3) and employee satisfaction (figure 4). Employee satisfaction was measured by a standardized survey instrument from John Baird and Associates. Our scores were statistically above the national mean, with 87% of our employees participating, compared with a national participation rate of 60%. We scored 5.78 on a scale of 1 to 7 for overall satisfaction (national average: 4.55). And we surpassed the scores from our last two employee satisfaction surveys: 5.46 in 1993 and 5.33 in 1996.
This innovative project takes an unusual approach to resident satisfaction by creating a welcoming environment similar to that of a fine hotel. Rather than focusing only on training and written materials, it requires senior leaders to “walk the talk” and be role models on every possible occasion. It also proves that if you can’t measure it, you can’t manage it. Although we had been measuring resident satisfaction for years, the reports were usually sent to departments and then filed in binders, while we “hoped” to do better next time. Now a team of frontline employees has been taught how to interpret the data. They review the data and meet with department managers, highlighting those indicators that are the top priorities for driving resident satisfaction, and then develop and implement action plans to improve them. All data are shared and celebrated at quarterly employee meetings, as well as posted on communication boards for all to see. Resident satisfaction is a standing agenda item at all department meetings.
Employees are consistently rewarded and recognized spontaneously when they live and perform according to RED CARPET values. A quarterly RED CARPET Award is given to an employee who truly exemplifies the spirit of the program. Employees are nominated by peers, supervisors, residents, and family members. The winner is selected by members of the board of directors and recognized at a board meeting, as well as receiving media attention and further internal recognition. All of this has enabled us to disseminate the information throughout the organization. We have received both statewide and national awards for this program’s innovativeness and success, including:
- New York Association of Homes and Services for the Aging Innovation of the Year Award
- Iroquois Health Care Association Innovation in Health Care Award
- 2003 Press Ganey national Success Story Award
- 2003 Press Ganey Compass Award
- New York Department of Health Quality Practice Recognition
This program has allowed us to focus on accountability and, because of that, we have evidenced improvement in our quality indicators, as well. This has been demonstrated by the reduction in our rate of pressure ulcers in the skilled nursing facility from 22% in 2000 to less than 3% in 2003. This won us both a statewide and a national award.
The commitment and energy devoted to this type of culture evolution cannot be understated. It has been a journey filled with learning, creative ideas, fun and, most of all, involvement of everyone. We are proud that the RED CARPET Program has made a difference.