Vol.
10, Issue 5, May 2002
“You may have a bunch of
satisfied employees, but that
doesn’t mean they’re going to
stay if the hospital down the
street offers an extra $1.25 an
hour. Loyal employees are go-
ing to stay because they have a
relationship, they have matched
values with the organization,
and they feel like they are em-
powered to make a differ-
ence."
Pamela A. Bilbrey
Baptist Health Care
Pensacola, Fla.
In This Issue
Beyond Patient and Employee
Satisfaction to
Loyalty..................................1
Book Review: CEO
Succession..........................10
Special Report:
Nurses Get a Shot in the
Arm.....................................12
News Front..........................14
Governance & Leadership
Forum..................................24
Healthcare Leadership & Management Report
Beyond Patient and Employee Satisfaction to
Loyalty: The Baptist Health Care Experience
by Lee Reeder
H
ow would it make you feel if you
knew that your hospital or health
care system was number 1 in
America in employee or patient satisfaction?
What would you imagine to be the bottom-
line results of such satisfaction? When does
satisfaction cross over into loyalty, and how
does a hospital or health system make the
leap from satisfaction to loyalty?
Baptist Health Care, headquartered in
Pensacola, Fla., serves northwestern Florida
and southern Alabama. The system has
some of the highest rated facilities in the
nation in customer and employee satisfac-
tion.
Interest from throughout the country
sparked the development of the Baptist
Health Care Leadership Institute, which pro-
vides education, training and consulting to
a wide range of healthcare organizations.
Baptist Health Care has become a bench-
mark for hundreds of healthcare organiza-
tions around the country that have come to
Pensacola and taken lessons of patient sat-
isfaction and service excellence back home
with them.
The organization reports that 1,100
healthcare groups and more than 5,000
healthcare professionals from 47 states have
benchmarked Baptist Health Care for best
practices. The system's Web site at
www.eBaptisthealthcare.org contains an
extensive list of healthcare organizations
from around the country that have sent rep-
resentatives to Pensacola to study its prac-
tices in service excellence and patient satis-
faction.
Baptist Health Care is listed 10th on the
Forbes 2002 list of the 100 Best Companies
to Work For. The organization has also been
honored with the USA Today/Rochester In-
stitute of Technology Quality Cup Award for
Service Excellence in 2000 and the Voluntary
Hospitals of America’s National Leadership
Award for Excellence in Patient Care in 1997.
The organization is also highly wired. In
2001, the organization was named one of the
nation’s 100 Most Wired hospitals and health
care systems by Hospitals & Health Net-
works, the journal of the American Hospital
Association. It is a winner of the CIO Web
Business 50 Award from CIOmagazine, which
recognizes the eBaptistHealthCare.org Web
site as one of the 50 outstanding Web sites
among business, government and nonprofit
organizations.
Baptist Health Care facilities include the
492-bed Baptist Hospital in Pensacola, Fla.;
Gulf Breeze Hospital, a 60-bed acute care fa-
cility in Gulf Breeze, Fla.; the 55-bed Jay Hos-
pital in Jay, Fla.; D.W. McMillan Memorial
Hospital, a 91-bed facility in Brewton, Ala.;
the 51-bed Atmore Community Hospital in
Atmore, Ala.; Baptist Medical Park
Pensacola; and Baptist Medical Park Navarre
in Navarre, Fla. Baptist Health Care also has
affiliations with: Azalea Trace, a retirement
community in Pensacola; Baptist Manor, a
subacute care and rehabilitation facility; and
an addiction treatment facility called The Fri-
ary in Gulf Breeze; and Lakeview Center, a
mental health facility in Pensacola.
May 2002 n 1
 Beyond Patient and Employee Satisfaction to Loyalty (cont...)
The Journey to Service Excellence
Begins
One factor that contributed to the need
for an emphasis on customer service was
the competitiveness in the local market of
the system’s largest hospital. Baptist Hos-
pital is in one of the top ten most competi-
tive areas for health care in the United States,
according to Senior Vice President of Cor-
porate Development Pamela A. Bilbrey. She
said that in this 15-square-mile area in
Pensacola there are three large hospitals,
and that it has been estimated that the com-
munity is over-bedded by approximately 400
beds. The two other hospitals in the market
were claiming to provide exceptional service,
so to differentiate itself in this area, Baptist
had to reach national heights in patient sat-
isfaction.
The story of Baptist Health Care’s jour-
ney to excellence began in the early 1990s
with a healthcare system that had “lost its
Figure 1: Service Team Evolution
Teams Begin
(Oct. 1995)
Score
IP: 82.9 - 28%
Teams
Measurement
Standards
Communication
Linkage
Irritants
Physician
WOW
2 n May 2002
focus.” At the time, patient satisfaction
ranged from the 20th to 40th percentile, annual
employee turnover was at 30 to 40 percent
and employee satisfaction was “dismal.”
When the organization began looking
for solutions to these problems, the in-house
researchers realized that Baptist Health Care
had always found past success by being a
mission-driven, values-centered and cus-
tomer-focused organization. Bilbrey said,
“We really challenged ourselves and asked,
‘Are we living and breathing being mission
driven, values centered and customer fo-
cused every single day and in every interac-
tion we have, whether it’s with our patients,
our physicians or our co-workers?’” She said
the management of the organization had to
admit the answer was no. “We had really lost
our focus.”
The immediate reaction for an organiza-
tion might be to quickly jump into a number
of patient satisfaction initiatives. However,
Bilbrey pointed out that an organization can-
Satisfaction
Teams
(Sept. 1997)
Scores
IP: 87.3 - 88%
OP: 91.4 - 93%
ER: 81.6 - 53%
AMB: 91.0 - 68%
Teams
Measurement
Standards
Linkage
Loyalty
Inpatient Satisfaction
Outpatient Satisfaction
Physician Satisfaction
not achieve service excellence and patient
satisfaction unless employees first are satis-
fied. So the Baptist Health Care journey
started with focusing on employee satisfac-
tion. The effort began with the leadership
asking employees throughout the system
what they believe had to be created in order
to achieve employee and patient satisfaction.
According to their responses, the goal would
be to create:
• an organizational culture built on open
communication
• a “no-secrets” environment
• a “no excuses” environment
• a culture in which employees feel val-
ued, manage their own morale, behave like
owners and are inspired.
Employees of the organization were also
invited to review the mission statement and
values of the organization. During this pro-
cess employees noted that the organization
was missing a focused vision statement.
Loyalty
Teams
(Oct. 2001)
Scores
IP: 90.3 - 99%
OP: 93.8 - 99%
ER: 82.3 - 70%
AMB: 92.1 - 86%
Teams
Culture
Communication
Employee Loyalty
Customer Loyalty
Physician Loyalty
Healthcare Leadership & Management Report
 Beyond Patient and Employee Satisfaction to Loyalty (cont...)

Based on the employee feedback, the result- partment, their facility and about the or- an example of scripting, which is widely used
ing vision statement was simple yet chal- ganization. As one initiative, they placed in the system’s patient satisfaction efforts:
lenging: “The vision of Baptist Health Care communication boards in each depart- “One area of special concern that con-
is to be the best health system in America.” ment, on which information can be posted sistently appeared as an opportunity for im-
Bilbrey said that although this vision for all to see. The activities of this team provement was ‘staff sensitivity to the in-
may be impossible to achieve, “We needed were merged into all of the teams during convenience that health problems and hos-
something that would continue to drive us the reorganization in 1997 (see Figure 1). pitalization can cause,’ To combat the per-
on the journey to excellence.” However, in the 2001 reorganization, the ceived insensitivity, the team wrote a script
After revamping the mission and val- Baptist Health Care reinstated this as a and encouraged staffers to use the words
ues statements and creating the vision, the stand-alone team because of the impor- when faced with a ‘sensitivity’ situation. One
organization’s first seven service teams were tance of its work to the overall effort. such scripted response was: ‘I realize that it
formed in October 1995. When this effort may take a while for the physician to see
began, Baptist Health Care you. Is there anything I can
made a rule that vice presi- do to help with the inconve-
dents or senior vice presi- “The vision of Baptist Health Care is to be the nience?” Use of the script
dents could volunteer to best health system in America.” has proved successful. For
be on teams, but they the first time in a year, the
could not lead teams. “We “sensitivity” issue was not
didn’t want this to be an Baptist Health Care Vision Statement among the top five items on
administrator-led effort,” the priority index. This strat-
Bilbrey said. egy at Baptist is yet another
The seven initial teams were comprised Linkage—This team is responsible for example of the importance of strong commu-
of volunteers from throughout the organiza- making sure that all activities and initia- nication, both internally and externally.”
tion. The teams meet at least weekly and tives are linked to the five pillars of ser- Although Bilbrey said that the organi-
sometimes several times a week depending vice and operational excellence and that zation believes in the power of scripting, she
on their current activities. The teams each each employee understands how their cautioned that there is a downside to the
had a primary area of responsibility for ser- behavior supports the pillars. The five pil- practice if it is not used with discretion. She
vice. They were: lars are: People, Service, Quality, Finan- said that scripts should not be taught to
cial, and Growth people to say verbatim and without feeling.
Measurement—The Measurement Irritants—The Irritants Team’s duty
They should be developed to be used as
Team continually collects and analyzes guide messages in certain critical circum-
was to identify those activities and be-
satisfaction data, and then develops an haviors that were dissatisfiers for patients
stances, and people should be free to com-
ongoing series of satisfaction priorities for municate the guide message how they
and to develop ways to eliminate each irri-
the system. The team then ensures that tant.
choose.
the information is communicated through- Another successful script for the hos-
out the organization. The priorities are Physician—The Physician Team fo- pital is used when a caregiver is about to
disseminated in department meetings, on cuses developing specific behaviors, ac- leave the patient’s room: “Is there anything
bulletin boards and in weekly reports. This tivities, and processes that enhance the else I can do for you? I have the time.” The
team’s activities are now part of the Cul- physician’s experience with the health sys- creation of this script was in response to
ture Team. tem. low Press Ganey scores on call light re-
Standards—This cross-functional team WOW—The WOW team focused on sponse. It started out as just, “Is there any-
was put together to create the standards reward and recognition for employees by thing else I can do for you?” However, us-
of performance for all employees. The creating incentives for exceptional cus- ing just this part of the script was found to
team developed ten standards, which in- tomer service. be ineffective, especially when combined
clude attitude, teamwork, and commitment with any body language that suggested that
to coworker. All applicants must agree in The teams set to work on their tasks the caregiver was eager to get out of the
writing to abide by this behavior code in and measurable positive results started com- room. Therefore, employees are now encour-
order to work at Baptist Health Care. This ing in as employee, physician and patient aged to walk over to the patient’s bedside
team’s activities are now also part of the satisfaction all began to improve. and say something to the effect of, “Is there
Culture Team. In a 1999 success story submitted to anything else I can do for you? I have the
time.” The use of this script has resulted in
Communication— This team focuses Press Ganey Associates, Corporate Direc- greater patient satisfaction and a significant
on ways to assure that every employee tor of Compensation and Special Projects decrease in rework for employees.
has access to information about their de- Celeste Cutter provided an example of how
the Measurement Team works, and provided

Healthcare Leadership & Management Report May 2002 n 3

 Beyond Patient and Employee Satisfaction to Loyalty (cont...)

Reevaluation and Reorganization at Baptist Health Care was among the high- The methods used to achieve patient
est the firm had ever seen in a large organi- satisfaction vs. those used to get to patient
Two years into the effort, the organiza- zation in any industry. loyalty are also different. “Satisfaction fo-
tion was forced to conduct a reevaluation of Because of these gains and consistent cuses on an event,” Bilbrey said. “For ex-
the Service Teams (see Figure 1 on page 2). high satisfaction, Bilbrey said that in 2001, ample, you’re hospitalized for three days.
By 1997, inpatient satisfaction had risen to “We made a major shift in our frame of refer- Satisfaction is focusing on what happens
the 88th percentile. At that time, Bilbrey said ence.” That shift again required the teams during that three days. When you’re work-
the effort had hit a wall. ing on loyalty, you’re look-
“The teams were function- ing at building that relation-
ing, but they were having ship over time, and at what
a tough time making it to “Satisfied individuals may be happy, but that kinds of value-added ser-
the next level.” The teams doesn't mean they're going to come back, it doesn't vices you can provide to
that person, and how you
were then redesigned into mean that they prefer you as their provider, and it can continue to engage that
“satisfaction teams.” To
the original Measurement, doesn't mean they're going to go out and tell all of individual.” She said these
Standards, Communication their neighbors how wonderful your organization efforts can include member-
ship programs, using the
and Linkage teams were is.” medical call center to make
added the Loyalty, Inpa-
tient Satisfaction, Outpa- Pamela A. Bilbrey follow-up calls to patients,
tient Satisfaction and Phy- after-discharge nurse fol-
sician Satisfaction teams. low-up calls, and getting
The activities of some of the original teams and the effort to be reorganized, and the loy- people to allow the organization to send them
were merged into these new teams as the alty teams were formed, consisting of Cul- personalized educational materials.
needs of the organization evolved. This pro- ture, Employee Loyalty, Customer Loyalty Bilbrey said the same concepts hold true
cess of reassessment and reorganization and Physician Loyalty. She said that part of with employees. “Take, for instance, the is-
occurred again about four years later. this effort consisted of looking closely at sue of salary,” she said. “You may have a
the satisfaction data to identify the factors bunch of satisfied employees, but that
that can reveal how the organization could doesn’t mean they’re going to stay if the
An Enviable Position Creates Need
enhance the loyalty of physicians, employ- hospital down the street offers an extra $1.25
for More Change
ees, families and patients. Bilbrey called this an hour. Loyal employees are going to stay
the organization’s “leap into loyalty.” because they have a relationship, they have
By 2001, the organization was again up Bilbrey explained her view of the differ- matched values with the organization, and
against a wall, but an enviable wall to be up ence between patient satisfaction and pa- they feel like they are empowered to make a
against, as the facilities in the system con- tient loyalty. “When I think of patient satis- difference. People use the words satisfac-
sistently hit the 99th percentile and made a faction, I think of individuals who are pleased tion and loyalty interchangeably, but they
national mark in patient satisfaction, which with their experience here,” Bilbrey said. are two very different constructs.”
continues today. For more than 72 months “They’re pleased with their treatment, the
Bilbrey admits that loyalty is also much
straight, the organization’s Gulf Breeze Hos- care, the compassion and so forth. When I
more difficult to measure. She said that de-
pital has been number 1 in the nation in pa- think of a patient who is loyal, I think of an
spite a great deal of work with market re-
tient satisfaction in Press Ganey Associates’ individual who has a relationship with Bap-
search firms looking at factors that indicate
large hospital database. Baptist Hospital, tist Health Care. Satisfied individuals may
loyalty vs. satisfaction, “I don’t believe we
Atmore Community Hospital, D.W. be happy, but that doesn’t mean they’re
have found a really good measure of loy-
McMillan Memorial Hospital and Jay Hos- going to come back, it doesn’t mean they
alty.”
pital have been at the 99th percentile for pa- prefer you as their provider and it doesn’t
tient satisfaction for four years running. In mean that they’re going to go out and tell all Turnover might be considered one mea-
2000, Lakeview Center was named number 1 of their neighbors about how wonderful your sure on the employee loyalty side, and Bap-
in the country for client satisfaction and organization is. On the other hand, if it’s tist Health Care has made great strides in
number 3 for staff satisfaction by the Men- someone with whom you’ve reached that this area, cutting its turnover rate by more
tal Health Corporation of America for orga- pinnacle of loyalty, they feel a real tie to the than half since its cultural journey began in
nizations with five to seven client types. 1995.
organization. These are the people who go
The organization was also making great out and tell others, and who say, ‘No—that’s While many organizations measure pa-
gains in employee satisfaction. When the where I want to go.’ Having high satisfac- tient satisfaction twice a year, Baptist Health
management-consulting firm Sperduto & tion is great, but it is only a beginning step Care measures it weekly. “We did that from
Associates Inc. conducted its 2001 employee in my mind. You really are striving for high the beginning to make a point to everyone
satisfaction survey of the organization, con- patient loyalty.” how important the area of patient satisfac-
sultant Chris Reilly remarked that the morale tion is,” Bilbrey said. To communicate the

4 n May 2002 Healthcare Leadership & Management Report

 Beyond Patient and Employee Satisfaction to Loyalty (cont...)

findings widely, every Thursday at 2 p.m. a

meeting is held, at which the latest patient
satisfaction numbers are presented to the
“Firestarters,” a group of about 70 depart-
ment heads and managers. At the meeting,
the participants see how all of the depart-
ments are doing in satisfaction, and recog-
nition is given for those that excel.
Every patient discharged from Baptist
Hospital receives a patient satisfaction sur-
vey. Approximately 27 percent of the sur-
veys are returned to the organization. The
weekly data on patient satisfaction come
from a data analysis system that Baptist
Health Care developed in-house. The scores
are not the certified scores, which come from
Press Ganey Associates, but Bilbrey said the
in-house scores usually closely mirror those
of the certified scores.
Sometimes the news is not good for a
given department. Earlier this year, patient
satisfaction in the Baptist Hospital Emer-
gency Department slipped to the 50th per-
centile and then to the 40th percentile. One
might believe that the other departments that
were hitting the 99th percentile may be un-
concerned about those that were experienc-
ing a dip. This is not the case at Baptist
Health Care. In situations such as these, the
extraordinary culture that has been devel-
oped in the organization kicks in. “The cul-
ture is such that if one department dips in its
patient satisfaction scores, it becomes the
responsibility of all of us,” Bilbrey said.
People in other departments pitch in with
brainstorming, advice and assistance in or-
der to help improve the scores of the falter-
ing department. Bilbrey said that there is a
real spirit of camaraderie in the organization
that plays a big part in resolving such situa-
tions. eBaptistHealthCare.org: Part of the Overall Loyalty Strategy

Employee Satisfaction Begins
Before Day One
Baptist Health Care commonly has job
applicants who say that they want to work
there because either they or someone they
know had been patients in the system and
were impressed with the care and compas-
sion of the organization and its people. “We
are finding that our strategies of service ex-
cellence and being the employer of choice
are speaking for us," Bilbrey said. “It’s do-
ing the recruiting for us.” She added that
The Internet and the company's intranet figure prominently in Baptist Health
Care's loyalty strategies for patients, physicians and employees. In 2001, the
organization was named one of the nation’s 100 Most Wired hospitals and
healthcare systems by Hospitals & Health Networks, the journal of the Ameri-
can Hospital Association. It is a winner of the CIO Web Business 50 Award
from CIO magazine, which recognizes the eBaptistHealthCare.org Web site
as one of the 50 outstanding Web sites among business, government and non-
profit organizations.
Plans are in the works to create an online "Temperature Check" on the
intranet to measure employee morale. The surveys will be quarterly. The
organization's Web site on the Internet is used as a tool in the organization's
patient loyalty strategies, providing valuable healthcare information.

Healthcare Leadership & Management Report May 2002 n 5

 Beyond Patient and Employee Satisfaction to Loyalty (cont...)
even though Baptist Hospital pays nurses a
little less than a crosstown competitor, the
facility does not have a nursing shortage.
The commitment to employees begins
even before they are hired. No manager at
Baptist Health Care may hire an employee
unless the prospect has gone through at
least one peer group interview. The people
with whom the applicant will eventually work
conduct the peer group interviews. The peer
group interviews the prospects, and then
makes recommendations on who should be
hired. This practice is designed to ensure
that positions are staffed with the people
best suited to a job, which the organization
believes results in better productivity, higher
satisfaction and lower overall employee turn-
over.
The commitment is demonstrated again
when a new employee starts working at Bap-
tist Health Care. On the first day, each new
employee receives a new employee greeting
card from the team with which the employee
will work. The card includes a digital photo-
graph of the entire team and is signed with
welcoming messages by everyone. All em-
Figure 2: First in Patient Satisfaction
Source: Bilbrey, P. "Journey to Excellence: The Baptist Health Care Story." Presentation at the Customer Service for Health
Care Symposium. May 6, 2002
6 n May 2002
ployees also get a certificate on their first
anniversary to celebrate the occasion, and
often these anniversaries are celebrated in
various ways in the individual departments.
Employees often comment on their deep ap-
preciation for these practices.
Training and education are also vital to
the success at Baptist Health Care. Orienta-
tion for new employees includes the tradi-
tional training and information found in
many hospitals and health systems, but it
may also include some fun, such as a trea-
sure hunt to teach them their way around a
facility. Preceptors are always assigned to
new nurses. Ongoing training is also em-
phasized. For 40 hours each year, leaders in
the system attend “Baptist University.”
Approximately 550 people attend the train-
ing. At the end, they are given a kit of train-
ing materials to help when they go back to
their departments in fulfilling their require-
ment to share with their people what they
have learned.
At the 90-day mark in employment,
employees attend the half-day ServU (for
Service University) to reinforce expected
service behaviors. In part of this session,
participants are provided the opportunity to
critique whether their fellow employees in the
organization are truly living the service be-
haviors that were presented to them in new
employee orientation.
Every 18 months, the organization con-
ducts, through Atlanta-based Sperduto &
Associates, a formal employee satisfaction
survey, which currently contains 58 ques-
tions. In addition, the Baptist Health Care
conducts quarterly “morale checks,” which
contain those questions from the larger sur-
vey that most closely correlate with em-
ployee loyalty. The quarterly surveys may
also contain selected questions that may be
designed to solicit feedback on a particular
initiative that is under way at the time. The
return on the latest of these surveys was 80
percent corporatewide and 93 percent from
Gulf Breeze Hospital.
Much care is taken in ensuring that the
results of the surveys are confidential, and
managers stress that the purpose of the sur-
veys is to improve, so employees should be
honest in their responses. Even so, Bilbrey
says many of the comments and suggestions
the organization gets are received orally in
Healthcare Leadership & Management Report
 Beyond Patient and Employee Satisfaction to Loyalty (cont...)
small meetings. “People are not shy about The WOW program cost the organiza- From the group of Champions, the most
telling us where we need to improve or where tion $130,000 last year. Some might say that exemplary employees are recognized as Leg-
we’ve gotten off target,” Bilbrey said. “It’s this a large sum of money to spend on an ends. This recognition includes presenting
not uncommon for someone to stand up in a incentive program, but Bilbrey does not them and their stories at the annual board of
quarterly employee forum and say ‘I’ve got agree. “I think it is an incredibly efficient use directors’ retreat. The stories of the Legends
a beef with this.’” are published in a Legends
Baptist Health Care booklet and in a full-page ad
will soon begin using a “Having high satisfaction is great, but it is only in the local newspaper.
Web-based employee “What we have to do in
morale instrument called a beginning step in my mind. You really are striv- the healthcare system is set
the “Temperature ing for high patient loyalty.” up the culture so that people
Check,” which will be can do the right thing be-
conducted quarterly. cause they want to do the
There is also an effort Pamela A. Bilbrey right thing, they want to ex-
under way to make the ceed expectations, and they
Internet and the want to make a difference in
company’s intranet available and readily ac- of dollars to help people focus on the be- peoples’ lives,” Bilbrey said.
cessible to the entire staff. haviors that we’re trying to implement Empowerment is also seen in service
Baldrige examiners have also been help- throughout our system,” Bilbrey argues. recovery activities of the organization. Any
ful in garnering employee feedback. Bilbrey When behavior goes far beyond what employee of Baptist Health Care can spend
said that three years ago the organization is expected, the employee is recognized as a up to $250 to address a service recovery is-
began “dabbling” in using the Baldrige Na- Champion. The following is an actual ex- sue without asking permission or providing
tional Quality Award criteria. “We realized ample of actions that earned one Baptist an explanation. The average cost of a ser-
we were getting nowhere fast by dabbling in Hospital employee Champion status. A vice recovery item is $25. Employees can go
the Baldrige criteria.” She said the organiza- nurse was preparing a man for surgery when to the gift shop, pick out an item for service
tion made a huge commitment to the he told her that he was not overly worried recovery, and then sign for it. Or if they need
healthcare quality criteria, and during the about his surgery, but that he was put out cash for this purpose, they can sign for that
past two years has been able to do well in because the surgery was going to make him out of a cash box in the emergency depart-
meeting some of the criteria. The Baldrige miss the season finale of his favorite televi- ment. Baptist Hospital even has a separate
examiners have visited the organization for sion series. At home that night the nurse phone line for reporting service recovery in-
each of those two years. Bilbrey said that taped the show and then brought the tape cidents so that they can be documented for
the feedback provided by the examiners in to the very appreciative patient the next day. improvement purposes.
their reports is “incredibly valuable” to im-
provement efforts at Baptist Health Care.
Bilbrey said the formation of the Em-
ployee Loyalty Team has been critical to Bap- Figure 3: Positive Employee Morale
tist Health Care’s efforts. According to the
organization, the duties of the Employee Loy-
alty Team are to establish and maintain the
organization’s standing as an employer of
choice, and recognize and reward employ-
ees’ achievements through hospitalwide
celebrations.

Loyalty From Reward, Recognition

and Empowerment

The organization provides incentives

for individual initiative by recognizing em-
ployees with WOW awards. Five WOW
awards may be exchanged for gifts, which
include $15 department store coupons and
$20 hospital gift shop coupons. This award
Source: Bilbrey, P. "Journey to Excellence: The Baptist Health Care Story."
recognizes behavior that goes beyond what
Presentation at the Customer Service for Health Care Symposium. May 6, 2002
is expected.

Healthcare Leadership & Management Report May 2002 n 7

 Beyond Patient and Employee Satisfaction to Loyalty (cont...)
Bilbrey listed some best practices the things to see, especially in the cost-savings physician loyalty, came out of efforts to en-
organization has implemented in service re- arena,” she said. “Now we really have to hance both the patient and physician expe-
covery: challenge ourselves to look at the sacred rience in the organization. Both physician
cows—the things that we’ve been doing and non-physician team members come to-
• Establish recovery gether to work on this
guidelines and standards. team.
• Incorporate service re- “People use the words satisfaction and loyalty The efforts of what is
covery into hiring, train- now known as the Physi-
ing and empowerment.
interchangeably, but they are two very different con- cian Loyalty Team began
• Offer multiple channels structs.” with asking physicians
for customer complaints what the organization
and service recovery re- Pamela A. Bilbrey could the
do better. Some of
first enhancements of
sponse.
the team were made in
• Create a system for
nursing issues. Physicians
identifying service failures, sharing data, forever that might have been someone’s pet
had often said that they had trouble recog-
analyzing causes, and developing and project—and say, 'Maybe it’s time to make a
nizing RNs vs. non-RNs in the units. The
implementing solutions. change.'” team worked with nurses on this issue, and
Employee empowerment is also seen in the nurses came up with their own standard
Baptist Health Care also empowers em- the work of teams and their decision-making of dress. Also, on their badges, the letters
ployees with its Bright Ideas program, which capabilities. An example of this came in a RN are large and they are colored bright red,
began in 1998. According to the organiza- team meeting over a need identified by pa- so that RNs can be readily identified by both
tion, “Anything that helps an office, a de- tient satisfaction surveys. Two of the frus- physicians and patients.
partment or the facility to operate more effi- trations that patients expressed on satisfac-
The physicians also said they often had
ciently or that makes life easier for the cus- tion surveys were that parking at Baptist
difficulty locating a nurse when they needed
tomer is a bright idea.” The goal of the Bright Hospital was either too far away or too hard
one. The solution was to give each nurse on
Ideas program is “empowering employees to find. The Inpatient Satisfaction Team at
duty a cell phone to use while on the shift.
to take ownership of improving their work Baptist Hospital met and decided to create a
Now physicians can contact individual
environment.” Employees are not restricted valet parking service at the hospital. Then
nurses by calling that nurse’s cell phone.
to suggesting bright ideas in their own de- they just created it.
The organization also took this a step fur-
partments; they are encouraged to look
“These teams are empowered to make ther by allowing patients to contact the
throughout the system for ways to improve
nurses via cell phone. Another problem was
service excellence, and save time and money. decisions,” Bilbrey said. “They do not have
to go to an administrator and say we want to when physicians would be called for ques-
The bright ideas are submitted to managers,
tions about a patient, the nurse often would
who are required to report within 30 days on recommend this—they just make it happen.”
At first, the service recruited college stu- not be able to answer specific questions
whether the bright idea was implemented and
why or why not. dents to volunteer their time to provide the about the patient. In response to this prob-
no-tip service. However, because of the very lem a procedure was put in place to require
In the past year alone, 6,717 bright ideas positive response to the program, staff was nurses to have the patient’s chart in hand
were implemented for an average of 1.79 hired to provide the service. Bilbrey said that when calling the physician.
bright ideas implemented per full-time em- now, all of the hospitals in the Pensacola
The following are other enhancements
ployee. The goal for this year is to have 2 area have valet parking services. “We set
that have been made by the Physician Loy-
bright ideas implemented per full-time em- the expectation for the entire community.”
alty Team:
ployee. The goal for 2003 has been set at 2.5.
Bilbrey worries that these gains might be Physician satisfaction and loyalty are
integral to the satisfaction efforts at Baptist • Physician birthday lists are dissemi-
harder to achieve than the earlier progress.
“For the first few years it was the low-hang- Health Care. The Physician Satisfaction nated to all department heads so employ-
Team, which Bilbrey started, and remains a ees can wish them a happy birthday.
ing fruit—the ideas that were fairly easy
member of the team as the senior adviser for

Pamela A. Bilbrey is senior vice president of corporate development for Baptist Health Care. She is responsible for executive
oversight of strategic planning, all marketing and public relations functions for the health system as well as the organization's call
center and centralizing scheduling functions. Additionally, Bilbrey has responsibility for Baptist University. Bilbrey serves on the
performance improvement steering committee and is responsible for Baldrige 3 initiatives. She also holds executive level responsi-
bility for the Baptist Health Care Leadership Institute, which provides training and consulting services for healthcare leaders
across the country.

8 n May 2002 Healthcare Leadership & Management Report

 Beyond Patient and Employee Satisfaction to Loyalty (cont...)

• Thank you notes are given to physi- during the period and a report is presented Bilbrey said the following are the les-
cians from staff at the end of the 90 days. This information is sons the organization has learned and the
• Physicians can also be recognized as also shared with other departments. things they need to do to make sure the gains
Champions Communication is another factor that continue:
• Part of emergency department physi- sustains the momentum and the culture. In
cians’ payment under their contracts is addition to the aforementioned communica- • Constantly strive to exceed expecta-
tion boards and access to financial reports, tions
based on patient satisfaction scores.
• A physician-only action line has been the organization holds quarterly employee • Be willing to accept feedback from cus-
forums, new leader luncheons and employee tomers
established that allows them to submit
both complaints and compliments. feedback luncheons with administrators. • Create a culture in which employees
Storytelling is a big part of the communica- feel valued
• Physicians participate in implementing tion at Baptist Health Care. Much of this
service recovery • Align behaviors with goals and values
storytelling now occurs via e-mail through-
out the system. The organization’s intranet “The journey continues, and it’s a tough
So What Does it Mean? site and Web site are also rich and growing journey that we constantly have to take a
information sources for the employees. look at,” Bilbrey said.
In the beginning, the initiative at Bap-
tist Health Care was focused on improving
employee morale, and then improving patient
satisfaction, rather than seeking to increase
market share. “The reason that we entered
this cultural transformation is because we
had lost sight of what we were as an organi-
zation,” Bilbrey said. “We really did not ex-
pect market share to increase, but we are
happy to report that market share has in-
creased as word has gotten out and we have
become a preferred hospital in the region.”
Bright ideas have also been successful.
The economic impact of the Bright Ideas pro-
gram alone has been $2.9 million in savings
just for fiscal year 2001.

How Long Can it Last?

Bilbrey said that the hardest part of an

effort such as this is to sustain the culture.
She said in the beginning of the effort, some
people saw the initiative as “flavor of the
month” or objected to the changes imposed
on their behavior, and they left the organiza-
tion.
In order to keep this from happening
continually and to sustain the culture there
is a concerted effort to maintain focus on
loyalty. This is where the “Five Pillars of Op-
erational Success” come in. These pillars are
People, Service, Quality, Financial and
Growth. Every department leader is required
to prepare and maintain a 90-day plan that is
organized around the Five Pillars. The plan
states what priority action items will be per-
formed under each of the five areas during
that 90-day period. The 90-day plans are
monitored by the respective departments

Healthcare Leadership & Management Report May 2002 n 9