RETHINKING THE PATIENT EXPERIENCE ELLIOT K. FISHMAN, MD, SIVA P. RAMAN, MD
Stories From the Kitchen: Lessons for Radiology From the Restaurant Business Cindy Wolf, Elliot K. Fishman, MD, Karen M. Horton, MD, Siva P. Raman, MD MS CINDY WOLF Perhaps there are no two greater pleasures in life than to eat good food and drink good wine. My involvement in the restaurant business has been based, at its core, on my passion for food and the culture of the people who initially created those foods, and it’s my love for those two things that I try to convey through my restaurants and menus. My goal at the Charleston, and all of my other restaurants, is to take care of my customers—make them feel cared for, even loved, as they enjoy great food and drink. Clearly, those of you in health care are dealing daily with lifeand-death issues, and although the restaurant business is certainly stressful and difficult, life and death are not within my business’s purview. Nevertheless, we are both in the business of ensuring the happiness and comfort of our customers, and in that way, I think there are clear parallels between the restaurant business and health care. We have the greatest respect for the customers who choose to come into our restaurant. Our patrons have incredibly high expectations every time they enter the door—the average bill for a customer at the Charleston is over $150, and putting aside the money our customers are paying, it is not at all infrequent that we have customers whose trip to the Charleston is a truly special event, such as a couple with a new baby making their first trip outside the house. We never forget the expectations such customers have, and consequently, every element of those
customers’ experiences at our restaurant must be exceptional, from the moment they make a reservation up until the moment the valet hands them their car keys for the return home. At the Charleston, we refuse to ignore a single moment of that experience, and there is no part of a customer’s service that we regard as being inconsequential. For example, when we started our restaurant, we initially hired an outside company to handle the valet service for our customers. For a number of reasons, that service was not up to our standards, and as a result, we did not hesitate for a moment to begin our own internal valet service just for our customers, completely free of charge, performed at the same high standards we expect for every other part of our business. We now run 6 successful restaurants, a fact we are incredibly proud of, given the high failure rate among restaurants in general. In the restaurant world, different aspects of the business are often described as being “back of the house” (ie, kitchen and food preparation) or “front of house” (all other aspects of the business, including interacting with customers, managing finances, etc), and many chefs fail because they cannot combine excellence in these two widely disparate areas. I think that is a primary reason so many restaurants fail, despite having great food and wonderful cooks—possessing a great kitchen is not enough if you cannot properly manage the front of the house, the
ª 2015 American College of Radiology 1546-1440/15/$36.00 n http://dx.doi.org/10.1016/j.jacr.2014.07.005
part of the restaurant customers see first and that determines much of their experience. I have been lucky in that regard, as my partner, Tony Forman, is one of the great front-of-the-house restaurateurs in the business. He knows the finances, wine, and customers as well as anyone possibly could, and he has been a vital component of my success. He can tell you a particular customer’s preferred table at a restaurant we owned almost two decades ago. He understands that every guest is always the most important person in the room, and we have instilled that ethos in all of our staff members. Interestingly, this is one area where your industry, in my experience, fails: several years ago, my father underwent major surgery, and I felt that the health care staff did not consider him to be the most important person in the room and were simply not listening to what he and my family had to say to them. We maintain this emphasis by paying attention to how every person in our organization deals with the customer. This begins with a focus on carefully training newly hired employees, rather than simply having them start working under the hope that they will naturally do a good job. We give each trainee a clear job description, and we do our best not to overwhelm trainees with too much all at once but rather to slowly bring them up to our expectations. Everyone is trained by the best possible person: a new waiter is not just trained by the last waiter we hired
307
but rather by senior people, such as our general manager. I train and work with every new hire myself, imparting my philosophy and expectations, and giving them a sense of what I believe they should know. We train everyone until they are ready. Needless to say, we do not allow our newly hired staff members to “practice” on our customers! Given the care we put into training our employees, it is not surprising that we want to prevent turnover. We pay our employees very well, provide them health insurance, and give them creative freedom, things that are not common in our industry. We are constantly paying attention to the performance of our employees and trying to make things better. At the same time, however, we handle those changes and criticism very carefully—I never scream at or embarrass our employees, something that occurs far too often in my industry. Necessary changes are made quickly, but I respect my employees too much to ever embarrass them by highlighting those corrections in public. As a result, we have enjoyed remarkably low turnover at all of our restaurants, and we have retained many of these highly trained employees, in some instances, for decades. Given the stability of our staff, we have teams of employees in our restaurants that now work on “autopilot”—their every interaction with a customer is natural and intuitive on a daily basis. Not surprisingly, this philosophy has allowed us to maintain a remarkable constancy of quality in each of our different restaurants. Having put the time and effort into training our staff, often from the earliest entry positions, we almost always promote from within
whenever we start new restaurants, thereby maintaining our expected quality at every new establishment. I realize that managing the customer experience will undoubtedly be harder in a big organization like yours. Nevertheless, that is no excuse not to try. Hire people who care about and believe in what your organization is doing, and keep paying attention to every aspect of the customer experience.
n
KEY POINTS AND LESSONS FOR RADIOLOGY n
n
The juxtaposition of the back of the house and front of the house is an apt one for radiology. We spend much of our time thinking about the back of the house (ie, the practice of radiology), with very little attention to the “front of the house” (ie, appointment schedulers, receptionists, parking, etc). As in the restaurant business, the problems with the front of the house can be devastating for the economic success of a radiology practice, and in most cases, a patient’s perception of your practice can be driven largely by the front of the house, no matter what the quality of radiology being practiced at your institution. Cindy Wolf ’s emphasis on providing her customers with an exceptional “end-to-end” experience should be a lesion for us. Radiology practices often seem to care only about the short period of time during which a patient is being scanned and the study is being interpreted, without thinking about the other aspects of a patient’s experience. How many
n
practices would pay as much attention to their valet parking service as Ms Wolf, even though we charge our patients much more than the Charleston does for a meal? Ms Wolf ’s philosophy to make each customer feel like the most important customer is definitely applicable to our radiology practices. We are all aware of VIPs who visit the department, and we always try to make sure these individuals have an exceptional experience. Our goal should be to make sure every patient is treated with the same attention to detail. Every patient should be considered a VIP. The care and effort taken by the Charleston in the training of its employees is thought provoking. Radiology staff members involved in roles other than patient care are usually paid poorly, given poor benefits, and provided with very little training (if at all). Just as important, radiologists are likely to pay little or no attention to the quality of work being provided by such personnel. At our institution, likely reflective of practices across the country, radiologists pay little attention to this group of employees, virtually never interact with them, and are often blind to the importance of these staff members in driving patients’ perception of a practice and the ultimate economic success of a radiology group.
ADDITIONAL RESOURCES Additional resources can be found online at: http://dx.doi.org/10.1016/ j.jacr.2014.07.005.
Siva P. Raman, MD, Karen M. Horton, MD, and Elliot K. Fishman, MD, are from the Department of Radiology, Johns Hopkins University, Baltimore, Maryland. Cindy Wolf is co-owner and executive chef of the Foreman Wolf restaurant group in Baltimore, Maryland. Siva P. Raman, MD: Johns Hopkins University, Department of Radiology, JHOC 3251, 601 N Caroline Street, Baltimore, MD 21287; e-mail: [email protected].
308
Journal of the American College of Radiology Volume 12 n Number 3 n March 2015
Stories From the Kitchen: Lessons for Radiology From the Restaurant Business Cindy Wolf, Elliot K. Fishman, MD, Karen M. Horton, MD, Siva P. Raman, MD MS CINDY WOLF Perhaps there are no two greater pleasures in life than to eat good food and drink good wine. My involvement in the restaurant business has been based, at its core, on my passion for food and the culture of the people who initially created those foods, and it’s my love for those two things that I try to convey through my restaurants and menus. My goal at the Charleston, and all of my other restaurants, is to take care of my customers—make them feel cared for, even loved, as they enjoy great food and drink. Clearly, those of you in health care are dealing daily with lifeand-death issues, and although the restaurant business is certainly stressful and difficult, life and death are not within my business’s purview. Nevertheless, we are both in the business of ensuring the happiness and comfort of our customers, and in that way, I think there are clear parallels between the restaurant business and health care. We have the greatest respect for the customers who choose to come into our restaurant. Our patrons have incredibly high expectations every time they enter the door—the average bill for a customer at the Charleston is over $150, and putting aside the money our customers are paying, it is not at all infrequent that we have customers whose trip to the Charleston is a truly special event, such as a couple with a new baby making their first trip outside the house. We never forget the expectations such customers have, and consequently, every element of those
customers’ experiences at our restaurant must be exceptional, from the moment they make a reservation up until the moment the valet hands them their car keys for the return home. At the Charleston, we refuse to ignore a single moment of that experience, and there is no part of a customer’s service that we regard as being inconsequential. For example, when we started our restaurant, we initially hired an outside company to handle the valet service for our customers. For a number of reasons, that service was not up to our standards, and as a result, we did not hesitate for a moment to begin our own internal valet service just for our customers, completely free of charge, performed at the same high standards we expect for every other part of our business. We now run 6 successful restaurants, a fact we are incredibly proud of, given the high failure rate among restaurants in general. In the restaurant world, different aspects of the business are often described as being “back of the house” (ie, kitchen and food preparation) or “front of house” (all other aspects of the business, including interacting with customers, managing finances, etc), and many chefs fail because they cannot combine excellence in these two widely disparate areas. I think that is a primary reason so many restaurants fail, despite having great food and wonderful cooks—possessing a great kitchen is not enough if you cannot properly manage the front of the house, the
ª 2015 American College of Radiology 1546-1440/15/$36.00 n http://dx.doi.org/10.1016/j.jacr.2014.07.005
part of the restaurant customers see first and that determines much of their experience. I have been lucky in that regard, as my partner, Tony Forman, is one of the great front-of-the-house restaurateurs in the business. He knows the finances, wine, and customers as well as anyone possibly could, and he has been a vital component of my success. He can tell you a particular customer’s preferred table at a restaurant we owned almost two decades ago. He understands that every guest is always the most important person in the room, and we have instilled that ethos in all of our staff members. Interestingly, this is one area where your industry, in my experience, fails: several years ago, my father underwent major surgery, and I felt that the health care staff did not consider him to be the most important person in the room and were simply not listening to what he and my family had to say to them. We maintain this emphasis by paying attention to how every person in our organization deals with the customer. This begins with a focus on carefully training newly hired employees, rather than simply having them start working under the hope that they will naturally do a good job. We give each trainee a clear job description, and we do our best not to overwhelm trainees with too much all at once but rather to slowly bring them up to our expectations. Everyone is trained by the best possible person: a new waiter is not just trained by the last waiter we hired
307
but rather by senior people, such as our general manager. I train and work with every new hire myself, imparting my philosophy and expectations, and giving them a sense of what I believe they should know. We train everyone until they are ready. Needless to say, we do not allow our newly hired staff members to “practice” on our customers! Given the care we put into training our employees, it is not surprising that we want to prevent turnover. We pay our employees very well, provide them health insurance, and give them creative freedom, things that are not common in our industry. We are constantly paying attention to the performance of our employees and trying to make things better. At the same time, however, we handle those changes and criticism very carefully—I never scream at or embarrass our employees, something that occurs far too often in my industry. Necessary changes are made quickly, but I respect my employees too much to ever embarrass them by highlighting those corrections in public. As a result, we have enjoyed remarkably low turnover at all of our restaurants, and we have retained many of these highly trained employees, in some instances, for decades. Given the stability of our staff, we have teams of employees in our restaurants that now work on “autopilot”—their every interaction with a customer is natural and intuitive on a daily basis. Not surprisingly, this philosophy has allowed us to maintain a remarkable constancy of quality in each of our different restaurants. Having put the time and effort into training our staff, often from the earliest entry positions, we almost always promote from within
whenever we start new restaurants, thereby maintaining our expected quality at every new establishment. I realize that managing the customer experience will undoubtedly be harder in a big organization like yours. Nevertheless, that is no excuse not to try. Hire people who care about and believe in what your organization is doing, and keep paying attention to every aspect of the customer experience.
n
KEY POINTS AND LESSONS FOR RADIOLOGY n
n
The juxtaposition of the back of the house and front of the house is an apt one for radiology. We spend much of our time thinking about the back of the house (ie, the practice of radiology), with very little attention to the “front of the house” (ie, appointment schedulers, receptionists, parking, etc). As in the restaurant business, the problems with the front of the house can be devastating for the economic success of a radiology practice, and in most cases, a patient’s perception of your practice can be driven largely by the front of the house, no matter what the quality of radiology being practiced at your institution. Cindy Wolf ’s emphasis on providing her customers with an exceptional “end-to-end” experience should be a lesion for us. Radiology practices often seem to care only about the short period of time during which a patient is being scanned and the study is being interpreted, without thinking about the other aspects of a patient’s experience. How many
n
practices would pay as much attention to their valet parking service as Ms Wolf, even though we charge our patients much more than the Charleston does for a meal? Ms Wolf ’s philosophy to make each customer feel like the most important customer is definitely applicable to our radiology practices. We are all aware of VIPs who visit the department, and we always try to make sure these individuals have an exceptional experience. Our goal should be to make sure every patient is treated with the same attention to detail. Every patient should be considered a VIP. The care and effort taken by the Charleston in the training of its employees is thought provoking. Radiology staff members involved in roles other than patient care are usually paid poorly, given poor benefits, and provided with very little training (if at all). Just as important, radiologists are likely to pay little or no attention to the quality of work being provided by such personnel. At our institution, likely reflective of practices across the country, radiologists pay little attention to this group of employees, virtually never interact with them, and are often blind to the importance of these staff members in driving patients’ perception of a practice and the ultimate economic success of a radiology group.
ADDITIONAL RESOURCES Additional resources can be found online at: http://dx.doi.org/10.1016/ j.jacr.2014.07.005.
Siva P. Raman, MD, Karen M. Horton, MD, and Elliot K. Fishman, MD, are from the Department of Radiology, Johns Hopkins University, Baltimore, Maryland. Cindy Wolf is co-owner and executive chef of the Foreman Wolf restaurant group in Baltimore, Maryland. Siva P. Raman, MD: Johns Hopkins University, Department of Radiology, JHOC 3251, 601 N Caroline Street, Baltimore, MD 21287; e-mail: [email protected].
308
Journal of the American College of Radiology Volume 12 n Number 3 n March 2015
