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Principles of Service, a customer service program emphasizing accountability, has expanded beyond expectations since its inception two years ago at the University of Texas Medical Branch (UTMB) at Galveston, says Randy Kirk, assistant director of patient finance/admitting.
The program (first profiled in Hospital Access Management in January 1996) is centered around 14 principles under the headings of "professionalism," "teamwork," and "improvement," which make up a service code. (See code, inserted in this issue.) It got its impetus from UTMB’s chief executive officer, administrators, and physicians, known for leading the wave of change in the organization.
The first phase of the project targeted employees who come in direct contact with patients, including admitting, clinic, and emergency department staff front-line employees as opposed to those who work behind the scenes. Phase two, which addresses nursing and other caregiver areas, has been going on for a little more than a year and is almost finished, Kirk says.
Phase three, aimed at some 1,300 employees in such areas as transportation, pharmacy, and laboratory, also is under way. The university’s non-clinical business offices have started their own Principles of Service program, he adds. "The ultimate goal is to go through the entire university."
One of the program’s key benefits to date is that it has opened the eyes of admitting personnel to the duties of their counterparts in other areas, and vice versa, Kirk says. "This promotes teamwork and improvement. People not involved in a process often will say, Why can’t such and such be done?’ and the person involved responds, I never thought about that.’"
Alliances forged during Principles of Service training sessions spill over into the workday, he points out, creating a camaraderie among departments. "From that cooperative spirit comes continuous process improvement."
Originally designed for only the few areas of UTMB that deal directly with the public, Principles of Service has caught on and spread much further than anticipated, Kirk says. "Each branch started seeing what was done and saying, We want to be a part of it.’" It’s very difficult to be held accountable for an attitude, he explains, but the program has defined "attitude" and made the concept real. "It’s evolved into something that’s necessary for the entire university, not just the clinical side."
As part of the program, staff undergo "360-degree" performance evaluations by supervisors, co-workers, internal customers, and patients. Although training plays a key role, the program stresses staff accountability over education.
When employees receive their feedback on the evaluation, they’re told verbatim how they’re perceived by co-workers, supervisors, and other departments, Kirk explains. The individual must make a written plan of action in response to the three lowest scores.
For example, an employee might receive a low rating on the statement, "treats co-workers fairly, with consideration and respect," which is under the main topic of professionalism and the principle, "demonstrate competence, caring, and compassion to each individual." He or she would then design a plan, with an ending date, for improving performance in this area perhaps watching a video or reading a book about that principle. The person’s supervisor signs off on the plan and then returns to the employee at the appointed time and asks, "What have you done?"
Employees also must write action plans on one of the areas in which they receive a high score. That plan might entail, for example, being a mentor to a co-worker who needs help in that area.
The program includes "contracts" between departments, outlining what each expects of the other. For example, the admitting department might agree that cash collected by its cashiers will be delivered to patient finance promptly at 3 p.m. each day, or that there will be no more than a 1% variance on account numbers. Patient finance might agree to have a staff member available at 2:30 p.m. each day to pick up the cash.
One factor that distinguishes Principles of Service from other quality improvement initiatives is the high degree of support and participation by physicians, Kirk says. This participation "from the top down" gives the program more credibility among employees, he notes. In addition to serving on task forces and committees, physicians recently began receiving instruction on the principles.
The program has been well-received and appears to be having a positive impact, although there are no hard data yet, Kirk says. "People are interacting better with each other, both staff to staff and with patients.
"There are always a few naysayers," he says, "but eventually those people who don’t follow the path of the principles or conform and accept them will be surrounded by those who do, and it will be uncomfortable for them."
In the end, he adds, the major impact of the program will be on the customer. "Because people have a choice of where they receive their health care, good customer service is going to be the determining factor. If that’s what brings people to UTMB Galveston, then we’ve reached our goal."
[For more information, contact Randy Kirk at UTMB, Route 0209, Galveston, TX 77550-0209. Telephone: (409) 772-1579.]