In the Real World: Talk to Stakeholders

Our local hospital has a national reputation as a high-quality institution. If you know anything about healthcare, you understand how valuable that is. High patient satisfaction ratings mean more federal (and sometimes state) dollars. Happier patient stakeholders mean more referrals and more revenue. In healthcare, quality isn’t just a buzzword.
But getting into the hospital is like gaining access to Fort Knox. I understand the need for security, but it adds a good 10 minutes to a visit. The main lobby is always crowded and confused; if you go in that way, bring your patience too.

The Problem

Patient Parking SignMy husband requires a monthly medical treatment. We park at a back door, in a small lot designed to serve out-patients who need access to the few departments nearby. Otherwise, it’s a long, long walk from the bustle of the main lobby. It’s also a convenient shortcut for vendors servicing medical equipment
Getting in and out is quick and easy and the security guards are great: they get to know you and greet you with a smile. I don’t know how they stay so cheerful, because there is no shelter from the elements. Even in good weather, strong winds blow around a nearby corner. It gets brutally hot in the summer, miserably damp and cold in the winter. The equipment they need to look up names and print ID tags never works—it wasn’t designed to be used outside.
We asked about the situation as one guard wrote out our nametags by hand on a “Hello My Name Is” label. The hospital refused to invest any money in an adequate guard station. It was only a back door and not as busy as the main lobby. Why bother?
Unfortunately, bad people recognized an opportunity. They began to sneak in. The staff had problems with unwanted guests trying to steal drugs and equipment, or harass patients. It was getting out of hand.

The Solution Worked—Until It Didn’t

Russian guardsHospital security implemented a solution. They installed a camera and intercom system. To get in, you buzzed the security office. They examined you through the camera, asked you to hold up your ID, and then let you in or sent you around to the main lobby. But the hospital was unwilling to invest in a good camera and visitors were unprotected from the elements. Most of the time the guard who answered the call couldn’t clearly see visitor’s faces, much less read the proffered ID card. Many were sent to the madhouse in the main lobby.
A lot of the patients who use that door are in poor health. Walking around the building is difficult, even if you’re agile. Having to go to the front strained parking attendants and volunteers, held up medical procedures, delayed equipment repairs, reduced the number of patients the departments could treat in a day, and, as a result, reduced revenue while increasing costs. Worse, stakeholders were irritated to the point of irrationality. It risked impacting the patient satisfaction scores.
That got everyone’s attention.

Who Needs Stakeholders?

vault lockFrustrated by all the complaints, hospital security went for the cheap-and-easy solution: lock the back door. Grant access only to staff with access badges.  That was it, problem solved. 
Oh, and don’t tell anyone that’s what you’re doing. 
You can see where this is going.

Well, That Didn’t Work Either

Not only did it make things even worse, it caused a number of unforeseen problems. The hospital added temporary staff to answer the increased volume of complaints. Because many patients couldn’t walk from the main lobby to the back of the hospital, more volunteers were needed to push them in wheelchairs. But the volunteers didn’t return the wheelchairs when they were done, so the hospital had to purchase more wheelchairs—and find more people to return the wheelchairs to the main lobby.  Meanwhile, the wheelchairs were starting to pile up in corridors and waiting areas. (I thought the hospital looked like the set of “Dr. Who.”)
Vendors were delayed further in getting to their repair appointments. Expensive medical equipment sat unused—and not generating revenue—even longer than before. To keep patient satisfaction scores up, a small nation’s budget in Starbuck’s gift cards were sent out acknowledging the inconvenience and thanking everyone for their patience
Staff schedules were upended because patients and vendors were delayed. Not only did that cost the hospital more money in overtime, it also meant staff was upset. To their credit, they didn’t take it out on patients, though managers sure got an earful.

The Point Is…

Talk to your stakeholders. Start by investigating the following questions for yourself, then check your understanding with your stakeholders.
  • What problem are you really solving? People were sneaking into the hospital through a back door. The real problem: Security guards weren’t equipped to work effectively. (A little root cause analysis would have sussed this out.)
  • Why does the problem need solving? Bad people were trying to gain access to drugs, equipment, and patients. Yup, that’s a good reason to fix the problem!
  • Who is impacted by the problem? Bad people, sure; but also security guards, out-patients, volunteers, parking attendants, staff, and vendors—stakeholders no one thought about.
  • How would your stakeholders solve the problem? Locking the back door seemed like the simplest, easiest solution. Who doesn’t love simple and easy?
A better solution: Invest in a weatherproof station and equipment to protect the guards, help them do their jobs, and make them more comfortable. Yes, it cost money in the short run. But the solutions that were implemented turned out to have a much larger impact on costs, revenues, quality and customer satisfaction.
  • How will you measure results? Clear indicators catch problems in the making. In this case, the solution eliminated security problems at the back door and meant the guards could be reallocated elsewhere. (Yay! Problem solved!) But the unintended consequences were more costly by far–and weren’t uncovered until much later. Oh, and in all the confusion, more bad people were getting past the guards at the main lobby. (Boo! Hiss!)
A final note: By the end of the first week, the back door was reopened and smiling guards were once again greeting us. It turns out cranky out-patients are a force to be reckoned with.