Tale of Two Hotels, Part 2

As mentioned last time, back in September, Katie and I were in Las Vegas.  The first hotel we stayed at was an aggressively service-oriented hotel.  I say “aggressively” because I have been at service-oriented hotels before, but I have not seen this level of attention to every detail at any of those hotels.  Again, in the interest of the story and not the business being the focus, I won’t identify them.

Last time I addressed those who will reject cross-industry examples for healthcare.  But, as I was writing this, I realized that, if you separate out the clinical aspect of an inpatient stay, hospitals and hotels are very similar from a patient’s¹ perspective.  First, the reason you find yourself there has nothing to do with the room itself.  You are in a hotel room because you are on vacation or working.  It is a waystation to the REAL reason you are in town.  Even if the hotel itself is a spa or resort and you are there for self-care, you are there to get a facial or play a round of golf.  As much as the hotel photos show people sitting in bathrobes, drinking coffee and looking at the view, that is not the primary reason people are dropping a couple-hundred bucks a night to stay there.  It is even possible that a guest at a hotel didn’t actively choose that hotel or doesn’t want to be there to begin with.  There may have been limited options for the time or in the community.  Someone may be staying there to visit a sick friend, or go to a funeral, or even go to a wedding for a family member that they don’t really like and can’t really afford.²  I probably would not have chosen the Las Vegas hotel I was at, were it not where the conference I was attending was located. 

While it may seem strange to some, most patients chose the hospital that they are at.  There can certainly be insurance elements, an “unplanned hospital admission” (healthcare-speak for when shit meets fan), or general lack of bed availability, but in a broad sense, patients have choice.  If you think patients don’t have choices, then you can please explain why hospitals have marketing teams and spend money on billboards, TV, on-line media, or naming rights to sports arenas. 

So, a hotel room, like a hospital room, is essentially means to an end.  This is not meant as an insult, but the four walls of that room are a blank canvas.  While a hotel, like a hospital, will want you to pick them instead of their competitors, the basic descriptors of a room—bed, bathroom, chair—are essentially the same across all options.  So, for both, the real differentiators are the people who serve that room and that patient/guest.  Having high thread-count sheets can make something a luxurious experience, but it does not make it a remarkable experience.  The staff do that.  In that way, a hotel is a lot like a hospital. 

While at this hotel, I had a chance to spend about a half-hour with the head of guest services, and I was curious to discover how he was able to align the corporate philosophy with the reality of the workforce.  Given that another similarity between hospitals and hotels is that they are both chronically understaffed, I was really interested in how he was able to hold people accountable for service when there is considerable stress just to hire warm bodies to do the actual work of parking cars, cooking food, making beds, cleaning bathrooms, emptying trash.  He talked about two things that are not new or revolutionary, but I was excited to hear that he made them top-line priorities.

The first was a focus on empowering staff to close service gaps immediately.  This, like so many things, seems obvious in the abstract, but becomes challenging in the moment.  In hospitals, we tell staff to address concerns quickly, but then we circumscribe this request with a bunch of rules and provisos.  Before my friends in Risk get panicked about non-clinicians crossing some line, remember that much of what a patient or family member wants or needs is not related to clinical care.  If a family member missed breakfast so they could be in the room at 0600 when the doctor does rounds, can a nurse order that person something from food and nutrition services?  Can the housekeeper or lab tech give them a voucher for the cafeteria?  Or do these things require prior approval or are only allowed in special circumstances?  Hospitals certainly function on their documentation, but if you require additional hoops to hop through to address an issue in the moment, you miss TWO important opportunities.

• First, you miss the win of immediately addressing something.  Imagine that you are dealing with some service gap and the person you are dealing with says “I’ll have to check with my manager.”  (Or even worse they say, “YOU will have to check with my manager.”)  You know now that getting a resolution will become a burden.  Now you must determine whether getting a resolution is worth the rigmarole—the time, the seven transfers and the two accidental disconnections.  How often have you thought “I am not asking for much, why can’t they just take care of this?” or, “They are just making this difficult so I will give up”?  Even if you do persist, and get a resolution, the time between your request and their approval mitigates any positive impact.  In fact, if there is a lot of time between you calling a company and you finally getting a resolution, you will likely give yourself the credit for doing the hard work rather than give the company credit for giving you what you want.  In an effort to be good stewards of resources, they lost the opportunity to wow you or even get credit for helping you.
• Second, by creating all of the rules, you teach your staff that it is just too much work to engage with patients.  If addressing a concern requires a ton of documentation or gets you dinged by your supervisor because you stopped your work to get a warm blanket for a patient, you are teaching your staff that the juice for the patient is not worth the squeeze on them.  I am a numbers nerd, and we need metrics to measure performance, but your time-per-call metric is more important than a scheduler getting a patient the appointment that works for them, your focus on resources is the reason you are not getting top-box scores.

The second thing he talked about was a need to make sure that work silos would not be an excuse not to act.  Everyone has their job duties, but one of them is making sure that the guest gets what they need.  The person who brings room service is not the guy who stocks the towels or pods for the coffee maker.  But when they say, “Is there anything else I can to for you?” there is a strong possibility that these are the things that people ask for.  Instead of having staff say, “call housekeeping” or even “I will call housekeeping” the training is that room waiter will say, “I will take care of that.”  Part of that is hiring and training well.  But, as referenced above, part of that is giving that person autonomy to act and not get beaten with a bag of oranges for returning late from a delivery.  This has three benefits.

• First, it is likely faster.  Having the room service waiter go down the hall to the supply closet and grab three coffee pods and two towels will take less time than having them get on the radio, pull a housekeeper away from what they are working on and then verify later that the request was resolved.  Having a food service person show a patient how to change the channel on the TV, or get them another blanket is faster than putting that task on the nurse’s plate.
• This builds collegiality among staff.  When I see you doing my job without complaint, I am more likely to step in and do your job as well.  It isn’t a one-way street where it all rolls down to me.  You get towels and I will take care of a room-service tray in the hallway.  In the long run, it evens out and the guest wins.
• It also allows for triage in the moment.  If I complain to housekeeping that the room is too hot, they can check to make sure the thermostat is set appropriately before calling in the HVAC team.  If you have silo-blindness, you will automatically put a ticket into HVAC and they can discover that the switch was accidentally set to heat instead of cool, which wastes their time and delays the customer’s satisfaction.

When I train, I call this having organizational accountability.  Hospitals are great at stressing individual accountability.  But even if everyone is doing what they need to be doing at all time, things fall through the cracks.  By encouraging staff to keep their eyes open and their head on a swivel, they can address things that are not “their job” but will make things so much smoother for them and provide a better experience for the patients.

I was in upstate New York one February, working with a hospital.  I was early so I could just sit in the lobby and watch things.  At this hospital, the cafeteria was directly off the main lobby and the line for breakfast was creeping into the lobby.  I saw an EMT get in line, but as he stood there, he saw two things that no one else did.  First, he saw an elderly woman approaching the sliding front door with her walker.  Second, he saw that the carpet mat at the front door (catching all the slush and snow) had developed a wrinkle or ripple.  He quickly did the math—walker + slush + wrinkle = tripping hazard—and leapt into action.  He left his place in line, ran over, straightened the mat and helped the woman into the hospital.  It all took less than forty seconds.  He lost his place in line doing something that was not his job.  Heck, as an EMT, he may not even have been employed by the hospital.  But he saw an opportunity to make a difference and operated with attention to organizational accountability and not individual accountability.

What these two concepts—empowering staff and organizational accountability—teach us that being present matters.  No one is a ghost in the machine.  Further, it teaches us that often acting is less important than listening.  One of the top complaints that patients have is that they are not heard.  Conversations between clinicians too often happen across a patient’s bed rather than to the patient in that bed.  Yes, a patient wants to have a working TV, but first they need someone to hear that the TV is broken and treat that problem as a priority.  This is what an aggressively service-oriented workplace looks like.

¹One element that will probably trip me up here is the fact that hotels have ‘guests’ and hospitals have ‘patients.’  (Though I did work at one hospital that called their inpatients ‘guests.’)  For this essay, I will probably use these terms interchangeably, as I bounce from one space to another.  I apologize in advance if this causes confusion.

²One other thing to consider is that both hotels and hospitals deal with people dying in those rooms.  Between age, overdose and suicide, there is a 1-in-40 chance that someone has died in that hotel room you are staying in.  One might argue that it is harder working in a hotel here, since at least the last two will end up being surprise discoveries for the cleaning staff.