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BirdsEye View

The medical profession has never been the beacon of customer-centricity; in fact, some say quite the opposite.  This is why I was so struck by the recent experience Dick and I had with Dr. Ranawat, the Hospital of Special Surgery and his entire knee replacement process.  There is much to learn from their protocol.

Dick and I went to see Dr. Ranawat in NYC on the recommendation of a friend.  Dick has experienced knee pain for years, and the local doctors said it was time for some shots to ease the pain and improve mobility.  We flew to New York expecting similar but better executed advice.

The first shock came when we set the appointment.  They answered the phone on the second ring.  They were not surly.  They accepted our limited availability given the pre-scheduled flights and found time for us.  They told us what to bring and why.  The scheduling was actually a pleasant experience.

Next came the appointment.  Stunned again, we did not have to wait.  The receptionist welcomed us and sent us to a room.  Dr. Ranawat’s nurse came right away and asked countless questions.  Then another doctor came to collect further data, apologizing if he repeated any of the questions asked by the nurse. Shortly thereafter, in glided Dr. Ranawat, with three doctors in tow.  He watched Dick walk, then asked him to lie down and with his bare hands touched the knee and measured it, murmuring numbers under his breath that were immediately recorded by his followers.  He then looked at Dick and said:  "This will not get better.  You need a full knee replacement.  You don’t have to get it today or tomorrow, but it will not get better."  We were shocked.  This wasn’t what we expected.  I asked, "Will it deteriorate further if he doesn’t do the operation?"  Ranawat said he could delay the inevitable as long as he wanted without consequences.

We thanked the doctor.  We were ready to leave with a heavy heart.  But the nurse insisted that we see one more person to conclude the process.  That person, Ana, was the best closer I’ve met in years.  She spent the time explaining why knee replacement was the only solution and the right one.  She handled all conceivable objections before we even had time to consider them, being still stunned by the news that such a drastic procedure was the best answer to Dick’s situation.  She elaborated on what made this hospital special, why Dr. Ranawat was different and how comfortable they would make Dick before, during and after the operation. We absorbed maybe half of what she said, but it was indeed compelling.

Ana also noted that the Doctor had one opening in June, and then nothing until late August.  The entire sales process was needs-based and very soft.  If you didn’t know any better, you’d think there was no sales process at all, but simply a consultation session.

As we walked (Dick hobbled) down the New York streets on the way back to our hotel it was clear Dick had no intention of doing this. But by the time we got home, we were both convinced it was the right thing to do, and jumped on the one available day in June the operation could take place.  We canceled a trip to Israel with Liat and her boyfriend to do this, which included my first grade reunion.  This is how strong our conviction was that we must do this.

If you think of all that took place until now as the first phase of needs-based selling (need identification, diagnosis and solution recommendation) of, say, a mortgage, next came the interim period of document collection, data collection and back-and-forth questions.  Ana and the nurse were the “mortgage processors” in this case, collecting additional data and answering many silly questions.  They were always available, positive and responsive, no matter how small or embarrassing the questions were.

A week before the surgery Dick flew to New York and had a full day of examinations, tests and education.  Yes, education.  The well-oiled machine required a 1 1/2 hour class to explain the entire process, prepare the patient for what will happen and why, and talk about recovery.  Dick met with the surgeon, the anesthesiologist, and the cardiologist who would be watching him throughout the process etc. It was a brilliant move to build patient confidence in the service team and highly anxiety reducing. Dick had so many people he could call with any questions or concerns, plus he knew he’d be seeing the same faces throughout the process.  This was not only a great move to improve the entire experience, but also for cross-selling purposes.  Guess who is Dick’s cardiologist now?

And then the fateful day arrived.  Check-in was a breeze.  All initial contact was done at the Family Atrium, a well-lit and comfortable large room with stunning Manhattan views.  The receptionist knew who we were and within minutes we were ushered to the pre-op room where Dick’s name, allergies and other vital details were confirmed yet again.  His leg was shaved with an electric “snipper” to avoid painful and infection-prone nicks.  The surgeon came once again to shake his hand and sign both his ID bracelet and his leg.  The anesthesiologist arrived and told him again what would happen and what medicine he would be taking.  Dick was introduced to the “Ranawat” cocktail, a combination of infection-fighting medications and numerous strong pain killers.  In addition, Ranawat injects pain killers directly into the knee during the operation.  Its effects last almost 36 hours.  These two steps are unique to the doctor, and are aimed at improved patient comfort but also faster healing.  Patients without pain move better...

The product itself was also of the highest quality and had some unique features, most of which I’m sure I don’t know. Dr. Ranawat’s prosthesis has plastic in it, not just metal-on-metal.  His incision is straight through the middle of the knee, not on the side.  His stitching is continuous, not one stitch at a time.  I’m told this makes for better healing and mobility.

We had heard how painful knee replacement surgeries are, especially when physical therapy starts.  In Dick’s case it started the same day of the operation.  He walked that night – and yet, no pain.  The doctor’s philosophy is to be ahead of the pain, and that’s exactly what happened.

Countless times a day we were asked if there is anything we need.  The food was edible (!), at least by Dick’s standards... Beverages and snacks were available 24/7.  Nurses responded to pings in a timely manner.

Dick was released from the hospital on the third day.  He had an exit interview, a booklet depicting the exercises he needed to do and their frequency and number, as well as plenty of pain medicine.  The next day, Sunday, a visiting nurse followed up with us at the hotel to ensure all was well and to check his vitals.  The same day someone called for a customer experience survey to ask Dick about his experience, both whether there was anyone to recognize and whether any issues arose.  The next day, Monday, a physical therapist who had also had this very surgery came to work with Dick.

This is not an ode to Dr. Ranawat, although it might as well be.  This is an observation on a non-differentiated product that was differentiated 100% on service and anticipation of customer needs.  The product itself, as mentioned, was also somewhat different, and arguably of better quality.  But knee replacements take place thousands of times every day around the country, so product differentiation itself might not be enough.

The customer experience was defined through the customer’s eyes, from the very first time the customer entered the hospital.  Attentiveness and timeliness of service and information gathering created a strong first impression and a sense of well-being from the first point of contact.  A subtle sales process took place as an integral part of the first appointment.  Objections were handled preemptively.  From the moment the customer bought the product, they were placed on a well- oiled assembly line that appeared fully customized and addressed a wide range of possible needs.  Service was attentive yet efficient, since the process was clearly established.  It was almost amusing to hear almost every time a new medical professional observed Dick: "You must be a Ranawat patient!"  That by itself inspired confidence.

We must learn that the customer experience is defined by the customer, not us.  So when we measure transaction times, they should be measured from the moment the customer enters our parking lot until they leave, because that’s how the customer measures transaction duration.  Measuring how long they wait from the moment they enter the teller line until they leave it might be easy to measure and produce good results, but it does not reflect how the customer thinks.

Medicine and financial services aren’t all that different.  Heavy fixed costs, heavy human resources and technology costs, and customer expectations for zero defects.  I think there is much we can learn and emulate from Dick’s knee replacement surgery.  In addition to many individual elements, the overriding themes are:
 

•  See the process from the customer’s eyes
•  Define process start and end as the customer would
•  Identify all main elements of the process and mass customize (standardize) them
•  Allow some but not much flexibility by vesting some authority in the front line
•  Gather customer feedback immediately after the experience
•  Reevaluate and do it all over again
•  Incorporate technological innovation into the process as appropriate

You can certainly assemble your account opening, mortgage selling and fulfillment and other major sales processes around the bank using this logic, and both you and your customers will benefit from this effort.