Assess your current strengths and weaknesses related to service – to patients and internal customers. Typical assessments include a review of relevant documents such as patient and employee satisfaction survey results, and interviews or focus groups with key stakeholders. It is critical that the assessment be conducted by someone who is seen as unbiased and impartial, so that the results are seen as credible. Many organizations bring in an outsider to conduct the assessment, even if they plan to carry out the culture change work without a consultant.

This group will use the Assessment report to make decisions about what changes to make to improve service to patients, families, physicians and internal customers. Members should include front line and management staff. It is critical the group be empowered to make changes, in spite of opposition they will no doubt encounter along the way. Action Teams chaired by Steering Committee members should focus on specific categories of change. They should set aggressive goals, and should continue to raise the bar as early goals are achieved.

Standards of Behavior must become baseline expectations of all employees. They must be concrete and observable or measurable. A plan for holding people accountable for following the Standards should be developed concurrently.

All stakeholders need education. Board members need to understand the scope of the planned changes. Leadership, management and front line staff need to understand the reasons for change, and must understand expectations for new behavior. Physicians should be included. Also have a plan for reaching new employees.

No one should be hired or promoted unless they embody the spirit of Service Excellence. Job descriptions should include prominent mention of service expectations. Hiring practices should include communicating service expectations via video or reading material before applicants are interviewed. Behavioral and peer interviewing should be used. Performance evaluations should give substantial weight to service behaviors.

You want people to behave in new and different ways. Behavior that is noticed is repeated. Recognition is a no-cost way to thank employees. Use it often. Have multiple systems to reward employees, at the department and organization level. Change formal systems often, so they remain a source of motivation. Involve front line employees in designing recognition and reward systems.

Develop specific expectations of all leaders and managers. Determine how they will be held accountable. Don’t forget Recognition and Reward for managers. All departments should have relevant 90- Day Improvement Plans, and should discuss them regularly with their superiors. The Steering Committee should provide feedback to senior leaders about how their behaviors are helping or hindering the culture change.

Every department should appoint one or more non-management people to reinforce the Service Excellence culture by serving as a communication link between the Steering Committee, manager and staff. The Department Rep becomes an ambassador for service, and can help communicate about various organization-wide changes, or lead the department’s improvement team. This role should be seen as a prestigious one.

Communication about the Service Excellence culture change initiative should be constant, and should cover every aspect of what is happening – Assessment report and goals, Standards of Behavior, progress toward goals, lessons learned, etc. Use multiple media (emails, intranet website, bulletin boards, flyers, newsletters, payroll stuffers, etc.) and repeat, repeat, repeat.

Finally, they must appoint someone to be the Operations Lead for this work. This lead will be responsible to keep the momentum going. S/he will chair the Steering Committee and assure Action Teams stay on track. The Operations Lead will keep Department Reps updated and assure they have tools or training necessary to be successful. This person should be obsessed, creative, high energy, well-respected, and a role model.