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‘Sometimes’ is the Enemy of ALWAYS

Posted By Jake Poore, Friday, July 24, 2015

In Jim Collins’ famous book "Good to Great”, he says ‘good is the enemy of great’. His premise is that we often settle or become comfortable with good or good enough instead of striving for more... reaching for the last inch that drives great experiences.

Great companies not only create experiences that reach more heights (or go the extra mile), they also seem to get everyone in the organization to deliver it, consistently... creating a culture of always.

If good is the enemy of great in business, then ’sometimes’ is the enemy of ALWAYS in healthcare.

  1. If we say, "we’re always going to knock on the patient’s door, wait for their reply, enter, make eye contact, smile, wash hands and introduce ourselves”, and we do this often, sometimes or even most times... we fall short of a culture of always.
  2. Imagine seven nurses care for a patient of over a three-day stay. If five nurses do these behaviors always and two don’t feel this is important and skip it, we’ve created a culture of sometimes – and again, we’ve fallen short on the journey to become a culture of always.

Unintentionally, I believe, we’re creating a silo mentality where everyone does their own thing. That’s a fragmented way to lead any organization. It creates chaos, dissatisfied patients (and employees) and ultimately, low patient satisfaction scores.

For today’s healthcare administrators, this isn’t just something that’s nice to do; it’s a must-do. Federal financial reimbursement is tied to CMS surveys. And these surveys only give credit for "always” answers. If your facility scores a 0 to 8 (never to sometimes), you get zero credit. Clearly, a culture of always means survival.

The popular phrase "culture eats strategy for lunch” rings true. If your culture is weak, how your employees perform their daily job tasks will trump any corporate strategy. You may have good intentions, but they’re only as effective as the integrity of your organization’s culture.


  • Some doctors shake hands with patients; some don’t.
  • Some sit and listen to the patient’s story before diagnosing; some interrupt within 18 seconds to "move along.”
  • Some nurses introduce themselves; some don’t.
  • Some offer to close your door for quiet from noise; most don’t.
  • Some food service workers offer to help elderly patients open plasticware and milk cartons; others drop and run.

Besides doctors and nurses, the average patient interacts with more than 100 care team members along their healthcare journey including call center employees, front desk reception, volunteers, transporters, security, food service, housekeepers, etc.

If culture is what we do every day, and we aim to create consistency to survive and thrive in healthcare, then we must create new daily habits as a team so everyone is on the same page. The key is redesigning the culture with input from every employee group.

It seems everyone is admiring this problem, but nobody has a clear solution. The real problem is we’re throwing spaghetti at the wall and hoping it will stick. The solution is to no longer teach to the test as a long-term strategy. To get to a culture of always, we have to change our culture.

Patients are like the canary in the coal mine. They’re sending up warning signals of a flawed culture because, just like the canary, they’re most susceptible in a toxic environment. And make no mistake - they’re calling us out on things that poison the patient experience.

Through patient satisfaction surveys.
By telling friends and family about the level of care they received.
And by taking their business and their loyalties elsewhere.

 *Hear more from Jake Poore about patient loyalty and creating exceptional patient experiences at the upcoming San Francisco Regional Roundtable.

As Founder and President of Integrated Loyalty Systems, a company on a mission to help elevate the human side of healthcare, Jake (@jakepoore) knows what it takes to create and maintain a world-class service organization. He spent nearly two decades at the Walt Disney World Company in Florida helping to recruit, hire, train and align their 65,000 employees toward one end in mind: creating memorable experiences for individuals, not transactions for the masses. In 1996, Jake helped launch the Disney Institute, the external training arm of Disney that sold its business secrets to the world.

Tags:  culture  patient experience  patient loyalty  service excellence  team 

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Comments on this post...

Renee Rountree says...
Posted Tuesday, August 04, 2015
Right on target!
Permalink to this Comment }

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