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After reading this article, answer the following questions:1. What provider gaps are addressed in the article?2. According to the article, how is Mayo Clinic addressing each of these provider gaps?Provide some specific examples to support your assessment.3. What useful insights did you get from the article?4. Using the process information identified earlier, please evaluate the effectiveness ofIsland Hotel for each of the provider gaps below. Use a 10 point scale where 1 is“poor” and 10 is “excellent.” In the space provided for each of the gaps, please providesome examples from the case to support your scores.
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BEST PRACTICE
In
Customers
by Leonard L Berry
and Neeli Bendapudi
When a company’s
offerings are hard
to judge, customers
look for subtle
Indicators of quality.
The Mayo Clinic
knows how to send
the right signals.
100
N
OBODY LIKES going to the hospital. The experience is at best
unnerving, often frightening,
and, for most of us, a potent symbol of
mortality. What’s more, it’s very hard for
the average patient to judge the quality
of the “product” on the basis of direct
evidence. You can’t try it on, you can’t
return it if you don’t like it, and you
need an advanced degree to understand
it – yet it’s vitally important. And so,
when we’re considering a doctor or a
medical facility, most of us unconsciously
turn detective, looking for evidence of
competence, caring, and integrity-pro
cessing what we can see and understand
to decipher what we cannot.
The Mayo Clinic doesn’t leave the
nature of that evidence to chance. By
carefully managing a set of visual and
experiential clues. Mayo tells a consistent and compelling story about its service to customers: At Mayo Clinic, the
patient comes first. From the way it
hires and trains employees, to the way
it designs its facilities, to the way it
approaches care. Mayo offers patients
and their families concrete and convincing evidence of its strengths and values. The result? Exceptionally positive
word of mouth and abiding customer
loyalty, which have allowed Mayo Clinic
to build what is arguably the most powerful brand in health care – with very
little advertising-in an industry where
few institutions have any brand recognition beyond their local markets.
It’s called “evidence management”:
an organized, explicit approach to presenting customers with coherent, honest evidence of your abilities. Evidence
management is a lot like advertising, except that it turns a company into a living, breathing advertisement for itself.
Other organizations manage evidence
well, too. Ritz Carlton, for example, very
effectively communicates outstanding
personal service: Employees at all levels
HARVARD BUSINESS REVIEW
take note of customer preferences and
are empowered to solve problems on
the spot, continually tailoring the experience to each person. Mayo Clinic does
not have all the answers; health care is
a highly inventive industry, and many
institutions could serve as fine examples to business. However, during our
extensive study of the Mayo organization over a five-month period, we saw
evidence-management practices that
rival or surpass anything we’ve seen in
FEBRUARY 2003
the corporate sector, practices that are
applicable outside of health care. As
part of our research design, we interviewed approximately 1,000 Mayo employees and patients, observed hundreds of doctor-patient visits at two of
Mayo’s three major campuses (Scottsdale, Arizona, and Rochester, Minnesota;
the third is in Jacksonville, Florida), and
stayed in the hospitals overnight as patients. In almost every experience and
interaction, in subtle and not-so-subtle
ways, we got the message that at Mayo
Clinic, the patient comes first.
Many businesses sell products that
are intangible or technically complexfinancial and legal services, software,
and auto repair are just a few-and their
customers naturally kxik for clues that
can help explain what they don’t understand or see. In fact, in just about any organization, the clues emitted by people
and things (humanics and mechanics,
respectively, as introduced to the management literature by Lewis Carbone
and Stephan Haeckel) tell a story to customers or potential customers. The question for managers is whether the clues
tell the intended story. Mayo Clinic’s effectiveness at designing and managing
evidence offers a lesson other service
organizations would do well to heed:
Understand the story you want to tell,
and then make sure your people and
your facilities provide evidence of that
story to customers, day in and day out.
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BEST PRACTICE • Clueing In Customers
Clues in People
credo-“The best interest of the patient
is the only interest to be considered”guides hiring decisions to this day.
It’s difficult to get a job at Mayo Clinic
because of intellect or technical skill
alone. Demonstrated task competence
is essential, of course, but the hiring
managers are also trained in behavioral
interview techniques, and they are expected to use them to elicit an applicant’s values. A candidate may be asked,
for instance, to discuss a time when he
continuity that, in turn, helps boost the
quality of care.
Once hired, all new employees go
through an orientation process specifically designed to reinforce the patientfirst mentality. The program for nonphysician empioyees-whether janitors,
accountants, or nurses – is designed to
help all staff people understand how
their jobs affect patients’care and wellbeing. If housekeeping fails to maintain sanitary conditions, for instance, a
When we interviewed Mayo patients,
we were struck by how consistently they
described their care as being organized
around their needs rather than the doctors’ schedules, the hospital’s processes,
or any other factor related to Mayo’s internal operations. The actions of Mayo
staff members, according to what we
were told, clearly signal the patient-first
focus. Here are representative remarks:
“My doctor calls me at home to check
on how I am doing. She wants to work
with what is best for my schedule.”
Evidence management is a lot like advertising,
“When 1 had a colonoscopy, [my docexcept that it turns a company into a living,
tor] waited to tell me personally that
I had a polyp because he remembered
breathing advertisement for itself.
that my husband died from small bowel
cancer, and he knew that I would be
set a developmental goal for himself patient’s health may be compromised
worried I may have the same thing.”
and how he met that goal, or to describe no matter how excellent the medical
“My oncologist is…the kindest man I
the proudest moment in his career or care received. Storytelling figures heavhave ever met. He related some of his
even the moment he found most frus- ily in these programs, with the emphapersonal life to me. I was more than my
trating. Interviewers avoid discussing sis on how employees have used Mayo
problem to him. He related to me as
hypothetical situations that allow can- values to make difficult decisions on paa person.”
didates to figure out the “right” answer tients’behalf.
Such glowing praise isn’t limited just and instead probe for specific details
Storytelling continues in the workto the doctors and nurses. One patient, that reflect true experiences and per- place because, once people are away
for example, was “amazed” at how well spectives. For example, a candidate who from the classroom, the idea of putting
the people at the registration desk han- identifies making a difference in a pa- the patient first can seem distant and
dle requests: “People who come up to tient’s life as his or her proudest mo- sometimes even unrealistic, given the
the desk are nervous, or angry, or abu- ment may be more attuned to Mayo’s stress and unpredictability of day-to-day
sive. These ladies at the registration desk values than one who mentions achiev- work. Consider, for instance, one story
just keep their cool. I wish they could ing a career milestone.
featured at several orientation sessions
train the customer service reps in deThe people who make the cut – in- and widely disseminated throughout
partment stores.”
deed, the people who are drawn to the organization. A critically ill patient
It’s no accident that employees com- Mayo in the first place-are those who was admitted to the Scottsdale hospital
municate a strong, consistent message take pride in having the freedom to shortly before her daughter was to be
to patients. Mayo explicitly and system- put patients first. We heard many doc- married, and she was unlikely to live to
atically hires people who genuinely em- tors and nurses say that they appreciate see the wedding. The bride told the hosbrace the organization’s values. The being allowed to practice medicine as pital chaplain how much she wanted
clinic emphasizes the importance of they feel it should be practiced. Those her mother to participate in the cerethose values through training and on- feelings of pride and the alignment of mony, and he conveyed this to the critigoing reinforcement in the workplace, employees’ attitudes with Mayo’s values cal care manager. Within hours, the hosa practice that began in the very early contribute to lower stafPtumover across pital atrium was transformed for the
part of the twentieth century, when the board. Annual turnover among wedding service, complete with fiowDrs. William and Charles Mayo started hospital nurses is only 4% at Mayo ver- ers, balkx>ns, and confetti. Staff memthe organization. Indeed, William Mayo’s sus 20% for the industry as a whole – bers provided a cake, and nurses arranged the patient’s hair and makeup,
dressed her, and wheeled her bed to the
Leonard L. Berry is Distinguished Professor of Marketing and holds the Zaie Chair of
Retailing and Marketing Leadership at Texas A&M University in College Station. Neeli atrium. A volunteer played the piano
and the chaplain performed the service.
Bendapudi is an associate professor of marketing at Ohio State University in ColumOn everyflotir,hospital staff and visiting
bus. Berry is author of “The Old Pillars of New Retailing” (HBR, April 2001), and Bendapudi is coauthor of “How to Lose Your Star Performer Without Losing Customers, Too” family and friends ringed the atrium
balconies, “like angels from above,” to
(HBR, November 2001).
102
HARVARD BUSINESS REVIEW
Clueing In Customers • BEST PRACTICE
quote the bride. The wedding scene provided not only evidence of caring to the
patient and her family but also a strong
reminder to the staff that the patient’s
needs come first. They got the message:
We heard the story again and again in
our interviews with employees.
Another story was initially told at a
leadership development program for rising Mayo administrators. In one session.
Mayo staff members shared experiences
that showed how the service philosiv
phy affects care. An emergency room
physician told of a patient who walked
into the ER with severe shortness of
breath. When told she had a bacterial infection requiring immediate surgery,
the woman expressed concern about
her sick dog, which was in her illegally
parked truck. The attending nurse assured her that he would move the truck
and take care of the dog, but when he
walked outside, what he saw was not a
pickup but a semi, which he wasn’t licensed to drive. He was about to have it
towed – for $700 – when he stopped to
consider ways he might save the patient
the expense. In the end, the nurse took
it upon himself to obtain permission
to park the truck at a nearby shopping
center for a few days and find a fellow
nurse – a former trucker – to drive the
truck there. He took the dog to a veterinarian and then cared for it in his
own home while the patient recovered.
When asked what prompted him to do
this, the nurse replied,”At Mayo Clinic,
the patient’s needs come first.”
Various events celebrating exceptional service on behalf of patients further reinforce empk^ees’ commitments.
The Rochester campus hosts an annual
Heritage Week, celebrating the clinic’s
history and values and reinforcing their
relevance to Mayo’s work today through
historical presentations and displays,
lectures, ecumenical and liturgical services, concerts, and social events. Employees, retirees, volunteers, patients,
visitors, and members of the community
are invited. Mayo Rochester also recognizes exceptional service with its quarterly campuswide Karis Award (Karis is
Greek for caring). All staff members
are eligible and can be nominated by a
FEBRUARY 2003
coworker, patie
ily member;
the identity oft
tor is not disclosed, which removes political considerations from the process. One 1999
winner, a world-renowned colorectal
surgeon with numerous scientific recognitions, told his tablemates at the award
luncheon that he cherished the Karis
more than any other award he’d received, calling it “the only award 1 have
for just being a really good doctor.”
Clues in Collaboration
In 1910, William Mayo said: “In order
that the sick may have the benefit of advancing knowledge, union of forces is
necessary… .It has become necessary to
develop medicine as a c(x>perative science.” Dr. Mayo’s vision protbundly infiuences the organization’s approach
to care. Patients experience the Mayo
Clinic as a team of experts who are fc>
cused on patients’ needs above all else.
They perceive an integrated, coordinated response to their medical conditions and, often, to related psychological, social, spiritual, and financial needs.
Elsewhere, doctors may be reluctant to
admit to any gaps in their knowledge.
Not so at Mayo. Mayo Clinic assembles
the expertise and resources needed to
stilve the patient’s problem. If a Mayo
doctor can’t answer a question and
needs to bring someone else onto a
team, she freely admits it to the patient.
The doctors meet with one another and
with the patient-visible evidence that
they are collaborating to solve the patient’s problem rather than passing it
from one doctor to another. One patient
we interviewed expressed a common
sentiment when he said,”I have a lot of
problems, and 1 like that I can go to
Mayo and be seen by a team of specialists who work together to see the big
picture.” Collaboration is particularly
The Research
Mayo Clinic has three major campuses (Rochester, Minnesota; Scottsdale,
Arizona; and Jacksonville, Florida); primary care clinics in more than
60 communities; 21 owned or managed hospitals; more than 2,800 staff
physicians; medical technology, medical publishing, laboratory, and
health care benefits-administration businesses; and revenue in excess
of S4 billion. It serves more than 500,000 individual patients annually.
For this article, we conducted the largest service study ever done at
Mayo Clinic. During a five-month period, we interviewed approximately
1,000 Mayo patients, physicians, nurses, allied health staff^ and managers
at the original Rochester campus and the Scottsdale campus. We also
collected data as participant observers, checking into the hospitals as
patients, observing surgeries in the operating room and more than 250
doctor-patient interactions in the examination room, making hospital
rounds, and flying on the Mayo One emergency rescue helicopter service.
We formally studied service delivery in 14 medical specialties selected to
provide a cross-section of the practice: cardiac surgery, cardiology, dermatology, emergency medicine, endocrinology, family medicine, gastroenterology, medical and radiation oncology, neurology, orthopedic surgery,
preventive medicine, thoracic surgery, transplant surgery, and urology.
Mayo Clinic gave us complete access to study its service culture and
processes, and our study was approved by the Mayo Clinic Institutional
Review Board.
103
A SPECIAL HARVARD BUSINESS REVIEW
AOVEATISING SECTION
WanderLuxe
An Insider’s Guide for the
^Traveling Connoisseur
IF YOU LIKE TO GO FIRST Clueing In Customers
and floor, glasswork sculpture suspended above, and a multistory wall
of windows looking onto a garden. The
building’s soaring lobby houses a cancer education center because, as one administrator put it, “the more visible the
center, the more you remove the stigma
of having cancer.” The lobby of Mayo
Clinic Hospital in Scottsdale is also visually stunning, with its atrium,
indoor waterfall, stonework,
and wall of windows overlooking a mountain range.
Mayo doesn’t limit its facilities’ clue management
to public spaces. After all,
the scary stuff in a medical
facility happens elsewhere-in
the catheterization lab, in diagnostic imaging, in the hospital room. At
Mayo hospitals, staff members write the
names of attending doctors and nurses
on a white board in every patient’s
room, which helps stressed-out patients
and families keep track of multiple caregivers and serves as a visible clue that
there’s a real person they can talk with
about any concerns. In-hospital showers, microwave ovens, and chairs that
convert to beds are available for family
members because, as one staff member
explained, “People don’t come to the
hospital alone.” The pediatric section of
the emergency department of Mayo’s
St. Mary’s Hospital in Rochester transformed artwork by local schoolchildren
into a colorful array of wall and ceiling
tiles. The resuscitation equipment in
pediatric examination rooms is hidden
behind a large picture (which slides
out of the way when the equipment is
needed). While the hospital was under
construction at the Scottsdale campus,
officials arranged to have an automobile lifted into the building so physical
rehabilitation patients would be able to
practice getting in and out of a car in the
privacy of the hospital.
Environmental clues in the outpatient setting are orchestrated just as
carefully. Mayo Clinic buildings include
quiet, darkened private areas where patients can rest between appointments.
Public spaces are purposely made softer
with natural light, color, artwork, piano
106
music, and the sights and sounds of
fountains. In examination rooms, the
physician’s desk is adjacent to a sofa
large enough for the patient and family
members, a design that removes the
desk as a barrier between doctors and
their patients.
Mayo also understands that the way
employees present themselves sends
a signal to patients. Patients
don’t encounter doctors in
casual attire or white coats.
Instead, the more than
2,800 staff physicians
wear business attire, unless they are in surgical
scrubs, to convey professionalism and expertise. It’s
a dress code that some outside
Mayo have called”pretentious,”yet we’d
argue that it’s no more pretentious than,
say, the dress code for airline pilots. Airline passengers don’t want to see their
pilot in a polo shirt, and patients feel the
them. Offended, Morris said that she
worked in a laboratory, not with patients, so why should it matter? Her boss
replied that Morris had contact with
patients in ways she didn’t recognize going out on the street wearing her
Mayo name tag, for instance, or passing
patients and their families as she walked
through the halls-and that she couldn’t
represent Mayo Clinic with dirty shoelaces. “Though I was initially offended,
I realized over time [thatl everything I
do, down to my shoelaces, represents
my commitment to our patients and
visitors,” Morris told us. “Tventy-eight
years later I still use the dirty shoelace
story to set the standard for the service
level I aspire to for myself and my coworkers.”
A dirty shoelace might seem pretty
minor, given the important work of caring for the ill. But a shoelace is something a customer can see, whereas medical expertise and technical ability are
Clearly identify a simple, consistent message, and
then manage the evidence-the buildings, the
approach to care, even the shoelaces-to support
that message, day in and day out
same way about doctors. In effect. Mayo
Clinic doctors-just like service workers in many other industries – work in
a uniform; it’s a visible clue that communicates respect to patients and their
families.
Such attention to visual clues extends to the most minute detail. Mayo
Rochester employee Mary Ann Morris,
the administrator of General Service
and the Office of Patient Affairs, often
tells a story about her early days with
the organization. She was working in a
laboratory-a job that required her to
wear a white uniform and white shoesand after a hectic morning getting her
two small children to school, she arrived
at work to find her supervisor staring at
her shoes. The supervisor had noticed
that the laces were dirty where they
threaded through the eyelets of Morris’s shoes and asked Morris to clean
not. It’s a piece of evidence, a small but
integral part of the story Mayo tells to
its customers. We aren’t arguing that
“patients first” is the only story a medical institution might choose to tell patients. A hospital might instead choose
to signal,”We hire the smartest doctors,”
and manage the evidence with prominent displays of academic credentials
and awards, a lecture series, and heavy
publicity about new research. What
Mayo Clinic has done better than just
about any organization we can think of,
however, is clearly identify a simple,
consistent message and then manage
the evidence-the buildings, the approach to care, and, yes, even the shoelaces-to support that message, day in
and day out.
^
Reprint R0302H
To order, see page 127.
HARVARD BUSINESS REVIEW
Marketing Management
Assignment 2
Part 1:
Please read the following article:
Berry, Leonard L. and Neeli Bendapudi (2003), “Clueing In Customers,” Harvard
Business Review, Feb., 100-106.
After reading this article, answer the following questions:
1. What provider gaps are addressed in the article?
2. According to the article, how is Mayo Clinic addressing each of these provider gaps?
Provide some specific examples to support your assessment.
3. What useful insights did you get from the article?
Part 2:
1. Please read the following short case for Island Hotel.
For those of you accustomed to staying at hotel chains when you travel, consider your
experience with the Island Hotel, a bed and breakfast located in Cedar Key, a small
barrier reef on the gulf side of the Florida coast. You telephone the inn to reserve a
guest room and speak directly to one of the owners, who sounds very happy to take
your call. She tells you that the hotel, build in 1859, is on the national Register of
Historic Buildings and that each of its 134 guest rooms is uniquely decorated. She
discusses each of the available rooms until you find the one that sounds right for your.
When you arrive at the Hotel, she and her husband and the inn’s famous chef Jahn
McCumbers meet you in the lobby and welcome you personally. The husband, not a
bellhop, carries your bags to your room, which is charming and has an old-fashioned
claw-footed bathtub right in the corner. After you open your bags and freshen up, you
go to the restaurant downstairs, renowned as a superior seafood restaurant in Cedar
Key and the surrounding area. You choose the house specialties, Crab Bisque and
Heart of Palm Salad, and say hello to the chef when she stops by your table to ask if all
is OK. You shop in the small bar that has a large mural of King Neptune and his
court stretching across the wall and find that the bartender and all the customers
welcome you as if you were a regular. When you return to your room, the owner is
putting fresh towels on your bed and wishes you a good evening. You make one more
stop before you sleep: you step out on the balcony to sit on a large rocking chair and
look out over the bay and marina, feeling as if you have just spent a day with a warm,
caring family in an impeccable home rather than in a hotel. This feeling is repeated
every day of your stay, and when you leave, the owners and chef are in the lobby to
personally thank you for coming and send you on your way.
Most of you will agree that the service experience at the island Hotel is exceptional.
The reservation is tailored to you; the employees (in this case, owners and chef and
bartender) are concerned and genuinely care about your comfort; the setting is ideal;
the other guests and customers are friendly; the food is superb; and – perhaps most
impressive- the whole experience from reservation to stay to check out is coordinated
to make you feel known and special.
2. Using the process information identified earlier, please evaluate the effectiveness of
Island Hotel for each of the provider gaps below. Use a 10 point scale where 1 is
“poor” and 10 is “excellent.” In the space provided for each of the gaps, please provide
some examples from the case to support your scores.
The Listening Gap
1 2 3 4 5 6 7 8 9 10
The Service Design and Standards Gap
1 2 3 4 5 6 7 8 9 10
The Performance Gap
1 2 3 4 5 6 7 8 9 10
The Communication Gap
1 2 3 4 5 6 7 8 9 10
Total Score for Island Hotel = ______ points
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