Lessons in hospital courtesy

What can Massachusetts General Hospital learn from Ritz-Carlton hotels?

In the area of customer service, plenty, starting with how to answer the telephone.

Boston teaching hospitals -- known for their world-class medical care, but sometimes brusque treatment of patients -- are responding to increased competition among themselves by trying to make patients feel more like valued customers.

Mass. General brought in a consultant from Ritz-Carlton, the global hotel chain known for its luxury service, to stress what may seem obvious: the importance of a warm smile and addressing patients by name.

Beth Israel Deaconess Medical Center dispensed with its limited menu of prepared-in-advance food and is rolling out a hotel-quality meal service that features an expanded menu of made-to-order selections.

Brigham and Women's Hospital distributes beepers to patients so they can visit the cafeteria or other parts of the hospital while waiting to see a doctor.

And telephone etiquette has become a focus at all three hospitals. Phones are now answered promptly, and managers monitor calls to make sure receptionists are polite and follow standardized scripts.

Instead of a terse, ''Radiology, please hold," callers now are more frequently asked, ''How may I help you?"

''For whatever reason, we have gotten away in the healthcare industry with acting very, very poorly towards our customers," said Elizabeth Woodcock, principal of Woodcock & Associates, an Atlanta medical consulting firm that's helping Brigham & Women's train employees in telephone etiquette and other courtesies.

''Historically, these esteemed institutions have been able to rely on their reputations," Woodcock said. ''Now they understand that they must provide exceptional service, in addition to their clinical performance."

Getting customer service right is a higher priority because patients are becoming more discerning and are more likely to shop around for care, said hospital officials. Also, starting in 2007 the federal Medicare program plans to post the results of standardized patient-satisfaction surveys. That will allow the public to view how patients ranked their hospital experience.

As a result, the teaching hospitals affiliated with Harvard University, Tufts University, and Boston University are borrowing methods perfected by employees of Southwest Airlines and Disney World.

''We're in the process of changing our culture," said Sheryl Katzanek, director of patient advocacy at Boston Medical Center, which this year designated nonclinical employees as ''ambassadors" who visit nine inpatient wards every day to ask patients how their stays could be made better.

They also make sure patient bathrooms and privacy curtains are clean, and that the names of doctors and nurses are written on white boards in each room. Acting on feedback, they already have made changes, including turning off a noisy page system at night on certain floors.

''It can sometimes be impersonal at a large teaching hospital," Katzanek said. ''The care we deliver is quite good, but the way we deliver it needs improvement."

Brigham and Women's assigned some of its managers to solve chronic problems in reception areas. Their analysis, predictably, uncovered chaos.

Front-office receptionists were answering phones, checking insurance information, registering patients, monitoring waiting times, fetching files -- often simultaneously. There was little time to speak with patients, much less smile.

''These folks were so harried and had so much going on that it was hard for them to focus," said Sharon Cohen, a program manager at the Brigham and Women's physicians organization. The hospital also asked patients what they thought, and got an earful. ''We heard some pretty impassioned statements," Cohen said.

The fix was to redistribute tasks, so receptionists could concentrate on their primary duty: welcoming patients.

In the Brigham and Women's neurology clinic, for instance, the hospital set aside a closet-size space for two employees to do nothing but answer phones. Another office employee was designated as the insurance information fact-checker and billing trouble-shooter. Those two moves freed up the front-desk receptionist to greet patients and make sure they were comfortable.

The moves yielded instant results. According to the hospital, unanswered telephone calls in neurology dropped from 40 percent to 10 percent in one month after the program began in January 2004. The number of bills rejected by insurance companies for incomplete or inaccurate information dropped from about 8 percent to less than 4 percent.

Even with the obvious advantages of polite and efficient service, convincing some Brigham and Women's employees to change their habits has not always been easy, said Craig Williams, administrator for the neurology and neurosurgery departments. ''You get some eye-rolling," he said.

But hospitals have demonstrated a willingness to change personnel to achieve the desired effect. When Beth Israel turned its attention to a call center for its physician group that receives 1,500 calls a day, it asked all 13 receptionists to reapply for their existing jobs. Only three members of the original crew survived.

Food has become a major part of the effort to make patients happier. Mass. General is concluding a six-month effort to improve its food service that included retraining servers.

''The servers are told to speak directly to the patient, call the patient by name, announce what your name is and where you are from, and why you are there," said Susan Barraclough, director of Mass. General's nutrition and food services.

Room-service meals -- served at the time of day requested by a patient, and featuring an expanded variety of choices -- have become common in smaller community hospitals. The practice has been slower to catch on in urban medical centers, though Children's Hospital Boston and Tufts-New England Medical Center make it available, as do certain areas of other hospitals, like the maternity ward at Brigham and Women's.

Beth Israel said its room-service program, with made-to-order meals served within 30 minutes, will be introduced throughout the hospital by the end of January. The plan required kitchen renovations, new computer systems, and retraining.

But hospital officials say the benefits are worth it. Previously, meals were cooked, chilled, then reheated for delivery to patients. When patient surveys showed widespread dissatisfaction with the results, the hospital at first attempted to tweak the system.

''We had tried a lot of other things. We kept revising patient menus, and we would retrain our staff. Nothing was working," said Joanne Marqusee, Beth Israel's senior vice president for operations and facilities.

The new menu puts the emphasis on freshness and choice. For example, there are 10 dessert choices. But despite the upgrades, some things about hospital food apparently will not change: Beth Israel still offers ''gelatin cubes."

Christopher Rowland can be reached at crowland@globe.com.