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Leading a successful emergency department (ED) requires a diverse and sometimes seemingly disparate set of skills. One of the most important and yet elusive of these skills is motivating the ED staff towards the absolute importance of matching clinical excellence and service excellence. Leadership teams increasingly require demonstrable metrics in all areas of ED operations, including customer service scores. And yet while all hospitals and healthcare systems place a premium on delivering the highest quality customer service, until recently very few of them actively trained their staffs in the specific skills required to deliver this elite level of service. Further, and sadly, very few nursing schools and even fewer medical schools have made service excellence training a part of their core curriculum.1

This chapter focuses on the importance of understanding the concept of patient expectations as well as 2 fundamental issues necessary to effectively and predictably lead teams to service excellence and sustain that level of service over time:

  1. Why should leaders and their teams focus on service excellence?

  2. How can excellent results be attained and sustained?

Once the “Why” and the “How” have been practically defined, a specific set of core competencies and tools (“The A Team Toolkittm”) are delineated to accomplish the goal of establishing a culture of service in the ED.

In every clinical situation, the patient and their family and loved ones bring a certain set of expectations to the encounter. These expectations essentially form their “mental model”2 of what is likely to transpire over the course of their care. These expectations may be accurate or inaccurate, but they must never be ignored. As Box 10-1 shows, many healthcare providers feel it is simply their job to meet these expectations—no more and no less. However, if those providing healthcare do no more than meet the patients' expectations, the patient is “merely satisfied,” meaning they are neither disappointed nor delighted with the care provided. What they expected to occur fundamentally did occur. Thus, when concerns are brought to the attention of those who cared for the patient, it is common to hear, “But I provided adequate care and I met the patient's baseline expectations.” In the current highly competitive healthcare market, “merely” satisfying patients will almost certainly not be enough to meet the service excellence targets set by and for ED teams. More importantly, as the next section emphasizes, it is difficult if not impossible to create staff satisfaction if we are merely satisfying the patients.

Box 10-1 Merely Satisfied Patients

When patients' expectations are not met, the patient is dissatisfied and patient complaints occur (Box 10-2). It is precisely to the extent of the difference between the patient's expectations and the failure to deliver a service that meets those expectations that the complaint ...

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