Reproduced with permission from the January/February 2010 issue of Spectrum,
© 2010 by the Society for Healthcare Strategy and Market Development.
Planning
Achieving Performance Excellence Through
Transparency
In the recent push by healthcare organizations
to improve their performance, there has
been a tremendous and necessary focus on
external customers, whether they are
patients or referring physicians. In the
process, complex, service-oriented
industries such as healthcare risk
overlooking the needs of internal
customers—the clinical depart-
ments that depend on support areas
to deliver the customer experience.
Effective experience management
recognizes the contributions of
departments such as planning and
strategic support, human resources, and
IT to the effectiveness of those with cus-
tomer-facing roles.
A Commitment to Performance
Excellence
Froedtert & Community Health, based in Milwaukee, provides
comprehensive medical care through a system of hospitals,
physician networks, and an affiliation with The Medical College
of Wisconsin. As the health system with the only academic med-
ical center in eastern Wisconsin, the pressure is high to deliver
personal care and access to the latest medical technology.
In 2005 Froedtert & Community Health leadership endorsed
an organization-wide commitment to performance excellence.
Our goals were to recognize the meaningful contributions of all
functions and to focus the entire organization on achieving
benchmark performance in strategic priorities such as service,
physician and staff engagement, quality, and finance.
To get the ball rolling, leaders of departments across the
organization participated in action-oriented workshops to define
their roles, their contributions to the customer experience, and a
process for working together toward achieving common goals.
The training, however, was only a start; we recognized the need
for reinforcement to maintain internal momentum to make our
commitment to performance excellence a reality. We realized
that although training and leadership buy-in were necessary, they
were insufficient in themselves to build an organizational culture
around service excellence.
Given the success of previous “voice of the customer” exer-
cises eliciting feedback from patients and physicians, leaders saw
an opportunity to do the same with internal customers. The
research focused on one key question: how well do we serve one
another?
Focus on Internal Customers
Froedtert & Community Health, working with Gelb Consulting
Group, outlined a program to systematically elicit and respond to
feedback from internal customers. We modeled the notion of a
SPECTRUM
support services evaluation tool after a best practice
outlined in Quint Studer’s book, Hardwiring
Excellence (Fire Starter Publishing, 2003).
Key objectives included the ability to
reach across departments—to invite the
participation of those with whom a
department worked on a regular basis
and provide a mechanism for service
recovery (i.e., instant feedback and
response). In addition, the mechanism
had to accommodate the volume of
responses from more than 40 separate
departments, ranging from Accounting
to Volunteer Services.
We began the process with open
conversations with a small steering group of
key stakeholders—including representatives of
administration, the medical staff, and leadership
of clinical and support areas—to ensure we met the
needs and addressed the issues most important to the organiza-
tion. These conversations included discussion of key measures
and primary uses. We evaluated a variety of approaches on the
basis of cost, functionality, and timeliness of results. Ultimately,
our team concluded that an online performance excellence dash-
board was superior to any alternatives (e.g., free online survey
software) and was necessary to maintain internal momentum for
our performance excellence program.
A dashboard was chosen over a one-time survey for many
reasons. The dashboard moves beyond a traditional survey in
that it provides a web-based tool and complete transparency of
results. As highlighted in Table 1, leaders are able to review
results in real time, and service issues can be identified and
escalated for immediate response.
Why a Dashboard?
So, what is a performance excellence dashboard? These web-based
systems provide organizational leaders with an active, online
listening tool. More than just a one-time satisfaction survey, the
tool provides real-time data, is accessible at any time, and flags
issues for escalation and resolution.
The features of an online dashboard include:
• A standardized way to elicit feedback from customers
across all product lines and functions.
• The ability to develop a questionnaire that can be modified
to examine specific delivery standards.
• Automatic escalation of dissatisfied customer responses for
follow-up.
• The potential to generate a volume of responses sufficient
for tracking and additional analysis.
continued on page 8
7 JANUARY•FEBRUARY 2010

Achieving Performance Excellence Through Transparency
(continued from page 7)
Table 1. Comparison of Dashboard and Annual Survey
• The ability to develop a survey that is driven by the
customer experience, not by an arbitrary deadline.
• The ability to easily compare results across regions and
product lines and functions.
• Real-time distribution of responses to key internal
stakeholders through an online system.
• Opportunities to refine the dashboard to incorporate
additional metrics (e.g., department goals).
Designing the Dashboard
To initiate the project, the Office of Planning and Strategic
Support worked with a team of key stakeholders throughout the
organization to outline the requirements, define the scope, and
highlight the critical success factors for this project (e.g., user
training). Team members included the Performance Excellence
Steering Committee plus a few nursing and support area leaders
who had volunteered to pilot-test the tool.
Our initial discussions addressed:
• How best to gather feedback from internal customers (the
survey process).
• Which questions to ask (questionnaire design).
• How to present results online (dashboard reporting).
• How to follow up on issues raised by dissatisfied internal
customers (service recovery).
JANUARY•FEBRUARY 2010
Reproduced with permission from the January/February 2010 issue of Spectrum,
© 2010 by the Society for Healthcare Strategy and Market Development.
Once the questionnaire was designed, mock-ups of the
dashboard, the survey report, and the flow of information were
developed and presented to the end users for review and approval.
The stakeholder team then pilot-tested the tool to determine
how the data would be used and shared. At that point, the
dashboard was programmed. After the launch, users participated
in web-based training activities to review how to access data and
interpret the results.
How It Works
On a quarterly basis, leaders of support departments send surveys
to their internal customers in areas they support. The surveys are
available for a two-week period, and every leader who receives
one is expected to respond. The surveys are sent to department
leaders, who respond for the entire department.
Managers of support areas, in turn, are expected to monitor
the feedback and follow up with any leader who rated the sup-
port area a “3” or lower (Figure 1). If an internal customer is
deemed “at risk” or otherwise dissatisfied with the support
received, the support area manager can review the detailed
response (Figure 2) and organize a problem-solving session.
Leaders of support areas also use the data collected through the
dashboard to set annual improvement goals.
The Results
Deployed in 2008, the Froedtert & Community Health
Performance Excellence Dashboard (Figure 3) continues to be a
8 SPECTRUM
 Reproduced with permission from the January/February 2010 issue of Spectrum,
© 2010 by the Society for Healthcare Strategy and Market Development.

valued resource, with more than 70 percent of clinical leaders Figure 1. Sample Dashboard Report for Office of Planning
throughout the system responding to the survey each quarter. and Strategic Support
Leaders of support areas comment that they now have an addi-
tional listening post and direct feedback on what their groups
can do to provide better service to internal customers.
As Froedtert & Community Health has grown to include an
additional hospital and physician practice, the process has been
scaled to include those areas. It has become part of our organiza-
tional culture.

Keys to Success
• Clients and vendors should work together to build a cus-
tomized tool. Each organization is unique and has its own
standards, expected behaviors, and organizational language
that should be honored. End users will also make use of the
data in a variety of ways.
• Internal buy-in can be achieved through senior manage-
Figure 2. Sample Escalation Report
ment support and direct input into system development.
At Froedtert & Community Health, we took ample time
to engage department leaders to understand their areas of
interest and how to design a useful tool.
• Accountability is key to reinforcement. The Office of
Planning and Strategic Support, which manages the system
and vendor relationships, reviews the tool’s usage on a reg-
ular basis to identify opportunities for improving the process,
enhancing functionality, and increasing participation.

In summary, all healthcare organizations have both external

and internal customers. Monitoring their satisfaction and
managing relationships with them are key to an organization’s
success. An active listening tool like the performance excellence
dashboard allows organizations to identify and address customers’
issues and concerns in real time. Although dashboards are used
mainly to highlight problem areas, an organization can also use Figure 3. The Froedtert & Community Health
them to make note of and acknowledge those who are delivering Performance Excellence Dashboard
exceptional service and products.

Written by:
Caryn B. Esten
Director, Planning and Strategic Support
Froedtert & Community Health, Milwaukee, WI
414.777.7498
cesten@froedtertcommunityhealth.org
www.froedtert.com

John McKeever
President
Gelb Consulting Group, Inc., Houston, TX
281.759.3600, x1022
jmckeever@gelbconsulting.com
www.gelbconsulting.com

SPECTRUM 9 JANUARY•FEBRUARY 2010