Entrepreneur Association of Tokyo
Seminar Summary - John Wocher, Kameda Medical Center

Delighting the Accidental Customer
- Kameda Medical Center
March 07, 2006

What could the normally staid, sterile environments of hospitals possibly have to do with entrepreneurship? Actually, more than you might imagine.

Attendees at the 7 March 2006 Entrepreneur Association of Tokyo presentation heard from John C. Wocher, Executive Vice President for Administration and Director of International Patient Services of Kameda Medical Center, as he described how the innovative, patient-centered solutions being created by his hospital can be applied by entrepreneurs.

Injecting creativity into the system
Wocher kicked off his presentation by announcing that hospitals and healthcare are not fertile grounds for entrepreneurs − at least in Japan. “All hospitals are non-profit by government regulation, have fixed pricing by insurance organizations, and physicians who are licensed for life, are not required to have continuing medical education, are not subject to peer review, and who usually don’t have their credentials verified before they go to work.”

So, how does Kameda, a large organization with 858 beds, 2,200 employees, 311 physicians, 620 nurses, and a freestanding ambulatory care center that averages more than 2,500 outpatient visits per day, stand out from the crowd? A hospital is a difficult organization to manage in terms of being an entrepreneur, Wocher admitted, but an entrepreneurial spirit is well and truly alive within the walls of this approximately 360-year-old institution that overlooks the coastline in Chiba prefecture. Wocher explained that one of management's goals is to introduce sufficient creativity into the system to create an ‘A-ha’ factor that delights customers − and makes them want to return.

What steps are being taken to achieve this?
“We are trying to make our organization not look or act so much like an institution,” Wocher said. “We don’t believe in being square, white, threatening and dull like most hospitals. We create the same level of amenities that you would expect in a 5-star hotel.” Part of that package involves providing a carefully planned “healing environment” in which all patient rooms are private, carpeted, and carefully utilizing color to trigger significant emotional feelings in patients that support the healing process.
But the innovation doesn’t stop there − Kameda also has 24-hour visiting hours for families, provides English, Arabic, Korean and Chinese capabilities, internet connection and TVs in every room, and full disclosure of medical records.

Delighting customers with the ‘A-ha’ Factor
How often do your customers say “Wow!” about your products or services? “This reaction is a good, unofficial way to see whether your customers are satisfied with your service,” Wocher explained. “When they say, ‘Gosh! I’ve never seen that before!’, ‘I didn’t know you did that!’ − these are real compliments.” Kameda’s goal, he says, is to delight patients, not simply satisfy them, and companies can leverage this concept too.

Wocher then asked a key question related to his industry: how do you delight customers who would never use your services voluntarily? These people, he described, are what he calls the “reluctant,” or “accidental” customers, who are often in physical discomfort, may not live much longer, and may not even like or trust the physician. When you have all of these circumstances in the mix, how do you create customer satisfaction, or better still − customer delight?

The answer? Patient-centered care.
“We don’t use the term ‘Customer Satisfaction’ − we think that is a little bit of an outmoded term,” Wocher explained. “We are really looking at customer delight − to create the ‘A-ha Factor.’”
To realize this goal, more than 300 Kameda employees working in service points of contact have been trained and managed in customer satisfaction by Japan Airlines. In their 16 hours of training, staff received instruction on providing customer satisfaction, including such simple techniques as learning how to bow and address customers correctly. Results came quickly: staff rudeness, which was among the top 10 issues, dropped right off the list after training was completed.

Breaking tradition to benefit customers
Most people have memories (usually bad) of the white, bland and sterile-looking inside walls of hospitals they have visited. But is white conducive to healing and wellness? And can a twist of tradition-breaking creativity change the scenery to benefit customers? The answer appears to be “yes.”
Referring to recent studies investigating factors constituting a good environment for healing, Wocher spoke about research carried out by a Japanese doctor at Nippon University on lactating women in terms of the color of the breast-feeding room. Of three colors: pink, green and white − green had a significant effect on the amount of breast milk mothers were able to produce. None of the breast-feeding rooms Wocher has seen in Japanese hospitals are painted green. “This is just a small aspect among many, but there is a lot to be said for a comfortable environment where healing can take place,” he said.

Other ways Kameda is advancing patient-centered care in innovative ways are:
- Accepting EBM (Evidence Based Medicine) − “We want to do things based not on what we think works, but on what we know works.” Evidence can also be used for marketing. “If you are number one and whatever you use as a success rate is factual, that can separate you from your competitors.”
- Advancing Telemedicine − The idea that healthcare can now be delivered remotely, ie: in a patient’s home. “We are seeing more remote delivery of healthcare than ever before.”
- Electronic Medical Records − “Kameda has been paperless and filmless for 10 years − we don’t have any medical records on paper and don’t even read films any more, and we have about 3,000 records that are now Web-based so patients can check lab test results online as soon as they are ready. Patients are also able to check all their medical records online from any device with an Internet connection on the planet.”
- Benchmarking − measuring yourself with yourself, over time, in key performance indicators that are important to you, and measuring yourself against others. Then find best practice and improve on it.
- Emerging Risk Management − Kameda is taking the uncommon step of utilizing advanced IT systems to reduce the risk of preventable errors, many of which end in patient deaths.

How can similar concepts be applied to business?
Wocher suggested entrepreneurs look hard at their corporate environment and ask:
- How well do your customers react with you? Do you make it easy for them to transact with you?
- How much of what you do and say is based on evidence?
- How do you minimize customer risk?
- Do your really benchmark against best practice?
- On a scale of 1-100, how customer focused are you?
- How IT ‘wired’ is your organization?
- What is your ‘honesty’ level?

Home healthcare an explosive market
Pointing to a parallel in the airline industry, Wocher said both industries face a similar challenge − to try to delight customers on the way to their destination, which in Kameda’s case, is departing the hospital, preferable in the same or better state than when they entered.
“We think that satisfaction is really a neutral concept,” he said. “Ninety five percent of our patients are satisfied, however I’m not sure whether that tells us much. I think if 95% of our customers told us they were delighted with our service and would use our hospital again, that would be a different measurement.”
Other points Wocher made that can be applied to business were:
- Satisfaction is not universal − what is satisfactory to one person may not be satisfactory to another.
- Satisfaction is temporary − it is event-based. “We are looking to provide satisfaction over a lifetime.”

Are there any areas in healthcare that entrepreneurs should be keeping an eye on?
Definitely. “Home healthcare is an explosive market that offers many opportunities for entrepreneurs,” Wocher said. “Focus areas include free-standing ambulatory care centers and free-standing dialysis units, which make a lot of sense as patients don’t have to come in to a central location.”

Key to lifetime business has holistic roots
Wocher moved on to explain that creating long-term business with customers actually has holistic roots. “Even if a customer comes to you for a financial transaction, they still have physical, mental, social, financial, and cultural concerns about their interaction with you, and if you see them only as a customer, I think you miss the chance to get the repeat partnership that you need for lifetime business.”

Could these apply to your company?
- Sound; Internal, External, Privacy, and Control
- Temperature; Ability to Control
- Privacy; Control, Security & Personalization
- Light; Too much? Not Enough?
- Color; Can lift the spirit and delight the senses
- Communication; Internal and External
- Amenities: For Patients, Families, Visitors, and Staff

Spreading the word
How can you get your message out when advertising is prohibited?
“We let other people advertise for us,” Wocher said. “We contact movie and program producers making movies with hospital backgrounds and offer our entire facility for use in their filming. Then when people see those productions, they will see Kameda. So, we let others promote us and are very aggressive about cultivating the media.” But while all entrepreneurs can learn from doing this, Wocher warns it can be a two-edged sword that can cut both ways if good − or bad − news is released.

Upping the ante
Touching on identifying best practices, Wocher described how Kameda sends about 100 staff abroad each year to hospitals in the USA to identify the three things they do the best. “So, if you go to your competitors, ask, what do you do that you are really proud of? That’s what you should be looking at.”

Wocher also briefly mentioned trends, saying they are often rapid. “You have got to get on them − trends are often dynamic, evolving, improving. Quality improvement is never-ending − there is always a better way to do something. Doing the right thing is never a trend, but a constant in our profession and it should be in yours.”

Wrapping up, Wocher encouraged entrepreneurs to be bold. “Make history, don’t just read history. If you want to read history, you are a follower. If you want to make history, you are a leader.”

Further reference:
Kameda Medical Center [ www.kameda.jp ]

Text: Jonathon Walsh

Jonathon Walsh is a professional Corporate Editor and Writer of more than 275 articles published in Japan and internationally. He is also Director of Business Grow, an innovative company specializing in providing a wide range of high quality Editorial Content and Advertising services.

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