How to Clean up Your Image in Just Three Easy Steps

Gienna Shaw, for HealthLeaders Media, April 23, 2008

"The patient experience" is all the rage right now. And it makes sense: Make a good impression on patients and their visitors and they'll say good things about you. That spreads positive word of mouth to other patients and referring physicians. And that ultimately helps the bottom line. And because I care about your bottom line, I am going to share with you a three-step process guaranteed to improve patient and visitor experience, perception, satisfaction, and word of mouth:

  1. Walk to the nearest restroom
  2. Take a look around
  3. Flush the toilets

A few weeks ago my father had heart surgery at a medical center that is consistently listed among the best hospitals in the nation. It is world renowned for its research and clinical excellence. It posts its quality data online for all to see. It has the top doctors, is affiliated with the top medical school, and has competent and caring nurses and attentive staff.

The hospital handles about 1.3 million inpatient and outpatient cases and performs more than 35,000 surgeries a year. It bustles like a small city and hums like a machine. The sounds of construction are a constant sign of its continued growth. The cafeteria has healthy food, the coffee shop handles long lines with amazing efficiency, and the gift shop is well-stocked with some really cute stuff.

But the bathrooms are disgusting.

Wastebaskets overflowing with paper towels, dirty floors, dirty walls, dirty ceilings, dirty mirrors, dirty everything. Unflushed toilets. Old, yellowed cigarette burns on the toilet seats. Seriously—when was the last time anyone could get away with smoking a cigarette in the bathroom of a hospital? They can afford a new building, but they haven't changed the toilet seats since the 1980s?

There was a cleaning schedule on the wall—I suspect it was forged. And when I told a staff member of the state of things down the hall, she said that she'd sent me to that bathroom because it was usually the least disgusting. "Oh," said another staffer. "I always thought that one was the worst!"

The two women debated the relative squalor of the various bathrooms for a while. Neither one of them picked up the phone to call housekeeping.

The truth is that my family and I felt confident in this well-known hospital with the trusted name that treats heads of state and crowned princes. But the state of the bathrooms really threw me. And, after telling folks that my dad is doing well, that's what I end up talking about.

And I'm not the only one. Paul Spiegelman, CEO of The Beryl Companies, talked about the patient experience at the Healthcare Strategy Institute's consumer-based marketing conference earlier this month. He pointed out that patients will spend 20 seconds talking about their clinical outcome and 30 minutes talking about poor customer service—whether the noise kept them up at night, whether the nurses answered their call button, whether the bathrooms were clean.

Dale Dauten, a Boston Globe columnist dubbed the "corporate curmudgeon," says bad restrooms are a kind of antimarketing, especially among women. "When customers and employees see your restroom, Web site, phone system, waiting room, or product-return counter, they are seeing a picture of what you think of them," he writes.

Listen, it might seem a little silly to talk about the bathrooms of a world-renowned medical center. And if you are at or near the top of the market, maybe you can get away with bathrooms that are less than stellar. But if you're in a crowded market where you have to fight for share? If your referring physicians have been sending business elsewhere lately or complaining that their patients weren't impressed with your facilities? It's the so-called little details that can make a big difference.

"If we treat our customers well, we don't have to worry so much about the competition down the street," Spielgelman said.

Gienna Shaw is an editor with HealthLeaders magazine. She can be reached at

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