Unreasonable EMS

Will Guidara opens “Unreasonable Hospitality” with a story about his interviewing questions.  He asks, “What’s the difference between service and hospitality?”

One candidate answered, “Service is black and white; hospitality is color.”

And with that, the reader is taken on a multiple course meal of the evolution of his New York City restaurant, Eleven Madison Park, and of himself.  And, through the pages, we get to let our minds nibble on a smorgasbord of what could be for us in our own industries and workplaces.

“Omotenashi” is the Japanese spirit of hospitality and service—the tea ceremony is perhaps the most well-known example.  Omotenashi is focused on anticipating needs, attention to detail, and expressing gratitude.  Will Guidara doesn’t mention omotenashi, and yet I see this mindset in the culture he and his co-owner developed in their restaurants (interestingly, there is an YouTube video with his former boss, Danny Meyer). 

I ate one time at a Ruth’s Chris and was shocked that anyone would pay that much for a steak and a few  sprigs of asparagus.  I’ve not been wooed by the Disney experience (the one time I attended the park I thought “So this is what several million dollars can buy for a ride.”).  For me, I’m happy if the cashier looks at me when they say, “Have a nice day.”

The reality is probably that most of us haven’t ever received great service, let alone great hospitality… which means the bar for giving a patient or co-worker a mind-blowing experience is pretty low… and pretty easy to do.

Will’s restaurant not only crafted delicious dishes but also crafted a guest experience that was so bespoke, so guest-focused, that it not only complemented the food but it enhanced the diner’s special moment.

They recognized that bustling waiters and table setters were distracting, so they established a traffic flow pattern so they would blend in better with the background.  Hand gestures were used to signal the type of water the diners wanted so that while the diners were getting situated at the table, glasses would magically appear.  A coatroom that would have the diner’s coats at the ready when they walked up, because the coat room was attentive to the tables that got their checks; even the giving of the check was refined—it was given along with a bottle of cognac so there was no sense of rush, no transaction.

But it gets better. Wait staff paid attention to the needs of the diners.  If someone mentioned they were on their honeymoon and staying at the Ritz, when the couple got back to their room, there was a bottle of champagne waiting for them.  A diner commented on their wonderful NYC experience but lamented they didn’t get to have a street hot dog as part of their trip.  Boom, an exquisitely plated New York City street hot dog, served at one of the best restaurants in the entire world.  Legendary service and dreamweaving alongside worldclass food.

Read the book and let your mind swim.

Ok, shall we connect this to EMS?

The way you do anything is the way you do everything.

The staff and leadership wholly embraced a goal of being the best restaurant in the world (there is such an award).  They also wholly embraced continuous improvement—of learning from failures, of fixing what bugs them, of tapping into the individual strengths to make the team better. But, it was their identity that drove the culture which drove their actions.

 If you say you’re a high performing EMS agency, or that you’re focused on excellence, is that mindset seen in everything you do, or just some of the things you do?  Are you as focused on the bathroom experience as you are on the clinical experience?  Do you worry about the shine of your personnel as much as you do about the shine of your apparatus?  Does your Billing service reflect the good that you’re investing in your frontline staff?

High quality all the way to the final inch.

Its not the what, it’s the who.

As the restaurant refined its hospitality, they realized the importance of hiring people who loved to give gifts, that it was a natural expression of themselves, versus per policy.  At one point, interactions with diners were scripted, and both diners and wait staff hated it, because it wasn’t authentic (Will hand-crafted the script because it was so important to him… and it ended up betraying his trust in his staff to do what he knew they could do naturally).

Similarly, former Phoenix Fire Chief Alan Brunacini, who developed the idea of customer service in the Fire Service, said that he would rather hire and train a firefighter who only has customer service experience instead of a career firefighter—putting out fires is a skill that can be taught; taking care of people comes from the heart and some people have it more than others.

Are you assessing for the hearts of your personnel?  Not just “nice” and “kind” but actual works?  What’s a time when they showed it?  Making a PB&J for a diabetic is normal; making PB&J, cutting it into triangles, and washing up the dishes is actual human-centered care.  Ask your crews how they’d spend $100 on anything other than themselves and see what kind of answers you get.

If you’re pursuing continuous improvement, when your team truly feels free/secure enough to address the friction points that bug them, your team’s mindset has shifted into something special, because now they see the way in everything; they're not just providing patient care, they're figuring out ways to better provide patient care (or to provide better patient care).

Oh, the restaurant also implemented staff wellness strategies, but they didn't call it that.. it was simply compassionate collaboration. They taught breathing exercises to the staff; when one of them saw an overwhelmed coworker, they would whisper the reminder phrase to their friend. Also, they would touch their lapel as a silent signal that they needed help from a manager or coworker; again, it was impactful on the workers that they could get the help (physical and emotional) they needed and it was impactful on the diners because they were blind to the system at work in front of their eyes.

Make it simple to do good.

“You call, we haul, that’s all”.  Often, our only tool in our toolbox is to transport to the ER.  We don’t have phone numbers to connect a service to a need.  Maybe our system puts subtle (or not-so-subtle) pressure to have quick scene/patient contact times.  But, what if…

What if you welcomed crews spending 30 minutes on scene with a no-transport instead of 60 minutes for an unnecessary trip to the ER (which then ties up another crew with extended wall time)?  What if tools and resources were at their fingertips?  The answer should be where the question is.  Give them the chance to do right and easy, instead of cookie-cuttered.

Could you talk with the patient before you unload at the ER about what they’re going to experience?  It’s very much a hard transition to go from 1:1 care with a provider literally in your face for 20 minutes to the noise and chaos of an ER, or a cath lab, or CT; similarly, the transition from inpatient to being discharged onto your stretcher is an opportunity to reduce the harshness of the moment.

Could you play their favorite music genre during transport so they can relax?

Could you put something on the ceiling so they have something interesting to look at while they’re looking up all the while?

But, really, this isn’t anything unreasonable, is it?

What would be?  What would make an unforgettable experience? What would be legendary?

There’s so much goodness in this book, and I hope you enjoy it as much as I did, and that it gets your wheels spinning on how we can take care of people better.

What would you attempt to do if you knew you could not fail?