by Tony Chen

Even though it's been almost 2 years since I posted the now-infamous 8-part series of "If Disney Ran Your Hospital," I continue to get impassioned comments (just got another one yesterday). Below are some criticisms of the book from hospital impact readers - mostly from seasoned administrators, experienced nurses, or former disney employees. See all 29 comments here.

Here's a long comment from Rick. If you don't want to read the whole thing, the summary: "The last thing I need is another hospital administrator yapping about the latest book craze"

from Rick...

I remember my wife and I taking my kids to Disney World. I had given my notice at one well-respected academic medical center to leave for another in another city, and this vacation provided a break in the stress of all the change affecting all and each of us.

I doubt that if I had been moving from one Disney location to another, I would have taken my family to a world-class hospital to relax.

When I was an undergraduate I worked in a consumer electronics business for almost three years. Part of my job involved home service of their televisions. Like those who believe they learned everything they ever needed to know in kindergarten, I believe I learned enough about customer service from what my parents and other adults taught me. I sure as hell didn't need to pad some writer's pockets back then to learn how to respect a fellow traveler, and I sure as hell don't now.

That said, a number of years ago I surveyed customers of a group I supervised regarding what they expected and appreciated about our services. As I expected, what they appreciated most was our professionalism, but key to that was the expectation of technical expertise. Professionalism, i.e., customer service, was of little value in the absence of competence.

My guess is the expertise involved in portraying a duck, mouse, Snow White, etc, hasn't changed much in recent years. Ditto cooking a hmaburger, managing a ride, picking up trash before it hits the ground, etc. But the rate of change of health care is off the scale and accelerating. When I entered the field, computers were just showing up at the nurses' stations of ICUs. Now there are easily ten or more in the equipment at the bedside of a single patient.

Over the years, those of us in the field have heard how we should adopt 7 Habits, TQM, CQI, and now MIC KEY MOUSE. Every time, when we reply that we need tiome to learn how do it, other than for a pilot project here and there, there is simply no time in which tio fit it in. Why? Because we'd need money for that, and one thing that people will not part with to make health care work is a bigger slice of GNP. The same people who will hop on a plane amd throw thousands of dollars to spend a few days in a Magic Kingdom, the same people who would throw everything they at getting care for a family member suffering with a possibly terminal illness, these same people go nuts when they hear their health care premiums are on the rise.

Here are the choices:

1) Keep spending the same amount of money and treading water as the system continues to devolve under the pressures of accelerating technological and social change

2) Throw the money instead at gurus to teach us to say the equivalent of "Would you like fries with that?" and permit the system to devolve even faster than it is now?

3) Examine what we get for each incremental health care dollar and make the tough decisions whether the interventions and services we can provide are worth it. It would be a huge leap forward if we could move the economic discussion from guns-or-butter to health-or-entertainment. But that would require will and discipline that we seem to have lost from the days when we set out to build the health care system capable of what it is doing today. Now it's more "What have you done for me lately?"

Many people in this business know what needs to be done. We've figured out how to treat heart disease, cancer, and stroke among others; we can do this. Just let us know what you really care about by not only telling us what your choices are but putting your money where your mouths are.

The last thing I need is another hospital administrator yapping about the latest book craze. Five dysfunctions, indeed. After thirty years, I've learned it best to view MBA prattling with a Christian perspective: Forgive them, for they know not what they do.

Here's one from Dave who highlights that the ideas at Disney are not transferable to hospitals, given the vastly different environments.

from Dave... The idea that Disney has anything to teach us about how to run hosptials is a stretch, at best, and a more likely a counterproductive fantasy. A hospital is not a luxury resort, an operating room is not a ride, a surgeon is not a cute tour guide in a uniform. Nobody dies if they can't afford to go to Disney World. There is a lot that can be improved in our hospitals and our healthcare system, but I hope we can find better role models than the Walt Disney Corporation.

Dave, I agree that these are vastly different universes. Nonetheless, we are still serving the same market - people. Disney has transferable insights about how people feel safe, respected, and delighted - regardless of who those people are and what environment they are placed in.

from quade... Having worked at Disney for 29 years, lemme just say that the LAST thing you'd want a medical facility to be run like is a Disney theme park.

For example;

1. Perceptions > Reality

Perceptions are greater than Reality? Really? Isn't that what they call in the medical profession the Placebo Effect?

Quade - I'm not saying that we "fake" good care in order to somehow "trick" the patient. Good care is essential, but not all good care seems like good care to the patient.

from Lisa... About 10 years ago, I worked at an emergency department in an inner city. The Disney organization was paid to come to our facility to "teach" customer care. Needless to say I thought this was ridiculous, how do you compare an emergency dept with Disney World? There is no comparison. The E.R. is a place where emotions run high, life or death situations are a constant and patience by the patients is worn thin, not to mention the many, many people who use the E.R. as their doctor's office. What is the worst thing that can happen at Disney? Can it at all compare to death of a loved one? The Disney people who were recruited to come to our facility could barely speak to one another, never mind our patient clientele, they were in a word, shocked by what they had encountered. The staff at the ER had already been through sensitivity training, and are some of the most caring, compassionate, empathetic people I had the pleasure to work with, not to mention, not easily shocked. People do not need a book or a Disney staff to teach customer care, what they need is to look at how they'd like to be treated, "do onto others as you would yourself."

I wouldn't be surprised at this. Talk about culture shock. I have mucho respect for those folks who spend a career in the ER. How do you keep from getting jaded, bitter, calloused when you've seen it all?

other comments, criticisms? Let's keep the conversation going.