Writing in coffee shops has always been enjoyable to me, being surrounded by interesting people and rich aromas. My latest spot is a new Mariano’s grocery store in the Chicago area, where I discovered an approach to delivering quality customer service that provides lessons for the healthcare industry.a


I have long believed healthcare organizations can identify new ways to improve their business processes by cross-pollinating ideas from other industries. So as I observed the impressively smooth operations and excellent customer service of my local Mariano’s store, I recognized an opportunity to gain insight into how an executive of a successful, nonhealthcare organization effectively uses business intelligence (BI). I asked the store director, Mike Binder, how his organization uses BI to improve efficiency and profitability. His initial reply rendered me momentarily speechless: “Don’t make me out to be a bean counter.” 

Binder’s response took me aback because I had heard about how grocery stores have used big-data BI and business analytics (BA) to analyze market trends, demographics, and inventory management. My intention for the conversation was to understand specifics of big-data use as it would relate to healthcare organizations in a changing environment (e.g., transition to accountable care, addressing healthcare reform mandates). After my initial surprise, I asked him, “Can you clarify your statement for me?” Binder elaborated by sharing a simple focus I think hospitals should maintain regarding their use of BI: “Don’t lose sight of people intelligence.”

Getting Everyone  Involved

“Our primary success is focusing on 100 percent teamwork,” Binder said. “For example, if someone sees something on the floor, I expect them to clean it up right away regardless of their position.” (I witnessed this principle in action when a pharmacy department employee helped a produce worker clean up spilled food.)

Binder also stressed that Mariano’s has no remote executives. “Our CEO knows what’s going on by continually walking the stores, making sure things are going well by talking to team members and customers,” he said. “We don’t have executives who just rely on reports and dashboards; they want to see firsthand what is going on. And if one department is overloaded, the executives pitch in and work. I have seen executives make phone calls or bag groceries at peak times to prevent customers from becoming dissatisfied. Our executives come into the store to help us.” 

I think Binder’s last statement aptly sums up the chain’s success: top-down, leading-by-example teamwork. His comments offer a simple takeaway for health care: We should not lose sight of the importance of teamwork in the delivery of efficient, high-quality care by relying on electronic health records (EHRs) and BI to address current issues. 

My conversation with Binder happened the week the news broke regarding negative patient care and falsified reporting at Department of Veterans Affairs (VA) healthcare facilities. The question I then asked myself was, “Would the VA have been better able to deliver high-quality care and prevent deaths if executives had routinely walked the VA facilities speaking to patients and helping staff firsthand rather than focusing on data?” EHRs streamline communication between professionals, patients, and families. BI supports decisions by either validating or posing questions about trends and outcomes. But information automation cannot replace personal observations and hands-on teamwork. 

Applying Mariano’s Lessons to Health Care

The common focus for BI today is on “big data” and “real time.” But data analysis is valuable only as long as it is used in conjunction with personnel intelligence, and real-time analysis should coincide with real-time observation. Many healthcare organizations have instituted daily interdisciplinary meetings to foster cross-departmental communication: Executives and various representatives (e.g., physicians, nurses, care managers, social workers, therapists) each morning discuss operational reporting, difficult cases, and patient throughput roadblocks. 

But following the example of Mariano’s CEO suggests that throughout the day, administrators and executives should continually monitor firsthand what is happening so they can take action as issues arise—and then use BI to assess how those actions translate into positive trends. It is important to remember that actionable BI is still retrospective, reflecting what has already happened. Actionable observations enable positive BI outcomes.

Applying the Mariano’s example to a hospital, if emergency department (ED) backlogs are a top facility concern, executives should routinely visit the ED and closely observe the processes occurring there. The executives should identify possible improvements (e.g., assisting the removal of case management roadblocks by making phone calls or bed allocations at peak times to streamline flow and ensure proper admissions), evaluate report/dashboard numbers while rounding in various departments, and then review outcomes at the end of the day. Rounding and occasional participation in registering patients could provide executives with valuable insight into BI dashboards and enable them to identify areas that require attention, such as possible coding issues (e.g., observation/inpatient designation changes and DRG ordering).

Using Observation to Validate BI

Executives who rely solely on viewing BI and reports in remote offices are distanced from the actual delivery of care. Those who consistently take time to observe care and support services understand and validate their BI—and are immediately aware when numbers are not telling the whole story. 

A recent personal healthcare experience reinforced this point for me. I was scheduled for a routine outpatient test I knew should take 10 minutes, with a door-in to door-out time of less than 30 minutes. The encounter took 95 minutes, with doors opening at 7 a.m., a scheduled start time of 7:20, and an actual start time of 7:45—with four other patients still waiting. I noticed breakdowns at several stages of the admission and procedure processes. The next day I shared my observations with the administrators, who responded, “Thank you for letting us know what happens on weekends when managers are absent.” To their credit, they followed up immediately, but their response was still retrospective, and a patient left the facility dissatisfied with their service. 

Because management had not witnessed the process-related problems, the administrators were unaware of needless point-of-entry bottlenecks and inefficiencies. Moreover, negative patient engagements were not reflected in reports—especially as witnessed by someone in the healthcare field. In keeping with Binder’s idea of “no remote executives,” C-suite executives and administrators could benefit from performing formal and impromptu rounds, including on weekends, because patients deserve—and the Centers for Medicare & Medicaid Services (CMS) expects—consistently high-quality service levels, regardless of time of day or day of week.

With today’s healthcare focus on EHRs and big-data BI, it is important to remember that tools don’t automatically fix problems. Executives should observe, promote teamwork, foster a culture of asking “Why?” and be personally involved. 

As an example: A hospital contracted with a housekeeping company, and the facility’s executives received monthly reports reflecting 95 to 100 percent compliance with licensure requirements and observations of manager rounding. The CEO then performed ED rounds and found clean supplies and equipment stored in a dirty utility room. She stopped a housekeeper from the service to ask why the dirty room had clean items, and to inquire about her training. The housekeeper couldn’t speak English, even though English proficiency was a contract stipulation, so a supervisor had to be paged to act as an interpreter. The CEO then spoke directly with the staff and found out the dirty room had always been used in this way. By reviewing BI only, the CEO would have remained unaware of the contract breaches, the violations of CMS and Occupational Safety and Health Administration/Joint Commission regulations, leadership breakdowns, and potential infection-control issues.

Creating the Context for BI and BA

BI is valuable for supporting, but not replacing, personal and personnel intelligence. And real-time business analysis should take place in conjunction with real-time observations. Only then can healthcare BI and BA be effectively used as real-world solutions.  

Rose Rohloff is an independent healthcare consultant, Chicago.


a. Roundy’s is the parent corporation of Mariano’s, with nearly $4 billion in sales in 2014 and more than 23,000 employees operating 169 retail grocery stores and 114 pharmacies.

Publication Date: Monday, September 01, 2014

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