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Hospitable Healthcare with Stowe Shoemaker

• Jeff Borman and Matt Brown

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Ever wonder how the experience at a hotel might transform your next hospital visit? Stowe Shoemaker is a legend in hospitality academia, and we discuss his new book Hospitable Healthcare: Just What the Patient Ordered!, co-written with Peter Yesawich. Hospitals are taking a closer look at how hotels approach care, service, and satisfaction, and a change in your hospital stay might come sooner than you think.

https://hospitablehealthcare.com/
https://www.unlv.edu/news/expert/stowe-shoemaker

Matt Brown:

Jeff, we have a legend today in our midst, a legend in hospitality academia. Hi everybody, it's no Show. I'm Matt Brown, joined us always by Jeff Borman. Stowe Shoemaker served as Dean of the William F Harrah College of Hospitality at the University of Nevada, las Vegas, from 2013 to 2023. The College of Hospitality is currently ranked the number one hospitality program in the US and number two in the world. He's also served on the faculty at the School of Hotel Administration at Cornell University, where he taught courses in strategy, service operations, strategic pricing, revenue management, strategic marketing, customer loyalty you name it.

Matt Brown:

He's written articles, he's written research papers and he has a brand new book that we're going to talk a little bit about today, called Hospitable Healthcare Just what the Patient Ordered. He did that with his co-author, peter Yesowich, and he's developed pricing strategies for airlines, hotels and restaurants. I think he also it's important to say here he enthusiastically supports Vegas's growing roster of pro sports teams. He's met Bon Jovi. He's had wine with Bon Jovi. He's an Epicurean of the highest order. He loves great food and great wine. So welcome to no Show. Well, thank you.

Stowe Shoemaker:

I mean with that introduction we're setting up the audience, for expectations are too high, so I'm sure it'd be a failure.

Matt Brown:

but it's great to be on the show. Let's start with the basics. What is your book Hospitable Healthcare about?

Stowe Shoemaker:

So it's really about how do we bring what has made us to hospitality industry create great experience for its guests, how can we take some of those learnings and bring them into the healthcare environment? And it really is that simple. We do great things in hospitality. What are the lessons that can be translated into healthcare Earlier in your career?

Matt Brown:

you worked with MD Anderson in Houston. Had the seeds of the book and the connections between hotels and hospitals been around for a while, or was there kind of a light bulb moment over the last few years that galvanized you?

Stowe Shoemaker:

Yes, it was a light bulb moment. I moved to Houston and met a young woman who was working for Memorial Hermann Healthcare and she said hey, you know, we need some help thinking about how we can create a great patient experience. And I thought, well, that's really interesting. So we did this really fun project that really was very successful for Memorial Hermann and I actually wrote a paper on it with my grad student. We tried to get it published.

Stowe Shoemaker:

We tried to publish it in some hospitality journals and people were this is the hospitality has nothing to do with healthcare, and so it was really rejected right off and I thought, well, that's really odd, because there's really some interest there or there's things are related. So then I was really interested in this whole idea and I got to know some folks at University of Texas MD Anderson Cancer Center and they were like let's kind of figure out how we can create a great patient experience at Anderson, bringing hospitality principles. So I actually had a joint appointment there for about a year and a half and it really just changed my life. I mean, I just love the fact that here we were taking people at their worst moments, finding out they had had cancer, and then using our principles of hospitality to create a great experience and make them feel like loved family members, and that really was the launch of my journey into hospitable healthcare.

Jeff Borman:

Yeah, in your book you say it focuses on three questions. How do you define the components of service, given the intangible nature how service expectations are formed? The second one was the one I wanted to get a little insight from you here. Most is what causes the difference between service performance and expectations. Can you give us a little quick view into your thinking there?

Stowe Shoemaker:

It's interesting because my dissertation, my degree, was really in cognitive psychology, although I studied in the hospitality college. My degree was in cognitive psychology and statistics and biometrics. And I studied cognitive psychology because I wanted to know how our expectations formed, because in the hospitality industry we always talk about we have to exceed customers' expectations. But I realized that if we always exceed customers' expectations, they keep wanting more. So the question was when services are intangible, how do we then make them tangible without exceeding their expectations, but meeting their expectations? And when I investigated all the service marketing literature which really came out around the same time I was doing my PhD, they talk a lot about the dimensions of service quality, which are reliability, assurance, tangible empathy and responsiveness. So at any time we have that moment of truth when the employee meets the guest, how do we incorporate some component of that? So the guest goes, wow, this is great service.

Stowe Shoemaker:

Because what I found in my dissertation by studying scripts and schemas the first time we see something that's not expected, we go, wow, that's amazing. But if we see it over and over again, it becomes part of our script of what we expect is going to happen. And so that's really how I got into that and I thought, okay, well, in the hospital situation and what happened at MD Anderson was MD Anderson is an incredible cancer incident, but people would say, oh, terrible there, terrible there. When I had my contrast, I got a cold blanket right, something about wow, the reader was amazing, just the best care in the world. They used tangible things to judge how well their service was. And once we started talking about making the waiting rooms look like hotel rooms, where they were really open and airy and colors and we put warm blankets on them when they were having their contrast, suddenly the actual thing they were really buying, which was the care, seemed better. So that's how that all came about.

Jeff Borman:

I spent many years with the Ritz Carlton brand and still very proud to say that the service values there are 12, they're well known. The second one is the one that always was closest to my heart and you touched on it a bit which is I'm always responsive to the expressed and unexpressed wishes and needs of our guests. What you just described really doesn't seem to fit that same luxury over the top, even the unexpressed wishes of our guests. Right, you're saying let's get those standards down to something where we can deliver every single day and then exceed on occasion.

Stowe Shoemaker:

Did I hear that right, yeah, you did, you did and Ritz Carlton was able to do that because at the time you were smaller chain right, you were run very, the culture there was incredible right, and you had very different guests and you were able to charge a lot of money. But to the average hotel company, and especially for hospitals that are dealing with Medicare, medicaid patients, we can't provide Ritz Carlton type service on a regular basis and be profitable. And Ritz Carlton had the nice model that they could charge a lot of money for that. But Ritz Carlton, as you think about it, they also won the Malcolm Baldritch Award twice. There was a lot of standards put in place to guarantee that quality was always there. So it wasn't like, oh, we'll just exceed their expectations every time. Ritz Carlton put lots of standards and policies in place to make sure that the basic service was delivered.

Matt Brown:

Is Ritz Carlton the one with the 510 rule?

Stowe Shoemaker:

Yes, 10-5. Yeah, 10 feet away you nod, and then 5 feet, you say hello.

Matt Brown:

Oh wow, If every hospital did that. No, that would freak people out. It's like, why is everybody telling me hello all the time?

Jeff Borman:

I was thinking, as you were describing the difference between a Ritz Carlton and a hospital, that most of our health care providers are the only places where an overnight stay costs more than a Ritz Carlton.

Stowe Shoemaker:

Yes, that was probably true.

Matt Brown:

So you've written about anxiety as a factor for patients as they move through the medical system and kind of struck us as we were reading some of your articles and reading a little bit of the book, like how different that kind of starting foot is when you walk in the door of either a hospital or a hotel. I mean, when you're in a hotel I feel like you've got a little bit more of an advantage, because people come in with some kind of expectation of gratification. In hospitals, I think there is an expectation of anxiety and I wonder how you try to bring those two things more in line with each other.

Stowe Shoemaker:

So I would argue that both situations bring forth a lot of angst because for people who are traveling and if you think about the vacation traveler, they've taken time away from work to go on vacation, so there are certain angst is it going to meet my expectations? Am I going to enjoy myself? I've given away my precious time to stay in this property, so there's going to be angst before they purchase. In a similar way, in healthcare, there's going to be angst about oh my gosh, are they going to be able to take care of me? Am I ever going to be cured, and all those kinds of things. So what I'd like to think about is what we've done in the hospitality industry to reduce that angst is we've spent a lot of time in the service gate, in the lobby. Every hotel has their own scent. They all have different types of music, they have the lighting, the fixtures. So when you walk into a lobby of a hospitality enterprise, you automatically have this sense of well-being and it reduces that angst of wow, this is going to be what I hoped.

Stowe Shoemaker:

In healthcare, we've been so concerned about what happens behind the front of the house that the front of the house is very sterile. Think about going into. In most hospitals the walls are white, there's hardly any pictures, that usually has HDTV on it, or if there's any TV at all, and so it's very like not welcoming a woman. And hospitals are beginning to start to redesign themselves so that the lobby space of a hospital is more like the lobby space of a hotel, because it reduces that angst of oh my God, what's going to happen. And so I think there's a lot of parallel between angst. It's a different type of angst, but they're still angst, if that makes sense.

Matt Brown:

Absolutely. Hospital systems have become mammoth entities and, like any mammoth entity, change can be very slow, especially with all the internal stakeholders involved, Not even just talking about the patient side, but on their side. You've got boards, you've got unions, you've got government agencies, you've got doctors, nurses, you've got everybody who's doing cleanup, you've got counselors, insurance companies let's not forget them. So ton of stakeholders. So how do you start a conversation with a hospital group in order to get everybody on board with looking at their customer service model? And the real question there is getting them to fund a new customer service model.

Stowe Shoemaker:

So that's an incredible, that's a great question and it's a question that often comes up is because when we use the term bringing hospitality principles of the healthcare, the first reaction that people have is, oh, you want to provide four seasons care for wealthy people who are self-paint at the expense of Medicare patients. And what we really tried to focus on in the book is that if you're staying at a laquita, you can have a great experience. If you're staying at a Rich Carleton, you have a great experience. So what are the principles that laquita does that makes a great experience that can be translated into healthcare in a similar way with Rich Carleton does. How do we get healthcare people excited about this?

Stowe Shoemaker:

We don't talk about it in terms of, oh, we're going to bring hospitality principles we're going to talk about we want to help, we want to. We call it enhanced patient experience and we talk about it in terms of making your patients feel like they are loved family members, people who work in healthcare, just like people who work in hospitality. We all want to serve. We want to do the right thing. So if we think about what are the things we need to do to make our patient feel like a loved family member. How we implement this is we start at the level where the employee meets the patient and we talk to them about let's talk about creating, making people feel like loved family members. What is it that we need to do as an organization? What tools and some things do we need to give you that you can deliver that kind of service? And then we work our way up. It's kind of like we get rid of Ciderhouse rules right, and Ciderhouse rules says if he works in the Ciderhouse, doesn't make the rules. We want to start at the people who are in the Ciderhouse. Let them make the rules, and I'll give you a great example of how this worked.

Stowe Shoemaker:

At MD Anderson, we started doing our research and we interviewed all the radiologists because we were working in the division of diagnostic imaging. The radiologists talked to us about all the things they did and all the things that technicians did, some things they did well and the things that the technicians did wrong. And the technicians in their minds were the people who were taking the pictures on these big scanners. So I go down to talk to what I thought were technicians and I bring up the word technicians and they had a revolt and they go technicians fix toaster ovens. We're technologists. So we went back to the doctors and we said you could start calling them technologists, and once they changed the language now the technologists felt more empowered.

Jeff Borman:

Are there hospitals that have started deploying these tactics? Case studies.

Stowe Shoemaker:

So MD Anderson is the main one that we so I worked for MD Anderson about 10 years ago and the book was only just came out, so we have not tested the payer model per se. But I can tell you that over the 10 years that I did the research at Anderson, I went back this summer and did some seminars. The whole culture at Anderson has changed and they do refer to people as loved family members. They changed the way they deliver quality care. They changed the. They did a lot of redesign of the waiting area so they're much more like hotel lobbies and the culture has really changed at Anderson because of the work we did 10 years ago.

Matt Brown:

One of the big complaints whenever you have a friend or family member in the hospital is that, if they're there for any period of time, there's no place for you to sleep as the as the friend or family member. Do you ever think that we'll have a world where a hospital and a hotel actually merge, so that you go in the left direction and there's the hospital, and then you go the right direction and it's the hotel for everybody else? Who's there checking up on the people in the hospital?

Stowe Shoemaker:

Yes, in fact it's already happening. Down at the Texas Medical Center, right next to MG Anderson, there is a Marriott Hotel. The city of Hope in Los Angeles is building a hospital right next to their facility. The Cleveland Clinic has the same and, with the Mayo Clinic, also have hotels right next to the hospital. They may not be in the same building but they're right next to each other so people can walk back and forth. In fact, at the Medical Center in Texas the Marriott you can walk from your room to the hospital without ever having to go outside.

Jeff Borman:

One of my bigger learnings as a young revenue manager was a situation like you described. There is a hotel and I won't give the brand name, but it was attached by a breezeway to a Mayo Clinic. As often happens in the life of a revenue manager, we weren't making our market share growth according to STR results. I was tasked with increasing intensity to go fix that hotel. I did exactly that. I flew to that location and, after about three hours of property detailed review, raised rates astronomically, not realizing that the owner of the hotel was actually the Mayo Clinic Foundation and they were paying the room rates for all the guests who were also visiting loved ones in the hotel.

Jeff Borman:

So what went from a pricing learning into an ownership overall management lesson was pretty strong about six months later when I got a call from the owner of the family, the guy that ran the foundation, and said what have you done that you're draining my coffers? In your book, your Roger Conway story, you tell how he and his wife needed some time away together and that they had, and I quote, accumulated enough credit card points. Quote yes, you bothered to write that when you could have simply told the same parable with Roger and his wife going to a hotel and paying for their stay. The shift from paying guests to redemption guests, in my opinion, is one of the most threatening macro level trends in hospitality. Why did you choose to write that detail?

Stowe Shoemaker:

Because what we wanted to do was we're setting up the story for later in the book, where we talk about. One of the model that we come up with is called the payer model, which is we prepare, we anticipate, we engage, we evaluate and we reward. What we find is, or what the data has shown, is that probably about 46% of people who visit a hospital only visit it once and never go back, even though they have to go back to a hospital, and the idea is that so 60% are not returning to their same place. Right, and what we've done in the hospitality industry by creating this reward program is we've encouraged brand loyalty and we think that in healthcare, there's a huge opportunity to reward guests for their patronage.

Stowe Shoemaker:

Think about going to like.

Stowe Shoemaker:

Think if you have to go to the hospital on a regular basis, maybe because you're going in for, you know, blood work on a regular basis, or you have to go in for really anything that takes multiple visits You're always treated as if you're going the first time, because the data is never collected and never saved.

Stowe Shoemaker:

And so you know, this is my fifth time into the same procedure. I have to go in and check in and pretend like I'm brand new. It makes me crazy. But so by having some kind of reward program where we're collecting the data of our patients, we can say, oh, stowe's been here many times, stowe can go to a different line check in easier, he knows the procedure already. So it reduces some of that friction that I have to have. And by having it like as people sending up for a rewards program, we can kind of separate their medical information from their visits. Right, and so we avoid the legal issue of the you know the requirements but then lets the patient know that well, I can earn points or I can earn something. So I'm not treated as a first time customer all the time, and we think that's very important.

Matt Brown:

I agree with you guys, but I do want to point out the slippery slope of this. Where you have loyalty programs, they eventually beget credit cards and they then beget gold, platinum, double platinum status. I mean there's no question that, as points programs kind of come into play, you're definitely going to get sold. The Mayo Clinic triple platinum I'm sure they'll come up with a pity name for it but the triple platinum mastercard, I am a little fearful I mean as stratified as the medical system is already in the country that this essentially opens up the door for your hospital to treat you like zone eight when you're boarding a plane. What do you think?

Stowe Shoemaker:

No, I don't think that's the case, and the reason I say that is, at the end of the day, our goal is to take care of the patient and make them feel like a loved family and just like in hotels where you have self-service check-in so the frequent traveler can just go grease in and go right to their room. In healthcare, if you have that patient who has been there many times, they're not standing, they're not taking over the time of the person who is the first time visitor, has lots of questions. So the idea is that, by creating a mechanism for the heavier users that have an easier check-in process or an easier way to do things so that you can spend more time with the person who needs it because it's their first visit, we think we'll have a long time payout and the rewards don't have to be just for coming back to that hospital, but they can be rewards for multiple things. I did a project just recently with a gentleman named Jeff Arnold who created WebMD, and Jeff has created a company within. He created a company called Sharecare and they manage lives for different insurance companies, but within Sharecare there's a division called WeCare and, just like most employers will give health savings accounts, wecare will give health travel accounts. So if you do all the things you're supposed to do to maintain a healthy lifestyle, you'll get put money into your health travel account. That then will allow you to take vacations.

Stowe Shoemaker:

And so I did all the research to show would people change their behavior for this? And the answer was yes. And so what I envisioned happening in healthcare and again we want to test this if I'm a patient, and especially if I'm a Medicare patient or Medicaid patient, and I have to do certain things to stay healthy, right, the hospital wants you to do certain things to stay healthy, because they're evaluated and they're paid based on their readmins. Well, suddenly, now, if the patient's doing what you're supposed to do, that becomes a win for the hospital. They get paid more by the government, the patient stays healthier, and then the reward for the patient is they maybe get to do something they hadn't thought had been doing or thought they could afford to do because they have this health travel account.

Stowe Shoemaker:

We believe that the rewards will change the behavior in a favorable way to do the things which we want them to do, which is to stay healthy. Now, it's a radical idea, but we think it's something to think about. Another radical idea which we bring up in the book is guys in your health which basically came up with essentially 100% guarantee that if you're unhappy with the service you receive at one of their hospitals, they sit down and meet with you with a patient advocate. You go through everything and there's a chance that all your medical bills copays could be covered. So these radical ideas seem radical now until they're not.

Matt Brown:

So at the end of every episode we have a mystery question for our guest, and this one's going to be an easy one. It's right up your alley. You have lived on and off in Vegas for many years and, as I mentioned at the top of the episode, you are a Gourmand and a Procurian of the highest order. Give us a hidden gem. Restaurant Can't be one of the ones that shows up in the Eater list. Give us a hidden gem in Vegas that we should go eat at the next time that we're there.

Stowe Shoemaker:

Well, there's just so many great restaurants. I think there's a real hidden gem in Henderson called the Pasta Shop, restaurant Tourier, and it's been in town for probably 30 years, owned by the same family. It's an Italian restaurant and the food is tremendous. They make pasta that they sell to the strip. You know used to buy all their pasta from the pasta shop and it's just a family friendly. The husband who owned started it passed away but his wife runs it and his kids work there now and it's. I think it's just a hidden gem great food, inexpensive, but you walk in there and you feel like you're walking into Cheers. They know everybody by name and it's just a great restaurant. My wife and I go there a lot. It's called the pasta shop.

Jeff Borman:

Matt's questions are so much more uplifting. I was going to ask I love that in your book you compare getting a colonoscopy to staying in a Las Vegas resort and I was going to ask did you have a resort specifically in mind with that?

Matt Brown:

No, which means yes, he absolutely does. So this has been great. Thank you so much for taking time to talk with us today. Good luck with the book and we will hopefully talk to you soon.

Stowe Shoemaker:

Well, thank you very much. It's been really an honor to be on the show. Appreciate it. Thank you, bye.