A lesson in hospitality

Five-star service as standard – how seeing behind the scenes at a leading London hotel is complementing cancer care. Lucy Reynolds reports.

Step into the five-star Landmark London hotel and you will immediately be struck by its distinctive style and ambience – the elegance of its furnishings, the deluxe facilities and the welcome that greets you.

Not much propinquity to a cancer treatment clinic, you might think. But think again.

Leaders in Oncology Care (LOC) is a specialist oncology centre, devoted to delivering innovative cancer treatments and exceptional patient care. And it saw in the Landmark Hotel a model of design and service it could emulate to help patients.

Visitors to the clinic often comment that it does not feel like a hospital at all. With its plump-cushioned couches and golden drapes, it is more like a luxury hotel. But the similarities don’t end with interior design and this is not a story of style over substance.

For the clinic runs very similarly to a hotel, too, with cancer patients being booked into the treatment suite as they would be booked into a hotel room and drugs being made to order on site, much as a room service order for food is placed to a hotel’s kitchen.

These similarities immediately struck designers who had been commissioned by LOC’s chief executive Guy Reynolds to enhance patient and staff experience at the clinic.

The user perspective

The team at Uscreates specialise in applying design thinking to health and well-being services, and are always looking for new ways to understand the user’s perspective.

Co-founding director Zoë Stanton explains: ‘We had the idea of taking a group of LOC employees behind the scenes at a high-end hotel to explore the similarities and see what happens in the background to create a five-star guest experience.

‘And it was a fantastic exercise – we had the chief executive there, clinicians, nurses, treatment suite co-ordinators, receptionists – the whole team; and you could see ideas like light bulbs going off from the second we stepped through the door.’

Having shadowed LOC patients and staff for the preceding fortnight, the designers had already worked with the clinic’s team to identify three areas to trial rapid improvements:

1. Scheduling appointments;
2. Streamlining communications through reception;
3. Further optimising pharmacy services.

So, on arriving at the hotel, the LOC group was divided into these three ‘task teams’. Each one was met by a Landmark London employee, and guided to whichever part of the hotel best reflected what the LOC team did at the clinic.

Scheduling appointments

The ‘scheduling’ group was met by the hotel’s event sales manager, Leah Rose-Davis. LOC’s head of clinical services Marcella O’Brien says: ‘We were shown how the hotel’s bookings team use telephone guidelines for all of their conversations with guests – all of the staff follow these guidelines so that guests get the same information every time and any team member can carry out this conversation.’

What also captured the group’s imagination was the way in which guests’ stays were logged onto the system, to anticipate check-in and check-out times.

Ms Rose-Davis explains: ‘We capture as much information about a stay as possible, so we know that, if a guest is here for business and has a 7am flight, they are likely to check out early, allowing the room to be made up for the next arrival.

‘Or if a guest is staying for a birthday break, they’ll probably take a slower pace, so we assume a later check-out for that room. By predicting how long guests might stay, we’re able to manage our rooms very efficiently.’

The team was struck by this approach. Ms O’Brien recalls: ‘We were immediately thinking of how we could do things in the clinic. After we’d seen how the booking team worked, the ‘scheduling’ group came back together for a brainstorm and came up with lots of ideas.’

Several of these underwent rapid testing at the clinic in subsequent weeks and have now been adopted.

Taking the idea of using ‘scripts’ from the booking team, the LOC has developed its own script. This enables treatment suite co-ordinators – who manage patient flow through the chemotherapy suite – to phone patients the day before they receive Herceptin treatment to check they are OK and still able to attend their appointment.

This means that patients receive clear information in advance of treatment, without a clinician having to run through these checks on the day of the appointment.

Saving clinicians time

The estimated saving of clinician time is one hour per treatment. With the clinic running 1,364 Herceptin cycles a year (2014 data), this amounts to a saving of two days a week of patient time in the chair and one nursing shift a week freed up for other patient care.

Following their time with the hotel bookings team, the scheduling group also identified that they did not currently capture data on patient time in treatment.

LOC’s head of business intelligence Steve Rumbles says: ‘We wanted to know how long patients were spending in the treatment chair, so that we could baseline this to measure improvements and so that we could schedule bookings more accurately – like hotel rooms.’

Two approaches were rapid tested for a week. The first inv­olved sticking a piece of paper to the wall and asking nurses to log when patients arrived for and left treatment.

After a week, the piece of paper was pretty empty, so the prototype was deemed unsuccessful. The second prototype involved treatment suite co-ordinators logging patient arrival and departure times on the MOSAIQ patient information management system.

One week into the trial, 40% of patient episodes had been logged accurately, compared to 0% previously, and this data is now being comprehensively collected as stan-dard to build a clear picture of patient treatment times and support accurate appointment scheduling.

Welcoming guests

The ‘reception’ task group was collected by the hotel’s guest experience manager Gautier Colin and taken to the check-in desk.

There they were walked through the whole journey for each customer and shown the customer relationship management system used to log this.

He told them: ‘Whenever a guest checks in or phones to make a reservation, we capture detailed information, including a photo, so that we can build a guest profile. This means that we know their likes and dislikes

‘But the photo-bank also means that all of our team, from porters and cleaners through to managers, can greet each guest by their first name when they see them.’

LOC receptionist George Crispin recalls: ‘This was another revelation. Cancer treatment is extremely stressful, and feeling that you’re with people who know you well makes a huge difference.

‘We thought: “Wouldn’t it be amazing if our clinic reception and the treatment suite could identify patients when they arrived, and greet them by first name from the reception area?”.’

And exactly this approach is now underway at the clinic. After interviewing 72 patients to see if they would be happy to build a staff and patient photo-bank, over 90% said ‘yes’, so work is now in train to photograph patients on arrival.

It is hoped the resulting photo-bank will enable a culture of familiarity to grow, meaning that patients and their families feel supported and cared for as individuals.

The ‘reception’ team has also put forward a business case for introducing an electronic switchboard akin to that at The Land­mark London.

This will handle the huge number of calls currently processed by reception staff daily, ensuring that phone calls are always dealt with promptly and streamed to the right place, while freeing up valuable time for receptionists to interact face to face with patients without being interrupted by the phone.

The switchboard will save an estimated 2.5 hours a day of receptionist time (625 hours a year) to re-invest in patient care.

Pharmacy improvements

The pharmacy group was guided by food and beverage training manager Anna Napora to one of the hotel’s restaurants.

Here she explained how the hotel deals with numerous food orders among multiple restaurants.

She talked the group through the electronic system, and the preparation and communication processes, which enable the right food to arrive with the right guests at the right time – while still remaining hot.

LOC clinical marketing manager Nicole Elliott says: ‘We have a pharmacy on site at 95 Harley Street, where each patient’s treatment is individually prepared according to their needs. It’s just like having a restaurant, really – the pharmacy has to make lots of different prescriptions from scratch, for lots of different patients.

‘From the time a nurse places an order, pharmacy has 45 minutes to turn it around. It has to get the right drug to the right patient in time, just like room service.’

The impact of seeing the hotel kitchen in operation had a remarkable effect. After a tour and presentation from Anna, the LOC group thrust themselves into a brainstorm about possible ways to streamline the drug-making process in the clinic.

Again, a rapid testing of these ideas was carried out in the following weeks, and two of the ideas inspired by the hotel have led to permanent changes.

For a top hotel kitchen to run like clockwork, a lot of preparation work is undertaken in advance. For instance, potato chips are hand cut in the morning to enable them to be cooked quickly on demand.

Using the same principle, the LOC pharmacy has now started to pre-make the drug Paclitaxel the night before a patient’s visit to the clinic.

Pre-prepared drugs

This is ideal for pre-fabrication, as the dosage a patient receives tends not to change from week to week once treatment commences. Pre-fabrication of the treatment means that, as soon as the patient arrives, the drugs are ready to go.

The initiative is working well with a noticeable difference in turnaround time, reduced phone calls between nurses and pharmacy to check on drug development and minimal wastage due to the predictable dosage throughout treatment.

Based on these strong results, the pharmacy is now pre-making all treatments, where possible. The only treatments which are not currently being pre-made are those involving very high-cost drugs or those which are based on current body weight and require the patient to be weighed before the drug is manufactured.

The pharmacy team has also used the idea of the kitchen’s electronic order tracking system to enhance communication across the team.

It already used an electronic dashboard to monitor drug manufacture against the 45-minute window, but the nursing team did not have sight of this information so had to phone the pharmacy to check on progress.

To address this, a shared dashboard has now been trialed, which gives nurses access to the pharmacy dashboard so they can monitor drugs as they are being prepared.

This has reduced the number of phone calls to the pharmacist, meaning fewer interruptions and less stress. And it has created better teamwork by giving nurses a clearer understanding of the timings of chemotherapy manufacture.

Further enhancements to the prototype are now underway to replace the Excel spreadsheet format with a more ‘real time’ tracking system, and ensure the dashboard is located somewhere that is convenient for nurses to monitor – just as The Landmark London’s waiting staff can see the progress of a food order while they are serving tables.

Some of the most powerful principles from this work have been related to design – service design, rather than interior design. This is not about opulent bowls of fruit or lavish curtains, but about the key principles of people-focused design solutions.

Leaders in Oncology Care

LOC is a specialist cancer treatment centre set up by four leading consultants in 2005 devoted to delivering innovative cancer treatments, exceptional patient care and a unique, individual patient experience.

A spokesman told Independent Practitioner Today: ‘At the heart of how we operate is a belief in treating people in a very personal way, with consideration and respect taking into account particular circumstances of their lives.

‘Supporting the whole patient has been a distinguishing feature of LOC and we strive to ensure continual patient support before, during and beyond cancer treatment.

‘Excellence is standard at the LOC, but we’re always striving for perfection. To support our mission to be the very best, we engaged Uscreates to listen to our staff and patients, to identify areas where we might improve; and to jointly create solutions to:
    Achieve best of class in patient experience;
    Foster a first-rate working environment for staff;
    Deliver the most efficient services possible.

‘A six-step process was undertaken, centred around the principle of ‘rapid results’, where prototypes are tried and tested quickly in situ before being developed into full interventions:

1 Listening, shadowing, learning – talking to people, observing practice and reviewing information;

2 Behind-the-scenes workshop in the Landmark London hotel – looking for service similarities and innovative improvement ideas;

3 Designing prototype imp­rovements – three ‘task force’ teams looking for quick wins in:

• Streamlining LOC’s reception process;
• Scheduling appointments more smartly;
• Optimising communications with the on-site pharmacy.

4 Rapid testing of prototypes in situ – to quickly see which ideas would or would not work;

5 Selecting prototypes to run with – planning implementation for the long term, with chief executive endorsement and support for change;

6 Monitoring what is working and how we are excelling – regular impact and evaluation reports, with designated leads for each initiative.

‘This work has led to significant transformation on the ground.’

The Landmark London hotel

The five-star Landmark London ranks among the finest of the capital’s leading luxury hotels.

A spokesman said: ‘Our luxury hotel combines classic British elegance and grandeur with the deluxe facilities required by today’s discerning travellers, such as hotel conference rooms, fantastic restaurants and bars, and a luxurious spa andhealth club with a 15 metre swimming pool and a gymnasium.

‘We continually strive to ensure that we not only meet our guests’ expectations, but that we exceed them. We take pride in offering the highest level of service to ensure that we continue to be one of the leading five-star hotels in London.’

• See ‘What patients really want’