What experiences has the Catharina Hospital had so far in processing direct patient feedback? We asked Piet Batenburg, Chairman of the Board, and Jolanda Mik, Care Group Manager, who is responsible for the project.

Was the hospitality at the Catharina Hospital really that poor?

Batenburg: “There was a mentality here that said: this hospital may not be very customer-oriented, but that’s normal for a top clinical hospital, patients come here anyway. Such perceptions are very difficult to dispel. However, when we scored the lowest in almost every category compared to other top clinical hospitals in a measurement by the CQI (Consumer Quality Index) two years ago, it was a significant wake-up call. It was clear that we had a problem. Subsequently, we made it a focal point in our multi-year policy plan. Patient satisfaction and hospitality were identified as the top priorities. Initially, we referred to it as customer orientation, but we expanded the concept. Hospitality has a greater impact.”

Was there immediate support for such a large-scale project?

Batenburg: “I found it remarkable to see that this idea was fairly well embraced within the organization. As our staff began to feel the competition with other hospitals, there was a sense on the shop floor that something needed to be done. Additionally, insurers started awarding designations to well-performing hospitals. Based on the results of the CQI, it was clear that we did not belong to that group—and our own staff members were certainly not happy about it.

During that period, we consciously asked ourselves: we need to address this, but how do we ensure its overall implementation and keep it alive?”

Mik: “It was clear that if you prioritize hospitality in your multi-year policy plan, you need dedicated individuals to lead the way. Because the ambition was to establish the project hospital-wide from the beginning. Not starting with a small pilot project or anything like that, but implementing it comprehensively right away. This is clearly not something that rests solely on the management’s shoulders; it must primarily come from the shop floor itself. I believe it is intrinsically close to the desire of doctors and nurses to improve. Intuitively, employees often know where they excel and where they fall short. The feedback confirms these suspicions. Teams can no longer ignore these findings; they have to act upon them.”

By choosing to use the CareRate application, you opted for a relatively new tool.

Batenburg: “During the period when we were working on this, the CQI transitioned from conducting two surveys to one per year. That’s when we internally realized that we needed a different measurement tool to gather feedback on our initiatives.”

Mik: “Furthermore, our goal was not to establish a one-way initiative. We wanted to create a situation of co-creation, with maximum involvement. A tool like ZorgkaartNederland falls short in that regard. With CareRate, you can have one-on-one private dialogues with patients who provide shortcomings or suggestions for improvement.”

Batenburg: “That’s the weakness of Zorgkaart. It’s comparable to the website Iens.nl, which provides restaurant reviews. You can criticize a dining establishment without even having eaten there. One of our specialists put it this way: ‘I have two ratings on Zorgkaart, one of which is negative. The negative one was given by my daughter when she didn’t get a raise in her allowance.’ So we couldn’t use Zorgkaart; we needed a closed system like CareRate offers.”

Mik: “Additionally, we wanted to be able to continuously measure patient feedback. Our objective was to generate two patient experiences per day per department. It may not seem like a lot, but each department would generate 700 experiences per year.”

A method that shares feedback from patients with all 3,500 employees. Isn’t that perceived as threatening?

Batenburg: “Admittedly, when I used to work as a medical specialist, I also found it scary to receive feedback. However, the current specialists, especially the younger ones, are already accustomed to it. And what you also see among colleagues of my generation is that when they themselves or their partners become patients, it can be a real eye-opener. Suddenly, they find feedback extremely useful. The rest of the employees already understood that, to be honest. Of course, the implementation of working with patient feedback was accompanied by intense guidance.”

Mik: “You have to deal with legacies from the past, among other things. A pilot project on customer orientation was once carried out in one of the departments, which had resulted in a lot of work for that department. They were absolutely not interested in doing that again. I heard them say, ‘Are we really going to do that nonsense again?’ In that regard, Piet’s support greatly helped the project.”

Batenburg: “Such initiatives only succeed if there is commitment from the Board of Directors. In the initial phase, the question was: how do you get things moving? Doctors don’t believe in such projects right away. They want to see numbers, above all. But numbers don’t tell the whole story. For example, patients who are not interested may not participate in patient satisfaction surveys. Their opinions are not reflected in the numbers, which distorts the picture.”

Mik: “Managers love numbers. Catharina Hospital is a high-tech hospital. It’s said that measuring is knowing. Doctors and managers consider that very important. But increasing hospitality is not about numbers; it’s about concrete improvement actions for the sake of the patient.”

How did you manage to get the organization on board?

Mik: “Because short-cycle improvement is also just fun, and it naturally excites people. If it takes too long, people lose interest. Not only the application of CareRate but also the approach itself has helped us tremendously, especially because the results are so visible to everyone. Maybe elsewhere there is hesitation to do it this way, but here it has never been an issue. That openness has actually contributed to our success. Managers have really come together.”

Batenburg: “A hospital naturally has a strong culture of individual departments. Originally, the focus was always on making sure everything on your own ‘island’ was well taken care of. Now, the idea has taken hold in the organization that it is necessary for ALL departments to deliver excellent performance. This way, they can collectively contribute to the hospital’s reputation.”

Mik: “We successfully broke through that silo culture, the barriers have been removed. Moreover, this tool was new to us. It aligns perfectly with this organization; we like to present ourselves as an innovative hospital. Especially when other institutions are not yet ready, we want to give it a try.”

Batenburg: “When you see the impact our efforts have had. Take, for example, the Surgery department, which used to be considered the least customer-oriented. They embraced it so enthusiastically that the department is still seen as a leader within our organization.”

Mik: “Of course, it’s important for the patients to see that their feedback is being acted upon, but it’s equally important for your own employees.”

Give me an example.

Mik: “It can be so simple. For example, who would think in advance that you shouldn’t wear skinny jeans when coming to the hospital for a vascular examination? You can provide your patients with extensive information, but something like that is not mentioned. You have to roll up your pant legs for such an examination, and that’s not possible with skinny jeans. So, you have to take off those pants and sit on a cold chair. It’s a small example, but we immediately incorporated it into our patient information. Every improvement, no matter how small, can make a huge difference. The fact that our management teams now systematically include patient feedback in their discussions is something that was unthinkable five years ago. There is now an awareness of: we need to do it together. I am super proud of what we have achieved. With a very innovative approach; for the first time, we trained hospitality in heterogeneously composed groups. There was initially some resistance. You would hear, ‘What does the manager from the phone center have to do with this meeting? They don’t even know what I do!’ That kind of reaction hits the nail on the head. In addition, the ‘train the trainer’ concept has given us a lot of ambassadors within our organization.”

Batenburg: “That concept also kept the cost level at an acceptable level. I dare to be honest and admit that.”

Mik: “Perhaps that can be an incentive for other hospitals. What I personally find amazing is that departments like HR are now also getting involved, and the thought process has also been initiated in Controlling. This project can be seamlessly rolled out to non-medical support departments. And if in the future we concentrate departments around target groups, then the methodology of CareRate is also very useful. This approach is not static but moves along with the development of our business units.”

Lessons learned with CareRate at Catharina Hospital

Do’s

• Ensure commitment at the board level and invite medical specialists to participate in a steering group.

• Assign individuals with a healthcare background (e.g., nurses) as responsible for policy and project management.

• Translate patient feedback into concrete improvement actions. Then, inform patients about the actions taken based on their feedback. This makes them feel truly heard.

• When you improve what you were already doing well, known as ‘polishing the pearls,’ areas where you were less proficient will naturally improve as well.

Don’ts

• Don’t focus solely on numbers. Going from a five to a six in patient satisfaction doesn’t yield significant results. Concrete improvement actions can achieve that.

• Avoid a siloed approach. Aim for hospital-wide implementation by sharing results widely and learning from each other.

• Minimize top-down directives. Give departments responsibility and let them take ownership.

• Outdated infrastructure and other invalid arguments should not be excuses to avoid addressing the issue of hospitality.