All organizations talk about service, but for healthcare organizations, service is everything. Fostering an exceptional service culture throughout your healthcare organization can be a challenge, but it can be done.

In my last book, Raising the Bar on Service Excellence, I talk about what it takes to get the people within the organization to this level. I depict the process as a triangle that involves the head, the hands, and the heart. Do they know what to do (the head or knowledge)? Do they know how to do it (the hands or skill)? And, finally, do they want to do it (the heart or attitude and desire)? If they do, you’ve got a winning combination!

Here are three essentials for making it happen.

1. Hiring for behavior. Healthcare leaders have typically focused on technical skills when hiring, and that’s certainly understandable. We want staff members who have the competencies to perform their duties, whether these duties are clinical or administrative. One of the biggest arguments about hiring practices when it comes to culture is whether we hire more for skill or total fit. We can teach staff how to perform their job duties if necessary. What we can’t teach them is how to be caring, compassionate, service-driven human beings. Those are the traits we need to screen for during the hiring process. Behavior-based interviews can help. Here’s how it works:

a. Identify the required skill. Perhaps it’s the ability to defuse highly-emotional situations with angry patients or family members.
b. Create questions designed to screen for the skill. That requires the candidate to recall an actual experience. Ask this question: “Tell me about a time when you had to handle a situation with a difficult patient or an angry family member. What was the situation and how did you handle it?”
c. Listen carefully to the response. You will be looking for a calm, matter-of-fact perspective and signs of empathy. You can look for signs that the candidate empathized with the angry individual. For instance, they may say: “I could understand why the person was angry….” Listen for cues that the individual took ownership for the situation and initiative to resolve the problem. Watch for red flags that indicate blaming, judgmental behavior, or we/they mentality.
d. Ask the interviewee what he/she might have done differently in hindsight. One of the red flags I’m alert for when hiring is when somebody says: “Well, I can’t really think of anything I would have done differently.”

Another good, behavior-based question that I like to use is: “Tell me about your favorite job of all time; what made you love it so much?” The response will give you a sense of what really motivates this person—is it the opportunity to serve others and make a difference? Is it the opportunity for intellectual challenge? Or could it be the opportunity to work as part of a highly functioning team?

When we’re hiring new staff members, our goal is for them to be part of a service-driven culture. So it’s important to get a sense of who they are and how they behave in certain situations that can give us a glimpse of their personalities.

2. Training and orienting new hires. When a new employee is hired, they are immediately influenced by the actions and behaviors of those around them—particularly their immediate supervisors and their colleagues. Culture isn’t something that’s described in your policy manual. Culture is “the way we do things around here,” and it will manifest itself in the behaviors, processes, and interactions that your new hires will experience from the first moment they arrive on your campus.

One of the things that I frequently observe is that senior leaders and those involved in the hiring and orientation process will have great intentions in terms of bringing the new employee on board and introducing him or her to the culture. They spend time during orientation talking about the mission, vision, and values. But, when the employee gets back to the unit to which they’ve been assigned, what they see does not match the picture that was painted for them. That disconnect is often a reality shock that leaves the new hire questioning the leadership’s credibility and wondering what other surprises are in store. So make sure that you are what you say you are.

It is critical that your middle-managers (the ones who will actually be working with employees on a day-to-day basis) are modeling, rewarding, and supporting the types of behaviors and actions that you want to see exhibited in your healthcare organization. They need to be providing both positive and constructive feedback and modeling the behaviors that define your service-oriented culture.

That can take time. Sometimes, in healthcare, we’re so anxious to get a warm body into the department that we don’t spend enough time orienting the new hire. I was shocked when I was researching my last book to see the difference between orientation in healthcare environments and other environments. The Container Store, for instance, orients new employees for six weeks before they get out on the floor. Starbucks employees go through 40 hours of orientation—16 of those 40 hours are dedicated to customer service. What does the orientation process look like in your healthcare organization?

3. Behavioral reinforcement and continuous development. So you’ve hired a service-oriented employee and provided training to ensure the employee exhibits the service behaviors that exemplify your culture. How do you make sure that you can maintain these behaviors? Performance appraisals provide a formal opportunity for feedback, but they usually only occur once, maybe twice, a year. That’s not enough. The ideal service culture is one where people are self-policing—they’re catching each other doing positive things, and they’re reinforcing those positive behaviors. They’re also noticing things that could be done better or differently, and they’re correcting those behaviors.

It can take a long time to get to this level. One of the biggest impacts on making it happen is having managers who do daily rounds, engaging with their employees to identify the stars and give them a thumbs up, to thank, to reinforce, and, yes, sometimes to correct and coach.

These are three of the leadership essentials—the hiring, the training and orientation, and the behavioral reinforcement. When you have these three things in synch, then you’ve got a great foundation for a phenomenal culture.