Process Analysis at Arnold Palmer Hospital
The Arnold Palmer Hospital (APH) in Orlando, Florida, is one of
the busiest and most respected hospitals for the medical treatment
of children and women in the U.S. Since its opening on golfing
legend Arnold Palmer’s birthday September 10, 1989, more than
1.6 million children and women have passed through its doors. It
is the fourth busiest labor and delivery hospital in the U.S. and
one of the largest neonatal intensive care units in the Southeast.
APH ranks in the top 10% of hospitals nationwide in patient sat-
“Part of the reason for APH’s success,” says Executive
Director Kathy Swanson, “is our continuous improvement pro-
cess. Our goal is 100% patient satisfaction. But getting there
means constantly examining and reexamining everything we
do, from patient flow, to cleanliness, to layout space, to a work-
friendly environment, to speed of medication delivery from the
pharmacy to a patient. Continuous improvement is a huge and
never-ending task.”
One of the tools the hospital uses consistently is process charts.
Staffer Diane Bowles, who carries the title “clini-cal practice
improvement consultant,” charts scores of processes. Bowles’s
flowcharts help study ways to improve the turnaround of a
vacated room (especially important in a hospital that has
pushed capacity for years), speed up the admission process, and
deliver warm meals warm.
Lately, APH has been examining the flow of maternity patients
(and their paperwork) from the moment they enter the hospital
until they are discharged, hopefully with their healthy baby, a day
or two later. The flow of maternity patients follows these steps:
1. Enter APH’s Labor & Delivery (L&D) check-in desk
2. If the baby is born en route or if birth is imminent, the mother
and baby are taken directly to Labor & Delivery on the sec-
ond floor and registered and admitted directly at the bedside.
If there are no complications, the mother and baby go to
Step 6.
3. If the baby isnotyet born, the front desk asks if the mother
is pre-registered. (Most do preregister at the 28- to 30-week
pregnancy mark.) If she is not, she goes to the registration
office on the first floor.
4. The pregnant woman is then taken to L&D Triage on the 8th
floor for assessment. If she is in active labor, she is taken to
an L&D room on the 2nd floor until the baby is born. If she is
not ready, she goes to Step 5.
5. Pregnant women not ready to deliver (i.e., no contractions
or false alarms) are either sent home to return on a later date
and reenter the system at that time, or if contractions are not
yet close enough, they are sent to walk around the hospital
grounds (to encourage progress) and then return to L&D
Triage at a prescribed time.
6. When the baby is born, if there are no complications, after
2 hours the mother and baby are transferred to a “mother–
baby care unit” room on floors 3, 4, or 5 for an average of
40–44 hours.
7. If therearecomplications with the mother, she goes to an
operating room and/or intensive care unit. From there, she
goes back to a mother–baby care room upon stabilization—or
is discharged at another time if not stabilized. Complications
for the baby may result in a stay in the neonatal intensive
care unit (NICU) before transfer to the baby nursery near the
mother’s room. If the baby is not stable enough for discharge
with the mother, the baby is discharged later.
8. Mother and/or baby, when ready, are discharged and taken
by wheelchair to the discharge exit for pickup to travel home.
Discussion Questions*
1. As Diane’s new assistant, you need to flowchart this process.
Explain how the process might be improved once you have
completed the chart.
2. Ifa mother is scheduled for a Caesarean-section birth (i.e., the
baby is removed from the womb surgically), how would this
flowchart change?
3. If allmothers were electronically (or manually) preregistered,
how would the flowchart change? Redraw the chart to show
your changes.
4. Describe in detail a process that the hospital could analyze,
besides the ones mentioned in this case.
M09_HEIZ0422_12_SE_C07.indd304M09_HEIZ0422_12_SE_C07.indd 304 20/11/15 4:35 PM20/11/15 4:35 PM
De Mar’s Product Strategy
De Mar, a plumbing, heating, and air-conditioning company
located in Fresno, California, has a simple but powerful prod-
uct strategy:Solve the customer’s problem no matter what, solve
the problem when the customer needs it solved, and make sure the
customer feels good when you leave . De Mar offers guaranteed,
same-day service for customers requiring it. The company pro-
vides 24-hour-a-day, 7-day-a-week service at no extra charge for
customers whose air conditioning dies on a hot summer Sunday
or whose toilet overflows at 2:30 A.M. As assistant service coor-
dinator Janie Walter puts it: “We will be there to fix your A/C on
the fourth of July, and it’s not a penny extra. When our competi-
tors won’t get out of bed, we’ll be there!”
De Mar guarantees the price of a job to the penny before the
work begins. Whereas most competitors guarantee their work for
30 days, De Mar guarantees all parts and labor for one year. The
company assesses no travel charge because “it’s not fair to charge
customers for driving out.” Owner Larry Harmon says: “We are
in an industry that doesn’t have the best reputation. If we start
making money our main goal, we are in trouble. So I stress cus-
tomer satisfaction; money is the by-product.”
De Mar uses selective hiring, ongoing training and education,
performance measures, and compensation that incorporate cus-
tomer satisfaction, strong teamwork, peer pressure, empower-
ment, and aggressive promotion to implement its strategy. Says
credit manager Anne Semrick: “The person who wants a nine-to-
five job needs to go somewhere else.”
De Mar is a premium pricer. Yet customers respond because
De Mar delivers value—that is, benefits for costs. In 8 years,
annual sales increased from about $200,000 to more than
$3.3 million.
Discussion Questions
1. What is De Mar’s product? Identify the tangible parts ofthis
product and its service components.
2. How should other areas ofDe Mar (marketing, finance, per-
sonnel) support its product strategy?
3. Even though De Mar’s product is primarily a service product,
how should each ofthe 10 strategic OM decisions in the text be
managed to ensure that the product is successful?
Source:Reprinted with the permission ofThe Free Press, fromOn Great Service: A Framework for Actionby Leonard L. Berry.
M05_HEIZ0422_12_SE_C05.indd 189 20/11/15 2:56 PM

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