Urology Pearls: What we can learn from each other

Shahar Madjar, MD

Several years ago, I was on a visit to Ann Arbor, where my two older sons were students at the University of Michigan. The first words I heard them utter were: “Dad, let’s go to Zingerman’s.” The Zingerman’s Delicatessen, they meant, the one established in 1982.

The line was long at Zingerman’s, and I was ready to leave. “Just wait, dad,” my sons said. So I waited, but not for long. A young lady, I assume a student, approached us. She was equipped with a smile that ran from one ear to another, her teeth were as white as snow. In my mind, I nicknamed her Snow White. She handed us the menus with great enthusiasm. And she waited politely for us all to make a decision.

Decisions aren’t easy at Zingerman’s. There is a lot to choose from, and a new vocabulary to master. In the corned beef section, for example, there are the Zingerman’s Reuben, the #13 Sherman’s Sure Choice, the #1 Who’s Greenberg Anyway? the #422 Eddie Big Deal, not to mention the #81.5 Rick’s 50/50 mix. Doubt crept into my mind: how sure should I be about Sherman’s Sure Choice, and who is Greenberg anyway?

I went with the Zingerman’s Reuben. Snow White nodded in understanding. She encouraged me to consider whether I would like to proceed with the Nosher size (Yiddish for “small eater”, $15.99), or with the Fresser size (Yiddish for “Big Eater”, $18.99). I was worried I would forever be remembered as a Fresser, so I immediately chose the Nosher. Another critical decision followed when Snow White asked: “would you prefer a NEW pickle, it is crunchy and cucumberly, or an old pickle which is the traditional, garlic-cured version.” I added tomatoes and horseradish (75c each), and Wisconsin muenster cheese ($1.5). Adding Zingerman’s potato chips ($2 a bag), a cup of coffee, and 3 pieces of Rogallach just came natural. My kids and wife went through a similar decision process. In my mind, I quickly added up the numbers. I concluded that if I ever wanted to become a regular at Zingerman’s, being a doctor in my current position might not be enough — I should add several days a month seeing patients at the office and at surgery, or, at least, rob a bank.

As I was biting into Zingerman’s Reuben, I turned from a skeptic to a fan. The food was delicious.

To top that, the service was admirable. It wasn’t just lovely Snow White. Everyone was polite, and enthusiastic. Our orders were executed without a single flaw. On my way out of the store, I surveyed the huge selection of delicatessen, and dipped small pieces of bread into samples of olive oil and balsamic vinegar (I added one of each to my basket).

And when I was at the register, I couldn’t resist buying a book written by Ari Weinzweig, one of the founding partners of Zingerman’s, called Zingerman’s guide to giving great service – treating your customers like royalties. As a doctor, I told myself, there must be something I could learn from what Inc. Magazine called: “the coolest small company in America.”

The Zingerman’s approach is: teach great service, define it, live it, measure it, reward it. The 3 steps for great service, Weinzweig writes, are: figuring out what your customer wants; getting it for them accurately, politely and enthusiastically; and go the extra mile for your customer. For full details, read the book ($30.22, hardcover, on Amazon).

What can a doctor learn? On page 48, Weinzweig describes the Zingerman’s 4 steps to order accuracy: once you place your order, they read back the order (Snow White did that); someone other than the order-taker checks for the order’s accuracy; after producing the order, and before delivery, someone other than the person who produced the order checks for its accuracy; and last, the server confirms with the recipient that the order was executed correctly.

Applying a similar process to a doctor’s office shouldn’t be too hard. And so I adapted some of the ideas into the work process in my office: the admitting nurse takes the initial history from the patient and extracts all of the relevant history from his prior medical records; I review and verify the information, and add information based on the medical history I take, and the findings on physical examination.

I discuss the goals of the visit, and later a treatment plan; I ask if everything is clear and if there is any further questions; the discharge nurse checks the patient out but not before she reads through our note for accuracy, verifies that all orders were filled, that the patient understands the plan, and that all questions were answered. On top, we try to be polite, and enthusiastic. The administration tells me that my patient satisfaction rating is high. It is a process that requires humility and calls for constant improvement, just like at Zingerman’s.

What can we learn from each other? In my next article, I will tell you about what doctors and hospital administrators can learn from orchestras. And what you can learn from the work of good doctors.

Editor’s note: Dr. Shahar Madjar is a urologist working in several locations in the Upper Peninsula. Contact him at smadjar@yahoo.com or at DrMadjar.com.