Cancer Treatment Centers of America is a chain of specialist medical centers with a mission to treat cancer patients as if they were family members.  Their staff constantly talk about the "mother test" used in decision making:  Is this how you would want your mother treated if she were in this hospital?  It's a variation on the Golden Rule, and it seems to guide lots of big and small decisions around their centers.

In February 2009, CTCA hosted a meeting of the NPS Loyalty Forum at their Phoenix facility.  During the meeting -- where Horst Schulze, a CTCA board member, legendary leader of the Ritz Carlton hotel chain and now Chairman and CEO of West Paces Hotel group gave a great talk that I'll summarize later -- CTCA staff gave us facility tours and explained how their service model works.  Moreover, they introduced us to some patients and shared some of their patient feedback with us.  Impressive on all dimensions.

While not entirely unique in the cancer treatment world, their approach to treating cancer patients goes far beyond the norm.  In 2005-2006, I experienced second-hand some of the best state-of-the-art cancer treatment available anywhere in the world when my father was treated for glioblastoma multiforme (an invariably fatal form of brain cancer) at the Cleveland Clinic.  His treatment was first rate. While the outcome would almost certainly have been the same in the end, however, there were huge differences between what he experienced there and how it might have gone at a CTCA location.  For treatment costs that are no higher than those charged by other providers, CTCA offers a large number of big and small services or service delivery improvements that seem to make a real difference for their patients.

Some examples:

• During the planning process, when a patient calls in to explore treatment options and schedule their treatment, they speak on the phone with a dedicated patient information specialist who helps them determine whether CTCA is the right option for them.  In a process that clearly weeds out some patients who would be outside of CTCA's areas of specialty or for whom the treatment style at CTCA isn't what they want, CTCA puts the "Be Picky" principle of loyalty leadership to work from the very outset.
• Patients and their families flying in from afar can be met at the airport by a concierge.  Intake processing is performed during the ride from the airport to CTCA's center to make the process go faster and with less hassle for the patient
• Patient family members are encouraged to stay with patients for the vast majority of their treatment procedures to provide support and encouragement along the way
• Patients and families are encouraged to stay on-site in hotel-like facilities that are set up for the comfort of the patient and family
• Concierges arrange meals, outings and other services for the patient and family member to provide diversions from the often painful and draining medical procedures
• On-site services include a salon specializing in temporary hair replacement (also called wigs) and other methods for making patients feel more comfortable with their appearance should they undergo changes
• Alternative medicine approaches, including accupuncture, herbal medicine and other treatments are fully integrated into the treatment plan, should the patient so choose -- these providers are part of the on-campus staff and form an integral part of the medical treatment team for each patient, ensuring that these treatments fit into the more traditional medical procedures being administered

In addition to providing these services -- again, recognizing that many of them are available from other providers -- CTCA has highly motivated and energetic employees who appear to believe deeply they are doing something exceptional.  We asked three radiology techs, all of whom had worked for many years at other facilities, what they thought was so different about working at CTCA.  They cited three major differences:

• "There is not a single bad apple at CTCA.  At my other jobs, there was always someone on the staff who was sour, mean, or just lazy.  There is not a single person in this whole place who doesn't really care about their patients and their job."
• "We only see cancer patients here.  The focus allows us to get very, very good at what we do, because we see all different versions of the same issues over and over.  It is much easier to feel good about yourself and your job when you know that you are really good at what you do.  We are good and we know it."
• "We get feedback directly from our patients.  First of all, we follow the same patients through their whole stay.  Of course, sometimes I'll have a day off and someone will sub in for me.  But we generally stay with our patients for the whole treatment as part of their team.  We get to know them.  Second, we get feedback from them through the Net Promoter feedback.  Sometimes they call one of us out as really making them more comfortable and that feels great.  You would never hear that in my old job."

This clearly comes through to patients.  One of the patients we met was effusive in her praise for the staff and the treatment she was receiving.  She went on and on describing the details that had made her and her family more comfortable.  Clearly, she has become a true Promoter for CTCA, though the medical outcomes of her treatment were still undetermined.  She was confident not only that she was getting the best available medical care, but also that there was no other place she could have received this quality of treatment.

Net Promoter is an integral part of how CTCA helps their staff apply the mother test.  They gather, collect and provide feedback from patients directly to their staff.  Follow a set of well thought out processes for helping front line employees learn from patient feedback.  And they tune their overall service offerings based on what they learn from patients.  While one might wonder a little about potential sample bias (I can't imagine that people who had fatally negative medical outcomes would be very responsive to a survey), they achieve impressively high mid-treatment and post-treatment Net Promoter Scores (in the 90s) using the Bottom-up approach.

Remember:  Bottom-up NPS (data collected from current customers to enable front line learning with granular data from individual customers in a closed-loop system) is almost always higher than Top-down NPS (data collected from the marketplace comparing companies or products in the relevant competitive set from which customers can choose).  So take their high NPS with a tiny grain of salt.  But it's still impressive.

For a little note about CTCA and NPS, see this short white paper PDF on the use of NPS at CTCA.

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