“SER IMSS” PROGRAM

National Strategy for reinforcing good personal treatment among workers and

users at Mexican Institute for Social Security (IMSS)

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Mexican Institute for Social Security •  Mexican Institute for Social Security, known as IMSS for its

acronym in Spanish, is the main governmental institution for providing social security in Mexico: ü Medical assistance ü Social benefits (day care centers, wakes, social security

centers) ü Economic benefits (pensions, disability insurances, among

others)

•  IMSS provides services to more than 70 million people, over 55% of Mexican population.

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Mexican Institute for Social Security •  The Institute has more than 440, 000 workers, only comparable

in number to international enterprises as Wal-Mart or PepsiCo.

•  95% of workers are affiliated to National Labor Union for Social Security Employees, the second most important union in the country after Education Workers National Labor Union.

440, 000 workers

= INTERNATIONAL

ONLY IN MEXICO

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Mexican Institute for Social Security •  Mexican Institute for Social Security has a great

infrastructure to provide medical, social and economical benefits and services to Mexican population:

5,756 Clinics

387 Hospitals

1,376 Day Care Centers

73 Theaters

15 Wakes

66 Stores

155 Sport, Cultural,

and Craft Centers

1,400 Pharmacies

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Mexican Institute for Social Security •  Everyday, IMSS provides more than:

300,000 Medical consultations

75,000 Specialty consultations

55,000 Medical emergencies

4.000 Surgeries

5,000 Hospital discharges

1,000 Attended births

700,000 Clinical Analysis

200,000 Attentions in day care centers

•  More than 2 million people visit our installations every day.

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Users’ perception about IMSS services •  Though service users’ satisfaction has been increasing for the

last years and has reached 82%/1 of very satisfied and satisfied users in 2017, opportunity areas were identified through users’ perception analysis.

•  “Mistreatment” is the main problem that IMSS services have been facing for many years.

•  The most frequent type of complaint related to IMSS services has been “mistreatment”, with 35% of total complaints/2, larger than “service denial” or “excessive waiting time for attention”.

•  According to the Medical Service Users’ Satisfaction National Poll,

the most common reason for unsatisfied users has to do with “mistreatment”. (30 percent of unsatisfied users)/3

/1 Source: Encuesta Nacional de Satisfacción a Usuarios de Servicios Médicos del IMSS. April, 2017. /2 Source: Memoria Estadística de la Coordinación de Atención a Quejas y Orientación al Derechohabiente, 2016. /3 Source: Encuesta Nacional de Satisfacción a Usuarios de Servicios Médicos del IMSS. April, 2015.

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What does “mistreatment” mean to IMSS users?

•  Even though it was clear that IMSS main opportunity area was treatment toward users, it was not very clear what “mistreatment” meant to them.

•  Through focus groups carried out with workers from the Institute, “mistreatment” was an issue identified in the working environment among co-workers. This groups also revealed that users also mistreated IMSS workers.

•  According to 9 focus groups carried out in 2015 different cities of the country to diverse services, “mistreatment” means to our users 5 types of conducts related:

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What does “mistreatment” mean to IMSS users?

Insensitive Differentiated Aggressive Not standardized Inefficient

Conducts while providing a service•  Ignoring users •  Not looking in the eyes •  Not hearing •  Not greeting •  Calling names (for

example, “madrecita”, •  Using cellphones •  Reading selling

catalogues •  Personal conversations

among workers

•  Giving privilege to certain users

•  Denying a service without a reason

•  Using an inadequate tone of voice

•  Using an inadequate or rude vocabulary

•  Making hostile gestures

•  Throwing documents or medicines

•  Physical violence

•  Different conducts toward similar situations

•  When an inefficient attention was given, users associated it with mistreatment as it was believed to be caused on purpose by an employee.

•  When service routes are complicated, they are associated to mistreatment.

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Service Experience

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•  1.4 million appointments are given in a month, more than 16 millones in a year.

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Service experience is built with every interaction that a user has with each person that she or he has contact with during a visit to a unit.

Verifies

people’s exit

Security Staff

Gives the

medication

Pharmacy Staff

Gives pre-emptive actions

(vaccination, pap smear,

etc)

Nurse

Gives

medical atention.

Issues the prescription

Ask for labotary studies.

Doctor

Records the

visitm weights and measure the

patient

Medical assistant

Gives service

orientation

TAOD

Verifies user’s ID for

access control

Security staff

Laboratory Studies

Service route in the first level medical atention (Visit to the Clinic)

What does “good treatment” mean to IMSS users? •  According to the focus groups and annual polls for evaluating

satisfaction, “good treatment” meant to IMSS users:

Adequate verbal and body language while IMSS employees provided attention toward users.

Fast attention to users’ medical and administrative needs.

Efficient processes to attend users’ administrative and medical procedures.

Simple procedures that did not force users to physically attend to medical or administrative units one or more times.

•  From this analysis, we realize that good treatment is not only determined by how we relate with our users, but other factors are also taken into consideration.

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Benchmarking and Training Companies Supply •  Once the problem was identified by its multiple factors, we needed

to understand how to provide a quality service.

•  A benchmarking was developed based on worldwide public and private organizations, and an analysis of national and international supply training companies was developed.

•  Main organizations used for the benchmarking were: Service Canada, Infonavit, Disney, St. Regis, American Express, Starbucks, Pepsi Co and Wal Mart.

•  Relevant insights were identified to achieve successful service quality and good treatment:

•  Labor unions and Company’s leaders involvement •  Design a training program by people who knew the

organization from the inside (ad hoc to the company’s needs) •  Evaluation and permanent supervision strategy •  Service protocols •  Effective communication toward employees

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Designing a “good treatment” Program •  After analyzing all that was learned through focus groups, polls, service

benchmarking and proposals from training companies supply, it was clear that a program for “good treatment” had to have 3 main objectives.

1.  Transform IMSS service culture toward a good treatment culture. 2.  Improve organizational climate among workers. 3.  Reinforce good treatment toward IMSS users

•  Main components of the program:

o  Specific Training. “Basic Good Treatment Training Workshop” was created for workers to acquire conscience, develop soft skills and to learn protocols. This Workshop has a duration of 12 hours distributed in 2 days.

o  Protocols. Six service protocols were designed for IMSS workers to standardize the service according to users demands and employees needs.

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Designing a “good treatment” Program o  Supervision. Physical and

remote supervision schemes were developed to monitor program implementation.

o  Communication. An intern communication campaign was created for the workers to k n o w t h e P r o g r a m , understand its objectives and the basic protocol.

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Designing a “good treatment” program o  E v a l u a t i o n . A n s t a t i s t i c

evaluation model was developed to know if the Program had been successful, as well as polls for users and employees and focus groups to know peop le´s perception.

o  P a r t i c i p a t i o n . A s h a r e d responsibility model across all the areas of the organization was created, since there was not a speci f ic area to at tend “treatment” subjects and the issue affected all of them.

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Good treatment Protocols •  Six “good treatment” protocols were developed and

included in the Training Workshop based on the main users’ demands and IMSS workers needs detected through focus groups and best service standards:

Protocol for providing good treatment to users.

Protocol for upset users‘ attention.

Protocol for good treatment among workers.

Protocol for giving bad news to users.

Protocol for medical attention.

Protocol for good treatment to disabled people.

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Good treatment Protocols From all the six “good treatment” protocols developed, I will be specific on those that we consider the most relevant:

•  Protocol for providing good treatment to users. Though this protocol the workers learn easy tips for improving their relationship with patients and service users.

•  Protocol for upset users‘ attention. This protocol substantially changed the situation workers faced toward users that were already upset by apologizing on behalf of the institution.

•  Protocol for good treatment among workers. This protocol changed the relationship among employees, particularly in medical units, as it set different conditions to relate with each other. For example, people started calling by their names instead of employee category (doctor, nurse, or cleaning service).

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Protocol for providing good treatment to users

Greeting

•  Make eye contact. •  Greet before the other person does it. •  Use the phrase: Good morning (afternoon/evening) my name is___. How may I help

you?”. •  Talk with respect and address to the by his name and/or last name: For example, “Ms.

Jane or Mr. Smith”. •  Smile, if the situation calls for it.

Hearing

•  Keep the eye contact with the other person. •  Pay attention in the interaction with the other person. •  Be sensitive according to the situation that the person is facing. •  Avoid personal interruptions while listening (phone, food, catalogs).

Responding

•  Use clear and simple language that the other person can understand •  Avoid using nicknames to address the other person, for example: little patient, mother, my

dear. •  Do not generate false expectations •  Do not use justifications or pretexts to deny an attention or service that it is possible to

provide without violating current regulations and/or damage property or the Institute interest.

•  If you don´t know the information, channel with the right person or with somebody who can give the proper orientation (TAOD personnel or work services, if that the case).

•  Make sure the person has all the information that you can provide before saying good bye.

•  Ask: Is anything else I can do for you?

Say good bye •  Kindly say good bye using the phrase: “Have a nice day (evening), I’m here to help you”.

Do not forget

•  Our priority is the care and attention of our users. •  Use your worker ID all the time. •  Use your uniform clean and complete. •  Use courtesy words such as: please, thank you and you´re welcome •  Remove all the objects from the area that obstruct your interaction with the people.

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Communication campaign and program’s name •  A communication campaign was created with the name SER IMSS and

the slogan “De buenas, es mejor”.

•  The name had two different ways of understanding it:

SER IMSS in Spanish means literally “To be IMSS” and it was developed it pretended to be understood as a phrase that helped to accept the Program and develop workers' sense of belonging.

SER is also the acronym for the 3 main steps of the Basic good treatment protocol for IMSS workers

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•  The slogan “De buenas, es mejor” is a Mexican slang phrase that means in Spanish: “Good mood is better”.

Communication campaign and program’s name •  Posters with the campaign name and

slogan were designed with workers images from 8 of the most important e m p l o y e e c a t e g o r i e s : m e d i c a l practioners, nurses, security guards..

•  Also, there was one version of users images posters to include them in the good treatment campaign.

•  Workers IDs designed was also modified and aligned to the program.

•  A jingle was developed to be used as

ringtone, waiting message for institutional telephone lines and official events.

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“Good treatment” program pilot •  Unit selection. 9 units (4 clinics and 5 administrative units) were

selected to implement a “good treatment” program in metropolitan area of the country that included all the elements previously mentioned. Other 9 units with similar characteristics were selected to compare results after program implementation.

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•  Results: -  Mistreatment complaints decreased 25% after 3 months of

implementation. -  Satisfied users increased in all units at different levels, with

better results in bigger medical units.

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30

40

50

60

70

T1 T2 T3 T4

Mistreatment complaints

Pilot implementation

National Strategy Adjustments •  After evaluating quantitative and qualitative information from the

pilot implementation, different adjustments were done to the Program to transform it in a national strategy:

-  Some training techniques were modified, as they generated conflict and the time dedicated to protocols was increased, as workers were interesting on that.

-  It was determined that unit directives should participate among the first three training groups organized, as it proved better leadership in the program and better results for the unit.

-  After this changes a trainig book was created and formally registered for trainers, as well as SER IMSS trademark and its slogan.

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“SER IMSS” Program Implementation •  More than 250 trainers were coached and certified to implement

the training program in 35 IMSS delegations through 52 IMSS training centers.

•  Other factors were considered to select the units to implement the program:

o  The 80/20 Pareto principle was used to select the units of the country that concentrated the 80% of IMSS users.

o  Units with the highest levels of mistreatment complaints were selected.

o  Units with the lowest levels of good treatment users‘ perception according to national polls were selected.

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•  The communication campaign was distributed nationally through posters, electronic messages, payment receipts, internal printed and electronic magazine, emails and the jingle playing.

•  Every time a medical or administrative unit started training their workers, local leaders had to organize an event to inform workers about SER IMSS Program. This improves the workers’ understanding and acceptance of the program.

“SER IMSS” Program Implementation

IMSS Headquarters

IMSS General Director and Labor Union General Secretary , iniciating togheter SER

IMSS Program

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Main outcomes and impact •  SER IMSS Program has been implemented in 635 medical and

administrative units in one year from May 2016 to May 2017.

•  More than 135,000 IMSS workers have been trained.

•  After finishing all the medical and administrative units programmed for training during 2016 and 2017, it will impact 65% of IMSS users around the country, more than 39 million people.

•  As a groundbreaking event without precedent, the Delegates of the Institute and Union labor representatives from each of the 35 delegations around the country were jointly trained.

•  User perception units‘ where SER IMSS Program was implemented, increased 4 perceptual points its evaluation of excellent or good treatment.

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+4 POINTS

Why “SER IMSS” does actually work? •  The Program is promoted from the highest directive level at the Institute and

the labor union. •  The training workshops are the same for directive and operative workers to

drive an equality culture inside the Institution. •  Each medical or administrative unit has to train 100% of its workers to create a

change in the everyday working climate, not only people who provide user attention.

•  The training workshops are mandatory for all the actual workers and the new entry staff, to avoid losing the strategy since it represents 20% of staff rotation per year.

•  The training team has been professionalized and its training techniques have been standardized in the whole country.

•  The communication campaign and the training strategy are driven by workers’ well being.

•  Service and attention protocols were created according to users demands and workers needs.

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Challenges •  Training has to be reinforced in a permanent way to create a

stronger service culture in the Institute. A new on line obligatory training program is being developed in order to help workers to remember protocols and deepen into some skills required to improve treatment toward users and other workers.

•  Aligning IMSS internal normativity is relevant to integrate “good treatment” as a transversal subject and priority for every area.

•  Defining processes for SER IMSS permanence is important to avoid political bargaining or political interests to change institutional progress on professionalizing public employees.

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Service improvement actions

•  In the last two years, the Institute has taken decisive actions in terms of service improvement which have contribute to improvement of satisfaction.

National Strategy to Reinforce Medical Attention

Digital IMSS Program

Infrastructure Program Procedures Simplification

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Treatment Improvement Program

THANK YOU FOR YOUR ATTENTION!

Contact Information: María Arizmendi González

Coordinator for Users Orientation and Complaints

Attention at the Mexican Institute of Social Security

maria.arizmendig@imss.gob.mx

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