Lack of "customer service" as beneficial factor for chronic disease process?

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    Is customer service helping or hurting our patients?

    Lack of "customer service" as beneficial factor for chronic disease process?

    I observed the following clinical scenario several times over the last few months and wonder if it is just episodic events or something more.

    There is a type of patients who openly abuse acute care system. Such patients have a multitude of chronic conditions which can be managed successfully on outpatient basis, but willfully ignore all recommendations, teachings and the rest of it. Instead, they come to ER within 24 -72 hours after discharge stating symptoms which, as they know perfectly well, would warrant readmission, such as chest pain. Once admitted, they terrorize providers and the rest of staff, refuse interventions which are recommended, demand increase of opioids, benzos and other "good stuff" and, in general, refuse to go home till receiving as much of "customer experience" as possible. The cycle is repeated X times. Then, one beautiful day, karma struck. The patient somehow bent the stick too much and totally and profoundly upset provider and nurses. Therefore, he couldn't get more of his beloved dilaudid 1 mg IVP Q2h, no more phenegran IV, appropriate 2 grams sodium/ADA1500 diet instead of regular, no private room which "they always put me in because that's what I want", and his call lights are somehow always got answered the last. Nurses even stop obligingly wipe his butt upon demand, even though "they always did it for me before". After a couple of temper tantrums, the patient leaves AMA or upon the first opportunity to do so, with a loud promise to (never shop there again) never come back to this bad, bad hospital where "nobody cares for me".

    That all is a common and well known and I wouldn't bother with it. But I saw several times recently that the patients in question truly disappeared from the ER for several weeks and, when they finally came back, they were there for legitimate reasons. Moreover, their behavior changed quite a bit. They stopped doing things which caused acute decompensations, such as skipping insulins and breathing treatments. They started to take most of their meds regularly, not only "ma' pain pills". They became more flexible with home and office care. They get flu shots and avoid large gatherings of people during flu season. In other words, they finally started doing what we wanted them to do for years before.

    I was so mystified that I asked two of them, indirectly, what happened. The answers were: since I cannot get what I want here, then I do not want to go here anymore unless there is no choice; so, I am just trying to stay out of this hospital. You told me that I have to do (X, Y, Z), so I give it all a try, so I might not have to go where I was treated so badly and couldn't get what I wanted.

    These observations prompted me to ask a silly question: can "customer service" paradigm actually attract chronically sick patients with significant knowledge about the system in hospitals and therefore negatively affect their health on the long run? And, as an opposite, can lack of "customer service" prompt these patients to finally take better care of themselves and therefore provide significant benefits for them?

    I would be thankful for others' observations and ideas about this topic. "Customer service" is pushed down the throats of all health care providers nowadays, but I never saw any research showing its benefits or lack of them in terms of long-term disease process.
    Last edit by traumaRUs on Feb 6
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    About KatieMI, MSN, RN

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  3. by   Davey Do
    Quote from KatieMI
    These observations prompted me to ask a silly question: can "customer service" paradigm actually attract chronically sick patients with significant knowledge about the system in hospitals and therefore negatively affect their health on the long run? And, as an opposite, can lack of "customer service" prompt these patients to finally take better care of themselves and therefore provide significant benefits for them?
    Again, interesting, Katie!

    So, in essence you're asking "Is the customer service we are expected to provide enabling our patients to continue with their self-destructive lifestyle whereas if we allow the patient to have to deal with the ramifications of their actions/inactions they are motivated to behave therapeutically?"

    My answer is "yes". For many of us, we only have illuminating revelations through having to deal with those conscious changing trials and tribulations that are often self inflicted.

    Karma can be a bi-otch, but it can also be an opportunity for learning and growth.
  4. by   oceangirl1234
    I love this post. I definitely think that the "customer service" attitude enables some peoples' self-destructive habits which can cause them to abuse the health care system. I see this way too often. Especially up here in Canada...really grinds my gears.
  5. by   KatieMI
    Quote from Davey Do
    Again, interesting, Katie!

    So, in essence you're asking "Is the customer service we are expected to provide enabling our patients to continue with their self-destructive lifestyle whereas if we allow the patient to have to deal with the ramifications of their actions/inactions they are motivated to behave therapeutically?"

    My answer is "yes". For many of us, we only have illuminating revelations through having to deal with those conscious changing trials and tribulations that are often self inflicted.

    Karma can be a bi-otch, but it can also be an opportunity for learning and growth.
    I made a solemn promice to myself and my husband to stop my formal education after MSN. But right now my hands are itching about making a small scale research project about this observation. I was suspecting for a long time that "customer service" must not be good for people's health but I had no evidence to prove of disprove it. The fact that "patient can be satisfied one moment and go to body bag next" is just a common sense, not a hard schience, and that some of hospitals which proposed "customer experience" as their prime and main gig, like University of Toledo/Ohio Medical Center, have otherwise awful indicators of morbidity, readmissions and mortality has way too many cofounders to make any reasonable conclusions.
  6. by   Davey Do
    Quote from KatieMI
    as an opposite, can lack of "customer service" prompt these patients to finally take better care of themselves and therefore provide significant benefits for them?
    Quote from Davey Do
    For many of us, we only have illuminating revelations through having to deal with those conscious changing trials and tribulations that are often self inflicted.
    These words reminds me of a certain patient I had to deal with several years ago on the adult male psych unit. This patient, who I called Cpt. Ron, was a menace. He was an acidic trouble maker to the nth degree. I could feel myself shake, probably caused by my sympathetic nervous system, in his presence. I had one heck of a time remaining professional with him, as I wanted to knock him down and beat the pulp right out of him. I cannot think of another patient to which I felt such venom.

    On one admission, Cpt. Ron's threat to kill me "or someone you love" got him transferred to the State Facility. I remember the day he was discharged after the next admission. He had a job lined up as a roofer.

    Years went by and Cpt. Ron was to be admitted to the Gero Psych unit and I was to do the admission. I learned that Cpt. Ron had suffered a back injury from a fall off of a roof years before and was a paraplegic.

    During the interview, I asked him how tall he was. He looked at his wheelchair and said, "Right now I'm about 4 ft!" We both chuckled at that one and I sensed a difference in Cpt. Ron.

    Since I was working 8 hour MN shifts, I never really got a chance to talk to Cpt. Ron, as he slept through the night. One night, however, he came to the nurses station and said to me, "So I hear my evil twin has been causing trouble around here" and proceeded to tell me of his back injury, infection, paralysis, and hypospadias as a result of urinary catheterization.

    Cpt. Ron was a different person. He apologized for his past transgressions and said he had learned a lot from his plights. We discussed how life's difficulties can make us change our view of things and I told him that I forgave him and complimented him on his struggle for growth. I remember the moment as a consensually touching one and feeling teary-eyed

    I wonder if I got Cpt. Ron's name from this movie?

    cpt-ron-jpg
    Last edit by Davey Do on Feb 4 : Reason: added image
  7. by   Davey Do
    Quote from KatieMI
    right now my hands are itching about making a small scale research project about this observation.
    Could a small scale research take place here on AN.com?

    That would be interesting as an article or thread.

    (Hint hint, nudge, nudge)
  8. by   KatieMI
    Quote from Davey Do
    Could a small scale research take place here on AN.com?

    That would be interesting as an article or thread.

    (Hint hint, nudge, nudge)
    The problem is, opinions of anonimous forum participants won't count much. If our credentials could be somehow verified (which is the question to Our Dear and Most Respected Moderators), at least well founded poll could be done.

    The studies I found used cohort designs which make access to medical documentation necessary.

    The Cost of Satisfaction | JAMA Internal Medicine | The JAMA Network

    Patient satisfaction linked to higher health-care expenses and mortality (link embedded)

    I can make a literature review as an article when the flu epidemics will subside.
  9. by   amoLucia
    I don't know if the "'customer service satisfaction' model at all costs" has been around long enough to gather enough reliable evidence.

    I graduated in the 1970s but healthcare was NEVER so burdened by the onus of 'satisfaction' impacting it. There were still the non-compliant, revolving-door pts then, but that was the exception, not the rule. It's gotten a good foothold now, but I don't know how one would be able to track it.

    Interesting thought though.
  10. by   MelEpiRN
    I'm definitely intrigued! I think it depends on the patient, I imagine many just hospital shop. I live in a small enough city...when the specialists all know each other it's easy to find out that pt so-and-so left us AMA and walked on over to the next hospital.
    When I worked in Atlanta, I remember one guy got kicked out of every dialysis center in the area- to the point where he was just calling 911 multiple times a week to get dialysis in the hospital. He was so awful it got to the point where he got dialysis and that's it...no food, nothing extra. As far as I know he never changed his crappy attitude.
  11. by   SpankedInPittsburgh
    I'm sorry I think this whole notion of customer service is nonsense. They are patients who need help with medical conditions not paying guests at Disney. What is customer service at its essence? Giving people what they want. What does it mean in a healthcare setting? Giving the addict more drugs. Giving the obese patient an extra tray. Having a staff member take a COPD patient outside to smoke....

    Codependent nonsense that very much helped drive the opioid epidemic in my opinion
  12. by   Davey Do
    Quote from SpankedInPittsburgh
    They are patients who need help with medical conditions not paying guests at Disney... Giving the addict more drugs. Giving the obese patient an extra tray. Having a staff member take a COPD patient outside to smoke....
    disney-jpg
  13. by   Susie2310
    I don't agree with this idea at all. It's too bad that some nurses and physicians are disgruntled. Health care IS a service business. Nurses, by virtue of our scope of practice, and code of ethics, are PATIENT advocates. I don't see any questions on the HCAHPS survey that are unreasonable, unless we want to go back to the bad old days (I have been an RN for over 20 years) when patients (and family members) had a much lesser voice in how they are treated by health care professionals and the health care system. When my family member received an HCHAPS survey they were happy to provide feedback on the survey, and also to the hospital administrator who called them and asked them about the quality of the care they had received (the facility was having problems with the quality of patient care). We were thrilled on a separate occasion when an administrator called into my family member's room to ask them about the quality of care they were receiving; administration was listening to patients experiences and taking actions to improve patients experiences, and we saw concrete evidence of this.

    In addition, let's not forget that the patients and family members, along with their insurance companies (usually) are paying the bill, and that health care professionals jobs are dependent on patients seeking health care at the facilities they work at.

    Are some people objecting to the expansion of Medicaid in some states? The fact that poorer people in some states can more easily receive health care now? This demographic, which has found it difficult to access health care for years have medical problems that have gone untreated/undertreated for prolonged periods. KatieMI, you frequently post about the unreasonableness of patients and family members; perhaps you should consider another career where you don't deal with the public. The ACA has been a boon for patients and family members in my opinion. The authoritarian model of healthcare is obsolete, and should be.

    My personal experience, and that of my family, with the facilities we receive health care in, is that patients and family members are accorded more respect since the ACA; it is certainly not a panacea however. As the John Hopkins study suggested, medical errors are the third leading cause of death in the US. Patients and their family members can and do play a big part in helping to prevent medical errors if/when they are listened to, and the ACA has assisted them in being listened to.

    My opinion on the attitude of the nursing staff when my family member/s are hospitalized is this: Since the ACA I find some nurses more polite and pleasant, and more ready to listen to patients/family members concerns. This is by no means universal; some nurses are very rude; fail to introduce themselves when they enter the patient's room to provide care for the first time, provide care with their name badges turned backwards, and ignore patient concerns brought by patients/family members. I would never leave a family member alone in the hospital, as quite simply, too many medical/nursing mistakes happen and too many patient problems are not recognized or are ignored.
    Last edit by Susie2310 on Feb 5
  14. by   Ruby Vee
    Quote from KatieMI
    These observations prompted me to ask a silly question: can "customer service" paradigm actually attact chronically sick patients with significant knowledge about the system in hospitals and therefore negatively affect their health on the long run? And, as an opposite, can lack of "customer service" promt these patients to finally take better care of themselves and therefore provide significant benefits for them?

    I would be thankful for others' observations and ideas about this topic. "Customer service" is pushed down the throats of all health care providers nowadays, but I never saw any research showing its benefits or lack of them in terms of long-term disease process.
    The "Customer Service" paradigm does seem to negatively impact patients' health. Whether it's the patient wanting gourmet food and hot and cold running opiates or the family screaming about drinks for the whole clan, blankets for everyone and oh, yeah can you find out how to get the Super Bowl on this crappy TV? -- customer service seems to be bad for health. As long as folks can run to the hospital and get whatever they want, there seems to be no incentive to take care of themselves. And nurses actually give them things that are contraindicated for their condition, just to keep them happy. It's nuts!

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