Patient as Customer model of healthcare - page 4

Our hospital has in the last couple of years initiated a number of changes. One of them is that in much of our correspondence from upper management the patients are refered to as 'customers'. ... Read More

  1. by   Altra
    Quote from maryloufu
    I am asking you seasoned nurses= when it comes to a point when a line is crossed- (Like when a patient is ordering drinks for guests in the room. I mean come on!) How can I tactfully refuse to play hostess? I have trouble with not being nice and sweet, but giving one patient all of the box lunches is a poor allocation of resources.:trout:
    To patient: "When I next go (down the hall, to the kitchen, whatever...) I'll be glad to bring you a patient ginger ale."

    Turning to family/visitors: "The cafeteria is on the 4th floor." Or ... "There are vending machines for your use in the lower lobby."

    Smile. Take the moment to reassess the patient's pulse ox, wound dressing, whatever ... it reinforces to the patient and to the family the role you play in their care and the role that you do not.
  2. by   Altra
    I've also been working on tactful ways to educate patients & families about egregious mandates from JCAHO, the state, etc. that do more to hinder patient care than to foster its excellence. Example: I'm tripping over family members who are surrounding their elderly loved one because crowded into the room, along with everything that needs to be there, are an extra trash can and the airway cart. Why? Because the state health dept. is on a rampage that we not have anything in the hallways. You better believe that if a patient/family member makes a comment about it, I take the opportunity to politely educate them on what these quasi-governmental agencies spend their time focusing on.
  3. by   ZASHAGALKA
    I understand the concept of trying to focus everybody's (patient and staff) attention to a more service related model.

    That being said, there are 2 fundamental flaws with a 'customer service' model.

    1. 'The customer is always right'. I'm not a MW teenager providing a fast food service. I have years of education and experience and in fact, the patient ISN'T always right. Very many times, I'M right. That's why hospitals exist, so that my particular expertise is brought to bear. We live in an information age where information is the tool of economy. Patients are in the hospital BECAUSE I have the information to correctly assess a situation; information that THEY do not possess.

    When you place nursing in terms of 'customer service', you encourage the intepretation that any unpleasant care is a customer service deficiency. Unfortunately, I DEAL with unpleasantries daily. NO, I DON'T want to stick you 3 times to get an IV; but if I must, that is NOT deficient customer service.

    2. The customer service model cannot take into account acuity. If my glass isn't filled timely at the dinner table, that is a customer service deficiency. Either the waitstaff ignored me for too long, or management didn't provide enough staff to timely meet my needs. Either way: that is a problem that needs to be addressed.

    But with flex staffing that leaves nurses at the margins for care, that whole dynamic changes. Timely takes on a completely different meaning when it is filtered through the concept of priority care involving multiple 'customers'. Basically, such a concept sets you up to fail in a particular way: those patients most likely to be completely aware of minor time and service delays are precisely the ones that normally must command less of my attention in favor of more critical patients.

    So, by encouraging patients to think of themselves in terms of customers, it sets up those very customers most likely to command less of my time by priority to be the most upset by not being afforded more of it.

    ~~~
    I don't think that nurses are more upset by the 'terminology' than the underlying meaning of it. I think that nurses don't like the terminology BECAUSE of the underlying conditions symbolized in it.

    ~faith,
    Timothy.
  4. by   GardenDove
    Quote from lauralassie
    i'v seen the model as well. bunch of crap. hospitals arn't walmart , they do painful things, people die, bad things happen. with all the ambulance chacer comercials on tv, no wonder people think they are entiteled to money every time something goes bad. now if i go to walmart and i get pneumonia from a dvd i bought or if i die from a bad pair of slippers i bought i might be a little upset. if you get something that doesn't work at walmart you take it back. but if you used it, threw it around, hit it with a hammer they look at you and laugh. if you go for open heart surgery with etoh hx, overweith, smoker who watches /tv 22 hours a day, and you leave the hospital "broke", then do we refund the money ? will that make our "cousomer happy?" hospitals need to get a grip on hiring all these expensive consultants and get a brain of their own.
    hey, great post, you said it all!
  5. by   caroladybelle
    I am currently on assignment (Hospital from Hell Tour 2007) at facility that is the nightmare of customer service.

    We will get around the visitors and patients that have VIP cards that entitle them to a carefully worded Thank You of great G-dlike benefactor/factoresse for their gracious generosity and entitles them to have us at their beck and call. We will get around the VIP unit, with its fluffy terry cloth robes and plates of petit fours. (Another traveler was going to work there, and I pray for the woman nightly...she must be insane).

    We will get around having to carry a phone, a pager and a nurse lowjack. Even since we have to sign in on our sheet, and in the agency office (one end of the building) and pick up our lowjack/pager at a separate office (the other ed of the stinking building) and then are permitted to go to our Floor and clockin (but better not be late - you'll be docked). Why do we need to a pager -well, if we do not answer the phone quickly enough, they will page us.

    Would some brain dead administrator could figure out, if we don't answer the darned phone it is because we are busy TAKING CARE OF THE PATIENTS!!!!!!

    The call light does not go to the desk but to a centralized dispatcher. And they time how long it takes for the nurse to answer the call and enter the room.

    They have paper pushers to monitor every single high tech (expensive) surveillance. What don't they have, you might ask?

    Well, for one thing, wash basins in the hall for the staff to use. There is one at the nurse station, one in the med station, and one in the kitchen and one in the BR. Count'em Zero, outside patient rooms or outside patient bathrooms. 30-40 beds, no hall wash sinks - on a floor with severely immunosuppressed patients. Yes, they have that gel crap.....which is utterly useless against C.Diff (prominent in immunocompromise patients). Do you really think it good for the nurse to wash her hands using a sink in a CDiff patient's bathroom. And we will invest in phones/pagers/lowjacks and portable med carts w/ computer screens, so that nurses can easily get to the phone, but make him or her hike a mile to stand in line to use sink at the nurse's station. Not to mention, most calls involve the nurse needing the chart and they still have to hike to the station.

    Sorry, but I think that they should spend money on a sink or two, and ditch either the pager or phone.

    We have patient concierge and of course, press ganey. The patient concierge basically makes twice as much work for the nurse ....surprise!

    Interestingly this facility had over 120 employees at last orientation....over 1/2 were RNs. And still has traveler positions available. It is a medium size facility, in an attractive area, close to 100% insured clientele. So has anyone ever checked out why the turnover.

    The orientation nazi....er...instructor used the one customer complaint/incident, etc. you get a pink card, the second you get fired. I, who have never hard a patient complaint as a traveler of 5 years, was really tempted to toss his paperwork back in his face and walk. This is not the way to motivate people in the first few minutes. But I signed a contract and will see it through.

    Garbage like that makes me want to screw up royally in orientation..to get bounced from an assignment for first time and to do it deliberately. Just because they are so arrogant.

    The MD orders/notes are THE WORST!!! handwriting that I have seen in 13 years of nursing. I spent 3:54 (the phone has a counter) trying to get corrections on orders, decipher orders, get orders (two different MDs tell patients that they will be DC'd by 1000, AND DON"T WRITE A D^&N DC order. So I get to waste nearly 4 hours of shift, on hold/playing phone tag/stroking overblown MD ego because Dr. Idiot couldn't be bothered to write "DC patient".

    But MDs are "customers" just like patients. They might send their precious patients to some other facility. Fat chance as they would have to mingle with uninsured, there. But we mustn't upset them, oh no. Poor dears, are so stressed with those nasty little med reconciliations that JCAHO requires, that none of them can seem to sign and review. They can't dictate nonnemergent orders to the nurse and must actually WRITE them while in the building.

    Why it is amazing that the MDs do not break down under the strain.
    --------------------------------------------------------------------------

    I treat ALL my patients as VIPs. And I have cared for some truly famous, notable people....ALL of whom donate huge amounts of money to hospitals/charities and NONE of whom carried VIP cards or required special deference.

    I treat my patients wonderfully. But just dealing with this "customer" service crap makes me want to quit the profession. When I am comforting someone that has justed learned that they have less than 3-6 monthes to live, I do not need a phone ringing, calling me to the desk to read off a patient's insurance code.

    And I am not the McDonald's drive through rep. - don't time how many minutes it takes me to comfort the family of dying patient "A" while patient "B'" wants an extra cup of ice.
    --------------------------------------------------------------------------
    And please pray for me for the next few monthes. I may run amok soon.
    Last edit by caroladybelle on Jan 13, '07
  6. by   GardenDove
    Carolladybelle, that all sounds like an elaborate kindergarten system. When my kids were in kindergarten, they had this dropping a card system for naughtiness, and putting names on the board, with escalating penalities. Rather ridiculous to be using these tactics for professionals.
  7. by   GardenDove
    My hospital is on a huge customer service campaign, with a big mandatory patient care inservice coming up. They instituted an obnoxious silly program that is very similar to what my kids' school does with 'gotcha cards' and pizza with the principal. They bought it from some company, paying big bucks. Then, when nurses didn't participate enough in some units, our Hitleresque director of nursing with the major Napoleonic complex had major fits. They also instituted a code of excellence which they began using against staff whose noses weren't brown enough.
  8. by   VivaLasViejas
    Good post, Timothy.:yeahthat:

    Frankly, I think healthcare went into the dumper when people started looking at it as a BUSINESS, rather than as a necessary service. We have waaaaay too many executive types thinking up "scripts" that make us sound more like parrots than professionals, and developing more and more paperwork to make it look like we're providing the care the papers say we are, but don't have time to actually DO because of all the paperwork!!:trout:

    And this "customer-service" garbage..........don't even get me started on that one, it's ridiculous.:angryfire I don't need anyone forcing me to be nice to people; I operate under the Golden Rule as it is, and I've never had a single complaint about how I treated patients (oops, I mean 'clients'.......yuck). However, there are times when my professional expertise should trump patients' so-called rights, especially when it comes to their "right" to make bad decisions for themselves, or to be nasty just because they can.

    My feeling is, I'm paid to give care, not contribute to your problem or put up with your verbal or physical abuse........and if you don't like it, well, take your "business" someplace else. I'm sorry, but I was never one to take a recovering MI patient out for a smoke, and I never permitted anyone who was A&O to treat me badly. I guarantee that if 80% of the nation's nurses were to refuse to go along with this corporate horse-pucky, it would stop; and P-G scores be damned!
  9. by   GardenDove
    :yeahthat:
  10. by   nurse4theplanet
    Timothy, you took all my thoughts exactly and worded it better than my young mind could have ever conveyed! Bravo on your post!
  11. by   Works2xs
    There are 2 fundamental flaws with the resistance to looking at patients as customers.

    1. People who end up sick and in the hospital aren't there because it's a good time. It's not like they are there to do us a favor. Many, many people have to pay substantial sums of money to have the privilege of being cared for by people with years of education and experience. Often times, this cost is second only to their mortgage. For that level of burden, there's an expectation of something more than just sitting there and taking whatever is dished out.

    About the only thing worse than being sick enough to require hospitalization is having to endure it while surrounded by a bunch of surly, out of sorts people who seem to act as though I should just shut up and accept whatever they deign to throw my way. While I might have to put up with some MW teenager tossing a sandwich to me at a drive-thru, you can bet that for the money I'm spending on my hospital stay, I expect to be treated with some degree of dignity and respect.

    2. And while my years of experience and educaction might not be in the field of medicine, it was certainly as difficult to come by. And as a result of that time and effort, I'm not just some blithering idiot. If you'd just stop long enough to explain a thing or two to me, rather than treating me with less attention than you'd give your house plants, I might just accept your ministrations with a level of understanding that you'd find surprising. I realize that there are people just down the hall or around the corner that may be more acutely sick/injured than myself. I'm more than willing to put up with some suffering while you treat those who are more ill than me. On the other hand, I don't want to end up on the bottom of the priority list simply because I'm not a "squeaky wheel."
    ----------------------------------
    Ok... before you blow your top at the veiws above, let me explain a little. I understand that the nurses in this thread are tired of bad patients treating them like serving wenches. However, there are also nurses who treat their charges as a nuisance regardless of how understanding and patient they are with the lack of attention they might be receiving. So let's at least try not to throw the baby out with the bathwater here. Just as there are unreasonable patients, there are also unreasonable nurses. Regardless of how great you might be, they need a readjustment to their approach.

    Here's another view... Is it possible that you can provide the same level of care to your patients and still tune your approach to make their stay any more endurable? These people are sick and feel a near complete loss of control. Often times, their irritability is just a function of their illness and nothing at all to do with how they are being treated. Part of the skill of a nurse is their ability to reduce their fear and anxiety. Those skills aren't just measured in how many IV's you can start with one stick. They are also measured in how well you can communicate with those receiving your care.

    Perhaps it's just me, but having had the unfortunate need to be parked in a hospital bed a fair number of times in my lifetime, I've had the opportunity to see both sides of the coin. One of the reasons that I chose nursing was the fact that the people who often had the most profound impact on my stay were those with whom I spent the most time - the nurses. Most of the time, it wasn't that the care given was any better. Rather, it was the manner in which it was provided. You may be the most skilled and educated practitioner on your unit. However, if your people skills aren't any better than some turnkey at the local prison, then unfortunately nobody will ever know it. And if they do, they'll be too bent out of shape with the other part of your care package to make any difference.

    If you already practice the arts I'm speaking of, then good for you. However, I'd bet that you know of some member(s) of your peers that don't. It's these folks that management's aiming at. It's too bad that some small minority can bring customer and management ire to all of us. Perhaps when you sit in the driver's seat, you can instill your skills in your charges so that such measures won't be necessary in the future.

    Oh.. btw... I recognize the fact that management is often really lousy at implementing these sorts of initiatives. That doesn't make the need for the initiative any less important. It just illustrates the need for tons of work at that particular part of the business. But that's a subject for a different thread.
  12. by   ZASHAGALKA
    Quote from Works2xs
    There are 2 fundamental flaws with the resistance to looking at patients as customers.
    You make some good counterpoints.

    Here's the problem: I understand that there are bad nurses out there. I just despise being treated by the same brush. In an effort to deal obliquely with those bad nurses, instead of directly, management has painted all nurses by the same brush.

    That's bad management. As you pointed out.

    I said I understand the point, just not the execution. That's the case. There is a balance here. Letting 'surly' nurses force their care on patients is bad in one extreme. Expecting that my priority should be redirected to timely creature comforts with no consideration for higher priority concerns is bad in the opposite extreme.

    Ultimately, instead of treating nurses like we're all prima donnas that need some form of systemic control, management would be better served directly dealing with the bad nurses and letting the rest of us, well, nurse.

    Yes, it's a no-brainer that concepts instituted by non-nurse consultants that have no idea what nurses do will not be well received by nurses. That's the case here, and it more then explains the animosity.

    ~faith,
    Timothy.
  13. by   caroladybelle
    Quote from Works2xs
    There are 2 fundamental flaws with the resistance to looking at patients as customers.

    1. People who end up sick and in the hospital aren't there because it's a good time. It's not like they are there to do us a favor. Many, many people have to pay substantial sums of money to have the privilege of being cared for by people with years of education and experience. Often times, this cost is second only to their mortgage. For that level of burden, there's an expectation of something more than just sitting there and taking whatever is dished out.

    About the only thing worse than being sick enough to require hospitalization is having to endure it while surrounded by a bunch of surly, out of sorts people who seem to act as though I should just shut up and accept whatever they deign to throw my way. While I might have to put up with some MW teenager tossing a sandwich to me at a drive-thru, you can bet that for the money I'm spending on my hospital stay, I expect to be treated with some degree of dignity and respect.

    2. And while my years of experience and educaction might not be in the field of medicine, it was certainly as difficult to come by.

    If you already practice the arts I'm speaking of, then good for you. However, I'd bet that you know of some member(s) of your peers that don't. It's these folks that management's aiming at. It's too bad that some small minority can bring customer and management ire to all of us. Perhaps when you sit in the driver's seat, you can instill your skills in your charges so that such measures won't be necessary in the future.
    --------------------------------------------------------------------------
    You are making a lot baseless assumptions towards the posters. You presume that patients have ever found fault with how we care for them, treat them. Let me tell you that nothing could be farther from the truth.

    But honestly, the post above could have been written by any number of my colleagues or myself, about 15 years ago. Back when we left the IT or business world. The tune will change about 3-5 years after you graduate and have worked for a while, in a facility that will spend millions on lowjack/pager systems, but not even invest in sinks or safe (non flimsy) gloves, to prevent infection. The times when staffing is so poor that you have worked 12 hours without breaking/eating, and you are staying after two hours to finish paperwork, and a bean counter gets fussy because you did not get anyone to initial in triplicate the time that you stayed after. Or when you as a patient are trying to deal with a cancer diagnosis, and your nurse is comforting you, but she gets the mandatory phone ringing to go fetch a newspaper.

    Johns Hopkins is rated the number one hospital in the nation. And it holds that position year after year. And I certainly did not have to wear a lowjack/pager/beeper for them. No little cards got handed out. No little timers

    Hospital at UPenn generally rates highly. NYP - Cornell is consistantly rates in the top ten in the nation. Guess what, I didn't have to carry beepers/lowjacks/pagers. No little timers. And not a lot of staff turnover.

    All of these facilities are considered excellent and known by health care consumers...and they do not have to need for these demeaning tactics. A coincidence - I think not.

    And nurses still have the highest "trust" rating, year after year, as noted by Gallup Polls. Yet they are consistently are subjected to the greatest distrust by administration. They won't lowjack pharmacists, doctors, the hospital chaplin, and the accountant (all of whom have lower ratings, and several of whom are known for risk of theft of money/equipment/drugs or unethical behavior), but they will search the nurse's bag.

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