Patient as Customer model of healthcare - page 5

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   Works2xs
    Quote from caroladybelle
    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.
    Sorry, I don't know what assumption you think that I've made.

    I know that management of any organization can be boneheaded.

    I know that such boneheadedness is often expressed by poorly implemented "solutions" to problems that are really just symptoms of crappy management.

    I also know that it's entirely possible that a management principle can be valid and still be subject to poor use or implementation.

    I'm also aware that while the above statements are fairly accurate, none of them have any real bearing on the question of whether it's appropriate to look at those in our care as being a "customer" or "client".
  2. by   ZASHAGALKA
    The straw that broke at my last job was implementing the "lojack", the infrared tracking system.

    I will NOT wear a nurse collar. I respect myself too much.

    Customer service or not, I'm not a dog.

    If you don't trust me, then do the job yourself. But after you publicly declare that you don't trust me with such a system, don't expect any fashion or form of respect from me, respect that clearly doesn't run both ways. In fact, don't expect ANYTHING from me but a resignation notice.

    Management might get away with such garbage because nurses put up with it, but not because of this nurse.

    ~faith,
    Timothy.
    Last edit by ZASHAGALKA on Jan 16, '07
  3. by   GardenDove
    Quote from ZASHAGALKA
    The straw that broke at my last job was the "lojack", the infrared tracking system.

    I will NOT wear a nurse collar. I respect myself too much.

    Customer service or not, I'm not a dog.

    If you don't trust me, then do the job yourself. But after you publicly declare that you don't trust me with such a system, don't expect any fashion or form of respect from me, respect that clearly doesn't run both ways. In fact, don't respect ANYTHING from me but a resignation notice.

    Management might get away with such garbage because nurses put up with it, but not because of this nurse.

    ~faith,
    Timothy.

    You've gotta be kidding? I've never heard of anything so demeaning in my life.
  4. by   nurse4theplanet
    Quote from ZASHAGALKA
    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.
    The problem is just that. Management does not deal with the problem directly.

    In fact, it's not the floor management that is instituting the customer service nazi program...it's corporate. That opens a whole new can of worms.
  5. by   nurse4theplanet
    Quote from GardenDove
    You've gotta be kidding? I've never heard of anything so demeaning in my life.
    This was also being used at a hospital that I teched at during school. Obviously, I did not take that job after graduation.
  6. by   caroladybelle
    Quote from Works2xs
    Sorry, I don't know what assumption you think that I am making

    I'm also aware that while the above statements are fairly accurate, none of them have any real bearing on the question of whether it's appropriate to look at those in our care as being a "customer" or "client".
    You make the assumption that any of these inventions "improve" patient care or even make it "customer" friendly.

    As demonstrated by the success of those facilities that do not use them, obviously they are not needed to improve "customer" relations. And as nurses feel dmeaned by them, may actually harm patient.

    Financially, they do not make good fiscal sense. We are pouring a lot of money into something, that has extremely little benefit (if any) to the patient. And if enough staff are alienated by the lowjack (and excellent nurses can pick and choose their jobs), turnover remains high and this is actually harmful to good "customer" care. It also results in higher complications and poorer care.

    Take into account that many of healthcare's "customers" are getting a partial or total freebie. If you go to Mickey Ds, everyone is paying out of their pocket, and paying the same amount for their food. In healthcare, many are not paying a penny or only a small fee for what others are paying thousands for.

    And, quite bluntly, many people are in the hospital are unhappy, distressed and often in related to poor healthcare decisions. If we try to implement good healthy behavior, they are probably going to be unhappy. If we go by good "customer" service principles, we will make them happier, but they will not have their healthcare served....the purpose of healthcare. "Customers" often want things that are not appropriate for them.

    And while buying the wrong car, or the wrong dressing, because one prefers one store to another, can be inconvenient, going to the wrong hospital because they are "nicer" there, can get you killed by the nosocomial infection and errors. Infections spread due to money being placed into lowjacks and nice inoffensive nurses being hired...instead of sinks bought and competent staff employed.
    Last edit by caroladybelle on Jan 14, '07
  7. by   Works2xs
    Quote from caroladybelle
    You make the assumption that any of these inventions "improve" patient care or even make it "customer" friendly.
    I'm afraid that you've made an incorrect assumption. I wasn't endorsing any of the inventions to which you refer. I was responding to the OP's question regarding the use of "customer" in place of "patient."

    Quote from caroladybelle
    And, quite bluntly, many people are in the hospital are unhappy, distressed and often in related to poor healthcare decisions. If we try to implement good healthy behavior, they are probably going to be unhappy. If we go by good "customer" service principles, we will make them happier, but they will not have their healthcare served....the purpose of healthcare. "Customers" often want things that are not appropriate for them.
    Interesting point of view. I thought that those in our care had full autonomy. For example, consent for treatment is required. As I understand it, we're supposed to provide information for the individual to use in making a decision. Which sort of brings us back to the question of "patient" or "customer".

    The term "patient" is often used to denote someone who is in somebody else's care - a dependent to somebody in a superior or authoratative position. While it's true that individuals often make decisions contrary to their own health, that is their right. Someone who is in a dependent position might be seen as someone who can have decisions made for them, or as you say, for their own good. This approach strips the individual of their autonomy which is arguably anathema to today's healthcare model (and legal right).

    The use of the term "customer" usually denotes someone who's in an independent position with respect to making decisions on their own behalf. It also usually denotes someone to whom we are dependent on for our own livelihood. In today's healthcare model, it looks (to me at least) to be consistent with what organizations advertise in things like "Client Bill of Rights" as well as protections provided to every individual as part of the law (and if we fail to provide those rights, they can adversely affect our livelihood).

    Collectively, we (nurses, etc.) might not like what the "customer" decides. But that's entirely beside the point. It's not our "right" to "make" anybody do anything against their own will. One could argue that knowing that certain decisions, approaches, whatever, are of more value than another then we should work all the harder to present those options in the best terms that a particular individual can understand. Looking at someone as a dependent, incapable "patient" lends itself to bypassing all that extra effort. However, if they can grasp all the context and/or background of all the choices, then the "customer" can make the best choice that fits within their own interests.

    Yeah, perhaps it's all semantics. However, as we see in nearly every political movement, words can frame perceptions. Looking at those in our care as a "customer" can frame how we approach them within the context of what ensures individual autonomy, facilitates outcomes that more closely match individual expectations, and ultimately protect us from making choices that will end up putting us in a courtroom somewhere.

    But then again, that's just my opinion. I could be wrong.
  8. by   subee
    Quote from Works2xs
    I'm afraid that you've made an incorrect assumption. I wasn't endorsing any of the inventions to which you refer. I was responding to the OP's question regarding the use of "customer" in place of "patient."



    Interesting point of view. I thought that those in our care had full autonomy. For example, consent for treatment is required. As I understand it, we're supposed to provide information for the individual to use in making a decision. Which sort of brings us back to the question of "patient" or "customer".

    The term "patient" is often used to denote someone who is in somebody else's care - a dependent to somebody in a superior or authoratative position. While it's true that individuals often make decisions contrary to their own health, that is their right. Someone who is in a dependent position might be seen as someone who can have decisions made for them, or as you say, for their own good. This approach strips the individual of their autonomy which is arguably anathema to today's healthcare model (and legal right).

    The use of the term "customer" usually denotes someone who's in an independent position with respect to making decisions on their own behalf. It also usually denotes someone to whom we are dependent on for our own livelihood. In today's healthcare model, it looks (to me at least) to be consistent with what organizations advertise in things like "Client Bill of Rights" as well as protections provided to every individual as part of the law (and if we fail to provide those rights, they can adversely affect our livelihood).

    Collectively, we (nurses, etc.) might not like what the "customer" decides. But that's entirely beside the point. It's not our "right" to "make" anybody do anything against their own will. One could argue that knowing that certain decisions, approaches, whatever, are of more value than another then we should work all the harder to present those options in the best terms that a particular individual can understand. Looking at someone as a dependent, incapable "patient" lends itself to bypassing all that extra effort. However, if they can grasp all the context and/or background of all the choices, then the "customer" can make the best choice that fits within their own interests.

    Yeah, perhaps it's all semantics. However, as we see in nearly every political movement, words can frame perceptions. Looking at those in our care as a "customer" can frame how we approach them within the context of what ensures individual autonomy, facilitates outcomes that more closely match individual expectations, and ultimately protect us from making choices that will end up putting us in a courtroom somewhere.

    But then again, that's just my opinion. I could be wrong.

    OK - I can't take it any more.
    Hookers have clients and customers - I have patients. There is an increased expectation from the implied relationship of nurse-patient. Did hookers or salesmen devise the first professional code of ethics? No, because its not expected of a non-professional who has no requirement of ethical behavior beyond conducting a pleasant, but strictly business relationship. Just as an add-on if you (meaning the posters who complain) feel like a server, its not the demands of the job that make you feel demeaned but the way you handle the demands and with which level of skill. Its a really long learning curve, I know. But just remember there's nothing wrong with you (if you are a quality nurse) - its THEM. They're the dysfunctional ones and thank God you're not. You're never going to escape the stupid and rude people - they multiply quickly. Unless you work in a cave, you're gonna have to deal with them. Don't allow yourself to get emotionally drained from the jerks. Learn some stress reduction techniques and USE THEM. Its not easy but its a wonderful investment you can make in your Self which will carry over to your non-work life. We're only as happy at work as we are when we get there, and the same can be said of our homes.
  9. by   ZASHAGALKA
    Quote from Works2xs
    Collectively, we (nurses, etc.) might not like what the "customer" decides. But that's entirely beside the point. It's not our "right" to "make" anybody do anything against their own will.
    Here's the thing. While 'customers' have the right to refuse any treatment, it is simply NOT my job to foster those poor decisions, in a 'customer service', or any other model.

    As I very recently said to a patient that was more than annoyed about being woken up for planned care: if you don't want the service we provide, why are you here? Since she was refusing all care, that is a legitimate question.

    Simply put, rights or no, it's NOT my job to be supportive of poor decisions. I provide a well planned, science tested service. If a patient comes to me for care, they 'sign on' to the service I DO provide. If not, that does NOT make me a 'poor customer service provider'. That makes that patient's hard earned dollars paid for my service wasted dollars.

    I happen to like the concept of 'patient' with all the underlying semantics better precisely because it DOES lend credibility to an expectation of full acceptance of my care. Once we fully convey the thought process that 'customers' can pick and choose the care they receive, any concept of comprehensive 'science' behind that care goes right out the window.

    For example, sure, you can refuse the beta blocker and ace inhibitor status post MI. But it wasn't just decided nilly-willy that you receive that treatment. Once you feel entitled to refuse that, no matter how well I provide the remainder of care you DO allow, your chances of a repeat MI have now doubled.

    That might be excellent 'customer service', but it's downright poor healthcare.

    The disconnect is the difference between wants and needs. Customer service is a vital component of seeking to provide for the wants of people. They can go to Burger King for better service than McDonalds if they WANT. But when it comes to providing an essential need, what you NEED is not always what you WANT. Whether you go to ABC hospital or XYZ hospital, either the empirical level of care will be identical, or science is being traded for 'service'. THAT's simply not a good healthcare model.

    In the end, the result of such models is to supplant the provision of needs for those of wants. If you WANT top dollar service without having your NEEDS met, go to the Hilton. If you want your NEEDS met, then let me do my job. Going a little extra to make somebody happy or comfortable is a fine idea. Ultimately however, I'm not being paid to make you happy but to help make you well.

    Let me break that out fully: most of us in the trenches are well aware that the first two phases of grief are anger and denial. Combine that with a service mentality that gives the customer the complete right to decide what constitutes good 'care' and you end up completely yielding to those defense mechanisms. The term 'patient' with all its semantics was purposely designed in order to provide the expected norming of care that allows healthcare workers the ability to place those mechanisms in check in order to give appropriate care.

    Expecting me to yield completely to those defense mechanisms might result in better press-gainey surveys but it's not a given that it leads to better care. In many cases, BECAUSE of anger and denial - normal coping mechanisms btw - providing appropriate care might just lead to lower 'satisfaction' surveys, but at least it is consistent with good science. If appropriate care isn't the prime directive, then something vital is lost in translation.

    ~faith,
    Timothy.
    Last edit by ZASHAGALKA on Jan 16, '07
  10. by   hollyvk
    Quote from incublissRN
    People don't know what services we offer. Patients probably think I have nothing better to do then fulfill their every whim; afterall, that is my job isn't it? And if I didn't, was that a bad healthcare experience even though excellent medical and nursing care was provided?
    Having supervised the patient representatives in one of my many healthcare jobs (and heard many a tale of patient-nurse problems), I can tell you that the best tool at your disposal in dealing with these issues is to set the patient's expectations yourself.

    "Good evening, Mr. Smith. My name is NancyNurse, I'll be the Registered Nurse caring for you for the next 12 hours. The nursing assistant working with me is Jessie, she will be in every 4 hrs to check your blood pressure and your other vital signs. I will be in to give you your medications as ordered, to check the dressing over your incision for any bleeding, to attend to your IV, and to assess you for any problems related to your surgery. Your doctor has ordered you to be on bedrest with bathrm privileges, please use your call button to call for assistance when you need to go to the bathroom. I or one of the other RNs or nursing assistants on duty will respond as quickly as we can when you use the call button, but please be advised that I am also caring for 6 other post-operative patients, some of whom are much more ill than you are. I will do my best to keep you comfortable during my shift, please let me know if your pain worsens. And I can show your wife the kitchen where she can get you ice water or something to drink, and where we keep the linen in case you need an extra blanket later on. Do you have any questions or any concerns I should be aware of in caring for you?"

    And while that last sentence may slow you down a bit, what usually happens is that patients feel that their needs and concerns are being addressed up front, and this can save you A LOT of time in the long run.

    HollyVK, RN, BSN, JD
  11. by   GardenDove
    Hi Holly, that seemed like good general advise.
  12. by   Cosper123
    Two things that concern me about the "customer" label. Firstly, the title implies and leads to what the patients wants instead of needs. Patients should NOT be making decisions about what they need, unless of course it is in an area they hold some expertise in. Why is this? Well, as it turns out, 99.99% of the time, what the patient wants is not what the patient NEEDS. And secondly, to those who tout the customer label because the term patient implies that something is wrong or illness....well, take the time to consider that if something wasn't wrong with them then they wouldn't be in the freaking hospital
  13. by   PANurseRN1
    Quote from Angie O'Plasty, RN
    I understand what you're saying, but really, the term "customer" is as much of a semantics issue for patients as it is for nurses.

    You, the nurse, are a customer because you are in a business relationship with the hospital. So is the doctor. So is the patient/customer.

    The patient does have an indicator of quality care--personal comfort. Am I comfortable with the staff, the surroundings, with the amenities? Did they hurt me? Did they care if they hurt me? Obviously, if someone doesn't care if I'm comfortable, I won't get that extra pillow, which will make me wonder what other uncomfortable things will happen to me while I am there.

    Now instead of relaxing and trusting my caregivers, I'm uncomfortable, I'm anxious, I'm scared into silence.

    Is that the kind of patient you want?

    Nothing conveys concern like taking care of the "little nitpicky things" like giving someone a toothbrush and a wash basin to wash up with, or an extra pillow, or a midnight snack before going NPO. If a patient/customer is not clear about what is expected during the hospital stay, we can always show them the little blurb underneath the "Patient Rights" that describes "Patient Responsibilities." Yes, patients have clearly stated responsibilities too.

    Yes, there is a line. Yes, there are patients who ask too much of us. There are also patients who ask too little.

    It comes with the territory.

    But we need to remember that doing all those "nitpicky things" are part of good nursing care. When we resent doing those things for patients, it says a lot about what we've allowed ourselves to become as nurses.

    The whole "customer service model" is really based on Nursing 101:

    If I'm sick, I want someone to act like they care about me.

    I don't need a medical degree to figure out who gives a darn and who doesn't. The nurse that gets me that extra pillow or who takes the time to teach me that water will only make my stomach more bloated and cause me to vomit and later buy an NG tube, is showing me who cares about what happens to me.
    You must have been spying on my recent hospitalization. No toothbrush (kinda gross when you're vomiting), no soap, no towels or washcloths, bed linens never changed, no water at bedside (and yes, I was supposed to be trying to drink), nurses who reeked of perfume (wonderful when you're already nauseated), and a few who acted as though my mere presence was such a burden that I was afraid to ask for any of my prn meds, let alone ask for something to drink. And I'm the last person who would be "on the call bell." I am pretty self-sufficient, even when I'm as sick as a dog.

    In the case of the one prn med, I wound up having a family member bring it in from home, because after 4 hours of waiting I finally gave up all hope of ever getting it. When, after two and a half hours, I rang to ask about the med I was yelled at by the nurse "We don't have it yet!" Believe me, I knew better than to ask for it again.

    And no, I didn't get a "Patient Satisfaction Survey" when I was D/C'd.
    Last edit by PANurseRN1 on Jan 16, '07

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