Patient as Customer model of healthcare - page 6

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   cardsRN
    ok, i usually stay far away from these threads because i realize i will never change the minds of those who disagree with me and it will just be a frustrating experience. however, in this case i feel i must weigh in. my problem with the "customer service initiative" is that it assumes that nurses will provide crappy care and don't give a s*** about our PATIENT's comfort unless forced by administration to care. it assumes that we are all rude, surly dissatisfied individuals who don't have the time of day for someone else's concerns. that is just false. the majority of nurses really want to make people comfortable and happy. that is just not always possible. in these days of shortage and understaffing, time is a resource and pt's compete for it, that means that people have to wait for things. hospitalization is an uncomfortable and scary experience, and if we only had more staff, and therefore more time, perhaps we could provide for you that blanket and juice that would really make you more comfortable and make you feel like we care.
    another faulty assumption is that the term patient is used by healthcare providers to take power away from people receiving healthcare. another poster was talking about consumers of healthcare as able to make autonomous choices and select or refuse services. that's all well and good but it has nothing to do with customer service initiatives with all their pagers and warning cards. here's a clue. administrators aren't referring to you as a customer or client because they really respect your autonomy and brilliant shining soul. it's because they want your money. and they are willing to do just about anything to get it. and guess what? they don't really care about your concerns as a pt or what is involved with nursing satisfying those concerns, they just want the doors to revolve faster and people to churn in and out of their facility pumping the insurance money in. i mean, "would you refer this facility to a friend or family member?" no, i would not reccomend the experience of being ill to anyone. it irks me when people post on here like nurses have never been patients. most of us have been on both sides of the bed. i'm betting that when you graduate and have a family depending on your salary and health insurance you won't be too fond of the possibility of losing your job over not escorting a customer personally to the cafe either.

    no thanks. i will just try to ignore that and do what i am trained to do. provide excellent and compassionate care to ALL my patients (term used specifically because they are people for whose wellbeing i am legally responsible, and who look to me for guidance and comfort). regardless of VIP status, regardless of nurse lo-jacks, regardless of press gainey. give us some credit please. most nurses respect individuals and their rights and just want to help people.
  2. by   lorster
    Quote from 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.
    Ok, I'm sitting here in po dung montana and have not idea what a lojack is. Can someone explain this to me?
  3. by   caroladybelle
    Quote from lorster
    Ok, I'm sitting here in po dung montana and have not idea what a lojack is. Can someone explain this to me?
    I spell it lowjack, Tim spells it lojack.

    It is a nurse locator beacon. It tracks you from room to room and place to place. Some of them (Wescoms) also turn off the call light when you enter the room. That way they keep a record on your response time.

    There are advantages. At Hopkins, you can go to the nurse's stn and see where everyone is. At others, you look up at the light outside the pt rooms - a steady red is aides, steady yellow is LPN, steady green is RN. Blinking lights mean that the type of staffer is needed in the room.

    Some places give you a cock and bull story about...little old pt sues after a fall in the hospital - pt says that no one came for 60 minutes after s/he put the call light on, so she got up by herself and fell. And the poor nurse is SAVED!!!!!! by the Wescom proof that she responded in 2.34 minutes.

    They neglect to tell you about how no one cares what you may be doing, if you are late (?) to a room and someone complains, you will be called on the carpet....that some (usually for profit) facilities use it to analyze how much time you are taking in various areas and how that they can "shorten" the length of time.

    The device is also expensive (50-90 dollars) and that you will be charged if you lose/break it.

    Most places couple it with a phone or beeper ( in my case both), so that whether you are at lunch or in the bathroom, someone can call you at ANY time for ANY thing. Which frequently means you will get a phone call while you are peeing on your break off the floor....from the MD...whom you have been paging for the last 2 hours for his new admit..who wants to give you a page and a half of orders...that he is too d^&n lazy to come to the floor and write or fax to you.

    In my case, I have to get to work early to go to 9th fllor to sign in, go to first floor and other side of the building to pick up beeper/lojack, and go to other end of building and up several floors to finally clock in. And return the same way when I leave.....if I am lucky.

    If I am unlucky, one of these offices will either be closed, or they will be out of beepers and/or lojacks. So I will have to hike back down a time or two, later in shift.
  4. by   CaLLaCoDe
    Quote from TriageRN_34
    YOu go to the hospital to be treated for a condition...not to badger a nurse and get disgruntled when your Low Fat Latte isn't there in 5 minutes or less!


    [BANANA]Your customer/client expired today...could she/he please have a refund![/BANANA]
    Last edit by CaLLaCoDe on Jan 17, '07
  5. by   RunningWithScissors
    Most places couple it with a phone or beeper ( in my case both), so that whether you are at lunch or in the bathroom, someone can call you at ANY time for ANY thing. Which frequently means you will get a phone call while you are peeing on your break off the floor
    We use cell phones....I swear there's a sensor in the thing to make it ring as soon as I get in the bathroom!!!!
  6. by   GardenDove
    That Lowjack sounds pretty creepy and big brotherish to me...
  7. by   nurse4theplanet
    The facility that I worked at that had this tracking system also had a call system set up so once they tracked you, they could speak to you while you were in the any room or at the nurse sub stations...it was being abused frequently to eavesdrop on nurse to nurse conversations and it was really annoying to be in the middle of helping a pt and have the unit secretary interrupt, "What are you doing? Dr. so and so just called and said blah, blah, blah...402 needs this...Have you completed such and such...when are you going to be finished with so and so..." It tramples on pt privacy, not just employee privacy. Its downright rude when not being used appropriately. I don't work there anymore and it was a brand new hospital...I wonder how long it (the system) will last.
    Last edit by nurse4theplanet on Jan 17, '07
  8. by   Altra
    Quote from ZASHAGALKA
    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.

    ...

    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.

    ...

    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.
    Excellent post.
  9. by   JessicRN
    Quote from ingelein
    I can hear it now, "Hi my name is Mary, I will be your server today.How may I help you?"

    As long as it also says PLEASE REMEMBER TO TIP 15-30% OF YOUR TOTAL BILL. thank you.
  10. by   withasmilelpn
    I think the problem with the label 'customers', is how some people feel its a license to treat nurses with disrespect. I once had a family member threaten to sue us over the w/c leg rests being in the wrong position. Now the patient was all the time playing with them and it was a simple matter of using the lever to lower it, which was what I stopped to show her how to do. The family member refused to listen stating it was PT's job. She was simply unwilling to listen that PT only adjusted the length not the position etc. The entire time she was going on and on to about the money they pay, sueing , verbally berating his nursing assistant until I finally told her she could no longer treat us this way and to take it up with administration!
    Just a sidenote- this was not my patient. Now I avoid this family when I usually try to take care of anybody's complaints, concerns.
    I feel that when family members are clearly out of control, upper management needs to step up in our defense.
    Nurses leave the profession because they don't feel supported.


    Also I think that lojack system is simply unrealistic. Callbells don't get answered timely because nurses simply have too much to do and too many patients. Some things simply can not be fixed by better time management.

    Yes there are some lazy, grumpy nurses out there. If management actually knew their staff, it would be easiar to weed those people out. As for the grumpy nurses, no it is not fair to the patients (they didn't ask to be sick) however, if management was receptive to their concerns maybe some would not be so grumpy!
  11. by   SchnauzersRock
    Quote from ZASHAGALKA
    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.
    I like how you think. Kindred spirits, ya know! I wish everyone could see it this way.
  12. by   medsurgrnco
    I worked in a hospital with a tracer tag. When a patient lied and said I only checked on him twice in a 12-hour shift, they printed the tag record and it didn't show I was in the patient's room more times. I had documented checking the patient more times on the hourly rounding sheet and in the computer documentation. Even tho their tracer tags apparently were unreliable and there was other documentation, the patient was believed as management believes that patients never lie. I find it shocking that nurses are trusted to give meds and provide patient care, yet patients are believed over a nurse whenever there is an issue with "customer service".
  13. by   BlueRidgeHomeRN
    thanks for jump-starting this old thread--still relevent!

    i would bag groceries before wearing a tracer collar--woof, woof!!

    i agree that these sick people are "patients", and that the posse with them are usually "visitors" who need to have restricted hours, unless there is someone (spouse, sibling) who is actually present to get the ice, blankets, and be useful to the patient. if you're sick enough to be an inpatient, you don't need to be entertaining the neighborhood!!

    having said that, i did, once, as a post-op pt, check myself out ama after my pca infiltrated, and my call bell was unanswered for 57 minutes (not an exageration!). even pulling the cord out of the wall to activate the emergency system did not work. by the time i got through by dialing out, dialing back into the main number, and asking for my unit, i had stopped the iv, taken two percocet from my overnight bag (can't imagine the pain of a new tib-fib orif otherwise!) dressed, and had my husband in route to pick me up. did i mention this was my own hospital!!!

    needless to say, the charge nurse wasn't happy with me. so....i understand that it can be frustrating to be a patient, but it does not excuse patients who really think in their little selfish pea-brains that their pillow fluffing is more important than someone else's airway or pain!!

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