customer service versus patient care

peck13 · Jul 15, 1999

my hospital has had a customer focus for a while (we have "patient focused medicne" sa our advertising slogun). in my town (indy), there are multiple hospitals to choose from, and the hospitals are now all focusing on the "warm, fuzzy" aspects of being a patient. it does get irritating sometimes, but i can see the logic in it too. they say that if someone has a good experience, they tell 5 people, but if they have a bad experience they tell between 10 and 20. i have always said that my 4 years in food service has helped my with patient care. i have always thought about customer service (both patients and staff). good luck!

peck13 · Jul 15, 1999

my hospital has had a customer focus for a while (we have "patient focused medicne" sa our advertising slogun). in my town (indy), there are multiple hospitals to choose from, and the hospitals are now all focusing on the "warm, fuzzy" aspects of being a patient. it does get irritating sometimes, but i can see the logic in it too. they say that if someone has a good experience, they tell 5 people, but if they have a bad experience they tell between 10 and 20. i have always said that my 4 years in food service has helped my with patient care. i have always thought about customer service (both patients and staff). good luck!

MollyJ · Jul 24, 1999

Hi Norma, Like you, I am suspicious of this attitude, even though I agree with peck that a little of it is not all bad. The large, tertiary care hospital I used to work for NOW has lobbies that look like corporate offices and appalling reputatins of disarray in floor care because the nurses are so busy running hither and yon with minimal staff. Patient and family centered care is in nursing's blood and so the core concept of "customer satisfaction" isn't so foreign. Of course, reducing what nurses and docs do to a grocery store clerk/customer relationship belies that our clients come to us for special expertise and isn't exactly in sync with the professional notions of service, consultation and the true nature of dependency with which many of our patients are afflicted. (For example, a family's idea of customer service might be, "Don't turn dad; it hurts him." VS the professional notion of "doing for" [Orem] a client what they would do if they could and turning them to promote skin integrity and respiratory health.)

So, know who you are. I think the customer satisfaction ethic all too often has the net effect of reducing nurses to replaceable workers on the assembly line and focuses on providing services that are reimburable (make money) like IV antibiotics or procedures. There is no reimbursement attached to therapeutic conversation, back care and touch, or giving a bath and that has not escaped the notice of corporate health care.

Still, as one of my profs said, "It is easy to manage resources in time of plenty; more difficult in times of shortage." We are starting to see shortage due to cut reimbursement that only promises to get worse.

Lots of words; no answers.

suebarton · Jul 24, 1999

I too was initially concerned about the "customer" approach...having observed it for a few years, I am feeling differently. Quality is ALWAYS job one and "don;t turn my dad cuz it hurts" is sticky. I find I am educating more and more and documenting family concerns more because the care isn't always easy or convenient. In the end the patient does get to refuse but I have to get it in writing. Having been the Mom of a hem/onc child, I am now on the customer service bandwagon because sometimes it was the only perspective that allowed me to be heard. I believe that nurses, especially in Peds, have generally been taught to put the family and parents in the mix and include them in all decisions and treatment. However, when I have dealt with staff who didn't want my participation, the "new" approach could help them see a little different way. I think "customer service" helps the staff who are not direct care-givers get the point that we have had all along. The places where it helps the most is when "rules" and policy are invoked to limit family participation (not including the out-lier occasioanally disruptive family who require MORE than rules and policy) AND those front line folkds who will send a patient to the other side of a hospital for a piece of paper that wasn't included in the packet. Obsiously this is near and dear to me and touched on the "what does patient satisfaction have to do with quality" question. We are in the middle addressing both these days. Quite the challenge.

bluesboyj · Jul 24, 1999

The hospital where I worked in Ca was at war against the county hospital and spent millions$ to keep the county facility to expand and upgrade their lab and kitchen, which were at risk of losing the licenses because they were so old. When we were told of the war at it's start the administrator said point-blank "these are not patients in our beds, they're market shares, dollars and cents." Welcome to managed care/HMOs.

molly w. · Aug 8, 1999

A memo from administration recently stated this "....we should think of this like a business..... If Wal-mart did business like this, they would not be in business long....." This was in reference to a clinic (that is a dept of our hospital)when it was closed a couple of days because the medical provider took APPROVED vacation days.

MissyS · Mar 12, 2000

Back in th 80's, the hospital I worked for began the customer service routine. The nurses hated it. We give care,not service. If the physicians want to be a service industry that is up to them. They shouldn't drag nursing into it. We give care, not service. When a family member complains about the service, that is my answer. This isn't a grocery store. The sickest are taken care of first. Allows hospitals and physicians to turn us into a service industry will delete from our autonomy and uniqueness.

scooty · Mar 18, 2000

I think part of the problem with the customer service approach is that "the customer is always right" way of thinking does not apply in healthcare. How many of our patients or patients families have a medical background? I feel a lot of times they are dissatisfied with our "service" because they don't understand the reasoning behind what we are trying to do. For example(since the food is always a big deal to complain about), patients are kept NPO or on a certain diet for their benefit, but even after the explaination is given, some are still unhappy. My job is to help promote and maintain good health in my patients (and keep dying patients comfortable), and it is my education and experience which allows me to do so. Where do we draw the line between doing what the "customer" thinks is best and what we as nurses think is best?

Mijourney · Mar 18, 2000

Hi,

I too am concerned that the heart and soul has been completely removed from health care. It's not necessarily because of the semantics used to describe the delivery or focus of care. It's the extent of exploitation of resources and mindset that goes along with change that is so grevious.

I think it is incumbent of nurses, though, to have a thoroughly holistic approach and attitude to delivering care and not just regurgitate knowledge and learning. It may be nurses, with all of our faults, that help save the health care "industry" from itself and from undermining this consumer-oriented economy.

In retrospect, I don't ever recall the provision of health services, particularly medical services, as being patient-centered. That got thrown out the door when ready reimbursement from insurance companies became prevalent.