Customer Service...........yay or nay?

[eriksoln, BSN, RN]

Remember going to school and learning the older, crazy approaches to medicine that people used to practice:

Drilling holes in the head to relieve sickness, letting spirits out.

The belief that sickness was a punishment from God and was a direct result of sins.

Civil War doctors who removed limbs the second someone was shot/scrapped in the leg because it avoided infection.

Those are the one's I can recall right at this moment. I know there are more. Today, we are in a stage of major change within our health system. There is a push for "customer service" that was not there before. It is no longer simply something schools/administration talk about, it is expected. Surveys asking if the nurses fetched your AM coffee on time type questions abound. Doctors who talk down to or belittle patients are no longer tolerated by hospital administration. Compensation to facilities can be reduced despite properly caring for the illness because it was not done with a smile.

Do you think this is simply the "vogue" theory of today and will eventually be replaced, or is it truly a push towards a new future in healthcare?

I am undecided TBH. I don't agree with the degree in which the "customer satisfaction" is being made a priority. Its almost as if hospitals would fare better with the general public and the powers that be if we simply stopped treating illness and took on a Bed And Breakfast style of treatment. To this I say "Be careful what you wish for, you might get it." Already I see managers pushing "smile when you enter the room" when they should be concerned with possible med errors and pt's being transferred to their unit who are not appropriate for said unit.

Its almost as if there is this "We need to get paid, times are tough. Just give them what they want" surrender going on with hospitals and facilities. So, what you are telling me is, no problem if a pt. receives another patients meds or is aspirating their own meds..................so long as we smile and make everything happy.

Seems to me some patients should just save themselves the hassle and just to to Denny's or go on vacation. They could get all that at a quarter of the cost.

I don't know if good medical treatment always lends to good customer service. If you've ever worked on a M/S unit with the non-compliant diabetic you know what I mean. They want snacks that don't conform to their diet at all constantly, and are very upset if they are not granted. Then you have the smoker who insists he is SOB because the doctor doesn't know how to order the right inhaler................the COPD has nothing to do with smoking over a pack a day. And we have all seen the pt. who just refused to break out of the sickness "asking for help" role and start doing for themselves. They refuse PT/OT, want everything done for them and are going to end up in a nursing home if they don't get their bottoms out of bed. But, if you tell them they must start being more active in their own ADLs, you are a jaded/bad nurse and the survey scores reflect this.

We are, very frequently, in a position of having to tell the truth, even when said truth is not "nice" or lends itself to "customer service". What benefit are we giving our pt. when we stash the truth in order to earn better survey scores? Yes, in the short term they are very pleased with the quickness in which we fetch the third ice cream they request, but when their foot is amputated..........what do they think of our service to them then? Truth is, if "customer satisfaction" promoted healing, Denny's would have people walking after years of being wheelchair bound and Retail stores would be the place to go for that abd. pain. It doesn't work that way.

Customer service definitely has its place in the healthfield, but not to the degree it is being taken. Who amongst us doesn't know that grouchy, unhappy with EVERYTHING nurse who has been told to act differently with people..........and thinks it was long overdue. I know of two specific doctors who were mandated to take classes to improve their bedside manner (oh, how we all snickered at this). I don't think the expectation of respect and kindness are out of order. But is what we are doing now relative to this? Or are we going to read about ourselves in 20 years in some new nursing book "The customer satisfaction age of medical practice was dollar driven and lead to an increase in foot amputations blah blah.........."

[chloecatrn]

I hope that it's both. I hope that eventually, as the customer service approach gets older, the novelty and drive to be "perfect" at it will wear off a bit, but I do think that it has its merits. I've been in the hospital several times recently, and the customer service was awful. I asked that my blood pressure not be taken above a running IV line and was told that it didn't matter. I asked why they fresh stick for labs every morning instead of drawing from IVs and was told it was policy and that if I wanted to refuse that the tech had other places to be so to hurry up and make up my mind (I was just asking... making small talk). I had to ask several times for a stool sample that was going to make or break my discharge to be picked up. It was charted that I had refused pain meds, when I wasn't offered pain meds. I listened to an IV beep for over two hours one night. The nurse's response? "You could've fixed that. You work here." And each of these instances were DIFFERENT care providers.

Part of providing excellent customer service is giving the right meds to the right patient at the right time. It's not just going into the room with a smile on your face, and if you think it is, then you're not understanding what you're being asked to do.

Are we busy? Yes. Does nursing to provide excellent customer service require increased staffing? Yes. But is it really going to kill you to walk into your patient's room each morning with a smile on your face? No. It doesn't take an extra care provider for YOU to give ONE smile. Like it or not, patients are our customers. They can decide to go to the hospital down the street, to request a different unit if they're a frequent flier, to ask to not have you as a nurse. When that happens too frequently, management's going to start to wonder; plus, it's going to hurt the bottom line, which is what pays for our salaries.

[gentlegiver, ASN, LPN, RN]

Customer Service has it's place, in LTC I see problems with it all over. Smile when you answer the phone (even if you just ran all the way down the hall and you med pass has been interrupted for the umpteenth time). Renal patients who refuse to follow thier diets, Diabetics with infections leading to amputations, Dementia patients who's families insist that if you just wait on Mom or Dad hand & foot then they will be happier & not scream constantly (thus upsetting the rest of the patients. Anxiety is curable by giving in to all behaviors). Patients who stay up all night & refuse treatment until 5 minutes before your shift ends, keep notes on when they last got thier PRN pain meds so they know when to ask for the next one (God help you if your busy when they call for it) or tell you "My PRN pain med is due in 3 hours, wake me if I'm asleep". Order supper & when it arrives decide it's not what they want & get mad when they have to wait for another meal to be cooked.

There is so much more, but, it all works down to make them happy for now, worry about the consequences later. WHat ever happened to keeping them safe & helping them heal??

[nursemike, ASN, RN]

Recently heard a good thought (from management!!!) on this topic. Pts will rate us on a scale of 1 (worst) to 5 (best). Instead of killing ourselves trying to raise 1s to 2s, we should focus our efforts on making 4s into 5s. Eureka! Not to say we shouldn't do our best for everyone, but if one patient is mad because you brought Splenda, it does seem kinda logical to say, "Sorry, we don't have Nutrasweet," and move on, especially when one who appreciates everything you do is calling for pain meds.

[fiveofpeep]

I struggle with this quite a bit as a new nurse. Some times I feel like I am totally failing at customer service in the first few hours of my shift because I am so busy doing what I have to do and calling the docs for problems before it gets too late at night.

I always feel like Im a totally different person when Im busy and much more amicable when caught up.

They do stress customer service where I work and I think it's here to stay.

It's sad that managers focus more on the customer's happiness than their overall physiological well being (thanks to the nurse). I dont think anything will change it though.

[eriksoln, BSN, RN]

I hope that it's both. I hope that eventually, as the customer service approach gets older, the novelty and drive to be "perfect" at it will wear off a bit, but I do think that it has its merits. I've been in the hospital several times recently, and the customer service was awful. I asked that my blood pressure not be taken above a running IV line and was told that it didn't matter. I asked why they fresh stick for labs every morning instead of drawing from IVs and was told it was policy and that if I wanted to refuse that the tech had other places to be so to hurry up and make up my mind (I was just asking... making small talk). I had to ask several times for a stool sample that was going to make or break my discharge to be picked up. It was charted that I had refused pain meds, when I wasn't offered pain meds. I listened to an IV beep for over two hours one night. The nurse's response? "You could've fixed that. You work here." And each of these instances were DIFFERENT care providers.

Part of providing excellent customer service is giving the right meds to the right patient at the right time. It's not just going into the room with a smile on your face, and if you think it is, then you're not understanding what you're being asked to do.

Are we busy? Yes. Does nursing to provide excellent customer service require increased staffing? Yes. But is it really going to kill you to walk into your patient's room each morning with a smile on your face? No. It doesn't take an extra care provider for YOU to give ONE smile. Like it or not, patients are our customers. They can decide to go to the hospital down the street, to request a different unit if they're a frequent flier, to ask to not have you as a nurse. When that happens too frequently, management's going to start to wonder; plus, it's going to hurt the bottom line, which is what pays for our salaries.

Eh, we are talking about different things. The smile thing, w/e. People who smile in their personal life tend to smile while they practice nursing. I don't want to hear about smiling when there was just a pt. admitted to my assignment who is on cardiac drips the unit doesn't do. If everything medically were hunky dory and efficient, yeah, then move on to worrying about if I smile or not.

Like I said, I don't thing expecting kindness or respect are out of order. On the other hand, when I am complained about because I didn't fetch the diabetics (not allowed I might add) ice cream quickly, when I was more concerned about another pt's rectal bleed..........then we are going too far with it. We've stepped out of pt. care orientation to dollar driven "customer service."

Perfect example would be your phlebotomy tech. that you wanted to "make small talk" with. Now, there is a way to educate without being............demeaning. That is the "kindness and respect" that I believe is completely appropriate to expect. This person was obviously in a hurry, lots of things to do, and didn't want to be bothered. That is "poor customer service". Take two minutes to discuss why IV drawn blood is not acceptable, apologize and empathize that the pt. has to be stuck every morning, and give them time to think about it if they wish.

The situation I am talking about is.........say you had insisted they be drawn from the IV, the results are inaccurate and something goes wrong. OK. The Tech. made you happy in the short term, got your lab draw the way you wanted, but........its not in your best interest. It was just a way to get a good survey out of you. This is an extreme example, but we are getting close to being this way. Take for example my diabetic pt. who's sugars are consistently in the upper 300's who makes no secret of the fact that if they don't get the ice cream the very minute they request it, the survey will reflect such. So..........you propose I give it with a smile and get the good survey results in the name of "customer service"? Thats where we are headed.

[eriksoln, BSN, RN]

Recently heard a good thought (from management!!!) on this topic. Pts will rate us on a scale of 1 (worst) to 5 (best). Instead of killing ourselves trying to raise 1s to 2s, we should focus our efforts on making 4s into 5s. Eureka! Not to say we shouldn't do our best for everyone, but if one patient is mad because you brought Splenda, it does seem kinda logical to say, "Sorry, we don't have Nutrasweet," and move on, especially when one who appreciates everything you do is calling for pain meds.

I had a manager tell me something very similar, but different:

"If someone is threatening poor survey scores and is a chronic complainer, don't bother with them. Give them their meds and get out of the room. Spend the extra five minutes you just saved with someone else. You will spend all day trying to make this one happy, and scores everywhere else go from 5 to a 4 or even a 3. For what? To get a 3 or 4 out of one person who would have given us a 2. I'd rather have five patients score us 5 with one other pt. scoring 2 then everyone score us at 3 or 4."

Kinda scary, but in short, she was telling me to ignore the pt's who will score us low. Now that is a dollar driven mentality too. Thank goodness that was just a travel assignment, and I did not renew.

[Scarlette Wings]

eh, we are talking about different things. the smile thing, w/e. people who smile in their personal life tend to smile while they practice nursing. i don't want to hear about smiling when there was just a pt. admitted to my assignment who is on cardiac drips the unit doesn't do. if everything medically were hunky dory and efficient, yeah, then move on to worrying about if i smile or not.

like i said, i don't thing expecting kindness or respect are out of order. on the other hand, when i am complained about because i didn't fetch the diabetics (not allowed i might add) ice cream quickly, when i was more concerned about another pt's rectal bleed..........then we are going too far with it. we've stepped out of pt. care orientation to dollar driven "customer service."

perfect example would be your phlebotomy tech. that you wanted to "make small talk" with. now, there is a way to educate without being............demeaning. that is the "kindness and respect" that i believe is completely appropriate to expect. this person was obviously in a hurry, lots of things to do, and didn't want to be bothered. that is "poor customer service". take two minutes to discuss why iv drawn blood is not acceptable, apologize and empathize that the pt. has to be stuck every morning, and give them time to think about it if they wish.

the situation i am talking about is.........say you had insisted they be drawn from the iv, the results are inaccurate and something goes wrong. ok. the tech. made you happy in the short term, got your lab draw the way you wanted, but........its not in your best interest. it was just a way to get a good survey out of you. this is an extreme example, but we are getting close to being this way. take for example my diabetic pt. who's sugars are consistently in the upper 300's who makes no secret of the fact that if they don't get the ice cream the very minute they request it, the survey will reflect such. so..........you propose i give it with a smile and get the good survey results in the name of "customer service"? thats where we are headed.

i so totally agree with all of your entries!

i want to shout

"i am your nurse!

i am not here to give you warm fuzzies and make you happy.

i am here to save your life and help you get well.

for fru-fru and pillow fluffing go to the hyatt regency hotel.

the staff there get tips by the way.

they also have room service and a spa."

someone has confused medical care and nursing interventions with hotel maid service and the door man.

on another note, i hear of many times patients want their iv sites or central lines and picc's used for lab draws. the risk of line related blood stream infections increase the more those lines are accessed. lines are for a purpose. they are not there for the ease of blood draws. (with the exceptions of internal caths on chemo patients) the more hands that access an iv line, the higher the potential for infection.

[PostOpPrincess, BSN, RN]

There is a place for the "customer service" part of nursing.

As a patient, I want to go to a hospital where people will treat me with respect and go out of their way to MAKE ME FEEL SAFE AND CARED FOR.

I have worked in several hospitals and can honestly say I would never go to a hospital that has a reputation of uncaring staff. If that particular hospital has such a bad reputation, who will go there for their elective surgeries? C-Sections? The birth of their kids? For the MRIs? CT scans? Our area public hospital has that type of reputation. Guess where the staff come for their elective surgeries? Yep. My hospital.

Let's talk honestly people=--no matter how much we want to pretend that business and making money isn't part of the hospital environment--it is unfortunate, but we have to embrace that's how we get paid. No money coming in...no money towards us.

Now if the hospital's one and only true goal is to make profit--then you know this "customer service" thing becomes unbalanced and often ridiculous. Example: Customer who wants Pineapple ice cream before he goes home, and people cave in to go get it. That's no longer hospital care--that's hotel care..and WE know there are LIMITS to everything. And if management caves into to that, the staff knows it is ALL ABOUT THE MONEY. Miserable work environment? Miserable Staff. Bad customer service scores.

Now I personally work in a not-for-profit hospital. Our motto is "treat people the way you would like to be treated." It works well....the customer and staff--both are happy.

In other words...we know our place...both sides have appropriate expectations and when EITHER side gets ridiculous (staff has to be PROFESSIONAL AT ALL TIMES)...we set limits.

We do what we can...within reason...when it becomes out of control--we don't give in. Example: "Customer/Client" insists on driving home from surgery. He is under the influence, so that would be a big giant NO. And if he did, the police in the parking lot would pull him over the DUI. No if, ands, or buts. That's the way it is.

AND....

Management supports us. Now if your management supports you and creates an environment where YOU FEEL supported...then giving good customer/client patient care...comes more easily.

That's my take..and I've been in nursing for 18 years.

Edited to add: I work in a recovery area where things happen quickly...I am not sure that what I wrote applies to other areas. We can't make people "happy" when they are miserable. We can only do what we can do.

[Scarlette Wings]

just a thought here, but i go to the hospital my insurance will cover. period. i don't choose.there is no choice. i am never asked unless i am willing to pay totally out of pocket. insurance chooses for me. and no hospital is so great i can afford out of pocket payments.

[eriksoln, BSN, RN]

just a thought here, but i go to the hospital my insurance will cover. period. i don't choose.there is no choice. i am never asked unless i am willing to pay totally out of pocket. insurance chooses for me. and no hospital is so great i can afford out of pocket payments.

i brought this exact point up during one of our many "customer service matters" meetings. i pointed out most people don't have a choice where they go, and no one is going to go to a hospital that their insurance makes them pay an extra $800 dollars for just because the nurses "smile better".

i was told there actually is a very large population of people in our current area that have complete autonomy in choosing where they go. they named a few, but mostly its the elderly.

[Limpingaway]

I agree with everything said. I have worked in many aspects and in many settings of healthcare for 35 years. Most recently I've been an LPN for the last 12 years and I have found that the "customers" have finally completely burned me out. I am suppose to renew my license in the next 5 days and quite frankly I don't want to. If I am going to give people what they want with a smile instead of what they need with understanding and caring, then I'll flip burgers. I have ALWAYS greeted my patients (yes patients) with a smile, a caring hand on the shoulder if they allow and carefully explained what, why, and how. Lately I leave a bedside with confidence that while not pleased with their situation, they are comfortable with it. An hour later I'm being called into the charge nurse's office being chewed out for being mean and/or rude to the patient and/or the family! I did my nursing duty, I brought them that extra helping of ice cream with a teaching that this may not be their best choice for a diabetic and perhaps they would do better with the apple slices or sugar free cake I also brought along. But how rude of me to suggest such things! The "client" knows what is best for them, I'm told. I have seen nurses lose their jobs for consistantly doing their job in just this way. I believe in doing everything and anything within the confines of the healthcare process to make a patient happy and comfortable but this customer satisfaction has come to a place where healthcare is no longer part of the process.