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

[eriksoln]

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.........."

[Ruby Vee, BSN]

exactly why i said earlier that i'm afraid of the awnser i might get if i ask my manager what he would rather have - live patients or 5s on the survey.

dead patients don't give negative surveys.

[kmrmom42]

Wow, this thread has been very interesting to me. I am a nurse who, fortunately or unfortunately, gets to see both sides of things, the clinical and the administrative. I have worked at the bedside for many years and still can and do in a pinch. Currently I am a unit-based educator and, as such, I am privy to the administrative processes that go into keeping the hospital operational.

The most important staff in ANY hospital are its medical and nursing staff. Administration knows that they are to be protected almost at all costs. An administrator can take on the job of two or three other administrators to their detriment but nurses cannot be asked to do the same without huge costs to the operation.

Most hospitals in my current area have had to make cuts to save costs, not only due to the current economy but also due to the regulatory environment we are currently functioning in. I am sure that most of you know that hospitals do not get paid for the treatment of a UTI, skin wound, pneumonia and other conditions if they are acquired during the hospital stay. DRGs have made it necessary to try to get patients out of the hospital as quickly as possible because there comes a point in a patient's stay when their care is no longer paid for AT ALL because there is a set number of days they are expected to stay r/t those DRGs. In response to this need to cut costs in order to be able to pay the salaries of the medical and nursing staff administration in almost all of our area hospitals has taken huge hits. I currently work for two organizations involving three hospitals. Both organizations have cut salaried staff from 40 hours to either 37.5 or 36 hours per week. In addition, there was not only no decrease in the expectation for work produced but, in fact, many administrators have been let go and their jobs incorporated into the now decreased paid hours of the ones who remain. Directors and managers are now responsible for two or three service areas....an almost impossible task.

As a result there have been NO lay offs or salary cuts for the medical and nursing staff and that is okay with those of us who do not provide the day to day care of the patients, we KNOW that is the priority and we work without pay to make sure that you can do your job.

I agree that there are a lot of requests that come from administration that seem silly- scripting, increasing customer survey scores etc. but they come from an effort to increase revenues so that they can keep their nurses. Hospitals are starting to look at successful businesses for solutions to our issues. What is it that they do that makes their "customers" happy? Like it or not we do have customers. Patients, non-hospital employed physicians, outside vendors etc. These are all people who can take their business elsewhere. Hospitals do have to make money in order to pay salaries and the largest hit they take is nursing salaries, appropriately so. Hospitals are now required to post their pt. satisfaction scores as well as their rates on those "acquired in the hospital" infections so that patients can choose where they want to go for their care (and yes, many people do have options).

So, in this current environment what you may not see is all the effort that is going into trying to increase outpatient services and other service lines that actually bring in money as opposed to inpatient care where we often lose money.

That leaves administration in the difficult position of having little time to do anything but try to come up with quick fixes for inpatient issues.

As nurses we have a lot more power than we recognize. If a group of you who truly care about what happens on your units took some time to get together and try to come up with some real solutions to your issues that you can present to administration I can't help but think they would at least listen if not respond. The hard thing for an administrator is when people come with complaints but don't offer solutions expecting that overwhelmed administrator to come up with the solution themselves.

I am not an administrator per se but I am one of those people who has had hours cut, more expectations piled on and people come to me with issues expecting me to solve them. I love it when someone comes to me with workable solutions, I stand on my head to try to help make those solutions happen!

Now I think I can predict what the reaction will be to my comment above...."how can we take time to get together to come up with solutions, we are already swamped". The truth is we are ALL swamped, just in different ways and if we are ever to get out of that situation we need to solve our own problems and not just complain. I know that many of you are trying to do just that, we just need MORE of you to help us get out of this rut. There is power in numbers. Unfortunately money is needed for many of the solutions but we just need to keep that in mind as we propose those solutions. What will solve our problems that will be cost-effective, allow us to provide the best evidence-based care and make our patients happy at the same time? We need to put our thinking caps on and provide solutions to administration that will truly work for nurses and patients alike.

Sorry for the soap box, being in the middle is a tough place to be, I value the points that both sides are trying to make, we just need to all get together and find some common ground. (And yes, sometimes I DO wear rose-colored glasses)

Thanks for listening!!

[belgarion]

dead patients don't give negative surveys.

are you sure you're not my boss in disguise?

[pedicurn, LPN, RN]

Interesting thing about post 91 it mentions why a non-nurse would post and visit the board. The number ONE reason why i visit this board is because of past experiences that I had with medical care. There was always that feeling of what they say to the patient because its just "what they are supposed to say" and then hearing medical professionals (not just nurses)converse about how they really feel about things that are going on within medical care .Things they would almost never say to a patient and actually have their guard down.

Only thing is I don't believe the "general public" is as quite blind as you think. I'm basing my views on what I have seen and experienced YES as a patient and what I have seen family members go through dealing with healthcare and the conversations that have been raging for years.It's based on my experience having a facility try to talk me into a surgery I knew I did not need and when I asked why I was LITERALLY told....."Well you have insurance....... you might as well get it done." Wow she was to lazy to even try to make up any medical mumbo jumbo. It's based on a beyond humiliating experience at a hospital that i won't even go into right now.........that could have been totally avoided.

I

Sounds like you have issues with past experience in the healthcare system. If there's something you didn't/don't understand about your experience....then you should be talking to your doctor.

I'm kinda getting a vibe you have a grievance with a provider ??? Again, we are not the people for you.

[NRSKarenRN, BSN, RN]

think about it, does any other industry allow its "customers" to have so much say?

do restaurant's let customers set the menu prices or decide what is on sale? nope. everything would be sold at a loss and instead of putting up stuff you need to move on sale, you'd have the popular dishes that sell anyway being sold at a discount price.

do cable providers care if the installation man shows up right on time or let its customers pick their channel lineup exactly? nope. too many channels would never get picked and the cable guy would have to give up the "we'll be there between noon and six pm" habit.

comcast cable company now promises visit within one hour window that you select...and wearing shoe covers in the home because they care about keeping your home clean...

updated: comcast to launch xfinity rebranding campaign - 2010-02 ...

xfinity came about because comcast has lost over half a million customers in the last year to dish network and other satellites. where they once had a tight grip what goes to your tv., they are letting a lot of customers slip through their fingers. a smart ceo would notice that they have a long list of complaints against them and constant stream of bad pr, and decide they need to make their service better and build a campaign around renewed interest in their customer base like dominos has. for whatever reason, the management at comcast decided to blame it on their brand name. a lot of big companies use their advertising companies as scapegoats when numbers go down. a great ad campaign can do wonders but it isn't magic. if you have competition and your competition is doing what you do better, they're going to take your business, that's capitalism.

[canoehead, BSN, RN]

Just because I choose to not change bedpans for a living doesn't mean I shouldn't be allowed to respond to a post.

I can agree/disagree with anyone about any topic and be respectful.....If you can't or choose not to then that's a sign of your character AND NOT MINE! GET OVER YOURSELF!

Ironically, I don't see a need to add much. You just made my point.

[bubczac]

@kmrmom42: well stated top to bottom. i cannot say that i am shocked that the topic kept going in the "bash the non-nurse" direction when there was just a wealth of really well made points in your post.

i just agree with so much that you said i do not know where to start. i think middle management carries the burden of being not too far removed from the floor while still trying to please "the suits." our hospital is just starting to talk about pay for performance in terms of survey results for floor managers/charge nurses. this seems to me like a good way to lose a lot of well-established, seasoned leaders. i have been put in the position of starting a committee made up of nurses from different units to analyze our deficiencies in customer service. i see it as an opportunity that can at least create a dialogue in our hospital. but i also see it as turning into a complaint forum. "well your unit doesn't do this, or your unit doesn't do that." i loved the line that was said about you cannot have complaints without offering solutions. this committee is my effort to keep non-bedside management from making decisions about bedside customer service behaviors. i think when this can be established as a key to the way customer service should be handled in a hospital, nursing can start coming up with solutions. as is evident on this board, nurses do not want to be told by non-nurses what they should or shouldn't be doing. but until we can come up with valid solutions rather than just argue that a hospital is not a hotel (customer service is not going away), we will have management and hr telling us how to do our job. nurses need to be proactive in this environment of customer service instead of rejecting the thought in a reactive/non-productive way. you cannot please anyone, but you have to try. that is all this customer service is about.