Patient as Customer model of healthcare

Nurses General Nursing

Published

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'.

What do you all think? Should we think of our patients as customers? Somehow it has a capitalistic ring to it that I don't like. Ours in a small community hospital, btw, funded by county taxes, in addition to revenue collected from patients. We are also a critical access hospital and this also brings in additional revenue.

Specializes in Critical Care, Pediatrics, Geriatrics.

Timothy, you took all my thoughts exactly and worded it better than my young mind could have ever conveyed! Bravo on your post!

There are 2 fundamental flaws with the resistance to looking at patients as customers.

1. People who end up sick and in the hospital aren't there because it's a good time. It's not like they are there to do us a favor. Many, many people have to pay substantial sums of money to have the privilege of being cared for by people with years of education and experience. Often times, this cost is second only to their mortgage. For that level of burden, there's an expectation of something more than just sitting there and taking whatever is dished out.

About the only thing worse than being sick enough to require hospitalization is having to endure it while surrounded by a bunch of surly, out of sorts people who seem to act as though I should just shut up and accept whatever they deign to throw my way. While I might have to put up with some MW teenager tossing a sandwich to me at a drive-thru, you can bet that for the money I'm spending on my hospital stay, I expect to be treated with some degree of dignity and respect.

2. And while my years of experience and educaction might not be in the field of medicine, it was certainly as difficult to come by. And as a result of that time and effort, I'm not just some blithering idiot. If you'd just stop long enough to explain a thing or two to me, rather than treating me with less attention than you'd give your house plants, I might just accept your ministrations with a level of understanding that you'd find surprising. I realize that there are people just down the hall or around the corner that may be more acutely sick/injured than myself. I'm more than willing to put up with some suffering while you treat those who are more ill than me. On the other hand, I don't want to end up on the bottom of the priority list simply because I'm not a "squeaky wheel."

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Ok... before you blow your top at the veiws above, let me explain a little. I understand that the nurses in this thread are tired of bad patients treating them like serving wenches. However, there are also nurses who treat their charges as a nuisance regardless of how understanding and patient they are with the lack of attention they might be receiving. So let's at least try not to throw the baby out with the bathwater here. Just as there are unreasonable patients, there are also unreasonable nurses. Regardless of how great you might be, they need a readjustment to their approach.

Here's another view... Is it possible that you can provide the same level of care to your patients and still tune your approach to make their stay any more endurable? These people are sick and feel a near complete loss of control. Often times, their irritability is just a function of their illness and nothing at all to do with how they are being treated. Part of the skill of a nurse is their ability to reduce their fear and anxiety. Those skills aren't just measured in how many IV's you can start with one stick. They are also measured in how well you can communicate with those receiving your care.

Perhaps it's just me, but having had the unfortunate need to be parked in a hospital bed a fair number of times in my lifetime, I've had the opportunity to see both sides of the coin. One of the reasons that I chose nursing was the fact that the people who often had the most profound impact on my stay were those with whom I spent the most time - the nurses. Most of the time, it wasn't that the care given was any better. Rather, it was the manner in which it was provided. You may be the most skilled and educated practitioner on your unit. However, if your people skills aren't any better than some turnkey at the local prison, then unfortunately nobody will ever know it. And if they do, they'll be too bent out of shape with the other part of your care package to make any difference.

If you already practice the arts I'm speaking of, then good for you. However, I'd bet that you know of some member(s) of your peers that don't. It's these folks that management's aiming at. It's too bad that some small minority can bring customer and management ire to all of us. Perhaps when you sit in the driver's seat, you can instill your skills in your charges so that such measures won't be necessary in the future.

Oh.. btw... I recognize the fact that management is often really lousy at implementing these sorts of initiatives. That doesn't make the need for the initiative any less important. It just illustrates the need for tons of work at that particular part of the business. But that's a subject for a different thread.

Specializes in Critical Care.
There are 2 fundamental flaws with the resistance to looking at patients as customers.

You make some good counterpoints.

Here's the problem: I understand that there are bad nurses out there. I just despise being treated by the same brush. In an effort to deal obliquely with those bad nurses, instead of directly, management has painted all nurses by the same brush.

That's bad management. As you pointed out.

I said I understand the point, just not the execution. That's the case. There is a balance here. Letting 'surly' nurses force their care on patients is bad in one extreme. Expecting that my priority should be redirected to timely creature comforts with no consideration for higher priority concerns is bad in the opposite extreme.

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.

Specializes in Oncology/Haemetology/HIV.
There are 2 fundamental flaws with the resistance to looking at patients as customers.

1. People who end up sick and in the hospital aren't there because it's a good time. It's not like they are there to do us a favor. Many, many people have to pay substantial sums of money to have the privilege of being cared for by people with years of education and experience. Often times, this cost is second only to their mortgage. For that level of burden, there's an expectation of something more than just sitting there and taking whatever is dished out.

About the only thing worse than being sick enough to require hospitalization is having to endure it while surrounded by a bunch of surly, out of sorts people who seem to act as though I should just shut up and accept whatever they deign to throw my way. While I might have to put up with some MW teenager tossing a sandwich to me at a drive-thru, you can bet that for the money I'm spending on my hospital stay, I expect to be treated with some degree of dignity and respect.

2. And while my years of experience and educaction might not be in the field of medicine, it was certainly as difficult to come by.

If you already practice the arts I'm speaking of, then good for you. However, I'd bet that you know of some member(s) of your peers that don't. It's these folks that management's aiming at. It's too bad that some small minority can bring customer and management ire to all of us. Perhaps when you sit in the driver's seat, you can instill your skills in your charges so that such measures won't be necessary in the future.

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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.

But honestly, the post above could have been written by any number of my colleagues or myself, about 15 years ago. Back when we left the IT or business world. The tune will change about 3-5 years after you graduate and have worked for a while, in a facility that will spend millions on lowjack/pager systems, but not even invest in sinks or safe (non flimsy) gloves, to prevent infection. The times when staffing is so poor that you have worked 12 hours without breaking/eating, and you are staying after two hours to finish paperwork, and a bean counter gets fussy because you did not get anyone to initial in triplicate the time that you stayed after. Or when you as a patient are trying to deal with a cancer diagnosis, and your nurse is comforting you, but she gets the mandatory phone ringing to go fetch a newspaper.

Johns Hopkins is rated the number one hospital in the nation. And it holds that position year after year. And I certainly did not have to wear a lowjack/pager/beeper for them. No little cards got handed out. No little timers

Hospital at UPenn generally rates highly. NYP - Cornell is consistantly rates in the top ten in the nation. Guess what, I didn't have to carry beepers/lowjacks/pagers. No little timers. And not a lot of staff turnover.

All of these facilities are considered excellent and known by health care consumers...and they do not have to need for these demeaning tactics. A coincidence - I think not.

And nurses still have the highest "trust" rating, year after year, as noted by Gallup Polls. Yet they are consistently are subjected to the greatest distrust by administration. They won't lowjack pharmacists, doctors, the hospital chaplin, and the accountant (all of whom have lower ratings, and several of whom are known for risk of theft of money/equipment/drugs or unethical behavior), but they will search the nurse's bag.

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".

Specializes in Critical Care.

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.

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.

Specializes in Critical Care, Pediatrics, Geriatrics.
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.

Specializes in Critical Care, Pediatrics, Geriatrics.
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.

Specializes in Oncology/Haemetology/HIV.
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.

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."

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.

Specializes in CRNA, Finally retired.
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.

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