Shortly after having a nice dinner with a couple friends I have not seen for some time, I found myself pondering the flaws in the assertion that healthcare must be "customer service" oriented. My friends, both of whom are, through no fault of their own, only marginally aware of the problems facing healthcare, both insist the push for better "customer service" in healthcare is long overdue. Well, unfortunately, I went off into a rant about all the reasons it does not and will continue to not work. I actually said a few things that surprised myself, at certain points it seemed as though I were talking and learning at the same time. Needless to say, both my friends have new and different gripes to pursue regarding healthcare now. I also believe it may be some time before we have dinner again.
Have you ever seen the movie "Lethal Weapon"? If not, I highly recommend it. There is a scene in that movie which, to this day, remains one of my all time favorite movie scenes. A cop, played by Mel Gibson, finds himself on a roof top trying to talk down a possible suicide jumper. What this jumper doesn't know is, the cop trying to help him has a lot of issues of his own going on, and he suffers from depression also. His depression though results in a suicidal approach to his police work. Well, the cop keeps talking to the man in a business suit on the ledge, all the while getting closer and closer to him. Finally, he is right beside him, still putting on the "nice cop" act and he cuffs him so he can't jump, and the nice guy act immediately goes away. He tells the guy "OK, shows over, its time to go, get off the ledge."
the man in the business suit isn't satisfied with this ending to his suicide jump show though. He begins to argue with the cop, even threatens to jump and take them both off the ledge. Finally, my all time favorite movie scene comes: the cop looks the jumper right in the eyes with a look of the Devil on his face and asks him:
"You wanna jump...............huh................Do you really wanna?"
Next thing you know, he takes the businessman by the shoulders and both are falling off the ledge towards the air bag beneath them. By the time its all over, the businessman can't wait to get away from him and is screaming for help to come undo the cuffs, "Help me, he's trying to kill me."
I believe the next time someone suggests to me that healthcare should be more like "customer service", they are going to have a similar experience with me. For me, its just a simple matter of "watch what you ask for, you might get it."
To start, I need to insert the disclaimer. When I say customer service has no place in healthcare, I am not advocating that nurses should be allowed to ignore pt. Needs, say whatever they want to family members or show up in jeans and a Metallica shirt for their shift. As with other healthcare professionals, nurses should be held to the highest standards of professionalism. Proper etiquette, treating patients with respect and dignity and a sense of duty to do what is right for patients has and should continue to be the basis of nursing's approach to people.
With that said, I will interject though that "customer service" and healthcare do not mix. They are like trying to mix water and oil. Why? Because the industries that are considered "customer service" (the food industries, retail etc...) use liberties to make the "customer service" model work for them, and said liberties would be unethical in the healthcare field.
1. Systematic customer service vs. Individualized customer service
Customer service industries, while taking (or at least advertising) a "the customer is always right" approach, don't always let their customers decide what is best or how to make the business function. Customer service industries are able to take either/or approach and decide for themselves which one is best for different situations. In plainer terms, customer service industries have the luxury of deciding when to put the business first and when to put the customer first.
Take the fast food industry for example. Think about any national fast food establishment. Now, compare how differently one restaurant, from the same chain, functions compared to the others in the surrounding area. Store a is open 24hrs/day, store b closes at 10pm. Why the difference? Because the powers that be who make decisions for the company have seen trends that say closing store b at night was going to save money, meanwhile keeping store a open all night had benefits.
The customer service industry makes many decisions like this, all the while keeping profits as high as possible. Customer satisfaction is weighed against the cost of keeping them satisfied, and decisions are made with the business's best interest in mind.
Take the above example a step farther. You are a customer of store b, and you don't get out of work until 10pm. You can't go to their drive through and get a late night dinner on you way home. Now, complain to the store manager. Chances are, you will get a very practiced and sincere (sarcasm) apology, but nothing will be done about it. Next, contact the administration who made the decision to have the store nearest you close instead of be open all night. You will get the same response and perhaps a $5 gift certificate. It's simple, staying open all night and getting your ten dollar sale doesn't justify paying a couple hundred dollars in employee wages. So, in the end you lose.
Give telling the cable man he can only fix your cable box at noon, no later and no earlier, a try. Chances are you will be listening to the radio for a very long time. Tell me what happens if you tell the local grocery store bagger that he must wear a tie or you don't want him bagging your food. Wait, I already know the answer.......you bagged your own food.
That is real life "customer service" at work.
This would not work for the healthcare industry though. It is a well known fact that a personalized approach to care is a major focus of the healthcare industry. If you get sick at 2am, the er at your local hospital will be open. The public and political backlash would be epic/historical if it weren't so. Can anyone imagine a hospital saying "we are going to accept patients only between the hours of 7am and 10pm, its just better for us and in turn will make things better for our patients." or, how about a home healthcare agency that does not take emergent calls during certain hours. With all the cutbacks being made in healthcare and everywhere else, it has not gotten to this point at least.
This is "patient care" at work.
2. Freedom to distinguish good customers from bad customers, and act accordingly
For this example, we will use a well known, national retail store, better know as a "convenience store". Cogo's is everywhere in the u.s., it survived the recession and will probably still be here when nothing but cockroaches and fungi roam the earth.
Walk into the Cogo's or similar local convenience store. A few things you will notice: the ever present and popular "no shirt, no shoes, no service" sign, signs around the cash register telling you this/that are not accepted behavior or these/those forms of payment are accepted, a security camera (sometimes multiple) making sure you are aware you are being watched and of course the also ever present and popular "shoplifting is illegal and we prosecute" sign can't be left out. The cashier working at the time may or may not say hello as you enter, depending on their mood.
Not the warmest welcome, to say the least. So, why do they continue to strive with such a poor first impression being their trademark? Because, all these things are a part of being allowed to decide who deserves service and who does not. They won't cater to anyone, especially if it is not good for business. Customers who are lewd, loud or disruptive are promptly removed from the premises, because they are bad for business. If a customer who does not like the prices of soda becomes verbally abusive or physical, they will be promptly removed and may be arrested.
This is real life "customer service" at work.
Lets return to the restaurant scene for a moment. Do you have a favorite place to eat at? Chances are, if you go there often enough and are a good tipper, you get a little better treatment than the unknown customers. Ever been to an unfamiliar restaurant while traveling. I'm willing to bet you saw a few locals getting better service than you. Do you have a friend (or, are you the one LOL) who does not tip or is demanding/abusive towards the staff? If you do (or are the one), then you certainly know what it means to get the minimal service, and, yes, your food may have been dropped on the floor a few times before you got it. Fact is, service industries do give that extra effort when a well liked big spender comes in the doors. It is a give/take relation to them, like it or not. Even the retail businesses do this with rewards for spending a lot and staff who are told "be extra nice to that one, he spends a ton of money here." anybody recall how the phone service giant, sprint, recently "fired" a large amount of customers and told them to find phone service elsewhere?
This is real life "customer service" at work.
The healthcare industry does not have this luxury. The mantra is "these people are sick, they are at the lowest point in their lives." I do believe that, to a degree, and believe any nurse who still has compassion does not take every patients actions personally. I think er nurses more than anyone can attest to the fact that we give people a lot of room for mistakes, and they still receive the care they need. Drug addicts attack hospital staff, family will insist you forget about everyone else and only tend to their loved one ("hey you, nurse, how long are you going to be doing CPR on that man, my mom wants water.") and verbal abuse is the norm. Despite conditions that would make the average citizen break down in tears, we strive to keep the patient first, regardless of whether they deserve it or not. We are obligated to do so. Does an er nurse telling you "sorry, can't cardiovert you until you put on shoes and a shirt" sound like something you want?
This is "patient care" at work.
3. The ability to keep business as the primary focus and turn away customers who can't/don't pay
No need to specify any specific industry for this, they all exemplify it.
Go to the local burger joint and when it is your turn to order, say to them "I don't have any money or credit cards, but you are "customer service" oriented and I am hungry. Soooooo..............hop too with making my burger and don't forget to hold the onions. After the laughter stops, you will be excused from the premises by the manager.
Don't pay your phone/cable/gas bill for a few months then call them and tell them "I'm going to give you very low ratings if you shut off my service" and see how effective your threats are. After the laughter stops, you will be isolated/bored/cold.
Fill your gas tank at the local gas station, but leave without paying. Trick is, you have to leave a card with your personal information behind so they can find you (OK, this is a stretch, but you get the point). After the laughter stops (for your stupidity and for your inability to pay), you will be fined.
This is real life "customer service" at work.
As healthcare providers, we are obligated to provide the best care we can, regardless of ability to pay. Yes, healthcare is a business just like all the other service industries. We do have to keep the doors open and staff paid somehow. The healthcare industry also gives vast amounts of charity care. Even without taking how uninsured patients use the er as their primary care service, this is still true. People are well within their right to sign up for "self pay" and receive the same care as anyone else. We know they will not be able to afford the bills, as do they. It's just a formal dance to get the patient admitted so treatment can be rendered. We take these people in, give them the same care as everyone else and don't look back. Often, people think its that way because it has to be. In truth, we wouldn't have it any other way. Everyone deserves life, regardless of ability to pay for insurance.
This is "patient care" at work.
What is the point of all this? My point is, you can not make "customer service" a part of healthcare without taking the good with the bad. To invite w/e aspects of "customer service" it is you are seeking into healthcare, you also invite "real life customer service" into the mix. This would be disastrous on many levels. Do you want a healthcare system that:
Closes at night, because its more profitable.
Tells the nurses to ignore the uninsured patient and focus on the paying patients (like the waitress).
Tells patients who are not as pleasant as they would like to "get lost" and not come back.
Only offers the services that are profitable for them at the time ("sorry, we don't have cardioversion equipment, it was too expensive to upkeep.")
So, I will say to the proponents of "customer service":
"Do you wanna jump?.........................huh................Do you really wanna?"
