Patient as Customer model of healthcare

UM Review RN, ASN, RN · Jan 3, 2007

The flaw in the customer service model is that patients envision and group together their impressions from retail operations, like hotels. It's comforting to the patient to have some idea of what to expect going in, but it's up to us to refine that perception.

So IMO, the customer service model can work, but you have to make your terms clear. My biggest customer service complaint is "I can't get any sleep with people waking me up at all hours."

I now take steps to clearly state what can be expected of us and our hospital RIGHT AT ADMISSION.

I will say, "You can expect me to come in and get your blood pressure at midnight, and then Lab will be in to draw your morning labs sometime thereafter."

Some patients angrily respond, "That means I won't get any sleep!!"

My answer: "Yes, that's right. This is one way that our hospital is helping you keep costs down. You see, the docs check the labs in the morning, and if your labs are OK, you get to go home sooner, thus saving everyone money. You don't want to spend an extra day here, do you?"

I tell them what I can and cannot do. I usually get reasonable people who really are exhausted from the ER and want some sleep, a couple extra pillows, and some food. In general, the patients who want to go down to smoke (not allowed--I tell them up front) are few and the patients who try to get around that are fewer still, though they do tend to stick in our minds.

The part of the customer service model that I like the best is that EVERYONE IS INVOLVED and I have rights too. Docs yell at me? Well, as a "customer" I also have a right to be treated appropriately, and docs are no exception.

The customer is not always right where I work. We work together as much as possible to keep everyone comfortable as well as healing, and folks, that's just a very basic part of holistic nursing, to help our patients get better by creating a safe, comfortable environment for them in addition to the medication and treatment regimen.

GardenDove · Jan 3, 2007

Angie, your post makes plenty of sense. For me, it boils down to human decency and respect. Clear communication helps, and giving the pt plenty of choices. I'm a big believer in TLC and little niceties. Asking "Do you want your door opened or closed?" "Do you like ice in your water?" and other little pleasentries really goes a long ways with pts. Not seeming to rush out of the room really helps people feel valued. Taking an interest in them beyond their diagnosis is a big hit.

I remember one pt who complained about days, he was a DKA who felt like crap and he couldn't get a piece of toast made by the day nurse, he went on and on about how great I was for offering him a snack. Still, I didn't think of him as a customer. Nursing is too much of a spiritual vocation for me to think in those terms.

country mom · Jan 3, 2007

Customer? They're so much more than that. For goodness sake, we're saving their lives, not selling them a car.

UM Review RN, ASN, RN · Jan 4, 2007

Customer? They're so much more than that. For goodness sake, we're saving their lives, not selling them a car.

However, a "customer" is a consumer of goods or services, so the term is essentially accurate. The problem comes in when people--nurses and patients alike--associate the word with retail sales as opposed to vital services.

To my doctor, I'll be a patient, but I am also a consumer who has the right to shop around for a doctor, hospital, or nursing service that best matches my resources and my needs.

If my doctor is rude, leaves me waiting in a chilly room, naked, without a covering, and then leaves the door open, you can bet your bippy that I'm going to be mad when I get that $400 bill. I will not care that he was called out on an emergent C-section, or that he has 15 other people scheduled for the same time slot. What matters to me when I am the consumer, is how well I am treated, all things considered.

One of the failings of the nursing profession is that it fails to consider that we are selling a service. In fact, nurses were trained to refuse offers of money and sacrifice their salaries in the interest of the common good.

That was pulling the wool over our own eyes as a profession at best and at worst, has caused the powerlessness and invisibility of nursing. Because we refused to acknowledge the nursing profession as a business model--and it certainly IS possible to deliver good care while maintaining ethical standards, because doctors do it all the time--nurses have basically given up their autonomy.

This could be why we cannot bill for our services separately, like Radiology or like ambulance services. They too are in the business of saving lives, no matter what nomenclature is applied to the consumers of those services.

I believe that the customer service model is much more holistic and ironically, more suited to the nursing model, than the old paternalistic medical models used to be.

Maybe we need to realize that people will pay for good healthcare and maybe we need to recognize the dollar value of what we do, and translate that into something that the average Joe can understand and identify with.

Your thoughts?

allnurses Guide · Jan 4, 2007

I've searched and searched and cannot find the original article but I know I read it in the last few days about an ER that gives patients (customers) free gifts if they are not seen in a certain amount of time. It supposedly has helped the ER staff to speed up the pace.

I wish I could find it - it made me angry. All the onus is placed on the ER staff and NONE on the folks who come to the ER for a runny nose they've had for a week.

I want to be the best nurse I can be and give the best care - but this plan makes it seem like we just fiddle-fart around in the ER and take our own sweet time getting to the "customer".

And that just isn't true.

steph

dream'n, BSN, RN · Jan 4, 2007

Look, the term customer implys dollars and cents, a business relationship, goods and services being bought and sold. The heart of nursing is compassion and empathy. Where do dollars and cents enter into providing tender support to a terminally ill patient, or assisting a patient with keeping their dignity while dying? Those people are my patients, not my customers! Nursing CANNOT be measured by the business model, and I personally resent that the 'bean-counters' are trying to do so. So much of what we do isn't fiscally sound. For example, we spend precious, well-payed time providing oral care to those on vents, giving bed-baths to those that cannot do it for themselves, or just lending an ear to a scared patient. What if that vent patient isn't awake and never will be, what if they will never be able to 'spread the word' that xyz hospital provides good care? The nurses at that patient's bedside will still spend their time and give the very best care they can. In business, if a customer cannot pay for the services/goods rendered, the company will cease providing those services/goods. Nurses provide care to all.

RunningWithScissors · Jan 4, 2007

I have no problem with hospitals wanting to make stays more palatable for the ill. I think it's a good idea. But I do NOT think nurses are the ones to fulfill the "hospitality/hotel" needs every 15 minutes. As someone stated above, if you want to provide that type of service, AS WELL AS great medical and nursing care, then provide the staff to do it.

I've got it!!! :idea:

How about hiring a unit concierge.....take THAT, Press-Ganey!

GardenDove · Jan 4, 2007

Oral care for people on vents actually does save money by reducing the incidence of ventilator associated pneumonia.

Antikigirl, ASN, RN · Jan 4, 2007

From Angio's first post (love you babe!) "So IMO, the customer service model can work, but you have to make your terms clear. My biggest customer service complaint is "I can't get any sleep with people waking me up at all hours."

Oh man...I tell pts that they are in a hospital and we work 24/7 with or without an MD because that is what is needed. And if they whine a bit after that I simply say..."what? you want your RN's to keep MD hours????"

That usually does it! Especially for those folks that complain and complain but "don't want to bother the doctor"....(got to love those huh? LOL!).

I actually had a pt that said "why do you guys keep comming in here every hour or so?!?!?"...and I said..."sir...do you know where you are, or what date it is???"...he looked at me funny and said where he was, and what date it was....and I said "whew...I thought you may have thought you WEREN'T in a hospital about to have open heart surgery in less than 8 hours! Of course we are checking on you frequently...you are about to have a serious surgery and we want you to make it to it! You are not well sir, and we will check frequently to assure your safety and well being and not let anything happen to you go unnoticed!"...He quit complaining and understood and thanked me and the staff!

I fear most people are getting a Mc Donalds attitude towards everything...hot, fast, now...and forget that the human body..although very very impressive...does have its limits and we are trained to help those!

Which reminds me...what about the phrase 'have it your way" or "I'm loving it" for CUSTOMERS...doesn't fly in healthcare..and wow...those are two of the largest customer based francises in the world!!!!!

Tweety, BSN, RN · Jan 4, 2007

I've got it!!!
How about hiring a unit concierge.....take THAT, Press-Ganey!

The manager of one of units has just that. Actually it's a tech. that makes rounds on all the patients, making sure they are happy and taking care of any complaints they have, handing out samples of the P-G surveys, etc. I don't think she works everyday, but the sole goal is to raise P-G scores. The kitchen has a "patient advocate" that rounds on the patients, making sure they are happy with their food and taking care of any issues that they have, all in response to complaints we get from P-G surveys.

incublissRN, BSN, RN · Jan 4, 2007

However, a "customer" is a consumer of goods or services, so the term is essentially accurate. The problem comes in when people--nurses and patients alike--associate the word with retail sales as opposed to vital services.

I feel like hospitals perpetuate the idea that it is retail sales instead of vital services. With all the commercials about meeting their needs and the philosophy "the customer is always right" patients come into the hospital with unrealistic expectations. I understand that we need to make their stay as comfortable as possible because it is a scary environment but don't hospitals take it too far at times? When patients have unrealistic requests and become angry with me I explain to them what I can and will do and remind them that I deserve respect too. Luckily I know that my management will back me up.

One of the failings of the nursing profession is that it fails to consider that we are selling a service. In fact, nurses were trained to refuse offers of money and sacrifice their salaries in the interest of the common good.

People don't know what services we offer. Patients probably think I have nothing better to do then fulfill their every whim; afterall, that is my job isn't it? And if I didn't, was that a bad healthcare experience even though excellent medical and nursing care was provided? I agree with Tweety, too much emphasis is placed on customer satisfaction which is not reflective of the care they received.

I feel like viewing patients as "customers" gives them too much power. However, the patients provide the money (most of the time ) and with money comes power. Hospitals are competitive so I don't think anything will change.

I agree with you Angie, if we were able to bill for our services we would have greater autonomy. But nursing is an expense and isn't profitable, so I don't know how that would work.

UM Review RN, ASN, RN · Jan 4, 2007

I feel like hospitals perpetuate the idea that it is retail sales instead of vital services. With all the commercials about meeting their needs and the philosophy "the customer is always right" patients come into the hospital with unrealistic expectations. I understand that we need to make their stay as comfortable as possible because it is a scary environment but don't hospitals take it too far at times? When patients have unrealistic requests and become angry with me I explain to them what I can and will do and remind them that I deserve respect too. Luckily I know that my management will back me up.

When patients have unrealistic expectations, we need to educate them as to what can be expected and what we can and cannot do for them.

Remember that any model is just that--a model--and within that framework, we have a lot of options.

People don't know what services we offer. Patients probably think I have nothing better to do then fulfill their every whim; afterall, that is my job isn't it? And if I didn't, was that a bad healthcare experience even though excellent medical and nursing care was provided?

Nurses have been trained NOT to tell people what they do, to ensure patient confidentiality and to keep the patient from worrying more about the nurses' needs ("I didn't call because I knew how busy you are," says the patient from the floor). Yet there are diplomatic ways to say what you do. I hear far more often things like "do I really have to call you if I need to get up to the bathroom?" than I hear unreasonable demands from patients.

If the patient is too unreasonable, I document it all and ask the doc for a psych consult, as the patient who doesn't want to let you out of the room, calls constantly, and makes trivial demands is often acting out of fear and anxiety about something. True PITAs who are that way without some kind of psych issue are rare, IMO.

I agree with Tweety, too much emphasis is placed on customer satisfaction which is not reflective of the care they received.
I feel like viewing patients as "customers" gives them too much power. However, the patients provide the money (most of the time ) and with money comes power. Hospitals are competitive so I don't know anything will change.
I agree with you Angie, if we were able to bill for our services we would have greater autonomy. But nursing is an expense and isn't profitable, so I don't know how that would work.

That would work like the docs do--we'd have priveleges at a certain hospital or group of hospitals along with use of its equipment, supplies, and services. Nurses would form agencies or workgroups, and instead of working for the hospital, nurses would work for the agency. Hospitals would contract out for nursing services, just as they do for Radiology, and each of us would either be in independent practice or work with a group of nurses, according to our specialty.

Something like that. But if docs and PT's and Radiologists can do it, why can't we? If they can deliver timely, appropriate, ethical care and still make money, why can't we?

I have to at least ask.