Patient as Customer model of healthcare

[GardenDove]

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.

[ZASHAGALKA, RN]

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.

Here's the thing. While 'customers' have the right to refuse any treatment, it is simply NOT my job to foster those poor decisions, in a 'customer service', or any other model.

As I very recently said to a patient that was more than annoyed about being woken up for planned care: if you don't want the service we provide, why are you here? Since she was refusing all care, that is a legitimate question.

Simply put, rights or no, it's NOT my job to be supportive of poor decisions. I provide a well planned, science tested service. If a patient comes to me for care, they 'sign on' to the service I DO provide. If not, that does NOT make me a 'poor customer service provider'. That makes that patient's hard earned dollars paid for my service wasted dollars.

I happen to like the concept of 'patient' with all the underlying semantics better precisely because it DOES lend credibility to an expectation of full acceptance of my care. Once we fully convey the thought process that 'customers' can pick and choose the care they receive, any concept of comprehensive 'science' behind that care goes right out the window.

For example, sure, you can refuse the beta blocker and ace inhibitor status post MI. But it wasn't just decided nilly-willy that you receive that treatment. Once you feel entitled to refuse that, no matter how well I provide the remainder of care you DO allow, your chances of a repeat MI have now doubled.

That might be excellent 'customer service', but it's downright poor healthcare.

The disconnect is the difference between wants and needs. Customer service is a vital component of seeking to provide for the wants of people. They can go to Burger King for better service than McDonalds if they WANT. But when it comes to providing an essential need, what you NEED is not always what you WANT. Whether you go to ABC hospital or XYZ hospital, either the empirical level of care will be identical, or science is being traded for 'service'. THAT's simply not a good healthcare model.

In the end, the result of such models is to supplant the provision of needs for those of wants. If you WANT top dollar service without having your NEEDS met, go to the Hilton. If you want your NEEDS met, then let me do my job. Going a little extra to make somebody happy or comfortable is a fine idea. Ultimately however, I'm not being paid to make you happy but to help make you well.

Let me break that out fully: most of us in the trenches are well aware that the first two phases of grief are anger and denial. Combine that with a service mentality that gives the customer the complete right to decide what constitutes good 'care' and you end up completely yielding to those defense mechanisms. The term 'patient' with all its semantics was purposely designed in order to provide the expected norming of care that allows healthcare workers the ability to place those mechanisms in check in order to give appropriate care.

Expecting me to yield completely to those defense mechanisms might result in better press-gainey surveys but it's not a given that it leads to better care. In many cases, BECAUSE of anger and denial - normal coping mechanisms btw - providing appropriate care might just lead to lower 'satisfaction' surveys, but at least it is consistent with good science. If appropriate care isn't the prime directive, then something vital is lost in translation.

~faith,

Timothy.

[hollyvk, BSN]

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?

Having supervised the patient representatives in one of my many healthcare jobs (and heard many a tale of patient-nurse problems), I can tell you that the best tool at your disposal in dealing with these issues is to set the patient's expectations yourself.

"Good evening, Mr. Smith. My name is NancyNurse, I'll be the Registered Nurse caring for you for the next 12 hours. The nursing assistant working with me is Jessie, she will be in every 4 hrs to check your blood pressure and your other vital signs. I will be in to give you your medications as ordered, to check the dressing over your incision for any bleeding, to attend to your IV, and to assess you for any problems related to your surgery. Your doctor has ordered you to be on bedrest with bathrm privileges, please use your call button to call for assistance when you need to go to the bathroom. I or one of the other RNs or nursing assistants on duty will respond as quickly as we can when you use the call button, but please be advised that I am also caring for 6 other post-operative patients, some of whom are much more ill than you are. I will do my best to keep you comfortable during my shift, please let me know if your pain worsens. And I can show your wife the kitchen where she can get you ice water or something to drink, and where we keep the linen in case you need an extra blanket later on. Do you have any questions or any concerns I should be aware of in caring for you?"

And while that last sentence may slow you down a bit, what usually happens is that patients feel that their needs and concerns are being addressed up front, and this can save you A LOT of time in the long run.

HollyVK, RN, BSN, JD

[GardenDove]

Hi Holly, that seemed like good general advise.

[Cosper123]

Two things that concern me about the "customer" label. Firstly, the title implies and leads to what the patients wants instead of needs. Patients should NOT be making decisions about what they need, unless of course it is in an area they hold some expertise in. Why is this? Well, as it turns out, 99.99% of the time, what the patient wants is not what the patient NEEDS. And secondly, to those who tout the customer label because the term patient implies that something is wrong or illness....well, take the time to consider that if something wasn't wrong with them then they wouldn't be in the freaking hospital

[PANurseRN1]

I understand what you're saying, but really, the term "customer" is as much of a semantics issue for patients as it is for nurses.

You, the nurse, are a customer because you are in a business relationship with the hospital. So is the doctor. So is the patient/customer.

The patient does have an indicator of quality care--personal comfort. Am I comfortable with the staff, the surroundings, with the amenities? Did they hurt me? Did they care if they hurt me? Obviously, if someone doesn't care if I'm comfortable, I won't get that extra pillow, which will make me wonder what other uncomfortable things will happen to me while I am there.

Now instead of relaxing and trusting my caregivers, I'm uncomfortable, I'm anxious, I'm scared into silence.

Is that the kind of patient you want?

Nothing conveys concern like taking care of the "little nitpicky things" like giving someone a toothbrush and a wash basin to wash up with, or an extra pillow, or a midnight snack before going NPO. If a patient/customer is not clear about what is expected during the hospital stay, we can always show them the little blurb underneath the "Patient Rights" that describes "Patient Responsibilities." Yes, patients have clearly stated responsibilities too.

Yes, there is a line. Yes, there are patients who ask too much of us. There are also patients who ask too little.

It comes with the territory.

But we need to remember that doing all those "nitpicky things" are part of good nursing care. When we resent doing those things for patients, it says a lot about what we've allowed ourselves to become as nurses.

The whole "customer service model" is really based on Nursing 101:

If I'm sick, I want someone to act like they care about me.

I don't need a medical degree to figure out who gives a darn and who doesn't. The nurse that gets me that extra pillow or who takes the time to teach me that water will only make my stomach more bloated and cause me to vomit and later buy an NG tube, is showing me who cares about what happens to me.

You must have been spying on my recent hospitalization. No toothbrush (kinda gross when you're vomiting), no soap, no towels or washcloths, bed linens never changed, no water at bedside (and yes, I was supposed to be trying to drink), nurses who reeked of perfume (wonderful when you're already nauseated), and a few who acted as though my mere presence was such a burden that I was afraid to ask for any of my prn meds, let alone ask for something to drink. And I'm the last person who would be "on the call bell." I am pretty self-sufficient, even when I'm as sick as a dog.

In the case of the one prn med, I wound up having a family member bring it in from home, because after 4 hours of waiting I finally gave up all hope of ever getting it. When, after two and a half hours, I rang to ask about the med I was yelled at by the nurse "We don't have it yet!" Believe me, I knew better than to ask for it again.

And no, I didn't get a "Patient Satisfaction Survey" when I was D/C'd.

[cardsRN]

ok, i usually stay far away from these threads because i realize i will never change the minds of those who disagree with me and it will just be a frustrating experience. however, in this case i feel i must weigh in. my problem with the "customer service initiative" is that it assumes that nurses will provide crappy care and don't give a s*** about our PATIENT's comfort unless forced by administration to care. it assumes that we are all rude, surly dissatisfied individuals who don't have the time of day for someone else's concerns. that is just false. the majority of nurses really want to make people comfortable and happy. that is just not always possible. in these days of shortage and understaffing, time is a resource and pt's compete for it, that means that people have to wait for things. hospitalization is an uncomfortable and scary experience, and if we only had more staff, and therefore more time, perhaps we could provide for you that blanket and juice that would really make you more comfortable and make you feel like we care.

another faulty assumption is that the term patient is used by healthcare providers to take power away from people receiving healthcare. another poster was talking about consumers of healthcare as able to make autonomous choices and select or refuse services. that's all well and good but it has nothing to do with customer service initiatives with all their pagers and warning cards. here's a clue. administrators aren't referring to you as a customer or client because they really respect your autonomy and brilliant shining soul. it's because they want your money. and they are willing to do just about anything to get it. and guess what? they don't really care about your concerns as a pt or what is involved with nursing satisfying those concerns, they just want the doors to revolve faster and people to churn in and out of their facility pumping the insurance money in. i mean, "would you refer this facility to a friend or family member?" no, i would not reccomend the experience of being ill to anyone. it irks me when people post on here like nurses have never been patients. most of us have been on both sides of the bed. i'm betting that when you graduate and have a family depending on your salary and health insurance you won't be too fond of the possibility of losing your job over not escorting a customer personally to the cafe either.

no thanks. i will just try to ignore that and do what i am trained to do. provide excellent and compassionate care to ALL my patients (term used specifically because they are people for whose wellbeing i am legally responsible, and who look to me for guidance and comfort). regardless of VIP status, regardless of nurse lo-jacks, regardless of press gainey. give us some credit please. most nurses respect individuals and their rights and just want to help people.

[lorster]

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.

Ok, I'm sitting here in po dung montana and have not idea what a lojack is. Can someone explain this to me?

[caroladybelle, BSN, RN]

Ok, I'm sitting here in po dung montana and have not idea what a lojack is. Can someone explain this to me?

I spell it lowjack, Tim spells it lojack.

It is a nurse locator beacon. It tracks you from room to room and place to place. Some of them (Wescoms) also turn off the call light when you enter the room. That way they keep a record on your response time.

There are advantages. At Hopkins, you can go to the nurse's stn and see where everyone is. At others, you look up at the light outside the pt rooms - a steady red is aides, steady yellow is LPN, steady green is RN. Blinking lights mean that the type of staffer is needed in the room.

Some places give you a cock and bull story about...little old pt sues after a fall in the hospital - pt says that no one came for 60 minutes after s/he put the call light on, so she got up by herself and fell. And the poor nurse is SAVED!!!!!! by the Wescom proof that she responded in 2.34 minutes.

They neglect to tell you about how no one cares what you may be doing, if you are late (?) to a room and someone complains, you will be called on the carpet....that some (usually for profit) facilities use it to analyze how much time you are taking in various areas and how that they can "shorten" the length of time.

The device is also expensive (50-90 dollars) and that you will be charged if you lose/break it.

Most places couple it with a phone or beeper ( in my case both), so that whether you are at lunch or in the bathroom, someone can call you at ANY time for ANY thing. Which frequently means you will get a phone call while you are peeing on your break off the floor....from the MD...whom you have been paging for the last 2 hours for his new admit..who wants to give you a page and a half of orders...that he is too d^&n lazy to come to the floor and write or fax to you.

In my case, I have to get to work early to go to 9th fllor to sign in, go to first floor and other side of the building to pick up beeper/lojack, and go to other end of building and up several floors to finally clock in. And return the same way when I leave.....if I am lucky.

If I am unlucky, one of these offices will either be closed, or they will be out of beepers and/or lojacks. So I will have to hike back down a time or two, later in shift.

[CaLLaCoDe, BSN, RN]

YOu go to the hospital to be treated for a condition...not to badger a nurse and get disgruntled when your Low Fat Latte isn't there in 5 minutes or less!

[bANANA]Your customer/client expired today...could she/he please have a refund![/bANANA]

[RunningWithScissors]

Most places couple it with a phone or beeper ( in my case both), so that whether you are at lunch or in the bathroom, someone can call you at ANY time for ANY thing. Which frequently means you will get a phone call while you are peeing on your break off the floor

We use cell phones....I swear there's a sensor in the thing to make it ring as soon as I get in the bathroom!!!!

[GardenDove]

That Lowjack sounds pretty creepy and big brotherish to me...

[nurse4theplanet, RN]

The facility that I worked at that had this tracking system also had a call system set up so once they tracked you, they could speak to you while you were in the any room or at the nurse sub stations...it was being abused frequently to eavesdrop on nurse to nurse conversations and it was really annoying to be in the middle of helping a pt and have the unit secretary interrupt, "What are you doing? Dr. so and so just called and said blah, blah, blah...402 needs this...Have you completed such and such...when are you going to be finished with so and so..." It tramples on pt privacy, not just employee privacy. Its downright rude when not being used appropriately. I don't work there anymore and it was a brand new hospital...I wonder how long it (the system) will last.