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.

[Altra, BSN, RN]

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.

...

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.

...

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.

Excellent post.

[JessicRN]

I can hear it now, "Hi my name is Mary, I will be your server today.How may I help you?":rolleyes:

As long as it also says PLEASE REMEMBER TO TIP 15-30% OF YOUR TOTAL BILL. thank you.:monkeydance: :monkeydance:

[withasmilelpn]

I think the problem with the label 'customers', is how some people feel its a license to treat nurses with disrespect. I once had a family member threaten to sue us over the w/c leg rests being in the wrong position. Now the patient was all the time playing with them and it was a simple matter of using the lever to lower it, which was what I stopped to show her how to do. The family member refused to listen stating it was PT's job. She was simply unwilling to listen that PT only adjusted the length not the position etc. The entire time she was going on and on to about the money they pay, sueing , verbally berating his nursing assistant until I finally told her she could no longer treat us this way and to take it up with administration!

Just a sidenote- this was not my patient. Now I avoid this family when I usually try to take care of anybody's complaints, concerns.

I feel that when family members are clearly out of control, upper management needs to step up in our defense.

Nurses leave the profession because they don't feel supported.

Also I think that lojack system is simply unrealistic. Callbells don't get answered timely because nurses simply have too much to do and too many patients. Some things simply can not be fixed by better time management.

Yes there are some lazy, grumpy nurses out there. If management actually knew their staff, it would be easiar to weed those people out. As for the grumpy nurses, no it is not fair to the patients (they didn't ask to be sick) however, if management was receptive to their concerns maybe some would not be so grumpy!

[SchnauzersRock]

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.

I like how you think. Kindred spirits, ya know! I wish everyone could see it this way.

[medsurgrnco, BSN, RN]

I worked in a hospital with a tracer tag. When a patient lied and said I only checked on him twice in a 12-hour shift, they printed the tag record and it didn't show I was in the patient's room more times. I had documented checking the patient more times on the hourly rounding sheet and in the computer documentation. Even tho their tracer tags apparently were unreliable and there was other documentation, the patient was believed as management believes that patients never lie. I find it shocking that nurses are trusted to give meds and provide patient care, yet patients are believed over a nurse whenever there is an issue with "customer service".

[BlueRidgeHomeRN]

thanks for jump-starting this old thread--still relevent!

i would bag groceries before wearing a tracer collar--woof, woof!!

i agree that these sick people are "patients", and that the posse with them are usually "visitors" who need to have restricted hours, unless there is someone (spouse, sibling) who is actually present to get the ice, blankets, and be useful to the patient. if you're sick enough to be an inpatient, you don't need to be entertaining the neighborhood!!

having said that, i did, once, as a post-op pt, check myself out ama after my pca infiltrated, and my call bell was unanswered for 57 minutes (not an exageration!). even pulling the cord out of the wall to activate the emergency system did not work. by the time i got through by dialing out, dialing back into the main number, and asking for my unit, i had stopped the iv, taken two percocet from my overnight bag (can't imagine the pain of a new tib-fib orif otherwise!) dressed, and had my husband in route to pick me up. did i mention this was my own hospital!!!

needless to say, the charge nurse wasn't happy with me. so....i understand that it can be frustrating to be a patient, but it does not excuse patients who really think in their little selfish pea-brains that their pillow fluffing is more important than someone else's airway or pain!!

[talaxandra]

I can't agree enough with the poster who said all this surveillance boils down to admin distrusting nurses (despite our record public trustworthiness rating).

I'm all for patients being actively involved in their care, making decisions, weighing pros and cons - I strongly believe that this is not only the only ethically appropriate way, but also results in the best outcomes for the patients.

I accept that health is not the highest or most absolute priority for many people, and that our belief (often) that it is comes out of our involvement in environments where that's the only presented paradigm. For real people, living with chronic illnesses, enjoying a traditional Christmas lunch with their family may be more important than sticking to food and fluid restrictions, for example.

However, not all patients know what's best for them all the time. Not all patients have enough information, or are able to process information given to them, or are sufficiently capable of weighing pros and cons, long- and short-term consequences, well enough to be able to make these decisions.

Some patients don't care about their fluid restrictions, for example. It doesn't matter how many times you remind them, educate them about how much fluid is in each kind of container, demonstrate a running total, explain why it's important, have them keep the fluid balance themselves, hire an aide to follow them around all day reminding them about the restriction (until the aide's threatened with violence and the doctors agree that maybe it's not that the patient can't remember about the fluid restriction), and it makes no difference how many times the excess intake leads to pulmonary oedema and middle-of-the-night MET calls and BiPAP and a nursing special and genuine fear of death, because tomorrow he's just going to exceed his restriction before morning tea.

Okay - rant over. My point? He's not a customer. He doesn't know best. The people looking after him are not their to meet the needs he thinks need to be met, they're their to improve his physical (and, as much as was possible in this case, which was not much) well-being and get him well enough to get the hell out out of our hospital.

He's a patient. And all the re-labelling in the world won't change that.

[VivaLasViejas, ASN, RN]

I have one word for the "patient as customer" model: PHHHHHLLLBBBBBFFFFFFTTTTTTTTTT!!!:angthts::flmngmd::spbox:

[clee1]

Totally unmitigated bullsqueeze... brought to you by the "you want fries with that" school of management.