"Do you wanna.......huh...........do you really wanna?"

[eriksoln, BSN, RN]

Ever see the movie Lethal Weapon, when Mel Gibson goes on the roof to talk down the guy threatening to jump? The guy insists he is going to do it blah blah blah..............so Mel looks him right in the eye, gets this "I'm not all there" glare in his eye and asks him "Do you wanna..................HUH.........do you really wanna?" Next thing you know, Mel is pulling him off the ledge, forcing him to make the "jump" he was threatening to do. The guy is so scared by the time its over, he is screaming to get away from Mel.

I think the next time someone tries to tell me customer service is the focus of healthcare is going to have a very similar incident with me.

I was talking to some friends who were (yes, the past tense is intentional) big proponents of the push to make the medical field more like the "customer service" industry. I pointed out to them why healthcare can never completely adopt "customer service" policies.

1. Healthcare is and forever will remain a business. In that aspect, yes, we are much like any other retail/food industry establishment. On the other hand, we have more than any other industry taken the role of public servants. We continuously admit people who we know have no ability to pay their bills because it is our duty to do so.

Consider for a moment going into McDonald's with the famous line "I'll gladly pay you tuesday for a burger today." Or simply consider going in and saying.............."I can't pay, but I am hungry and you are service oriented sooooo..........hop too with making my burger and don't forget to hold the onion."

Once the laughter stops, you will quickly find said McDonald's management showing you the door. This is Real Life customer service.

Is this how you really want your local ER operating? We continuously treat people despite their ability to pay. We do not have the option of turning away customers simply because they are low on funds. Ask the guy who, with no health insurance, who falls and breaks his leg if he likes the RL version of "customer service."

2. The healthcare field more than any of our "customer service" counterparts must have the ability to personalize our service. We exemplify "Have it your way" more than any Burger King will. Yes, the grocery store will bag your sale exactly how you wish, yes BK will add/subtract whatever condiments to your liking. But we go much further than this. Timing of medications, treatments given (PT/OT, Social Services etc), everything down to how much your legs should be elevated is personalized for the best results for each individual patient.

Other sevice industries have the luxury of offering a service and placing difinite, concrete parameters on how it can be received. If you don't like their way of offering the service, more than likely they are not the company for you and good luck with your search for someone who does w/e it is (eating out, shampooing carpets) better. Tell me how successful you are in getting the cable guy to come to your home at 11PM becasue "its what I am most comfortable with." Next time you wake up with an urge for a night snack at 2AM and want pizza, tell me how well it goes when you call the pizza joint that closes at 10PM.

Is a hospital that stops admitting between certain hours what you want? What would you think of a physician who writes med orders like the cable company makes appointments.........."Take one tablet daily until somewhere between April 9th and May 5th"?

Point is, "customer service" industries are able to set their own parameters of "service" so they don't over promise.

If you don't agree with their way of doing it, your only real option is to find someone who does it your way, and more than likely it will cost more. This is RL "customer service". In order to cater to many, there are policies in place that allow for a systematic approach to be used. We on the other hand don't have the freedom to go between systematic and personized.

3. Ever been to a restaraunt where you've been to 1000 times before and gotten.........extra special benefits because you're known as a good tipper? or.............Ever been to a restaraunt for the first time and gotten so/so service because the waitress doesn't know you and is busy with their familiar good tipping crowd?........or, Know of anyone who tends to get bad service at the local restaraunt because they are needy or don't tip?

Industries in the service industry put a lot of effort into keeping the "good customers" and freeing themselves of the less desireable ones. If you are one of the "less desireable" types, service industries will tell you to pack it up and take your high demands elsewhere. I used to work in the food service industry and have witnessed more than a few times "clients" being told they should probably seek another place for their next meal because they were too demanding.

Retail and service industries are allowed to draw the line in the sand when someone is out of line. We, as healthcare providers, are not so fortunate. We can be attacked, spit at, verbally abused and all sorts of demands made of our time are needlessly made (often by non-paying patients) but............"Ah well, they are sick so it is their right" is the general opinion of onlookers.

Do you really want a healthcare system that gives better care to the patients who "tip" best? How about a nurse who can't be bothered getting you pain meds because they are too busy fluffing the pillows of the big tipper? How does a nursing manager telling you to take your demands elsewhere because you have no shoes/shirt on when you need cardioverted sound? Thats RL "customer service".

My point is, if you want "customer service" to be a part of healthcare, you have to take the good with the bad. It works for the service industries because they can implement it under their own terms. No government fines because the steak was Medium-rare instead of Medium, no being forced into catering to unrealistic demands, freedome to choose who the "good customers" and "bad customers" are and act accordingly.

The "customer service" approach works for retail and food service because they have liberties that will never be accepted in healthcare. Without said liberties, you can't have the other aspects.......not because I don't think they should be there but because they simply don't work without the balances or ying/yang in place.

So, to end, I will ask all the proponents of customer service out there:

":devil:Do you WANNA................huh................do you really wanna?"

[Ruby Vee, BSN]

and mcdonald's will sell you a milkshake even if you're lactose intolerant. long john silver's will sell you a shrimp basket even if you're allergic to shellfish. you can get a coke at any restaurant in town even though you have surgery scheduled in two hours and they'll sell you a steak even though you have no teeth to chew it with. there's a big difference between customer service and patient care. long live patient care.

[Davey Do]

Eric, I like your analogy with the Lethal Weapon scene: Confronting someone with the reality of a situation.

Your entire post was insightful and entertaining. I doff my proverbial hat to you, sir.

You know, as I've aged and matured in this field, I feel as though I can BE who I really am and expess myself accordingly. All I really had to do was to work within the parameters of appropriate behavior when someone was watching. When someone wasn't watching, I felt free to bend the rules slightly, and manipulate my media to achieve a desired outcome. I think creatively working within the framework of the Healthcare Field has allowed me to grow and evolve.

I'm guessing that creatively working within the framework of the Healthcare Field may be something that's helped kept you going, also.

Thanks for a great Post.

Dave

[TheCommuter, BSN, RN]

I agree with you. I have previously mentioned that the not-so-wonderful customer service model has no place in healthcare facilities.

Customers who angrily throw plates at the restaurant waiter will not be served. If a customer is acting creepy around the pilot on one of the numerous major airlines, we can count on the air marshall to make the person exit the plane before it leaves the ground. Quick-tempered customers who verbally abuse bank tellers will be asked by security to leave. Customers who threaten the bellhop at the local hotel will be told that they cannot stay there any longer. Mouthy patients and demanding family members who hover over the physician at his/her private practice will be asked to leave, and they might even be told to find another doctor by a specific date.

On the other hand, administration tells nurses to accept the public's deviant behaviors because the 'customers' are sick and not feeling well. Management demands that we coddle to rude visitors because they're 'under stress.' This mentality is wrong on so many levels.

It is time for abusive patients and menacing visitors to be made responsible for their socially unacceptable actions. There's no way that I would be able to come to another person's workplace, tell them how to do their job, hover over them all day like a helicopter, and curse at them when things are not going my way. This happens to bedside nurses daily.

[eriksoln, BSN, RN]

Actually, I might be onto something here.

Am I allowed to accept tips for giving dilaudid?

<_>

>_>

Oh heck with it, doctors and administration take kick-back. Why should I be the alltruistic one?

[Guest219794]

Another issue is how you define "customer", Is the customer the payor, or the recipient?

[Medic/Nurse, BSN, RN]

Wow.

I think I :redbeathe you!

The only problem I see with the dilaudid tipping is - are you gonna give the big tippers a "generous" portion??? You will make the jack if you do - awesome!

Maybe you can start the "movement" - I would go back to the bedside, if (big IF) I could really treat "customers" as "customers"!

Practice SAFE!

:angel:

[mama_d, BSN, RN]

Erik, I have to say I enjoy reading your posts. Regardless of if I agree with you 100% on a topic, they are well thought out and you express yourself well.

I have gotten reprimanded in the past for telling pts and families (mostly families) "Patient safety first, customer service second." Luckily my current management is such that if an issue where those are in conflict arises, as long as we conduct ourselves professionally, they have our back. The distressing fact though is that managers like this are the ones who tend to be weeded out by corporate headquarters and replaced by those who make us toe the Press-Ganey line regardless of how it affects pt outcomes.

Have you ever noticed how we have it all out there, signs up in rooms, ads on TV, brochures about how wonderful extra-special we'll cater to the pt...but if you dare to point out to a problem pt that there is also a list of pt responsibilities to go along with those pt rights, we're likely to get in trouble?

I wish I could print your post out to hand to the next pt I get who needs education on why we should not be an industry where customer service trumps pt care and safety.

[emtb2rn, BSN, RN, EMT-B]

Awesome post.

[Esme12, ASN, BSN, RN]

Actually, I might be onto something here.

Am I allowed to accept tips for giving dilaudid?

<_>

>_>

Oh heck with it, doctors and administration take kick-back. Why should I be the alltruistic one?

:yeah::yeah: Eloquent as usual!!!

[chicookie, BSN, RN]

Excellent post as usual.

I personally would accept "tips" (aka bribes) for everything.

You want your pain medication on time? Well for the small price of $10 per pop I will be sure to be in your room 10 mins before its due and have it all ready to go!

That's at least $30 extra a day per patient. WOOOT! Bring on the money. LOL

[llg, PhD, RN]

I agree with you on this one, eriksoln.