THE Epic failure of surveys and the new focus on "customer service".

[eriksoln, BSN, RN]

ok. i'm one who argues that the slant towards "customer focus" is killing the medical field. others will say its long overdue. not opening up that debate here.

i have a problem with a certain..........contradiction i see going on a lot. i think in a lot of ways, with these surveys and "customer service" we/the general public/administration/politicians are talking outta both sides of the mouth.

the two points which i see in collision are:

1. you will see it said many times in here, in many different threads "people go to hospitals for the doctors, not the nurses." i've never once seen this viewpoint rebuked or argued. next time will be the first. its not easy to slip anything through this site without getting some sort of "oh, but see, it's really this way and that way blah blah blah tomato tomoto and water isn't really wet". somehow though, this idea, that doctors more than anything else determine who goes to what facility............is never challenged.

2. surveys, yes, they ask about the doctors. but, they really focus on the nursing and ancillary departments.

so, if people choose their provider according to the doctors, should that not be the focus of the surveys. and, to a degree, does this not prove..................................this customer service stuff is an epic fail, people still choose the grumpy impersonalized doctor over the facilities with more smiling nurses. the care being "right" medically still must come before the medical care being nice.

[StNeotser, ASN, RN]

Agreed.

I think that hospitals should be rated on obscure things like nosocomial infection rates, safe staffing levels and cleanliness.

[Carlyjo]

I totally agree. This mess about being customer service oriented is crazy. I treated every patient with respect and give them the best medical care I can provide. You cannot make everyone happy 100% of the time. Most companies have gone to "have it your way" instead of focusing on accurate care. A great nurse just lost her job where I work due to a patient complaint that was a total lie.

[GHGoonette, BSN, RN]

Ok, I'm repeating what I have said in so many threads..... Our patients go to see their GP, or family doctor, who refers them to a specialist. The specialist determines that hospitalization is required. Because he is a private practitioner, he probably has connections to more than one hospital. He may say to his patients, "Mr/s Blah, I can admit you to Hospital X or Hospital Y; the patient knows that Hospital X is the cruddy-looking old place in the slightly seedy part of town, while Hospital Y is the upmarket new place with pretty gardens, nice views and state-of-the-art beds.

What Mr/s Blah doesn't know is that the staff at Hospital X is absolutely stellar and will provide them with an amazing, caring environment, while Hospital Y has the reputation of having the most unfriendly, miserable staff in the region. Despite the specialist informing them of this sad fact, the patient goes for the pretty!

Attitudes like this, given the intense competition from larger, newer hospitals in our area, led to the eventual bankruptcy of our old hospital, and I have no words to describe my bitterness about this. The company that bought us out built a brand-new hospital which looks beautiful, but is a health and safety nightmare; their management style has all but destroyed the high morale and standards upheld by the "old guard".....but guess what? The place is bursting at the seams-we frequently do not have sufficient beds for our patients....

[Mudder]

well, I'm speaking from a nurse that was a patient perspective. Last year, I fx my patella, had the BEST ortho around do my surgery and he, of course, put me in the local hospital. The nursing staff there was the pits.......don't know if it was the pay, stress or what but I take better care of my dogs than the care I recieved there. Long story short, I'm about to have surgery again to remove the hardware and I told this excellent Dr if he planned on putting me back in that hosp. I would change Doctors. Needless to say, I'm being admitted to another facility :)

[Flo., BSN, RN]

During my last hospital stay I got a seperate survey just for the doc. Oh how I loved filling it out!

[middleager]

Wow from a patient perspective, I never thought of that aspect. I understand how this transpires. As stated, the only time I have used a hospital has been a referral from my PCP to a specialist, same with taking care of family members. So while the first adventure to the hospital was definately Dr. driven, my satisfaction (assuming no real issue with the outcome or medical treatment) was mainly the result of my interaction with the staff other than the Dr. I never really thought about it that way. First off let me say, 90% of my experience has been positive to very positive. While I do recall the interaction with the Dr. I recall the nurses and staff's interaction much more clearly and felt it had more impact on my opinion of the facility. The true care a patient gets comes mainly from the nurses, from the treatment side, right or wrong we see the treatment of the illness or injury to a large degree set by the Dr. and carried out by the nurses with their discrection and input directing execution of the treatment. So I would agree with above, the Dr. may put me there, but it will be the nurses that will determine how I feel about it and keep me coming back...or not. So my satisfaction is to a large degree determined by the nurses

[diane227, LPN, RN]

I am old school. I will NEVER refer to someone getting medical care as a "customer" or a "client". They are patients. That is what I expect when I am in the hospital and that is what I refer to as a nurse. It is getting more and more difficult in a hospital to know who is a nurse and who is not. That is one of our problems. Second, we don't all dress the part for our jobs. We don't always look our best or look professional. I know I am going WAY out on a limb here but if I had my preference, all RN's would still be in white uniforms with their nursing pins displayed. Hair would be up and out of the way. Nails would have no more than clear nail polish etc. And I can tell you that this works. I have long worn a white lab coat every day to work. I have a friend who works in an ED who still wears white and even wears her nursing cap. And I cannot tell you the difference you get in regard to respect from patients, visitors and physicians. I know that this will never happen again in my lifetime. But if you want to be treated as a professional and foster a sense of security with your patients, you have to look the part.

[cookienay]

I am all for a certain level of customer service. For starters, people most likely will not sue someone that they like. Secondly, it makes my job easier. To go above my patient's expectations is something that actually alters their perception of the actual care they receive. Unfair as this may be, most people equate "nice nurse" means "good nurse". They don't care that you are 30 minutes late with their meds, fail to advocate for them, or choose to play on facebook while they sit on the bedpan for an extra 10 minutes. They just want you to be sweet. For the most part, I love that my facility is known in my region as the place where you are treated the best. Yes, we also give great medical and nursing care.

Now are all of our nurses Susie Sunshine?? Absolutely not. But there are standards of conduct and we are all held to those standards. And yes, the entitled, demanding patients are a pain in the keester. However, they will always be that way whether you have a "customer service" component to your care or not.

For myself, I could have the most hateful nurse and doctor and not care one whit. As long as they know what they are doing and follow the standards of care, that is all I really want.

Just my perspective. Sorry to hijack this thread, carry on. :)

[eriksoln, BSN, RN]

I am all for a certain level of customer service. For starters, people most likely will not sue someone that they like. Secondly, it makes my job easier. To go above my patient's expectations is something that actually alters their perception of the actual care they receive. Unfair as this may be, most people equate "nice nurse" means "good nurse". They don't care that you are 30 minutes late with their meds, fail to advocate for them, or choose to play on facebook while they sit on the bedpan for an extra 10 minutes. They just want you to be sweet. For the most part, I love that my facility is known in my region as the place where you are treated the best. Yes, we also give great medical and nursing care.

Now are all of our nurses Susie Sunshine?? Absolutely not. But there are standards of conduct and we are all held to those standards. And yes, the entitled, demanding patients are a pain in the keester. However, they will always be that way whether you have a "customer service" component to your care or not.

For myself, I could have the most hateful nurse and doctor and not care one whit. As long as they know what they are doing and follow the standards of care, that is all I really want.

Just my perspective. Sorry to hijack this thread, carry on. :)

To a certain degree, thats what I'm confused about. I just don't get how service with a smile has replaced getting the medical aspects of the care right. To me, that equates to buying a car that stalls but looks pretty on the outside.

If you judge hospitals on performance (infections, pressure ulcers, proper med administration, no extra days hospitalized due to slow staff taking forever to get tests done)..........the service side of it will by default follow. In order to meet these goals, the proper staffing must be in place and the support staff/system must be proper also. Hence, the "personalized" service part comes along with it.

By contrast, providing "smiling service" does not by default lead to better medical care. So, why the focus on it?

I don't agree that people choose hospitals based on the flavor of the coffee and how much the nurses smiled. I imagine it goes like this:

1. Which one will the insurance accept? No one is going to pay an extra $500/per day out of pocket just because nurses at one hospital smile more. Insurances, more than any other aspect decide where people go.

2. The Doctor. If a doctor who is good at the procedure you need is at one hospital, not the other.........whether or not the service is good never comes up. Maybe its just me, but when the heat is on to choose, picking a better chance at no complications just seems hard to pass up.

3. Location. Is hospital X closer to some relatives who might visit. I see a lot of patients at my hospital who drove two hours to get to us..........simply because we are in the neighborhood of the daughter who will be visiting most often.

IDK. Maybe I'm looking at it through a nurse's goggles and completely missing what really matters to the patient. But thats how I see it.

[metal_m0nk, BSN, RN]

Agreed.

What baffles me is...Surely the people who construct and/or direct the construction of these surveys realize how capricious and idiosyncratic customer satisfaction can be. Why on Earth would they use it as an all encompassing measurement of success??

Edit: $cratch that...An$wered my own que$tion...

[belgarion]

Having a wife who averages 5 to 6 hospital stays a year I can comment on both ends. We do not fill out surveys. If we want to give credit to certain individuals who go above and beyond we fill out a comment card or mention it when the follow-up call comes a couple of days after discharge. If some one has been less than adequate, we use a comment card or send a letter to the quality control manager.

The big problem I have with these idiotic surveys is that people, by default, tend to focus on the negative. A person might have received superior care fron a couple of nurses or CNAs, really crappy care from a couple of others, and average from the rest of the staff. What happens when they get the survey. They remember the crappy care and trash the whole staff. Also, many people just mark every question with average without really reading the questions.

Unfortunately someone did a marketing study in the past that indicated that these surveys make a person choose hospita x over hospital y. Until some hard evidence comes out that this is not the case, we are stuck with the status quo.