Are they patients or customers?
Are they patients or customers?
Answer lays foundation for customer service
No matter how well you plan a customer service initiative, it may be a waste of time and money unless it addresses the essential dilemma: Are the people we care for patients or customers? Thom Mayer, MD, FACEP, FAAP, chairman of the department of emergency medicine at Inova Fairfax (VA) Hospital, insists that unless that question receives a "clear, concise, meaningful, and pragmatic answer," staff may only give lip service to the training's concepts. Mayer shared his views in a recent issue of The Satisfaction Report, published by Press, Ganey Associates, a patient satisfaction measurement firm in South Bend, IN.
Otherwise you're laying the foundation for resistance because staff, traditionally trained to administer medical interventions rather than customer service, may not accept the message that patients are customers. "You may hear staff say that, `Customer service may be fine at Nordstrom's, but we're not a department store. And our beds don't make us a hotel.'" Others, he says, feel they are too busy saving lives to worry about customer service. Finally, overworked and understaffed, many health care professionals wonder who is worrying about their needs.
For a customer service program to succeed, both physicians and staff must understand that those they care for are both patients and customers, Mayer explains. "When [health care personnel] realize they already are making these distinctions instinctively and that all they need to do is to treat the patient part with science and the customer part with art, it is a moment of epiphany," he says.
To help expedite these moments, he and co-author Robert J. Cates, MD, MF, vice chairman of emergency medicine at Inova, designed the Patient-CustoMeter, an exercise that helps make staff more aware of their "internal barometer" toward those they care for.
"Instead of expecting the expert speaker or consultant to come up with a definition of what constitutes a customer, we believe it is better if the staff realize they have their own definitions of patients and customers, even if they haven't clearly articulated it," he says. "It helps them see that they have been defining the customer all along."
In the exercise, the "meter" is an arrow situated halfway between the word "patient" on the left and "customer" on the right. "Staff are presented various scenarios and asked whether the needle points to patient or customer," he says.
For example, the first scenario paints the picture of a 55-year old woman transported to hospital by paramedics after sudden onset of substernal chest pain. The electrocardiograph clearly shows she is having a myocardial infarction.
In the second scenario, parents bring a 3-year-old child with a 99.2° temperature to the ED at 3 a.m. stating they "can't get the fever down." Earlier in the day the child had been diagnosed by a private physician with left otitis media and started on an antibiotic.
The third scenario is the same as the second one, except staff are asked to imagine the child is their own.
"We've used this exercise hundreds of times in training sessions across the United States and the results are consistent: The first scenario is universally rated as a patient and the second is the customer," he says. "In the third one, the needle waivers a bit."
Mayer and Cates have written similar scenarios for outpatient settings, intensive care, medical- surgical units, and long-term care facilities. The responses demonstrate that time and time again, staff consider someone a patient if he or she is more dependent, passive, and has less choice in the health care system because he or she is more acutely ill, says Mayer. "The control is with the health care provider who is busy providing life- or limb-saving interventions," he says.
Customers, however, are more independent, more actively participate in the health care interaction, and have substantially more choice in where and how to seek such health care.
"The more horizontal they are, the more they are a patient and the more vertical they are, the more they are a customer," Mayer says.
A patient may also change from horizontal to vertical as he or she progresses through the health care continuum. For example, staff regard the woman with the myocardial infarction as a patient but as she recovers and becomes more vertical, customer service issues may emerge.
"Customers have more control in the health care interaction than do patients - a fact which many health care workers resent," he says.
It's that resentment that must be directly addressed in a customer service training because "it's an essential feature of the distinction between patient and customer," Mayer cautions.
The resentment occurs because staff are held accountable for a skill - customer service excellence - in which they have never been formally trained, he adds.
In the training sessions he and Cates have presented, he asks audiences "Who has higher expectations - the woman in the first scenario or the parents and child in the second scenario?"
"Without exception, they say the customer has higher expectations. We then ask `What does the woman with the heart attack want?' When they reply `to live,' we point out that living is a pretty high expectation," he says.
Then he continues to explain to the audience that the parents and child need reassurance. "They begin to realize it's very strange that we regard someone who wants to live as having low expectations and someone who wants to reassurance as having high expectations," Mayer says.
That transposed reasoning occurs because health care professionals haven't been explicitly trained in customer service, he explains. "We're unclear how to meet their needs. Yet with the acutely ill, we rate them low because we clearly know how to deliver the life-saving intervention they need," he says.
After Mayer and Cates used the Patient-CustoMeter as a basis for an eight-hour course in the "customer service quandary," patient complaints dropped from 2.5 per 1,000 to about 0.5 per 1,000, while patient compliments rose from 0.5 per 1,000 to 5.1 per 1,000 ED visits, he says.
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