The Customer is NEVER Right - A Nurse Practitioner's Perspective
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...more unsolicited "Food for Thought"

The Internet is inundated with patient customer service satisfaction information from both sides, Pro and Con. However, most favorable presentations come from established organizations whose presentations are well organized. On the other hand, hostile presentations come mostly from so-called disgruntled persons, like me some would say, although I would disagree. While writing the book I purposely avoided researching such and thought every time I came across such information it was due to my hypersensitivity to the subject. After publishing the book I did not expect to continue to run across more of the same. Yet here was another unsolicited opportunity.
 
 
Surfing the internet last week I came across a video titled “Patient Satisfaction or Patient Experience” and of course it caught my attention. It was one of 20,686 videos published by TEDxMaastricht: The Future of Healthcare. Who or what is TEDxMaastricht? Irrelevant for this blog but something tells me that with 20,686 published videos on YouTube they may not believe they are irrelevant. I am holding on to the link hoping you read the blog before viewing the video that was published Apr 2011.
 
 
The speaker of the video, just as irrelevant I thought, except the speaker, Fred Lee, published a book in 2004 titled If Disney Ran Your Hospital: 9 1/2 Things You Would Do Differently. Yes, Disney! Because Lee, a former healthcare administrator in the 1980’s (the period in healthcare when the patient became a customer) was recruited by Disney for “his expertise in helping hospitals achieve a culture that inspires patient and employee loyalty” according to his website (http://www.patientloyalty.com/abouttheauthor.html). Yet Lee’s website admits that “patient satisfaction scores have been stuck at 82% for the past 10 years!” I guess 82% satisfaction is not good enough, just not enough revenue I guess.
 
 
So in order to sell another product, whether needed it or not, Lee reinvented and repackaged the same idiotology [sic] as new and innovative. Why? Because the first attempts of copying other service industry’s scripts did not move the healthcare customer service satisfaction needle above 82%. Scripts, Lee equated in the video, “...just like a waitress.” However, administrators who see healthcare as a service, “just like waiting tables”, have once again embraced such repulsive stupidity pundits sell at conferences and then administrators return to their organizations to preach and demand employees implement those at any cost.
 
 
Part of the script Lee mentioned included, “Is there anything else I could do for you? Just like a waitress.” A reference that make me boil because I too always try to ask patients, “Any questions?” Just like a waitress Mr. Lee. NO! NOT just like a waitress. I ask because I want to help others. More importantly, I added it to my script on my own because it makes sense and not because some healthcare administrator suggested it, “Just like a waitress.”
 
 
Unsurprising, Lee, like most administrators, purposely make-up different language in favor of their reinvented and repackaged product and without shame discredit the old and describe their latest manipulative tactics as new and innovative. In Lee’s case, it was no longer customer service but instead an emotional experience healthcare workers were to deliver. Because, according to Lee, no one talks about service but instead they talk about the experiences they had. Lee added that a service is something we could do for ourselves, like mowing the grass, making a sandwich, painting your house; confirming that I have been arguing for so long, healthcare is not a service and because of that could NOT be a customer service driven industry. What we do in healthcare is unique and not equal to other industries.
 
 
“An experience is something different...No one comes out of a movie or away from Disneyland talking about the service they had. Instead they talk about the experience they had,” Lee added. Really!?! It took these great minds to come up with this after decades of coming up short with their pathetic idiotologies [sic] that healthcare was a customer service driven industry.
 
 
Of course, “Disney the quintessential example of the service economy,” Lee said and like Disney, healthcare can be seen to be in the experience economy too. Really!?! It’s not just that that suggestion is a bad idea but more so that people, like Lee and others, sat around and thought Disney and healthcare were comparable.
 
 
Thankfully, Lee recognizes that unlike Disney healthcare is not entertainment, having said that, Lee then pushes the similarity of healthcare being an experience. In the book I described the act of seeking medical attention as likely being the most miserable experience in anyone’s life. Yet Lee highlights that an experience can be both good and bad and uses Tom Hanks (Actor) as the animated voice in Toy Story versus dying of AIDS in Philadelphia as examples, respectively.
 
 
It is well known that in the 1980’s healthcare diverted into the service economy thinking patient satisfaction and satisfaction scores would lead healthcare into the same things that service does in the service industry. Yet, something was missing from the service industry when it came to patient and Lee’s reasons were none of the ones I documented in the book, imagine that!
 
 
Could healthcare be the same as Disney but offering a different experience? The same but different. Hmmm? Makes sense to those not listening to Lee’s words but instead are searching for anything, anything that claims will move healthcare’s satisfaction scores pass 82%. Disney is about fun. Healthcare is nothing fun but instead about helping others at bad times. “A hospital without compassion is like Disney without fun,” Lee says. REALLY!?! What hospital is without compassion? Likewise, what theme park, Disney or Putt Golf, is without fun? Where do these so-called pundits come up with these examples? Making matters worse was the fact the audience was drooling over the same old idiotic ideas repackaged as new and innovative.
 
 
Unlike so-called pundits, I make my money as a healthcare worker by helping others. My intent was never to write a book to pay my mortgage or to seek speaking engagements. The intent of The Customer is NEVER Right was to get administrators to notice the collateral damage they were causing to healthcare by chasing after waterfalls, especially when whatever the flavor of the month was over quality medical care.
 
 
In the video, Lee quotes W. Edwards Deming (Quality Measurement Expert) with stating, “If you cannot measure it you cannot improve it.” However, in the following sentence, Lee states but comments that although rare Deming was quoted with saying, “The more important figures for management are unknown and unknowable.”
 
 
Disappointing, Lee calls measuring the patient’s perception, “The single greatest thing to focus on.” Only to quickly correct himself [oops]...“next to safety.” Of which Lee did not specify if it was the patient’s safety or the healthcare worker’s safety being first. But Lee, like many administrators and a theme in my book, neglected the significance of the medical care patients seek as instead being THE FIRST AND GREATEST THING WE NEED TO FOCUS ON!
 
 
Lee presented two scenarios that were only different in their presentation, as both outcomes were the same, to only ask at the end, “How do you measure the [multiplying] effect of going from good to great in patient perception?”
 
 
Example #1: Sherry’s script which included silence during an invasive procedure which Lee thought allowed a patient’s mind to wonder with negative thoughts. However, I would remind Lee that healthcare’s intent is to help others and never to be malice. In the book I quoted a healthcare pundit with saying “Our patients should not be expected to understand us. Instead we are the ones who need to understand them.” [pg. 161] After viewing Lee’s presentation it is likely the above statement was learned at a similar type of conference emphasizing on patient experience versus satisfaction.
 
 
Nonetheless, Sherry was successful at drawing the patient’s blood which the patient perceived as a lucky stick rather than that is what Sherry does, that is her job and she is a subject matter expert at it. I realize it is minutia that administrators are okay with those perceptions of the patient, that Sherry was lucky, rather than both administrators and patients alike recognizing the healthcare worker’s education and experience for why or how the stick was successful and not that Sherry was bubbly or tooting her horn about the work she did.
 
 
Lee than asks, “Was Sherry great?” Only to answer himself, “She was perfect…clinically, for service, for courtesy. But was she great [Lee appearing somewhat disappointed that Sherry was not great].” And he goes on to add that you could not improve on Sherry’s performance of her job…and you cannot ask the patient how to improve it because the PATIENT does not know. Yet patients are who healthcare administrators rely on to improve their organization’s customer service satisfaction scores. If not, why would they spend millions to survey patients if, according to Lee, PATIENTS do not hold the answer to how Sherry could go from preforming her job perfect to being great!?!
 
 
Example #2: A more conversational and interacting Sherry who distracted the patient from his anxiety. Nonetheless the process is similar, to include the “pinched skin”, except the patient is distracted especially when Sherry divulges her experience at her job and announces she is known as “Gentle Sherry”. A comment Lee finds as “…too Disney for this group…[and even] too American.” REALLY! Too American. A claim Lee extrapolated from clinical trials where the Best Nurses were defined as “nurses who get compliments from patients” and Average Nurses “do not get either compliments or complaint from patients.” After hearing those definitions I must conclude the Worst Nurses are those who get complaints from patients. Maybe Lee is not aware, as mentioned in the book, that studies have not shown a correlation between liking one’s healthcare provider versus good medical care and what I consider most significant in healthcare and the intent of helping others—good medical care. Nonetheless, between the two Sherries the difference was words as the success of the procedures were the same.
 
 
To Lee and administrators who subscribe to similar idiotology, I may have apologized for my dispassionate and phlegmatic character but I will NOT apologize for being a citizen of the United States of America to a foe, even if it cost me my life, and much less will I apologize for being a citizen of the planet’s greatest nation just to keep a job!
 
 
According to Lee, passionate, compassionate, caring people are the only ones that perform like the second Sherry because it has to come from the heart as you cannot fake it. Lee adding that experts say, “Experiences occur whenever an individual has been engaged in a personal or memorable way” and that was the difference between the two Sherries according to Lee. I agree, an experience does “occur when a person has been engaged in a personal or memorable way” and that is my delivery (a significant psychological event). It just happens patients take it to be negative when my intent is in their best interest.
 
 
After his demonstration of the two Sherries, Lee request “Gentle Sherry” return to draw his blood versus having the same done by “Rough Rudy” who likely is not rough at all but instead the patient’s perception as the first Sherry was not rough either, just not great according to Lee.
 
 
Lee quotes Deming as saying, “That difference between being perfectly satisfied and wanting the person back again cannot be measured, scripted, reduced variation, or standardized. It comes only from the heart. It can be physical or emotional.” Lee than quoted Han Selye, a Psychoneuroimmunologist, who stated, “Compassion can affect the immune system if you believe compassion can reduce stress in a patient.” Lee also quoted Mother Teresa with saying, “We can do no great thing. We can only do great small things with great love.” What does that mean? Yet Lee walks off stage to a standing ovation. Did anyone in the audience really (critically) listen to the things Lee said? Where does so-called “rough Rudy”, whose skills are just as good, find a job?
 
 
Finally, here is the video’s link http://www.youtube.com/watch?v=tylvc9dY400&feature=related Have a look after reading the above as another point of view. Also look at some of the post following the video. One describes Mother Teresa as not being compassionate at all but instead “a pop star” of the Christian church. Another post included free healthcare versus going to Disney for free and how “You can’t please those types.” Ironically, both comments perceptions as Lee suggested yet neither an issue of mine.
 
 
However, maybe it is time to pass on trying to move the healthcare customer satisfaction needle beyond 82% and instead focus on improving the 44,000 to 98,000 patients that die each year in our nation’s hospitals due to preventable medical errors (Institute of Medicine, 1999 [http://www.nap.edu/openbook.php?record_id=9728&page=26]). Although not my area of expertise or the book’s scope, I would think improving medical errors is of greater importance over customer experiences. Maybe correcting medical errors would be the answer to what leads everything else in healthcare to fall in its place. Yet somehow customer experiences are a more common interest of healthcare administrators as that is where budgets are limitless. Just curious to how much more profit healthcare organizations would have if Medicaid/Medicare mandated deaths in hospitals due to preventable adverse events were reported instead of the latest new and innovative HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) numbers.
 
 
Unfortunate for TEDxMaastricht, who claims to be “The Future of Healthcare”, Lee’s video has only been viewed 16,441 times since posted on 6 Apr 2011, not exactly gone viral, with 43 Likes and 1 Dislike (not me). An approval rate of 0.26% (Liked) and a 98% of disinterest for those who viewed the video without having a great enough experience to move the viewers to rate as Liked or Disliked. I guess like the first Sherry, Lee was perfect but not great. Too bad.
 
 
Lastly, imagine how surprised I was while searching for HCAHPS on Goggle and I came across this website http://disneyinstitute.com/topics/additional_topics/be_healthcare.aspx?CMP=KNC-DINonBrand|M|4120170.DI.SM.02.01&s_kwcid=TC-18444-3561420644-e-473065549 and it just happen to be listed first on the results list as if a calculated effort was made to link the two, the website and HCAHPS. I cannot make this stuff up on my own but is Disney trying to get a piece of healthcare’s financial pie too. I guess! After all its money everyone is after. But Disney Institute’s “Building a Culture of Healthcare Excellence” REALLY!?!
 

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