The Customer is NEVER Right - A Nurse Practitioner's Perspective
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A talk with the patient advocate

I am back, for two weeks, at the hospital where I worked for five months without hearing from a single administrator about patient complaints and where I was told by the family of a seventeen year-old patient, “Watch your back!” After crossing paths with the hospital’s patient advocated on a stairwell and him acknowledging me by name I thought it was that he must have heard from patients who complained. That assumption because of my customer satisfaction paranoia, with regard to being asked to resign so many times, and not that it was a small rural hospital where he likely knew everyone’s name, including the names of locum workers, as I later learned.
As I documented in the book, and I am reminded by healthcare administrators, I have not been able to rid myself of the black cloud that patient complaints have been to my career in nursing. With that in mind, and the fact that the patient advocate knew my name, I thought I would pay him a visit to learn how many patient complaints I had accumulated from my last tour of duty.
When I had a free moment, from seeing patients, I went to the patient advocate’s office and asked him if he had a moment to chat. To which he said, “Yes,” and invited me into his office. The conversation began with me asking if he had gotten any patient complaints related to me during the five months I had worked in the emergency department and to my surprise he said, “No.” I was shocked, to say the least, as I was sure a number of patients I saw would have had definitely complain, or at least those I blogged about.
The patient advocate was somewhat surprised too, however, I could not say if his wonder was that I expected patient complaints or that I could not believe that no one had complained. I then mentioned to him that I had written “The Customer is NEVER Right” and he seemed interested in the subject, asking me how I came up with the title, so I provided him a business card about the book and shared with him a short explanation for the title.
I then asked the patient advocate if he recalled the day we first met and I asked him, “Do you know patient advocates have not moved the customer satisfaction needle?” Which he did not remember me asking him but he explained the role of the patient advocate, just like he did the first time I asked him the same question and he explained his role to me then too.
Again, I could not tell if the patient advocate was surprised, or concerned, that I had asked him about me getting patient complaints when he asked me, “Why? Should I have gotten complaints about you?” Knowing the black cloud, regarding customer satisfaction, not only lingers over me but it also follows me around and after a number of patients vented their dissatisfaction to me or abruptly walked out on me, I did expected some of them to complain. Having said that, I am well aware that not every patient will complain formally, but NO complaints. That was something new. Not that I am hoping for any but NONE! Unheard of, and as I mentioned in the blog Have I found the mojo? I do not believe that I have turned a new leaf and much less found the mojo need to avoid patient complaints. Because of that, I was overly surprised that the patient advocate had not heard from at least one patient who complained, and if any, at least from the family that threaten me to watch my back.
Then the patient advocate gave me some insight of his philosophy and one I agreed with, not because of convenience but something I mentioned in the book from at least one patient who complained and I was given the opportunity to confront, that was that patients want to be heard. To that I add, as that one confronted patient voiced, to be heard without intent of having anyone fired.
On that note, what the patient advocate declared more specifically was that he only considers patient dissatisfaction a complaint “…when the patient files a formal written complaint. On the other hand, if the patient sits in that chair [pointing at the chair I was sitting in and the only other chair in the office besides the one he sat in] and verbally complains than I do not take that as a complaint but as a grievance.”
With that said, the patient advocate had spoken volumes. Not that I realized that then but later when I was back in the clinic and I thought of what he had said. Those words came from the patient advocate, the role in customer satisfaction I had been told, and who I told, had not moved the needle in customer satisfaction. The claim that healthcare administrators make as the reason for patient advocates not moving the customer satisfaction needle was that patient advocates lacked medical knowledge.
However, from what this patient advocate had just told me I thought patient advocates would be the best return on investment with regards to customer satisfaction in healthcare. Here is why, most who complain, in healthcare or other industries for that matter, even when they say, “Heads will roll” or “I will have your job,” they simply want to vent without intent that the person they are complaining about be fired. As I mentioned in the book, most of us say things in our private lives, during heated moments, which we wish we had not said and we wish we could take back because we did not mean it literally. Those heated moments are no different for patients when their exaggerated unrealistic emotional expectation were not met, who likely, when the dust settles, will realize they were provided adequate medical care and they are going to be just fine.
With that said, why not permit patient advocates to do their jobs of settling the dust or putting out fires. Because medical knowledge should be the job of healthcare workers and if the patient is seeking that knowledge from patient advocates it is because we, the healthcare workers, failed the patient in not doing our jobs and not the patient advocate who failed.
On that note, imagine the money saved from listening to grievances rather than taking patient’s complaints at face value, or chasing after customers with touchy feely advertisements, or the cost of Press Ganey and the likes, or the cost of constructing facilities that remind patients of being at home, yada yada yada. An idea that came from, not an administrator, but a patient advocate, the role healthcare administrators dismissed for not having sufficient medical knowledge. Maybe it is the healthcare administrator who is missing the knowledge, the knowledge of common sense, and the leadership to get others to do what needs to be done by providing direction, motivation, and purpose rather than just facilitating policies between subordinates and superiors.
Just my two sense!

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