The Customer is NEVER Right - A Nurse Practitioner's Perspective
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“It’s easier to fool people than to convince them they have been fooled.” -Mark Twain

A week, or so, ago, someone on LinkedIn posted an “article” and added the following headliner, “Here’s proof that an exceptional patient experience improves the bottom line.” The title of that “article” “U.S. Hospitals That Provide Superior Patient Experience Generate 50 Percent Higher Financial Performance Than Average Providers, Accenture Finds.”The intent of this column is not to be an Internet troll who hunts down these stories with the intent of bashing those perpetuating them. Instead, the intent is to point out that as long as healthcare continues to let outsiders to herd healthcare down the wrong tracks healthcare will not be able to pull out of the current silent national crisis it finds itself. A silent national crisis that has significant collateral damage and nothing else to show despite all the money, time, and effort invested, as pointed out in a number of columns before.To those drinking the Kool-Aide one word. Really? Well, a few words, do you REALLY(!) believe “[This is the] proof that an exceptional patient experience improves the bottom line[?]” Here is a rebuttal to the LinkedIn post:
  1. You must know healthcare’s altruistic, submissive and accommodating culture is what gives outsiders the upper hand over healthcare as healthcare lacks the testicular fortitude to push back.
  2. You must know, as healthcare pundits know as well, that healthcare’s greatest secret is that customer experience scores in healthcare have NOTHING to do with healthcare but profits. Not that there is anything wrong with profits except that is not how the customer experience is being sold to the public. Maybe in other industries the two, customer experience and profits, are synonymous. But that is not the case in healthcare, the only industry where services are sought during some of the worse moments of our lives and during inconvenient times, for uncertain, unpredictable and volatile choices in places that are unknown, unpleasant and unforgiving, rather other industry where services are sought based on disposable income and/or time. Not to mention, as studies have shown, in healthcare there is ABSOLUTELY NO correlation between satisfaction scores and good healthcare. And more than anything that is what is wrong with the current customer experience push. On top of that, despite all the money, time, and effort invested by healthcare the customer satisfaction needle has not move either. Not to mention, the persistent hustle of customer satisfaction scores has not contributed anything to healthcare but leave behind an overwhelming trail of collateral damage, which includes, but not limited to, healthcare directed violence and our nation’s greatest silent national crisis.
  3. On that note, you must know the LinkedIn post's attached “article” piece is not really an “article” and much less a vetted study but instead a company’s (Accenture) "press release", which equals to the company promoting itself and written by itself, a company’s representative, as well--not that there is anything wrong with that. Except it's not vetted as evidence for the mentioned claim.
  4. You must know the mentioned “methodology” in the press release is no more than correlation without causation and not statistical research and much less evidence. Not to mention, as mentioned in “The Customer is NEVER Right: A Nurse Practitioner’s Perspective”, “In healthcare we are critical of objective scientific-supported evidence and before accepting well-performed published research articles as truthful scientific evidence, healthcare workers will dissect those scholarly articles with a fine-tooth comb. However, patient complaints are taken at face value without challenge.” The same applies here where healthcare outsiders will cite anything to promote their idiot-ology [sic] of herding healthcare down the wrong tracks, to include substance-less press release pieces like the one linked here.
  5. You must know, “Why rating your doctor is bad for your health?”  which is not a research article but an independent journalistic article with vetted facts highlighting the fact that rating healthcare is NOT a good idea and actually a BAD idea.
  6. Instead, you must know, “Patient satisfaction [is] linked to higher health-care expenses and mortality.” –UC Davis Health System Newsroom. This, a vetted, research article that “evaluated data from more than [are you ready?] 50,000 adults…” and not the just under 4,000 hospitals that participate in CMS’ HCAHPS' “dog and pony show”. On top of that, notice the UC Davis’ research article’s structure difference to the linked “press release”, Background, Methods, Results, and Conclusion. The greater difference, “Accenture is a leading global professional service company…” (Accenture website), whatever that is, and, on the other hand, UC Davis is a pillar of world-renown healthcare research. Yet, which did outsiders choose as more credible?
  7. Having said all that, here is research you could have chosen instead  over Accenture’s self-promoting “press release”. As this one, “Higher CMS star-rating associated with lower patient mortality and readmissions”, is not only a research article but it counters UC Davis’ findings as well, a torn on healthcare's side. However, what is swept under the rug in the "Higher CMS star rating" research and maybe, just maybe, why outsiders skipped it, as the deduction is clear, “No large hospitals had five stars, and more than half of the five-star facilities didn't have an intensive care unit, Fenton told Reuters Health by phone,” for the "Higher CMS..." article. In being transparent, Dr. Fenton coauthor the linked UC Davis research. The point here, extrapolating from Dr. Fenton’s words, if a consumer, not a patient but a consumer, were to chose a hospital based on CMS’ “dog and pony” star-rating system it is very likely the consumer would chose a 5-star over a 4-star hospital. But at what cost if the 5-star choice is a rural hospital without an ICU, and, worse, has never seen your disease process before your admission? All of the above is why healthcare finds itself where it is today as, “It’s easier to fool people than to convince them they have been fooled.” -Mark Twain.

Don't judge my words. Judge my intent.

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