The Customer is NEVER Right - A Nurse Practitioner's Perspective
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Scope: Healthcare, a time-honored profession, is genuinely dedicated to helping others and OBLIGATED with saving lives and stomping out disease. Despite that heritage and DUTY healthcare has been cheapened, by any means necessary and at the cost of so much, into just another customer-driven service. Rating healthcare has done nothing for healthcare but leave behind a significant trail of collateral damage and our nation’s current silent national crisis.

 Try listing a single benefit from rating healthcare!

1. Healthcare is like NO other industry, NONE.2, 3, 7, 17
2. There is NO correlation between satisfied patients and good healthcare.3, 4, 17
3. Despite ALL the money, time, and effort satisfaction scores remain unchanged.3, 17
4. Some of the collateral damage from chasing satisfaction scores:1, 2, 3, 4, 8, 10, 11, 12, 16, 17
  • a. HCAHPS undermines those with less-than-stellar scores by withholding payment causing those organizations to close their doors resulting in decreased overall access to healthcare.
  • b. Those patients having to go elsewhere where they lead to deplorable circumstances and catastrophic outcomes, i.e. increasing wait times, treatment delays, nursing workloads, and medical errors.
  • c. Perverse incentives, as carrot on a stick, for better satisfaction scores have led to nothing but improper admissions, diagnostics, procedures, opioid prescriptions and their abuse, and other improper prescriptions as well.
  • d. Studies have shown the most satisfied patients not only spend the most on healthcare and prescriptions but they are also most likely to be admitted and most likely to die.
  • e. In 2011, the Centers for Medicare and Medicaid Services (CMS) spent $226 BILLION on overtreatments that did not benefit anyone. How much of that to avoid complaints from patients?
  • f. That $226 billion wasted does not include the BILLIONS lost because of healthcare directed violence. A violence that has become more frequent, more brazen and more violent and those statistics skewed, as healthcare workers fear losing our jobs and why negative incidents are underreported.
  • g. Those are but a few of the collateral damages and the true reasons as to why so many have left healthcare rather the proposed “compassion fatigue”, as NO one fatigues from helping others.

Rating healthcare is NOT the solution to healthcare’s problems. Rating healthcare is healthcare’s problem. 

Proposals: In 2013, the federal government announced a college rating system, with similar intent as that to HCAHPS, to withhold billions of dollars in federal student aid money from low performing colleges.15 Sound familiar? However, thanks to college leaders who stood their ground and pushed back, that college ranking system was abandoned. In pushing back those leaders pointed out the proposed “misguided” rating system was “quite wrongheaded”, “uncharacteristically clueless”, “oversimplified to the point that it actually misleads” and “prioritized moneymaking”. All predictable and were actualized in healthcare before (private consumer rating companies i.e. Press Ganey) and after HCAHPS. To MAKE HEALTHCARE GREAT AGAIN we must ABOLISH HCAHPS and implement the following:17

  1. Rid ourselves of traditional thinking to create the future.
  2. Everything customer service must be deflated to a byproduct rather the driving force.
  3. Healthcare is in desperate need of leadership.
  4. Promote healthcare workers as valuable and trustworthy.
  5. NO one gets fired over patient complaints or for reporting healthcare directed violence.
  6. Clinical outcomes and the safety of healthcare workers and patients FIRST!
  7. Dismiss those who annoy us.
  8. Siding with loyal employees and coworkers.
  9. NEVER see the ill or injured as customers, clients, or guest! But as the patients they are, ill or injured.

1. Anonymous. (2012, December 13). Reducing waste in health care. Health Affairs. Retrieved from
2. Doyle, T. (2011, June 2). Suck it up, America: The tough choices we face for real healthcare reform.
3. Falkenberg, K. (2013, January 2). Why rating your doctor is bad for your health. Forbes. Retrieved from
4. Fenton. J.J., Jerant, A. F., Bertakis, K. D., & Franks, P. (2012, March 12). The cost of satisfaction: A national study of patient satisfaction, health care, utilization, expenditures, and mortality. JAMA Internal Medicine. Retrieved from
5. Fred Lee, About the author. (n. d.). Patient Loyalty. Retrieved from
6. Fred M. Lee, Speaker/Author. (n. d.). Innovative Healthcare Speakers. Retrieved from
7. Gallup. (2014, December 8-11). [Bar graph illustration] Honesty/Ethics in Professions. Retrieved from
8. Gates, D., Gillespie, G., Smith, C., Rode, J., Kowalenko, T., Smith, B., & Arbor, A. (2011). Using action research to plan a violence prevention program for emergency departments. Journal of Emergency Nursing, 37, 32-39.
9. Kjerulf, A. (2006, July 12). Top 5 reasons why “The customer is always right” is wrong. Retrieved from
10. Lucian Leape Institute. (2013, March 19). Through the eyes of the workforce: Creating joy, meaning and safer health care [PowerPoint slides]. Retrieved from
11. Munro, D. (2014, February 2). Annual U.S. healthcare spending hits $3.8 trillion. Forbes. Retrieved from
12. Papa, A., & Venella, J. (2013). Workplace violence in healthcare. The Online Journal of Issues in Nursing. Retrieved from
13. Salzberg, S. (2014, May 26). Dr. House was right: Give patients what they need, not what they want. Forbes. Retrieved from
14. Scheinfeld, A. (2014, June 2). 5 things your nurse wants you to know (but can never tell you). Retrieved from
15. Shear, M. D. (2015, September 12). With website to research colleges, Obama abandons ranking system. The New York Times. Retrieved from
16. TEDx Talks. (2011, April 6). TEDxMaastricht-Fred Lee-Patient satisfaction or patient experience? Retrieved from
17. Torres, J. A. (2012, October 25). The customer is never right: A nurse practitioner’s perspective. PublishAmerica.


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