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How Does Customer Care Fit in Health Care Quality?

In my previous post I cited an example from real life how a hospital experience with a good clinical outcome was negatively affected by poor customer service.

Customer Care has taken on an even greater role in our society thanks to the internet and social media.  Bad customer experiences get spread quickly, often with significant negative results to the individual or organization providing the service.  More of us check out Customer Reviews of services and products before we make our purchases.  It is only natural that this means of evaluation is being applied to the delivery of health care.

Many patients take technical quality for granted.  For example, they assume that all Board Certified interventional cardiologists perform cardiac catheterizations equally well, just like all auto mechanics perform oil changes equally well.  For the diagnosis and treatment of the non-complicated cases, that assumption is pretty much correct.  It is with the more unusual or complicated cases that the level of competence plays a role in outcomes.

Since most patients can’t judge the clinical quality of most aspects of medical care, they often look to the quality of customer service to judge the quality of their care.  In addition, patients these days expect both technical and customer service excellence.  Gone are the days when the doctor is placed on a pedestal, where he can do no wrong and his advice must be followed without question.  This change in perspective underscores the importance of good physician-patient communication.  Ideally, the experienced physician should anticipate the questions and concerns of his patients and address them proactively.  He must take a personal approach with every patient.  My friend’s experience with the physician who saved her life but didn’t communicate with her left a lot to be desired in this dimension of her care experience.

The personalized approach also applies to the other staff who interact with patients, from the medical office receptionist to the nurse in the office or hospital.  In my friend’s case, the Nursing Assistant could have looked beyond the task she had to do and realize that she should have made adjustments in when and how she measured my friend’s temperature.  Likewise, the nurse who noted that my friend did not have a fever, but claimed that she was powerless to stop the unnecessary tests, should have used her common sense and contacted her supervisor to prevent the waste of resources and inconvenience to my friend.  Had they put themselves in my friend’s place, I think they would have found a way.

I don’t think we have to compromise on the extent of the quality of care that is delivered.  We shouldn’t have to settle and compromise because the technical procedure was a success.  We should have quality in all aspects of patient care, and, as the episode with the fictitious fever in my previous post demonstrates, save money in the process.

The question remains, what can the average patient do to get optimal care from both the technical and customer service perspectives?  I’ll offer some suggestions in my next post.

For Your Health – Dr. Bob

Does Customer Care Trump Technical Skill in Health Care Quality?

Recently, a close friend of mine, whom I’ll call Judy, suffered a heart attack and went into shock.  Without reversing the shock, she would die.  The on-call cardiologist saved her life by opening up the blocked artery and inserting a temporary pump to assist her heart until it was able to maintain a normal blood pressure on its own.  He saved Judy’s life for which we were all extremely grateful.

Exemplary care so far.  But…

My friend began to have misgivings about this cardiologist who didn’t see her the next day, and, when he did see her, it was difficult to communicate with him.  The nurses also indicated that they continually had communication issues with this doctor.  Based upon this, Judy was determined to find another cardiologist after her hospitalization.

More Questionable Quality

While she was in the hospital, several other incidents left Judy doubting the quality of the care she was getting.  One incident occurred while she was trying to get some sleep at night.  Because she was cold she covered her head with a blanket.  About an hour later a Nursing Assistant (NA) took her temperature with a device that measures the temperature of the patient’s skin.  It should be taken on exposed skin, ideally the forehead.  Instead the NA checked the temperature on my friend’s neck that had been covered by the blanket.  Naturally, the temperature was high suggesting my friend had a fever.  Rather than checking it again later after the blanket had been off, she charted that Judy had a fever.  Because an infection after a procedure can cause serious complications, doctors often write standing orders for their post-procedure patients specifying what tests should be performed and what treatments should be given if a patient develops a fever.  So, charting that “fever” set the ball rolling and that included a chest x-ray, blood draws for blood tests, blood cultures and getting a urine sample.  All this happened in the wee hours of the morning so Judy couldn’t get any sleep.

What added insult to injury was the fact that shortly after the erroneous temperature was recorded in the computer, a Registered Nurse (RN) rechecked my friend’s temperature and it was normal.  But the nurse said she couldn’t stop the testing once it was charted.  Consequently, Judy was needlessly inconvenienced and unnecessary charges were generated that her insurance will have to pay.

Here are the areas that raised questions about quality during this 3 day hospital stay from Judy’s perspective:

  • Poor communication by the physician
  • Lack of training & common sense on the part of the Nursing Assistant
  • Either lack of training on the part of the Registered Nurse on how to override the computer, or
  • Poorly devised computer system that doesn’t allow for legitimate overrides

Since it’s true that the most important thing was the fact this doctor and the care at this hospital saved Judy’s life, someone might say that these few quality concerns should be overlooked.  Indeed, most of these concerns really fall under the category of Customer Care or Service.  How important is customer care in the delivery of health care?  Does poor customer care trump technical clinical quality?

In my next post, I’ll explore customer service and health care.  Please share your thoughts on this topic.

For Your Health – Dr. Bob