Saturday, May 9, 2015
There is a story going through the national media that makes two points that are critical to healthcare quality. The first is that Quality falters in any system when there is an endless supply of customers (patients) and there is no benefit for good performance and no consequence for bad performance, which in essence describes most of our public health care system across Canada. The second is that all healthcare organizations are surrounded by Quality Partners (educators, accreditors, proficiency/competency assessment, oversight bodies, etc.) but the most powerful effector of Quality change is an outraged public.
In essence this story is of a woman who is given an appointment to attend the hospital to have a cortisone injection. Unfortunately prior to the 5 minutes it took to receive the injection, she sat and waited for an hour and a half, in part because the clinic booked 5 patients and the same time, and more importantly because the clinic staff decided to take an hour for lunch while the patients sat. [see: http://news.nationalpost.com/news/canada/after-an-hour-and-a-half-wait-woman-sends-ontario-hospital-122-50-bill-for-wasted-time ]
After a deliberate period of time, the patient decided to bill the hospital for her time, and to make sure that the public was made aware. As she told the media in an interview “It’s the total lack of courtesy on the part of everybody at the hospital that really angered me. It’s totally disrespectful.” I suspect the hospital’s response did not make her disposition any better. “We welcome constructive feedback that will help us to improve our performance and provide our patients with the care they deserve.”
The problems here are systemic.
What on earth would motivate a physician and staff to take an hour for lunch with people sitting and waiting? Are they venal and nasty, intent upon creating harm? Not likely. What is more likely is that they have become inured to patient inconvenience. If this was a lifesaving crisis, they likely would have acted differently, but was not about harm, it was about petty inconvenience. Harm is a big deal, in part because doing bad can have consequences. Causing inconvenience does not.
Public healthcare has little regard for customer service, other than what it puts into moto’s and brochures. “We strive for patient-centred care…” or “We endeavor to put the patient first…” Words, words, words.
This has become a truth not only in emergency departments and clinics, it is a reality throughout this system, including, with regret the laboratory. Take a look at ISO 15189, our international standard on Quality and competence. The document contains almost no statements relevant to customer service. This was not by accident; the crafters of the document were well aware of the customer service requirements in ISO9001:2008, but chose to not include hardly any.
And accreditation bodies don’t help by not making customer service a priority for accreditation. A telephone call to a laboratory’s pre-selected client doesn’t put across a message that competence at customer service is important.
The day of reckoning is coming. We live in a very different society today as compared to even 20 years ago. The public has become much less interested in the authority of institutions. The public has found its voice through a myriad of social media vehicles. The word about bad behaviour gets around very quickly.
Institutions will learn either on their own, on through the hard ways that customer service matters. Good service may not have lots of rewards, but bad service will most certainly have consequences. We, in Canada, may not have a litigious society; malpractice suits are not our style. But public shaming can be very powerful and weasel words like “We welcome constructive feedback…” don’t cut it.
Next time the hospital should try “We apologize for what was truly inappropriate behaviour. We will improve our customer service and will put in every effort to reinforce the message that poor service has no place in our organization”
PS: For those interested in Quality Conferences, be aware that we are hosting our 4th conference in Vancouver BC on October 28-30, 2015. See: http://polqm.ca/conference_2015/home.html
If you decide to register and attend, I would be interested on your thoughts about this blog.