He Was Terrible - Will Never Use In The Future

After a recent presentation about quality to a large group of Saskatchewan health care leaders, the feedback forms about my presentation ranged widely, from "What I Liked Most" about the workshop, to "What I Liked Least". I've learned to expect variation, and, striving to improve, I try to learn and adapt based on all the feedback I receive.

The most critical feedback comment I received after this presentation was:

The message of giving patients what they want, when they want it is not realistic. He was terrible - will never use in the future.

Now this one threw me at first, as the insecure side of me reacted to the "He was terrible" part. I quickly re-read some of the other "He was great" comments to restore myself, and then thought about this one for a while. I'm certainly open to adapting my speaking style, or my audience participation exercises, or the ways I present information, but that didn't seem to be what this commenter was saying.

The message here, as far as I could see, was that giving patients "what they want, when they want it", was not realistic. Granted, there's plenty of room for misinterpretation, since it was a very brief comment with no opportunity for discussion or clarification. Still, this is a deeply disturbing comment coming from a health care leader.

If we don't give patients "what they want, when they want it", what do we do instead? What is "realistic" for the health care industry?

1. Not give patients what they want. Perhaps we should ignore our patients' desires for good health, for effective interventions, for relief of pain and symptoms, for respect, for information, for good service. My mom wanted an appointment with her doctor this week; the clinic's schedule wouldn't allow it. Maybe that's a good thing?
2. Give patients what they don't want.  Perhaps we should try to increase the number of hospital-acquired infections, clinical errors, or prescription drug interactions. A study published in the Journal of the American Geriatric Society found that one out of thirty senior hospital admissions were due to adverse drug reactions.
3. Give patients what we want. Perhaps we need to reschedule their appointments more at our convenience, make them walk further around the hospital, drive to an even-more-distant specialty hospital, and put a few more people into each bed while we're at it.
4. Not give them help when they want it. Face it, patients are whiners. The whole idea of wanting health care when you're sick is just so needy. Perhaps it would be better to extend wait times even further, and add more handoffs and waiting rooms to each procedure along the way.
5. Give them help when we want to. Perhaps it would be better to require people to pre-schedule their visits to the emergency department, or maybe spread out their influenza infections throughout the year. Or, like a recent friend's experience, send notice of a scheduled specialist appointment at an arbitrary date in about six months, then push it back two months, then push it back another three months.

What scares me most about this critical comment is the suggestion that good customer service in the health care industry is not realistic. In every other industry, customer service (giving customers what they want, when they want it) is critical to business, a differentiator between success stories and business failures. Yet somehow it's "not realistic" in health care? I don't think so.

In today's StarPhoenix, Mark Lemstra wrote that Health care needs ideas, not more money, I couldn't agree more. And some of the old ideas and attitudes might have to go, to make room for new ones.