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.
