Tuesday, July 28, 2009

Customer Service in Healthcare (not):
An All-Too-True-Story

Cross-posted from my day-job blog

exasperated woman

What is wrong with these people???

I've been having a pain lately, in an arm that shouldn't be having pain due to a past condition. The orthopedist who took care of my bones said to get an x-ray at some local shop and send her the CD. (She's happy to save me the time of driving into Boston, and she knows local clinics can make a good x-ray.)

So I called the radiology department of a well-known, highly rated clinic in nearby Burlington – let's call it Elsie – to make an appointment.

(You know about appointments. They help customers get served quickly and conveniently, and help managers plan their resource utilization. The win-win thing.)

Me: "Hi. My doctor says I should get an x-ray and send her the CD. Can I do that? -- Good, I'd like to make an appointment."

Elsie staff: "Oh, you don't need an appointment. Just come right in. I mean, you can have one if you want, but you don't need one."

Me: "Cool!"

Me to my manager: "I'm going over to Elsie to get an x-ray. They said I can walk right in – should be quick."

I get there, find my way through their campus (the directions were perfect), and find radiology.

The line to check in goes out into the hall. And at the front of the line, the sign on the desk says the current wait time is 30 minutes.

I look at my watch, conclude I don't want to wait 45 minutes (or even 30) for a "no appointment needed" x-ray, and leave.

The parking machine wants money for my ticket. I talk to the cashier and the information counter; saying I wasn't able to get my appointment so I don't want to pay. (I've been there less than 10 minutes.) Both people look at me like I'm crazy and say there's nothing they can do. A third person says maybe security will validate it. They gladly do.

On the way out I call again.

Me: "I want to make an appointment for tonight."

Elsie staff: "Oh, you don't need an appointment. If you want to make one for sometime tomorrow you can."

Me: "I can't make one for this evening so I don't have to wait?"

Elsie: "No…" (sounding rather uncertain about why I'd be asking)

It's clear to me that my time is not the slightest consideration to this clinic. I've been hearing this about healthcare in general, but I know of places where they do care. (My own hospital is one of them, and I know there are others.)

I just wonder, what on earth is so complicated? I happen to know first-hand that an appointment system for a few workstations is not at all expensive. (I work for TimeTrade Appointment Systems.) Instead, they have a line of people out into the hall – sick and injured people, typically – and they cheerfully (genuinely cheerful) say "Oh, you don't need an appointment."

Right: just show up and wait. We'll get to you when we get to you. Reminds me of the t-shirt that says "I don't have a drinking problem. I drink, I get drunk, I fall down. No problem."

Methinks the world of healthcare is (mostly) so wrapped up in its own importance that it doesn't even occur to them to respect their customers' time. And that's gotta change.


  1. Hi Dave -

    Customer service in the health care services industry is a disaster.

    I'm a doctor by training and a business guy by profession and I can tell you that in no other industry would customers (read patients) be forced to endure what you have to deal with as a patient.

    I think what you (and many other people) have observed is explanable by at least three factors. First, most "administrative" people at hospitals are unfortunately not trained in basic management priniciples, and if they have been trained they have not usually been trained to manage in a customer-centric (i.e. patient-centric) fashion. There are some great examples of well-run health institutions (Mayo in Rochester, MN is a good example) that treat patients well and have well-managed processes, but they are the exeption. I think getting more professionally trained people into administrative positions might help, as would ongoing customer service training.

    Another thing you see is a lack of coordination at most hospitals and other health facilities. For the most part these health organizations tend to be very siloed and I can say that was definitely the case where I trained to be a physician. The nurses do their thing, the doctors do their thing, support staff is doing something else...you get the picture. What's missing is a unified plan for delivering the product (say in your case the x-ray) to the customer (the patient) by having all the actors (doctors, nurses, staff) work together in the most efficient way possible. Perhaps organizing a hospital according to product lines (as some hospitals have done) might help with this problem.

    Finally, a last problem that you see a lot is what I call "butt-covering and box-checking". All too often as a healthcare provider you are forced to document A, B, and C to make sure you have complied with X, Y, and Z regulations. When this occurs and you're plowing through paper it can be really easy as a health provider to take your eye off the ball (the patient) and focus on something that's really tangential to the care you are providing. Regulatory streamlining might help here but there are lots of regulations that would need to be addressed to make a big change.

    At the end of the day improving customer service in health care services is a huge challenge, but there's a great opportunity out there for anyone willing to tackle the problem.

  2. Terrific comment, Jean-Luc. I took the liberty of adding it to this post over on my day-job blog.

    I hope we get more discussion. I didn't write it just for the purpose of ranting; as always, I hope to generate change, or (gasp) even transformation, by awakening awareness in readers.

  3. Businesses are always in competition. For example, I have heard that even in planned economies with fixed prices, gas stations will begin to compete on the cleanliness of their bathrooms and high-quality service.

    Elsie clearly does not make a high level of customer service part of their value curve. What makes them competitive? From your post, location seemed like the biggest deal to you. Is that it or do they have other competitive advantages keeping them in business? Cost? Deals with insurance companies? Location? Or is it just the case that you had no other options?

  4. Sometimes I make myself crazy when I cross-post... comments pop up in both places. So I'm going to move over to the day job blog to continue this.

  5. Can I get a witness on this story? I have waited 5 hours just to see my PCP in Newark for a 5 minute consultation. Sometimes I waited 2 hours, other times 3 hours. One time, I waited 4 hours to see my PCP, only to spend a half-hour hearing him complain about how the HMOs were screwing him (and then I got charged 50 dollars for the visit - who's screwing who?). In cambridge, I've been lucky to only wait 15 minutes, sometimes half-hour, but in places like Newark or Appalachia - the wait is longer (and I don't even want to think about Appalachia because imagine the time to literally GET THERE). You right on multitudes of levels and I am glad you got a sharp needle to burst their bubble.

  6. It's funny how everybody, even people who work in healthcare, knows how badly managed it is, but it rarely gets any better.

    There has been a drive the past few years for health care providers to stop identifying patients by their diagnosis or room number. I wonder how much of the issue is simply forgetting that the "lever in 209" is a real person who should have the respect and help he needs?

    I have worked in hospitals. There are times when things get crazy and all you can do is run from one room to another. But how hard is it to remember the people we do all this for-the patients? Not the doctor, not the hospital, not the medical establishment at large-the patients. Everything else is a cog in the wheel of getting that patient well.

  7. Jody,

    I'm very late in replying on this. The clinic involved contacted me and actually made some stunningly good improvements - even before they talked to me. And, they invited me to come meet with them, AND they explained at great length how they do indeed think, a LOT, about the patient/customer's experience.

    This particular topic - awareness of the patient's time - genuinely did catch their attention, and once they did, they acted. Immediately, nimbly, effectively. How cool is that?

    I owe everyone an update, and I plan to do it this weekend. My bad for the delay - life has been busy. Good, but busy.

  8. What's really strange is how the healthcare sector functions pretty much the same way in other countries as well.
    I work with a specialized hospital in Dubai and patients who have appointments have to wait longer than their alloted time to see a doctor. Sometimes they end up waiting for an hour or more. Frustrating? You bet!
    Fortunately we may be able to learn and correct the mistakes by changing the culture we work in, management can help all levels of staff by training and engaging in smart customer service practices and most importantly increasing awareness among patients about the way the hospital functions and how they may be able to help in experiencing a better service.

  9. I live in Vancouver, BC, Canada, and am similarly frustrated by the lack of customer service in most of the health industry.

    My previous family physician made it a habit to always overrun his time with patients, to the point that by the end of the day he is late by 1-2 hours for his appointment. When he is with his patients he is very attentive and talkative and he probably feels he is providing great service...not.

    One time, after having had to wait an hour for my regular check up, I asked the receptionist if next time I should arrive one hour after my appointment time, and she said "everyone has to wait". I told her I had to miss work for that appointment and that I was paid on an hourly basis, but she just shrugged at me.

    Another time, my daughter had a really bad case of flu (our family don't visit doctors for regular cases of flu/cold/cough). We made an appointment to see this doctor, and my feverish daughter was made to wait almost two hours before the doctor had to run off to deliver a baby. He hurriedly told my daughter to take some tylenol on his way out.

    Needless to say, we have a new family doctor now. It takes a lot of will power not to mention the doctor's name, but it starts with a Z and ends with a K.

  10. I always ask if the doctor is running on time as soon as I get to their office. What I don't understand is why can't the office staff be honest with me. If the doctor is running 45 minutes late please just say so. Maybe I haven't eaten and will gladly go and eat while I am waiting. Or maybe I can't wait and I will want to reschedule. I always make it a point to tell the doctors of my displeasure if neccessary and have walked and not returned.

  11. Try seeing a doctor in the Bronx, New York.

    I've had to wait 4 even 5 hours to see a gynecologist.

    2 to 3 for a regular physician.

    It's absolutely disturbing! I'm am so glad I left New York city. ANIMALS DOWN THERE-

  12. I've got zero sympathy. Go somewhere else if you have to wait and find that the Physician is not worth waiting for. Given the reduction in reimbursement along with the increased documentation it's no wonder people have to wait. What's next, are you going to send the restaurant a bill for bringing your food late? This isn't the service industry we are talking about, you sought them out, you are asking for their professional opinion for a problem you have. Plan on sending your attorney a bill for the next time you have to wait on them? Get over yourself and your time, I promise you it's not because the Physician was at Starbucks just prior to your appointment and just couldn't break away.

  13. Anonymous, I don't live in NY, but increasingly I'm hearing about www.ZocDoc.com, which displays doctors with available time slots, even on short notice. I think they're based in Manhattan. I know a friend in Westchester http://www.howardluksmd.com/ offers that service.

    Offering appointments is different from staying on schedule but I suspect docs who offer features that are clearly customer centered may make a point of not over-committing. Not sure, but I suspect.

  14. Zero Sympathy,

    I don't disagree - I myself have changed doctors when I didn't like the service.

    I disagree, though, with the assertion that this isn't a service industry. It's surely a professional services industry, but there's no reason why service can't be part of the mix.

    Candidly I expect we'll see more and more patients AND DOCTORS dropping out of the insurance system so they can get back to simply practicing medicine, without the ever-more-profitable insurance people in the middle, providing "services" that are of increasingly questionable value.

  15. I was medically neglected for 10 hours in the ER and then the on-call neurologist abused me under the guise of a neuro exam, lied about the findings to serve his cruel agenda, and libeled me in the ER record. I later discovered that they had done this as a "team" (4 doctors in all), and to add insult to injury the internal "patient advocate" whose job it was to advocate for patient's rights was completely biased because she took their word over mine, and every remedy I asked for from the hospital to set things right has been refused. There was no disciplinary action taken against these physicians who basically ganged up to mistreat me and failed to render me aid. These people behaved like high school bullies, not seasoned professionals and because the hospital has refused to remove the libelous material it has hurt my current doctor/patient relationships with the regular doctors I see within that healthcare system, and has probably ruined the chance for my condition to be treated there ever again by the caliber of specialists I need to consult. Because what these doctors wrote was so stigmatizing I will have to go out of state to be evaluated by unbiased professionals so that I can disprove the offending doctors' allegations and set the record straight. I am on a fixed income because I'm permanently and severely disabled so I cannot afford all the associated expenses involved. Not only has the experience traumatized me, (which now needs to be treated), but it delayed assessment and treatment of my neurological condition(s) that I went to the ER for in the first place. To get in to the specialists I will need to see elsewhere I now will have to wait approximately 6 months just to reach the diagnostic stage, not to mention how long it will take to arrange for treatment (some of which probably won't be covered by my insurance). I was never really interested in money; just wanted to pursue my diagnosis and treatment in peace with dignity, but now I am placed in the awkward position of needing to go that route to clear up the mess THEY created. I think the idea of billing is a good one, although how does one put a price on one's reputation, credibility, and I don't know even how to begin to charge restitution for the violation of my trust and sabotage of my medical care. I am still very ill and not only did they not help me, but they made my life even more difficult. I never in a million years anticipated that a trip to the ER would end up like this. I actually did start a blog about it and after doing a search I discovered that this kind of exploitation in the ER happens alot more often than the general public knows, especially to populations of patients that are poor, have little community or family support, and the disabled. It seems as if in these settings having an MD after one's name affords them total immunity from consequences and they can get away with just about anything. The patient is at a distinct disadvantage when 4 doctors cover one another's asses and it's the one patients' word against theirs. Of course they are going to lie when questioned by investigators, because they each played a part in it. Something really needs to change systemically so that patients don't continue to be taken advantage of in such a way. Patients in this type scenario are sitting ducks with little or no recourse, as these large healthcare systems are designed to be circuitous and shift the blame to avoid accountability. Too often their internal grievance procedures aren't genuine and are only there to give the appearance of fairness; not to actually provide it.


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