Patient Safety / Quality

Beyond customer service

Do you and your team squirm when you hear about the need for better customer service? I’m convinced that how we talk about service improvement fuels resistance. And this resistance has hampered efforts to create truly healing environments for patients, families, and caregiver teams.

Why the resistance?

Many nurses don’t like to hear their patients called “customers.” Patients aren’t shopping. They are sick and vulnerable. And a nurse’s goal is to help them heal, not to make them happy customers.

Nurses also know that the maxim, “The customer is always right,” doesn’t apply to patients. In many situations, catering to the patient’s and family’s preferences would be irresponsible. Nurses have specialized knowledge about which foods, activities, and therapies are best. A patient may want pizza the night before surgery, but he shouldn’t have it.

Many nurses see customer service strategies as superficial. They feel insulted by the idea that leaders think they need to learn to care. Some nurses even call workshops on how to interact with patients “charm school.” After all, nurses are healthcare professionals who care deeply. They work with patients who are sick and dying. The thought of being taught to smile more touches a raw nerve.

Also, many nurses are offended by the focus on their behavior, instead of on the obstacles to patient care, such as a cumbersome discharge process or an inadequate delivery system that requires them to leave the unit—and their patients—to pick up supplies.


Changing customer service lingo, rationales, and strategies

The focus on customer satisfaction over the last few years has addressed an important need by helping staff members realize that patients and families have choices among providers and that patient and family satisfaction and the resulting grapevine influence these choices. Also, the customer focus has helped staff members realize that patient satisfaction affects their organization’s future and their jobs.

Now, it’s time to move to the next level in our language, rationales, and strategies. To do so, I propose five message points that I’ve found reduce nurse resistance and foster inspired engagement.

1. Caring with compassion

Unlike customer service, the term care with compassion brings to mind most nurses’ initial calling to a healing profession. The concept “care with compassion” doesn’t raise hackles because it’s in harmony with every nurse’s professional goals and self-image. It’s also substantive, not cosmetic. It evokes empathy for the patient’s discomfort and plight and encourages emotional generosity and personalized care.

Care with compassion addresses what is unique to health care—patients are sick, scared, and vulnerable. They need and depend on nurses. Everything nurses do to be a healing force in their anxiety-ridden experience is a gift.

2.  Making sure caring comes across

No wonder nurses are insulted by reminders to be caring. Clearly, nurses care deeply. The question is: Does the caring come across to patients? What a shame when patients don’t feel the nurse’s caring. Meaning well, thinking caring thoughts, or being motivated by good intentions aren’t necessarily visible to the patient.

A nurse who calls a patient “honey” may mean well and may be trying to show warmth, but many patients are offended by the term and feel disrespected. A nurse may tell a patient’s daughter, “Visiting hours are over. Don’t worry. Your mother will be fine.” The nurse intends to offer reassurance. But it backfires. The daughter resents being told what to feel. It’s her mother after all, and the daughter hears the nurse as dismissive, not caring.

How do you make sure you’re not hurting when you’re trying to help? By learning communication skills that will help you more effectively express your caring and thereby create a better experience for patients and families. (See Six ways to make caring visible.)

3. Paying quality attention

In response to customer service strategies, many nurses express frustration that their managers’ expectations are unrealistic—that their managers are urging them to spend more time with patients to provide better service. But unless barriers are removed and staffing and processes are improved, there simply is no more time. The idea that nurses should spend more time with patients—time that nurses don’t have—is maddening. In fact, the key is not to pay more attention to patients, but to pay better attention to them. Focus on quality, not quantity.

If I could advance one skill that would create breakthroughs in patient satisfaction and anxiety reduction, it would be the skill of presence or mindfulness. This skill involves controlling your attention, so the person on the receiving end feels like the center of your universe at that moment. Using this skill produces payoffs for both the patient and nurse. When patients feel your focus and caring, you connect with them, and your work becomes more meaningful. When you practice presence, patients feel they are your sole focus. And this helps them feel supported, less anxious, and grateful. The pivotal skill of presence doesn’t take more time. It makes every moment of connection with the patient precious.

4.  Reducing patient anxiety

Borrowing the customer service mindset from the entertainment and hospitality trades, many healthcare leaders stress the importance of making patients happy. The response of many nurses is something like: “This is health care, not Disney!”

For nurses, the focus should be reducing patient anxiety, not making patients happy. Such a focus stems from compassion and acknowledges that patients aren’t typical customers. Patients and their families are burdened by anxiety. With word and deed, nurses can significantly reduce it. At each step of the care process, nurses should focus on what they can do to prevent or reduce the patient’s anxiety. By the way, this approach is not taught in charm school.

5. Your personal calling

Some leaders unknowingly communicate ambivalence about the need to improve service. They may sound apologetic about putting more pressure on their nurses, or they may see the pursuit of better patient satisfaction as a senior management issue. Some leaders claim that most of their nurses don’t need to improve service, and some think nurses barely have time to meet the demands of their jobs.

If you’re a leader, be careful about appearing ambivalent. If staff members think you’re not serious about improving patient satisfaction, they won’t be either. By viewing customer service as providing care with compassion, you, as leader, can commit to the improvement initiative and inspire your team to do the same. Consider how to express your commitment, so you elevate your team’s commitment.

Time to change

It’s time to go beyond customer service and to embrace care with compassion as the goal. Patients and families rely on nurses to provide the healing environment they deserve. And nurses rely on their leaders to help them provide care with compassion and feel pride in their care.

Wendy Leebov, EdD, is President of Wendy Leebov Inc., a speaker and consultant to healthcare organizations on service excellence and organizational change, an expert on patient satisfaction, and author of more than 10 books.

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