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Patients Are Always First But Not Always Right

Tuesday, August 27, 2013
James Merlino, MD, Chief Experience Officer, Cleveland Clinic Health System, President, Association for Patient Experience We are in the ultimate customer service business. There is nothing more personal or service-oriented than healthcare. Think about what we do! People, patients place their absolute trust in us; they put their lives in our hands. This occurs at their most vulnerable and often most frightening time of their lives. We have an absolute responsibility to care for them. But while this is the most important customer service business, we are in a customer service business where the customer is not always right.

In many service businesses - retail, hotels, airlines (well, maybe airlines is not a good example), customer service and service recovery becomes a layered amenity. Employees are taught to smile, be nice, and transition to as much customer service centricity as possible. What I mean by layered amenity is that well-performing service and customer-centric organizations are taught to do as much as they can to make the customer happy and to never let the customer leave unhappy. If the food is late, then buy the drinks, desserts or provide a discount. If the customer doesn't like the food, keep changing it until they get something they like or adjust their bill.

My first job, which was at JCPenney, illustrates the point. I worked in the sporting goods department as a clerk, and one of the many products we sold was a variety of tennis shoes. I remember when the occasional customer would bring back well-worn shoes with no receipt, saying that they were "defective" and demanding another pair. Penney’s had this "never say no" return policy, so our only recourse was to give the customer another pair. It was like a lifetime guarantee against shoes ever wearing down. Now, obviously not every customer was like that. In fact, I would bet that most didn’t even know about the policy. But the point is that some customers abused a policy that was designed to do the "right thing" when something went wrong. The customer in these cases was not right!

As a colorectal surgeon, I obviously do a lot of operations that affect the abdominal cavity. These surgeries can be painful and can impact the patient’s mobility in the early days of recovery. The day after surgery, understandably, patients are tired, in pain, weak – frankly exhausted! However, early ambulation after surgery is essential for recovery as it decreases the risk for a variety of complications. We work very hard to get patients feeling better and to control their pain, but they absolutely need to get out of bed, sit in a chair, and ambulate. This is essential for their safety, but it is also important to help ensure we minimize the risk of complications, such as blood clots.

Often I will walk into a patient’s room, and they will tell me that they don’t want to get out of bed – occasionally they argue with me. It’s not an option. I do not say; "Okay, I will come back tomorrow, and we will see how you feel." The patient is going to get out of bed! They are going to ambulate! These are not negotiable points, because failure to move the day after surgery risks their safety!

I spend a lot of time at Cleveland Clinic explaining to patients why this is important. I talk about how we prioritize our thinking around our "Patients First" philosophy, and how we discuss the patient experience.

At Cleveland Clinic, a "Patients First" philosophy means four things:
  1. Safety
  2. Quality
  3. Satisfaction
  4. and Value

In that order. Patient satisfaction is never more important than patient safety or quality. It is important that we have these conversations with patients to ensure they understand and do not judge us based on their interpretation of what is right or not. When I force a patient out of bed, they are not happy. But they accept it, because we have discussed that it is critical to their care.

Patient satisfaction metrics are important, and we should be very concerned about the experience patients receive in the hospital. But patients must always understand that we will occasionally do things that are important for their safety, and we are willing to compromise their satisfaction to keep them safe.

Tags: service, safety, patient satisfaction
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