shawn whatley md

Grumpy Tech Meets Grumpy Customer – What Do Patients Want?

Medicare assumes fixing patient problems is crucial, and being nice, less so. We prefer polite, but don’t believe it’s essential.

Jill Dean, CEO of Brand Biology, gave a presentation “Grumpy Tech Meets Grumpy Customer. This Can’t End Well … Or Can It” at a recent customer experience conference. (Thank you, Bruce Palmer, for tipping me off to this!)

Check out the 30 min. presentation on YouTube.

Virgin Media sends out technicians to help customers with cable service problems.

Techs arrive at customer’s homes harried and edgy. Customers call when they have problems; when they are frustrated. Like healthcare, both provider and customer are often frustrated long before they meet.

Virgin tried to figure out what drives client satisfaction: technical skill or pleasant service.

They asked customers to score service on a scale from +100 (happy customer who would recommend to others) to -100 (unhappy, no recommendation). They found that when technicians:

Fixed the problem and were friendly and polite, customers scored +74

Fixed the problem and were neutral in tone, customers scored +26

Fixed the problem and were rude, customers scored -44

Did not fix the problem and were friendly and polite, customers scored 0

Did not fix the problem and were neutral in tone, customers scored -64

Did not fix the problem and were rude, customers scored -87

Rudely fixing a problem was worse than being nice but not fixing the problem at all.

No doubt, if “fixing the problem” equals saving life, people prefer having their problem fixed. However, only a tiny percentage of people seek care for life-threatening problems. Canadian emergency departments send 89% of patients home without life-threatening diagnoses.

We need to align system incentives so that everyone works to provide great customer service, not just fix problems. We should aim for every patient to recommend us to their friends.

Enough Engagement, Healthcare Needs Partnership

Engagement is over-used; we don’t need more of it. We need partnership, not engagement. Leaders want supportive followers, but do not want to give up command and control for partnership.

Engagement

Leaders talk about people being engaged, how to engage, lack of engagement, and otherwise use engagement to explain all kinds of operational failure and success.

Engagement, for leaders, means interested, positive followers. Interested, negative people are labeled irritants, not engaged. Leaders love engagement, but change requires more.

Partnership

Peter Block writes that partnership is

Exchange of purpose
Absolute honesty
The right to say No
Joint accountability
No abdication of responsibility

Engagement means support for a pre-defined purpose. Partnership exchanges and builds purpose together.

Staff engage, but hold back criticism or gossip, whereas partnership demands absolute honesty.

Partnership gives others the right to say No. It requires vulnerability, humility, and willingness to give up command and control.

Followers enjoy complaining about leaders’ decisions no matter how much they engaged. True partnership eliminates complaint through joint accountability.

Engagement fizzles when parties walk away. Partnership means parties keep their commitments.

Medicare needs partnership

Government needs to embrace partnership, and providers must follow through in all it demands. True partnership would lessen the turmoil of election driven change, allow us to build on success, and create meaningful change for patients.

(photo credit: smallbusinessbc.ca)

Myth: Physicians Lead Medicare

Bureaucrats and nurses lead Medicare. Aside from a few CEOs, and a smattering of administrators, physicians do not lead Medicare. Most of the MDs in hospital admin positions do not have signing authority, cannot hire and fire, and have no budget.

If we include all paid leadership positions, non-physicians out-number physicians by at least 15:1, if not much more.

Physicians bear final responsibility for medical care. Until we figure out how to give other providers final responsibility, physicians should represent at least 30-50% of paid, senior leadership positions.

We need to train physician leaders and attract them to take leadership positions. Physicians won’t apply for leadership roles for a fraction of clinical earnings.

40 years ago, Medicare bureaucrats assumed leadership and fought physicians for control when necessary. This must change. Medicare will not run well without physicians holding many of the top positions. I said ‘many’, not ‘all’.

Once we create opportunity, physicians must not abrogate their responsibility to help run the system. Physicians need to value system involvement and not see it as ‘going to the dark side’.

Patients assume physicians run hospitals. They stare in disbelief when they hear physicians have almost no role in administrative hospital function.

Without a majority, or substantial portion, of physician members, leadership teams avoid decisions that might anger medical staff, or they make poor decisions for lack of physician leadership input.

Physicians do not lead Medicare; the myth has to change.

(photo credit: net.acpe.org)