In a facebook group called “Show me your stethoscope/ A nation of Nurses” a question was posed. “Are patients’ customers?” There were 2,734 responses as of the date of this writing. Although I did not read all of them, I did read many and the majority are from nurses who said an emphatic “NO!” Utilizing, I made add, descriptive language that left nothing to the imagination of how they felt. 

I believe their feelings on this are grounded in the association that a customer is something degrading and a patient is a protected and cherished persona. Although noble in their understanding of what a patient is, if a patient behaves as a customer, all noble thoughts are discarded and replaced with comments such as as “I get paid to save their a** not kiss them” or it’s a “hospital not KFC, you get what you need not what you want.”

So, what is a customer? A client? A purchaser of services? A patron? Simply stated, a customer is an individual or business that purchases another company’s goods or services. Customers are important because they drive revenues; without them, businesses cannot exist. So if patients purchase healthcare services and have choices, are they customers? Wouldn’t you as a healthcare provider want their business? It is possible to be both a patient and a customer – this is a reality.

In today’s reality, we are all customers no matter what the exchange is. Being a patient does not make us less of a customer, it makes us more so. I cannot think of a situation that mandates excellence in care and caring or creating positive experiences than a patient seeking services for one’s health, particularly when ill and vulnerable. Patients as customers should be listened to and  have input into  be able to contribute to their personal plan of care as they partner with their care providers. The patriarchal inflexible medical model of “do as I say” without question must be placed in the past. It no longer reflects the needs of patients as customers in today’s global healthcare environment.

For the past 20 years, if not more, Customer Experience has emerged as a discipline in the business world and successful businesses have mastered how to create exceptional customer experiences. Does it not make sense that patients who are customers in every aspect of their lives be provided exceptional patient experiences in their interaction with their healthcare providers? Isn’t this what they’ve grown to expect in every other exchange?

Perhaps we should look back at the founding of modern nursing by learning from Florence Nightingale. Known as the lady of the lamp, a visionary, pioneer, statistician, and leader. Miss Nightingale was many things, but the dedication of her life’s work was to the welfare of the patient, her primary focus. Today that must be our focus as well.

What can we learn and apply to our patient experience initiatives from her early observations and wisdom? Many things:

  • When it comes to patient centered care, Nightingale stated, “Apprehension, uncertainty, waiting, expectation, fear of surprise, do a patient more harm than any exertion.”

From this pearl of wisdom, we know that patients need to be included in care decisions that impact them. Communication with the patient and not about the patient will allay fear of anticipation, and fear of the unknown. Patients today rightfully insist on partnering with their care providers and to be intimately connected to their health and wellness plan of care. To meet the demands of the healthcare consumer today, organizations must fundamentally reorganize themselves from patriarchal, non-flexible, and non-responsive models of care to one that is transparent and inclusive. The model must be one that is “patient obsessed.”

  • “Sick children, if not too shy to speak, will always express this wish. They invariably prefer a story to be told to them, rather than read to them.”

Patient choice is a crucial element in a patient centered culture. Choice is exemplified in Nightingale’s early understanding. Somewhere between Nightingale and modern nursing today we lost sight of choice, of hearing the patient’s voice, and partnering with the patient. Berwick (2009) noted that patient-centered care must be transparent, personalized, respectful, dignified, and without exception offered with patient choice. All of which can be found in Nightingale’s writings. Respect for the patient and patient choice as a consumer cannot be far from our minds especially at the bedside. For it is at the bedside that the true connection happens. We have the power to influence a patient’s choice as a consumer. We also have the power to influence their choices and create advocates. 

  • “Never speak to an invalid from behind, nor from the door, nor from any distance from him, nor when he is doing anything.”

The lesson to be learned here is that communication with patients and their family should be genuine, face to face, where one can provide empathy and compassion. This is very difficult, particularly today, with contactless patient encounters, but the basic premise of interpersonal connection cannot be lost in a world where we strive to provide personalized, individualized patient-centered care.

  • “Unnecessary noise is the most cruel abuse of care which can be inflicted on either the sick or the well.”

Some things never change and noise in a care setting has been a challenge for care providers throughout the ages. Today it is a measure included in our HCAHPS. The one nationally accepted measure of patient experience. 

Yes, patients are customers. As such they are respected, cared for and made to feel included in decisions that impact their well being and health. We guide them, support them, care for them and we should be able to do this on their terms. If they can order shoes on Zappos and have them delivered the next day, we should be able to answer a call bell, request for pain medications without them feeling like they are a burden or an inconvenience.

Yes, patients are customers and we cannot have patients thinking they get better service from Amazon than they do in receiving care.

 


Berwick, D. (2009. Health Affairs, vol. 28, Supplement 1.  “What Patient-Centered” should mean: Confessions of an extremist”