Care not same as caring

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Mark Eleanor Wickersham
Mark Eleanor Wickersham
When “Dianne Butler's” mother was rushed to the emergency room with signs of a heart attack, the ER nurses quickly cut away her snug, pullover silk shift. Hurrying to do CPR and start IVs, that dress was the last thing they were worried about.

Yet, the ruined dress was the first thing Dianne recounted when she told acquaintances about her mother's saga. The shift was a recent purchase, an extravagant buy for the older woman, and the idea of destroying something her mother had saved for made her daughter angry. “I might just sue,” she said, vindication in her voice.

“You've got to be kidding,” you're saying. “They were trying to save her life.”

Herein lies the quandary of customer service.  Quality of clinical care does not equate to caring for the customer. From acute care to home care, a sincere interest in and sensitivity to the patient's and family's needs and concerns — however trivial — must be a vital part of service delivery.

A hospital administrator explains that she got nothing but grief about emergency room care at her tiny critical access facility in a rural southern community. People complained about wait times. They complained about the competence of the contract physician services. They griped about the lack of privacy in the cubicles. They wrote angry letters about the callous nurses.  Training session after training session made no difference. It was the one area of the hospital that got consistently low satisfaction scores.

They quit griping when she terminated the physician service contract and worked out an arrangement with a local, likeable doctor who handled staffing with people he knew.

“The improvement is clearly attributable to having somebody who actually gives a damn,” she explains. “He lives here, and they live here. He wants to be able to look people in the eyes when he runs into them in the grocery store. He might not be able to save every life, but the fact that he is invested in the community means he cares about the people who are coming to the ER. They are people, not patients.”

Do individuals count?

Customer service is not about an organization's core values or mission statement, although these are vital parts of building an organizational culture that values customer care. It's whether the people who work in your health organization are really committed to caring for individuals instead of “patients” — not just “making eight.”

One middle-aged woman whose critically ill husband wound up in an acute long-term care hospital after spending four weeks in an ICU, reiterated complaints similar to those the administrator heard about the emergency department.

“They're very pleasant,” she said. “They're good at what they do, but I hate this place. He's getting good service, but he's not being cared for.” For her husband's sake, the tired spouse wanted someone in this big hospital in a city more than an hour from home to know how important her husband was in his community and to his family. She wanted them to see him as a person, not a patient.  With the indignities of bedpan and tube feedings and bed baths, she wanted someone to say, “Tell me about your husband.”

In nursing facilities, families often feel the same way. Respecting each person's contributions to community and family and treating people as more than residents helps ensure person-centered care.

What your facility needs

Consistent “relationship” staffing, writing short notes or calling family members when there is good news, and listening to the story you might have heard 100 times before are steps toward developing the family atmosphere your facility needs to be successful. Clean floors, pleasant smells, and hot meals should be givens.

True caring is what will set your facility apart.

Caring is also vital for the organization in our litigation-happy society. In his popular book, Blink, Malcolm Gladwell writes, “What comes up again and again in malpractice cases is that patients say they were rushed or ignored or treated poorly.” 

Gladwell recounts research by Wendy Levinson in which she taped and analyzed patient-doctor conversations, dividing the study groups between those who had been sued and those who had not been sued. Her findings? The “not-sued” group uniformly spent more time with their patients, explained processes and procedures more thoroughly, appeared to be engaged listeners, and talked more respectfully to their patients. In short, they exhibited real interest in the patient.

Patients, Gladwell would say, clearly know how to “thin-slice” the attitudes of their caregivers.

Delivery of quality services, focusing on performance improvement, process changes, goal-setting and review of outcomes are as essential to today's healthcare as infection control and avoiding medication errors. But caring undeniably plays a vital role. 

According to My InnerView's online report, 2006 National Survey of Resident and Family Satisfaction in Nursing Facilities: “Within the quality of care domain, the highest predictors of overall satisfaction and recommendation ratings were caring and competent staff, as well as quality nursing staff.”

The survey, which tallied more than 92,000 responses, also indicates that respect is a key quality indicator related to customer satisfaction. Respect for the individual is a first step in caring.

Quality care is an expectation. Quality of caring is what makes the difference in real customer service.