Is the health service really so different from other service industries?

I've been fascinated for a long time by the University of Pittsburgh Medical Center's patient and family-centred care initiative. And recently I was due to go and see it for myself as part of my work on the Point of Care Programme. But a snow storm put paid to that plan, leaving me stranded overnight in a US airport.

We often reflect on how different health care is from other services and industries, but my experience as a passenger made me think about the similarities.

First – disorientation. Where am I? Where do I go? What is the system here? The environment was acutely unfriendly – full fluorescent lighting 24/7. Then the lack of information and the misinformation – being told flights were cancelled, then that they were not, (then that they were again). Hours passing – being directed from one end of the airport to the other, then back again, standing in line for hours, then being scolded for not being in the right place at the right time with the right piece of paper. Sound familiar?

Then – uncertainty. Will I get to where I am expecting to go, and what will happen to me if I don't? Who will make a decision and when? Not knowing who is in charge, who to ask for help, and no help being available. Finally, impatience and disregard from staff, who, themselves stressed and tired (and unable to get home), are sharp and unhelpful, most evidently with those who are most vulnerable, least able to comprehend and least able to look after themselves.

But it didn’t have to be like that. On the advice of one of the airport cleaners, I masqueraded as the passenger of a different airline, whose staff assured passengers that they would be there with them all night (and that they would be safe). They cobbled together blankets, food and drink, and did periodic walk-rounds to check if people were alright. What a contrast. Ultimately, the experience was the same – we were all stuck in the same place, for the same time – but the sense of being cared about and empathised with was very different.

I hesitate to name the company, in case this was simply a case of the basic human values of the individuals concerned and not corporate policy. But the staff's helpfulness and compassion made me consider how, in turn, their company treats them, as opposed to the company with whom I was supposed to travel.

The big difference is, of course, that in travel as in many other industries, customers do have some choice: when I confessed that I was not their passenger, a staff member said 'That's all right, I'll bet next time you will be'. In health care – at least, at present – one's capacity to choose is not the same. But the feelings of loss of control were highly familiar to the stories we hear all the time from patients. Health care providers could learn a few lessons from the second airline in treating patients with respect and reassurance.

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#333 Mary E Hoult

Excellent summing up,
It reminds me of reminds me of a CEO in industry that I worked for who treated his order book like the Crown Jewels,perhaps if the NHS did the same especially with waiting lists, patients might feel more valued.Informatics,data systems are not good enough to meet the needs of patients in keeping them informed and regular revalidation when things go wrong does nothing to reassure ill people.

#334 Red Dolphin
Red Dolphin

To answer the question: Yes it is. Very different.
Whilst there are certainly lessons to be learnt about customer-service from all manner of different industries - the example here is an excellent one - there is one thing that makes the Health Service uniquely, over-archingly and forever different and that is the unquantifiability of health and healthcare.
Part of this is related to choice: the airline passenger can choose a different airline (or not fly); the hungry customer can eat in any restaurant or prepare food at home but the ill person needs a doctor and the vast array of technologies that this implies. Part of this uniqueness is also the heterogenicity of healthcare that drives economists to distraction for how does one truly measure the value of a hip replacement against the successful prescription of an anti-depressant against the reassurance given by a normal CT scan? Of course one cannot other then by wholly arbitrary means and thus the whole house of cards that is the industry of quantifying the unquatifiable means that healthcare occupies a special place in the economy of a nation.
And this is not even to mention the emotive, moral and ethical issues associated with it. No sane doctor would not treat an emergency problem, irrespective of the niceties of how it might be funded later; no sane airline would give you a free seat if you arrived at the check-in with no ticket, no money but a sob-story about absolutely having to go to, say, a Point of Care conference in Pennsylvania.

#341 Martin Kentish
Free Range People

Patients, just like customers in any organisation, feel along their journey of using an organisation. Some things jar against you, some things create that “Aahhhh..” feeling of having been considered.

So it is with healthcare. After a recent visit to a hospital as a patient, I could quite easily spot a dozen or so simple changes that would have contributed to a much better experience, even though the medical care in the end was excellent.

This issue is the same for staff and patients. If you encourage their ideas to flow into operations and be acted upon, it will have a direct positive impact on all fronts. Yet the largest barrier to implement such an approach is the reluctance or fear to engage people and listen.

Sadly, in a hospital or in the airport described, listening to the experiences of the users is low down the agenda. This means many of the quick-wins to opportunities to improve efficiency and better experiences are missed.

#343 Steve Cribb
GP Practice Manager

From my experiences in the NHS and in Customer Service driven commerce I see a big difference, good and bad. On the good side I see positive caring support of patients free of consideration of costs (relatively). On the bad side I see some service levels reminiscent of the 60's & 70's. The former is driven by an independence between care and money (tho' I fear the current changes may put pressure on that ethos) the latter is driven by a lack of real choice at primary care level - its fine having a choice of pathways but not much good if the gatekeeper isn't open for business.

#345 Mary E Hoult

Steve,I really like your analysis.Choice is only available when there are no Capacity Issue Notices.I am sad to say a lot of NHS Trusts do have real capacity issues when choice is placed second.

#353 Andrew Mimnagh
GP Principle
Eastview Surgery

The answer is yes fundamentally so.
I do believe clients /customers/ (Am I allowed to call them patients without being struck off?) should recieve consideration dignity and efficient service as a basic human right.
That said unlike any other industry where this positive experience generates a repeat useage (with an increased profit margin) in many aspects of the health service including Family Medicine, the more the patient attends the less resource left to offer them the service.
NHS higher management requires cost containment above all else.
Is it surprising that basic human courtesy is lacking in some settings if the outcome is to discourage use and deliver cost containment?

#356 Misra Budhoo

Healthcare is a service industry. We should treat every patient as a valued customer and ensure that as far as possible they leave satisfied. Whilst other constraints often may intefere, being polite and good communication doesn't cost much. We also need to ensure good infrastructure to ensure that the basics are supported.

#361 Michael Wong

Healthcare is a service business - a satisfied patient indicates good care - and there's even a study to "prove" it.

Duke University's Fuqua School of Business recently conducted a study that "compared patient satisfaction surveys and clinical performance measures, such as administering standardized tests, from two large federal databases". As study co-author Richard Staelin, professor of business administration at Fuqua, said “If you want to figure out if a hospital is providing high-quality care, asking patients if they were satisfied with their care is a better indicator than whether the staff competently performs a battery of tests.”

For more, pls see --

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