-Douglas MacArthur

JANUARY, 2006

Do your patients get their money's worth?

by J. Trey Vanderburg, M.D.,M.B.A.

Think for a minute, the most expensive 2-3 night stay you have paid for. Was it $250 a night? $350? $500? $1000? Now think about the service you received. I bet every employee there was eager to do or get whatever it was you needed. Fresh towels, clean sheets, as many toiletries as you desired, pleasant phone skills, courteous greetings and departures and every conversation ending with “Is there anything else I can do for you?” And I bet it didn’t matter if it was noon, 5PM or 2:45 in the morning. Everyone enjoys being pampered and waited on.

Now, think of the last time you or someone you know spent 2 or 3 nights in the hospital. How was the service? Were there clean linens? Was the room tidy and orderly? How did it smell? Was there enough soap, shampoo and toilet paper? How was the staff? When you needed assistance, how long did it take to get a response? Was it a polite one? My bet is that the majority of these questions can be answered in a not so flattering manner.

Why is that and should we even expect it?

I believe we should. Sure, we strive for excellence in patient care and all, but I think there is a message in medicine that is being sorely overlooked. If we aren’t treated fairly when we go somewhere, how do we respond? I don’t know about you, but I shrug off and say, “I’ll take my money elsewhere and never come back here again.” In addition, I make it a point to tell everyone I know how miserable my experience was. On the contrary, when I am treated well and am met with exemplary service, I try to three things. One, I establish loyalty. I reward their politeness with more of my money. Second, I tell as many people as I can. Third, and admittedly I don’t always do this but do try, I make a call or jot a short letter to a supervisor and specifically mention certain employees who made my experience enjoyable.

Now how much do you think a hospital room costs? Not an ICU bed, telemetry room or labor and delivery suite. Just your plain Jane run of the mill room. $500? $1000? $2000? But that doesn’t matter you say. Insurance pays for the majority of that, not the patient. Ok, let’s think about that. I’ll remove the patient who has no insurance and is going to have to foot the ENTIRE bill themselves. I’ll also assume the patient has met whatever deductible their plan has set. Now, most plans pay anywhere from 70 – 80 % of hospital charges. If you are one of those whose companies pays 100%, consider yourself lucky. (I’ll also bet you have large deductible or steep premiums, but we won’t get into that.) So, the patient is responsible for 20-30%, on average, of their entire stay. That figures to be anywhere from $100 - $500 per night that the patient must pay. Now, add that to the premiums that the holder pays every month just in case they need it. Now you are talking a substantial amount of money that has been paid up front so to speak.

Now do you see where I am going?

But a hospital is not a hotel, you say. You are correct. And people that stay in a hospital are patients, not consumers. That is where I disagree. A consumer is someone who exchanges something, usually money, for goods and/ or services. Isn’t that what we have just deduced happens when you stay in hospital? Because of the changes with managed care, along with the increase in premiums and decrease in the percentage insurance companies pay, more and more of the expense has fallen on the shoulders of the patient. In addition, some hospitals have resorted to requiring a substantial down payment prior to elective admissions such as surgery and births. How far of a stretch do you think it is to assume that the more a patient pays, the more they will expect? How far will they drive to get it? How far will they drive to get AWAY from not getting it?

We can never turn a hospital stay into a vacation resort or spa that I understand. However, I do believe some lessons could be learned from some of the more customer friendly companies. What if we could make patients feel at home? What if we could provide them with service that they would normally not expect? What if we could make a scary experience almost a pleasant one? Think of the patients we could attract and think of how everyone would benefit. The pride would just exhume from every employee from the CEOs and physicians to the endless ancillary staff.

Now, think if we can’t. Think if we don’t. I promise you – someone will. Just ask Wal-Mart. You don’t think they see Target in their rearview mirror? Same products, same prices – nicer employees. Don’t be reactive. Be proactive. Make a change. Be a leader. Do something different. Excellent service doesn’t cost a lot of money. It comes from within. Motivate your employees to do well. Praise in public, criticize in private. Learn names. Give out compliments. Visit the floor and talk with patients. What do they want? Who was nice to them? Get their names and send them a thank you note. Jot a letter to their immediate supervisor and ask them to recognize that employee and place that letter in their permanent record. I bet if that employee is disciplined, that goes in their record. Be fair but be consistent. It won’t happen overnight, but I promise you it will happen. And just think, it was all your idea.