Pharmacy student, James Herbert joins us today.
Our guest blogger this week is James Herbert, a Pharm D Student at South College School of Pharmacy, Knoxville, TN. He is a Husband, Father, Doctor Who fan, science fiction fan, philosophy-theology aficionado, and ex-IT guy with dreams of using informatics and technology to enhance pharmacy’s role in improving patients lives. He says, “I’m just a regular guy livin’ the dream because in the end aren’t we all?”
His topic addresses a situation begun decades ago and is now coming to a head. We introduced this subject last week with an article regarding the re-branding of patients to customers. Herbert believes there’s more to it than just semantics.
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James Herbert
A paradigm shift in healthcare begun years ago, speeds toward the downgrade of the patient to a statistical economic construct.
Patients are now being referred to as customers.
This is a dangerous shift that moves the focus of the patient’s medical needs towards the consumption of goods and services. Consumption of services does not require the relationship between patient and healthcare provider necessary for patient care. The purpose of healthcare is to provide appropriate care to patients. This shift away from the fundamental principle of personal attention is detrimental to the public health.
“Customer” is an economic term: A party that receives or consumes products (goods or services) and has the ability to choose between different products and suppliers.1 A patient is a person who has a medical need. In times of an emergency a patient does not have the luxury of choosing who provides their care. In cases of extreme emergency they have no say what so ever. Patients do not consume the “goods” and “services” of healthcare in the same way they would in a traditional retail environment. You will not see patients lined up at a hospital door on black Friday for example.
Dorland’s Medical Dictionary (2008) defines patient care as the services rendered by members of the health profession and non-professionals under their supervision for the benefit of the patient
Taking care of customers is commonly called customer service. “Customer service is a series of activates designed to enhance the level of customer satisfaction –that is, the feeling that a product or service has met the customer expectation.”2
Customer satisfaction is measured by the satisfaction survey. Here is where the disconnect begins
A survey, by its very nature, limits itself to the chosen parameters. That is to say that there are “buckets” that are being weighed as they are “checked off” in the survey. It is in this way that the customer is reduced to a set of statistics. In surveys, the person is irrelevant, it is the data that is important. Chosen members of management chose the parameters.
Data identifies trends and trends can be impacted by a series of scripted efforts. These efforts are called metrics. Metrics reduce customer service to a series of equations. CVS uses Triple S and KPM metrics3 in order to quantify and improve service performance. Customer expectations can be manipulated in scripted measures. Sitting down with a customer influences their perception of the amount of time spent with them4. Adding key words or phrases to encourage additional purchases is another scripted method of providing customer service (See CVS Pharmacy Business Metrics Paper)
Pharmacy may be measured by its Triple S and KPM or similar metrics but for hospitals to be reimbursed for providing care to those with Medicare/Medicaid, HCAHPS is the golden standard. Press Ganey is the leading provider of patient satisfaction surveys designed to help meet the HCAHPS requirements.
The manipulation of satisfaction scores may have nothing to do with providing safe and ethical healthcare. In one case a physician was able to achieve a 7% improvement in his satisfaction scores by prescribing an antibiotic to all his patients who complained of a cough, sore throat or sinus headache5. Managing low scores can lead physicians to prescribe powerful opiates for toothaches6. Healthcare professionals under pressure to meet metrics, forego patient care to perform customer service. The result is that most satisfied patients tend to be those who have higher healthcare cost, drug expenses, and most shockingly, have higher deaths rates than those who do not feel satisfied with their care7. The customer purchases their “good” but they may not get care for their health.
The retail pharmacy chain is the end game when customer service once and for all trumps patient care. In the retail setting, “wait times”, scripts per hour, and profit margins are king7. The pharmacist as healthcare provider is no longer part of the business model. Overwhelmed with hundreds if not thousands of script per day and skeleton staffing the pharmacist’s role is reduced to that of a dispensing machine. The result is they are not perceived as healthcare professionals. One woman demanded: “Please just do your jobs and fill what you see and stop trying to make yourself something you are not”9. In retail chain pharmacy healthcare is not important. Customer service is. Customer service quantified by metrics.
When results are all that mater then there is no “person” behind the customer or patient. They have been dehumanized. All that is left is the data. People do not get treatment. Data gets manipulated. Customers are not getting service. Data gets manipulated. When all that matters is the data, then the ends justifies the means. Metrics and surveys, by their very nature, dehumanize people.
The future of healthcare is freighting if the focus does not turn back to personal patient care. A therapeutic relationship addressing a patient’s medical need with personal and individual care, trust, and understanding. This includes a healthcare provider who has a specialized set of knowledge and skills that are not available on website, a television ad, or a talk show.
When raw, sterile numbers take precedent over warm flesh, people are no longer in the equation.
Without people there is neither health–nor care.
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References:
# http://www.businessdictionary.com/definition/customer.html
# Turban, Efraim (2002). Electronic Commerce: A Managerial Perspective. Prentice Hall. ISBN 0-13-185461-5.
# CVS Pharmacy Business Metrics: http://s3.documentcloud.org/documents/472510/250510-rx-tg.pdf
# Simple tips to improve patient satisfaction http://www.medscape.com/viewarticle/743875?src=mp&spon=25#vp_2
# Patient Satisfaction is Overrated: http://www.medscape.com/viewarticle/821288
# Why rating your doctor is bad for your health: http://www.forbes.com/sites/kaifalkenberg/2013/01/02/why-rating-your-doctor-is-bad-for-your-health/
# Patient satisfaction linked to higher health-care expenses and mortality http://www.ucdmc.ucdavis.edu/publish/news/newsroom/6223
# Pharmacists: Corporate greed putting patients at risk http://www.khou.com/story/news/investigations/2014/11/06/iteam-prescription-errors/18591573/
# LETTER: Pharmacists aren’t doctors http://www.courierpostonline.com/story/opinion/readers/2014/11/17/letter-pharmacists-doctors/19044977/
February 5, 2015
FCEtier
FCEtier 
7 responses to “Changes in Healthcare Delivery are Dangerous to Your Health”
Joy Ombati
April 14th, 2015 at 12:18
I also join in to the line of thought of disengaging the patient from being the customer when their very need makes them incapable of consumption of the health care products indiscriminately. The notion of the customer always being right is an economic mantra embedded on mere sales and aims at maximising its outputs pegged on just consumption while impersonating the touch and individualised needs of the patient. There’s need to take charge albeit tactfully I the guidance and fill update of patients to enhance optimal health care and satisfaction from goods and services provided.
JOK, student in Health systems management.
Joy Ombati
April 14th, 2015 at 12:25
….to tactfully guide patients in the choice most appropriate for their needs to complete the care aspect while rendering health products hence achieving optimal satisfaction of the same. ( the last paragraph has errors I spelling which I have clarified in this reply).
ato1952
February 8th, 2015 at 11:35
ottom line is that there are a multitude of reasons why patients should not be considered “customers.”
Now if only more hospital administrators would buy into this concept. Unfortunately with health care dollars shrinking, the idea that the medical “customer is always right” won’t go away.
Patient and customer…quite succinctly the former means someone who is receiving from or requires care of medical professionals and the latter means one who purchases goods or services. The empowerment of the customer comes from the money exchanged and his ability to take his business elsewhere if not satisfied. When a customer chooses to purchase something, he will come armed with some knowledge of said item and some means to pay. A patient does not have to concern himself about payment or any knowledge of his condition….there is an absolute expectation of services and also an absolute expectation of a positive outcome which of course is unrealistic. An empowered patient listens to treatment options and makes a choice or if incapacitated the decision making person assumes that role, understanding risks and consequences. We can call them patients, customers whatever the next buzz word is but until people act like reasonable adults using reason, they dis-empower themselves.
REPOSE FROM: Communities Forum… https://plus.google.com/communities/113557639288217155427
ato1952
February 8th, 2015 at 11:44
Note the typo; Bottom line….(at the beginning)
FCEtier
February 8th, 2015 at 16:35
Thanks for reading and for your comment, Alfred!
chellecordero
February 8th, 2015 at 01:01
Terrific perspective and seriously touches on a growing problem. Healthcare should be about rendering aid et al, it should not have the almighty dollar as its compass.
James Herbert
February 7th, 2015 at 16:46
Reblogged this on Pharmacy, Informatics, IT, stuff and commented:
I’m a guest blogger!