The Patient Side of Healthcare

There is nothing like getting a fresh perspective on the state of healthcare than a personal visit to the hospital via ambulance.  My firsthand experience came after I exhibited a brief neurological malfunction that thankfully turned out to be a strange kind of migraine.   

 There was only one snag in the entire weeklong episode. When I got to the Emergency Department, they took some blood, checked my vitals, ran me through some nose touching exercises, and sent me to Radiology for a CAT Scan.  When the doctor – young, blonde, pregnant and devoid of personality – informed us that the Cat Scan showed something but they weren’t sure what it was, i.e., calcium or blood, they recommended that I be admitted into the hospital. 

 The snag was ultimately leaving the ER against the advice of the physician.  In hindsight my advice to all patients is do so at your own peril.  Not once did anyone explain what would happen if we did stay, only that if I left I could die or, perhaps worse, have some sexual dysfunction.  It was my wife who asked the doctor if there was a neurologist onsite.  She said no.  She never mentioned that there was one on–call 24/7 as my Neurologist later explained.

 My wife then asked what we should do if we decided not to be admitted.  The doctor responded that I should see a Neurologist and have an MRI done.  We chose that option.  Little did we know that that decision labeled us as uncooperative and unceremoniously pushed us out of the loop.  It took a referral from my internist to get us back in. 

 The takeaway is consistent with what I find in my consultancy – healthcare is woefully short on explanations.   Providers still expect patients to accept everything without question.   But is that the Baby Boomer way?  As a patient I am quite passive.  I make few demands and I know I don’t ask as many questions as I should.  But that doesn’t describe my wife or the many friends we talked to about this experience.  If they had “read” us, they would have known that the “because I said so” approach wasn’t going to work.

At the Health Care Summit yesterday, Senator Tom Coburn of Oklahoma (Coburn transcript) took an approach that I thought had left the healthcare reform debate. In addition to the tremendous waste associated with preventive medicine and fear of litigation, his time was spent discussing the extraordinary waste caused by fraud.

Coburn quoted experts who believe that 15-20% of all government healthcare is fraud. This, he said, equates to at least $150 billion a year. He said that instead of a “bunch of new government programs” to detect fraud, the best thing is to use undercover patients to verify that patients are being charged fairly. President Obama later agreed with the concept. And we do too.

As healthcare mystery shoppers, we believe that there is no better way to independently assess process and behavior than mystery shopping or using Dr. Coburn’s phrase, undercover patients. Senator Coburn’s point is that there is no better way to put the fear of God into the cheaters than to let them know someone is watching. Will doctors like it? Absolutely not. But will it prevent some from bilking the system that we all pay for? Yes it will.

A hospital administrator once informed me that a mystery shopping program we had concluded two years prior was still paying dividends because employees continued to comment on the mystery shoppers they had encountered. A well-run undercover patient program will have the same impact.

We intend to reach out to Senator Coburn to share our expertise in any way possible.

From the very beginning of our mystery shopping business, we have used two evaluation standards that for us have said so much about the discrepancy between healthcare employees and their constituents. The first standard is “The employee showed respect for the customer.” The second is “Employees showed respect for one another.” Now, granted, the scores associated with these standards are from the mystery shopper’s perspective and it is possible some of them may be more sensitive to the outward show of respect toward them. However, based on thousands of encounters, most healthcare organizations are biased in favor of interactions amongst themselves. In fact, the difference is 18 points on a five-point Likert Scale – 4.75 versus 4.57.

I have always found this statistic somewhat troubling, but understandable. The odds of recognizing and showing respect toward another individual with a name badge on are high. The closer an organization gets to having the customer respect standard equal to the employee respect standard, the more positive and responsive constituents will be.

What will it take? In a DVD presentation we recently did for a client, we asked employees to “hold their heads high.” It is often too easy for healthcare employees to become complacent about their roles as ambassadors. They need to see what is going on around them – find opportunities to assist visitors or reach out to people who are hurting or lost in the hospital maze. It’s part of their job and it shows pride in their workplace. Walking with your head up and a smile on your face says you are “of” the organization and not apart from it. The message of saying something as simple as hello is that it tells patient and visitors they are not strangers.