My second real job was working as a cashier at Nordstrom in the Women’s Shoe department (my first job as a sales associate at a small children’s bookstore – Sunnybooks for Kids). At orientation, Nordstrom taught us a few things that have stuck with me throughout my life since – people are generally telling the truth, customer service is paramount, and treat everyone with dignity. Lessons that should be applied to healthcare (and life).
For those who don’t know, Nordstrom is renown worldwide for their customer service. They have always had the policy that customers come first. And if there is an issue with any product, you can return it. Even if it’s years later, even if you’ve worn it, even if you don’t have a receipt. You never have to fight for a return – they just give it to you. They aim to please knowing that the value of their store is based on respect, trust, and feeling valued. Sadly these ideals rarely seem to be at the forefront in healthcare. I can honestly say of the countless providers I’ve encountered there are few who I ever felt respected me, valued me (and my time), and trusted me.
Case in point, a dear friend went into the hospital last week needing care for her rare diseases. Because she often goes to the ER and has a lot of doctors and a lot of information to keep track of, she comes in with prepared personal health records (because we cannot rely on electronic health records yet…) and explains her case. But instead of listening to her, instead of respecting her knowledge of her diseases, caring for her as a person, and trusting her words – they immediately peg her as a drug addict. They tell her that her bad attitude (may I remind you she is very very ill at this moment and thus allowed to have any attitude she wishes) is why the nurses are not doing their best for her. They make excuses for not taking care of her central line port properly. All of it falling back on my friend. Somehow it’s all her fault – she’s a liar, she’s rude, so the providers are vindicated in their treatment. As a result, my friend’s pain was not managed and at times she felt even worse in the place that was supposed to make her feel better. Not to mention serious malpractice implications that unfortunately probably have no redress because even though you probably do you have your receipt – I mean bill – there are no refunds not even a simple “we’re sorry you felt bad.”
If a cashier with Nordstrom training were to handle this case the outcome would be completely different. We weren’t allowed to question the veracity of a customer’s claims. We only asked so we could write on the return reason and flag if there was a manufacturer error. We learned to listen so that we could address the problem and find a solution that would make the customer happy. If they said it was our fault – we would take that in stride. Okay, we did something wrong and we want to make it right. That simple. If the customer needed extra assistance – no matter how demanding or rude or exasperated or rich or poor they were – they got it. It didn’t matter that they were yelling at me the day after Christmas because I didn’t get the extra discount on the trade in when 100 people were behind them in line equally frantic to get through the holiday crowds. We did our jobs efficiently and did everything in our power to make the customer happy.
And in so doing, we gained customers’ confidence. So that frustrated, rude, exasperated mother of 4 with her children running around who came in thinking she’d have to yell at us for a refund or replacement would realize in fact she did not have to fight. She would realize she didn’t have to raise her voice and she could take a breath and it would be solved. And if it happened again (which would be rare) she could come back to us and we’d do the same for her.
In healthcare though, we aren’t really given an option of where to “shop” – especially in an emergency, which is perhaps why they can get away with bad “customer” service. In healthcare, if one patient is a drug seeker and lying about some aspect of their lives, all patients are liars. In healthcare, patients are rarely even able to get out their entire story and have it heard by the provider so the provider can even start down the right path to a solution. In my experience, in healthcare, if you have an “attitude” you are labeled as “difficult” and thus can be treated as less than a human being. If you ask for extra, you are labeled as “demanding.”
Contrast that to my recent experience as a Nordstrom customer. In 2011, I bought some rain boots. I don’t have much money but I was riding the bus at the time and tired of having cold, wet feet walking to and from the stop, so I splurged. They were great until they got a hole where the seam ripped – which ultimately defeats the purpose of having rain boots. I went back to the store in 2012 (since there’s only one Nordstrom in Austin and it’s not all that easy to get to by bus, it took a while to get back there) to exchange them and like that I was on my way home with a new pair of (pink!) wellies. But then it happened again – same manufacturer, same problem. So I emailed Nordstrom and they quickly replied that they’d be happy to replace them but they didn’t have a lot to choose from replacement wise. Knowing I didn’t have to choose right then, I waited until this week I saw a new pair of purple wellies! I emailed them back and just like that they sent me a return label to ship back the defective ones and the new ones should be here on time for Christmas! All for a pair of boots that had a defect from 3 years ago. No hassle, no questions, no screaming or pleading or crying. Just a happy to help and “I hope your feet have warmed and dried, nothing worse than wet feet to dampen your mood! Have a great day.” I know it sounds silly, but it really does mean a lot (especially with my feet getting irrationally cold due to poor circulation).
Customer services really isn’t all that hard. At the clinic I just ended my relationship with – it would mean answering the phone, returning a message, or even returning a tweet (yes it was that desperate with the phones not working). It would mean not making me wait an hour and a half past my scheduled appointment time to see a doctor who really is only going to write a refill for a prescription I’ve been on for years. It would mean that when I explained my frustrations, the clinic wouldn’t say that they just didn’t have the ability to meet my needs (in other words – you’re too demanding and difficult).
Customer service for my friend would have meant actually reading and believing the document she took the time to craft for the providers to make their lives easier. It would mean listening to her when she said she’s in pain and treating her with respect when that pain isn’t met and she’s justifiably upset.
It really is more simple to operate by the principles or respect, dignity, trust, value in the long run and it really can improve health. If patients are respected and trusted, treated with dignity and recognized for their value in the healthcare system, health outcomes improve. When I feel listened to and trusted, I in turn feel I can trust the provider more, which means we can discuss more, which means we can get to the root of the problem, which means that I can get better. When I’m treated with respect, my whole demeanor changes (I know I should be kind and patient all the time, but when I’m feeling ill and disrespected a side of me comes out that I am not all that proud of). When my demeanor changes it puts the provider at ease and it puts me at ease – no more fighting. When my I am valued, I don’t feel desperate to have my voice heard and feel like I need to yell. Instead, my provider and I can form a team and even a bond that will lead me back to health.
In this holiday season and in the weeks to follow when people are elbowing their way through crowds, digging for the greatest deals, and fighting to exchange that gift your grandma got you that really isn’t your style or if you’re in the hospital waiting long hours in an ER with a nurse that calls you a liar and a doctor that says that you have a bad attitude – I wish that all our experiences could be transformed by good customer and patient service. By sales associates who will still greet you with a smile even though it is Christmas Eve and they want to go home or by a doctor who will sit down at your bedside to talk to you even though he is harried by all the paperwork he has to complete for the insurance companies. The concepts are universal:
Respect. Dignity. Trust. Value.
To see the snowball effect of bad customer service see this (I think the guy is in the right to be honest). As for bad patient service, just ask any epatient…
I should also mention this is how Nordstrom treats it’s employees, which again should be the way healthcare systems treat providers. The company took care of us. They paid a fair wage. They used positive reinforcement by complimenting us when we did well. When they asked us to work late or on holidays or hard sale days, they brought in food. They made sure we had breaks and gave us fair hours.
By taking care of us as employees, we were happy to go an extra mile. We could do our jobs with a smile on our face even when people were yelling at us. And thus we could serve others as we were meant to. Wouldn’t that be wonderful if our providers were likewise treated with the respect, dignity, trust and value they deserve so that they in turn could pass that on to patients?
Other good encounters lately (for I believe good service should be recognized as much as bad should be complained about):
- Seton Medical Center in Austin – for it’s true passion to transform to “humancare” and assistance through my spinal surgery
- Austin Pain Therapy – for their taking the time to really listen and help me through spinal surgery recovery
- Texas Sports and Family Medicine – for their incredible staff and attention
Consumer Goods and Services:
- Tillamook Cheese – when I asked them to help me with a surprise for my mom, not only did they send her some cheese but ME TOO!
- Amazon – whenever I have a problem and report it they fix it or give me a refund without fail. Easy peasy.
- American Airlines – when they had horrible disability services in June, they made up for it without hassle or excuse.
- Virgin Airlines – I contacted them before flying and they were incredibly helpful.
- Office Depot – always willing to make things right.
- Favor App – incredibly helpful to someone whose illness means they can’t always get outside to get things done.
Want to know who’s on the naughty list???? Ask me and I’ll tell (or look at my twitter stream as I often call them out).