Clint Maun, CSP
New sets of expectations have grown increasingly ever-present in the world of healthcare. Along with all matter of complexities of care and treatment innovations, there are distinct reimbursement challenges, changing financial concerns, as well as today’s monumental issue of staffing that just a few years ago was a less looming consideration. But, all those concerns gathered together often pale in light of the issue of patient involvement that the customers of today bring to the table. “Patients, too, have changed. By and large they are more informed, and desire to participate actively in decisions affecting their own care and treatment” (“Advance Directives”).
Healthcare professionals “need to give up the false notion that the doctor supplies all of the answers.” Patients “see the physician as simply one source, albeit an important one, of information about their health” (“Medical Leaders Examine Benefits“). Today’s customers in healthcare are much more involved in their care and treatment. They are more knowledgeable regarding what they should expect and what they should accept. Arriving with high levels of expectations and a clear understanding of the healthcare provider’s role in creating a positive difference in their lives, they have shopped in advance through resources such as the internet or reports published by healthcare organizations, educating themselves regarding the kind of involvement they can and should have. They also understand the conditions of managed care and government programs—HMOs, Medicare and Medicaid, capitated reimbursements and the like.
Armed with such information, healthcare customers are no longer shy about expressing their knowledge and desires. Because they have the basic information well in hand, what they want is for you to hear them, to understand what they are dealing with and going through, and to know what they want you do to.
That, of course, does not mean that you can or should follow all their dictates. An honest discussion needs to take place with customers prior to treatment so that a well-informed collaborative decision can be made. Laying out all the clinical information and alternatives in plain language is critical, but so is defining roles, responsibilities and rights of both healthcare provider and customer.
Sometimes customers come in with unrealistic expectations: “I want my mother’s Alzheimer’s to be eradicated.” “I want my youth to re-emerge.” “I want to walk without a limp.” “I want the surgery to have remarkable results.” “I want to be cured of this deadly illness.”
It’s clear that the healthcare customer is not always right, but they do identify strongly with the one thing they invariably bring to the table: perceived satisfaction. If customers think they’re satisfied, then they’re satisfied even if they really shouldn’t be satisfied. Conversely, if customers don’t think they’re satisfied, then they’re not satisfied even if they really should be satisfied.
Perception can be a bit like voodoo. What the customer perceives to be true is true for that person. Dealing only in actualities, outcomes and results will not satisfy today’s customers in healthcare. They also want their perceptions dealt with. A customer satisfaction program that deals only in realities and outcomes, dictating to patients what care they will receive, and how they will move from point A to point B on the assembly line, misses the mark because patients truly want to be partners in their care. Patients “can offer valuable insights into their experiences of and perspectives on... perceived benefits and harms of treatments and care regimes” (“Patient Involvement”).
Moreover, “many clinical decisions involve value judgments” as well as medical information. “Health care providers cannot automatically infer what patients value, nor can they assume what care decisions are in the patients’ best interests” (Ruland). Their own involvement in their care is of primary importance to them. They want you to know what they expect, that they’ve done their homework, and that their expectations encompass not only their needs, but also their wants and desires. “Physicians need to speak less during a patient’s visit, and learn active listening techniques” (“Medical Leaders Examine Benefits”).
Keep in mind, though, that “patient involvement should not be seen as an end in itself but as a means to improving the quality of care to the patients” (“Patient Involvement”). Customers need to understand that you are there to listen to them and to meet their needs, wants and desires, but that reality is always going to be part of the equation. Reality cannot be pushed out of the way as though it doesn’t exist, simply for the sake of patronizing the customers. While they are looking for their wants and desires as well as needs to be met, they do not want to be patronized at the expense of quality care.
Actions resulting from the “increasing realization that an important piece of evidence is missing without the patient’s perspective” must be an integral piece of the healthcare process (Ruland). The best results of customer involvement come from shooting straight with them and listening to their expectations, while at the same time realizing that you are dealing in a world of perception, complicated with that ubiquitous and ever-so-evil thing called reality.
“Advance Directives: Making Healthcare Decisions.” Presbyterian Patient Guide. Presbyterian Healthcare Services (Albuquerque, NM). March 2004.
“Medical Leaders Examine the Benefits of Collaborative Decision Making in Health Care.” Aetna News. 13 November 2001. Report on the Academic Medicine and Managed Care Forum. March 2004.
“Patient Involvement in Enhancing Service Provision.” Royal College of Obstetricians and Gynaecologists. January 2002. March 2004.
Ruland, Cornelia. “Patient Preferences in Health Care Decision Making.” Columbia University Biomedical Informatics. 2002. Department of Biomedical Informatics. March 2004.