Ask Len: Should I treat my patients as customers?

  | January 12, 2018

Len Schlesinger, Baker Foundation Professor at Harvard Business School, has written extensively for athenaInsight on the need for healthcare organizations to focus on customer experience under value-based payment models. In our Ask Len series, Schlesinger answers questions from healthcare executives about his research on success in service industries.

You argue that healthcare is a service industry. Am I really supposed to treat my patients like customers?

When I was president of Babson College, I would occasionally be confronted by disgruntled students complaining about their grades. Their perspective was that they were the customer and it was my job to keep them happy. I'd try really hard not to roll my eyes, and then I'd say something along the lines of, “When you are in the bookstore, you are a customer. When you are in the dining hall, you are a customer. When you are in my classroom, you are my partner."

A similar tension exists in healthcare. There are a host of service-oriented functions involved in the delivery of healthcare during which the patient is, essentially, a customer, and should be treated as such. I'm thinking of billing, scheduling, communications, the experience in the waiting room, and so on.

How patients are treated in these “moment-of-truth" interactions will determine their likelihood of referring other patients, or indeed remaining patients themselves. As they design these interactions, healthcare organizations absolutely should have customer service in mind.

The patient as employee?

I'm the first to say that healthcare needs to see itself more as a service industry, and borrow from best practices from service leaders. But the analogy only goes so far. I don't believe, for example, that patient satisfaction measures are particularly useful in a clinical context. As many doctors grimly note, a sure-fire way to boost patient satisfaction stats is to liberally prescribe controlled drugs whenever asked. That will certainly satisfy a segment of the patient population.

The experience between a patient and a clinician is entirely different and cannot be translated into simple transactional terms. Just as I explained to my college students, providers must think of the relationship with their patients as a partnership.

To take that thought further: When it comes to clinical encounters, patients can even be viewed as employees. After all, they have jobs to do – filling prescriptions, chasing down referrals, taking medication. They are doing the important work of translating physician instructions as best they can and connecting the parts of the healthcare system that currently don't work well together.

Patients should be supported in this work by clinical staff. Viewing them as employees and investing energy in defining patient jobs, training them to do those jobs well, and insuring feedback is far more valuable than seeing them as transactional customers.

Once we develop this view, we may even find patients will be open to "managerial oversight" from their clinicians. When we ride Lyft or Uber today, the driver gives us a rating. I can imagine a future when doctors gently assess their patients' performance in the same way – and the rating powerfully shapes healthcare outcomes for both patient and practice.

Ask Len: Should I treat my patients as customers?