Customer Loyalty Blog: Good Service is Good Medicine

Good Service is Good Medicine

May 02, 2006
Greg Robinson, Customer Loyalty Blog

Last Sunday morning I awoke to find my 10-month old daughter howling. Little Katie had a nasty allergic reaction to a penicillin-based antibiotic and was about to take a quick trip to the emergency room (she is fine). During the 90 minutes that followed, it brought to light the important of the service aspects of a medical practice on the perception of the quality of the medical care received.

For sake of the argument, let’s accept that a physician has two primary objectives related to the care of the patient: (1) providing superior medical treatment and (2) building patient confidence that the medical treatment is right and will have the desired effect. We are lucky in that we have a pediatrician who gets A+’s on both accounts. His is great with kids (kind of a job requirement!) and speaks plain English to parents. Imagine Mr. Rogers with a stethoscope. Unfortunately, he was not on call on Sunday morning.

We arrived at the Emergency Room to find an empty lobby and an available physician. After examining Katie, the ER physician prescribed a course of care that included the injection of a steroid to ease the swelling caused by the antibiotic. Being an ESPN addict, I am hyper sensitive to the subject of steroids, particularly when it comes to by baby girl. So I wanted to check with our pediatrician that this was the best course of action.

I called the physician at 8:46AM to verify that the use of the steroid was the appropriate course of action. I got the answering service. I told the operator who answered the call that I was in the emergency room and wanted a second opinion on the prescribed course of treatment. She told me that she would deliver the message to our physician’s partner, who was on call that day.

Five minutes passed and we received no call. 15 minutes passed without a call. 30 minutes passed and still no call. At this point, the nurse came into the treatment room to administer the shot. Without the advice of our trusted physician, my wife and I gave the nurse the go give Katie the shot. Another 15 minutes later, after checking to make sure that Katie had no negative reaction to the shot, we were released from the hospital.

On the drive home, the phone rang. It was the on call physician returning my call. It was 9:54, 68 minutes after I had placed my call. She said she had just gotten my message! Good thing this wasn’t an actual emergency!

When we arrived home, I asked my neighbor, Brad, who is an OBGYN, what it meant to be “on call.” He told me that it meant that he had to be reachable (pager and/or mobile), but that sometimes physicians batch their calls (meaning that they only get called every hour or two with their messages) or they go “emergency only” (meaning that only critical calls are forwarded as they are received). He then told me that the trick to use with the answering service was to tell them that you want a call back right away and this will prompt them to pass the message through immediately.

Anyway, what struck me about this experience was the impact the 68-minute turnaround time had on my confidence in my physician even though he was not directly involved in the situation. I never would have guessed that I would have to tell the operator that I wanted a call back right away when I told her that I was calling from the Emergency Room. I would have expected that part of the training for operators would be to ask callers if this was an urgent situation (or give the operators a set of questions to ask to determine this for themselves). I also would have expected to get a clearer sense of when I would be hearing back from the physician. Getting back to you right away is measured in minutes if you are in the Emergency Room with a baby. If the operator had set clear expectations about when the call was going to be forwarded, then I would have insisted upon a more urgent handling.

The funny thing is that I am less satisfied with and less confident in our pediatrician as a result of this experience even though he had nothing to do with the way in which the call was handled. This is because the gap in quality of service I experienced with the answering service and the on-call process has a negative halo effect on my perception of him and his organization. It makes me wonder whether or not I can trust them to be there in a timely manner in the future? It makes me wonder what other tricks I need to learn from Brad to ensure that I get the best possible care?

What’s clear in this situation is that a process/training breakdown occurred. The operator should assume that if she hears the phrase “emergency room” an immediate call to the physician is warranted whether the patient requests it or not. She should also be trained to ask the right questions to assess the urgency of the situation, decide how the call fits with a well-defined escalation process and set clear expectations with the patient.

Getting the process and training issues in sync builds confidence in the medical care provided. It also increases patient/physician trust. Medical providers need to take care to this aspect of their service to ensure they are meeting and exceeding customer expectations at critical moments.