Letter to the Editor
I have long been a fan of Dr. Shari Welch's articles and look forward to them in each publication of Emergency Medicine News. Unfortunately, the April article that focused on patient satisfaction has activated me to respond to what I see as a growing problem in medicine in general and emergency medicine specifically. (“Service Recovery Boosts Customer Loyalty and Patient Satisfaction,” EMN 2012;34:6; http://bit.ly/QMrecovery.)
Dr. Welch has advocated in past articles an observation of service-oriented businesses as potential opportunities to improve emergency medicine quality. Unfortunately, these affirming articles as well as the April article do not reflect the perils of equating health care or health service to hospitality services. Indeed, many Harvard Business Review articles (such as the one Dr. Welch mentioned) are applicable to our industry if they are universalized, but we also must recognize the uniqueness of health care in the individual's life and in the larger community and avoid associating with hotel usage or other consumer activity.
I agree that providers should be aware of the need for hospitality, including patient satisfaction, and understand those service qualities in relationship to a health system or hospital fiscal stability and market share. But the provider is in a unique position, perhaps by oath obligated to speak and act as an individual or a collective as the medical staff to balance a service-oriented, hospitality-focused institution with the core or fundamental cause of its existence, which is to provide the care. The key issue is to recognize the difference between a service such as providing coffee and providing health care; the emphasis must be on the term “care,” a distinct relationship between the provider with the knowledge, experience, and technical ability to relieve a patient of pain or suffering or even a life-threatening event, which is often occurring when the patient is unable to be an adequate consumer (such as in an emergency).
Moreover, the Institute of Medicine's six aims do not include patient satisfaction, only centeredness, a very different item. I would encourage the individual provider and the medical staff to be steadfast advocates for those aims focusing on technical accuracy and efficiency that balance an administration's approach to hospitality. This balance may actually achieve a higher level of interaction when separate units bring their strengths together for the good of the patient.
Service recovery has only slight if any indirect impact on patient safety or medical outcomes. Medical errors are still occurring, and patients are still being injured. We have not achieved the Institute of Medicine's six aims to any significant degree. Perhaps we should focus on these, achieving a higher outcome of error-free care, before we as physicians start focusing on serving coffee and handing out movie tickets.
Anthony Ferroggiaro, MD, MHA