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Are you doing your whole job, really?

A most interesting article that hits the nail on the head as far as what is affecting proper service delivery. A substantially large number of service providers are guilty of this fundamental trait they must be mindful of if they are to at least satisfy their customers, let alone delight them. Many businesses crash these days and they attribute it to bad times/ state of the economy etc. without realizing that a major cause is loss of customers to their competitors who provide a "better" service that is expected.This is a must read for all managers.

Lol, So prity much your having a go at the Doctor.

She got an earful from me at the hospital as well.

This doctor was completely out of line, and the hospital needs to look at their policies about who can admit and discharge.

Not only that, but I'd write a letter of complaint to the hospital, and cc the insurance company and refuse payment for the extra hours in the room.

Hospitals are required to have a QA and Compliance officer, and are required to address any complaints and get back to you within a certain period of time, so if you contact that person, you'll be gauranteed a response. It may not be the one you want, but you'll get one.

No, These doctors have huge work loads, Unless you were in a private hospital these wait times are not that bad lol, But it might be different in America.

Australian Hospitals are bad, We don't have as many beds as we need so this would of never happened.

Never mind the quality of care for the patient himself.

If there was no reason for Toni's father to be in the hospital, the doctor should have released him immediately.

Now, I know how it is with some doctors, especially if the admitting doctor is a surgeon or otherwise in a position to be locked into a task for hours on end*, but one that can't come by within two days to sign paperwork is a moron.

* Been there, done that. Surgeon was in emergency surgery for 20-odd hours, and quite unable to sign the release forms.

edit: But we've been blown off at least once, like Toni's father, for a couple of days.

In my hospital, this doctor would be yanked in by the Chief Medical Officer so fast her head would spin.

Of course, we have hospitalists, who do the admitting and discharging for most patients, so this would be a very rare occurence. It takes no time to return a page, so a busy work load is not an excuse.

You and German680 don't understand. In the US the only doctors that work for the hospitals are newly graduated doctors doing their internship. The other doctors have their own outside practice and have a "relationship" with one or more hospitals. This doctor was the patient's personal doctor. She decided to send him to the hospital. Then once he was admitted she promptly forgot about him for three days. So the Chief Medical Officer has no jurisdiction over this private physician.

And the reason some doctors have extraordinarily heavy workloads is their own decision to double and triple book patient appointments. I showed up at 9:15 AM for a 9:30 appointment at an orthopedist. I finished my paperwork and was ready at 9:30. Then I found out that this doctor had scheduled three people for 9:15, three more for 9:30, and three more for 9:45, etc. Since my PCP had referred me to him, I waited until 10:45, then I had to leave because I had another appointment. That practice lost my business and I went another where an appointment was considered an appointment. However, I could do this only because my insurance company did not require referrals for me to see a specialist. If I had one of my previous companies I would still be waiting.

The reason that now only the admitting doctor can authorize dischage is because until recently hospitals would discharge patients whether the patient was better or not, because the insurance companies would only authorize a stay of x days for each specific reason. (My mom had back surgery and was discharged the next day without seeing the surgeon again because Kaiser only allowed one day for that type of surgery.)

However, it seems to me that the extra days costs should be reported as Medicare or insurance fraud by the doctor, the hospital or both.

That was a pretty excellent detail of how things work in the US. They all underscore the real problem in that the patient is really not the customer, the insurance company is the customer. Since they're going to get paid no matter what they do or don't do to you, and you're ultimately not the one to determine that, they can treat you however they like. Throw in all the added government regulations and you get even more of a mess. Just wait until Obamacare is fully implemented. Medical care is going to be much worse before it even has a chance to get better.

In australia - they Also - drive on the "wrong" side of the road!
. . Don't start on the "military" hospitals.!.!

Good article. The "Golden Rule" of thinking has been forgotten by most. I strive to be proactive and provide excellent service, knowing that I could be on the receiving end someday. I get more pride and feel better about myself when I help others and don't think of myself, which I see most people do today (being selfish).

Maybe this generation will learn and think more of others and not themselves and things like what happened to your dad won't happen (glad to hear he's okay).

Thanks and have a Happy Thanksgiving!

EMD

First, you said that the admitting physician had to discharge the patient. That is not true - my guess is the attending physician or another physician with the authority did not want to discharge the patient until the admitting physician was able to review the case and either concur or suggest additional tests. In the case of your experience with the hospital, it sounds like their was either a lack of communication or a lack of someone else taking ownership in the experience.

But bringing your example further, I would like to share an experience I had that I would consider it to be rare. I am an analyst - I build databases and datamarts, but occasionally I need access to other databases (so I can either link or import data for analysis). I requested access of a certain table, and it turns out, there were two very similar tables. The person who assigns priveleges needed to know what was the precise table. We emailed a third person, but by the time he responded, the original DBA was on vacation. The original DBA had his emails forwarded to a third person who actually granted access while on vacation, and allowing me to complete the project. I was so pleased with the service.

Coming back to your father's visit in the hospital. Had the admitting physician clearly indicated why your father was in the hospital and what he/she wanted to gain by the admission, perhaps some other physician could have discharged the patient in such a way that the patient and their family was happy, and the admitting physician was also satisfied.

About a lack of communication being the issue, but the doctor ignored pages for a day and a half after the tests were done. So I blame miscommunication, poor time management, and a WHOLE lot of arrogance.

Potential insurance fraud. Hospital stays are expensive, and generally the bill is calculated on a per-day basis. An extra day here with this patient, an extra day there with that one... it adds up.

Didn't the new insurance plans take care of hospital costs? Sorry, I've never paid to be in the hospital so it's all a bit foreign to me, even when hospitalised state side, my Canadian plan with extended benefits covered it all for me.

What the new health care reform did is very little except raise costs and reduce payments to hospitals who lose money on every Medicaid, Medicare, and self-pay patient. When I say lose money, I don't mean lose profit, I mean not even meeting 50% of the cost of treating the patient.

When your mix of those 3 categories is 75% of your case mix, or more, then you are losing money on 75% of your patients, and the 25% that are left have to make up the difference just to keep the doors open.

It doesn't help when you have a provider like Toni dealt with, because that provider not only provided bad service, but hospitalized a patient that didn't need to be, took up a bed and other resources that are now not free to treat another patient, and in general increased the cost of overhead for the hospital. Medicare will most likely deny payment for the majority of the tests, and the hospital will have to eat that cost, all because the provider couldn't be bothered to provide decent service to her patient.

That's pretty nice of the doctor to run up the hospital bill for the insurance company.

I'm a bit surprised not to see the issue of feedback addressed. I have a client that I have created well over 100 reports for over the last three years. This is on the management level; they have no interest in learning anything about the application and they're usually annoyed with the interviewing process to pin down their needs. I have never received a word of feedback after the reports have been completed and I have even creted a tool to see if the reports are being accessed. Less than a dozen of them have even been used once. Truly I am at a loss as to why these requests are even given to me. I would even find more satisfaction if they were to tell me I screwed up. It's only cha-ching that keeps me responding.

The glitzy, beguiling Power Point presentations of the outsourcing companies do not, in general, mesh with the _lived_ experience of the _remaining_ workerbees who have to DEAL with the outsourcer's personnel AND their local users.

Used to getting your password reset by your local IT support? Outsourcer: Submit a request, wait 1 - 10 hours for it to be done. Complain, or fill out a "survey" - and absolutely nothing happens

Used to having your DBA, your Windows, your UNIX support work with you to get your requests done? Outsourcer: Submit a request, it will be rerouted for a week or more to the wrong group, then sit somewhere until two levels above the user's management complains, and then it MIGHT be done. And whatever remaining local support there is, has to ARGUE with the outsourcer's DBA's, Windows and/or UNIX personnel about what should be done on the servers (which BELONG to the COMPANY, not the OUTSOURCER)

Good post Toni!
Of course this has application in a lot of other areas besides, doctors, end users and outsource people. Most notably, empathy (remember, thats what we started off talking about?), also is needed when managers start making promises which their subordinates have to make good on. Too often these directives are issued without due consideration of other departments. Even when well-intended, they are often ill-conceived with no thought given to the impact on the people who have to carry them out. Rarely is any consideration given to the fact that the rest of the workload those subordinates are responsible for has not gone away just so they can attend to this new imperative. This most often occurs when said subordinates have multiple "bosses" who all feel they should be given the highest priority whenever they walk down the hall and demand something.
Here is where "managing up" becomes an invaluable skill. It can be most effective (and sometimes quite entertaining) to push these conflicting requests back up the ladder and have the "bosses" slug it out to determine who really gets top spot when there simply isn't time or resources to do it all.

And it drives me bat**** insane to have to work with and for these types. I get damn near all my support and consideration from my clients, who really should be bringing the hammer down on my management.

I'm a backups guy, and sometimes my end users get hung up about a backup that didn't work, or a report that didn't happen.

Now I could and often do jump to and address their immediate concerns, but if push comes to shove I'll skip it.

Why? Because more important than their one backup getting done is the big picture, that the offsite copies get made on time for the courier to pick them up and get them away. That there is a daily point of consistency created and that it has everything needed in it.

One server's missed backup overnight means nothing. What the user really wants though he doesn't know it is that when the big earthquake hits (we're on a fault line here and one is overdue), or a power surge goes through that fancy disk array, that I can get his data back. Not for that one server... he may have to go back a day, but for everything else.

Sometimes, the little act can have the greatest impact.

Nice article. We also need to look at from this perspective... what if the accounts department fails to do the needful at pay time, how would i feel about that?

After-all, it is just a delay of a day or two...... serves us all IT people right, right?

A few years ago my teenage son was on his bike and got hit by a car. Both legs were damaged, minor cuts on one leg, the other leg was ripped open. The wounds were covered and an ambulance took him to hospital (this is in New Zealand).

When I got to hospital my son was waiting to go into surgery and he said that his leg was in pain. I asked the surgeon if he had x-rayed the leg and he told me that he did not need to because the ambulance guy had told him (the surgeon) that his leg was not broken. The ambulance guy had explained that because my son was in shock he only thought that his leg was in pain because of how it looked.

I told the surgeon and the registrar, (who agreed with the surgeon), that I was sure that my sons leg was broken just under the knee and should be x-rayed.

After arguing with the surgeon and the registrar and getting nowhere, another doctor came in to see how my son was doing and suggested taking an x-ray of both legs - what a good idea. My sons leg was broken.

The ambulance guy should have stuck to his own job, and the surgeon should have known better.

I remember working with a user a few years back where it seemed every which way I turned around she moved the goalposts regarding what she wanted, even to the point of saying she "couldn't help misunderstandings" when the report I created matched her drawn outline perfectly but she'd just changed her mind (again).

Ultimately it turned out she was afraid that as soon as she signed off the project as complete she'd drop right to the back of the queue for any updates and that anything new would be A New Project that would have to be scheduled for some time several months in the future. As soon as she realised that my job was to make her job easier and that since my team was the RAD team we could and would respond to small changes quickly without endless form-filling, she was happy as anything and signed off what she came to regard as "Phase 1" as complete.

I grew heartily sick of IT wonks who wanted to use the latest and greatest technology to make their CV look good when what they delivered to the end user didn't work. By the same token I remember leaving one guy who interviewed me somewhat stunned when I said I didn't care about the latest technology, I cared about producing a system that worked for the users using whatever technology was appropriate. I think that attitude alone blew my competition clean out of the water and landed me what became a very lucrative contract.

It can be a serious mistake to trust "the experts" and it becomes the well-known bike shed mistake quickly. Expertise is fine, but people are human and imperfect. One should never completely give over their executive powers to another. Make sure people do their jobs completely for you. Don't wait around for them to do it. Doctors are one group that are notorious for this lingering on, and people typically put too much faith in them.

I have always felt that the potential user needs to be involved in any application I am designing. That is why I have constant design reviews and tests with them before I roll anything out. But the project I am working on now is had module leads that control the way the modules work. However, on many occasions, once the fleet gets it, they either don't use the tools or screw up their use because the module leads never consulted with the fleet on their use. So although I have never forgotten that my work is being designed for use by the war fighter, because of the intervening layers of management, you don't get any feedback until after the tool is rolled out and made accessible to the fleet. I don't know of a way around this.

The point is how we come over and how we treat the "patient" whether we know better or not. I have users who think it's the worst thing in the world that they forgot their password and are "bothering" me. I make sure to reassure them that I'm really glad that's what they're calling about because it means they're *not* calling to tell me the building is on fire, and if they're a serious beat-themselves-up type, to reassure them that I forget mine sometimes too. I have users who have no idea why they are on the back burner, and I give them a brief list of what we're working on and an eta for when we'll be able to extricate ourselves. There are times when we have a system outage and we have no eta because we haven't figured out the problem yet, and I find that in those cases nothing stems spreading panic like sending a really quick note that says we've got the guys in the server room taking a look and I'll let them know the status as soon as I hear. This isn't just a kindness to the customer, it's a sensible business move - if the customer doesn't dread calling me for a password reset he's less likely to badmouth me to his neighbor and eventually get back to my boss. If the customer doesn't think he's been forgotten entirely he's less likely to take it to the top executive in the food chain. If the customer knows we're looking at their problem they're less likely to complain back and forth across the entire agency and build the impression that IT is the problem itself. I had a group of known "problem users" who had their own distribution list where they would immediately work each other into a lather about any system problem, until I started telling them how much I appreciated them letting us know about issues so we can fix them quickly because their work is important to us all. Now they pop out a question to each other on the list when they're seeing a problem to check whether others are as well, and copy the mail to me so I see replies which let me know whether we have a single user issue or a widespread problem. When I see we have a widespread problem, I let them know what I'm doing to address it, whether it's sending someone to check the servers, siccing a DBA on the issue, or talking to their desktop tech about software compatibility issues from a new Java version. When the situation is ongoing I give them an update every few hours and if I don't have a solution yet I ask them further questions about the issue, and when it's done I ask them to test for me to verify it's all right and thank them for their help. I get an early alert system for weird issues that I don't have a way to set alarms for, they get ongoing information, I get a beta tester group both to check symptoms and test solutions, and all of us are cheerful at the end of the issue. Good customer service makes good business sense and makes my day easier as well as making it a pleasure to talk with long-term customers who are happy I'm the one on the other end of the email. The doctor (intern or resident) who kept a gentleman trapped for three days is not only being a jerk, but is also setting herself up for a serious fall if that behavior comes to the attention of her Chief, and adding a very interesting footnote to any lawsuit that happens to come up if she's been negligent about an issue that impacts her patient's health. She's also deprived herself of a shared smile, what a waste! ^_^

The needs of the many, are ultimately the needs of the one. It's been my personal distortion of Mr. Spock's sage words and a personal motto. In this world of high touch, high availability and high accountability it has to be THE way that business gets done.

Ultimately business rests on it. No matter how big the organization you will always deliver to the "one" end user. Love your neighbor as yourself, build it for them like you would build it for you, design it for them with the same care you would take to make it for your grandma, what ever it is. Train them with the same attention that you want to see when you go to training and so forth.

It's not hard to conceive, but it is hard to deliver. In that divisional access profile that is supposed to apply to almost everyone, the deliverable is to the one. If you can make that switch though, you'll be the difference maker, the short-cut, the visionary, the go-to guy and that drives up your value. A company cannot value it's employees, instead, the people in the company value each other, and that's how it gets done.

No matter how you slice it, the individual is the difference maker, on both sides of the equation. Think about that when you are designing "solutions" for companies, divisions, departments, work groups, teams, and those ever present "exceptions to the rule."

IF not - Get OUT, of the road. . ! Lead or Follow - but DON'T block the road! - Office, work, Career - WHERE EVER! - As we learned at school: Achieve the Honorable - - At Least - ACHIEVE!

I agree it is important for tools to do everything it needs to do. But often having it do everything the end user wants it to do is an impossible task. What they want can be a very time consuming and costly project that offers little utility. Secondly, what they want will change over the development of the project and sometimes contradict what they wanted before if you let it. All this is horribly complicated by office cultures that refuse to separate what they need from what they want and have constantly shifting "urgent" priorities.

Also, if I did all my job, I wouldn't sleep. Many people aren't in a position to do everything people need from them. They need to prioritize some parts of their jobs over others or they'll quickly burn out and won't be any help to anyone and maybe unemployed. I think the doctor failed to prioritize 3 days of a patients time over other duties. And I think the hospital failed to have another doctor available to discharge him or failed by creating a bureaucratic rule that kept other doctors from doing so.

I have done a LOT of helpdesk work over the years.
Griping about the medical stuff aside -
When an email hits the helpdesk, members of our team will often send an immediate reply of "On it!" or "Calling now" to let both the user and the other team members that someone is on it. If we can't get to it immediately, a simple "We are shorthanded at the moment, we will get to you as soon as we are able." Seems to alleviate the griping.
I do my best to both remote and call at the same time (users all over the country, it's kind of neccesary). This avoids any impersonal feelings. If I am on the phone telling them I am going to fix it - I get MANY sighs of relief.
Once all is well, I send a recap email to the user and the helpdesk group so everyone knows what went down, what the solution was and any follow up / instructionals that need to be sent.

A little communication goes a LONG way.

In general it's more enticing to work for a successful company than a struggling company. Those that can, often leave struggling companies, especially when there's a leadership issue. If the company is struggling long enough, it becomes rank with mediocrity. That goes for management as well as direct labor. Those remaining are showing up for paychecks, accrued vacation time and the fact their skill sets have atrophied. These places are run on old timers who are "experts" on legacy products and have little interest in leading edge technology. It's sad when a new high level manager comes in and realizes what he's got to work with. He knows the talent he needs won't be attracted and he either becomes part of the problem or leaves himself.