There is an old (but in many ways sad) joke about two clinicians–actually, the way I first heard the story, it was two psychiatrists. The point of the story is the same regardless of the discipline of the provider. Anyway, two therapists meet in the hallway after a long day spent meeting clients. One, the younger of the two, is tired and bedraggled. The other, older and experienced, looks the same as s/he did at the start of the day: eyes bright and attentive, hair perfectly groomed, clothes and appearance immaculate. Taken aback by the composure of the more experienced colleague, the younger therapist asks, “How do you do it? How do you listen to the trials and tribulations, the problem and complaints, the dire lives and circumstances of your clients, minute and minute, hour upon hour…and yet emerge at the end of the day in such good shape?” Slowly shaking his head from left to right, the older and more experienced clinician immediately reached out, tapping the less experienced colleague gently on the shoulder, and then after removing the thick plugs stuffed into both of his years, said, “Excuse me, what did you say?”
Let’s face it: healthcare is in trouble. Behavioral healthcare in particular is in even worse shape. And while solutions from politicians, pundits, industry insiders and professionals are circulating in Washington with all the sound and fury of a hurricane, the voice of consumers is largely absent. Why? Of course, many of the barriers between providers and consumers are systemic in nature and as such, out of the control of average clinicians and consumers. Others, however, are local and could be addressed in an instance with a modicum of interest and attention on the part of professionals.
Chief among the steps practitioners could take to bridge to chasm between them and consumers is the adoption of routine, ongoing feedback. Seeking and utlizing real-time feedback from consumers has the added advantage of significantly boosting outcomes and increasing retention in services (several studies documenting the impact of feedback are available in the “Scholarly publications and Handouts” section of my website). Healthcare providers can download two well validated and easy-to-use scales right now for free by clicking on the Performance Metrics tab to the left.
So far, however, few in healthcare seem interested and others are downright hostile to the idea of asking consumers for input. Consider the following story by reporter Lindsey Tanner entitled, “Take two, call me in the morning…and keep it quiet.” Tanner discovered that some in healthcare are demanding that people (patients. clients, consumers) sign “gag orders” prior to being treated–agreeing in effect not to post comments about the provider (negative and otherwise) to online sites such as Zagats.com, Angieslist.com, and RateMds.com. According to the article, a Greensboro, N.C. company, ironically called “Medical Justice” is, for a fee, now providing physicians with standardized waiver agreements and advising all doctors to have patients sign on the dotted line. And if the patient refuses? Simple: find another doctor.
Can you imagine a hotel chain or restaurant asking you to sign a legally-binding agreement not to disclose your experience prior to booking your room or handing you the menu? Anyone who has travelled lately knows the value of the information contained on consumer-driven websites such as TripAdvisor.com. It’s outlandish really–except in healthcare.
To be sure, there is at least one important difference between healthcare and other service industries. Specifically, healthcare providers, unlike business owners and service managers, are prevented from responding to online complaints by existing privacy laws. However, even if this problem were insurmountable–which it is not–how then can one explain the continuing reluctance on the part of professionals to give people access to their own healthcare records? And this despite federal regulations under the Health Insurance Portability and Accountability Act (HIPAA) permitting complete and unfettered access (click here to read the recent NPR story on this subject). Clearly, the problem is not legal but rather cultural in nature. Remember when Elaine from Seinfeld asked to see her chart?
Earlier this summer, my family and I were vacationing in Southwest Michigan. One day, after visiting the beach and poking around the shops in the lakeside town of South Haven, we happened on a small Italian bistro named, Tello. Being from a big city famous for its good eats, I’ll admit I wasn’t expecting much. The food was delicious. More surprising, was the service. Not only were the staff welcoming and attentive, but at the end of the meal, when I thought the time had come to pay the bill, the folder I was given contained a small PDA rather than the check. I was being asked for my feedback.Answering the questions took less than a minute and the manager, Mike Sheedy, appeared at our table within moments of my hitting the “send” button. He seemed genuinely surprised when I asked if he felt uncomfortable seeking feedback so directly. “Have you learned anything useful?” I then inquired. “Of course,” he answered immediately, “just last week a customer told us that it would be nice to have a children’s menu posted in the window alongside the standard one.” I was dumbstruck as one of the main reasons we had decided to go into the restaurant rather than others was because the children’s menu was prominently displayed in the front window!