Spotlight on Pediatric Emergency Care Volume 3, Issue 2, April 2005 What Do YOU Think? Improve Medical Quality or Customer Service? Is it appropriate, in healthcare, to focus on customer service? Or should the focus remain on improving medical quality of care? I asked that question last month during my talk at the American College of Emergency Physician's Spring Congress in Orlando. While many in the audience felt a focus on customer service is necessary, some felt otherwise--that shining a spotlight on "customer service" is not, as they say, where the money is. I wasn't surprised. My experience is that although a customer-centric focus in healthcare has exploded over the last few years, still plenty of physicians, nurses and mid-level providers continue to resist moving in that direction. I've seen resistance at both the day-to-day provider and the clinical leadership levels. The reality, however, is that quality care and customer service are not mutually exclusive. We don't need to pit one against the other. In fact, I believe we do the families we serve a tremendous disservice if our focus is lopsided--either way. How to Build a Balanced Foundation Medical quality of care is the foundation of what we do. The increased national focus on medical mistakes by the Institute of Medicine highlights medical quality as a core issue that requires greater attention. We can strengthen our focus in this area by ensuring that our emergency department quality improvement (QI) program includes a focus on children. It's not sufficient to simply address pediatric QI issues as part of a generic focus on medical quality. And smaller community departments should incorporate mechanisms for enhancing a focus on pediatric medical quality. One way to accomplish this is to develop prospective QI indicators specific to the pediatric population served by the department. Great medical care undoubtedly forms the foundation for improved pediatric service. To balance and strengthen that foundation, however, requires an added focus on customer service through which your great care can really shine. If a family senses that no one really cares about them, they're going to seek future care from other places. If there's a complaint related to poor communication, we're going to hear about it. In a way, how we communicate with children and their parents is the ultimate key to enhancing both real and perceived emergency care for children. When a family comes in to your emergency department, they are typically anxious or worried. It may be a trivial complaint to you or your staff, but to the parent, it's a real and immediate concern. How does a family learn about the quality of care at your facility? It's through their perceptions of 1) the physical facility and 2) the communications that take place. And let me tell you--first impressions count a lot! In fact, it's been suggested that those vital first impressions are formed during the first seven seconds of an encounter. If a family comes in and sees a clean, child-friendly facility, and has a great experience connecting with the triage nurse and a reasonably pleasant experience with registration, they are primed for a good experience with the physician or other provider. And then even if problems do arise, such as a delay in lab results, they'll be ok with it, especially if good communication continues and they are informed about the delay. On the other hand, if a family gets an overt or subliminal message that "we really don't care and have other things on our minds" at triage, or if the registration clerk starts discussing the family's confidential information in front of other people, the provider who will see the child is placed, unwittingly and, in most cases, unintentionally, behind the eight ball. It'll take much more energy and focus to turn the family's overall experience into a good one. And even so, they'll still remember--and tell their friends--about their initial impressions. So what can you do to build a truly balanced and strong foundation? Create a family-friendly environment that's evident from the moment families step into your department. If you truly want your ED to be viewed as "the place" to go for pediatric emergency care, you must create a physical and attitudinal environment that clearly and unequivocally proclaims: "We welcome you; we are focused on taking care of your child." This caring attitude must extend through all family communications and interactions. Excellence in pediatric clinical care, combined with a strong focus on excellence in communication and customer service, is a powerful formula for strengthening the foundation of pediatric emergency services in your hospital, and in the community it serves. About Our Organization Created in 2003, Petrack Consulting is dedicated to helping physician and hospital leadership bring excellence to emergency services for children. We work collaboratively to fully understand our client’s needs, and then address programmatic initiatives with measurable outcomes. Our unique background in pediatric emergency medicine, administrative medicine, and organization development allows us to create uniquely effective solutions for enhancing emergency services for children.