Reflections from a Healthcare Worker: Can we please expunge the term “Service Recovery”? (part 1 of 3)

May, 2013

*guest post by Craig T. Albanese, MD, MBA

Imagine this: A new state-of-the-art hospital is built, keeping the same prestigious name and place in the community as its predecessor.  You fill it with the best and the brightest doctors, nurses, and staff members. Five years later the hospital is struggling; volume is down, staff is dissatisfied – patients are migrating to the other hospitals in town.  Sound familiar? Could this happen?  Has this happened? Why would patients leave this “prestigious” institution of healing?

There are many possible explanations.  Based on my many years of experience and expertise in both medicine and business, here is a simple central theory: Healthcare today has become an industry that is dependent on the principles of service recovery – correcting abnormalities that, in many cases, could be avoided.  Rather, its focus should be providing excellent service.  Our doctors, nurses and staff are trained and expert at solving patient medical problems; however, we are woefully inadequate at solving system problems. In fact, we have created most of the problems endemic to our healthcare systems. Thus, there is an ongoing need for service recovery – solving the problems we’ve created instead of avoiding them in the first place.

Why is this? First and foremost, American healthcare built hospitals and their care processes around the wrong customer – the doctor and his/her healthcare team.  The principle customer in healthcare is the patient and the patient’s families (other customers are referring physicians and payers).  Physicians, nurses, and related staff members are stakeholders. So when we allow the wrong customers to dictate process development, the system becomes unbalanced.  We build big waiting rooms.  It becomes acceptable for physicians to be late to clinic, late to the operating room, to order tests that are not needed.  And when the physician and related workers are empowered to run the system, the system in turn blames them – persecutes them –  when care systems go awry.  Finally, the healthcare team, by default, becomes the frontline for fire-fighting process problems, placing band-aids where big fixes are needed, devising short cuts, and “working the system” so that care can be delivered.

In what other industry is this tolerated?  I submit that healthcare should be the ultimate service industry—there is very little about it that is discretionary.  However, we presently have a broken system, broken by well-intentioned smart people, all trying to “do the right thing and help patients.”  Furthermore, this mismatch between intention and output piles despair and frustration on top of inefficient and ineffective processes, compounding the problem.

Let’s look at another service industry—food service.  In contrast to healthcare, this industry is highly discretionary.  How much service recovery can restaurants tolerate before losing business? Think back to the last time you made a reservation for a fine dining experience.  With few exceptions, I’m sure you secured a reservation within a week or so of your desired date.  You arrive at the restaurant.  How big is the waiting room?  Do they even have a waiting room? Probably not, perhaps a few chairs, perhaps the bar. But what is your expectation for your 8pm reservation?  Do you expect that you will be seated on or around 8pm?  What if you were seated at 9pm?  How would you feel?  How many “I’m sorries” and free drinks would it take before you left? What if you were seated and a server doesn’t appear for 20 min?  Would you be angry?  What if the food was cold?  Even if this particular restaurant is known for the best chefs in town, would you ever go back, given this level of service?

Service is defined by high quality, safe, empathetic, and efficient delivery of care in a hospital – or in any healthcare setting or non-healthcare industry.  In healthcare, until we change our processes, eliminate waste, create service standards, and agree that the patient is the primary customer, we will forever be a service recovery industry.  For institutions sensitive to the plight of the patient in this type of environment, service recovery will be characterized by a plethora of coffee cards and free parking to abrogate the long waits and inconveniences bestowed upon our patients; armies of service recovery professionals will gather to dole out sincere apologies, and peer review meetings will continue with the shame and blame culture levied at all professionals involved in any adverse clinical outcome.

About Craig Albanese, MD, MBA

Craig T. Albanese, MD, MBA, is Vice President of Quality and Performance Improvement at Lucile Packard Children’s Hospital at Stanford University Medical Center. In this role, he is responsible for overseeing the children hospital’s Lean transformation. Under his leadership, Craig is approaching Lean transformation by developing a rigorous daily management system to support ongoing improvement efforts and the hospital’s core goals.  In addition, he has recently overseen the implementation of a production control management system in the perioperative services department and is expanding this work to the rest of the hospital. Craig is also a pediatric general surgeon, Professor of surgery, and holds the John A. and Cynthia Fry Gunn Directorship of Surgical Services at Lucile Packard Children’s Hospital.

Craig obtained his BS in Natural Sciences and Mathematics from Washington and Lee University.  He earned his MD at Downstate Medical Center, subsequently completing his general surgery training at The Mount Sinai Hospital in New York and his pediatric surgery fellowship at the Children’s Hospital of Pittsburgh. He was on the faculty at the University of Pittsburgh followed by the University of California, San Francisco before joining the faculty at Stanford in 2002. In 2008 he earned an MBA from Santa Clara University’s Leavey School of Business. Craig still practices pediatric general surgery.  His 26 years as a surgeon in a broken healthcare system has shaped his passion for increasing value for our patients.