Does this sound familiar to any of you? You are sitting in your office having a generally nice day when you get a phone call from an upset patient or family member. In the course of talking with the caller, it becomes clear that the issue is not level of care or the clinical skills of your staff, but rather customer service. The bottom line is your staff failed to meet a certain level of courteousness in the mind of the caller — simple as that. As a result, you find yourself once again banging your head on the desk, wondering how to get the message across to people that there is more to being an EMS provider than just being proficient in skills.
I wonder if patient outcomes would improve if we changed all protocols and algorithms to have the same first step: “Be nice.” It seems so simple and routine that many of you may be thinking that adding a “niceness” clause would just be over-emphasizing the obvious.
But is it? Wouldn’t we see a better patient outcome if we made a concerted effort to hold people to the same level of accountability for their customer service skills as their clinical skills? My gut instinct is yes.
Those of you who are in leadership roles have no doubt been involved in a case review in which there has been a complaint about how your crew handled the call. I am sure you found yourself sitting there thinking, “If only our staff had treated the patient with respect and dignity, we wouldn’t have to meet to discuss the issue.”
I imagine each one of us have experienced situations in which good customer service skills made a difference, as well as situations in which an absence of good customer service has led to a negative outcome. I experienced a case of the latter back in the ‘80s.
I had responded to a call involving a SIDS patient at a daycare. We provided care strictly according to protocol, but in the end the child did not resuscitate. Nevertheless, I felt pretty good about my skills and performance. After all, I had performed my first intraosseous on a patient with successful infusion. I left feeling that the call was managed well.
Several days later, I was contacted by the folks who ran the daycare center, who wanted to talk to the paramedic who had responded to the SIDS call at their facility. I was a little taken aback by the fact that they wanted to talk to me. I had done everything by the book, so what could be the issue?
When I met with two representatives from the center, they started off by thanking me for my skills during treatment. But then they said something that still sticks with me. They told me that because I had never communicated with them about how things were going or what our course of action was going to be during our attempts to save the child, they felt guilty when we “ran out the door.” Basically, because they did not understand what was occurring, they felt as though they hadn’t done enough to prevent the death of a child.
After a long conversation, they got up to leave. They both gave me a hug and simply asked that I remember that I am responsible for more people than just the patient. I can tell you that I still vividly remember the hurt and pain in their eyes and it reminds me of the importance of treating all persons involved in a call with respect. It has been some 20 years and this one event still lingers in my mind as a reminder of the impact I had as a paramedic.
EMTs, paramedics and communications staff generally work in an environment that is managed by rule books, protocols and SOP’s. Yet we ask them to go out into the real world every day and deal with the unknown. They are given the responsibility to make determinations on patient care within their scope of training. On top of that, they are expected to interact with people whose lives have been totally turned upside down and who are, many times, in their most vulnerable state.
What we ask our employees to do is to follow a rather narrow set of guidelines, to act as the eyes of the physician, and to be the ombudsman for the patient. We want them to do it all in a rather short period of time, and we expect them to do it correctly every time. This creates an environment in which they must rely on adherence to the rule book for guidance and protection. When in doubt, they follow protocol to a ‘T.’
I would guess that this works fine a majority of the time, regardless of whether or not the caregiver has the ability to smile, hold a hand, or communicate to a family member. If there is a complaint, the caregiver will be protected by the fact that he or she followed the protocols.
But this doesn’t account for the daycare workers who — in the face of tragedy — just need to feel confident that they did all they could. Since EMS providers encounter the concept of human death on a daily basis, we may fail to remember that patients and their families need a little extra care to cope with the situation. This leads back to my original point: the number one step, regardless of the situation, should be to treat the patient and everyone associated with the patient with kindness and respect.
We have all had experiences in a healthcare environment, either as caregiver or a patient. And most likely, these experiences include examples of customer service that fall on both ends of the spectrum. As health professionals, it’s important that we take the time to reflect on these experiences, especially the ones that provide positive models for your own patient interactions. Like when a doctor or other healthcare provider took time to speak with you and explain what was going on. Or when their sincerity reassured you that they were there to help you feel better, no matter how lousy you felt or how scared you were. Whether it was for yourself or a loved one, their conduct helped you to begin to deal with the recovery process. And all it took was someone being nice.
So why make a seemingly obvious, unspoken protocol into a written rule? Simple. We are creatures of habit, and by holding providers accountable for their actions, we will make it more likely to become the norm.
Back in the ‘80s, wearing gloves on a call was the exception. Now we wouldn’t think of violating that protocol. I want even the most emotionally vacant paramedic to give the same level of importance to being nice as they would to personal protective procedures. In the end, I want the phone to ring with someone calling to tell me about how much they appreciated having our caregiver hold a patient’s hand, console a family member, or simply smile when it was needed.
