Healthcare often looks to other industries for ideas about how to improve experiences, workflows and revenue. Although this practice creates significant opportunities to learn and innovate, it has also ignited a trend of referring to patients as customers. This view is problematic. The definition of a customer focuses on a person’s purchase of a product or service. In healthcare, the context is much more complex. While we want patients and health systems to benefit from successful approaches in other industries, several tensions arise from using customer-oriented language.
Clinicians should be focused on the care of patients and their overall health, while businesses focus on customers to generate revenue and maximize profits. Referring to patients as customers creates a misalignment of purpose and an ethical dilemma for clinicians, who may feel pressure to consider healthcare as a business rather than focusing on improving wellness.
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Not everything in healthcare generates sufficient revenue to cover the cost, but the services—such as primary care and behavioral health—are essential to the well-being of patients and communities. In addition, vulnerable groups can be further marginalized through attempts to treat them as customers based on what they can afford, not what they need. Are decisions made in an equitable fashion to achieve desired health outcomes, or are they made to drive revenue through being customer-centric? Every healthcare organization experiences these tensions, and their impact on clinicians has become more pronounced.
The clinician-patient relationship is also at risk when patients are viewed as customers. This relationship is the bedrock of trust required for personalized care to be delivered; it also enables the shared decision-making necessary for complex and life-changing choices. There is no corollary to this in a clinician-customer relationship. Clinicians are not selling a service. They are partnering with their patients to determine the best course of care to optimize health. This could entail recommendations that no further services are needed (such as unnecessary testing or imaging), additional services are needed (referral to a specialist), or non-reimbursable communications and care management are needed (asynchronous care via patient portals, for example). The formation of a therapeutic relationship requires patients and clinicians to partner, not customers and clinicians to engage in a transaction.
A customer-focused approach may also lead to service fragmentation. We have experienced ongoing industry entry based on the potential for revenue generation, rather than on enhancing care coordination and communication for patients. The fragmentation is frustrating for clinicians as well as patients, who are left to navigate additional complexities in an already burdensome healthcare system. Often, we try to solve the care fragmentation with additional resources that seem poorly utilized, and in competition with investments that could directly improve patient care.
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Clinicians have also experienced the tensions between quality of care and so-called customer experience. Most of us have experienced buying a product, after which the business reminds us, “When you get your customer survey, please rate us with a 5.” While we want to create those meaningful “rate us with a 5” experiences in healthcare, the lens of the satisfied customer should not drive care. Rather, patients should always receive high-quality, evidence-based care even when their satisfaction may be at risk. For example, a patient with a non-bacterial upper respiratory tract infection asking for antibiotics should not be prescribed one simply because it would earn the clinician a “5” rating. Viewing the patient as a customer would unintentionally favor the request of antibiotics rather than the more difficult route of education, reassurance and symptomatic care.
All of these tensions that result from misused considerations of patients as customers have a broader risk—the erosion of trust in healthcare providers. We are at a time in healthcare where we need to actually build trust between clinicians and organizations; between clinicians and patients; and between provider organizations and the many businesses they could partner with to achieve a healthier society. How should we approach the lessons learned from other industries to minimize the dangers outlined above? What can we do to truly improve the relationships among clinicians, their patients, health systems and communities?
We believe this is an exciting time to acknowledge these tensions and to see the opportunities to leverage them in a positive and impactful fashion. By translating the "customer experience" in non-healthcare industries to the "patient experience" in healthcare, we can avoid the patient-as-customer trap and the problems associated with it.
