Other articles in Summer 2006
Anesthesia Customer Service
Vice President Anesthesia Business Consultants, LLC
If you believe that clinical excellence will ensure your continued success and prosperity as anesthesiologists or CRNAs, you are in for a rude awakening. A growing body of objective evidence clearly indicates that in today's competitive healthcare market a solid commitment to service excellence is a far more critical determinant of the longevity of an anesthesia practice. The problem for the typical anesthesiologist or CRNA who was trained to anticipate the physiologic responses of surgery and a complicated array of pharmacological options and respond with an appropriate alternative in a matter of seconds is that the economic forces affecting the future of all medical specialties do not respond to the same kinds of quick fixes and historical solutions as does the human anatomy. The problem-solving skills that were so carefully learned during residency have little relevance outside the operating room. It has become one of the great ironies of modern medicine that experienced clinicians who can make life or death decisions in a matter of seconds become hopelessly paralyzed in the face of today's economic realities.
Every anesthesiologist and CRNA understands the value of good customer service when dining out with the family or getting the car serviced. We can all appreciate the value of a promise that is consistent with reality. Who does not appreciate the employee that goes out of his way to deliver an unexpected service? We all understand why the waiter comes back to the table after the food has been served at a good restaurant to ensure that expectations have been met; it clearly demonstrates the restaurant's commitment to satisfying the customer so he or she will not only come back but rave about the experience to others.
Perhaps the real problem in anesthesia is that patients are not seen as customers, but they are. So too are the surgeons who bring them to the facility, the administration that makes it all possible and the various other professionals without whose diligence and persistence operating rooms would not run at all. To the extent that the focus of one's efforts is viewed as a patient the interaction is limited to a dispassionate exercise in clinical problem solving, but when these same patients become customers then their hopes, fears, expectations and requirements all become part of a much more complicated and dynamic equation.
The situation is further complicated by the variety of customers and the diversity of their expectations and requirements. While the goals and objectives of anesthesia administration can be clearly defined, it is not so easy to reconcile the often conflicting expectations of patients, surgeons, operating room staff and hospital administrators. Sorting them all out is a much less objective process; in fact, it can be highly subjective and unpredictable. It is all too easy to suggest that anesthesia providers are not good at it because this was not part of their training. Anyone who can get an "A" in organic chemistry can figure this out.
Market competition is based on the premise that customers have options that they will seek service providers who they believe are most committed to meeting their specific needs and expectations. This is the part of the equation that does not fit the clinical mindset and training. Clinicians want to believe they do what is necessary and appropriate because it is the right thing to do, not because it will win them points on a customer satisfaction survey. Just as college professors must now prepare their lesson plans with an eye to the evaluations their students will give them, so too are anesthesia providers increasingly being evaluated on their ability to communicate effectively and allay their patient's anxiety about surviving surgery.
The clinical algorithm does not allow for contradictions and inconsistencies; the medical scientist does not view the world through the same lens as the social scientist. Each anesthetic experience must be neatly packaged like a five act play. While the experience is designed to anticipate the almost limitless number of options that are created by diverse patient populations, thousands of surgical options and different operative conditions it is not a free-form improvisation. Most options and variations on the theme are carefully scripted and the product of experience. Ultimately, all the data and indicators should be reconcilable and result in a clear course of action. The specialty understands that its practitioners must strive for and embody ability, availability and affability except when these qualities conflict or do not seem to fit the circumstances. There appears to be an unwritten rule that if in doubt stick to ability and hope that the other two will eventually sort themselves out. This is analogous to the age-old advice that it is always easier to ask for forgiveness than permission.
Ironically, the specialty's greatest asset is also its most critical liability. The clinician's ability to be so focused and disciplined in the operating room is his greatest liability outside the operating room where problems are not solved in a matter of seconds, nor even by the application of a unilateral solution. There is no doubt that customer service represents a different paradigm. Customers must be enrolled in the promise of good service. Communication lies at the core of their experience and satisfaction. The good news is that figuring it out requires much less training and experience than giving anesthesia; it just requires a willingness and commitment to accept its relevance and importance and to practice it until it becomes second nature.