Can Consumerism Fix Healthcare’s Culture of Low Expectations?

When I worked in the hospital, things always went wrong: patient’s blood work got lost, lab results took hours to get back (even in the ER), patients were sent to the wrong unit after a procedure, unit clerks would forget to order tests, discharge instructions were never shared with the patient, follow-up appointments were never made…And on it went.

In the doctor’s office things went wrong there too—appointments were not on time, the medical record did not include the patient’s last hospital visit, medications took several days to re-fill, labs were drawn but results were never reported to the physician.

In every one of these examples, the patient—or consumer—was left holding the bag. Only the patient realized the hardship of the health system’s inefficiencies. It was the patient who suffered the consequences of extra needle pokes, extra x-rays, extra trips to the doctor’s office, a delayed diagnosis, or a delay in treatment.

And when these daily occurrences happened, doctors, nurses and unit clerks would just shrug their  shoulders and think—or say—‘Yup, not surprising,’ or sarcastically, ‘How shocking.’ And not because doctors or nurses were uncaring or unprofessional, but because these were system problems they could not fix, and over time, they became used to operating in a low performing culture.

Low Expectations Is Expensive

According to the Institute of Medicine, roughly 35% of healthcare spending or about $765 billion (reported in 2013) was essentially due to a culture of low expectations: Test results not transferred to the doctor, x-rays not labeled, procedures needing to be repeated, lab tests hemolyzed…

For many years, medical professionals have understood what the larger business community is now trying to change—inside Healthcare, there is a pervasive Culture of Low Expectations:

Nurses would forget to arrange a follow-up appointment for a patient. ‘Opps. I forgot.’

        Unit clerks would fail to schedule procedures on a Friday afternoon because the department staff leaves  early. ‘It can wait.’

       Lab techs would walk by test tubes of blood because their basket was full. ‘I can’t take any more samples so I’ll let the next shift get these.’

Motivational “Burn Out”

And while clinicians and managers have tried to fix these problems, they haven’t been able to make meaningful improvement while also doing their regular duties of caring for patients. And over time managers and clinicians understood that their individual efforts cannot surmount the larger organizational barriers and so there is  a ‘collective giving up.’ 

These feelings of not being able to affect improvement leads to a downward spiral in motivation and ‘discretionary behavior,’ which are those very behaviors and activities which provide the ‘glue’ needed to do those ill-defined tasks which are not part of any job description, yet are vital to high performance.

 The simple fact of the matter is that this level of ‘slack’ is systematic throughout the organization and requires a different—and new—type of skill set to fix.

The Rise in Expectations

And so it should come as no surprise that we are seeing frustration from patients—AKA consumers—who are tired of low performance. And, it should come as no surprise that we see disruption from non-traditional entrants into healthcare who are tired of paying for re-work and waste. And these newly empowered, ‘voice-activated’ consumers and purchasers (and payers) are raising the bar of performance by demanding health care become like most other competitive industries—organized, efficient, connected, mobile and friendly.

The Promise of Consumerism

To meet this societal expectation, care delivery systems must understand that a central plank of consumerism is to understand the patient and to serve-up services and solutions in a flexible, mobile, simple, and error-free manner.  And in return payers and providers get a group of individuals who are engaged, and actively participate in their self-care. This is the promise of consumerism.

The plain truth is that the rise in consumerism is forcing a paradigm shift where the dominant culture is one of attentiveness, timeliness, accuracy and respect.

And this paradigm shift will be challenging for healthcare. Yet until we have a radical paradigm shift in what we expect from our healthcare delivery system the promise of consumerism cannot be realized.  

But isn’t it time to expect more? More communication, more efficiency, more organization, more mobility, more connectivity, more kindness and more respect, especially from an industry that calls itself ‘The Healing Industry?’

I invite you to join the consumerism ‘workforce’ and ask for more from your health care experience. It is only by raising expectations can Healthcare become a Healing Industry.

About the author: Recognized by LinkedIn as a "Top Voice" in Health Care in 2015 & 2106, & 2107, Julie Kliger is a Healthcare Social Critic and Change Agent who is passionate about improving health care and improving lives. She is a consultant, speaker and author. She specializes in healthcare thinking redesign, organizational strategy and change management.