Patients are not our customers

Our patients are not our customers and we ARE NOT a business!

In a mark to make our health care world seem more focussed and respectful I keep hearing people say, and repeat it when they hear it from others and not thinking themselves, “Our patients are our customers and we should treat them like that.” This sets off something deep in me and I have to work out why it presses the wrong button, makes me frown inside and want to formulate a response carefully and work out why for myself….and then hopefully tell lots of other people!

A customer – “a person who buys goods or services from a shop or business”

A Patient –  “adjective - able to accept or tolerate delays, problems, or suffering without becoming annoyed or anxious - noun - a person receiving or registered to receive medical treatment”

Those two definitions do not even sound in the slightest to correlate. That is because they cannot be.

Ok, so I have only worked in the NHS for a mere 16 years but I know a “patient”, a person in need, when I see it. So currently there is a young man sat outside the hospital I work at. He has been out there in and out of reception most of the day. He is thin, wearing NHS issue pjs, a huge pale yellow blanket, no shoes and a messy hair do. It’s a hot 29c outside, why is he wearing a blanket is the first thing that comes to mind. I assume he’s just out for a short cigarette break, but he is still there when I go to get something from my car. So I ask him if he’s OK? He says yes and that he’s waiting for tests and walks away.

The young man is not a customer. He is waiting for something, his diagnostic, like customers do. He is in a queue - but that young man also looks lost and in need. And whatever wrap around care he needs it is far more than our view of a traditional customer. That young man is a patient and he is waiting as a patient not a customer. He is unwell in more ways than one and this one hospital site is not going to provide all he needs under one roof either. He hasn’t chosen this hospital as his informed preferred option either - this is could be a last hope or his last option. He is hardly buzzing from the prospect of the care that the NHS has purchased for him and there are no advantage points from his visit, special coupons to entice his return custom or 10 pence bags for life carrier bags - apart from those carrying his belongings.

A big chunk of my NHS career was doing the, in my own words, rugged and teeth cutting work out on the streets of London in sexual health and HIV prevention. I worked in outreach roles talking to everyday people in dirty noisy pubs, made my way into sex worker premises distributing condoms, ran HIV drop in services and group work support. I would never say these emotional beings were customers. They are far more complex and business is never as usual for our services unless you’re a corner shop chemist in a rural village with cuddly toys in the window for sale. Painting a picture here?

So, we run our services like a business? No, we don’t, because if we did a lot of business would have been shut down as bust. All of us know, that NHS services are fundamentally about people who need and the service cannot just be closed down and custom self sent to the nearest other competitor. Patients, or people, do not have that ability.

So scenario of comparisons here - huge well known supermarket branch vs the local large hospital in same town: Imagine that each member of supermarket staff on the shop floor has dedicated responsibility for all of the customers that come into the shop and to help them with their shopping. However in this case all the customers take a whole day, or longer than any individual shift, to do their shopping. Some will still be there the next day or days later. That some of the people do not know what shopping they need, that they can wander off any time and the staff need to make sure they don’t leave the shop, that some of the shoppers need to be pushed around to do their shopping, some need the staff to carry their baskets, some need to be taken to the toilet, some are throwing up in the aisles, some are falling over in the clothing department trying on new night wear and need picking up, some are aggressive and shout at the staff. The list just goes on. The staffing and experience (and maybe pay) in a large store would not be enough to cope with this, even with the conveyor belt activity to do so.  Agency staff would be needed last minute to cope and super store wouldn’t have the time to train their agency staff in all that is needed or where everything is, let alone provide customer care training so that they have a good experience - would it work? You could almost see a social experiment happening here and it being a complete heart breaking nightmare. Oh, and let me add in, that all of those people need to be taken home with all of their shopping – those delivery vans will take some converting!

So we can aim to manage productivity and improve processes in the hospital environment learnt from business – and often do – or often learn from our mistakes. And we can try the conveyor belt approach to discharges etc but our people are not customers…they are so much more and we need the emotional intelligence in our board rooms as well as the performance leads and wise heads around that table to feel, really feel, and express that. Calling our patients customers takes away from the needs we provide for.

The business model can be adopted, adapted to NHS yes, but the sociology of health and care means our patients are our patients. Life would be so much better for them if they didn’t need us.

We know that a customary smile and, “How is your day?” and thank you can help, but our patients need something far more deep rooted. Businesses make money, the NHS makes people better, and when they can’t, they still deal with it. The smile and, “How is your day?” and thank you from a business is a thank you for giving us your money and choosing our store. A smile and how is your day and thank you in discussion with a patient, opens up a lived experience that is not a short and is often filled with worry, pain and a long, or so often, a short road ahead.