Customer Service -- Bah, Humbug!

It is the holiday season.  Time for family, being grateful for what you have, and surprises, both good and bad.  Also time for lots of waiting, spending more than you planned, dealing with many strangers, and some frustrating service. 

In other words, a lot like most days in healthcare. 

In The Conversation. Professors Anthony Dukes and Xi Zhu make the argument that, contrary to what we might think, good customer service is not a prerequisite to business success.  In fact, they say: "Some of the most hated companies in the U.S. are also the most profitable."   Or, as Fast Company sub-headlined it in their version of the article: "Unfortunately for you, bad customer service is good for business."

Their research specifically looked at how companies made it difficult for customers to obtain refunds.  They found: "Many complaint processes are actually designed to help companies retain profits by limiting the number of customers who can successfully resolve their complaints."

Forcing customers to overcome chatbots, phone trees, and Level 1 human representatives without authority to fix the customers' problems are all part of the strategy.  Companies even use AI to gauge just how angry a caller is; only if the customer is deemed to be a risk of ceasing to be a customer does he/she/they get transferred to someone who can actually help. 

As they say:

This allows companies to exploit customers’ individual differences in age, race and gender so that only the “squeakiest wheels” are compensated...This all suggests that the tiered process may hit vulnerable groups in our society harder. Therefore, elderly customers and some minority groups will be less inclined to obtain a refund.

The professors cite Comcast and United Airlines as customers who brag about top-notch customer service even as customers routinely cite them for their poor service. 

It shouldn't come as a surprise, but they note that "in markets without much competition, companies are more likely to implement a tiered complaint process and profit from the reduced payouts to customers."

And we're back to healthcare. 

One would think that an industry built on caring, and, in fact, filled with many caring professionals, would put customer service at a premium.  "Treat every patient as you would a family member" is the kind of attitude we'd expect.  But that is not the reality most of us experience.

Healthcare is often maddeningly opaque.  Many of us don't quite understand the terminology, what our diagnosis really means or exactly what our treatment will be, what everything/anything will cost, and how much our health coverage will pay.  Most of our time dealing with healthcare entities is spent waiting -- on the phone, in waiting rooms, for treatments.  We rarely know how long the wait will be or exactly what will happen next.

We might ask about costs in advance, but good luck.  The healthcare professional we ask is most likely to admit they don't know, or only have an approximation and only for their specific services, not others that are included in the treatment plan.  And, of course, the cost will differ by where you receive services, who is treating you, and which health plan you have. 

If we have questions about what has happened/is happening/might happen, most likely we'll spend more time waiting to get an answer, one which may or not prove helpful. 

Should we decide to complain, well, to whom should we?  We've come to accept a low bar for customer service in healthcare.  We might get apologies but not are likely to get action.  Even when we suspect medical errors or incompetence, complaining to the state medical board or filing a medical malpractice claim are both processes that often end up being fruitless. 

How many Bill of the Month stories does Kaiser Health News have to run before healthcare organizations actually change their billing practices?  How many times does ProPublica have to report on conflicts of interest for healthcare professionals before they take it seriously?  How many times does NPR have to report on healthcare organizations suing patients before they become too ashamed to do it? How many more health system settlements for anti-competitive behavior do we need to get them to, you know, stop the anti-competitive behavior? 

Most importantly, why are there still so many medical errors? 

The next time you can't get through to a customer service representative at your health plan, or the next time you can't get timely help as an inpatient, find out how much the CEOs of the health plan and hospital, respectively, make annually, and it will be clear how much they value customer service. 

Healthcare is good at charging a lot of money, and at making a lot of money, but no so good at using that money to deliver a good customer service experience for the people who use it.  Despite that, we trust our doctors, consider our hospitals community anchors, and even are pretty happy with our health plans. 

It's as if we're in an emotionally abusive relationship with the healthcare system.  It doesn't treat us well, but we stick with it.  We complain about it to friends and family, but we still love things about it.   We fool ourselves into believing it will change for the better.  And we view ourselves as being too dependent to ever leave it. 

Let's face it: we're a long way from ensuring quality care.  Our health disparities are shocking.  We're not getting better at preventing patient harm.   We constantly worry about affordability.  All that is shameful, and must be addressed. 

But, honestly, isn't the very least that our healthcare system could do is to provide excellent customer service?  At this point, most of us would probably settle for "good" customer service -- for being treated fairly, for being treated like we are listened to.   For being seen as people who need help, rather than as sources of revenue.   

We want straight answers, responsive service, and appreciation for our time and money. 

If Ebenezer Scrooge can reform and get Tiny Tim the health care he needed, perhaps our healthcare system will experience its own Christmas Carol revelations.  As Tiny Tim said, "God bless us, every one."