How customer service mechanisms don’t exist in health care

Now that I am a “civilian,” I get to experience the health care system like most of you. I marvel at the degree to which customer service mechanisms used by service providers in other sectors do not exist in health care. Please understand that I am not talking about the quality of care, or empathy, or attentiveness offered by doctors, nurses, radiology techs, lab techs and the like. On that front, I remain tremendously impressed. Indeed, I am even more impressed that they can offer such fine care now that I get to witness the logistical “systems” in place to do the humdrum things that are required to provide service, work flows whose design not only makes things harder for patients but also for providers.

For example, I contact my PCP who recommends that I see a specialist. The PCP is on the patient information portal, but the specialist is not. This means that I cannot use the portal to set up an appointment. Can I do it by email? No, I am told. I must call the specialist’s office. This results in several back and forth telephone calls, using up the precious time of both the patient and the desk clerk. An opportunity to benefit from the asynchronous nature of email or other electronic scheduling is lost.

I need to have an image made before seeing the specialist. His office tries to enter the order for the image, but the system kicks it out because my insurance company does not have the name of my PCP in its records. The person entering the order does not have the authority or ability to inform the insurance company of this piece of data, although it is known to her. Instead, the specialist’s office has to contact me, and then I have to contact the insurance company, and then I have to call the office back and tell them that I have done so, and then the order can be entered.

Then, because electronic scheduling does not exist, I have to call the radiology department to get an appointment for the scan. Here’s the first bit of good news. The scan and the radiologist’s reading is inserted into my electronic medical record so the specialist has access to it before my appointment. Indeed, I have access to the report, too, through the patient portal (oddly, in that the specialist does not participate in the patient portal.)

But my PCP and the specialist recommend that I see yet another specialist. I search for his information and find that he uses the patient portal. I go to my page in the patient portal and attempt to add him as one of my doctors so I can make an appointment electronically, but the following message appears saying that I must have an initial appointment with him before I can do so: Catch-22!

There is no email available for him, so I am left to call his clinic and make an appointment.

By the way, this occurs in a physician practice organization that regularly receives awards for being part of one of the most wired health care institutions in the country. And, truly, it deserves that honor compared to many others, but the kind of lacunae I describe above are indicative that the standard against which such awards are granted is low compared to what you would expect in many other industries.

Also, the Press Ganey survey I received after the appointment with the first specialist had no questions related to any of these problems.

Paul Levy is the former president and CEO, Beth Israel Deaconess Medical Center and blogs at Not Running a Hospital. He is the author of Goal Play!: Leadership Lessons from the Soccer Field and How a Blog Held Off the Most Powerful Union in America.

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  • Kaya5255

    Technology is wonderful……when it works??!!

  • guest

    I don’t think that the ldea in healthcare is to make it easier for the pt. It is different than other businesses. THe less you use it the more they make. No wonder the insurance co made it difficult to enter the PCP data delaying your appt.

  • Suzi Q 38

    Welcome to my world.

  • guest

    Please help me to understand how an individual whose successful turnaround of Beth Israel Deaconess was featured as a case study in the HBR has somehow escaped being aware that health insurance companies have ZERO motivation (financial, moral or otherwise) to make their systems customer-friendly?

    I can only conclude that hospital administrators have Congressional-level health benefits, unlike us lowly providers and our long-suffering patients.

    • guest

      Also, since the Press-Ganey’s primary use appears to be to bully providers, there is no particular reason for it to address such piddling infrastructure issues as efficient use of the healthcare system.

  • maggiebea

    Thanks so much for getting these important observations into print in a high-readership environment. My insurance company has consistently asserted that the ‘only’ reason everything is so cumbersome is ‘regulatory requirements’. Since that also seems to be much of the problem with Electronic Medical Records, maybe we should find a better way to regulate?

  • petromccrum

    Just one more dysfunctional aspect of the healthcare system. Don’t know why anyone should be surprised.

  • guest

    A lot of the problems in our healthcare system can be traced back to something that is alluded to in the very first sentence of Mr. Levy’s piece:

    “Now that I am a “civilian,” I get to experience the health care system like most of you.”

    If our Congressional representatives had to experience much of what the rest of us have to as we interact with the healthcare system, we would all likely be much closer to meaningful reform.

    • guest

      Every chef should have to eat their own cooking.

      • Chris

        That is a perfect analogy.

    • gwen rothberg

      The federal employee exchange has been in place for years and most likely tackled these issues for quite some time, but the PP-ACA exchanges are not even open yet. A large part of these issues will be solved as time goes by. I would be more curious to see if there are intentional redundancies since the new law requires that 80% of every dollar be spent on actual care. Stay tuned.

  • ecb

    As a former president and CEO don’t you have some responsibility for this?