Ian Morrison

I grew up in Britain, in the Basil Fawlty school of customer service-customer as scum-which probably explains my low-level Maslowian view of most service businesses. I don’t need to self-actualize at my bank, I just need them to clear the checks I write (yet even this they find challenging).

All services should at least meet the basic Maslowian need of safety. Safe schools, safe airlines, safe hospitals should be a goal. The brilliance of the patient safety movement was that it set up a discussion of the lack of systems in health care by appealing to the most basic of needs. Great service companies like Charles Schwab or Starbucks have great systems (the information systems and the organizational capacity) to deliver consistent quality.

Beyond safety, most of us look for competence. Is the technical quality there? That’s harder to judge in health care-how do we know if our doctor does it right? Despite all the scorecards, most of us judge on subjective factors. Many patients in surveys claim to have changed doctors because they were dissatisfied with quality. It probably was not based on systematic analysis of the technical quality of the care, more that the physician didn’t connect with the patient, didn’t spend enough time with them, didn’t seem to care.

Comfort and convenience matter. The physical environment of health care is often intimidating, and caregivers are so harried they often don’t have time to make the patient feel comfortable. But why do we agonize over the nursing shortage and not over a bank teller shortage? Because banking has redesigned itself, with ATMs, to serve customers more efficiently. We have not redesigned health care delivery to maximize quality, customer service, and caring.

Caring is the key part of the health care experience. I am not talking about an affable bedside manner. I don’t want an excessively cheerful surgeon, kneeling by my bedside saying “Hi, I’m Bob. I’ll be your surgeon today.” God forbid that we turn the bedside into the same insincere, way-too-perky, customer service we get in chain steakhouses.

I want caregivers who recognize that I am vulnerable. No matter how smart, well informed, and empowered I may be as patient, friend, or family member, when I come in contact with the health care system I am frightened, anxious, and in pain.

Health care systems need to transform health care delivery to match the best in breed of the service industry in safety, competency, and consistency of customer service. But as we embark on the grand redesign of health care over the next 20 years, let us not neglect the caring part of the health care experience. We need to reduce medical errors, but we also need compassion, connection, and concern.

Ian Morrison is an author, consultant and futurist based in Menlo Park, California. A shorter version of this editorial was published in the September/October 2001 Issue of the Health Forum Journal.