The Satisfaction Struggle

The Satisfaction Struggle

The Problem With Patient Satisfaction & Small Business

When you own a small business, you live and die by customer satisfaction. You work hard to do right by your clients because one bad review can hurt just as much as one excellent referral can push your business to the next level. In medicine though, a nurse quite often is on the opposite end of that patient satisfaction scale. Advocating for what is right for the individual does not always mesh with what that individual really wants. Many nurses working in hospitals have received complaints, harassment, and even death threats from patients regarding their care, when in reality nurses were acting in the patient’s best interest (like not giving more pain medication than prescribed, or waiting until the correct time to give medication, instead of giving it earlier at the request of the patient). Relying solely on patient satisfaction to drive medically related situations is reckless and dangerous, both for the patient and the provider. They say patient satisfaction is killing us, and while I have written about this in the past, I have not really touched on its relevance when small business and medicine are combined.

Patient Satisfaction

Client Centered Care

Last year I worked with someone in a situation that dealt with the above issue. I was to advocate for them as a nurse, ensuring that their health wishes and needs were heard and respected. They had a complicated health history, which required multiple visits to gather the information needed to allow me to do my job to the fullest extent. After many conversations, I was told by a family member that while they appreciated my work and that I was fulfilling exactly what they needed and expected, they also wanted me to spend more time chit-chatting so that I could establish a friendship with the client.

Oh, the conundrum. As a small business owner, I want our clients to feel safe and happy, and I often say we are a “one-stop-shop” for their home health needs. But as a nurse I have a deeply ingrained drive to act professionally, drawing boundaries to prevent against overfamiliarity and conflicts of interest. As a medical practitioner, I often times need to give unpopular direction, like recommending not to take all of your pills with vodka, or, perhaps that drinking 2 liters of soda before you go to bed at night is what is keeping you up, so let’s try not doing that, okay? Friendship blurs the line of respect for the professional, and you run the risk of losing impartiality and authority, resulting in more “no’s” to answers, rather than “I guess I could try that option today”. More dangerously, the introduction of this non-professional facet can result in non-professional behavior and expectations, which can get all parties involved in trouble.

A Dissension of Duties

Another important aspect is that as a nurse and small business owner, I am being paid to do a job. You are compensating me to provide you with personal care and nursing care, and to act as an advocate. When I am working for you, you are actively agreeing to spend money every minute I am providing a service – I cannot morally justify ceding valuable time to anything other than providing you the very best service possible. Some may argue that “small talk” is part of the service, and if an individual wants to pay for this, then so shall it be. But unfortunately, all too often we now see in the news reports about seniors being taken advantage of, especially in advocate and guardianship situations. Unprofessional behavior and the lack of transparency that often goes along with it can quickly put vulnerable people into precarious situations. John Oliver recently did an excellent exposé (which was expertly finished by two of my favorite seniors, Cloris Leachman & Lily Tomlin), in which he describes this ever-growing issue in the United States. If you have time, it is definitely worth the watch (see below!).

But all funny jokes about hippos aside, this is what is at stake for those who have others acting on their behalf. And while I am not randomly stepping into people’s lives and taking charge (like in the above segment), as a nurse I am being asked to accurately and safely advocate for clients. I would always rather run the risk of being too professional and doing what I was hired to do, versus falling into a morally gray area, both putting myself, my practice, and my clients at risk. And this is often times where patient satisfaction and medical morals are at odds. I believe that the key to this issue is education, both for the professionals and the clients, whether they are in a hospital or home setting.

Often times feelings of frustration on both sides lead to a break down in communication, which leads each party feeling like the other is acting foolishly or maliciously.  Transparency in both your intentions as well as your reasoning (i.e. when I step foot in your home, I will efficiently use our time together to achieve our common purpose, because this is what you hired me to do and any action besides that compromises my role as your nurse) every step of the way is the best way to maintain that oh-so-valuable client/small business relationship. Home health care can be a difficult tightrope to walk, but open communication gives balance to both sides of the conversation, which is critical when time, money, and relationships are involved. And ultimately, honesty is always the best policy, whether you are in business or in medicine!

Home health nurse and wearer of many hats in sunny Santa Fe, New Mexico.

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