AORN JOURNAL MAY 1993, VOL 51, NO 5

Editorial

Skilled perioperative care is not enough-customer service is a must

he 1990s may well go down in history as T the decade of customer service. Supermar- kets no longer have customers-they have guests who require assistance with shopping. Colleges, which used to frown on older stu- dents, now market weekend certificate pro- grams to “mature individuals” in the workplace. Health care facilities now look upon patients as customers who wield significant power as con- sumers. Like it or not, modern health care is a business, and in the business world the cus- tomers’ needs are the driving force.

What do today’s customers want from periop- erative nurses? Technical competence? Academic knowledge? No, they assume these skills and knowledge are part of the basic service package (ie, a surgical procedure) that they pur- chase. What perioperative customers really want is information and evidence that we care about them and their families. Compare routine periop- erative nursing care with the leading satisfaction factors that 139,830 surgical patients identified in a recent poll.

Staff concern for patients’ pri- vacy. When we negotiate bank loans, our discussions take place in private offices. Yet, frequently, we conduct preoperative patient interviews in crowded, noisy hold- ing rooms where everyone can hear the intimate details of our patients’ lives. Staff sensitivity to the inconve-

nience of hospitalization. Cost- effective surgical care depends, in

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part, on procedures beginning on time and rooms being turned over as rapidly as possible. To avoid delays for the surgical staff and to achieve cost-effectiveness, we routinely ask patients to arrive at hospitals hours before their procedures are scheduled. This practice, which seems logical to hospital staff members, may not be the best customer service approach in today’s competitive health care market. We do not enjoy waiting for service at the airport, the supermarket, or the auto repair shop; our patients do not appreciate lengthy preoperative waiting periods.

Adequacy of family briefings on patient condition, treatment. Family members of patients undergoing surgery understandably are anxious. Brief, simple, limited nursing inter- ventions (ie, intraoperative progress reports) can reduce family members’ anxiety. Over half of all surgical procedures are being performed on an outpatient basis. These same-day surgery patients often require family members’ assis-

tance to carry out postoperative care instructions. Our attention to family members is a customer service that may improve their ability to under- stand discharge instructions, which ultimately may affect patient out- comes.

Nurses’ attention to patients’ per- sonal, special needs. Some of our surgical customers have special needs. Children, the elderly, and those with sensory impairments all

Beverly P. Giordano require special attention during the

AORN JOURNAL MAY 1993, VOL 51, NO 5

perioperative process. Some impairments and special needs may not be obvious, but they are important to a patient’s overall surgical experi- ence. Many years have passed, but I still remember and appreciate a nurse anesthetist’s special effort to explain the surroundings, equipment, and procedures that were taking place as I lay awake on the operating bed, “visu- ally impaired” by not having my contact lenses.

Nurses’ friendliness. Holding rooms, operat- ing rooms, and postanesthesia care units may be familiar surroundings for professionals, but they are frightening, foreign territories for our surgical customers. If you ever have been stranded in an overseas airport, you can remember how grateful you were to encounter a friendly person who spoke your language, answered your questions, and provided reassur- ance. Our surgical customers are travelers in an unfamiliar land, and they, too, welcome friend- ly smiles and reassurance.

Nurses’ information about tests and treat- ments. Today’s patients are assertive con- sumers. They want accurate information about their treatment, and increasingly, they look to nurses for this information. A nurse-patient who was scheduled for a laparoscopic proce- dure called the surgery department’s service leader to ask about the method used to process laparoscopes. Learning that the hospital’s pro- cedure did not meet AORN’s standard for high- level disinfection, the nurse-patient then obtained and relayed to the service leader the manufacturer’s processing recommendations. While not all patients may be this assertive or knowledgeable, we must be prepared and will- ing to provide appropriate answers to their questions.

Viewing patients as customers requires a sig- nificant shift in thinking that does not come easily for many health professionals. When patients become customers, the traditional rela- tionship between the “dependent patient” and the “all-knowing professional” takes on a con- sumer/supplier nature. As patients assume the customer role, they begin to ask questions (eg, cost of procedures, alternative treatments) that make us uncomfortable.

I can relate to this discomfort. When the ini- tial whispers of “customer service” f is t circu- lated in my previous ambulatory care practice setting, 1 was angry that my highly developed teaching skills, my master’s degree in nursing, and my specialty certification no longer were sufficient to meet my patients’ needs. Now I had to answer their questions about factors that, to me, smacked of program marketing, some- thing that I found alien to the nursing role.

I was not alone in my reaction to this trend in health care. When I returned from a national meeting eager to share the “new” concept that patients should be viewed as “clients,” my col- leagues were aghast. To say that the idea met with resistance is an understatement. The physician-director of our practice nixed the concept with one tight-lipped statement: “Attorneys and accountants have clients-we have patients.” If I still practiced in that group today, I probably would toss the “patient-as-a- customer” grenade and run for cover!

We may not be comfortable with viewing our patients as customers, but we cannot stop this trend. What we can do is measure how well we are meeting our perioperative customers’ needs. This issue of the Journal contains some landmark perioperative nursing research on assessment of patient satisfaction with care. Sit back, read, enjoy, and learn what our customers want.

BEVERLY P. GIORDANO, RN, MS EDITOR

Note

think,” Modern Healthcare 22 (June 1 , 1992) 44. 1. Press, Ganey Associates, “What patients

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