The following situations really occurred. Consider using them as a case study for quick discussions in staff meetings.

Handling out of the ordinary conditions:

Like many city hospitals, this one had a large, multi-story parking garage for its patients and visitors to use. On this cold winter morning, the garage elevator was not working. An employee was stationed at the entrance, and as people took their parking ticket from the machine, he briefly told them about the outage, and directed them to use the stairwell. He spoke so fast it was hard to be sure what he had said and he turned away to the next customer as soon as he spoke the words.

• What if the car contained people who could not use stairs, because of disability or having too much to carry?
• When you have a problem and have to implement a "Plan B," do you think through all the implications for your customers?
• What is your most common "Plan B" situation? How are you making sure you are meeting all your customers’ needs?
• Have you ever been guilty of giving an explanation or piece of information so quickly that an unprepared listener might not have been able to follow what you said?

Wait Times

The 88 year-old woman had been brought by her daughter to a new cardiologist for a simple pacemaker check. They arrived early to fill out the new patient forms. 45 minutes after the appointment time, the daughter asked how much longer it would be, and was told 40 minutes. She announced they would be leaving, as her mother was too tired to wait any longer. At that point, the nurse and receptionist came out and suggested the patient be rescheduled with a different doctor in the practice who "is always on time."

• Does your scheduler give advice to new, elderly patients about average wait times?
• What are your average wait times? Would your 88 year-old relative be able to handle them?
• Was there a better way the staff could have handled this situation?

Giving that "Little Extra"

Three women were out to dinner at a nice restaurant; The Capital Club in Pittsburgh. Shortly after being seated, one spilled an entire drink. The liquid was absorbed by the tablecloth and the few napkins the women put on the table. The server, Marjorie Simmons, was there almost immediately. Even though the patrons just asked for extra napkins, she cheerfully insisted on changing the tablecloth, asked for help from another employee, and the change was quickly made. She apologized for the inconvenience of changing the cloth, and had another drink brought almost immediately, at no charge! Throughout the evening, she could judge when the women needed help, and never seemed at all exasperated by their frequent questions. She acted as if she had all the time in the world for this table. Once she learned it was a special outing, she even brought a camera, took a picture, and printed three copies for the guests! Her behavior, as much as the food and drink, created a wonderful and memorable evening for her guests.

• What happens in your organization when a customer causes a problem like the spilled drink - whether it is a physical mess, a delay in getting information to you, or anything else? Are people annoyed? How do you respond?
• How cooperative are people in your work area when one employee suddenly needs help from another?
• Would your customers say you make them feel like you have enough time for them, or are you distracted during most of your interactions?
• Do the people in your department believe that the way they treat people matters as much as the treatment or task they complete?

The Patient's Point-of-View

The man was getting an MRI in preparation for cancer treatment. He had never had the procedure before. The tech did not give him any information about what to expect, how long the procedure would last, etc. A roll pillow was put under the patient's legs, which caused them to go to sleep and begin to spasm during the procedure. The tech chastised the patient for "moving your legs and ruining the picture," but simply tried to take it again without adjusting the pillow.

• What is your reaction to this case study? How do you think the patient felt?
• What improvements could have been made in this encounter?
• How do you know whether such types of things are going on during encounters with patients in your setting?

First Contact

A potential patient calls a doctor's office to ask questions about the practice. The receptionist has a warm and friendly voice, and answers the patient's questions patiently. He volunteers additional information he thinks might be relevant, and when he finds out the caller just moved to the area, welcomes her to his town. As the call ends, he tells her, "We’d love to welcome you to our practice," and encourages her to call and ask for him if she has any additional questions.

• What does a normal caller to your practice/department hear in your tone of voice?
• How do people in your department respond to questions from patients or internal customers?
• What other things could this receptionist have done to maximize the chance that this patient would come to them?

Keeping Patients Informed

A family arrived to visit in an infection-controlled hospital room. They were told to wash and gown, and did so. The elderly husband of the patient needed to use the bathroom during the visit, and did so in the patient's bathroom. When he flushed, alarms buzzed and lights flashed. The staff came running, and the elderly man, confused and frightened, stood with his hands up in the air saying, "I didn't take anything, I just flushed the toilet."

• What assumptions do we make about things our customers "know" about how we do business?
• How do we react when a customer violates one of our rules?
• How do we respond when a customer is obviously embarrassed by something they did not know about our norms?
• Does our failure to communicate ever make extra work for us?

The following situation really occurred. Consider using it as a case study for quick discussions in staff meetings.

The 57 year-old man had a heart attack. It came with no warning; there had been no hint of heart trouble in this mostly healthy patient’s life. Stents were put in, and doctors declared he should have a “full recovery.” He was told he would be scheduled for cardiac rehab, but in the meantime, should resume his life without doing anything “too strenuous.” Only when he and his wife pressed for examples, did they learn that meant 1 hour a day of walking, but no mowing the lawn, no dancing (his favorite activity), and no lifting over a certain weight limit.

• How often do we tell patients things like “don't do anything too strenuous” and assume they know what we mean?
• What are the consequences if they have a different idea in their minds from ours?
• Have you ever, personally, been given medical instructions that were not clear to you? Did you ask for clarification? If not, why not?
• How does this issue relate to the services your department provides?