Customer Service Can Be Taxing

Gwen B. Turnbull, RN, BS, CETN

Today is tax day--April 16, 2001. This year it's one day later than usual because April 15 was a Sunday and the post offices were closed. Every American citizen, whether resident or ex-patriot is required to have local and federal income tax forms postmarked by midnight tonight. Period. No excuses. And this has been the case since the federal income tax laws were established many decades ago. All day today and until midnight tonight, every procrastinator--that's one in three Americans--and those who are hanging on to every minute and every cent of interest they can squeeze out of the money they owe Uncle Sam--or borrow it!--are driving, walking, biking and grumbling all the way to the nearest United States Post Office (USPO). Like Cinderella, 40 million of us will flock to Post Offices and mailboxes today until the twelfth strike of the clock tonight. Forty million people.

Every good citizen . . . should be willing to devote a brief time during some one day
in the year, when necessary, to the making up
of a listing of his income for taxes. . .
Representative Cordell Hull, 1913

I've just come back from my local post office. I stood quietly in line for 45 minutes to get my tax returns postmarked and sent by certified mail. Cars were double-parked in the parking lot outside, and the line of people extended out the front door and halfway around the building. I love to watch people, so I spent my time in line observing the postal employees and their customers. The first thing that struck me was that each of the three of the windows was manned. Usually, only two of the windows are open. "Wow, that's great," I thought, "this won't take long." But my elation was short lived. Upon further scrutiny, I realized that only one of the employees was a "regular." And I was further horrified to see a struggling new employee-in-training at the third window. My smile turned upside down. A supervisor of some sort was standing next to her, observing her transactions and teaching her the proper procedure for each operation. This duo took twice as long to take care of one customer as a "regular" employee. I saw at least four more employees come out from "the back" to chat, laugh, borrow a pencil, or drop off something to those working at the windows--totally oblivious of the throng of poor taxpayers standing in line. "Oldies but goodies" blared out of a loud speaker over my head. At one point, one of the operators simply walked away from his window for about 20 minutes--reducing the number of active windows to two--actually, more like one and one-half. I thought I heard a collective groan as he disappeared, but I couldn't be sure--I couldn't hear over the Beatles.

From what I've been reading about the United States Postal Service (USPS), it sounds as though things aren't going very well for that branch of government. Mind you, I live outside of Philadelphia's home of Benjamin Franklin, first Postmaster General under the Continental Congress in 1775--so you'd think the Post Offices around this area would have the kinks worked out by now. Apparently, though, the USPS is expected to show a $2 to 3 billion dollar loss this fiscal year--that's billions of your tax dollars you worked so hard all year to pay today. According to their Website, the Post Office blames this loss on an increasingly competitive marketplace, wage rate increases that exceed the rate of inflation, escalating fuel costs and forecasts calling for the diversion of some first class mail to electronic alternatives. Does this sound familiar to you healthcare professionals?

Let me get this straight. The Post Office is in trouble and losing money. Competitors are outperforming the Post Office and making profits. The USPS knew that 40 million tax forms had to be postmarked by midnight today. I have one question--OK, several. Why weren't all three windows operating at full tilt today with qualified, efficient, experienced employees who could project one ray of interaction and cheerfulness to its already downtrodden customers? Why would any Post Office supervisor in his or her right mind choose one of the busiest mail days in the US to train a novice employee? That's like manning the emergency room with a team of student nurses on the day a tornado is predicted to strike. Whatever happened to ". . . nor gloom of night stays these couriers from the swift completion of their appointed rounds."--especially the swift part? Now I know the true meaning of 'snail mail.' What does all this tell me, the customer, about how I am valued by the USPS? A lot. Bottom line is they don't.

Trying to occupy my mind and keep my anger under reasonable control for the time I was in line, I began to ponder how this mismanaged Post Office branch would fare if it were reorganized and supervised by private enterprise. FedEx^TM popped into my mind as a benchmark of efficiency, customer satisfaction, and a total understanding and appreciation of customer needs. I should have called FedEx and they would have come to my office to pick up and deliver my tax returns. I could have met the deadline and still had the ability to track my delivery without standing in line or waiting. Would it have cost me more? Yes. Would the increase in cost have been worthwhile? Absolutely. By the time I drove to the Post Office, waited in line, and drove home, I lost two productive, revenue-producing hours of my time. I would have lost zero hours if I had used FedEx. All of this clearly tells me that FedEx knows their customers' needs and values their time. It is called customer service.

So what does this have to do with healthcare? Well, from where I sit, it's the same story. We're all operating in an increasingly competitive marketplace. What will differentiate us from our competitors is our understanding and appreciation of our customer's needs the quality of care we provide, and the expertise and professionalism of those who deliver it. In this ever-evolving healthcare delivery system, we may find that customer satisfaction and customer service may be the defining edge for those providers who survive.

Earlier this year, the Institute of Medicine (IOM) issued a devastating report by an expert panel about the quality of our nation's healthcare. It pointed out that our citizens should be able to count on being the recipient of care that uses the best scientific knowledge to meet their needs. Sadly, for many people, the system remains an intimidating maze that prohibits them from receiving the care from which they would truly benefit. The report goes on to illustrate that the system "harms too frequently and routinely fails to deliver its potential benefits."

Let's put this into a wound, ostomy, and continence perspective. No one can deny that the need is there. In wound care, for example, five million people in our country currently have a chronic wound and it is estimated that 1.1 to 1.8 new cases occur annually. About 120,000 new ostomy surgeries are performed each year, increasing the existing population of 450,000 Americans living with an ostomy. Approximately 13 million Americans suffer with urinary incontinence, a number expected to grow exponentially as our population ages. And yet, who is providing the care to these staggering numbers of patients and what is the quality of care they are receiving? Do each of these people receive the care they need and deserve?

Untrained, non specialized providers are the ones rendering the bulk of wound, ostomy and continence care in nearly every healthcare setting in our country. Current practice parameters continue to be based on tradition and habit without a bedrock of scientific evidence or even expert opinion, despite the existence of such guidelines and data. A lack of comprehensive wound, skin, ostomy, and continence care protocols across the continuum denies access to these patients, whose lives are comprised economically and socially, and who could benefit from state-of-the-art care that does exist.

Of all debts men are least willing to pay the taxes.
What a satire is this on government! Everywhere they think they get their money's worth, except for these.
Ralph Waldo Emerson

Just like the USPS, the American healthcare system is struggling and faltering--both economically and in the way it serves customers. Both systems suffer from a lack of coordination and comprehensive services that result in wasteful duplication and unaccountable gaps in service. American healthcare customers are American citizens who are spending more per person, per year than individuals in any country in the world. American healthcare customers are not pleased with the services we are providing or the price they must pay for them. Customer voices are getting louder and stronger. The American healthcare system needs to listen to customers in order to understand their needs. healthcare professionals must work together and encourage teamwork to make patient needs and preferences the centerpiece of care.

1 Institute of Medicine (IOM). Hurtado M. P., Swift E. K. , Corrigan J. M., editors. Envisioning the National healthcare Quality Report, Committee on the National Quality Report on healthcare Delivery. Washington, DC: National Academy Press, March 30. 2001.

2 Tallon R. Critical paths for wound cares. Advances in Wound Care. 1995;8(1):26-34.