Emergency Room Customer Service

I imagine that, in an environment of tight budgets, limited staff and increasing demand, those involved in managing emergency rooms in today’s hospitals don’t have many spare cycles to consider the customer service aspect of what they do: if someone’s arm is falling off, or their heart has stopped, it’s probably a good idea that they’re focused on that, and not on the magazines in the waiting room.

And, if my eight hour experience in the Queen Elizabeth Hospital emergency room on Friday was any gauge, that’s exactly what they’re doing: focusing on the care, ignoring the service.

I was there because my family doctor sent me there: I’ve had a nagging cough for a month, and I was worried, waking up with a heavy chest, that it had migrated into pneumonia. It turns out that it hadn’t, something I learned after a 7 hour wait followed by a 3 minute consultation with a doctor and a quick chest x-ray. The wait itself didn’t bother me (okay, it did; but I understand the wait, and was happy to have babies with the croup triaged in ahead of me).

What was frustrating to see, as someone who cares about service design, is how small changes to the physical layout of the waiting room, the signage and the registration process could result in significant impacts on the “customer friendliness” of the process.

One example: on entering the emergency room I was faced with:

• a volunteer-less volunteer desk
• a large stand-up display marked “STOP” and instructions for what to do if I thought I had the flu
• a whiteboard with directions to walk-in medical clinics elsewhere in the city

There was, however, no suggestion, through signage or otherwise, as to what I should actually do on arrival. I wandered, at random, over to a window that said “Registration” and sat down, only to be told that I needed to go and “sit on the green couch and wait to be called.” Which I did. Ten minutes later I was waved over to the “Triage” window and given a number and told to go back to “Registration” and register. Which I did. I was then sent with a sheaf of paper back to “Triage” and told that I would be called. Thirty minutes later I was called in, had my vitals taken, and was sent back to the waiting room and told I’d be called back “when a spot opened up.” Seven hours later a spot opened up.

Again, I don’t dispute the seven hour wait, but as someone sick and exhausted and thinking he might have pneumonia, the first hour of the process, with its mysterious dance among windows seemed designed to confuse and perplex me. Even if the process itself cannot be re-engineered, simply informing me how it works immediate upon entry would go a long way to reducing stress.

Ironically, while I was waiting for my “spot to open up,” CBC’s [[Compass]] came on the television in the waiting room and aired a story about a plan to install “wait-time monitors” in the self-same waiting room. While this would certainly help, I’m not convinced that it really gets to the root of the issue, for I can’t imagine that the current process was designed by people with any notion of what it’s actually like to be an emergency room customer, and it’s only when that happens that the process and the approach to service can really be changed for the better.

This is hard to do: it’s almost impossible for people “on the inside” to see customer service from a customer’s point of view. Hospital administrators cannot arrive in the emergency room with fresh, naive eyes. And so what appears, to we customers, as a confusing maze of process likely appears well-laid-out and completely logical to them, especially if they’ve optimized the logistics for staff efficiency and not for customer service.

Certainly medical outcomes have to remain at the forefront, and I’m not suggesting that the doctor who treated me needed to be friendlier or should have spent more time with me. But I’m convinced, after having spent 7 hours watching people arrive in the emergency room and take on the same glazed look of confusion that I did, that by listening and watching customers, and by engaging someone with an eye to service design, medical outcomes could remain paramount but the front-end of the process could be redesigned with clear, up-front, customer-focused information and systems that would decrease confusion, reduce stress, and make putting up with the necessary wait times more bearable.