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.


Johnny Rukavina's picture
Johnny Rukavina on March 14, 2011 - 14:26 Permalink

Well said, and surprisingly restrained considering you’ve lost eight hours of your life that you’re never gonna get back. Whats disappointing to me is that I thought the move to the new ER facility would provide an opportunity to take a fresh look at the “customer service” end of things, but anecdotal evidence suggests its worse than it was before. Sigh. Note that this is not a criticism of the doctors and nurses (who have been consistently great in all of my visits to the ER) but more of the process. Its like a poorly run business with a great staff.

AnonymousRN's picture
AnonymousRN on March 14, 2011 - 21:17 Permalink

But should ‘customer service’ be a focus in the EMERGENCY room? It depends on how you are defining customer service. Make it more user friendly, yes. Improve communication, clarify and streamline the registration process so that patients get efficient and appropriate care. Absolutely. But priorities should be emergency medical care.

Clark's picture
Clark on March 15, 2011 - 10:04 Permalink

You are far too polite — a 7 hour wait with little to no idea as to when you will be seen or what condition you may have is under normal circumstances inexcusable. The system is broken.

Everything you have described indicates to me that they should just hang a sign thats says, Go Away.

Lori's picture
Lori on March 15, 2011 - 13:09 Permalink

Couldn’t agree more. I especially like the above comment that “It’s like a poorly run business with a great staff”.
Dare I suggest this entry (or a form thereof) be run as an Op Ed piece in The Guardian?

Peter Rukavina's picture
Peter Rukavina on March 15, 2011 - 13:39 Permalink

You may be right. But&#160”fixing a broken system” is a much more difficult design and engineering challenge than “improving customer service in a broken system so that it’s less injurious to its customers.”

kara's picture
kara on March 15, 2011 - 15:23 Permalink

Why didn’t your family Dr. give you a requistion to obatin a chest X-ray at the radiology department. You could have bypassed the emergency room.
That is what my family dr. did when I was suffering from the same chronic cough

Peter Rukavina's picture
Peter Rukavina on March 15, 2011 - 17:42 Permalink

That’s a good question. I imagine that it’s because to give me a referral for an x-ray would have required that I come into the office, and that’s precisely (I except, due to capacity concerns), what my family doctor was trying to avoid.

Peter Rukavina's picture
Peter Rukavina on March 15, 2011 - 17:44 Permalink

For “emergency” medicine, obviously.

But the “emergency room” plays double duty: it’s also “outpatients” – that’s where I was directed by my family doctor’s nurse – which I take to mean “the place you go when you can’t wait a week to see your doctor, but for things that aren’t actually an emergency.”

kara's picture
kara on March 15, 2011 - 19:25 Permalink

Yes but if he knew you were sick with a chronic cough it would have only been a few mins of his time to fill out a form and …..you will know for next time! or get a new family Dr.

Peter Rukavina's picture
Peter Rukavina on March 15, 2011 - 19:35 Permalink

9:00 a.m. conversation:

Peter: Hi there. I’ve had a persistent cough for the last month and woke up this morning and it seemed to have moved into my chest and I’m wondering if I could see someone about it today.

Receptionist: Let me take your number and I’ll pull your chart and call you back.

Noon conversation:

Receptionist: I pulled your chart and the doctor looked at it and given your symptoms he suggests you go to outpatients.

That’s the sum total of my family doctor’s involvement in the case. I’m not sure what I should had said or done to make things work differently.

p slade's picture
p slade on September 1, 2012 - 06:18 Permalink

The reality to this post is that a cough for a month is NOT an emergency. If your physician sends your to an ER for a cough that is a month old;maybe you should change physicians to one who takes your condition more seriously. As a healthcare seeker, you must be proactive with your health needs and shop around sometimes. We have to remember that health care entities are businesses first and foremost and patients are consumers. You always have a choice in how your services are delivered to you. Patients wait for up to 24 hours in the Canadian health system for ER care at times unfortunately.

There is a total abuse of the ER system-people use the service as the primary care and take “spots” from those with more emergent issues.