Tuesday, November 13, 2012

Why things don't work

Why are government and business often so poor at customer service? The short answer is that the folks who run things are never on the receiving end. Many examples come to mind:

Every so often when I buy a product, it comes in a package that makes it exceedingly difficult to get out of the package. In some cases you may break the product trying to extract it the package. Clearly the packaging is poorly designed.

This tells me something about the company. It tells me that the CEO or CFO never buys his own products. If the CEO or CFO ever tried opening one of these packages, he’d see to it that the packaging was redesigned.

On a related note, if you’re the boss, and you make a phone call to some department in your company, you’re not going to be put on hold.

Most of us, when we call a corporation or government agency, have to navigate a labyrinth of menus within menus. Then, when you finally get the right number, you will be put on hold for 20 minutes, during which you’re reminded every minute by a prerecorded voice that “your call is very important to us.”

That tells me something. People who run the business or government agency have never tried to call their own business or government agency. They wouldn’t put up with that for a moment. The process would be streamlined if they found themselves in the situation of a customer.

Likewise, the boss never has to wait in line at his own business or government agency. They don’t even go to the head of the line. Rather, they’re just whisked through.

Can you visualize the CEO or CEF of an airline having to check his luggage, run the gauntlet of airport security, sit at the gate with the rest of the lumpen, then stand in line to board the plane?

Or take the ER. For those of us who’ve had to take someone to the ER, have you ever noticed the glacial pace of hospital staff. There’s something about the culture of the medical community that fosters lethargy. The patient’s time means nothing to them. They take 10 hours to do a 90-minute job.

But suppose the Dean of Medicine landed in the ER. Do you suppose he’d have the same experience? Hardly!

Life would be a lot more efficient if we demanded of those in charge that they put themselves on the receiving end of the process. Imagine if a newly elected president directed his cabinet officers to personally dial all of the public numbers of their agency.


  1. Sadly, I expect things to be worse for patients and physicians in the Emergency Department thanks to Obamacare.

    Of course, many physicians can simply stop accepting Medicare patients. However, emergency physicians don't have that choice. They have to see everyone and treat all patients who come into the ED due to EMTALA (well, excepting Indian Health Services hospitals and VA hospitals).

    Given Obamacare is going to add somewhere between 30-50 million more people under insurance, many of whom will be under Medicare and Medicaid and the like, and given in all likelihood more primary care and specialist physicians will stop accepting Medicare and Medicaid patients, I think it's quite possible more patients will arrive in the ED since there won't be too many other places available for them to go in order to see a physician.

    Worse, if EDs become overcrowded, and if emergency physicians are pressured to take care of more patients in shorter periods of time, then it's possible more mistakes will be made by ED staff. Quality of health care might be compromised.

    All this is in addition to the fact that Medicare reimbursements to physicians have been cut 29.5%. So doctors who are paid via Medicare will be reimbursed this much less, give or take. I wouldn't think the POTUS and the politicians who voted in Obamacare would be all that happy if they had to take a 29.5% pay cut in addition to having to attend to seeing 30-50 million more of their constituents in a given time frame while performing all their other duties.

    Anyway, in the end, it's plausible emergency physicians and perhaps other staff lose out, as well as patients.

    1. Also, each year adds more people eligible for Medicare. How many baby boomers who hit age 65 will use Medicare in the years to come?

      There's currently already a projected shortfall of doctors as well. This will only be exacerbated under Obamacare. After graduating from med school, we have to do a residency in a specialty (e.g. emergency, family medicine, pediatrics, internal medicine, surgery, radiology, pathology). Med school enrollments have increased. But not so residency spots (at least not by the government; at least as I understand it private teaching hospitals can pay for training spots themselves).