While we can’t please all of the people all the time, any goal short of 100% is unacceptable

For those of you lucky enough to hear Dr. David Feinberg give the closing keynote at The Beryl Institute Patient Experience Conference 2011, you heard a story of an organization with a clear commitment to patient experience. I was struck by the clarity with which Dr. Feinberg stated the mission of UCLA Health System – Healing humankind one patient at a time, by improving health, alleviating suffering, and delivering acts of kindness. While Dr. Feinberg reinforces that UCLA may be the only healthcare organization that incorporates kindness into its mission, I am also struck by the essence of this mission with its focus on “one patient at a time”.

Since my On the Road visit to UCLA I have been churning with this idea of what one patient at a time truly means, so it is only fitting that in another encounter with Dr. Feinberg something he shared helped me frame this in a way that should cause anyone committed to improving patient experience take pause.  In a new era of measurement where scores will equate to dollars, it seems there is new motivation to address patient experience issues. The challenge I think this continues to raise is that scores do not equal people.  Dr. Feinberg challenged this very notion by stating that his commitment was not to achieving percentile improvement, but rather percentage improvement.

Ah-ha!  This is where one patient at a time truly lives and should live for any of us committed to the highest quality, safest and best service-driven care. Percentages are the people themselves, percentiles becomes faceless statistics that will eventually numb us to what we committed to in the first place. We cannot let a new focus on scores actually pull us farther from our mission of care. This is something Dr. Feinberg was clear in sharing, that in looking at percentages, nothing less than 100% is acceptable.

Now I can already hear my friends in healthcare administration roles around the world asking me, Jason haven’t you ever heard the quote “You can please some of the people all of the time, you can please all of the people some of the time, but you can’t please all of the people all of the time.”  While the quote has been attributed to many, namely Abraham Lincoln (who it was noted used the word “fool” where “please” has been substituted), it raises the very issue that in healthcare we are dealing with human beings.  We are unpredictable and curious creatures that are driven both by personality and habit, yet influenced by the things that happen around us in any moment.

So how can I suggest and support Dr. Feinberg’s assertion that nothing less than 100% is acceptable? Easily. In healthcare we are, and must be, about one patient at a time. Experience is not a generality found in statistical comparison; rather it is found in the eyes, smiles and hearts of the patients, families and support networks we provide experiences for every day.  We do this not for our scores and dollars, though this now incentivizes us to act with greater vigor. We do this for those individuals who put their trust in us that we will give them our greatest of care, attention and service, as we did for the person in the bed, outpatient suite, exam room or waiting room that came just before them and who will follow.  If we play the game of numbers, while we may retain some short-term financial viability, we all lose. And while we will still not please all of the people all the time, our patients deserve nothing less than our commitment to 100%.

Jason A. Wolf, Ph.D.
Executive Director
The Beryl Institute