In modern healthcare, we are told that the patient is a “customer.” While making patients feel comfortable is important, there is a potentially dangerous side to this “Customer Service” trap in healthcare that many nurses are hesitant to discuss: Does prioritising a patient’s happiness actually compromise their health?
There are instances where hospital management responds to incidents by directing abusive language at nurses when patients misbehave or conflicts arise. This often stems from the prevailing belief that “customers are always right,” even when such attitudes unfairly place blame on healthcare workers. And this could undoubtedly lead to the Second Victim Phenomenon
What is customer service?
According to Oracle, Customer service refers to the assistance an organization offers to its customers before or after they buy or use products or services. Customer service includes actions such as offering product suggestions, troubleshooting issues and complaints, or responding to general questions.
The HCAHPS Pressures
Most hospitals are now tied to HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems). These are surveys sent to patients after discharge, and the results directly affect the hospital’s reimbursement.
On the surface, it sounds great; hold hospitals accountable for quality! But in practice, it puts nurses in an impossible position. If a patient is angry that they weren’t allowed to eat before surgery (NPO status) or frustrated that you woke them up for vital signs, they might give the hospital a “poor” rating.
To a hospital administrator, that’s a lost “star.” To a nurse, that’s just providing safe care.
READ ALSO: Beyond Nursing Burnout: Is It Exhaustion or Moral Injury?
The Tension Between “Happy” and “Healthy”
Nursing is often about doing the things that don’t make people happy in the moment:
- Checking a neuro patient every hour.
- Denying a diabetic patient a sugary soda.
- Forcing a post-op patient to walk when they just want to stay in bed.
When we treat healthcare like a service industry, we create an environment where the “customer” feels empowered to ignore medical advice. This leads to Decision Fatigue for nurses. If you are constantly being graded on how “nice” you are, you might feel subconsciously pressured to stop pushing for the difficult interventions that actually save lives.
The Safety Risks
One of the most researched dangers of the “Customer Satisfaction” model is its impact on prescribing practices. A landmark study in JAMA Internal Medicine found that patients with the highest satisfaction scores actually had higher mortality rates and higher healthcare costs (Fenton et al., 2012).
Why? Because patients who are “highly satisfied” are often those who were given exactly what they asked for, whether that was unnecessary antibiotics for a viral cold or higher doses of opioids for chronic pain. When a nurse or doctor says “no” for the sake of safety, the “customer service” rating drops.
Reframing the Relationship: Patient as Partner, Not Customer
Nurses and other healthcare professionals need to move away from the Customer is Always Right mentality and back to the Professional-Patient Partnership. A customer buys a product; a patient enters a therapeutic relationship. In a retail store, the goal is to satisfy a craving. In a hospital, the goal is to restore health. Those are two very different objectives.
How Nurses Can Navigate the Customer Service Trap in Healthcare?
As a registered nurse, below are some things you can do to navigate this hurdle when attending to your patients.
- Explain the “Why” Early: Instead of saying “No,” explain the clinical risk. “I know you’re hungry, but if we give you food now, it could cause a life-threatening complication during your procedure.”
- Separate Comfort from Care: Focus your “service” skills on things that don’t compromise safety, like a warm blanket, a quiet room, or a listening ear, while remaining firm on clinical boundaries.
- Advocate to Management: Remind leadership that high HCAHPS scores shouldn’t come at the cost of nurse morale and patient safety.
Conclusion: The “Customer Service” Trap In Healthcare
When we treat patients as customers, we devalue the expertise of the nursing profession. We aren’t waitstaff or hotel concierges; we are highly trained clinical advocates.
True “Patient-Centred Care” isn’t about giving someone everything they want; it’s about having the courage to give them what they need to go home healthy.
References:
- Fenton, J. J., et al. (2012). The Cost of Satisfaction: A National Study of Patient Satisfaction, Health Care Utilization, and Mortality. JAMA Internal Medicine.
- Lichtman, J. H. (2015). The Role of Patient Satisfaction in Outcomes. Journal of the American College of Cardiology.
- The Danger of Satisfied Patients (The Atlantic, 2015)
