Customers First and Systems Thinking

 A loved one was in hospital for better part of last 5-6 weeks. I got to observe many things having spent most of my time as primary attendant. This is one of the better known hospitals and does indeed have an impressive mission statement that aims to put the customer (patient in this case) first. Doctors are very good, nursing staff excellent, administrative staff are very helpful, so are the lowest rung of staff. 

One problem is that each set works within their own framework:

• No one knows what time does the Doctor would come for rounds. When they come, and they definitely come, they are very patient, answer all the questions etc., Because they can't or don''t want to stick to a committed time, planning things become difficult. 
• Due to specialisation, it is very common to hear "my part is fine, you need to check with X for that other problem". At one time there were 4 specialists taking care, but I wondered whether they talk and co-ordinate amongst themselves. Hope they were, but it wasn't apparent.
• Nursing staff have their own pre-defined timetable to check vitals, draw blood, give medication etc., It doesn't matter to them whether the patient has just slept, or having some pain or need something else etc., I have to plead with them to come some 30mins later as my loved one might be fast asleep having completely missed the sleep the previous night! Ofcourse they are understaffed and it becomes difficult during weekend and holidays. 
• Billing, Insurance and other admin related are in their own world. It takes about 7-8hrs from the time the Doctor approves discharge for the patient to get home. They need to complete billing etc., write a lengthy discharge summary, send it to insurance company and they have to approve etc.,
• Insurance companies do not go over the bill incrementally say once every 2-3 days or so, even if they are all available. Everything has to happen on the day of discharge. 
• I met with the PRO (yes they have one) and gave him multiple suggestions. Guess his job is to only say "great suggestion sir, I'll see how best I can implement" and really not worry about it.

While each actor is doing fine within their own specialisation, no one seem to care about how the system as a whole is working and how does it affect the customers (patients and attenders).

No need to pick just on hospitals. We see such a thing happening in best of the organisations. Every group thinks that they are indeed doing well and perhaps are when looked from a narrow angle of their own department. However the overall result may not be satisfactory. 

Many organisations want to put their customers first, respond to customer's needs, be customer centric etc., etc., But when the goal/intent gets trickled down the systems perspective gets lost. Someone at the top cannot fix it. It calls for every person in the chain to see whether their actions are in line what the CEO wants to achieve and whether they can be open to let go of their "authority" for the greater good of customer.