3 ms·

Actually, you can rely on the customers. They're the only ones that can tell you.

by malfist 3mo ago

lostlogin 3mo ago
> you can rely on the customers. Patient or customer? I even struggle with that, but I guess that’s what people are in a privatised healthcare system.
- munk-a 3mo ago
  Most of the folks here on HN are dealing with customer feedback in systems automation in one form or another - it's pretty unavoidable in this age of LLM trendiness. The customers of healthcare (in both private and publicly funded systems) are the patients. So while the term might not be super natural it's an understandable one to use.
  - datsci_est_2015 3mo ago
    Patients are not customers, or at least I don’t want to live in a world where patients are considered customers. Customers and vendors are usually more of a symmetric relationship: price transparency, alternatives, lack of urgency. These are all characteristics of transactions that healthcare often lacks.
    - markdown 3mo ago
      If the hospital is owned by private equity, the owners definitely think of the patients as customers. Doctors and nurses shouldn't, but the owners do.
      - Quekid5 3mo ago
        Lack of empathy tends to trickle down, alas.
        lostlogin 3mo ago
        I’m sure the AI won’t show that.
    - deejaaymac 3mo ago
      Customer, user, patient...it's all the same.
    - fn-mote 3mo ago
      The customer has more power than a patient. I definitely want to be a customer.
groby_b 3mo ago
But they don't want to, because figuring that out is your job as a supervisor. If you outsource that work to customers/patients, you'll end up with the car dealership model, where the sales rep begs you to give a 10 on every single question including on the interior design so they don't get fired. That's the part most of this discussion misses. Supervisors exist for a reason. Congrats on your flat org structure, you fucked up an important feedback channel.
- BeetleB 3mo ago
  > where the sales rep begs you to give a 10 on every single question including on the interior design so they don't get fired. Oh yes, and the nurses did employ strategies like that pre-LLM (don't know if they still do). They had to be very strategic about it (you can't just say "Rate me a 10.")
ak217 3mo ago
Yeah, this whole discussion cracks me up. I have a number of direct experiences with Kaiser nurses. They repeatedly got into arguments with doctors in front of me, tried to countermand doctors' instructions, ignored their patients, and complained to each other about their patients while they were right there. Repeated unprofessional behavior with no discernible change after trying to address it. My take is that the Kaiser nursing org has a serious discipline and customer (patient) focus problem.
- drknownuffin 3mo ago
  To one degree or another, this is endemic among nurses. It's part of a broader cultural element: nursing programs have entrenched a culture of nurses vs. doctors. There are literally questions on their licensing exam to the effect of "which of these orders from a doctor should you refuse to enact?" (rather than, say, "which of these orders should you contact the doctor to seek clarification on?" or some other collaborative take). Nurses are taught their job is to protect patients from physicians. Given they don't have the expertise to do that , the general result is more broadly a power struggle in the guise of patient care.
  - ak217 3mo ago
    I agree (with the obvious qualification that there are excellent nurses out there who do a great job and don't let this stuff get in the way of helping their patients, some Kaiser nurses included). But I also see a marked difference in behavior and outcomes in other hospitals I've been to. Yes, there are still some unprofessional nurses in those networks as well, but judging by the outcomes, the hospitals don't let them do damage.
  - fn-mote 3mo ago
    I think this is an unfair take. The necessity of teaching nurses that doctors orders are not sacrosanct comes from the bitter experience of doctors giving orders that are wrong. Asking for clarification is great, but doctors can be very reluctant to hear. The bottom line is that the nurse must not do certain things and the certification exam is there to make sure they know it. Think of it in relation to the “anybody can stop the assembly line” part of quality control.

Actually, you can rely on the customers. They're the only ones that can tell you.

by malfist 3mo ago

Actually, you can rely on the customers. They're the only ones that can tell you.

> you can rely on the customers. Patient or customer? I even struggle with that, but I guess that’s what people are in a privatised healthcare system.

munk-a 3mo ago
Most of the folks here on HN are dealing with customer feedback in systems automation in one form or another - it's pretty unavoidable in this age of LLM trendiness. The customers of healthcare (in both private and publicly funded systems) are the patients. So while the term might not be super natural it's an understandable one to use.
- datsci_est_2015 3mo ago
  Patients are not customers, or at least I don’t want to live in a world where patients are considered customers. Customers and vendors are usually more of a symmetric relationship: price transparency, alternatives, lack of urgency. These are all characteristics of transactions that healthcare often lacks.
  - markdown 3mo ago
    If the hospital is owned by private equity, the owners definitely think of the patients as customers. Doctors and nurses shouldn't, but the owners do.
    - Quekid5 3mo ago
      Lack of empathy tends to trickle down, alas.
      - lostlogin 3mo ago
        I’m sure the AI won’t show that.
  - deejaaymac 3mo ago
    Customer, user, patient...it's all the same.
  - fn-mote 3mo ago
    The customer has more power than a patient. I definitely want to be a customer.

groby_b 3mo ago

But they don't want to, because figuring that out is your job as a supervisor. If you outsource that work to customers/patients, you'll end up with the car dealership model, where the sales rep begs you to give a 10 on every single question including on the interior design so they don't get fired. That's the part most of this discussion misses. Supervisors exist for a reason. Congrats on your flat org structure, you fucked up an important feedback channel.

BeetleB 3mo ago
> where the sales rep begs you to give a 10 on every single question including on the interior design so they don't get fired. Oh yes, and the nurses did employ strategies like that pre-LLM (don't know if they still do). They had to be very strategic about it (you can't just say "Rate me a 10.")

ak217 3mo ago

Yeah, this whole discussion cracks me up. I have a number of direct experiences with Kaiser nurses. They repeatedly got into arguments with doctors in front of me, tried to countermand doctors' instructions, ignored their patients, and complained to each other about their patients while they were right there. Repeated unprofessional behavior with no discernible change after trying to address it. My take is that the Kaiser nursing org has a serious discipline and customer (patient) focus problem.

drknownuffin 3mo ago
To one degree or another, this is endemic among nurses. It's part of a broader cultural element: nursing programs have entrenched a culture of nurses vs. doctors. There are literally questions on their licensing exam to the effect of "which of these orders from a doctor should you refuse to enact?" (rather than, say, "which of these orders should you contact the doctor to seek clarification on?" or some other collaborative take). Nurses are taught their job is to protect patients from physicians. Given they don't have the expertise to do that , the general result is more broadly a power struggle in the guise of patient care.
- ak217 3mo ago
  I agree (with the obvious qualification that there are excellent nurses out there who do a great job and don't let this stuff get in the way of helping their patients, some Kaiser nurses included). But I also see a marked difference in behavior and outcomes in other hospitals I've been to. Yes, there are still some unprofessional nurses in those networks as well, but judging by the outcomes, the hospitals don't let them do damage.
- fn-mote 3mo ago
  I think this is an unfair take. The necessity of teaching nurses that doctors orders are not sacrosanct comes from the bitter experience of doctors giving orders that are wrong. Asking for clarification is great, but doctors can be very reluctant to hear. The bottom line is that the nurse must not do certain things and the certification exam is there to make sure they know it. Think of it in relation to the “anybody can stop the assembly line” part of quality control.