Technologies and Compassionate Care

The customer’s always right: Tensions and Opportunities in the Privatization of Care

What do you look for in a company when you are searching for a service or product? We have all had the experience of being a customer, and we can likely all agree that as customers, we’d like to be satisfied and treated well whether we are purchasing a product or receiving a service or advice. Nowadays, “the customer is always right” motto has found its way into healthcare. This is especially true for privatized care in which patients are positioned as consumers of healthcare.

Many healthcare services in our Canadian healthcare system require patients to pay out of pocket. In my own profession of audiology, I have watched as our adult (and increasingly even infant and child) hearing care system has transformed from a publicly funded sector to primarily privatized care. As a result of these changes, hearing care professionals face new challenges in the delivery of care. A clinic in which performance is evaluated by generated revenue resembles a retail business. In today’s climate, audiologists are faced with the challenge of meeting their employers’ demands for sales while ensuring optimal patient care. This system requires a nuanced balancing of patient needs from an audiological perspective, patient needs and wants from the patient perspective, the employer’s expectations, and the profession’s obligations to ethical and accountable practice.

In the context of healthcare, the first thought of a profession with commercial/industrial interests is the potential barriers that those interests pose to the enactment of person-centered care. This is partly true because, for example, since the de-listing of audiology from Ontario Health Insurance Plan (OHIP), the majority of private audiology revenue comes from dispensing hearing instruments. While many clinicians and clinic owners may value person-centered care, some, may place a greater emphasis on the sale of products than on person-centered hearing care.

However, the philosophy of the “customer is always right”, which is becoming the new norm in today’s privatised healthcare, may actually support clinicians to remain person-centered despite what one might think at first glance. A sale orientation may present ethical tensions, but also promotes a desire to satisfy the patient, perhaps more so than a system in which the patient has little choice (cannot “shop around” for another clinician).

Succeeding and surviving in a very competitive and commercialised atmosphere demands a retail-minded approach to service delivery in healthcare in which the customer is always right. Although commercialised interests may pose a conflict of interest, many audiologists do not necessarily view them as barriers to person-centered care and may work with and around marketing strategies to turn them into person-centered opportunities.  For example, a clinician who is required to make follow up phone calls to her/his clients who have not purchased hearing instruments , may seize this sales tactic to instead provide person-centered follow ups. Therefore, instead of framing this as a telemarketing type of phone call, some clinicians may use the opportunity for another person-centered interaction.

However, the ability to traverse tensions in a commercialized healthcare industry and take advantage of the “pleasing the customer” approach to enact person-centered care requires a clear ethical conviction. Complying with organizational policies related to commercial interests does not necessarily mean that clinicians are violating ethical principles. Although clinicians may not openly challenge the status quo of the challenges imposed by privatized healthcare, they may be creatively resisting and persisting to provide person-centered care in response to the dynamic and complex care context.

About the author

Dr. Laya Poost-Foroosh

“Critical Social Approaches to Supporting Person-Centered Care in Audiology” …

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