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Wednesday, July 13, 2011RSS Feed

Do Nice Guys Finish First When It Comes to Health Care?

We've all had them. Those patients who, for whatever reason, are less than cooperative and not who one might classify as a pleasure to treat. Does this influence the level of care we give, our attitudes, or the ways in which we treat these particular patients? There's been much discussion on this subject and it's the focus of a recent article, Do Nice Patients Receive Better Care?, which appeared in the July issue of the Journal of the American Medical Association (JAMA).

Do nice patients get better care than others? That's a complicated question. As physical therapists we are on the front lines of patient care. Interpersonal relationships and close, one-on-one interactions with our patients are simply a part of what we do. Everyone is unique; we're all products of our own backgrounds and distinct experiences.

Now, I know we've all dedicated ourselves to delivering the highest quality care to our patients without regard for the variables that are part and parcel to individual personalities. The fact is, however, that we're only human and it is in our nature to respond to hostile or grumpy folks. The authors of the JAMA piece agree and conclude that "clinicians are human and subject to the influence of bias." They go on to suggest the development of methods for addressing the existence of bias to ensure that professional standards are consistently met.

The good news here is that we're ahead of the game with our Move Forward branding initiative. You've probably heard this before, but the brand is about more than just educating consumers and other health care professionals about who PTs are and what and how they treat. It's about providing patients a 'total experience' that includes not only excellent health care, but also a higher level of professionalism, organization, workplace cleanliness, efficiency, and overall quality. Once they’ve learned about us and decided that a physical therapist is the right person to see, we want them to have an outstanding experience - every time. Call it the 'Starbucks Effect.' When you go to Starbucks, you know you're going to get a consistently good cup of coffee whether you're in New York or Shanghai; large city or small town.

Based on consumer research, APTA has developed the core professional behaviors that make the Move Forward physical therapist. They are basic, simple and can be found on pages 8 and 9 of the Users Guide to the Brand located on the site, which is the place where all members-only information and tools related to the branding campaign are kept. These brand behaviors serve as a perfect guide to help us prevent personal biases and opinions from creeping in and affecting the way we handle one patient or another.

I suggest to you that if we all take a moment to learn more about the brand and adhere to the core behaviors, messages, and principles then we will be much more likely to deliver that consistent 'total experience' to all patients, regardless of who they are or how they behave.

Let me know - what do you think?


  • Posted by R Scott Ward at 4:12 PM
  • Labels: In the News


To think every patient will receive a Starbucks effect is crazy! First... APTA doesn't own a single clinic. This means APTA has zero control in day-to-day operations/experiences. Secondly, very, very few physical therapists are members of the APTA. This means non-members have zero access to member only information. How in the world is it reasonable to even come close to creating a Starbucks effect across the nation?
Posted by Selena Horner on 7/14/2011 8:05 AM
That's unfortunate that Selena had such a negative response to this blog. Even though APTA does not own a single clinic the goal of the PROFESSIONAL association is to help us become the best that we can be and exemplify the highest of standards. Not every therapist is a member, true, but there are thousands of us and positive (as well as negative) behavior is contagious. If the 1 or 2 (or hopefully more) therapists in a clinic who ARE members share this information and demonstrate it they can have a real influence and it can spread. Having a difficult patient can be frustrating. We all get them, and it's difficult to put our emotions aside and just stay focused on patient care. It's nice to know we are not alone in dealing with this problem and that there are tools available to help us. Thanks!
Posted by Rosalia Arellano on 7/14/2011 9:32 AM
Whether or not we can achieve a "Starbucks Effect" within our profession is dependent upon (1) how we define our objectives, and (2) how we approach the unification of our profession. If our "Starbucks Effect" is to look like a nation of PT's all wearing the same color, greeting patients with a common script, and offering the same menu of services whether across the street or across the nation, we've got our work cut out for us and I would tend to agree with Selena's comment. However, if our "Starbucks Effect" (i.e., our brand objectives) are defined to embrace our diversity while putting standards in place to ensure quality and value under every roof (the only real purpose behind brand building), then I think we're on exactly the right track with the Move Forward campaign. To my understanding, there's nothing within the essence of the campaign that intends to replicate or clone our professionals, services, facilities, or value. The defined brand behaviors (professional, entrepreneurial, inspirational, and knowledgeable), if embedded within PT's from coast-to-coast, will enhance, not detract from, the personality, style, and flavor of care that we are all so passionate about. So, how do we approach the unification necessary to achieve our own kind of "Starbucks Effect?" I think this already has a great start with the message and tools behind the Move Forward campaign. I would suggest that of the most important audiences that are the target of the campaign, we focus on (1) academic leadership, (2) students, (3) corporate and organizational leadership, and (4) our PT's on the front lines. While I'm not sure that these are necessarily in order of importance or sequence, I do think that focusing on our future early on is as important as it is easy. Students, free from bias, are likely to be interested and accepting of brand concepts that will lead to future successes. Focusing next on corporate and organizational leadership can allow for local and regional oversight of the professional standards associated with our collective brand. Lastly, and of ultimate importance, our front line PT's must represent the brand behaviors in their daily encounters in order to truly live the standards that are envisioned by the Move Forward campaign. It is difficult to create even the smallest of "Starbucks Effects" for a company of any size, and doing so within a profession of thousands of professionals is daunting. Having said this, I do believe it is possible given the right vision, leadership, and communication strategy.
Posted by Tannus Quatre -> >JUa@M on 7/14/2011 6:40 PM
Cudos Tannus! Well said. I like to think that the PT world is progressive and strives for efficiency and positive outcomes. I think it takes a bit of creativity, leadership, and guts. Yes there should be a standardized base, something to keep us striving for excellence. As Tony Robbins said 'C-A-N- I' Constant And Neverending Improvement... Consistency with evidence based practice, but the guts to try new improved techniques. Whatever it takes to give a quality product (ourselves) to our customers. A clinic may not be able to afford the latest equipment, but we can give the best of ourselves. WE are our brand. The collective PT's and PTA's. Like a couple of dancers, moving in unison, complementing each other. (I like to think that anyhow!:O))
Posted by Polly on 7/15/2011 2:28 AM
Hi friends, it is a wonderful blog.i came here willingly to know the at the moment topic, posting by polly is marvelous "As Tony Robbins said 'C-A-N- I' Constant And Neverending Improvement... Consistency with evidence based practice, but the guts to try new improved techniques. Whatever it takes to give a quality product (ourselves) to our customers. A clinic may not be able to afford the latest equipment, but we can give the best of ourselves. WE are our brand. kudos to you friends i am great full to one and all who are really helping to abate the sufferings of fellow human, Physio therapist is God sent guide to the one who is impaired, medicine helps, but the magic hand of PT'S heals the patient. keep it up friends last but not the least i am from India, and my wonderful daughter has a burning desire to pursue her Post graduation-DPT, can some one guide me regarding the top universities that are offering DPT.please friend if you care to share some of your precious moments , you have touched a life with HOPE. thanks in advance keep Moving Forward with respect & gratitude easwaran India
Posted by easwaran on 7/18/2011 11:02 AM
I saw this blog late. Interesting that I recently found an article on this very subject and copied and pasted it to print it out for those I work with because we seem to get our share of grumby gus's also. For the life of me I do not remembger the site or author; my appologies if they read this - I'm not selling or saying I wrote it - it is just a good read. Some people will always be unhappy because they are negative people. They lack the ability to look at a situation and see the good in it. When presented with a challenge or critique they see it as a sign that they’re doing something wrong, not an encouragement to do better. Some people are grumpy because it’s easier sometimes to be grumpy. It seems to take less energy. Once you start being grumpy everyone expects you to be grumpy so then you have less expectations to live up to. It can make for an easy life. Everything in the news at the moment seems designed to depress us. Even people whose jobs are not affected by the economic climate still seem to be grumpy. It’s almost as if you’re made to feel bad for being happy at the moment. If you are in a job the chances are your boss is using the recession as an excuse to get longer hours and harder work out of you, often with no extra financial compensation for it, by holding the threat of redundancy over your head. Now that’s enough to make anyone unhappy. The best ways to tackle these negative feelings are through getting yourself in a positive frame of mind in the morning, lots of exercise and time outside in the sun, and socializing with people who make us happy. Some of us are just unhappy and grumpy because we’re waiting for the sun to shine!!!!! A goodly number of my patient's are sent to me because they are in pain and this pain is hindering their ability to move. I don't know about you but when I have pain (the unrelenting dull tooth ache won't go away no matter what orthopedic kind)it is a chore to tell a funny joke with the desired affect. Anybody can treat the happy camper who seems to sail along in life on flowery beds of ease and is so grateful that their surgery went well and they can't believe it doesn't hurt. I am not introducing a debate here regarding manual therapy and/or other technical skills as a therapist. Have you had the patient who sits down during the initial evaluation and the first thing they say is, "I don't know why the doctor sent me here, therapy doesn't help, I am never going to get better because my knee has been this way for 30 years and besides, what are you going to different than the last 5 therapists?" I'm thinking "move foreward!!!" I don't know why but I love these patients. It is so rewarding a few visits later when it almost "pains" the patient to admit that they feel better. Each person is different but eventually I find something that perks them up and capitalize on that. It is true for some they will just find a way; "Well my knee does feel better but now my elbow and foot hurt and my neighbor still has that obnoxious dog!" As the song says, "Let the sun shine!" Although I make better coffee than StarBucks, I can't imagine NOT being a member of the APTA. To our President I say, "This is a nice challenge and well worth our thoughts and consideration." "Grumpy" just may be another symptom. I can't imagine mine or any other profession that would not strive to be the best, most efficient, highest quality, "most" professional, satisfying, kind and caring as well as performing at a high skill level tryng to achieve an excellent outcome for every client. I love what I do so this comes naturally but on a basic fiscal note; it is a very competetive health care areana out there. The public has a lot of choices; I want them to choose me (physical therapy) - word of mouth is invaluable - even the "grumpy guy" will tell an acquaintence about you when asked; if you "did them right."
Posted by Jeffrey LePage -> =IUZ?H on 8/4/2011 2:14 PM
I completely agree with Mr. LePage’s opinion in that I view working with these particular patients as a challenge and opportunity to embrace and exhibit our mission as therapists and the profession as a whole. I personally feel that we have all entered this profession with the desire and ambition to help others regardless of the obstacles that arise. As a PT student in my second year, I can say that the curriculum and expectations for us as practitioners is held to such high standards and reaching and maintaining these expectations is a huge challenge by itself. If we all continue to strive for excellence and quality as we have done throughout our educations, this attitude and approach will continue to carry over to our patient care. We need to take these opportunities to show these particular patients what exactly distinguishes us as a profession and as practitioners. Dedication, desire, determination, discipline, and diligence are the “5 D’s” that I strive to embody throughout by educational career. I will continue to encompass these characteristics while working towards playing a huge role in the health care industry and as a professional. Regardless of a the patient and their demeanor, we need to maintain professionalism and excellence as we continue to provide outstanding and essential care.
Posted by Hilary Albright -> AHY^?F on 9/12/2011 10:36 AM
hey ,I am a physiotherapist from India.I would like to share my experience from India.Here the patients are of different religion.There socioeconomic status,language of communication is different.Even the physio come under different categories,some physio came from different state to see patients of different state.People likes to take treatment from the physio who can communicate with them in there language.Patients here have difficulty in changing there habits, occupation, modification in there activities.Here patients are still not aware of importance of physiotherapy.There is always bias in treating patients.Patients who is compliant ,get benefited from physiotherapy intervention.
Posted by Pritesh Patil on 12/20/2011 8:04 AM
The idea of having the star bucks can be possible. despite patients from different backgrounds can become challenge, especially if the lack of understanding is not there. I believe that the more language that each care giver knows, can lead to a great start. Personalities traits can correspond to if a patient is treated the right or wrong way. An implement of simple language terms could be helpful.With a diplomatic approach towards all patients from different countries, state, cities, and towns a sigh of respect is key to making the "Starbucks Effect" a go process in APT development.
Posted by Samuel Sanya -> AIV]CK on 3/31/2012 8:00 PM
In the health care profession, there is panoply of patients with dealing with different functional limitations and the emotions that they bring into the office varies. As professionals, offering a better service to people with more positive mood levels is easy but finding a deeper level of empathy for patient who unresponsive or ill-behavior seems like the only answer. The Starbucks effect sounds like a great idea but the last thing a patient needs is one-stop place a single service as if it was a franchise fast food restaurant.
Posted by Paul Jean -> ANT\DJ on 4/8/2012 4:06 PM
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