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  • Writer's picturePaul DeChant MD, MBA

Do Patients or Care Givers Come First? It Depends…

For the past twenty years, most health care organizations have had a Patients First initiative.  While it seems intuitively obvious that the customer of the health care organization should come first, this initiative, when pursued without a deep understanding of the care process, can result in unintended negative consequences that lead to burnout for physicians and nurses.


The most serious consequence is cynicism among care givers (the doctors, nurses, technicians, and assistants) who are already stressed out, feeling over-scheduled, overburdened, and underappreciated.  The thought of being asked to do more, particularly by an administrator who is perceived as not understanding the realities of patient care, can leave the care givers feeling as though no one cares about them.  This is a recipe for burnout.


And if a Patients First program is implemented by holding an internal or external “Patients Come First” marketing campaign, the care givers are right.


Should Patients Come First . . . or Second?


One reaction to these campaigns is a movement known as Patients Come Second that works to ensure care givers’ needs are being properly addressed up front.  I have some concerns about this as a tag line. I’ll explain.


In my five years as CEO at Sutter Gould Medical Foundation, I started most meetings by asking, “Who is the most important person at Gould?”  It was gratifying to hear my team respond that the patient is the most important person. 


After all, without patients we would have no reason to come to work, no opportunity to fulfill our professional or personal goals, and no revenue coming in to pay our salaries.  Clearly the patients are the most important persons.


Then I would ask, “What is the most important thing that we do for the most important person?”  People would agree that taking care of our patients was most important.  Indeed the most important thing that happens in our work as clinicians is the healing interaction that takes place between a care giver and a patient.  And care givers included anyone who directly interacted with a patient, whether on the phone, at a check in desk, in the exam/hospital/procedure room, or anywhere else that interactions take place. 


Every interaction has the opportunity to be a healing interaction, giving the care giver the opportunity to reduce pain and suffering, relieve anxiety, provide solace, and/or educate and promote better health. In other words, an opportunity to put patients first.


While I have had tens of thousands of healing interactions with patients over the decades of my career as a family physician, when I was CEO I no longer directly cared for patients.  My role had changed. I was no longer doing the most important thing for the most important person in my organization.


It was my job to support the care givers, to ensure that they had everything that they needed to provide the best possible healing interactions with every patient every time.


The Role of Healthcare Administrators and Care Givers


So while the patient is the most important person, the care givers need the most support from management.  This is a crucial distinction.  The “Who comes first?” question has to be answered differently depending on the role of the person answering the question.


For care givers, the patient must come first, for the reasons discussed above.  Patients are reason for our work.  Care givers care for patients.


For administrators, the care giver must come first. Patients are still the reason for our work, but administrators rarely provide healing interactions to patients.  They provide care indirectly, through our front-line care givers.  Their job is to take care of the caregivers, with as much commitment, concern, and compassion as care givers have for their patients.  It is our responsibility.


I’ll ask the question again.  Who comes first?  For care givers, it’s their patients.  For administrators, it’s their front-line care givers.


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