Insights November -0001

Can't Get No (Family) Satisfaction...

Neil Seeman

Everyone, it seems, has their favorite Four Seasons customer satisfaction story. Here's mine: my mother was babysitting my niece (6) and nephew (4) one evening last summer in Toronto and, having exhausted all other hotel room entertainment, suggested they fill out the customer satisfaction card.
"You really should have bathroom toys for kids. You have crayons and little cars in the restaurant, but nothing for us to play with in the bathtub," they wrote (and signed their names). The next morning after breakfast, my brother's family came back to the room to find the tub filled with splashy toys - and the children's names spelled out on the sides in bright foam letters.

With health provider eyes focused on "patient-centredness," we often neglect family centredness. Part of this may have to do with the changing notion of "family" itself. In his Breakfast with the Chiefs presentation on caregiver burden and trends, healthcare strategist Adalsteinn (Steini) Brown noted that nuclear families declined 18% from 2001; the 2006 Census found there were three times as many single-person households (26.8%) as households with five people or more (8.7%).

That traditional families are morphing into different forms should make family satisfaction more important. As family supports fray - perhaps owing to divorce or physical distance - providers need to offer a user experience that embraces the patient as something more than an autonomous unit. Being sick is lonely enough; it is lonelier when the experience is alienating to one's family members.

We are not paying sufficient attention to family-centredness. There are about four times as many Google Scholar references to "patient-centred care" than "family-centred care". There are five times more Google references (80,000) to patient satisfaction surveys than family satisfaction surveys (16,000).

My colleague Karen Born educated me about a few pioneering organizations now measuring family-centred care - notably, the Dana Farber Cancer Institute in Boston and the Cincinnati Children's Hospital.

Others have observed how important family-centredness is in critical care. Nursing compassion is important to worried families in the Emergency Room, just as much as is the respect shown to the patient and, importantly, pain management for one's family members. Families care about the atmosphere in the waiting room and the frequency and human touch of physician communication.

Family-centredness is important when caring for the elderly. When seniors move into a nursing home, they say goodbye to the physical immediacy of family. The adjustment, by definition, affects the whole family.

A family orientation is important in mental health. Principles to guide the provision of family support in mental health practices have been proposed. These include: facilitating the family's tasks; supporting the stability of family members; enriching family involvement and interdependence; partnering with families and empowering them; embracing family diversity; and providing support to vulnerable families.

Four Seasons knows this. Anyone who has traveled with children knows that sleep-deprivation is conducive to stress, illness and frustration. Immediate attention to a family's needs is therefore preventive medicine - and good public relations.

A new book on Four Seasons tells the story about how Isadore (Issy) Sharp re-invented the hotel industry. Thanks to Four Seasons, we pretty much always expect fluffed pillows and packaged soaps at the most basic motel. With its origins as a single motor hotel in 1961, Mr. Sharp developed his vision into a high-class, world-wide, customer-friendly empire with 83 hotels in 35 countries.

Mr. Sharp has written a book about his secret sauce for making Four Seasons work: every employee enjoys the power to solve service problems as they arise without asking anyone's permission. That's how a Four Seasons chambermaid jumped on the request of a childishly scrawled consumer satisfaction card she found under the bed of one of her rooms and made one family very happy.

About the Author(s)

Neil Seeman is Director and Primary Investigator of the Health Strategy Innovation Cell at Massey College, University of Toronto.


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