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Arun Hariharan

Health Care

Expert’s Blind Spot

‘Everybody knows this’ will never be true

Published: Thursday, January 2, 2014 - 11:15

Last week, I accompanied my father to an eye hospital to get his eye examined for a suspected cataract. The hospital examined his eye and confirmed the presence of a cataract. They recommended surgically implanting an artificial lens in his eye—a fairly common procedure these days for cataract treatment.

We were told that certain pre-operative tests would be required before the actual surgery. This included an eye sonography and a few other eye tests that were completed at the hospital during the same visit. All that remained were certain routine blood tests and an electrocardiogram (ECG), to confirm his fitness to undergo the surgery.

For the ECG, we were advised to visit an external cardiologist. As for the blood tests, my father opted to get those done by an external pathological lab (being 86 years old, this would save him some trouble, as this lab could send a technician to his home to collect the blood samples).

We decided to get his ECG done the next day, and the blood tests the day after. I phoned the cardiologist to tell him that the eye hospital had advised us to visit him. He asked us to come first thing next morning.

The next morning, we went to the cardiologist’s clinic about 30 minutes before the opening time, so that dad would be the first in queue and wouldn't have to wait behind other patients. After we had waited about 40 minutes, the cardiologist’s assistant arrived, opened the clinic, and called us inside. When we showed her the papers given by the eye hospital, we were in for a surprise.

She told us that we actually needed to do the blood tests first and then come to the cardiologist, who would see the pathological reports, perform the ECG, and certify the patient’s fitness for the surgery. Of course, what she said made perfect sense once she explained it to us. Nevertheless, we were a little irritated, given the trouble it meant to my aged father to make two trips for what should have been done in one.

I pointed out that neither the people at the eye hospital nor the cardiologist, when I spoke to him on the phone the day before, had informed us that the blood tests needed to be done before the cardiologist could do his part. While being quite sympathetic and polite about it, the lady told us that perhaps this was so obvious to the doctors, medical personnel, and the cardiologist that they presumed patients would know as well. “Everyone knows this,” she said.

However, the fact is that everyone does not know. Dad and I are examples of typical customers of the hospital, i.e., reasonably educated but unfamiliar with medical procedures. When the assistant said, “everyone knows this,” she was talking about people like herself, not the customers.

The eye-hospital medical staff and the cardiologist suffer from what I call “expert’s blind spot.” They were completely unaware of what may not be obvious to their customers and put us through some clearly avoidable trouble.

I am sure the eye-hospital example gets repeated every day in other industries. Perhaps you have experienced speaking to customer service agents who keep throwing jargon or acronyms at you, expecting you to understand their language. It doesn’t seem to have occurred to them that perhaps you don’t understand their language, that perhaps the customer is not an expert in their field. Come to think of it, why should your customer be an expert in your field? It is your business to be an expert in your field, not your customer’s.

Process for continuous improvement

Now mind you, this eye hospital is ISO 9001-certified. In fact, except for this glitch, their processes for serving the fairly large number of patients who came in struck me as quite orderly and efficient. This is one aspect that perhaps got missed when they originally defined their process. If this hospital believes in continuously improving their processes, they will now, based on this feedback from a customer, make “inform patients about the sequence of pre-operative tests” a mandatory step in their standard process. If, on the other hand, they do not have a culture of continuous improvement, they will forego this opportunity to improve their process and end up continuing to irritate customers. They may end up losing customers and revenue.

In fact, I believe that using such experiences as an opportunity to improve business processes should be a process in itself. In other words, continuous improvement must be a planned activity rather than an accident.

The customer can see the expert’s blind spot

In the eye-hospital example, if the hospital had run their process by a few customers (patients or their relatives), chances are that the customers would have pointed out the gap in the process. This is because the customer can do something that the hospital (and perhaps its ISO consultant) could not do—which is to simply look at the process from the customer’s point of view. It has been my experience while helping quite a few companies in designing their business processes, that running the proposed process by a few customers often quickly brings insights that people inside the company could not see. Oftentimes only the customer can see the expert’s blind spots.

So, if you want to find out if your process has an expert’s blind spot, all you need to do is to go ahead and ask your customer. Don’t assume that what is obvious to you is obvious to your customer. Revise your standardized process to ensure that the customer receives the information they need when they need it, however obvious it may seem to you.


About The Author

Arun Hariharan’s picture

Arun Hariharan

Arun Hariharan, author of Continuous Permanent Improvement (ASQ 2014), and The Strategic Knowledge Management Handbook (ASQ 2015) is a strategic quality, knowledge management (KM), and performance management practitioner with nearly three decades of experience in these fields. He has worked with several large companies and helped them achieve substantial and sustained results through quality and customer focus. He is the founder and CEO of The CPi Coach, a company that provides partnership, consulting, and training in business excellence and related areas. Former roles held by Hariharan include president of quality and knowledge management at Reliance Capital Ltd, and senior vice-president of quality and knowledge management at Bharti Airtel Ltd, India. He is a frequent speaker at quality and KM events around the world. He is also the author of more than 50 published papers on quality and KM.


Will the hospital learn?

You could call it "expert's blind spot" or "bad process" or "lack of customer focus." 

I wonder if they will learn from this miscommunication? I'm sure it must have happened before...

In my work with hospitals, I've found that healthcare professionals, unfortunately, find it far too easy to blame the patient.

If the client is not a mindreader, beware.

A very important and often neglected quality issue, thank you for writing an article about it. The example with your dad illustrates nicely how seriously the hospital ruined a client experience by a "small" oversight. To inform you about the requirements would have taken them a few seconds, and best of all, it wouldn't have cost any money! I think that almost every organization on the planet needs to be aware of this. The funny thing is that this "small" issue is not easy to fix, it requires a profound culture change that has to be honestly and actively encompassed by the organization and by every individual.