Black Jet Theory – Volume 2020-23 – What’s Up with Chick-fil-A? December 4, 2020

Black Jet Theory – Volume 2020-23 – What’s Up with Chick-fil-A? December 4, 2020 by Marshall Snipes

Periodically, we take our grandkids to the local Chick-fil-A restaurant to pick up dinner.  Since the pandemic, only carry-out orders are permissible and, accordingly, we go through the drive-thru lane.  Chick-fil-A is always crowded both before and since the pandemic.  But something interesting happens, regardless of how long the line is, and sometimes it backs up for blocks. The process moves quickly and efficiently attended to by a group of school aged, energetic young people who have been taught the value of good customer service.  I always leave happy and amazed.

The food is consistent and good enough that there always seems to be a line regardless of the time of day.  I’ve often thought, what do those folks know that the rest of us have missed.  Why in healthcare do we not understand the real meaning of customer service?  There are those who will contend that the delivery of health care is far more complex than serving a fast-food meal, and I do not disagree.  But there are many lessons that can be learned from Chick-fil-A.  S. Truett Cathy, the founder of Chick-fil-A said it best –

“We should be about more than just selling chicken.  We should be part of our customer’s lives and the communities in which we serve.”[1]

I am not suggesting that there aren’t really good healthcare workers who are dedicated to their craft, who show up every day, perform good work and save lives.  There are millions of examples every year in the United States of positive outcomes, success stories and changed lives.  But all of that good work has been performed historically in an environment that is not built around the “patient” as a “customer”, where the goal is good customer service.  In the end, the Black Jet Theory would suggest that good customer service results in good outcomes whether it’s chicken sandwiches or cancer surgery.  

At Chick-fil-A, it’s not just about selling chicken, it’s about being part of their customers’ lives.  In healthcare it should not just be about providing fee-for-service sick care, but it should also be about helping patients live healthier lives and more efficiently taking care of them when they do get sick.  There’s a feeling when you are at Chick-fil-A, that somebody cares.  There’s someone standing outside waiting to help – last week in freezing, sleeting weather. It’s a friendly atmosphere with everyone is welcome.  In healthcare we tell our patients to show up at monolithic campuses, especially in larger cities, where parking is difficult, and a map is needed to find your destination.

Many hospital systems and physician practices have dramatically improved or at least attempted to improve the patient experience through on-line scheduling, remodeled waiting rooms and other attempts to improve the environment.  Chick-fil-A doesn’t just satisfy hunger, it strives to be part of people’s lives by providing healthier food and a friendly environment.  Likewise, healthcare providers should not just provide sick care, but should strive to be part of people’s lives by helping those patients to live a healthy lifestyle.

There are two primary barriers to make this happen.  First, the current fee for service model that the healthcare industry predominantly operates under, does not allow the opportunity to be like Chick-fil-A.  The reimbursements from the insurance companies and other payors are based on a rate system that doesn’t allow the healthcare provider adequate incentive to spend time with a patient to explore healthier lifestyles.  In most cases, payors don’t cover the kind of costs that serve to assist the patient in those healthier lifestyles.  Payors have been slow to cover mental health costs, for example.  Yet we now know that mental health and physical health are intertwined and treating one without the other does not yield long term healthier results. And the cycle continues.

Second, the existing culture, systems and processes have historically been built around the doctor.  The patient will, in the future, begin to act like a consumer.  Once competing healthcare providers begin to address consumerism, others will follow.  In their book n=1 How the Uniqueness of Each Individual is Transforming Healthcare, the authors wrote,

“Access to information is accelerating the desire of people to act, behave, and be treated as unique individuals.  In virtually every other aspect of their lives, individuals have choices and options, which is increasingly true in healthcare.” [2]

Until the processes that individuals deal with become consumer-centric, and until the information individuals have at their disposal is transparent and understandable, good customer service continues to be difficult.

What’s the answer? As we have mentioned in previous Black Jet Theory articles, the healthcare industry has been discussing for years the transition from a fee for service to a fee for value model.  That transition has been slow to gain traction.  It would seem to the Black Jet that it’s quite possible that transition will take many years, if ever, to accomplish.  Many believe that we will never eliminate fee for service, even in a fee for value environment.  In a fee for service model, the healthcare provider is rewarded for the number of encounters and procedures that are performed, a perverse incentive to “do more”.  In a fee for value model, the healthcare provider is rewarded for results.  

Some would argue that the fee for value model also provides a perverse incentive to “do less”, similar to the problems, years ago, with the HMO model.  However, it would seem those problems have been addressed in current thinking and that required quality thresholds or measures must be met.  Again, with a focus on the individual health status of the patient.  The Black Jet would suggest that the sooner healthcare delivery payment systems are converted to fee for value and, correspondingly, the culture is converted to a patient-centric model, the sooner incentives would be aligned to allow for good customer service.

Until then, we can only watch Chick-fil-A with envy.

Don’t take my word for it, think for yourself.

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[1] Chick-fil-A website.  https://www.chick-fil-a.com/about/who-we-are

[2] Koster J, Bisbee G, Charan R. n=1 How the Uniqueness of Each Individual is Transforming Healthcare. Published by Academy Press in association with Prospecta Press, Westport, CT January 2015.