I was recently doing some home shopping in Target. It was peak time and fairly busy. After I was done, I walked towards the front of the store and approached the counter area to pay. But alas, there appeared to be hardly any manned registers. Lots of people were strolling up and down, trying to do the same as me: find a real person to help us check out. We were then informed that the store was trying to cut back on people at the cash registers, and instead, encourage people to use the “self-service” checkouts. There was a collective sigh. Most people, including myself, scurried to one of the nearest few manned registers, despite the line being longer.

So there I waited. I did not want the hassle of doing it all myself. I had both small and large items, didn’t relish bagging everything, and simply wanted my usual checkout experience. The same one that I have had for over ten years, and was very happy with. I waited patiently for my turn as the several people in front of me were served first. The cashier was visibly getting frustrated with having to deal with the long line and being left out to dry by the organization.

I left the store later than anticipated owing to this unexpected delay, and thought to myself as I was driving home: This experience shouldn’t really be a surprise. It’s typical of the standard corporate modus operandi that pervades many industries, and is probably happening all over America in other stores too. A relentless drive to reduce manpower and maximize revenue by any means possible, regardless of the effect on the customer. The mentality is all about the bottom line and making a buck. That experience at Target represents everything that the bad side of corporations stand for: cost-cutting, depersonalization, and inflating shareholder profit. Customer experience is always shoved to the side, on the road to achieving this. I have since been back to the same Target a couple of times, and I can report that the situation was not a one-off — and continues to happen. Not enough mined registers and a desire to make us “check out ourselves.”

Sadly, the corporatization of health care over the last decade has brought this same basic approach to medicine. We see it every day in our nation’s hospitals and clinics. The departmental mergers, the staff cuts, the loss of that unique personal touch. It’s all about factory-like processes and dissecting illness down to numbers. In all of this, guess who loses the most? Yes, the patient.

A few years ago, I was speaking to a colleague who was rapidly climbing the health care administrative ladder. I was talking about improving health care quality and the patient experience. He remarked to me how he found his meetings really interesting, shook his head and said very honestly: “You know Suneel, you really don’t realize … in the meetings all I hear the top level hospital people talk about is money, money, money. How can we cut things and increase profit? How can we make more savings and ramp up our numbers? I rarely hear anything about actually improving anything.” I will never forget the way he said that to me. In some ways, that’s what business is all about, so one can’t blame the MBAs of this world for doing what they’re trained to do — especially after we’ve surrendered control to them.

I am a big reader of biographies, particularly about society’s most successful people. There’s so much to learn from these folks. A select few business geniuses really do understand that the above is the wrong approach. I read Walter Isaacson’s book about Steve Jobs several years ago. Despite being a notoriously difficult person to work with (OK, let’s be honest, he sounds like he was frequently an ass to work with!), Jobs was amazing at always putting the customer experience first. In fact, he was obsessed with it. An Apple store without him, would probably look just like any other standard shop — crammed with as much sellable stuff as possible. Another business genius, who has much more humility, is Sir Richard Branson, founder of the Virgin Empire. His latest book, Losing My Virginity, is the best book I’ve read this year. He describes his whole fascinating life story and thoughts on how to work with people and run a big organization. It is clear that Sir Richard also totally “gets it” when it comes to putting the customer experience first and not focusing solely on profits and the bottom line.

I have a lot of friends and family who have worked hard and reached very high-level executive positions. Some have even founded companies themselves. I’ve also, of course, meet many other senior level people in my own work. I would say there’s probably a roughly 50-50 split generally between those who appear to understand the need to stay focused on the frontlines, and those who don’t. That’s not to say the ones who don’t are bad people. It’s just that they tend to lose sight of the fact that no organization is worth anything without this as the primary motivating force. Furthermore, out of those who do “get it” — the reality is that only a minority have the communication and execution skills to actually make a real difference. Eventually though, the right way of doing things usually always wins through in a competitive business environment (and in the long-term is actually much better for profits). It can just be painful to see things go wrong at first and the harsh lessons being learned.

I am cautiously optimistic we’ll come full circle over the next few years, especially in health care. We are going to eventually realize that a bloated administrative C-suite approach that focuses only on the bottom line, at the expense of patient experience (and good clinical care), is going to implode.

In the meantime, how can you help change things if you see situations like the one at Target? Well, one simple thing you can do is give immediate online feedback and write reviews about the suboptimal service you’ve received. Be ruthless about ensuring you do this! It’s often more effective than verbal point-of-contact feedback to someone who may or may not be able to take it further. You can be both polite and firm at the same time, while communicating the message succinctly. In today’s world, no company wants to receive bad feedback. Neither can any organization afford to ignore it.

The lesson for health care is simple: the patient must always come first. Yet it’s seemingly so difficult for many in the corporate world to understand. As soon as you become a back-end self-serving organizational behemoth — you’ve lost. Whether it’s Target or your local hospital, when those scales tip away from the frontline experience and towards that “spreadsheet and numbers” mentality, you’re going to be in trouble sooner or later.

Suneel Dhand is an internal medicine physician and author. He is the founder, DocSpeak Communications and co-founder, DocsDox. He blogs at his self-titled site, Suneel Dhand.

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