Sunday, January 6, 2008 and Organizational Trust

In yesterday’s New York Times, Joe Nocera reports how Amazon rescued his Christmas. The story has lessons for health care organizational ethics.

Nocera had ordered a PlayStation3 for his son, but on December 21 he found that it had gone astray. Amazon was not responsible for the problem – a neighbor, who had signed for the package, left it in a public space from which it was stolen – but Amazon nevertheless got another PlayStation3 to him by Christmas Eve.

Nocera rhapsodizes about Amazon’s determination “to be the most customer-centric company in the world.” He describes how the company has chosen a strategy of “long term value creation” rather than chasing the short term return on investment that Wall Street demands. That strategy has created extraordinary customer loyalty and trust in the Amazon brand.

Amazon is doing what individual clinicians and health care organizations need to do. Without trust, treatment goes nowhere. Without customer (patient) loyalty, organizations go down the tubes.

Nocera attributes Amazon’s ability to resist the short term focus that grips publicly owned organizations to founder Jeff Bezos’ vision and commitment, but also to the fact that Bezos is Amazon’s largest single shareholder. This has made it easier to accept lower current profits for trust-building activities like solving Nocera’s PlayStation3 problem.

Amazon went beyond what its narrow contract with Nocera required – what ethicists call “supererogatory” action. We need to do the same in health care. Excellent clinicians and excellent organizations know that.

The problem with for-profit ownership is not the quest for profit per se, but the short term focus that dominates market behavior. Nocera's story is remarkable for the fact that most of the trust-building interactions were on-line. The only human exchange was on the telephone with a customer service agent. Amazon's blend of high tech/high touch interaction with its customers provides us with a model of how health care organizations can comport themselves to build and hold trust.

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