By Andrew Szabo, Managing Partner, Positively Outrageous Service, Inc.


What Are Patients’ Major Peeves With The Healthcare Profession?

Most of us who have been a patient at one time or another. What’s the connotation of a patient? The number one frustration? Waiting … waiting … waiting. “They don’t respect my time.” “Overbooking patients and then making everyone wait to see the doctor.”

Number Two. Poor communication. Not listening. Unclear explanation of the problem. Inability to hear the patient. “I am frustrated when doctors don’t listen to what you are telling them. As a patient and not a doctor, I don’t have the same vocabulary you do so that I might ramble a little. But if you dismiss my concerns and slap me with a diagnosis, without actually taking the time to listen to the complaint, I lose trust in you.”

Number Three. 

Patient care is not the same as caring for a patient. “Everyone was competent. Patient care was not the issue; sadly, there were only a few staff members where I felt cared for.”

This is not love …

“Doctors have one eye on the patient and one eye on the clock,”[1]

It’s not easy being in the Healthcare profession in the United States. Doctors are under constant stress. The public believes doctors know more and can do more than they can. It has also become commonplace for primary care doctors’ appointments to be scheduled at 15-minute intervals. Some physicians who work for hospitals say they now have to see patients every 11 minutes. The problem exacerbated as the millions who secured health coverage through the Affordable Care Act rushed to get care — many who had seldom seen a doctor and had a plethora of untreated issues.

Waiting; poor communication; not taking the time to care; each undermines the doctor-patient relationship, which is part of the prescription of excellent care. But there’s an antidote: Positively Outrageous Service® … creating a WOW experience your patient can’t wait to tell another about! 

Not only does Positively Outrageous Service experiences create that compelling word-of-mouth advocacy, but it builds intense loyalty and competitive differentiation. Additionally, in healthcare, engaged patients are more actively involved in their own health. Studies show that a lack of a dialogue between doctor and patient escalates patient exasperation. Abbreviated visits also increase the probability patients leave with a medication prescription rather than a behavioral modification — for example, lose a few pounds, begin working out, change your eating habits.

Patient Care or Caring For a Patient?

Do you have protocols and procedures for patient care, or do you care for your patients? There is a distinction. It came home to me during a hospital visit a couple of years ago. For the first time in my life, I was admitted into the hospital for an illness, not something self-inflicted like a bike crash! It was a fascinating experience. I very rarely get sick. I got there through a misfortune. I had an infection, with incorrect diagnosis and ineffective medication, the symptoms worsened. After four days of fever and no improvement, my doctor admitted me to the hospital. In the first three hours, I interacted with over 30 hospital personnel: admission, the battery of tests: blood, and other lab work, x-rays, EKG, the admitting doctor, my attending nurse, technicians, and several others including a shift rotation where everyone changed! I was clueless about the role of many. 

It was uncertain. It was my first time that I stayed overnight in a hospital in forty years! Over the 22 hours, I was in the hospital, the number of personnel I encountered quickly surpassed 50. I stopped counting. But it included at least five doctors, seven nurses, and innumerable others. Everyone appeared competent. Concerning patient care. But did I feel cared for? Most were reasonable but not great. A few were mediocre. At 2:30 in the morning, they wake me up. They woke me up 30 minutes before giving me another IV of antibiotics. Now I’m carted down to Radiology for a CT scan. The woman who takes me down to the Radiology department in the basement never speaks to me. She parks me outside the radiology in my half-naked gown and sits down 10 yards away down the corridor. I felt like a slab of meat. 

Fortunately, my spirits are lifted ten minutes later by the bubbly radiology technician who is amazingly high-spirited despite being in the middle of the night! She and about five others during my stay favored me with an outstanding experience: Positively Outrageous Service. They created an exceptionally emotive experience; they were motivated and willing to invest discretionary effort to go above and beyond the circumstances or situation.

While we expect doctors and healthcare providers to be about patient care primarily. Diagnosing and prescribing a course of treatment to improve patient health certainly requires knowledgeable and skillful personnel, but caring for a patient requires something additional. A way of thinking … compassion, sensitivity, and caring. While everyone was focused on patient care in the hospital, competent in aptitude, but it’s the attitude that makes the difference. Those that cared about me gave me peace of mind in my hours of uncertainty, alleviating my concerns, comforting me through clear communication, and even made it fun… giving me the gift of joy in a distressing situation.

So what’s your culture? Patient care or caring for your patient? Positively Outrageous Service is the distinguishing characteristic. 

But we each have the power to change the dynamic. Just as working out and nutritional protocols are habits. We have found that implementing Positively Outrageous Service is a cultural habit. It takes intention — a language, setting an example for others. 

“A culture is a community, created and characterized by what
we consent to, communicate, champion and celebrate.”


Three Simple Principles.

The principles of Positively Outrageous Service are relatively simple. 

  1. Random and unexpected
  2. Out of proportion to the circumstances
  3. Invite the patient to play or otherwise become highly involved

The heart of Positively Outrageous Service is LOVE!!!

I visited my orthopedic doctor recently. I hadn’t seen him for eighteen months. He took the time to look at the notes from my last appointment, the X-rays between the two visits. He remembered I was a biker and triathlete. Compared to most doctor visits, it was out of proportion to the circumstances; he patiently listened to some of my concerns — that was random and unexpected. And he was fun! 

It doesn’t take more time — but it takes intentional love! 

That intentionality also has to be habitual! 

We are what we repeatedly do. Excellence, then is not an act, but a habit.”
– Aristotle

“The challenge of delivering Positively Outrageous Service isn’t the principles; it’s the consistent application of the principles – putting them into action.” We have found the difference between one organization and another in the success of implementing the principles of Positively Outrageous Service comes down to creating and cultivating a culture of Positively Outrageous Service. 

The Seven Habits of the Positively Outrageous Service Culture.

To create and cultivate the culture and habitat for your talent to deliver Positively Outrageous Service to your patients requires the implementation of these seven habits: 


Identify and recruit “service naturals.” Yes, hire for aptitude, but more importantly, hire for ATTITUDE. You can give your team more experience and skills (aptitude), but you can’t give someone a heart to serve — to naturally love your patients! Some instinctively put service before self, where serving another comes instinctively. Also, ensure that you create alignment amongst your leadership on how you define service excellence and what the expectations are for Positively Outrageous Service (POS)! Then calibrate a candidate to the organization’s expectations of service situations. 

“In determining the right people, the good-to-great companies placed greater weight on character attributes than on specific educational background, practical skills, specialized knowledge, or work experience.”

— Jim Collins, Business consultant and author of Good to Great


It’s time for a revolution! Reignite the service revolution with Positively Outrageous Service. But the revolution starts with leadership — leadership ignites the fire and leads the way. If leadership isn’t advocating or practicing Positively Outrageous Service, how can you expect your teams and front-line staff to do the same? The body goes where the head leads it. Positively Outrageous Service is about loving your patient. Leadership must cast that vision and practice it by loving people first and championing the Positively Outrageous Service culture in your organization.

“I alone cannot change the world,
but I can cast a stone across the water to create many ripples.”
– Mother Teresa


If leadership provides the light, management fuels the heat for Positively Outrageous Service. Often there is a bottleneck between leadership and the frontline to deliver Positively Outrageous Service. It necessitates leadership to give management the freedom and permission to interpret and execute appropriately how Positively Outrageous Service looks like for their specific department. It requires catalytic coaching. Asking questions to foster creativity and engagement. Serving others. Out serve one another!

“The best teams have consistency and chemistry.”
– Roger Staubach


Your front-line staff, the ones who interact with your patients, whether directly face-to-face, or indirectly, by phone, email, text, or chat, is where Positively Outrageous Service truly manifests. By engaging them, asking questions, posing real-life scenarios, and soliciting their ideas, not only will you unleash the front-line creativity, but they will own the solutions. Ownership of Positively Outrageous Service results in authentic patient interactions rooted in love for one another — our highest calling and a passion for what they do! The best results come from small steps consistently discussed, owned and executed month-in, month-out!

“To win in the marketplace, you must first win in the workplace.”
– Doug Conant, Former CEO, Campbell’s Soup


One of the critical benefits of Positively Outrageous Service is creating compelling positive word-of-mouth advocacy for your organization. It is the most potent marketing ingredient possible. After all, what someone says about you is infinitely more credible and compelling than anything you could ever say about yourself. There’s only really one question you need to ask to determine if you’re delivering Positively Outrageous Service: “On a scale of 10 (extremely likely) to 0 (not at all likely) 5 being neutral, “How likely are you to recommend _____ to a colleague or friend?” 10 or 9 indicates they are positive advocates, 8, 7, or 6 means they are passive, five or less — they’re detractors. Improve your Positively Outrageous Service by measuring this score over time.

“To Measure is to know. If you cannot measure it, you cannot improve it.”
– Lord Kelvin


Consistent application of Positively Outrageous Service in all areas across an organization is key to delivering the WOW experience to your stakeholders. In a hospital, it doesn’t matter how good your patient care is, if a patient doesn’t feel cared for. Everything that went well gets erased in an instant. Identify your service gaps and make it consistent with the rest of the organization. Ask a second question in your survey: “How can we improve our experience?” (for passives) or “What went wrong with your experience” (for detractors).

“Adversity, in the big picture, is a really good thing because it shows you where your weaknesses are. It gives you the opportunity to improve.”
– Theo Epstein, President of the Chicago Cubs


Never underestimate the magnitude of celebrating to propagate the Positively Outrageous Service success stories and heroes. Release the power that public and private praise and parties do to elevate morale and reinforce the behaviors, attitudes, and creativity to bolster Positively Outrageous Service. Celebrating lifts the energy level of your entire team if you are positive and vocal in the victories won through Positively Outrageous Service. Also, life’s more fun when you love, recognize, appreciate, and learn from both the big and small Positively Outrageous Service moments and milestones. And don’t forget: “Life is short; wear your party pants.” – Loretta LaRoche

“Celebrate what you’ve accomplished,
but raise the bar a little higher each time you succeed.” 

– Mia Hamm

One final point …. A rose by any other name

William Shakespeare wrote, “a rose by any other name would smell as sweet.”

How sweet are your patients? What name do you even call them? Let’s face it; there is a hierarchy of names that we could call customers. Each one implies something different. Some are more outrageous than others. 

What are the possible names for customers? There are members, guests, patrons, clients, customers, consumers, tenants, passengers, and THEN patients. Each name implies something different. doesn’t it? At the top, there is a member; “membership has its privileges”… remember the old American Express advertisement? 

Then you have guests; that implies hospitality, hospitality implies you are serving another. Patrons suggests loyalty or support for a cause. Client infers there’s a relationship; lawyers and consultants have a relationship with their clients. Customers are the generic name, but in retail, it implies something more transactional than relational. As we descend the scale, we have passengers that are no longer stewarded but are attended to by “flight attendants,” implying the flight is more important than the passenger. Apartment management often deprecates the tenant. And then we arrive at patients. 

A few years ago, I gave an address to the leadership at Texas Health Presbyterian Hospital Dallas: “Double Down on your Communications.” In talking with the Chief Nursing Officer, he shared a fascinating paradigm shift. The hospital had made a strategic decision to stop calling their patients, patients! Because of all the negative connotations that are associated with that word! They call them guests. 

One serves a guest. Guests stay in a guest room, not a patient room. This one factor changed the mindset of the staff overnight. The hospital staff started to serve their guests, love on their guests, and satisfaction scores began to soar. Positively Outrageous!


Andrew Szabo

“Simply Irresistible!®” – yes, Andrew owns the trademark!

Andrew Szabo is well known for his ability to communicate sophisticated marketing and management concepts to apply in real-world situations. Andrew is best known as the creator of “Simply Irresistible® Marketing,” which the late Zig Ziglar called, “the whole shootin’ match!” He is the co-author of the third edition of “Positively Outrageous Service, How to Delight and Astound Your Customers and Win Them for Life,” which has sold almost 300,000 copies. Global business powerhouses such as Dell, Sony, RKO Motion Pictures, and Oracle sought his counsel over the years.

Szabo is equally at home in European as well as U.S. business settings. He credits his international business experience working with tech companies on both sides of the “pond.” And his love of hospitality came from his early days with Hyatt Hotels, where his early mentors taught him the fundamentals of Positively Outrageous Service.

On a personal level, Andrew is one of the crazy ones — he works out more times than there are days in the year. Last year he completed his third Ironman 70.3-mile event and his twelfth 100-mile bike race! He has finished five marathons, including one he ran accidentally! Who runs a marathon by accident? Much to his wife’s dismay, he won’t throw out the plethora of commemorative T-shirts that have accumulated from the numerous Olympic triathlons, 10K, 5Ks and other races that Andrew has participated in.

Andrew is lucky to have an amazing wife of 30+ years who puts up or participates in their life adventures of travel, entrepreneurship, ministry, cooking, and raising two extraordinary children. Yes, there are lots of stories!

Positively Outrageous Service Testimonials

“Implementing Positively Outrageous Service on a regular basis has enhanced our team’s engagement and buy-in to implementing fresh ideas to serve our clientele in creative and compelling ways. I’m also learning from my team things I never imagined was possible.”
 Theresa Tolle, Owner & Chief Pharmacist, Bay Street Pharmacy

“As a result of Positively Outrageous Service the whole work group is re-energized about customer service. Once they only dreamed of meeting their goal of answering 95% of their phone calls within 3 rings. Now they are on the 22nd consecutive day of meeting that goal!”
 Steve Richards, The Boeing Company

“I want POS to be ingrained in our practice!”
– Bradley Garber, M.D., F.A.C.S. Plastic and Reconstructive Surgery

“I took your concepts … it was like the lights went on.. it was wonderful!
– Janell Mc Neill, Curative Health

[1] David J. Rothman, Columbia University’s College of Physicians and Surgeons.

Top Doctor Magazine
Top Doctor Magazine

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Brianna Connors & Derek Archer Co-Editors