(Guatemala City, 1989) In my previous career as a software developer, I was on one of several routine trips to Central America. The software that my company developed was specialized for apparel manufacturing, and before most of that industry moved to China, Central America and the Caribbean were where much of our clothing was made, or at least assembled. Late one afternoon, after working through lunch to make the most of my time in the local factory, I was brought a ham and cheese sandwich from one of the women working there, and I gladly accepted. Let me tell you, this was the absolute best sandwich I have ever eaten, and if you know me, I’ve eaten plenty. Real ham, real cheese, and real bread. Simple. Delicious. Real.
Now, thirty-one years later, I still remember something as seemingly ordinary as a sandwich. And not one from a fancy New York restaurant, but from the factory kitchen of the apparel manufacturing plant in Guatemala City. You see, we eat sandwiches all the time. I’ve surely eaten thousands since that day. But our ham isn’t real ham, and our cheese isn’t real cheese, and our bread isn’t real bread. But we’ve been eating our processed ham-like meats and our assembly line manufactured “American” cheeses and our chemical preservative laden breads for so long that we think that’s what a ham and cheese sandwich is supposed to taste like.
We have done it for so long that in some cases, a step toward freshness and authenticity tastes foreign and unnatural to us. I mean, I absolutely love a McDouble hamburger. I am aware enough to know that I am eating garbage, but it tastes delicious to me. And I can go to the market and buy fresh ground beef and high-end cheese and grill myself a burger at home and know that’s what a burger should taste like, but our minds have been trained through years of abuse to expect the taste of the common, less expensive, higher profit alternative.
When you hear someone explain that the reason something is better is because they “made it with love”, this is what it means. It means it was not simply purchased from the industrial machine but was made carefully by their own hands. Doing something by hand, anything, in service to another, is an act of love. And when I think about my favorite sandwich in Guatemala, that was the secret. Someone hand making the bread, and someone else hand making real cheese, and someone else hand curing the pig and carving the ham, and finally, someone putting those things together and offering it to me as their guest. That to me is an act of love and it gives rise to a higher quality than can be manufactured otherwise.
I spent last week at my mother’s house in Charlotte, taking my turn at a weekly rotation along with my brothers and sister, in staying with and caring for my 96-year-old mother. She suffered a stroke this past summer and is now confined to bed and wheelchair, so one of us is here a week at a time to get her up and dressed, get her to the bathroom, get her fed, get her back to bed, and repeat throughout the day. During my stay, I found her box of recipes which included everything from dinners, to side dishes, to marinades, and yes, even Christmas cookies. So, I went to the store and got all the things we needed, including a sifter, to make some of her classics – pecan balls and coconut squares.
I did the prep work, and she did the sifting and measuring, and mixing, and rolling of balls and cutting of squares. She was intent on creating something for those she loved, something she has been unable to do for many months. She told me several times how much fun she had making these.
Made with love? You better believe it. We could have bought some pre-made grocery store sugar cookies with their chemically concocted frostings, but instead Mom used flour, and brown sugar, and eggs, and pecans, and all the other things, including love. You can taste the difference. If you could have been there to see her in action, to see the joy and sparkle in her eyes as she took respite from her usual day of watching Dr. Phil and Judge Judy, you would have gobbled up every one of them. That’s what love inspires.
Earlier in the week she had told me in passing, and in a depressed tone of voice, “I don’t think I’ll do any Christmas shopping this year”. Mom was always one to make sure that everyone had a gift or two, and when we gathered in the past at her house for Christmas dinner, there could be anywhere from 30 to 40 of us. Her children, our spouses, our children, our children’s children…everyone received something. If there were someone she wasn’t expecting, no problem, she had a gift for them too. So, to hear her resign herself to not being able to give gifts this Christmas was saddening. But the cookies seemed to give her a renewed purpose, a way to show her family she loves them.
Finally, this all brings me around to what I want to tell you. Something mentioned before in an article I shared written by Allison Sigmon who quoted renowned physician Avedis Donabedian, founder of the study of quality in health care and medical outcomes research who said, “the secret of quality is love”. Really? You mean the secret to quality in health care is not big data? It’s not some new technology or AI? It’s not digital? It’s not assembly-line style processes in clinical treatment or revenue cycle? It’s not some acronym of the day used to measure cost, efficiency, or patient experience?
No, it is love. Why? Because love is always the answer, no matter the problem. Let me say that again. Love is always the answer. A-L-W-A-Y-S. Now we do not claim to have a monopoly on love by any means, but we believe that loving patients is always a better option than traditional approaches. Encore Exchange developed our business as a small niche alternative to the traditional placement of self-pay accounts with bad debt agencies after 120 days of accounts receivable collection attempts. Why? Because we know, and you know, that healthcare is an act of love first, and a business enterprise second.
I can’t say that our service is like the homemade ham and cheese sandwich, or the cookies lovingly measured and mixed by my aging mother, but I can say that the secret to quality is love and love is not found in the numbers nor in reporting against a patient’s credit report. It is found in human beings and the work we do. It is found in the words we use, the gifts we give of ourselves, the acts of service we perform, the quality time we spend together, and the human-to-human caring touch and connections we make.
Love is a measure of authenticity; from the sandwiches we make to the cookies we bake and even to our business services and processes. The more love, the more authentic. And the more authentic, the more human and the more well-received.
I urge you to find some authenticity this Christmas, some way of expressing love that doesn’t come from Amazon or the mall or any store. Make something by hand, write someone a letter, perform a real act of service that nobody expected, rub your mom’s neck and shoulders. And always remember, #LoveThePatient.