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In Why Hospitals Should Fly: The Ultimate Flight Plan to Patient Safety and Quality Care published in 2008, author John Nance makes a case that hospitals would do well to incorporate aviation’s best practices into their daily operations. Clearly he was talking about safety, not customer service.

Why Hospitals Should NOT FlyToday, airlines continue to offer travelers a safe and reliable form of transportation but beyond that, there is little that hospitals, or any other business for that matter, should apply to their daily operations, most of all  in the aforementioned category of customer service.

Airline service stinks, especially when you compare it to the 1960s and 1970s.  The nice service and gracious treatment began to change in the mid-1980s when the onslaught of low-cost carriers such as Southwest began to seriously challenge the legacy carriers which were struggling to cut their costs instead of refocusing and right sizing their businesses.  The passengers ultimately paid the price for that strategic error.  Instead of shrinking their fleets to focus on profitable routes, the legacy carriers, locked into a hub and spoke route system and continued to operate with excess capacity.  To attract passengers they had to cut prices which meant carving out expense and marginalizing their customers.

The airlines did come up with one very smart plan to hold on to their best customers.  With the help of Dallas marketing executive Hal Brierley, they hooked us to the heroin of airline miles travel rewards along with the concept of passenger “status”.

Mr. Brierley’s contribution to what seemed like a good idea at the time was not limited to American Airlines.  He also consulted on United’s MilePlus plan as well as the more customer friendly operations of Hilton Hotels and Neiman Marcus.  American Airlines under Bob Crandall’s leadership best illustrated the cost-cutting mindset by bragging about how much they saved in costs by removing olives from salads served on AA flights.  Eventually, of course, American eliminated food in coach, and to avoid the temptation to return to the wasteful expense of actually feeding passengers at meal time, removed the ovens from the coach class galleys in their domestic fleet. Less weight in the galleys meant more savings per flight.  And the cost of meals certainly went down.

The elimination of coach meals was just the tip of the all too familiar iceberg of deteriorating airline customer service.  As AA’s reasoning seemed to go, if Southwest Airlines could get away with its infamous cattle car loading process and offering only peanuts for food,  why not cut even more service and weed out even that nasty expense? AA was certainly not the only bad actor to adopt that mentality.  Flying passengers for hours on a “regional jet” so small it seems like a sewer tube with two engines but with only one bathroom, can be a bigger indignity for customers.

The real irony is that the American frequent flyer awards program, AAdvantage©, became a good defense strategy to hold on to market share as they systematically treated all their passengers, including those who paid the higher fares, poorly.  The unintended genius of their rewards program is that even as they treat their best customers badly, those same customers continue to come back like drug addicts to an edgy street corner in search of another fix.

Their best customers have too many miles and elevated status which affords them valuable perks like priority boarding or shorter lines for security screening.  It therefore does not make sense to fly with a competitor where they have no status —  where they are just another member of the unwashed herd in boarding group four or five. American’s customers, along with those of other legacy carriers, just suffer the abuse and keep flying with their abusers because they have too many miles and priority status. To date, airlines have had no incentive to do a better job, even for their most valuable customers who were addicted to their customer status and the free flights.

Except the rewards are not free. Airlines, realizing they have accrued huge contingent liabilities with these programs, are making it harder to redeem miles for flights — there are fewer and fewer flight options on the most desirable routes and more black out dates.

This peeves me no end, so instead of flying American (where I have allowed my status to drop to nothingness) back to Dallas on Saturday, or making a change of planes in Houston or Chicago on United (where I do have status), I booked on Virgin America, one of the top-rated domestic airlines, which now offers non-stop service from LaGuardia to Dallas Love Field.  They have a rewards program too and, while I do not have status with them yet, you wouldn’t know it based on the way I was treated, the way all the passengers on my flight were treated. Their planes are clean, the crews are friendly — “you are our guest” — and passengers can order food and drink on a touch screen at their seat — in coach.

I know this sounds revolutionary, but I have come to the conclusion that, in the long run, airline service might actually improve if airline rewards programs went the way of S&H Green Stamps.

Hospitals have their own very serious set of challenges.  We do not need to create a marketing gimmick that will only encourage us to not treat people better. I am grateful this is one marketing temptation we have resisted.