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Patients Come Second: Leading Change by Changing the Way You Lead
Americans enjoy the finest healthcare delivery system in the world, but most people will tell you that we still have a long way to go. Far too frequently, patients leave the doctor's office or hospital feeling confused, angry, or neglected. Healthcare leaders recognize this problem, but in their focus on patients (and sometimes financials), they often overlook the true key to lasting patient loyalty and their employees. Patients Come Second shakes up the traditional healthcare model, arguing that in order to care for and retain patients, leaders must first create exceptional teams and find ways to engage nurses, administrative staff, physicians, supervisors, and even housekeeping staff and switchboard operators. By connecting employees' work with a higher purpose and equipping them with the tools to become leaders themselves, patient care can be dramatically transformed. And with continuing healthcare changes on the horizon and ever-rising pressure to acquire and keep patients, doing so now is more important than ever. Britt Berrett, president of an 898-bed hospital, and Paul Spiegelman, founder and CEO of a successful patient-experience company, are the perfect guides to the changes needed in healthcare leadership. With a rich combined experience in their field, they have filled each chapter with an abundance of engaging, insightful stories and write with a humor and friendliness that balances and enhances the urgency of their message.
206 pages, Paperback
First published January 1, 2013
255 people are currently reading
1041 people want to read
About the author
Paul Spiegelman
8 books3 followersPaul Spiegelman is founder and CEO of BerylHealth, a patient experience company dedicated to improving relationships between healthcare providers and consumers and The Beryl Institute, a membership organization that serves as the premier thought leader on improving the patient experience in healthcare; Paul also founded the Small Giants Community, a global organization that brings together leaders who are focused on values-based business principles.
Paul is leading a unique, people-centric culture that has remarkably high employee and customer retention rates. BerylHealth has won nine “best place to work” awards, including the #2 Best Medium Sized Company to Work for in America. Spiegelman was honored with the Ernst & Young 2010 Entrepreneur of the Year award.
Paul is a sought-after speaker and author on executive leadership, entrepreneurship, corporate culture, customer relationships and employee engagement. His views have been published in Entrepreneur, The Dallas Morning News, Inc Magazine., Healthcare Financial Management, Leadership Excellence and many other noteworthy publications, as well as in his first internationally published book Why is Everyone Smiling? The Secret Behind Passion, Productivity and Profit. His current book, due in March 2013, is called Patients Come Second: Leading Change by Changing the Way you Lead
Paul practiced law for two years prior to founding Beryl. He holds a bachelor’s degree in history UCLA and a law degree from Southwestern University.. To learn more about Paul, please visit www.paulspiegelman.com.
Paul is leading a unique, people-centric culture that has remarkably high employee and customer retention rates. BerylHealth has won nine “best place to work” awards, including the #2 Best Medium Sized Company to Work for in America. Spiegelman was honored with the Ernst & Young 2010 Entrepreneur of the Year award.
Paul is a sought-after speaker and author on executive leadership, entrepreneurship, corporate culture, customer relationships and employee engagement. His views have been published in Entrepreneur, The Dallas Morning News, Inc Magazine., Healthcare Financial Management, Leadership Excellence and many other noteworthy publications, as well as in his first internationally published book Why is Everyone Smiling? The Secret Behind Passion, Productivity and Profit. His current book, due in March 2013, is called Patients Come Second: Leading Change by Changing the Way you Lead
Paul practiced law for two years prior to founding Beryl. He holds a bachelor’s degree in history UCLA and a law degree from Southwestern University.. To learn more about Paul, please visit www.paulspiegelman.com.
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Displaying 1 - 30 of 55 reviews
November 6, 2025
I get the idea, treat your people good and they will treat the patients well, but the stories and examples seemed a little simplistic to me.
I guess I was expecting something new and I didn’t feel it. I do not disagree with the concept - it’s true and valid, I guess I just really don’t need to read the same stuff again.
I guess I was expecting something new and I didn’t feel it. I do not disagree with the concept - it’s true and valid, I guess I just really don’t need to read the same stuff again.
July 12, 2013
I am not exactly sure why this book received 1/5 ratings from others, especially with no rationales given, but here are the reasons I gave it 5/5:
I have extensive experience as a PATIENT. Over the past 6 years, my experience as a patient spans from small, rural hospitals, to treatment facilities and clinics, all the way to one of the largest and most widely known cancer treatment teaching facilities in the world.
----> Why did I read this book with my patient-centered background???
In a few weeks, I will be graduating with a Master of Healthcare Administration (MHA) degree, which is how I came to find this book. This book is a must for any level of leader - novice to expert.
Now, this book is not for everyone. In fact, I believe this book is not for most people. With that being said, this book has an extremely powerful message about how engaging, rewarding, and nourishing employees within healthcare settings is the most effective and efficient way towards their central goal - creating the most positive, loving, compassionate patient experience and encounter with healthcare.
The old adage of "don't judge a book by its cover" could not be any more true than with this one. Everything from addressing the book's title to providing a Culture IQ(TM) Checklist is included within the pages.
This book is an easy and fantastic read for anyone passionate about health care, service for the in need, or even business in general. The main points of this book can certainly extend into any service industry, not just health care.
Paul and Brett have created a short, easy to read novel which inspires personal and organizational growth, as well as engagement at all levels. I highly recommend this book.
I have extensive experience as a PATIENT. Over the past 6 years, my experience as a patient spans from small, rural hospitals, to treatment facilities and clinics, all the way to one of the largest and most widely known cancer treatment teaching facilities in the world.
----> Why did I read this book with my patient-centered background???
In a few weeks, I will be graduating with a Master of Healthcare Administration (MHA) degree, which is how I came to find this book. This book is a must for any level of leader - novice to expert.
Now, this book is not for everyone. In fact, I believe this book is not for most people. With that being said, this book has an extremely powerful message about how engaging, rewarding, and nourishing employees within healthcare settings is the most effective and efficient way towards their central goal - creating the most positive, loving, compassionate patient experience and encounter with healthcare.
The old adage of "don't judge a book by its cover" could not be any more true than with this one. Everything from addressing the book's title to providing a Culture IQ(TM) Checklist is included within the pages.
This book is an easy and fantastic read for anyone passionate about health care, service for the in need, or even business in general. The main points of this book can certainly extend into any service industry, not just health care.
Paul and Brett have created a short, easy to read novel which inspires personal and organizational growth, as well as engagement at all levels. I highly recommend this book.
January 27, 2018
Honestly, not a rating I've ever given out. Do not be fooled by the deliberately provocative title: this book is devoid of substance. There is no data provided, no research--it is entirely anecdotal and filled with self-aggrandizing stories where the authors indirectly praise there own ability to engage their employees. The same story is told ad nauseum over 200 pages. It could have been concisely written as a 2,000 word article. It is over wrought, indulgent, and just frankly poorly written.
January 18, 2019
This book is...fine. It gets the 3 stars because I think the message is right and the title is creatively and appropriately provocative. There really aren't any new ideas in the book compared to other business/leadership books, and the depth of examination remains pretty shallow.
The main premise is that to achieve improved patient experience and outcomes, hospitals must focus on engaging their employees. This includes caring about their wellbeing, developing them, and creating the right organizational climate which is connected to the mission/greater purpose of the organization. When you do those things, you get a hospital with employees who will provide the best possible care & experience to the patients. Hence patients come second (employees come first; and finances come third) in the directness with which you focus your efforts. The business ultimately benefits and that revenue can be focused back towards empowering and resourcing your people and organization.
A major shortcoming: I would like to have heard more about how hospitals can stop abusing/overworking its employees which remains a huge systemic problem. Most of the culture building advice seemed focused on rewarding and acknowledging people doing great things (granted this is also important).
The writing itself is campy and somewhat broad/unfocused. There is no original research or data presented. The bulk of the book are stories, anecdotes, and advice/quotes from various healthcare executives. The book overly relies upon and overly references the authors' own businesses. Again, the book is fine for an introductory look into the idea of employee engagement or professionally developing your people, but nothing new about leadership (in healthcare or elsewhere).
The main premise is that to achieve improved patient experience and outcomes, hospitals must focus on engaging their employees. This includes caring about their wellbeing, developing them, and creating the right organizational climate which is connected to the mission/greater purpose of the organization. When you do those things, you get a hospital with employees who will provide the best possible care & experience to the patients. Hence patients come second (employees come first; and finances come third) in the directness with which you focus your efforts. The business ultimately benefits and that revenue can be focused back towards empowering and resourcing your people and organization.
A major shortcoming: I would like to have heard more about how hospitals can stop abusing/overworking its employees which remains a huge systemic problem. Most of the culture building advice seemed focused on rewarding and acknowledging people doing great things (granted this is also important).
The writing itself is campy and somewhat broad/unfocused. There is no original research or data presented. The bulk of the book are stories, anecdotes, and advice/quotes from various healthcare executives. The book overly relies upon and overly references the authors' own businesses. Again, the book is fine for an introductory look into the idea of employee engagement or professionally developing your people, but nothing new about leadership (in healthcare or elsewhere).
February 14, 2025
I am in transition into a management role within my nursing education team. This book on the shelf of our library enticed me with its provocative title. The primary message is that focusing on employee engagement and development will ultimately drive better outcomes for patients in a health system. I align with that message and intention, but man, oh man this book sucked.
The two authors are constantly patting themselves on the back for how amazing they are with anecdotal stories told from their C-suite perspective of how their healthcare systems have a happy workforce as a result of the attention and focus they invest in the employee as an individual and a community member. As awesome as these ideas are, they are presented without any quantitative data to support their claims. The result is that the book comes off as self-pandering.
Furthermore, the authors have apparent blinders toward their own biases. This quote from a discussion about a book club they promoted demonstrates how out of touch and self-congratulatory these two yokels are, "you can guess who are the ones who don't want to participate by the reading the book right?...It's no surprise to discover that they they are the least engaged employees in the organization." The mindset in this example takes no consideration that some employees may commute two hours to work, may be struggling with juggling the demands of childcare, or are pursuing higher education in their off hours. They simply write off the possibility that an employee's personal time required to read a book and participate in a book club is an indication that the staff member isn't engaged. The authors are totally blind to their assumption that if an employee staff isn't doing the extra credit that they, the C-suite executive, find so valuable, this is proof that these staff members aren't engaged in their work.
I couldn't help rolling my eyes multiple times at these author's self-congratulatory self-anecdotes throughout the book. They describe coming to work dressed like clowns, promoting the sale of tents used in the heat with their company brand as a community-building endeavor, and sitting in a dunk tank as an opportunity to connect with their employees. When they veer outside of stories from their companies, they step way outside healthcare and reflect on the tired business writing trope about how awesome Steve Jobs is, citing examples that have nothing to do with healthcare and everything to do with the executive class worship of St. Jobs.
I gave it two stars instead of just one because the ideas are thought provoking, but it was just there isn't enough evidence within these pages to promote this book to anyone.
The two authors are constantly patting themselves on the back for how amazing they are with anecdotal stories told from their C-suite perspective of how their healthcare systems have a happy workforce as a result of the attention and focus they invest in the employee as an individual and a community member. As awesome as these ideas are, they are presented without any quantitative data to support their claims. The result is that the book comes off as self-pandering.
Furthermore, the authors have apparent blinders toward their own biases. This quote from a discussion about a book club they promoted demonstrates how out of touch and self-congratulatory these two yokels are, "you can guess who are the ones who don't want to participate by the reading the book right?...It's no surprise to discover that they they are the least engaged employees in the organization." The mindset in this example takes no consideration that some employees may commute two hours to work, may be struggling with juggling the demands of childcare, or are pursuing higher education in their off hours. They simply write off the possibility that an employee's personal time required to read a book and participate in a book club is an indication that the staff member isn't engaged. The authors are totally blind to their assumption that if an employee staff isn't doing the extra credit that they, the C-suite executive, find so valuable, this is proof that these staff members aren't engaged in their work.
I couldn't help rolling my eyes multiple times at these author's self-congratulatory self-anecdotes throughout the book. They describe coming to work dressed like clowns, promoting the sale of tents used in the heat with their company brand as a community-building endeavor, and sitting in a dunk tank as an opportunity to connect with their employees. When they veer outside of stories from their companies, they step way outside healthcare and reflect on the tired business writing trope about how awesome Steve Jobs is, citing examples that have nothing to do with healthcare and everything to do with the executive class worship of St. Jobs.
I gave it two stars instead of just one because the ideas are thought provoking, but it was just there isn't enough evidence within these pages to promote this book to anyone.
August 2, 2025
Gives a lot of hope by validating what we know with dozens of examples from successful hospitals around the country: Treating your staff well leads to better patient outcomes and financial sustainability in the long run.
While the authors make a point to de-emphasize financial benchmarks as the main indicator of a health systems success, they make it seem like it’s irrelevant. I was hoping for more instructive content such as; how do we convince CEO’s who aren’t already on board?; What about companies whose engagement scores are already dismal?; How much money can a hospital expect to invest upfront with these efforts, even if just to set shareholders’ expectations?
There was no practical guidance in this area, and it left me feeling disappointed. The Culture IQ assessment may be helpful, but otherwise there are no skills to apply to change culture, only evidence that it works.
While the authors make a point to de-emphasize financial benchmarks as the main indicator of a health systems success, they make it seem like it’s irrelevant. I was hoping for more instructive content such as; how do we convince CEO’s who aren’t already on board?; What about companies whose engagement scores are already dismal?; How much money can a hospital expect to invest upfront with these efforts, even if just to set shareholders’ expectations?
There was no practical guidance in this area, and it left me feeling disappointed. The Culture IQ assessment may be helpful, but otherwise there are no skills to apply to change culture, only evidence that it works.
This entire review has been hidden because of spoilers.
December 26, 2021
I really liked the whole concept of putting your team of employees before the patients because that will improve everyone’s experience! It was a nice little twist to an age-old tradition of putting the patient first. All the points were backed up with experiences from the authors or other healthcare workers, which I appreciated. I highlighted principles, wrote some notes, and made some goals. Sometimes it seemed like Berrett and Spiegelman were so pompous about their career paths that I didn’t care about their successes; there’s definitely a lot of bragging that’s backed up by cheesy jokes. But the good outweighs the bad and I overall really enjoyed this.
July 16, 2023
Solid leadership tips
March 15, 2023
Maybe I am not the intended audience, but I could not wait for this book to end. I began reading “PCS” as a recommendation for health care workers, but found it to be 90% focused on the management of health care workers. Mostly the entire book was focused on how to properly manage and motivate people in a way that resonates with them. The book did earn 2 stars in my opinion for its rare nuggets of insightful advice for the non-management employee sprinkled throughout. It was a tough read for how unfocused and spread out the information was. It did not read in any followable format, and instead felt like an overwritten article with lots of self praise given to themselves by the authors.
December 26, 2016
This is just pulp business blather for healthcare administrators (who usually know less about business than the manager of a fast-food restaurant). Nothing original, well except the title but even that is actually stolen from another business book (Customers Come Second). Read "If Disney Ran Your Hospital" instead.
February 10, 2016
Terrible...
August 29, 2019
None of the health systems used as examples in this book are high performing top tier systems. Book is hokey and a giant sales pitch to use the authors company.
May 13, 2017
This should be required reading for every manager or administrator in health care. When I was manager this was exactly the type things I was trying to do, yet had the brakes put on from above because they didn't see how it would financially benefit them. I feel like I could have written this book as there are many points that I have been making for years. Unfortunately my suggestions have fallen on some deaf or despondent ears that has left me less than enthusiastic about trying again.
I grew up with the saying, If momma ain't happy, ain't nobody happy. A corollary to that is the premise of this book. If you keep your employees happy then your customers (or in our case patients) will be happy.
The authors give very tangible experiences and examples of what they did as health care administrators to create a true culture of employee engagement. These can be easily applied and would really start to move you toward becoming a great leader and not just a manager.
This is only 200 pages so it could be read over a weekend if you wanted. If you are a manager it would be the most beneficial weekend you spend if you heed the advice and put it to use.
I grew up with the saying, If momma ain't happy, ain't nobody happy. A corollary to that is the premise of this book. If you keep your employees happy then your customers (or in our case patients) will be happy.
The authors give very tangible experiences and examples of what they did as health care administrators to create a true culture of employee engagement. These can be easily applied and would really start to move you toward becoming a great leader and not just a manager.
This is only 200 pages so it could be read over a weekend if you wanted. If you are a manager it would be the most beneficial weekend you spend if you heed the advice and put it to use.
April 4, 2018
A good application of more modern recommended management practices applied within a healthcare setting. Essentially, the book emphasizes the importance of focusing on employee health, satisfaction, and career growth in order to see a corresponding improvement in patient care and outcomes. An unhappy employee generally will not provide the same level of care as a unhappy employee, which can have dire consequences in an industry where "death" can be a very real possibility. However, to get the happy employee extra company resources need to be allocated into supporting employee interests and wellbeing. This is a book I will probably re-read again in the future in order to gain further insights I may have missed or overlooked during the first read.
August 19, 2018
Cheesy, but useful
I picked this up because I am a jew officer in the Army Medical Service Corps and this book is on the Corps Chief's reading list. I am not sure how useful this book's content would be in the army, as a lot of this "feel-good" type of leadership is typically frowned upon, but it had some good key points that could apply to even military leadership.
Like others said, it is a very easy read. Rather campy at times, a bit too self aware, and full of what some might consider some shameless self-promotion (the writers use their own businesses as prime examples several times). Still, it refreshed my thinking about leadership, and could be useful as a topic of discussion, especially its key points about employee engagement.
I picked this up because I am a jew officer in the Army Medical Service Corps and this book is on the Corps Chief's reading list. I am not sure how useful this book's content would be in the army, as a lot of this "feel-good" type of leadership is typically frowned upon, but it had some good key points that could apply to even military leadership.
Like others said, it is a very easy read. Rather campy at times, a bit too self aware, and full of what some might consider some shameless self-promotion (the writers use their own businesses as prime examples several times). Still, it refreshed my thinking about leadership, and could be useful as a topic of discussion, especially its key points about employee engagement.
November 5, 2019
Don't get discouraged by other reviews! As an aspiring healthcare administrator, I thoroughly enjoyed this read. I've read other "self-help" books that are involved in healthcare, but this one tops them all. Britt Berrett and Paul Spiegelman are engaging in the way that they bring real-life situations that they encountered, and their individual approach to solve problems. Berrett and Spiegelman do a wonderful job outlining a three-tier diagram in healthcare that has given me a different perspective from a business standpoint. You get a real sense of each author's individual personality, which was inspiring to me. Their thoughts fostered ideas on how I can better engage with employees, medical staff, and other healthcare professionals.
May 21, 2022
I was excited to read this, as the authors overall message is something I've been saying for years. The ideas and advice in here are useful, however I wanted more discussion on WHY so many healthcare workers feel unappreciated, the challenges we face, why job dissatisfaction and burnout is so high. Yes employee recognition and appreciation and rewards are important, however my concern is that without addressing the underlying problems, it's like putting a bandaid over a gushing wound. Nevertheless, there is a good message here that needs to be heard, and perhaps is the start of a conversation that needs to be had.
March 16, 2023
I like and agree with the basic idea presented in the book. The presentation of the idea is also very clear and coherent. I would have liked to see an additional chapter where the authors discuss, how to implement their suggestions when you are not part of the administration? I'm also uncertain as to how their approach could be implemented into Finnish society but that's a secondary problem compared to the previous question. I also don't understand how the authors have time to do any real work as they seem to be highly occupied with Dashboards, Chat and Chews, different award galas, painting classes etc
September 2, 2018
All of this!!!!
Working in an organization that is currently trying to overhaul its culture, this book has been a lifesaver. I have so many ideas to try that stemming from the authors’ successes, and I now know that we are absolutely right in making changes to engage our employees!
Working in an organization that is currently trying to overhaul its culture, this book has been a lifesaver. I have so many ideas to try that stemming from the authors’ successes, and I now know that we are absolutely right in making changes to engage our employees!
January 5, 2019
3 out of 5 stars. This is a great book about healthcare and how to engage staff. The biggest problem is that it is about 100 pages too long. Like many leadership or self help books the authors take a chapter to cover what was clear in a few paragraphs. I definitely have some good takeaways, but I wish there was a little less fluff. #healthcare #leadership #staffengagement #bookreview
May 9, 2020
An employee-focused, caring mindset to leading an organization. Examples and thoughts from health care executives and leaders add a story quality that allows the reader to "absorb" the concepts rather than just apply them like you would a technical manual. A great read for up-and-coming Executives who want to lead with their heart and not profit.
November 22, 2022
The future of healthcare is dependent on investing in every player within the walls of it and engaging them in the culture of care. Authors Paul and Britt walk readers through how employee engagement isn't a side project but the main event to achieving the best healthcare outcomes for patients. A worthy read for anyone in healthcare or healthcare management.
August 19, 2024
This book was good. My boss let me borrow it. I felt like it was a little repetitive, but the title is thought provoking and the premise is important. I would have liked more concrete anecdotes or research and it probably could have been shorter. I do think this is a valuable book for leadership/managers.
February 22, 2018
This is a great book about employee engagement. The authors suggest a leader's primary focus should be on the employees, who then do the work of creating great patient experiences. Well written, full of humor and anecdotes, along with great ideas for leaders.
January 31, 2024
I liked to hear about how important it is to make your job fun because in healthcare it’s so important to put your well being at the top of your priority list. Really business-y but overall the message was great!
June 16, 2024
I enjoyed reading this book. It gives tips on how to increase employee engagement. Not many new topics for me, but a good review. Recommend if you want to increase employee engagement at your organization.
December 21, 2018
Easy and fun to read book that helps you understand how to transform a culture and engage employees.
January 19, 2019
Excellent book, changes the way you look at healthcare leadership, patients not left out in fact get better care but not the leadership's focus.
September 29, 2021
Decent book. Had good arguments. I really liked the discussion on employee engagement and on making things fun and creative at work. I definitely will implement stuff from this. I give it 3.5 stars
December 25, 2021
A well written book that is a condensed healthcare business leader mentor.
Displaying 1 - 30 of 55 reviews