Tuesday, June 22, 2010

The Service of Health Care

Hospitals are, and always have been, service providers. Patients have a choice-in spite of some insurance restrictions-where they go for Emergency and elective procedures and care. Yet, some administrators still believe the patient needs the hospital, therefore, to concentrate on customer satisfaction is a mote point. Isn't it more accurate to say, though, that health care is a co-dependent relationship between provider and patient? Each needs the other. The patient needs what interventions the hospital is able to provide in a crisis and the facility needs the financial gain from disasters to fund their expenses. Health care is a booming business and for some, it is easy to shift the focus from placing the patients first, to capitalizing on profits. Sadly, in some hospitals, profit-driven mentalities has become an obsession.

In the July 2010 edition of Good Housekeeping, Melody Petersen hints at the profit driven reason behind the overuse of CT scans in her article Over Exposed. "Could there (be) a profit motive at work? The researchers raised that possibility in their report. Certainly imaging centers have become profit centers for many hospitals and physicians. Even doctors who aren't radiologists-cardiologists, gastroenterologists, orthopedists, and others-have installed CT scanners in their offices. And, having spent upwards of a million dollars on a device, they're going to find ways to cover their investment. Indeed, many physicians now count on the hefty fees they earn from scans for a significant portion of their income."

It seems as if the secret is out-not all procedures are ordered for the patients welfare or best interest. Hospitals and health care facilities are financially happy as long as the patient needs-or believes they need-the prescribed pill, procedure or treatment. It's an unsettling fact that to stay out of the red, hospitals need flu pandemics, accidents and acts of violence.

On the other hand, how awesome is our current technology that we no longer die from dehydration, a cut to the finger, or high blood pressure? Coming back from a shopping trip recently, I pulled over to the shoulder of the road to allow an ambulance to pass. Seeing the lights flashing and hearing the siren wailing as it passed reminded me that we don't lay in pools of sweat anymore, dying of fevers. High blood sugar doesn't automatically progress to comas, and a severed limb doesn't become gangrene overnight. To be able to bring medicine to the consumers front door is a luxury, even if the reason requires mandatory treatment.

The health care field has taken customer service above and beyond what Florance Nightingale envisioned. In the process and along the way, we also accumulated a lot of debt. The focus can't shift from patient care to debt elimination, though. By maintaining high service standards, repeat customers and reputation still remains the greatest asset to a medical facility.

There are some administrators that believe great customer service means getting to the bottom of a crisis in a timely manner, and treat ASAP. But as Scott Louis Diering states in his book Love Your Patients, "Quality care is more than excellent technical care. Good health care can only be delivered when we treat each patient as a person, not just some disease or complaint or injury." It's admirable to treat in a timely fashion. Your patients in the ER would really appreciate that endeavor. But along with that goal, remember they are people first, illnesses second. Don't talk down to the patient, or about them to another health care provider in their presence as if they don't exist. Learn to be passionate about showing compassion.

When I was in retail many years ago, a co-worker was having a rotten day and had no qualms taking it out on the customer. One feisty lady told her, "If you don't like what you're doing, get another job." In the same token, if as a health care worker you have a hard time treating the patient as a person instead of just a technical puzzle to figure out, get another job. At the end of the day, hospitals are customer service providers and need patient satisfaction to maintain their business. You can talk about profit margins and productivity all you want, but you won't have those problems to manage without a promising patient flow.

Saturday, June 5, 2010

Compassion vs Productivity

It's a monumental job overseeing the financial aspect of a hospital, as well as the productivity and morale of your employees. Sometimes, it becomes an impossible task. If you haven't learned the delicate act of balancing and prioritizing, you will most likely play catch up through out the day instead of blazing trails. For those that want to blaze new trails, thinking new thoughts becomes a daily endeavor. Here's a thought to mull over. Most health care facilities name patient satisfaction as one of their core values. Are you ensuring that your employees get the proper encouragement to take the time to be compassionate towards their patients to secure satisfaction, or are you making a statement for good public relations, yet pounding the importance of productivity in behind closed doors meetings? For many managers, it becomes an either/or situation. They argue taking the time to show compassion takes from the time of productivity.

I was insulted to overhear a conversation between the "coat and tie men" of one hospital. Though not word for word, the one sided conversation went like this.
"What am I suppose to do? Encourage a chat fest every time my nurses enter a patients room? Impossible. We need to concentrate on eliminating medication errors and the precise recording of vitals. I can not in good conscience give my nurses an excuse to be slack by saying it is ok to talk to their patients."

That statement told me a lot about his facility. I guarantee you the employees were miserable and when his name was brought up in conversation, it was not in a favorable way. It also spoke volumes in regard to how the patients were viewed. They were clearly liability to him and a mere responsibility. It was very clear his management style was not adaptable to a health care facility. When you work with patients while they are in the middle of a health crisis, it is inconceivable to treat them as robots and ignore the emotional impact this event has on their overall chances of recovery. It is obvious he had no clue the drama that unfolded on each floor of each wing or what his employees experienced on a day to day basis.

For an employee to be able to show compassion does not indicate an automatic drop in productivity-in fact, I argue, it may increase productivity. When a patient feels validated, safe, and unafraid, they cooperate more. What if the nurses had totally cooperative patients, followed by families that conceded to the nurses suggestions? Talk about a relaxed environment. The wheels of the hospital would rotate without much coaxing.

My Mom spent the last 18 days of her life in a hospital. Her time was split between the floor and the unit. (ICU) The first night she was taken to the unit was a scary time for her. New procedures and protocols went into effect after she had somewhat learned her nurses and adapted to their schedule on the floor. When I visited her the following day, the first thing I noticed was a red ribbon in her hair, tying back her long strands, preventing them from the annoyance they had previously caused while falling into her face. I knew the activity surrounding a transfer. During the production of getting her settled in, one of the top priorities was getting her long hair off her face for her comfort. It had nothing to do with reading charts, ordering tests, or starting new lines. Her comfort-and style, I might add-was one of the things her nurse capitalized on. Did that small gesture take away from her productivity? I doubt it, yet it made a giant statement regarding where the priority of my Mom's nurse was. She was there to treat the whole person-the woman-not just a disease.

Dr. William Mayo-one of the Mayo brothers responsible for the health care giant-penned three conditions that were essential to the success of Mayo clinic. One of those conditions is continuing primary and sincere concern for the care and welfare of each individual patient. That doesn't sound like a leader that believed demonstrating compassion was detrimental to productivity. In fact, it appears to be 33% of the reason Mayo is the commanding voice of health care today.

In his book "The Florance Prescription", Joe Tye points out "At the organizational level a core value should define your non-negotiable expectations regarding how your people behave, the goals toward which you direct your collective efforts, and how you work together." You can't say patient satisfaction is important-so important it is a core value of your hospital-and then discourage compassionate interaction with your patients. If you have a team in place that desires to have more interaction with the patient, or you are hearing from the rumor mill that the Nurses would like to be able to spend more time with their patients, you have engaged the values in your employees that can not be taught in a classroom. Productivity can be taught. Compassion can not be.

A smart leader will look for characteristics in his employees that promote compassionate exchange, and encourage that as much as productivity. It is near impossible to build patient satisfaction on productivity alone. The patient has to feel as if they were priority-not the mundane tasks involved in their care.

There is a balance that needs to take place in hospitals today. Managers can't be afraid to give the go-ahead for their employees to take time to care. Multi-tasking is one of the primary elements involved in direct patient care. Your Nurses and other employees can handle meeting your demands for productivity while making a positive impact on their patients if you give them permission and the freedom to do so. If you trust them to apply their knowledge to keep the patient alive, trust them with a flexible understanding that the patient comes first-both in medical treatment and in building an environment of trust and empathy. Sometimes, loosening the iron fist merits the greatest rewards.