Sunday, December 11, 2011

Service Training in Action

Now that our patient satisfaction scores will actually affect reimbursement rates, Hood Hospital is trying to teach all of us ragamuffins down in the ER how to act right so our patients will be happier. Who better to teach us than a bunch of people from finance and upper management who have never taken care of a patient in their entire lives? I can't think of anyone with a better perspective. Anyway. They've been doing mandatory training the last month, and despite the fact I will never get those hours of my life back, at least the things these people think will work to improve our scores are hilarious.
The vast majority of the stuff they are trying to teach is are things that decent nurses already do. Hi, don't start a Foley with the door open, don't talk to the patient about your child support case, explain what the hell you're doing before you do it, maybe talk about the discharge papers a little while instead of just throwing them in the patient's general direction. Yeah, okay. No, the true comedy gold happens when these jackwagons present to us the things they actually think will make our patients happy. It's kind of sad, really, as they've clearly had many a meeting about synergy in healthcare and buzzwords or some other bullshit and come up with some stuff that they probably think is really fantastic and practical, only to be met by icy, dead silence or riotous laughter when they present it to those of us who actually take care of the patients.
So, with that in mind, ER BFF and I thoughtfully considered their suggestions and pondered how they might apply to the situations we encountered that weekend. Here's a couple I'd like to share with you.
"Mr. Homeless McCrackhead, you seem upset. Please allow me to listen without interruption about what the problem is. Yes, I can see you're very upset that we can't bring you a third sandwich and that the staff won't allow you to go into other patients' rooms to ask for their phone numbers. I'm so sorry this is happening to you. Let me see what I can find out for you about a bus ticket to that nudie theater downtown. Thanks for choosing Hood Hospital!"

"Hi Mrs. Abdominal Pain of Mysterious Origin with Multiple Non-Narcotic Allergies! My name is Hood Nurse, and I've been an RN for nearly 3 years and I have a lot of experience starting 24 gauge IVs and pushing Dilaudid through them. I see that Dr. Unnecessary Workup is going to be your doctor today, and let me just say that he comes highly recommended by other patients with problems similar to yours. Today we will use state of the art technology the perform several fruitless tests on you, and when they all come back negative, we will continue to take your pain seriously by giving you criminal amounts of IV Dilaudid. After a couple of hours, Dr. Unnecessay Workup will probably admit you for pain control to Dr. Spazz Hospitalist. I've heard many good sources that he has a pulse, and I've noticed he's been urinating on himself a lot less lately. Please let me know if there is anything I can do to make your stay more like a combination between a spa and a trip to Disneyland. I have the time. And for the 40th time this year, thank you for making Hood Hospital your first choice. We are delighted to take care of you again and hope we have this opportunity to collaborate in your care again soon."

"Mr. Drunken Head Laceration, I'm sorry you're not feeling well today. I realize that hitting and groping the staff might make you feel better. However, we're concerned about some possible issues to your health and safety, so we may have to use some state of the art leather restraints in your care today. We may call in the hospital police to help make your stay more enjoyable. They and their tasers have several years of experience dealing with patients a lot like you, and they are excellent at what they do. Now the doctor is going to use his excellent technique to staple your head closed. We will allow you to voice you concerns in the form of multiple obscenities screamed at the top of your lungs in an uninterrupted fashion, because we respect your point of view. Let me, as an agent of hood hospital, express how sorry I am that the doctor will not prescribe narcotics for your head laceration pain. It seems he is concerned about the possibility of mixing them with alcohol. I recognize that this is unacceptable to you, so I'd love it if you'd stay to talk to our house supervisor, who would be happy to provide you with a gift card to our on campus Starbucks. We'd be happy for you to enjoy a gingerbread latte on us for your trouble. Or, if you really do feel that you would prefer we, as you say, 'shove that up our asses', we would be happy to do that as well, if it would make you more likely to recommend us to your friends and family. As always, thanks for choosing us today!"

I don't see how communication like this couldn't fix all of our problems. I mean, obviously any problems we're having with feedback are certainly solely related to our shortcomings in communicating, as opposed to lack of staff, budget, resources, training, or reasonable expectations.

33 comments:

  1. Whatever you do, don't forget to reflect on the experience so you can enable yourself to provide a wholistic nursing experience.

    Ah, Hood Nurse, different wards, hospitals and even countries, exact same bullshit.

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  2. Thanks, I needed that....(as he leaves for yet another customer service class).....

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  3. Reasonable expectations? Haven't you heard?

    You now work for Hood Hotel Hospital and Spa.

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  4. You're being Studerized, you know.
    -whitecap nurse.

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  5. We all know only the drunken abusers get the surveys of which you speak.

    I would also love for the finance uppers to try and use their cockamamie bullshit on the aforementioned patients. I don't think it would get them very far.

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  6. I had a hood rat throw his colostomy bag at me. Ididn't understand his "cultural" expression of anger. Alrighty now.

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  7. Lol. So true. And of course the more you cater to these patients the more they expect you to cater to them and their every need.

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  8. I would like those who think of this as an excellent way for patients to share their excellent experience to come and address these concerns themselves. This needs to be emailed to all who make decisions without any recent (with in the last year) experience of what it's like to walk in my shoes.

    Well said!

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  9. In every hospital across the country this training is happening. This is the kind of thing that happens in a fucked up medical system.

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  10. Did anyone mention you could do all that standing on your head in song and they'd still be pissed that they didn't get enough whip on their gingerbread latte...and that it's probably not even real whip cream but that shit in the can.

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  11. My brother worked for a call centre that arranged telephone service connections. At a "how can we do this better" meeting he offered this......"when we say a technician will be there between 9am and 1 pm how about we make sure he/she is" This was met with blank stares.

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  12. Our doctors are handing out little "information cards" with their name, education, "personal interests", and "personal statement". One of my favorite doctors (who's nearly 60 years old) asked if he could write "erotic novels and jumproping" as his personal interests. Apparently that wasn't acceptable.

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  13. Love it!Saying one if those scripts with all the right inflections pts will totally give you Guys an A+ on your scores!

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  14. We're doing something similar with a "heart, head, heart" method of communication. "Oh Ms Fibromyalguer, I'm so sorry you're in pain (heart). Too bad you have maxed out the amount of pain medications we can give and your breathing is borderline for narcan, as a result we cannot give you any more. (head) I really want to help... (heart). Yeah. That will improve patient satisfaction.

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  15. Yeah. What else can be said. These upper management types have clearly been to one too many Disney-esque seminars. Why don't we just start hiring playboy bunnies as nurses, catering by Spago, and invite the entire family to be cared for for free? Oh, and let's make sure the patient never has to pay a dime, or at least has no negative action to their credit when they don't pay anyway!

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  16. I just finished my customer service stint (it was way longer than one class) and most of my classmates were in mental health, which made it very funny. The instructor BTW was not a nurse or medical person but some sort of professional facilitator.

    I feel for you. We can't please all of the people all of the time. CMS will figure this out eventually.

    If they don't, I'm demanding a chair massage after every internist visit BTW since it's so darned stressful in the patient parking garage at Saintarama.

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  17. We were recently given laminated cards suggesting that we introduce ourselves with our name and position, how long we have been working in that capacity etc. Then were are to "talk up" the person caring for them next, and estimate how long they might wait. I thought it was just something the crazies in upper management at my hospital had come up with! How nieve of me.

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  18. I can just imagine a filthy drunk with a head lac sipping a gingerbread latte at the Starbucks.

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  19. This is beautiful! When I was in nursing school and studying for the N-Clex, I was taught in my N-Clex class that if the choice of what you should say to a patient made you think, "Who the F says THAT?!?" you shouldn't chose that as the answer! LOL! I am a new follower.

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  20. On the very last day of my very last nursing position, before I retire, I have several things to say to patients.
    1. Dear Mr. Nonwhite person: We are not treating you this way because you are black, blue, green, or orange with purple polka dots. You are simply an obnoxious idiot. If you will quit cussing, I will be able to finish assessing you and get you the narcotics you so desperately want.

    2. Dear confused little old person on c-spine precautions: I am not trying to kill you. If I wanted to do that, you'd be dead already.

    I promise myself this at least once a week.......

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  21. If there was any justice in the world these "higher ups" would have to work a full week,(weekends included)and put their think tank theories into action.

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  22. sounds like the speech an airline pilot has to give at the start and end of the flight..and just about as sincere!
    hubby had an ER trip out of state with a sports injury - they 'forgot' to give him discharge instructions (verbal or written) but found him just fine for the satisfaction survey and the bill - which our insurance did cover once we got it sorted out that he was there for a softball to bridge of his nose and not a 'sore wrist.'
    spent some time in OR/ICU waiting rooms this summer...read over the survey - all about politeness and decor and how did I 'feel" about the interactions - nothing about health care or medical outcome!! and surprisingly they did not send a card or anything when the patient died in ICU! (a totally expected outcome, surgeons are NOT God even if they get confused about that sometimes)

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  23. Awesome. You sum it up so well in your last paragraph.

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  24. I just recently had a class on how to say "Good Morning, Good Afternoon, and Good Evening" to the residents living at BigMoneyCCRC, and to ANYBODY that I meet in the halls. Listening to the chorus of sarcastically chipper "Good Afternoon!s" at the time clock at 3pm just slays me. *eyeroll*

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  25. Hood nurse... I am too a hood nurse (won't steal your thunder for that awesome blog name). Everything you said sums up the reality and bs of it all! I have had a patient upon discharge "whisper" to his "buddy" ; "hey man, whatchu think I can getton da street fo it?" REALLY!! YOU CAN NOT WAIT UNTIL I LeAVe To DISCUSS?!?!? Honestly, it Infuriates me tO know my tax dollars are enabling someone to do this... Oh well, I guess if I am really over it I can move to Ottawa. Maybe I ca get a "cab voucher" there :) .

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  26. Hood Nurse-You are a rockstar. You crack my ass up everytime. I have been a loyal follower of your blog for a few weeks now, and you always bring a smile to my face. As an RN on a tele floor we tend to deal with a lot of crabby old people and their sometimes equally bad or worse family. The thing that pisses me off unlike any other is management REWARDING their horrible, disrespectful behavior. I once had a patient's family member accuse me of putting his mother in contact isolation for C.Diff because I was pregnant and I wanted to ignore her (I had done nothing but bend over backwards for them, while 8 1/2 months pregnant). He then proceeded to throw a fit in the hallway, stated that I never explained contact isolation policies (TOTAL lie as evidenced by my charting) and screamed that he didn't "give a shit about me or my baby." My manager's answer-of course, reward him with a card and gift from our gift shop. My manager's answer for me? Write me up for "yelling at the patient's family member and not properly explaining isolation policies." (I never once raised my voice to that man) I swear it took every ounce of my being not to slam my badge down at the nurse's station, tell that man and my boss where to stick it and walk out. And if I wasen't pregnant and needed the health insurance, I damn well would have.
    Why are the rude pain in the asses the ones we have to bend over backwards to please and reward? And come on now, why would us nurses who actually have to deal with your rude ass even WANT you back at our hospital?
    This patient statistfaction/treating each patient as if they are at a spa/hotel/restuarant is getting seriously bananas!

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  27. Ahhh...just wait until they spend thousands of $$$'s at your hospital with the 4hr Team STEPPS program where you learn how to make a paper chain with one hand tied behind your back.

    I am at the point where my political correctness is about gone. "Seriously...we just dispensed $100 worth of antibiotic to you, called you a cab and found some clean clothing for you to wear home. None of this cost you a dime so I suggest you go back to your room, quit complaining that it's taking a few minutes for your nurse to gather your d/c paperwork and lose the potty mouth"

    Management at our hospital takes very SERIOUSLY the OB complaints so bean counters and highly paid QA nurses are strategizing how to improve the "quality of care". As we are the downtown crack-meth-whatever hospital and DHS removes over half of the newborns from their parentally unfit mothers...I don't think "We're taking away your baby..have a nice day" will make a big difference.

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  28. Sadly, my Press-Ganey score will remain at sub-therapeutic levels since I do not speak Spanasianalogian.

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  29. "i have time" hahaha love it. we use that one quite often.

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  30. same crap - different hospital. :0(

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