In reading blogs I've notice a common theme. Hospitals are expecting staff to do more with less. Less equipment, less nurses, less support staff, less linen and so on and so on. But still provide excellent customer service, which to their mind means service with a smile, a warm blanket and a TV.
BULLSHIT. (Pardon the language.)
This ain't a hotel. Good customer service in a hospital means that your nurse is highly skilled and knowledgeable so that if you begin to develop problems or complications they know what is going on and how to help you. It means that there is enough nursing staff so they have time to teach you about your illness, how to manage it, about your medications and how to cope at home - not just run into your rooms and quickly give you med's before running on to the next task. It means that there are enough aides and tech's to answer your call light quickly when it rings. It means there are enough physical therapists to work with you every day. It means serving tasty, healthy food. It means having enough ward clerks to answer the phones and take off the doctors orders. It means having enough pharmacy staff that medications can get filled and delivered quickly, not hours later. It means having enough discharge planners to REALLY plan for your discharge so that you don't end up in the ER later the same day. It means having enough housekeepers to really clean the hospital, not just polish the highly visible areas while the corners collect grime. All of this and more is what good customer service is to a hospitalized patient. A warm blanket may feel good but it doesn't mean squat when you are being given shitty care.
Shitty care is when all the nurses are new grads and travelers because all the experienced RN's have left to go where they are treated better. Shitty care is when you are given a cold meal tray because there isn't enough staff to pass them out. Shitty care is when there isn't enough staff to offer you a bath and change your linen's daily. Shitty care is when you put on your light and it takes a half an hour to get someone to answer it. Shitty care is when it takes the nurse 8 hours to realize that a heart rate of 160 may be a problem. Shitty care is when your doctor orders a new antibiotic and it takes the pharmacy 4 hours to deliver it to the unit. Shitty care is when the unit only has one house keeper to clean 30 rooms, rooms should be dusted and mopped every day, not once every three days. shitty care is when you have to sit in the ER waiting room for hours because they are holding admitted patients because there are no nurses upstairs to take care of them. Shitty care is what you will get at most hospitals these days because hospital administration does not care about the patients, they only care about the bottom line and profits.
Sunday, March 2, 2008
The New Customer Service Model
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24 comments:
Brilliant post.
this is really happening...
http://www.smokymountainnews.com/issues/02_08/02_27_08/fr_hrmc_timeline.html
Hi! I read your article with great interest. In reply I would like to add a few of my own observations that go towards poor care.
1. Staff who avoid a patient load.
2. Staff who humiliate others.
3. Staff that refuse to accept that team nursing is good for the patient.
4. Staff that see others struggling with their heavy workload and refuse to assist.
5. Staff who fail to pass on ward practises to new staff.
6. Staff who turn their noses up when asked a relevant question.
7. Staff that don’t take the time to supervise until something happens.
8. Poor orientation to a unit.
9. Non-permanent staff not being included in unit training.
Just to name a few. Thank you for listening.
Do what we do---seriously and dangerously understaffed?
Go on ambulance divert for the whole shift! That'll piss off administration enough for them to at least consider staffing the ER.
If you're going to be the ICU, tele, med-surg and the ER with half of the staff needed just to be the ER, going on ambulance divert seems reasonable enough.
Just say "inpatient units don't take ambulances that aren't directly admitted." That'll really piss them off.
Hear! Hear! You hit the nail right on the head! I only hope that every hospital administrator in the country reads your blog and begins to understand what happens when we substitute the trappings of customer service for what should REALLY matter -- good care.
The truth and nothing but. Nothing is worse than only having time to go into the patient rooms just to be sure they are still alive before rushing off to your next task. This is the reason I quit floor nursing. And they wonder why there's a nursing shortage?
I think our RN's fill out one of those "Unsafe Staffing" forms nearly every day and submit it to management.
Unfortunately I've only seen one hospital that's doing it right. If it weren't 700 miles away it would be the hospital that we always use.
You are scaring me with these "divert" ideas. Us poor amb folk aren't having a great life either, we really do try not to make the nurse problems but we do need to take the patients somewhere. Divert just increases the number of amb rides. First patient Z is diverted to away from hospitals A, B, and C(this happens at least once a week), Z is taken to hospital D, Some twenty miles away, Hospital D is not capable of dealing with disease/trauma so, when divert ends amb is sent to take him back to hospital A, after treatment amb take him home. Total rides three, total miles 50, Total sleep for amb drivers working 24 hr shifts 0.
Nothing will change until our health care system changes in a big way and if you think otherwise you are kidding yourself. And nurses will have to lead the way to that change.
Just to add;
Shitty care is having to crawl out of your own bed, post surgery, to help your roomie out who's three IV alarms have been going off for 45 mins and her pain level is so high, she's trying to fall out of bed to get attention.
The last thing I want as a patient is to be sent to court for doing someones job I'm not 'qualified' to do. It's scary as hell to know that if I end up hospitalized, I'll be 'lucky' to be cared for at all, and the odds of croaking while there are 50% higher today than 15 years ago.
I think our RN's fill out one of those "Unsafe Staffing" forms nearly every day and submit it to management.
So do we; I'm convinced they go in a paper shredder somewhere after they're submitted. What does anyone do about it? Not much.
Amb driver---Level 1 trauma centers can't refuse Level 1 trauma. Being 50% short-staffed is a really big problem, and it really IS hard to handle ambulances in addition to a full lobby. It's hard/busy with FULL staff!
Our facility has been on diversion more in the past 3 weeks than in the previous several YEARS put together....for DAYS at a time even.That does not stop the ambulances from coming.I get a "the patient requested THIS Hospital" In my opinion if they are stable enough to request a hospital, they can go somewhere else.When all moniters are being used on admitted patients holding in the ED (INCLUDING the transport Zoll) choosing to come to our little pearl of a facility may be detrimental to your or someone elses life .When I have to play," guess whose heart arrhythmia is least life threatening" so I can bump them to the stretcher in front of the bay doors, and see what is going on with the newly arrived LOM ,it makes my intestines clench.
Lately when all my patient's live through a shift I count it as successful, but I am not proud.
Articulated beautifully!
Great post -- as long as we're not confusing shit care with slow care. Just because something is efficient doesn't mean that it's of high quality and the opposite, just because somethings slow doesn't mean it's good. Sometime I want the IT and efficiency people to spend some time in the ER and wards at night when all is breaking loose.
www.waittimes.blogspot.com
Strangely enough, our Unsafe Care / Unsafe Staffing forms disappeared the same day they decided to screw with the staffing grid and add at least 1 more patient to every nurse and two patients to the charge nurse.
Shitty care is when your mother doesn't eat anything for two days because patients are expected to order their meals.
Order her meals? Mother hasn't been able to navigate a telephone for 3 years.
A can of Ensure on the bedside table, which she can't reach nor open is not a substitute.
So sorry to hear that about your mother.
More often than I care to talk about, I have helped staff feed patients because everyone else was too busy. Last week it was a guy who hadn't eaten in 3 days. The case manager was bullying the staff saying "he's gotta eat so we can discharge him", but it never occurred to the CM that he wasn't eating because he couldn't feed himself and no one had time to feed him.....or maybe they didn't care.
I left the unit feeling very frustrated that day.
StandingFirm: taking a patient to a hospital they don't want to go to is kidnapping, and none of us in the prehospital arena care to get sued or go to jail for such a thing because your hospital won't staff appropriately.
A smart medic will know that a hospital is on divert and explain to his patient why going there is a bad thing (I always did this with my patients, and a medic did this for me when I was on the *ahem* wrong side of the medic/patient relationship one day), and a smart patient will listen (I listened, and didn't camp in an ED for 12 hours).
A dumb medic will just dump the patient at the crowded ED without a warning.
A dumber medic will lie to the patient and take him to another hospital anyway, risking his livelihood and his freedom.
Absolutely fabulous post! I found something I wrote in 1980 that stated almost the exact same things you have said in this post. The exact same thing we see every day, and I have seen every day since health care went from not-for-profit to for-profit thanks the the first set of neocons to screw with our nation... Ronald Reagan and even old Darth Vader himself (Dick Cheney).
Our hospital was bought by good old HCA (you remember Hospital Corporation of America?) who immediately went on a cost cutting spree...eliminating telephones! No telephone for the nurses in the labor rooms or the delivery rooms..it was wasteful, we could walk down the hall.
Oh yeah, that works great when you need an help IMMEDIATELY! Oh, and we got to be housekeeping too. So, we delivered patients, scrubbed floors and toilets and beds, scrubbed the delivery rooms, washed and autoclaved the instruments, set up the delivery room again, and then "when we weren't busy" we helped in the ER. Yeah life was good.
I am old enough to remember when I could actually SIT DOWN and spend time with a patient, the family, and actually answer questions, do some teaching or even more importantly, give moral support.
My last day in a hospital as a full time RN came was 15 years ago. I absolutely could not take it any more. My husband still works in the hospital, and he comes home so extremely frustrated that I feel sorry for him. His dept (he is a RRT) isn't even inside the hospital proper, he has to walk 1/4 mile to the hospital pushing his equipment, and if he needs something that isn't in the Pixis on the floor, he has to haul his ass back to the other bldg. I mean where will this crap stop?
I can tell you why it doesn't stop. It's very simple. Health care professionals, RN, LVN, LPN, RRT, etc. are to chicken and too afraid to lose their jobs to speak up.
We complain, but we also stick our heads in the sand.
Until and unless we speak up, nothing will change.
Look at the elections this year....people are FED UP, and what are they doing, they are getting out there and caucusing, voting, and working to change things.
So, why are we doing this in the health professions? Hmm?
And, while I am on my soap box, can someone please explain why we can have tax payer funded fire departments, EMS, and libraries and schools, but not healthcare? I mean, really, is it all about who "deserves" healthcare and if you can't afford it, well, then it's your fault? That bullshit. Is that where are nation is now...if you have money you have it all, if you don't then too bad for you?
Ok, while I am on a rampage here I have one more thing to add.
When I hospitalized my 91 yr old mother in Nov. 2007 for a pleural effusion secondary to a fall (over our Boxer dog's bone) and chest wall trauma all the staff wanted to know what nursing home my mother came in from. My mother was alert, oriented, walked, talked, fed herself and could recite her medical history and her medication list. However, nobody, I mean nobody, believed either one of us when we said that she came in from home (our home), and that she was perfectly able to walk, talk, make her own meals, go up and down stairs and perform her own ADL's.
That, my dear nurse colleagues is something we all do. We assume old people are all sick because that's all we see. So we do tend to treat the very elderly differently, and we don't think they can be self-sufficient, we assume if they are old they can't do anything.
Sure they can't see or hear well, but many are healthy and do just fine at home, particularly in a organized environment.
That's what my mother had..everything scheduled for her, a dog to keep her company during the day, and good home-made food every single night.
What happened in the hospital? She became confused because she was not in a familiar place, and the staff became angry with me, like it was my fault. There was no discharge planning, because they said, she came in from a nursing home, and that's where she will go again when discharged. Despite all my pleas, and requests for assistance from a social worker to help me figure out how to bring her home, there was no help.
My mother died, in a nursing home, Jan 1, 2007, after an extremely unhappy experience, while I was struggling to find a way to bring her home.
Morale of the story? Take time, to do what you did not do...discharge planning, and listening to the family.
I know it's tough because systems are often not in place, but it just takes one nurse, just one, to make a difference. I wish I had met that nurse. I would have liked to have had a nurse colleague who would listen to my concerns and who would have helped me, even a little. When you are the caregiver, and out of your specialty area, you don't know all the resources available and you are often distraught and don't know where to turn. Just one caring nurse could have made a difference.
Thanks..great blog, great posts. Obviously nothing has changed in nursing since 2001 when I left bedside nursing...it's all still crappy and a PIA. Keep up the good fight ladies and gentlemen.
Peace be with you.
Wow we must work at the same hospital... probably not just a nation wide crisis. I am one of the newbies less than a year out and have had more than one time I was glad there are still a few experienced nurses on our surgery floor to answer questions. Recently due to severe nursing staff deficiencies our ER has been holding patients overnight until we can find the staff to care for them. Kudos to the staff in the ERs you are appreciated by your coworkers.
I am so glad to find your post about customer service. I was just told by a nurse manager that the reason I became a RN is to provide customer service! I disputed this and told her I have a hard time seeing our hospital following the same customer service attitude as Macy's. Apparently our hospital is ranked well because of our "strong" customer service. I left the corporate world to get away from these issues. Hospitals are about the bottom line and saving face. Patients first my ass.
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