Don’t Let Your Mood Dictate Your Manners

Most of the nation is still cooped up in the house, working out of their living rooms and holding the majority of their meetings through Zoom. It’s been two and a half months. We’re getting restless. We’re getting anxious. And we’re getting a little cranky.

Until recently, I’d been living apart from my husband and daughter, working in California while they stayed behind at our home in Northern Nevada. It was a 2-3 hour drive, depending on traffic, so I rented a place near the hospital and came home on the weekends. As hard as it was being away from them, it definitely had its advantages. 

It was quiet when I got home. The place was just as clean as I’d left it that morning. There was no discussion about what to have for dinner or what to watch on TV. No thermostat wars. No sharing of closet space. How much we talked to each other depended entirely on the length of our phone calls. 

But I actually did miss my family. When my engagement with that hospital ended, it was nice to be back home. I really enjoyed things like having dinners together every night and not having to cram all the family time into the weekends.

And then came COVID.

No one is leaving the house. After 14 months of living apart, we are on top of each other. All day. Every day. We love each other, but we’re starting to get a little tired of each other. And I’m reminded of something I learned early in my career: don’t let your mood dictate your manners. 

I was a new manager, trying to build a department from nothing, and working for a very demanding boss. I was having a particularly stressful day when someone I worked closely with asked me what I thought was a really obvious question and I just snapped. I don’t remember exactly what I said, but it wasn’t kind and the instant I said it, I wanted to take it back. I apologized, of course, but you can’t take back the words you’ve said. Once they leave your lips, they’re not yours anymore.

When we work in healthcare, or any industry in which you have to serve people, but especially healthcare when people are at their most frightened and vulnerable, we absolutely cannot our mood dictate our manners. Whatever bad day we’re having, whatever argument we had with our spouse before we left the house, whatever personal issue is going on, we can’t bring it to work with us. 

And even while we’re at work, whatever conflict is happening with another co-worker, whatever policy is driving you crazy, none of it matters when you’re with a patient or guest. 

It’s difficult to keep our mood in check, especially now with the additional stress of so many very sick patients and the families who are upset they can’t be there with them. We’re short on masks, we’re worried about space and ventilators and getting sick, ourselves, or bringing this virus home to our own families. It’s easy to let our mood take over and snap at the people around us.

But we can’t. 

We have to remember that they’re not the ones we’re mad at. If we take a moment to breathe, name the thing that’s actually upsetting us, and remind ourselves that this person in front of us needs our help, we stand a better chance of continuing to be kind instead of saying something we’ll regret later. 

It’s a good thing to remember, even after this pandemic is behind us.

What Are We Learning From COVID-19?

This is my 100th blog entry. I couldn’t have predicted I’d still be writing after all this time, but it turns out I have a lot to say about how to care for patients and employees. 

Things have changed dramatically since COVID-19 hit and I’ve been thinking a lot about how to best care for staff who are showing up every day and working hard to save lives. 

The name Lorna Breen has been in the news a lot lately. She was an emergency medicine physician and the medical director of the emergency department at New York-Presbyterian Hospital in Manhattan. I never met her, never even heard her name until her story hit the news a few weeks ago. But I think it’s important to write about her. There is so much we as healthcare leaders can learn from her story. 

According to an April 27th New York Times article, Dr. Breen had contracted the coronavirus, stayed home for just a week and a half, returned to work, was sent home, then went to stay with her family in North Carolina to recuperate. Upon arriving, she was hospitalized for exhaustion for 11 days, and once discharged, went to stay with her mom, then her sister. Two days later, Dr. Breen died by suicide. 

By all accounts, Dr. Breen was a fun-loving extrovert who enjoyed skiing, salsa dancing, throwing parties, and volunteering at a home for older adults. She was well liked, well respected and was always looking out for her colleagues, making sure they had enough personal protective equipment and were doing okay. 

Her family said that working in the trenches with so many patients dying from the virus changed her. She would be at the end of a 12-hour shift and stay to continue helping. With patients dying in the waiting room before they could even get into the ER, Dr. Breen had said they couldn’t keep up, she couldn’t go home, she had to stay and help. 

When you go into a profession in healthcare, you are compelled to help. When you run in when others run away, it’s normal to think that if you don’t do it, it won’t get done. But we have to start helping these professionals see that there’s no shame in putting the oxygen mask on your own face before helping others with theirs. 

I’m not going to lay blame at anyone’s feet. I’ll just say that we have to look out for each other and insist that people go home. Rest. Recharge. I’ve worked in so many environments that just don’t allow for that. If someone admits they’re exhausted or struggling to keep going, others turn their backs and make them feel guilty. We as leaders have to change that. 

Right now, we have healthcare workers, physicians, nurses, food service workers, housekeepers, IT professionals, and patient experience teams who are feeling vulnerable, frightened, and tired. We have to reach out. We have to let them know how much they mean to us and we do that not by hanging banners that say Hero, but by spending time with them. Let them talk. Listen without interrupting. Insist they go home and not stay past the end of their shift. Create programs that nurture and support them. Give them hazard pay and additional sick days. Don’t just tell them, show them how much we care.

I feel terrible that Dr. Breen took her own life. I’m hopeful that we learn from this and start creating a culture that acknowledges that physicians and nurses aren’t superheroes. They’re people who care. Let’s care for them.

Reach Out and (Virtually) Touch Someone

It’s been a month and a half and we are, for the most part, still sheltering in place and working remotely. There are those who have grown weary of the restrictions and are anxious to get outside and back to work; I’m observing fewer people wearing masks and keeping a six foot distance from others, but most experts agree it’s still too soon to open everything back up. 

I’m concerned for those who are truly struggling; whether it’s because of isolation or working in intense conditions caring for the sick. COVID-19 is taking its toll on us, emotionally and physically, and many of us are running out of coping mechanisms. 

Which is why it was such a wonderful surprise to get a message from a friend I had in junior high. She and I didn’t go to the same elementary school and we ended up in different high schools, but for two years in Emerson Junior High, she and I were inseparable. 

We’d kept in touch over the years through various social media channels and even met for lunch several years ago, but hadn’t actually spoken for quite some time. Then, out of nowhere, she sent a message asking if I wanted to do a video call and catch up.

It was wonderful. 

It was so wonderful, in fact, that it prompted me to reach out to friends I see fairly regularly (or used to, before all this started) and set up video calls with them, too. I’m calling my brothers more often than I did and am much more active on sites like Facebook to keep in touch. 

And this is significant because I’m not a person who generally craves a lot of social interaction. I love my alone time and need some peace and quiet in order to recharge. But this pandemic has made me realize that, when all is said and done, I’m not going to look back on my life wishing I’d spent less time with my family and friends. 

Our patients, their families, and our staff are no different. 

When trying to provide the very best experience, nothing beats a personal connection: someone reaching out to you, asking how you are, what they can do to help, and offering a shoulder to lean on. 

It isn’t always our clinical and technical expertise that makes an impression on people, but the way in which we interact with them that they remember. Taking a moment to reach out with genuine concern, actively listening, and giving people a non judgemental space to talk can make a world of difference. Even after 30 years.

How Leading Remotely is Changing Company Culture

As of this writing, most of us are sheltering in place and working from home due to COVID-19. Non-clinical hospital leaders, including the patient experience professionals, may be coming to the hospital a couple of days a week, but we’re doing most of our work from our living rooms over Zoom. So without being there, how do we know things are getting done?

Early in my career, I worked under several bosses who felt they needed to micromanage everything my colleagues and I did. Every moment between 8:30am and 5:00pm had to be accounted for or the assumption was we were slacking off. I always had a pretty good work ethic and wasn’t motivated to work out of fear. I did the job because I enjoyed the job and wanted to keep learning. I realize not everyone thinks that way.

But those colleagues of mine who didn’t have that same attitude didn’t do great work under that kind of micromanaging. They found ways to game the system and make it look like they were working. And they mostly got away with it. At some point, they might have gotten found out but that only brought the hammer down harder. I had to ask myself why they didn’t just let them go? Why spend your whole day surveilling your staff when you could be doing more important things?

When I came into leadership, one of the best things I did was hire people who appeared to have a work ethic like mine. People who got the job done without having to be watched like a hawk. People who had a passion for the work and who wanted to keep getting better at it. People I knew I didn’t need to micromanage.

And guess what – work got done. I had a great team who understood the expectations, had the tools they needed, knew they could come to me with questions, and were recognized and celebrated for doing a good job. I could spend my time setting the strategic direction of the department instead of yelling at them for coming in ten minutes late.   

And now that I’m not physically in the hospital, watching to be sure leader rounds are happening and staff are using AIDET in every interaction, I have to trust that they’re doing it because they know it’s the right thing to do, not because they’ll get in trouble if they don’t. 

For those managers who came up thinking that they always had to be looking over their employees’ shoulders, always there monitoring their every move lest they start goofing off, this new normal should be proof positive that that style of leadership doesn’t work. It never has. Anyone can get compliance, what matters is commitment. 

I don’t know what work will look like when this is over, but working remotely has forced micro-managers to trust their employees and change their style of leadership. It’s about time. I’m sorry it took a pandemic to do it.

The Virus

One of my very best friends says, “Hardship doesn’t develop character, it reveals it.” I’ve never really agreed with him on that. Until recently.

At this writing, COVID-19 has changed nearly everything in our world. We cannot leave our homes unless it’s to get essential supplies like food and medicine. Family members can’t drop in for Sunday dinner. Seniors in retirement centers aren’t allowed visitors. School is cancelled. And most people are working from home. 

Healthcare workers, on the other hand, are showing up every day to care for the sick and putting their own lives at risk to do so. There is a lot of concern about capacity, staffing, and equipment like ventilators, masks, and gloves. At a time when most people are hoarding all the hand sanitizer and toilet paper, healthcare workers are walking onto the front line, risking exposure, and caring for those who need them.

In hospitals all over the United States, there is a sense of unity and teamwork. Employees are reaching out across departments to offer help where it is needed most. No longer is anything “not my job”. 

Even the non-clinical staff are finding ways to help. Many have created Relaxation Rooms in which staff can take a quick 10 minute break for some healthy snacks, low lighting, and calming music to recenter and recharge in order to keep going in the middle of a long shift.

It’s inspiring.  

A close friend and former colleague who is a Director of Risk and Patient Safety said, “I’m observing improvement in communication and teamwork that I hope holds after the pandemic is over.”

And that’s the question, isn’t it: will it last? I’ve seen the people of this country pull together many times, be it after a hurricane like Katrina, a mass shooting like Las Vegas, and especially after 9/11. We were one nation coming together, helping one another. 

Do we forget about kindness and selflessness when times are good? Do we only check in on our loved ones when we’re fearful? Volunteerism shouldn’t just happen in the face of tragedy. That little old lady at the end of the block could use our help grocery shopping even when there isn’t a deadly virus out there. 

We still have a long way to go before this is over. We have many more weeks of sheltering in place and staying home ahead of us. But once that’s over, I’m hoping we still remember to call our family members and tell them we love them, visit our grandparents in the retirement center, offer to run to the store for those who have trouble doing so, put service before self. 

If hardship really did develop character and not reveal it, should it really take a pandemic to bring that out in us?

Shouldn’t You Call in Sick When You’re Sick?

How many of you work for an organization that rewards perfect attendance? 

I was at an awards ceremony at a hospital not long ago. They were giving service awards to employees who had been there for 5, 10, even 40 years. The chief nurse wanted to give a certified nurse’s assistant an award for never calling in sick once after working there for 35 years. I asked her if this was really a good thing. She looked at me in disbelief. “Of course it’s a good thing! She’s never called in, not once, in her whole time here. That’s amazing. That shows real dedication.”

I just stood there in stunned silence, wondering how she and I could be so far apart on this issue.  

As it happened, I was friendly with this CNA, so I asked her if she had ever been sick in those 35 years and came to work anyway. “Of course,” she said. “I got sick, everybody gets sick. I just put a mask on over my face and get to work.” 

Is this really what we want to celebrate?

As I write this, COVID-19, or coronavirus, is everywhere. There are over 250,000 cases and nearly 11,000 deaths globally. Industry conferences are being cancelled, cruise ships are being quarantined, and stores are selling out of toilet paper hand sanitizer all across the U.S. Do we really want to incentivize employees to come to work when they don’t feel well? Especially CNAs, who assist with feeding, bathing, and toileting people who are already sick?

Sick days exist for a reason. I understand not every company has them, but this one did. Generous sick leave, in fact. Part of me thinks this is a generational thing. My parents (and even me, to some extent) grew up believing that you keep your nose to the grindstone, work hard, and tough it out. I get it. 

But times are changing. Even before the coronavirus, I started to see signs in workplaces and elementary schools telling people to stay home if they didn’t feel good. And now, we’re socially isolating, sheltering in place, self-quarantining. And it makes good sense. Keep your germs to yourself.

The fact that this chief nurse was celebrating this CNA is incentivizing all the wrong things. I think people should take care of themselves and should be given time to rest, relax, and recover. The message she sent was the opposite of that. Maybe it’s generational, maybe it’s her set of values, but even after this virus passes, we need to tell our employees that their health and well-being is important to us as an organization and stop handing out perfect attendance awards. 

What Are We Celebrating?

Not long ago, I was at a patient experience conference and decided to sit in on a breakout session given by a hospital that had recently received an award for raising their H-CAHPS scores. We’re all looking for the secret sauce and I was interested in hearing how they did it.

The two presenters talked about how they took a specific question from the survey and made that their focus. They conducted huddles on that question at the start and end of every shift, they measured and posted results in every unit, the unit managers and charge nurses socialized it throughout the day every day, and individual coaching was given to everyone who wasn’t performing as expected for that particular question. 

The results were impressive. The whole time this was in place, scores went up considerably and patient comments reflected that the practice was being done. It was great.

And then…

And then they focused on another question. And guess what happened to the first question.  Did those results sustain? Did they continue to do those things they’d been drilled on for weeks before? Nope. They fell off like Humpty Dumpty.

The results for the question they were now focused on were great, just like the first one had been. But those didn’t last either. Whatever had the intense focus performed well. Nothing else did.

So I raised my hand and asked, “Can you speak a little about sustainability? When do these behaviors you’re coaching for become just part of a normal day, ‘this is how we do things here’? Can you explain why they weren’t sustained over the long-term?”

They looked at each other for a moment and one of them said, “Well, you know, we ask an awful lot of our nurses. They have so many things they have to focus on; we think we can only ask so much. One thing at a time.” 

I’m sorry… you got an award for this?

This, in my opinion, is what’s wrong with so many hospitals’ approaches to improving patient experience. Unless it’s part of your culture, unless it’s what employees commit to, unless it’s “this is how we do things here,” you don’t have real improvement. You have compliance, but not commitment. 

I was so disappointed when I left that session. Any one of us could have given that very same presentation. We have all done that very method of performance improvement and gotten the same results. Why do we keep doing it that way? 

It seems that’s exactly what so many leadership teams want. They want a spike in improvement that they can show to their bosses. Are we all really that short-sighted? Really? We’re celebrating a blip on a spreadsheet. That’s just not how I do things. Whenever you have a huge spike, you will have a huge fall. Patient experience is a culture, not a program, and it takes time. 

It’s time we start rewarding those hospitals that put in the work over the long haul and sustained those improvements over months and years. Let’s do it the right way and feature them at the patient experience conferences. 

What is your leadership team celebrating?

Our Scores are Bad Because of Our Patients

When you work in patient experience, you hear a lot of excuses for why scores are low:

  • We were under construction and the noise was bad
  • We had a lot of turnover and new staff wasn’t properly trained
  • We just merged with another big health system and there’s a lot of uncertainty
  • We’re here to save our patients’ asses, not kiss them 
  • Our hospital isn’t as fancy as the one down the street, we need a makeover, we need private rooms, we need valet parking, we need… 
  • We were focused on getting ready for The Joint Commission visit
  • Change takes time, we’re getting there

As much as I’ve heard these used as valid reasons, they are things that we have some control over and can work to mitigate. Much of it has to do with communication, whether it’s internal to the employees to set behavioral standards or external to the patients to help them understand what’s happening and why. 

So what really gets me is when we blame the patients, themselves, for our inability to provide an acceptable experience for them:

  • We have a really bad payor mix; they’re all uninsured and homeless
  • Our patients are all drug-seekers; they’re mad we don’t give them what they want

So it’s their fault?

Hey, I know there are people out there who can be pretty unreasonable and difficult to please, but that doesn’t mean we shouldn’t try. I’ve seen far too many staff members immediately take an aggressive stance as soon as they realize their patient is uninsured, experiencing homelessness, or trying to manage chronic pain. They make assumptions and treat these patients a certain way and then wonder why they return an unfavorable survey.  That’s just not acceptable.

And, incidentally, wealthier patients don’t always make for happier ones. Years ago, I worked in a very fancy hospital in a very affluent area and found that those patients had much higher standards. They seemed far less tolerant when things didn’t go as planned and much harder to please.  But that doesn’t mean we didn’t try. 

The bottom line is it doesn’t matter what socioeconomic class of patient we’re seeing. We should be doing our absolute best every time when it comes to serving our patients. And instead of blaming them for not having a good experience, we should be looking at ways we can better reach them. If we find our scores are low in a given demographic, it’s on us to figure out how to improve.

Oh, there was one excuse in the top section that’s actually true. Change takes time. You’ll get there.

Two Trips to the Urgent Care

This past week, I found myself in the throws of one of the worst head colds I’ve had in quite some time. I don’t get sick easily; all the years of working in hospitals has made my immune system pretty tough, so when I do get sick, it’s usually something major. I had been a little congested for a few days, but woke up one morning with an excruciating sore throat that made it nearly impossible to swallow. My primary care physician didn’t have an opening for me that day and I simply couldn’t wait to get some relief so off I went to the local urgent care clinic in town. 

I got in almost immediately and saw the nurse practitioner. She was great. Very kind, very thorough, and very sympathetic to my pain. My rapid strep test came back negative (surprisingly) as did the influenza test, so she didn’t want to prescribe antibiotics but, rather, manage my symptoms. That made sense to me. All I really wanted was some relief from the throat pain.

I picked up the prescription for viscous lidocaine, which did help the sore throat but tasted like motor oil, and stayed in bed for the next two days. 

I started to feel like I was getting better but three days later, not only was my sore throat back with a vengeance, but now my right ear felt like someone was sticking knives in it. My husband said I turned an eerie shade of white and insisted we get back to the urgent care right away. I didn’t argue.

We arrived 10 minutes prior to closing time and the receptionist told us they weren’t taking any more patients. I told her I had been there a few days ago and my symptoms had gotten worse. She apologized and said we could either come back in the morning or go to the Emergency Department tonight. The ED for a sore throat? No way.

I was contemplating how many boxes of popsicles to buy to hold me over to the morning when my husband suggested the urgent care about a half an hour away, which was open later. As much as I’m a fan of continuity of care, I knew there weren’t enough popsicles in the whole town to get me through the night so off we went.

The other urgent care center doesn’t look like much from the road, but inside it’s quite lovely. The receptionist was very nice, as was the tech who took my vitals, but the real star was the nurse practitioner. Her main concern was getting me some immediate relief, especially after she learned that I’d been suffering for nearly a week. She gave me a steroid, decadron, along with an antibiotic for the ear infection I’d developed. By the time I picked up a box of popsicles at the grocery down the street, I was feeling 100% better. 

I slept better that night than I had in several days and the pain in my throat never returned. It was amazing. That shot of decadron may have been slightly outside the usual course of treatment, but it was exactly what I needed. 

I’m not saying anything bad about the nurse practitioner at the first center; she did exactly what she should have. No antibiotics for a virus, I get it. But when it comes to relieving suffering, the second center knew just what to do.

Incidentally, I asked them how close to closing time they stop seeing patients. The tech said they don’t turn anyone away if they get there before 7pm. Even if it’s 6:59, if they need care, they get it that night. Admittedly, it can get a little tough on staff who are eager to get home after a 10-hour day, but the mission, the reason they’re there, is what keeps them going. They know they are there to help. And they did.

Yes, We Survey the Angry People

Last time, I wrote about patient experience scores, the percentile rankings, the distribution of responses, and how staff are almost always surprised when they see that it isn’t just the angry people who fill out surveys. One thing that inevitably gets asked whenever I present this kind of data is, “Can we filter out the people who leave here ticked off so they don’t get a survey?”  

I used to laugh when they’d ask that, but quickly realized they weren’t joking. They’d really like us to exclude dissatisfied people. But it doesn’t work that way.

Let’s start with the obvious. Really? You really want us to not get feedback from people unless they’re happy? Does any company have that luxury? With Yelp just a click away, every business is subject to ratings, good and bad. I can rate everything from my dinner at the four-star restaurant to the Uber driver who took me there. If they want good reviews, they need to do a good job, not cherry pick the satisfied customers. That’s not just dishonest, it’s silly, as it sets a completely unrealistic set of expectations. It would be even more disappointing to have a bad experience because, according to the reviews, no one has ever had a bad experience. 

But more importantly, we learn more from our unhappy patients than we do from our happy ones. As much as I tend to focus on the positive, there are often ideas or suggestions from patients who wanted something more from us that are really constructive and useful. 

For example, at one hospital, we added some simple signage in our parking garage to more clearly point out the entrance for day-surgery patients. At another, we created scripting for our medical assistants that let patients know they could skip the checkout desk unless they needed a follow-up appointment. These were things that were easy to address but, had it not been for the surveys, we wouldn’t have realized were dissatisfiers.

And most of us have a blind spot about our own words and actions. I’ve known plenty of people (myself included) who say things with the best of intentions, not realizing they’re annoying or downright offensive to some people. This is especially true in healthcare settings where people tend to be a bit more sensitive. But how else would we know if we didn’t receive the feedback?

Let me quick to say that it’s equally important to celebrate and recognize the positive comments that come through on those surveys. People love to know that their hard work doesn’t go unnoticed or unappreciated, and it’s a great way to improve your organization’s culture. But it’s a mistake to not look at ways you can make things even better.

Yes, it’s discouraging to see negative comments, especially when you remember that patient and you remember doing everything you could to try and make their visit a pleasant one. But any organization (or individual for that matter) that wants to improve needs to hear some honest feedback, even if it’s tough to take. Surrounding yourself with people who never complain or offer some constructive criticism won’t help you get any better.