A Tale of Two Hospitals

A few months ago, before just about everything was shut down due to COVID-19, a good friend of mine was suffering with some horrible, and all too familiar pain. He knew he had a kidney stone and went to the nearby emergency department to get some relief.

After a few hours and several imaging tests, the news wasn’t good. The stones were too big to pass and he needed surgery to have them removed. The physician went ahead and admitted him, hoping the surgery could be done in the morning. 

Although it was located in the middle of nowhere, this hospital had recently been acquired by a larger health system, one with a wonderful reputation in the community, not only for clinical excellence, but for exceptional patient care. I felt relieved that he was in good hands.

We spoke about a week and a half later. As it turned out, he didn’t have the surgery at that hospital. He had been there for a few days, waiting, but was unexpectedly released. His daughter then brought him to the hospital near her.

“What on earth happened?” I asked him.

“I have no idea,” he answered. “The whole time I was there, I didn’t know what the hell was going on. There didn’t appear to be any coordination or communication between any of the staff, like nobody was running the ship, and plenty of conflicting information.” 

He continued. “They wouldn’t let me eat anything because I was waiting for an OR, which was understandable, but this went on for two days. I kept asking when I’d be going in to have these things removed, and no one had an answer. Then, finally, they took me down to surgery and the doctor came in and said I was getting a stent.” 

“A stent?” I asked. “Why not remove the stones?”

“That’s exactly what I asked,” he answered. “Something about them not having the equipment to be able to do it, but they were telling me this while I was lying on a gurney right outside the OR. The whole time I was on the unit, I kept hearing them talk about removal. No one said anything about a stent”

“Afterwards,” he continued, “they gave me a prescription for some pain pills and told me to make an appointment for a follow up visit in two weeks. That was it. I felt like I was getting the ‘bum’s rush’ out of there. My daughter was furious and took me directly to the hospital near her and that’s when everything changed.”

“What happened there?” I asked. I had a feeling I knew what he was going to say.

“The physician there was amazing. He was confident without being arrogant and at some point he put his hand on my shoulder and said, ‘It’s okay. Everything is going to be fine.’ That felt great. Very reassuring. It was like night and day between those two places.”

He went on to tell me that it felt like everything was running smoothly; everyone knew the plan of care, and he never felt like he was being a bother when he asked for help. He even noticed that behind everyone’s ID badge, there was a plastic card listing ‘Always Behaviors’, similar to AIDET, something he’d heard me talk about a lot.

As happy as I was for him that he got the care he needed and was just fine, I was a little disappointed. I was really hoping for something new, some magic nugget of information that would turn the patient experience movement on its ear. Something we never knew, never tried. Something revolutionary that would solve it all.

Alas, it all came down to the same old things: listen well, communicate clearly, convey kindness. All those things we’ve been talking about and training on for years. No new shiny bit of technology, nothing terribly complicated. 

It really can be that simple.

No Words

A lot is happening in the world right now. I’ve spent the last few blogs writing about COVID-19 and, while many cities are opening back up, new cases are still being diagnosed every day.  And in the midst of all the division and politicizing about mask-wearing and whether or not certain businesses can reopen, we’ve had at least three high-profile cases of police brutality and blatant, unrepentant racism. 

This is far from the first time an innocent man of color was murdered while in police custody or chased down by white vigilantes and killed in the middle of the street. Our country has a long and ugly history of these very things. But more and more people are speaking up and demanding change. It’s important.

It’s important that all people, not just African-Americans, speak up, join the fight, donate money, support the cause. But it’s even more important that we start doing a better job of listening.

I’m no expert on race matters. I can’t pretend to know what it feels like to be black in America. So if I am to understand and be more effective in trying to change the system, it’s time to do more listening. There are thousands of voices out there, screaming to be heard. They don’t need our opinion, they need our support, and you can best support by listening. Listen for truth, listen to understand, listen with humility.

These are the same skills I use when I work with patient complaints. I wouldn’t dream of arguing with a patient who tells me they had a bad experience with us. I would never say, “Well yeah you had a bad time, but so did that patient over there; be glad that wasn’t you.” I would never tell them they were blowing it out of proportion or that it doesn’t happen all that often or it’s a lot better than it used to be. 

I would never tell them that the system works just fine and then not do anything to remedy their complaint. And I would never blame the people who bring us the concerns and think it was their problem, not ours.

It’s difficult to hear negative things about the place you work or the people you work with or even about yourself. The first reaction is typically to get defensive and gather up as much evidence as you can to prove the opposite. But that doesn’t bring you any closer to solving the problem. 

When a person who has difficulty walking tells me that navigating the hallways of our hospital is nearly impossible, I don’t brush it off thinking, “Hey most people can walk just fine and don’t have any problems,” and then do nothing. 

When we want to get a better handle on what it’s like to be a parent of a newborn in the ICU, we don’t all sit around the table and try to imagine it, ourselves. We contact people who have lived that experience and when we ask them what we can do better, we listen to them. Sometimes, their solutions are easy. Most of the time, however, they’re tough, time-consuming, expensive. 

But we do them because we know it’s the right thing to do. We take responsibility for having caused the issue in the first place and we work to fix it.

Novelist and activist James Baldwin said, “Not everything that is faced can be changed, but nothing can be changed until it is faced.” Such an obvious concept when it comes to customer service, patient experience, or process improvement, but so difficult when it comes to race relations and systemic oppression. 

Certainly, rules and laws are needed but they alone won’t solve the problem. We need to face the fact that we have a problem. We need to change people’s hearts. It begins with listening.

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.