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.

Some Positive Thoughts on Positivity

Earlier this morning as I was doing my daily patient rounding, one of the nurses I’d said ‘good morning’ to smiled and told me how much she enjoyed seeing me every day. “You always have such a positive energy around you,” she said. “It really brings the mood up when you come and talk to patients and to us. I really appreciate you.”

Wow. What a lovely thing to hear.

I sort of blushed and said thank you but what I really wanted to tell her was that it was a very deliberate decision every morning to show up with a smile. 

We patient experience directors have to walk a tricky line. On the one hand, we’re trying to dispel the outdated thinking that patient experience is ‘fluff stuff’ led by a bunch of vapid do-gooders who have no clue about real life. And at the same time, we can’t appear jaded and cynical or give in to all the forces that tell us that other things are more important.

I’ve taken a bit of heat in my career trying to be positive. I’ve encountered plenty of eye rolls, arms folded firmly across chests, sarcasm, and open hostility. I’ve been dismissed from meetings with a flick of the wrist, interrupted, had my data challenged in every conceivable way, and told ‘that’s nice, but we have real work to do.’

I’ve even had patients tell me to leave when I’ve come to round on them after learning I wasn’t a physician or a nurse. If I can’t give them pain meds then what good am I?

I have to choose to be positive. But honestly, why would I choose to be anything else? 

I’ve been angry, frustrated, outspoken, sarcastic, and cynical myself and you know where it got me? No further than being positive. Being positive just makes me feel better. Noticing the good, recognizing when something goes well, celebrating people who give a little extra… these things make me happy. And knowing that by doing them I can make someone else happy makes me even more happy. 

Staff perform better when the culture is positive. The world has enough desk pounders, enough cynics, enough people who are eager to rain on your parade. If I expect staff to be supportive and friendly and caring to patients, how can I not be that way to them?

So yes, when I walk in the front door, step off the elevator, and onto a med/surg unit, I am smiling. I am positive. Even if I have to fake it for a few minutes. Fluff stuff? No way. I’m changing healthcare.

The Elephant in the Emergency Department

I am a big fan of Liz Jazwiec and her 2009 book Eat That Cookie! Make Workplace Positivity Pay Off for Individuals, Teams and Organizations. In it, she talks of her time as the manager of a busy Chicago emergency department where the motto seemed to be “I’m here to save your ass, not kiss it.”

I first heard of Liz when the hospital I was working for at the time hired her to give a talk to our managers and directors. She had been a patient experience cynic who thought the whole thing was ridiculous. The president of her hospital told her she had to get her patient experience scores up or she’d be looking for another job. At first, she resisted but soon realized he was serious.

Like so many nurse managers I’ve met, she thought patient experience was fluff stuff and had no place in healthcare, especially a busy ED where things were quite literally life and death. She sneered at the smile police who told her to “just be nice” while she was working hard to bring people back from the brink of death.

To Liz, many of her patients were cranky, ungrateful whiners who were tough to deal with. But as she started being nicer, she was surprised that they started being less cranky, showed some appreciation, and were easier to deal with.

Eventually, Liz not only got her patient experience scores up, she became a believer in the patient experience movement, even becoming a coach for The Studer Group. I love her story and if you haven’t read her book, you really should.

Something else to consider when it comes to the ED is throughput and the effect it has on the nurses.

Much of the dissatisfaction in the ED comes from waiting too long with no idea of what’s happening and why. Staff can certainly help by keeping patients informed but when things are backed up, staff start feeling the pressure, too. When there’s no available bed on the floor, an ED nurse has to now be a telemetry nurse, something they don’t particularly enjoy.

ED nurses are trained to stabilize and either discharge or admit. Once the decision has been made, the ED nurse moves on to the next patient. To have a bunch of patients on gurneys lining the hallway needing ongoing care makes ED nurses anxious. They want the patients to get up to the floors as much as the patients do.

Additionally, there are patients in the ED who need specialized care that the hospital may or may not provide. Sometimes, getting a surgeon or psychiatrist to come in can be a challenge and getting a patient transferred to another facility can take hours. These situations, too, can make staff anxious; they have to manage the questions and complaints but they’re powerless to actually fix them.  

Without efficient discharge processes on the floors, patients can end up staying a day or two longer than needed and that means longer waits in the emergency department for patients who need an inpatient bed. Case managers, social workers, hospitalists, attending physicians, and house supervisors all play a role that affects wait times, and, subsequently, patient experience in the ED.

Nothing can take the place of a warm greeting, staff that meet and even anticipate your needs, and physicians that explain things in a way you can understand. But when it comes to patient satisfaction in the ED, you have to include throughput and inpatient discharge processes in your efforts or you’re only solving part of the problem.