“Management’s overall aim should be to create a system in which everybody may take joy in his/her work.”
– W. Edwards Deming
“Your skin is not thick enough to hear me yell for even ten minutes!” a 92-year-old patient’s family member shouted at me while attending a care plan meeting. I was soon asked to leave the room left with case manager, social workers and mid-level managers.
Later that evening, as I claimed my cup of coffee at Starbucks counter, I was cheerfully greeted by a young happy-go-lucky college student, I noticed happiness — something I have not seen in nurses, nursing assistants and doctors in a long time. As I sipped my coffee, I started pondering about what gave patients and their family members power to behave this way. As I thought through my experiences at thriving businesses like Starbucks, Southwest Airlines and Wegmans, I started to wonder about a million dollar question. Do these industries allow a customer to treat their employees this way?
As I left the meeting to carry on with my day, I was updated that patient’s family members not just yelled at me but made racist comments to the nurse, who, very calmly took everything in her stride. This was only the beginning of onslaught which lasted about 10 days with multiple requests for unnecessary consults, tests and procedures intermittently dispersed with yelling episodes with almost all health care providers involved. None of the health care workers had the courage to tell them how to behave in a socially civil manner, and they just continued the onslaught nonstop!
Employers have a duty to protect their employees from harassment based upon protected categories by customers, not just other employees and managers. Starbucks, Southwest Airlines and other successful businesses are not only known for their excellent customer service but are known as the best places to work. They have protocols, extensively reviewed by their heavy duty legal departments to protect their employees.
“Patients and family members like these make me think about leaving medicine,” said one of the doctors taking care of the above patient. Burnout – described as “a silent anguish of the healers.” The symptoms of burnout may include “emotional exhaustion, cynicism, perceived clinical ineffectiveness and a sense of depersonalization in relationship with coworkers, patients, or both.” 54 percent of U.S. physicians are burned out, and 37% of newly registered nurses are considering leaving their job. Above all, we need close to 100,000 doctors in next 10 years to take care of aging baby boomer population.
The health care industry is one of the most backward when it comes to catching up to the industry standards. You can estimate the reluctance of the industry to catch up to the fact that computers, as a means of documentation, was only widely adopted when Affordable Care Act made it all but for mandatory for industry survival. When the airline industry is using e-boarding passes on mobile phones for check in and more than half of the Black Friday shopping is done online, health care industry refuses to use anything but postcards to inform patients about their next appointment. How ancient is that?
Family members refused the fourth-skilled nursing facility for their 92-year-old dad who has been medically ready for discharge for two days now. The reason for denying is because it is not their first choice. They yelled again at the social worker for not being savvy enough to be able to get their first choice. The social worker listened to them, like every other health care professional on the case, and rushed to her desk in order to help satisfy her most challenging client yet. Like every other health care professional working alongside her, she remembers the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) score statistic shown to her in a team meeting and the need for that to go up.
We recently started receiving weekly/monthly updates on our HCAHPS scores. HCAHPS is a patient satisfaction survey required by Centers for Medicare and Medicaid Services (CMS) for all hospitals in the United States. The survey is for adult inpatients, excluding psychiatric patients. This customer service approach has recently been mandated by CMS as criteria for reimbursement for health care facilities. This recent change in reimbursement structure has drawn the attention of the C-suite:
When that family member behaved the way they did, a report was sent to the administration and soon enough a person in suit and tie (typical C-suite attire) showed up accompanied by security. He gave a memo to the family members which described the kind of behavior they cannot display in hospital and also contained consequences for what happens if they do act irrationally.
This is only wishful thinking on my part. And I can assure you, that those burnout numbers would be very different if we take this approach. As the health care industry tries to catch up with rest of the industries in consumer-oriented approach, health care employees continue to bear the brunt of irate patients and family members. Other industries have already moved decades ago to something known as “the customers comes second” approach.
“Customers come second” approach is something which has been the core of business philosophy for Southwest Airlines, Starbucks and many other successful businesses for decades. If you take good care of your employees, they will take good care of your business. The joy that these industry leaders create for their employees has led their organizations to the pinnacle of business success. How many nurses and doctors are we going to lose to burnout before we start taking care of our health care workforce? Either we need to start taking cues from these industries and apply to health care, or we can start screening future employees by asking, “Is your skin thick enough to work in health care?”
Ankit Garg is a hospitalist. Megha Garg is a rheumatologist.
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