As a young and optimistic business school graduate, I recall when the consulting firm I worked for was retained to evaluate “USA Hospital and Medical Clinics” (pseudonym). “USA” had grown quickly and was struggling to manage the recent expansion.

We interviewed doctors, nurses, and medical assistants, and they told us about the problems they faced every day: They were pressured to get patients in and out quickly to keep average visit times down. Budget cuts had replaced the front desk greeters with a check-in kiosk, eliminating receptionists who had developed relationships with patients over time and confusing elderly patients. Staff was overloaded with paperwork from insurance companies, and the administration had added more paperwork and hoops to jump through. Doctors felt pressured to cave to patient demands to keep satisfaction scores up. These things hurt good patient care.

I will not forget the glare I received from one doctor when I slipped up and referred to patients as “customers.”

I thought the staff didn’t understand that we were trying to help their patients, same as them. I believed patient satisfaction scores helped improve care.  The kiosks were more efficient. I thought that health care is a business – to treat it as such would benefit patients in the end. Like market research and effective messaging, business skills, and systems would lead to the most efficient system with the most satisfied patients. And we were all about customer (oops, patient!) service.

How my thoughts have changed.

The time I was a young and naive business school graduate is not so recent anymore. A few years ago, I found myself alone with an unresponsive and badly injured stranger. I desperately wished I could have done more to help them, to understand their injuries and how they could be fixed. I envied the medical crew that came – how quickly they took action, how they knew exactly what to do. I promised myself I’d do whatever it took never to feel that powerless again.  That day began an exploration into health care that would forever alter my life and career trajectory.

I volunteered at a hospital, took night classes, and eventually left the soul-sucking world of Excel to work as a CNA, with hopes of furthering my career doing something meaningful, or perhaps just in some bid to forgive myself for failing that stranger. Maybe I always cared too much to reduce humans to data points and numbers: to be understood only for profit.

The pandemic has forced me to reflect on the dichotomy of my two lives. Health care workers still don’t have PPE and supplies we need. For months, I told patients their loved ones couldn’t visit, from behind the same mask I wore last week and the week before. In our COVID ward, I spend their last minutes alive with them, trying (and probably failing) to fill the role of a beloved family member, wondering if the surgical mask I’m wearing is really as effective as our administration promised.

And where are the consultants? Society hails health care workers as heroes, but our government and administration fail to protect us. The truth is administration exists to serve patients; staff are merely a necessary end to that goal. Patients are profits; staff are costs. The unfair treatment of workers on the frontlines fills me with anger, yet I feel as powerless as the day I found that stranger.

“How can they sit in their ivory towers and tell people to work without protection?” I wonder. But I know exactly how they can.

Is there anything we can do? At Starbucks, new executives have to spend two weeks working as baristas: brewing coffee, toasting sandwiches, and taking the garbage out. Even the smartest and highest-earning future executives have to clean the bathrooms.

Picture this practice in health care. New administration staff spend a week shadowing doctors, nurses, and other health care workers impacted by their decisions. No doubt this idea is easier to execute with coffee, but if premedical students can shadow physicians, it is certainly possible.

I’ve seen both sides of the ever-growing chasm between patient-facing workers and hospital management. The disconnect is glaringly obvious, but maybe it takes a night of caring for 10 sick patients – without enough staff or equipment – to see it.

As a consultant, I’d never spent a day in the clinics. A true understanding of the complexities in today’s health care challenges can only come from seeing them firsthand. We cannot solve problems without first agreeing on what they are.  It won’t solve every issue (only taking money out of health care could do that). Still, maybe with more understanding of a “day in the life,” administration could work with providers on better systems – ones that ease the burden on health care staff rather than increase it, and in doing so serve patients better.

I’m tired. My patients look like fish out of water trying to breathe. They’re alone. I’ve zipped enough body bags. I spent enough nights seething about PPE, about how disposable nursing staff is to administration. I could have been working from home – but honestly, I’m glad I’m not. I wouldn’t have met the brave, compassionate team who shows up to take care of our community in the worst of situations.

I remain hopeful for a day when administration and health care workers feel they are on the same team.  And I hope to be on that team but with different letters behind my name this time.

The author is an anonymous certified nursing assistant.

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