The Customer is NEVER Right - A Nurse Practitioner's Perspective
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A healthcare conference about yoga, Play-Doh, soap bubbles and coloring with crayons. Really?

I recently attended a healthcare conference, not for the CMEs, but because it was the last of four conferences that had declined my proposal to present the book. All four of the organizations stated that the book’s theme was not relevant for their audience and it was that judgment, more than anything else, which prompted me to attended the conference. Because after being rejected four time I wanted to find out what was more relevant to healthcare workers than the book’s theme, that healthcare, the only industry genuinely dedicated to helping others, has been forced into being a customer-driven service, and worse, by any means necessary.

Because my interest in the conference was not CMEs I made no attempt to find out what the lectures were about. So imagine how excited I was when I learned that the keynote speaker was allotted seventy-five minutes to talk about yoga. And not about how yoga could benefit patients but how yoga would benefit healthcare workers in coping with our stressful jobs and even reduce our rate of burnout. Huh? I thought. I guess banging my head on a pole was no longer acceptable.

Having tried yoga, once a week for ninety days, and knowing it takes all kinds to make the planet spin, I thought I could sit though seventy-five minutes of “Mindfully multitasking [my] way to well-being through yoga” (the talk’s title) without me having an aneurism, so I paid to attend the conference. Then, when I asked about the breakout sessions I was told I could attend any of them except the yoga session because it was full. “Darn,” I said cynically. The registration person picking up on my sarcasm replied, “I could tell you were looking forward to it.”

So, let me clarify, not only was the keynote seventy-five minutes of yoga for healthcare workers but there was another two and half-hours of yoga as a breakout session as well. Really? I never knew healthcare workers needed so much yoga. However, I could not understand one simple detail. If yoga is considered that relevant to healthcare, than the collateral damage caused by accommodating exaggerated unrealistic emotional expectations, then why was there only room for 20 of 100 plus of us attending the conference?

Easy! Yoga is neither that needed or that relevant to healthcare. Instead, and for as long as I been in healthcare, I should have known that healthcare pundits favor soft themes over provocative ones, like the book’s theme. Because of the former I was not surprised that learning to breath was included in two other sessions, apart the yoga session. In one of those other sessions, aside the breathing exercises, we were given the opportunity to play with Play-Dou® and even blow soap bubbles. Not that there is anything wrong with that as so many in healthcare are the touchy-feely kind. However, I found it strange that the speaker of that session announced we could opt out of the activities. The reason I found it strange was because healthcare is the most peer-pressured profession I know, its like being in junior high school all over again, bullying included. Having said that, I could not see how anyone could opt out of what everyone else was doing without being noticed.

Lo and behold, it was not long before one of the participants, from the table I sat at, wanted to make sure that even I blew soap bubbles before she let me off the hook. Of course, those antics always draw a big smile from me. Little do they know, the smile cracking my knitted brow is not a pleased smile because that person found a soft spot in my heart. Instead, that smile is me laughing out loud in my brain, thinking, “Really? You just could not pass on the opportunity to be self-indulgent?” Not that there is anything wrong with any of that, as it takes different folks to make the planet spin, however, NOT FOR ME. Now go sit down and mind your business!

Having said that, I know there are more important issues in healthcare than yoga, breathing exercises, and most definite, worrying that the knitted brow at the table is not blowing soap bubbles or playing with Play-Dou®. On that note, and for those who have not noticed, outsiders bank on the touchy-feely genes of healthcare workers, especially those of administrators, to manipulate and blindly lead them down the wrong tracks. It is sad to admit but it is that blindness that has caused healthcare administrators to miss the collateral damage left behind by catering to exaggerated unrealistic emotional expectations. Ironically, expectations the same pundits do not accept at home from their children but demand their employees to yield to.

On that note, that is why healthcare pundits and gatekeepers to these conferences do not welcome provocative themes, like the book’s. Especially when those themes do not fit their idiotology [sic] that THEIRcustomers come first and healthcare workers second.

To pundits, who look away and only see denial as a river in Egypt, I say, “Healthcare is broke and broke in many ways.” On top of, although not breaking news, dismissing the collateral damage left behind from catering to exaggerated expectations and assuming a downward dog (a common yoga position) is not going to fix healthcare. Why? Simple! “We cannot solve problems by using the same kind of thinking we used when we created them” (Albert Einstein).

Aside attending the conference to find out why the book was so irrelevant to healthcare workers I also saw an opportunity to promote the book. With that in mind, I packed a handful of business card in my bag, put all the books I had in the trunk of my car, worked out the cobwebs of a Square® I have for credit-card purchases, dusted off a t-shirt I have with the book’s cover plastered on the front and the back of the t-shirt and once at the conference I also donated a copy of the book to the silent auction. However, I knew I had to be stealth with promoting the book as venders at those conferences pay big bucks to display their products and it was not fair I was advertising the book without paying to do so.

After checking into the conference I went to the bathroom and put on my t-shirt over the shirt I was already wearing. From the bathroom I walked into the main conference room seating up front, something I had never done before as I rather sit in the back. I then, intentionally, turned the chair so its back was to my side leaving the back of the t-shirt exposed so those behind me could read the book’s provocative title when I sat down.
At every session, for two days, I sat in the same manner, up front and with the back of the chair to my side exposing the book’s cover to everyone behind me. Interestingly, the only comment I got about the t-shirt was from the hotel clerk when I checked in and she immediately said, “I like your shirt!” as I walked up to her. Why did she like the t-shirt? I do not know, as I did not ask her. My guess, the hotel clerk being in a customer-driven service industry, she got the message.

On the other hand, why didn’t healthcare workers response to the t-shirt? I do not know. However, my guess is that although healthcare workers are genuine with helping others we are NOT necessarily customer sensitive as those in the customer-service industries. Why? Why should we when everything we do is with the patient’s best interest in mind?

However, allow me to explain before I get called arrogant by my junior high criticizers. Healthcare is the ONLY industry genuinely dedicated to helping others and the ONLY industry whose workers are known to be caring, compassionate, wanting to help others and who genuinely look out for our customer’s (patient’s) best interest. Those facts (We cry for our patients, We offer our shoulder for our patients to cry on, We want to get that IV on the first try, We sacrifice for our patients, and We love our patients) being more than enough virtues when compared to other industries and why healthcare workers do not need to find reason to have to accommodate customer-service idiotologies [sic].

Because of that, that is exactly why administrators believe we need to be forced into doing so. However, the administration’s silent reason as to why they force us into being customer sensitive is of greater arrogance—healthcare administrators do not trust that our industry’s uniqueness and the world-renown medical we provide is sufficient to attract or retain patients. That being an idiotology [sic] I so strongly disagree with. Yet, healthcare administrators hold it close to their pockets [sic] (not their hearts) and why they believe that disagreement between THEIR customers and healthcare workers jeopardizes their goal to retain customers.

However, despite the administration’s delusion, those conflicts rarely occur, and only occur, when we must interact with those that have exaggerated unrealistic emotional expectations. It is unfortunate, to say the least, that despite most of our experiences being so rewarding that those rare conflicts get the most attention when instead they should be dismissed for what they are, distractions from the greater picture. Sadly, what happens instead is that administrators expect us to bow, knowing we will, as those of us trusted with helping others have been nurtured with a few hot-wired vulnerabilities.

Those vulnerabilities being, first and foremost, our modus operandi is to help others, even if those we help mistreat us. Second, and our greatest fear, that if we push back those who mistreat us we will be labeled as uncaring and lacking compassion. Oddly, not so much labeled by patients, but worse, labeled by peers and colleagues. Because as mentioned healthcare is the most peer-influenced profession in existence. Sadly, it is those two vulnerabilities that outsiders exploit in order to herd healthcare workers as they wish, and with regard to customer-service down the wrong tracks.

More appalling, is that healthcare administrators, under the deception of outsiders who we have allowed to dictate our role and purpose, betray the care we provide and intimidate us into being customer-service waitpersons. Just like Fred Lee so bluntly suggested, “Just like a waitress…" (02:18) and healthcare administrators have invited him to every one of our national conferences since, well, for a $10,000 speaker fee.

The most repulsive of those tactics is telling healthcare workers that for the sake of the patient we must submit to being second to the customer’s experience. Yet, no one, NOT even Fred Lee, has the patient’s best interest in mind more than the healthcare worker caring for that patient. NO ONE! Something to think about!

On the other hand, and without disrespect, service industries worker may or may not be compassionate or even care for that matter. However, in their industries either of those two, caring or compassion, can be faked. I just cannot imagine a retail worker, a food and beverage worker, a hotel worker, a funeral worker, a banking worker or even a Disney worker, to include Fred Lee, choosing their industry because of a desire to help others and much less that any of them has ever genuinely been there for their customer or ever choked up, let alone, cried for their customers. I recall a fight attendant; air travel being pioneers in the customer-driven industries, telling me, “The customer is always WRONG except on my shift,” that being his way of coping with the outrageous demands from his customers.

On that note, regardless if service industry workers genuinely care or fake it, they are tasked with selling their product knowing they can only keep their job if their product sells and why they are NOT there for their customers, as healthcare workers are, but instead are there for their product. That being a fact regardless of what they say!

For example, when your waiter sends you a “thank you” letter that action is no more than advertising for you to send more business his way and not because he had an interest in you as his customer. Unknown to the blind customer, the waiter’s letter is NOT a token of appreciation for eating at his place of work. Instead, the letter is the waiter’s version of, “I bet you think this song is about you. Don’t you? Don’t you?”

On that note, no pun intended, the waiter was nothing more than sly in making small talk to get your business card, which he used to send you a letter, on the restaurant’s letterhead even! In healthcare, we are genuine and have no reason to be sly!

Knowing that differentiation between healthcare workers and other industries, I was surprised to hear two of the presenters, to include the keynote speaker, say, “…patients are crazy”. However, what surprised me were not their words, as those sentiments are common among healthcare workers and I am sure the workers of other industries think their “customers are crazy” too. What got my attention was that those sentiments are common only during private conversations so I was taken aback that anyone would share them in an open forum, like at a regional conference.

Unfortunately, to those speakers’ disadvantage, I believe their words were a slip of the tongue and not boldness. And why I would not get excited that healthcare workers are waking up to the dysfunction of healthcare where we MUST submit to being punching bags in order to keep our jobs. Because, if those were actually their bold words, why only mutter them at a safe venue, like at a conference of your peers, yet are so hesitant to push back at their organizations patients and administrators? Oh yea, because if they did push back it is very likely they would lose their jobs! Got it!

Pardon the digression, as this extra theme was not part of the conference. However, while on that soapbox I want to point something else out. It is also unfortunate that in the ONLY industry genuinely dedicated to helping others violence directed at its workers is regarded to as part of our job, an idiotology [sic] not so imagined in law enforcement. Yet, we, healthcare workers, must put up with “crazy patients” in order to keep our jobs.

Back to the conference, despite told we could keep the Play-Dou®, the soap bubbles, and I forgot to mention, a coloring book and crayons, I left them all on the table as I walked out of that session. I left them because I did not want to be tempted later on and discover that I am a closet touchy-feely kind and might of played with them when no one was looking. NOT!

I really did not care for any of them. In leaving them I thought that if confronted by my table neighbor as to why I did not keep the items I was ready to say, “They do not fit in my car’s trunk.” Comical of course, as I was referring to all the books in the trunk, minus one, which I donated to the silent auction and the far-fetched possibility that the person, some being nosey as well, would ask what the trunk of my car was so full of. However, she never asked.

Obviously the conference was not ONLY about yoga, Play-Dou®, soap bubbles and coloring with crayons. However, that is what I took away, as I did not take anything else away from the conference. Not physically and not academically as I found none of it to be relevant to my practice and much less would improved it. Well, maybe the yoga. Ah, NO! Like I said, I tried yoga for 90 days and found that after twelve years at being a nurse practitioner and over thirty jobs during that time, not by choice, banging my head on a pole or any other hard and stationary object works best for me. With that said, the conference was a waste of time. So much for topics that are relevant in healthcare.

With regard to promoting or selling books the conference was a disappointment. As I only got to pass out a single business card, the one I gave to the hotel clerk, and the only person who even noticed the t-shirt I was wearing. Which, as I write this I find quite ironic, because I always describe my job in healthcare simply as, “I get paid to make observations and answer questions.” Yet, while among other healthcare workers, none noticed my t-shirt. Something I found odd, because although I walked around and made an effort to sit so others would notice the t-shirt no one asked about the provocative words on my chest or back, except for the hotel clerk and she did so immediately, the moment I walked up to her. Huh?

Could I have gotten a better respond if I had paid for a table in the exhibition hall? Maybe. However, I did not even hear from whoever picked up the book at the silent auction. Nor do I know what the book went for. Not that the value mattered as 100% of whatever it was auctioned for was donated. However, I found it odd that whoever picked up the book did not approach me to ask about it either, the book cover plastered on my chest and back and not easy to miss. Yet, nada!

Adding insult to injury, at the conference I ran into my primary care provider, a nurse practitioner, and one of the first persons to get an autographed copy. Yet, after almost two years of having the book she told me she had not had an opportunity to read it. I am sure she has other things to do, as do I, and why I did not press her. But really? Two years. I would think that even if she only read it while on the toilet I am sure she would have at least gotten half way through it in two years. But no! Not her fault, as it is just the culture of healthcare that is just not interested, as healthcare is more about accommodating than pushing back.

As if not taking anything away from the conference were not enough, it did not help that three, yes THREE, presenters did not show up for their presentations either and for that we were directed to join other sessions. However, I found it odd that the “mother-in-law” of an absent presenter replaced the absentee’s session. Adding to the strangeness, the “mother-in-law” was a previous presenter. Huh? How did that happen? A bit of nepotism I would say. However, I am sure critics will fire back suggesting that I am bitter since my proposal to present “The Customer is NEVER Right” was denied by the conference’s organizers.

Let me be clear, by no means am I picking on this presenter. However, this session of three cancelled sessions highlighted a third issue that to me was even more notable than the nepotism and mother-in-law covering the cancelled session. The session’s title was “Creating a healthy new you” and was to be presented by a “Certified Personal Trainer”. I picked this session because neither of the other two breakout sessions during the same time block captured my attention and why I stayed put, not knowing I would be watching others blow soap bubbles, play with Play-Doh® and color with crayons. Yet, it cannot go without saying that being a nurse practitioner and wanting to present to my peers what others have highlighted, “is a useful contribution to the current healthcare debate going on at many levels in our great country”, it is disappointing that other nurse practitioners would choose a certified personal trainer over one of their peers. Not to mention, healthcare workers, a nurse practitioner and a physician presented the other two sessions during the same block.

To critics, not that I own any of them any explanations, I am not bitter. Disappointed? Yes! Why? Because “The Customer is NEVER Right” is a story that needs to be told. Not that it is a story about me, as that time has passed, but about healthcare, the ONLY industry genuinely dedicated to helping others and the ONLY industry genuinely there for its customers.

As for the mother-in-law, do not get me wrong, she deserves credit for stepping in to cover for her daughter-in-law who was ill, as those things happen and are not only unpredictable but out of ones control. I am sure the daughter-in-law felt bad that she was not able to complete her commitment as well.

On that note, not that it matters, but after the third session was cancelled the thought of offering to present crossed my mind, but I backed down knowing I was not prepared and fumbling through the presentation might have sent the wrong message. Especially, if I began by having to take deep breathes.

Oh well, so much for my crusade to get healthcare’s attention. However, I would have to say that the weekend was not a complete waste of time as I got to spend the evening with my life [sic] and our dogs and in that sense it was a great weekend. Especially, for the dogs that got to go to the dog park since it is too HOT in Phoenix for them to go to during this time of the year.

Hopefully the take away message from those reading this is that if your organization is not timid of provocative themes, I am available. The other take away message being,

Downward dog: Healthcare pundits’ answer to our broke system. Who knew?

DARN! I forgot to pick up my CME certificate!

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