The Customer is NEVER Right - A Nurse Practitioner's Perspective
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Violence in Health Sector Conference-Podium Presentation

Title: The Customer is NEVER Right: A Nurse Practitioner’s Perspective
Where: 5th International Conference on Violence in the Health Sector—Dublin, Ireland
What: Oral presentation 20mins & 5mins questions

When: 26 Oct 2016
Below is the transcript to the 5th International Conference on Violence in the Health Sector lecture in Dublin, Ireland with each number (#) corresponding to its PowerPoint slide.
(1) Thank you for this opportunity as so many have labeled this content as irrelevant for healthcare workers. You will disagree.
Unfortunately, although passionate about this subject I do not possess the talent of presenting without reading. But without reading I risk leaving out essential points from a conversation that matters.

(2) Objectives:
1.    Participants will be made aware that the current path healthcare is being “taken down”, with regard to customer satisfaction, is NOT good for healthcare and could even incite healthcare directed violence.
2.    Participants will appreciate that by putting healthcare and healthcare workers first and customer satisfaction to follow, everything else will fall into place, to include customer retention, profits, and, most significantly, a safer workplace.
(3) Disclosures:
I will not be discussing any investigational and/or off-label use. Unless a healthcare worker pushing back is considered off-label. I do receive royalties from book sales but have no other financial relationships to disclose.

(4) Why a disclaimer? This is going to be a provocative presentation about the elephant in healthcare’s exam room. I hope I still have a job tomorrow.

(5) Healthcare’s best-kept secret is that customer satisfaction scores are not about healthcare. And despite studies show there is no correlation between satisfaction scores and good healthcare satisfaction scores are the driving force that healthcare workers must bow to.
A driving force without accomplishment I must add. Because despite all the money, time and effort invested satisfaction scores have not added anything to healthcare except an overwhelming amount of collateral damage, to include healthcare directed violence.
Healthcare is a time-honored profession obligated with saving lives and stomping out disease. Despite that heritage and duty healthcare has been cheapened, by any means necessary and at the cost of so much, into just another customer-driven service where satisfaction scores are the driving force.
(6) However, healthcare is like no other industry, none! and…
-the only industry with patients

-the only industry where regardless of disposable income or time services are sought after and rendered
-the only industry whose workers maintain the public’s confidence year after year as the public has recognized us as the most honest profession and with the greatest ethical standard of any industry
-most notable, healthcare is the only industry where workers go to battle for every “so-called customer” and when “so-called customers” succumbs—we cry for them as well as the overwhelming numbers of patient experiences are rewarding, for both healthcare workers and patients.
(7) However, because of their sheer volume those positive experiences become blurs of one another and unless they are remarkably extraordinary their details are consigned to oblivion.
However, the melodramas of the complaining minority are permanently etched in our memories, some physically scarred. It is that misery and frustration that drags us down, as we must navigate, alone, that exhausting minefield just to stay safe and/or keep our jobs. Reason enough as to why so many leave healthcare and not fatigue as no one fatigues from helping others.
(8) What is the collateral damage?
Since the 1980s the belief has been that by increasing customer satisfaction healthcare’s quality and cost would improve.

(9) Instead, what we got is more expensive and inferior quality as a result of accommodating…

(10) …EXAGGERATED UNREALISTIC EMOTIONAL EXPECTATIONS, to include those who tread on us, just to keep our jobs.
Why? Because rather focus on variables that would improve the quality and cost of healthcare, such as outcomes and the safety of healthcare workers and patients, satisfaction surveys focus on wait times, pain management, housekeeping, and communication skills, none of which improve the quality or cost of healthcare.
(11) In 2011, the Centers for Medicare and Medicaid Services paid out $226 billion on overtreatments that did not benefit anyone.
How much of that wasted to avoid complaints or threats from patients?

(12) Pandering is not advocacy.

(13) That waste does not include the billions lost as a result of healthcare directed violence. A violence that has become more frequent, more brazen and more violent. And our professional and government organizations have nothing to offer except “feel good” policies that are impotent as they purposely fall short as to not offend patients or families.

(14) Despite those policies reports from victims continue to be greatly underreported.
Why? Because the first thing administrators ask is, “What did you do to piss off that patient?”

(15) After assaulted by a customer a taxi driver posted a video of the assault online and within the week that video was viewed by 2.5 million launching a debate about the safety of taxi drivers.

(16) Yet, despite statistics show healthcare workers are assaulted 4 to 5 times more often than taxi drivers in urban areas…

(17) …this video of nurses being assaulted by a patient has barely gotten 1/5 the views in almost two years since the incident.
Healthcare pundits tell us that healthcare directed violence is a rare occurrence and at the hands of the demented, psychotic or those under the influence of alcohol and/or drugs. Yet, healthcare workers will tell you that healthcare directed violence is more common than not. And more common than not it is not at the hands of those listed but instead at the hands of those who did not get what they wanted, tired of waiting, missed their honey-bunny, thought it was too noisy at the nurses’ station or whatever flavor of the week it is.
(18) Isn’t it sad the industry on the forefront of fighting domestic violence finds itself in an abusive relationship, to include justifying the violence and siding with the actions of those who are abusive towards us?

(19) “The Customer is NEVER Right: A Nurse Practitioner’s Perspective” is not the story of a disgruntled worker but the story of so many in healthcare and a story healthcare administrators are…

(20) …well aware of, as none of this is new. But administrators rather follow than lead, claiming, “That is what others are doing ‘up the street’ and so will we.”

(21) None having the testicular fortitude of going at it alone.

(22) When writing the book I purposely skipped the research as I felt collecting data seemed excessive, as the evidence is obvious. I realize critics will point out that my experiences are merely anecdotal.

(23) By the same token, Albert Einstein pointed out, “Not everything that can be counted counts, and not everything that counts can be counted.” That said, in the next few days presenter at this conference will confirm the point that…

(24) …“Healthcare workplace violence is an underreported, ubiquitous, and persistent problem that has been tolerated and largely ignored.”
This tolerated and largely ignored silent national crisis is not political as we only have healthcare’s submissive, altruistic and accommodating culture, and its obsession with customer satisfaction scores to blame. Not only did we follow the herd but we turned over the reins and since outsiders have taken healthcare in the wrong direction with their…
(25) …IDIOT-OLOGY that it is in the patient’s best interest.

(26) The theme here is not only that outsider and administrators have taken healthcare down the wrong tracks. But more important it’s about “The true soldier [who] fights not because he hates what is in front of him, but because he loves what is behind him.” For us, that love is healthcare.

(27) Plagiarizing Albert Einstein, “healthcare will not be destroyed by those who take it down the wrong tracks but by those who watch them without doing anything.”

(28) We cannot change what we refuse to confront and in order to take healthcare back…

(29) …we must surround ourselves with those who are bold and on the same mission as us. To accomplish this seismic paradigm shift we must remove the blinders that tolerate this ignored and shameful silent national crisis that insults healthcare workers and patients and puts them in harms way.

(30) In his Day of Affirmation speech, in 1966, Robert F. Kennedy said, “Few men are willing to brave the disapproval of their fellows, the censure of their colleagues, the wrath of their society. Moral courage is a rarer commodity than bravery in battle or great intelligence. Yet, it is the one essential, vital quality for those who seek to change a world which yields most painfully to change.”

(31) Now, is taking healthcare back possible? Absolutely!

(32) In 2013, the federal government announced a college rating system to withhold billions of dollars in federal student aid money from low performing colleges. Sound familiar? That college ranking system discarded after college leaders, unlike healthcare, stood their ground and pushed back pointing out the misguided rating system was “uncharacteristically clueless, quite wrongheaded, oversimplified to the point that it actually misleads and prioritized moneymaking”. All predictable and have been actualized in healthcare.

(33) By no means am I suggesting patients cannot complain as they are only venting their frustrations, anxieties and feelings of powerlessness. But when inappropriate they must leave because the culture of any organization is shaped by the worst behavior tolerated. Do not confuse accommodating or appeasing with advocacy as indulging those who make unreasonable demands on us only leaves us vulnerable.

(34) Because, as long as healthcare continues to be a doormat, not only will others walk all over us, they will wipe their feet on us as well.

(35) The literature is inundated with articles that list a plethora of reasons as to why rating healthcare is a slippery slope yet no one is interested.

(36) Albert Einstein warned us, “We cannot solve our problems by using the same kind of thinking we used when we created them.”

(37 #1) Meaning, we must rid ourselves of traditional thinking to create the future. We must no longer nurture this mistake of rating healthcare just because we spent a lot of money, time, and effort making the mistake.
(37 #2) For this insanity to end we must deflate everything customer service to nothing more than a byproduct of healthcare rather its driving force.
(37 #3) Unfortunately, healthcare needs leadership, as most healthcare administrators are not leaders but managers who merely facilitate policy between subordinates and superiors.
(37 #4) Healthcare needs change agents willing to go in a new direction, even if alone. A direction that promotes healthcare workers as valuable and trustworthy, supports our collaboration and professionalism and recognizes us as the good-doers over concerns patients may take their business elsewhere.
(37 #5) Healthcare is much bigger than any complaint and why complaints need not be feared, as the intent of those who complain is not to get anyone fired but an opportunity to vent.
Disagreement is not a hate crime or a crime at all. Nor is it a lack of caring or compassion. Who of us is absent of disagreement with those we love most? However, in healthcare, where we attempt to preserve the quality of life and prevent the loss of life, it is customer service complaints that are the end all.
(37 #6) Rather placate to customer satisfaction scores, healthcare would benefit most if we placed all our energy, time and money on clinical outcomes and those responsible for those outcomes, healthcare workers.
Because when the dust settles following a patient’s tantrum that is behavior you and healthcare administrators would NOT accept at home. Yet, healthcare administrators want us to accept that venomous behavior from those we are helping.
(37 #7) I say dismiss those who annoy us. Dismiss the rude. The entitled. The abusive. The demanding. And those who have taken us down the wrong tracks. By dismissing those who annoy us it frees us to focus on those who value, trust and appreciate us for the care we give. On this we must stand in solidarity and not waiver otherwise those who annoy us will not change their behavior as long as they can find tolerance elsewhere. Again, do not confuse accommodating or appeasing with advocacy, it leaves us vulnerable.
(37 #8) Instead, we must side with loyal employees and coworkers over the petulant, unreasonable, angry, demanding and those who tread on us for us not submitting to their EXAGGERATED UNREALISTIC EMOTIONAL EXPECTATIONS. This is not about us versus patients but about convincing patient that we are looking out for their best interest and if they desire our help they must stand with us. If they decline they must leave because intimidating us until they get what they want is manipulative and not what we are here for as it only divides healthcare workers trying to help others.
(37 #9) Lastly, we must get rid of the IDIOT-OLOGY that got us here. We must never see the ill or injured as customers, clients, or guest but as the patients they are, ill or injured.
(38) I am well aware of the wrath when we do not drink the Kool-aide. Yet, when administrators say to me, “You better pick your battles wisely, Mister!” My answer, “I have!” 

(39) Because picking your battles is the mantra of those who have not fought battles and a position of convenience. Because anyone who has fought any battle will tell you how inconvenient that is and it is that inconvenience and sacrifice which gives worth to the battle.

(40) Plagiarizing Mother Theresa, “I alone cannot change healthcare, but I can cast a stone across the waters to create many ripples.” In order to take healthcare back and steer it in the right direction, where healthcare and healthcare workers come first, and away from idiotic scripts and signage, standard uniforms, valet services, luxurious lobbies, and placating to those who make demands or tread on us…

(41) …we need companions, not to take part but to take over, across healthcare and geographic borders standing in solidarity as the time for conversation has long passed. Now it is time for accomplishments not accommodations. Anything short of that results not in fatigue but in frustration as no one fatigues from helping others.

(42) In closing, I AM A NURSE! A member of a time honored profession, trusted with saving lives and stomping out disease. I AM NOT…a bellboy at your favorite resort looking for a tip…I am not a cashier at Chick-fil-A whose script it is, “My pleasure”…I am not a hospital’s CEO chasing satisfaction scores…and most definitely I am not anyone’s punching bag! Not to patients, not to families and not to administrators either.

(43) I know that I am not alone in these thoughts and why I ask, don’t judge my words. Judge my intent.

(44) Again, thank you for the opportunity.

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